Unmet patient need in home care under managed care.

Social workers in home care agencies obtained through a national random sample responded to a mail questionnaire that examined the relationship between the frequency of discharge with unmet patient need and patient/family characteristics, agency auspice, and practice activities when social workers' assessment of patient needs and managed care payment limits conflict. Regression analysis found that the importance of social work financial planning with clients and intra-agency advocacy were significant negative contributors, and patient cognitive impairment, inadequate family care, and agency auspice were significant positive contributors to a regression model explaining 31 percent of the variance in the frequency of discharge with unmet need. Implications for practice, education, and research are discussed.

Managed care in home health: social work practice and unmet client needs.

Findings from a sample (n = 117) obtained through a survey mailed to a random sampling of social workers in home health agencies nation-wide suggest that the characteristics of patients discharged with unmet needs were psychosocial. Social work practice activities targeted transferring responsibility for care for patients from agencies and government/commercial third party payers to informal caregivers and community resources. Desired continuing education topics evidence the emphasis on effective interventions that facilitate discharge, interdisciplinary collaboration and practice evaluation.

Job satisfaction of home health social workers in the environment of cost containment.

This national survey examined the job satisfaction of 228 home health social workers in the restrictive reimbursement environment of the Medicare interim payment system. Administrators' helpfulness in resolving ethical conflicts between patient access to services and agency financial priorities contributed significantly to greater satisfaction in regression analysis. Supervisors' helpfulness in resolving the conflict moderated the difficulty of resolving the conflict.

Ethical conflicts over access to services: patient effects and worker influence in home health.

A survey of home health social workers (N = 51) explored the effects on patients of ethical conflicts over access to services. The findings suggest that patients were as likely to be discharged or not receive services as they were to receive the services without paying a fee. Social workers rated themselves as moderately influential in the resolution of the conflict.