Social Workers' Perspectives on Financial Challenges of Patients with Serious Medical Illness

Background and Purpose:  Family finances often become strained when dealing with serious medical illness and end-of-life care. Social workers employed in health care settings are frequently charged with helping patients and families manage these financial concerns. This paper presents qualitative evidence from interviews with social workers from five healthcare settings about the financial challenges their patients routinely encounter.

Methods:Twenty-six social workers participated in semi-structured interviews, and seven social workers took part in a focus group. Participants were recruited from hospice (n=5), long term care (n=5), intensive care (n=5), dialysis (n=6), and oncology(n=5). Interview and focus group questions centered around financial challenges patients encountered at the end of life. Interview data were transcribed and thematically coded. Trustworthiness of data was established with peer debriefing, member checking, and agreement on themes among the authors.

Findings:  Participants described three interacting areas of influence on the financial well-being and financial challenges their patients encountered. First, patients themselves presented with a range of characteristics that set them up for either financial burden or success. This included, among other things, their demographic profile, health status, health literacy, financial literacy, socio-economic status, social support network, and emotional coping skills. Second, the larger healthcare and safety net system provided valuable resources for some patients but not for others, and often involved advanced knowledge, experience, and persistence to overcome complex legal and bureaucratic access barriers. Third, the local setting where participants interacted with the patient needing care set the stage for conflict in matching the patient’s needs to available resources. Participants described a myriad of ways they navigated the interplay of these three areas of influence to meet their patients’ needs. The degree of perceived control over available resources varied and influenced patients’ financial well-being and social workers’ response to advocating on their behalf.

Conclusions and Implications: Findings reveal an interplay between three areas of influence on financial well-being of patients dealing with serious medical illness. Social workers reach across these three overlapping areas of influence to achieve the best outcomes for their patients who face financial challenges: characteristics of the individual patient, the local practice setting, and the larger safety net system. Achieving successful outcomes requires familiarity with these complex resource networks on all three areas of influence.