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Hospital Case Managers: Don’t Social Workers Already Do This?

The Albuquerque Journal recently posted this article about hospital case managers, people who act as nurses, social workers and teachers for patients.

According to the article case managers are advocates for patients and work with doctors, nurses, therapists, insurance companies, families and medical facilities to make sure patients get good care.

Excuse us, but isn’t this a service social workers already provide? Please read the article and let know what you think.

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  1. Talking points so precise and consistent…it’s like a Hospital CEO’s Think Tank. A few insights… “What we want to make sure is that that patient is not coming back to the hospital.” That’s because if they do come back within the next 30 days for a related illness the hospital does not get reimbursed. While that may sound fair, many complicated cases are stripped down and all aspects are not covered because if a patient stays too long reimbursement deteriorates as well. “Managers in hospitals are able to help patients discharge faster, Broshious says”… again by stripping down the care needs to the bear minimum, which isn’t always bad, but is always risky for the sick individual.
    Most hospitals simply combined two different departments, UR with RN’s (with Bachelors degrees) and Social Workers with MSW’s. They assume an RN has the same skills as an MSW and vice versa then to top it off the RN gets paid at least 20 grand more a year to complete the same level of work as the SW! Also, this article points out that this “profession” is becoming more and more popular, which tells me that it’s new and the “kinks” are not worked out. Note to the Powers That Be in the Social Work world…you are witnessing another process that may begin to dissolve parts of our profession.

  2. I’m a Medical Social Worker in Hawaii. In our hospital, the SWers works as a team with RN Case Managers to help patients work out their plans for when they’re discharged. In general, the CM’s work on the clinical aspects of the plan & the SW’s help with financial issues, coping & support, family issues, etc. Other hospitals do it differently, where CM’s do all the planning & SWers provide coping & support. We also do brief substance abuse interventions, provide help for domestic violence victims, and assist families w/hospice arrangements, among other things.

    We are often confused with CM’s, just as in the larger community you have SWer’s working as community case managers. I don’t mind. I’m proud to introduce myself as a Social Worker and help patients & families deal with all the stresses that come with illness.

  3. One of our local hospitals eliminated the positions of 9 social workers in one day in 2009. They felt that the RN casemanagers were able to handle everything. They stated that when social workers are involved the statistics show that the patients stay longer in the hospital. This was probably secondary to good discharge planning. The RN casemanagers don’t handle the Discharge Planning piece. Therefore, patients go home without appropriate support in the home and often return to the hospital within 24 hours. Patients also lose a really great Advocate when they don’t have a social worker.

  4. I am only a BSW-LSW. I have been looking at many of these case management jobs, but they all require the applicant to be RN-case management. Now, this is a recipe for disaster. I have spoken to several RN friends, and they feel that their system is already overburdened. Many of the RNs have stated there is a perfect storm coming. The common opinion stated that there are quite a few of the current RNs who are Baby Boomers, about to retire. Add to this the fact that by disallowing LSWs to be case managers, this is causing many people to avoid a Bachelors Degree in Social Work. The consensus? In 10 years, there will be a severe shortage of RNs in all fields, and case management will be one of the first to be delegated to another party, i.e., social workers. However, by then there may not be enough LSWs to take that position, as we are being forced to return and obtain our MSW – to survive.

  5. The services that social workers provide in the acute care setting vary greatly than that of a case manager. Sometimes, social workers act as case managers, as RNs do, but also counsel and support patients and families through death and dying, abuse and neglect referrals, substance abuse interventions, and a myriad of other instances where the MSW is the preferred skill set and talent for such situations. It is ignorant and dismissive to nurse case managers to compare these 2 roles. They work together, in collaboration with the MDs and other members of hospital staff to provide the best care to patients and families, to provide them with the resources they need at hospital discharge. The issues re: 30 day readmissions, denial of Medicare payments, and hospitals that are eliminating SWs do this article no justice. MSWs can be hospital case managers, do discharge planning, work alongside RNs for the best possible outcome for the patient, but not vice versa.

    Do not be misinformed. Case managers are also advocates. One does not need an MSW to advocate for a disadvantged member of society.

    Hospital social workers provide patients and families with skills, training, abilities and compassion beyond the concrete needs of case management.

  6. Yes, that is indeed what a social worker does. I wouldn’t read too much into the author’s surprise.
    When I did a career fair for my MSW progam at a local high school, I would ask the kids, “what do you think a social worker does?” and the response 9 times out of 10 was, “they are the ones who come and take the children away.”
    Ok, so that just means we need to do a better job of promoting our profession!

    We can look at it as a “thankless job” until we see that the help we provided has made life just a little (or even a lot) better.

    Keep on truck’n

  7. “I was the one who helped your mother battle depression, your son stay clean and sober, your grandpa manage his diabetes, your nephew stay out of gangs, your daughter find shelter from abuse, your parents obtain their citizenship, your niece get treatment for an eating disorder, your children get affordable health care, your son when he got home from war, your sister when she lost her home, your father cope with Alzheimer’s. I AM A PROFESSIONAL SOCIAL WORKER.”
    National Association of Social Workers, California Region. AFSCME locals 3511 and 2712. Older Adults FACTS Intern Council. ©Roger Lee Lewis

  8. I work in a hospital with RN case managers. RN case managers essentially manage every single patient in the hospital, including making report during rounds (sometimes instead of the charge nurse), phoning insurance to give review, and even making treatment/medication recommendations to MDs.

