YourVNA.org - Rochester District Visiting Nurse Association

The VNA’s social worker assists patients and their families to address challenges that arise due to patient illness or injury. This begins with a comprehensive assessment of the patient’s social, emotional and environmental strengths and needs. Goals are developed to address barriers that may interfere with the patient’s recovery or hinder their ability to cope with or adjust to their diagnosis and care needs.

Specifically, social workers can assist patients and families in the following ways:

Community Resource Planning: referrals can be made or education provided regarding programs and resources in the community that can improve patient safety and enhance quality of life. Some of those include:

Meals on Wheels
Emergency Response Device
Transportation Assistance
Adult Day Programs
Medication Assistance Programs
Housing Assistance
Financial Assistance Programs
Food Pantry/Commodity Foods
Legal Assistance

Long Range Planning: counseling is provided to help patients and their families plan for future needs. Assistance is provided with:

Education regarding a range of alternate living options such as assisted living, subsidized housing or nursing home placement
Assisting with advance care directives
Planning for the safest environment possible to allow for optimal patient independence
Exploring options for continued care following discharge from skilled VNA service
Education and referral for Home and Community Based Services

Short-Term Counseling: supportive counseling is provided to assist patients and their families to address the following issues that may arise as a result of the medical situation:

Coping with functional limitations that may occur
Understanding or accepting the disease process or prognosis
Caregiver stress and potential need for respite
Motivation or compliance with medical directives
Issues related to grief and loss