When we think of caregiving, we usually think of nurses, home health aides, family member caregivers–the people that provide direct personal care to patients in or out of the hospital.  But, Harbor House has discovered that caregiving really involves an extended family of people who care for our guests and their patients  in different ways.

The social work team at Strong is a key player in that family as they constantly navigate the challenges of finding safe, supportive and affordable accommodations for out-of-town family members whose loved ones are receiving treatment in Rochester.

LMSW Savannah Lee lives that challenge every day as she deftly manages a case load of 20-30 patients a week.  She notes that in contrast to social workers in the community, the hospital social worker has a “much shorter window of  opportunity”  within which to find solutions that meet myriad patient needs. Community social workers have access to more tools and resources for finding all kinds of support for families, e.g. specialized housing, food pantries, social security or disability services. The hospital social worker, she explained, has to focus on just ensuring the patient is successfully discharged from the hospital.  That means they “have a place to go, whether it’s home or a skilled nursing facility, or somewhere else.”

The discharge planning itself is often a complex decision-making tree of “what ifs,” she noted.  “You have to think outside the box in social work,” she said, adding that “Nurses have to follow orders to solve problems . . . social workers don’t have orders that tell us what to do for a patient.  We have to figure things out by asking specific questions and helping that particular patient understand what is going to happen and needs to happen to get them home.”

Fortunately, Savannah is someone who thrives on figuring things out.  It’s a behind the scenes journey you don’t see the way you see the patient’s clinical experience in the hospital.  And as she attests, the joy of caregiving is often in figuring out something that she’s never done before and having that be the thing that makes all the difference for her patient.