    In many situations, I’ve had RNs and RN case managers give me feedback on the manner I handle my patients. RNs and RN case managers provide the same support I do and do the same assessments that I do in the hospital. In many cases, my patients would rather talk to an RN case manager because not only do they provide empathetic listening, but they are able to explain the intricate details pertaining to their diagnoses, medications, IVs, treatments, etc. that I am unable to do due to not having nursing training.

    I can see how in a hospital setting, patients and staff may prefer nurses and RN case managers. When I see patients to provide support, a prevalent theme I have encountered is that patients want to know about their medical diagnosis, its specifics, and how it can affect them in the future. When a disaster happens, such as a Code Blue, families have wanted to speak to a nurse to find out what is happening medically, and in so many situations I have been pushed aside rather awkwardly.

    As for my own job duties, I typically perform basic assessments, handle financial situations, provide resources, give Medicare rights letters, arrange transport, and address end of life issues. However, during many instances RN case managers have taken over my cases completely if they become too complicated medically and socially. During rounds, social workers don’t usually bother to contribute because the floor nurses and RN case managers have already gathered psychosocial information from their own interactions end up telling the social worker what to do about it. Our community resources are uploaded online, so oftentimes our assistants and nurses just go ahead and discuss these resources with patients without us.

    I’m resigned to think that RN case managers will eventually take over social work in the hospital setting. If you look at the history of hospital social work, the first hospital social worker was a nurse whose job was to gather psychosocial information on a patient. I really don’t know what social workers can do to help the situation, but I think that lacking the nursing knowledge really hurts social workers when interacting with patients in a hospital setting. Furthermore, it hurts the respect of social workers in the hospital setting when floor nurses choose to consult with RN case managers because they are more familiar with the coupling of medical and social. Where I work, RN case managers can function as social workers and discharge planners. Unfortunately, I don’t know if the same can be said vice versa, hence the pay disparity. As much as I’d like to say I can be a case manager, I don’t feel knowledgeable enough to do things like suggest medication changes to doctors and discuss the details of complex medical diagnoses with patients. Maybe I would if I had a nursing degree.

    Working in a hospital setting is exciting, but frustrating because it seems as if social work will ALWAYS take a back seat to nursing and RN case management.

  9. Wendy Lomax writes about comparative data for RN/SW case management. Where is that data?

  10. I essentially provide a lot of the same services as nurse case managers. I also have more education, since most of these nurses only have an associates or bachelors degree. However, I’m paid half as much.

    I can understand nurses getting paid somewhat more because of their medical knowledge. But tens of thousands of dollars more? How is that fair?

  11. I have been working in hospitals whether in medical SW or in mental health for 2 decades, but in NC the case managers are only RNs and SW are not allowed to apply even with more education
    and experience.

  12. In health care settings, social workers have been losing ground to nurse “case managers” since 1983 when the prospective payment system went into effect and nurses were hired to communicate with the insurance companies. Since that time they have expanded their role.

    The social work profession does not self advocate very often, but needs to work on becoming a reimburseable service in hospital and long term care settings. This would hlep to establish the social work role, increase jobs and salaries, also ensure that social work services are available for patients in these settings. Hospitals themslves would benefit from having adequate social work staff to ensure thorough discharge planning for patients which would help to prevent unnecessary readmissions. Its a win-win situation where all parties benefit.

    Unfortunately, I have not seen NASW or orther organizations advocating for this measre, even now during a climate of health care reform. Now is the time, but the profession lacks leadership in this area. Perhaps we need a new organization specifically for social workers in health care settings to form and lead the charge ?

  13. I have worked in several major hospital systems since the late 1970’s, prior to formal licensing being on board, which occured in my state in 1986. It appears that the recognition and function of the social worker’s role was more prominent and part of the team PRIOR to the licensure for social workers. Of course, other variables also have made an impact on the corporate structure of hospitals and insurance companies. No longer is there even a social work dept in the 3 major hospitals in the city that I live in. All social workers now fall under case management and the department is steered by nurses only. Wow….where is the profession security? Medical systems pay far better than most agencies do that social workers often work in. It continues to look like social workers are a secondary profession in the hospital settings…losing leverage and not standing on equal footing with the spectrum of professions within a medical setting. What say you NASW?

  14. I have been working in a hospital for 3 years. I have a BSW. It seems most hospitals require MSW or LCSW to do discharge planning. The hospital where I work I have transitioned to being a Case Manager. I conduct Utilization Reviews, Dealing with Insurances, Counting Observation Minutes, and doing Discharge Planning. Does this exist at other hospitals?

  15. I am a Medical Social Worker in a large metro hospital in the Midwest. At our hospital the Case Management Dept includes RN Case Managers (CM), Documentation Specialists whom are RNs and Social Workers. We are required to have our MSW.

    Our roles are pretty defined – SW does ALL of the psychosocial assessments, crisis intervention, and access to community resources. We also coordinate all discharge planning needs: medical equipement (from walkers to oxygen and wound VACs), home infusion and enteral services, home health, hospice services, nursing home placements, rehab placements and LTACH placements.
    We also assist patients with Advance Directives, transportation arrangements, and anything else staff might have a random question about. We provide 24/7 coverage including holidays.

    The RN Case Managers deal with all utilization reviews for commercial insurance and ensuring Medicare patients meet their status (observation vs inpatient). As RN’s the CMs are able to gather the clinical picture better and inform the SW what a patient may need at discharge. We work as a team and are assigned to specific units together. The CMs are so busy with dealing with insurances I don’t see how/when they would have the time to visit with patients and families and initiate a discharge planning discussion. Maybe we just do things differently here.

    I am not afraid of loosing my position to a CM – there is just too much to do for one person. I also believe It is a Joint Commission requirement that hospitals have a SW on staff.

  16. Hi Heather,

    Thanks for the feedback. I work for a small rural hospital that is a part of a larger Health Care Center. My director transitioned me to CM duties due to low census and now I perform the same role as the current RN CM on our staff. We are expected to manage a case load of 35 pts each per day. This includes D/C planning, conducting UAI’s, Utilization Reviews, Contacting Insurance Companies. Not a conducive schedule as can work on a slow day 9-11 hours. I am listed as a Social Worker by title only. We do not have weekend CM as our hub hospital CM covers the weekend UM Reviews.

  17. I am an LMSW. I have been a hospital SWer for about 15 years. Recently I left my hospital position to take a Case Management position at another hospital. I think most of the conversations here are absolutely on point, however depending on the geographical area in which you work really depends on what you are able to do.

    In my current position, I function as both SWer and Case Manager, I assess all my patients, handle all of their psychosocial needs and I also do all of there UR reviews. I plan on getting my CCM next year and perhaps eventually go for my BSN.

    Both roles are necessary in the hospital environment, but the overlap is grey. I have been in this role for a few months now and there was a learning curve, but I am starting to get the hang of interqual and its just fine so far. So perhaps my fellow, BSW/MSW this may be the next chapter for us all.

  18. please give the name of the article your referred to as I am interested in this. the site could not be accessed in your entry

  19. I worked as a hospital social worker alongside nurses and all I can say is never again. I was paid almost half the salary as the nurses who had not even a third of my education. I was also treated as a lower tier employee. Basically I was their servant. I even dealt with sexual harassment and my supervisor RN swept it under the rug to protect all her nurse employees. I felt so disrespected I finally quit. I lost a lot of respect for hospital nurses working there. Never again will I put myself in a situation like that!

  20. Registered nurse case manager here. In my hospital we work with our MSWs as a TEAM! The social worker handles the social issues (homelessness, financial) while I focus on the clinical piece. If I’m being 100% honest I can everything the MSW can do but she cannot so everything I can do. The patients always want to talk to me because I can answer questions pertaining to their diagnosis and discharge instructions. I’m also the one who is familiar with the insurance portion of the piece. I give the clinical review to the insurance companies and know how many days we have been approved for and I fight the denials. I agree SW should be paid more. But y’all are not nurses and just because you have a masters doesn’t make you more educated. If that were the case you’d be able to answer questions. As a RN case manager I’m familiar with what resources we have so when my SW is out I can still do everything. If I’m out they call someone else in for help. Let that sink in.

  21. Aw, Sabrina. You seem to be lacking some critical thinking skills, hon. You write, “because you have a masters doesn’t make you more educated”. Horrible grammar aside, you’re missing the obvious. Of course, having “more education” means that one is “more educated”. And by definition, a Social Worker is much more educated than an American nurse, 55% of whom don’t even have a bachelor’s degree. And you’re seeing Social Workers in just one setting: hospitals. And of course an RN, superficial medical knowledge and all, will have more knowledge about physical health issues than a SW would. But guess who has a LOT more knowledge about mental health issues than an RN? Or do you imagine yourself qualified to assess for, diagnose and treat PTSD like LCSWs do? How about Substance Abuse Disorder? Or Reactive Attachment Disorder? Oh, and guess who has MANY MORE professional options than RN’s? Social Workers. Yeah, I think I’ll stick to seeing 4 clients a day in private practice for 100k per year while you choose between passing out meds/monitoring vitals or pushing patients out of the hospital.

  22. Aw, Sabrina. You’re confused. Of course having more education means that one is “more educated”. And between our Masters degrees and licenses, we Social Workers are much more educated than the average American nurse, almost half of whom don’t even have a college degree. So before insulting Social Workers (on a Social Worker site nonetheless!) I’d encourage you to think about the fact that we LCSW’s assess, diagnose and treat everything from ADHD to PTSD, something you nurses most certainly can NOT do. I’d also encourage you to think about the fact that we have MANY more professional options and hospital work is one of the lamest/dead end ones. Yeah, I’ll keep seeing my 20 clients per week in private practice for 100k while you choose between passing out meds/monitoring vitals or pushing patients out of the hospital. Now let that sink in.

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