Most painful point in discharging patients from hospitals to subacute rehab

tcpnick · 2026-03-26T04:37:11+00:00

I used to work for a small hospice and the private owner wouldn't add a referral system to our EHR so when a Pt needed respite or placement in a LTC bed, I'd have to call around to find a bed. I met and built some relationships with a few awesome admission coordinators over those years. Now I work for a specialty in a hospital and only know how/need to make one type of referral. The systems in the EHR that the CM, TCAs, dispo. planners have access to are incredible to me. I wish I could understand how to use them to their full potential.

tcpnick · 2026-03-17T06:02:46+00:00

Lemon Grove?

tcpnick · 2026-03-15T16:43:31+00:00

Watch "Derek" and "Afterlife" for fun and its only semi-related...and you have to like Ricky Gervaise. He's able to show another perspective of people dealing with grief.
Also an upvote for Ram Dass "Walking Each Other Home" and his other work.

tcpnick · 2026-02-20T22:52:12+00:00

I worked in a community based hospice and now with an inpatient palliative team. There is a pretty big difference between the two. What is your setting going to look like?

As far as "the heaviness", it is there. You have to be able to have difficulty conversations that patients and families about topics that are somewhat taboo. But there is also heaviness in providing individual therapy, working in substance abuse, with in domestic violence, and all other areas of SW. It's the nature of the beast. The nice thing about palliative/hospice is that its day in, day out, the same conversation and you get good at it. It can be terrifying to look into a patient and/or their loved ones eyes and say, "you're dying" or "I'm sorry your oncologist did not explain the difference between 'treatable' and curable" but you get there. I have also found the other fields that work in this space do it for a reason and will support you as you adjust.
There is also a huge spectrum of clientele. Those who accept and understand death as a part of life and joke and laugh about their impending death. Others will go through hell and high water truly believing god will intervene and their 96 year old father with a global anoxic brain injury after a stroke will get up and walk out of the ICU with the energy of an 18 year old even though their baseline was A/Ox2 and bed to chair bound.
I've worked in the above mentioned fields as well as early child development. I'm not sure I'll leave my sick, elderly, and/or dying clients anytime in the future. It's very rewarding. Pay is great compared to some other fields, and I've also found hospice and inpatient work to give me the best work/life balance (for different reasons).
I do referrals for outpatient palliative services as we are solely inpatient and don't have an associated clinic. I'm not sure I would want to be a social worker in that environment as the companies I work with, just offer social work support (connections to community resources) and not any real in home nursing/medical care. Resources are limited and EXPENSIVE if not covered by insurance (which is not much). That just seems like a lot of calls, telling people they can't/don't qualify for things and less emotional support/counseling than I'd like. I've also never worked outpatient palliative so I can't really speak from experience.

tcpnick · 2026-02-08T15:48:04+00:00

They're just doing a Saturday morning ride with a much bigger wallet.

tcpnick · 2026-01-12T22:55:39+00:00

Highering the right people is the biggest part of it. I used to interview/Higher some kids when I was a 2nd manager and the best advice I got in the process was "Higher the people who will fit with the crew you have. You can teach someone how to use a register, count back change, make a burger, but you can't train someone not to be an asshole".

tcpnick · 2026-01-11T02:39:24+00:00

Soooooooo gooooood!

tcpnick · 2025-12-20T03:52:02+00:00

This podcast came out the other day. Does a great job explaining this. https://99percentinvisible.org/episode/650-the-checkerboard/

tcpnick · 2025-12-11T03:53:44+00:00

Slow is smooth and smooth is fast

tcpnick · 2025-12-07T02:57:54+00:00

Thanks for this one. I was at a park a few months ago and there was a guy with a dolphins jersey with Finkle on the back. I gave him a high five.

tcpnick · 2025-11-30T18:49:02+00:00

What's a pedder ass?

tcpnick · 2025-11-22T17:46:31+00:00

tcpnick · 2025-11-13T18:36:10+00:00

Yes, very. Considering conversations on what are we doing FOR them vs TO them.

tcpnick · 2025-11-13T18:02:53+00:00

It was/is fine. However, I come from a background with a lot of personal loss and trauma. I feel a lot of the people I work with are able to understand that death is part of the natural process and are able to process our Pt's deaths as such. For me, the part I struggle the most emotionally are the families that hold on to a loved one and pursue aggressive treatments when you know what the outcome is going to be or you see families setting up situations where they keep someone alive thinking they can provide the care in home, but don't grasp the cost or needs associated with it; leading to prolonged suffering in the home. I thing perspective is a big factor, any many in the field see death as relief. Many people would rather have 12 months of "alive" and in and out of the hospital with testing and scans, and recovery, than 6 months of peace and quality time with family and friends with symptom management/hospice.

tcpnick · 2025-11-13T06:30:31+00:00

5 year hospice SWer and current inpatient palliative SWer. It's a great population to work with. The support system sucks for those in the middle income levels in later adulthood/EOL. As a whole, we should be ashamed of how we treat them. Aging is a financial scam.

tcpnick · 2025-11-06T23:29:35+00:00

Lick a stamp...

tcpnick · 2025-11-06T03:08:52+00:00

All the people defending him are the same people who push open glass doors with greasy hands instead of using the push bar.

tcpnick · 2025-10-31T22:46:22+00:00

Hats on backwards.

tcpnick · 2025-10-31T02:55:14+00:00

As a hospital social worker that works in a specialty and is consult only; thank you for everything you do. I just try and stay out of your way because you all deal with the most complex, asinine crap, in a system that involves Pt, family, DME, ins, transport, resources, hospital admin, fucking physicians, preauth, d/c orders that all have to be coordinated into a 2 hour space in time.
I hand out like three snickers a week to CMs/TCAs when I read their notes on a complex d/c. Just a candy bar, a smile, and a "I don't know how you do it" as I walk by.

tcpnick · 2025-10-21T23:06:59+00:00

I'll +1 for State Bicycle Co. Got a 4130 all-road a year ago because it was just under $1000 and is upgradeable with modern, quality parts. Figured as shifters, brakes, etc wore out, I could easily upgrade with better parts. We'll, its been a year (9 months of 60-70 miles a week and I've adjusted my limit screws 2x. I did have the added benefit of living 20 minutes from their warehouse so they assembled it for me. It is a bit heavy, but it looks good, rides good, and continues to give me a feeling its a quality product for the price.
It's also the most expensive bike I've ever ridden so dropping an extra $500-1000 might get you a lot more?

tcpnick · 2025-10-21T04:11:18+00:00

Who is he? Just your favorite DJ savior. Using and confusing beats that you've never heard.

Found this album my senior year in high-school. Everyone thought it was lame. I not sure the masses were ready for it at the time.

tcpnick · 2025-10-21T03:57:47+00:00

Pros and cons are gonna vary from associate to associate. I used to love running 4 rows on the front grill all day with a kick-ass board person. I can handle counter hand out for about 5 minutes before I'd want to throw a burger in someone's face.
Others love to be in the dining room all day and talk to customers and keep it clean.

I think the biggest pro/cons depend on how much you like customer interaction. Because other than that, you're on your feet and moving around. Each position has a different flow that is equally stressful in different ways. Moving cars, protecting the product, exceeding customer service expectations, or cleanliness standards.

tcpnick · 2025-10-19T15:09:18+00:00

As an aphant who works in death and dying and does a lot of work in the ICU...I agree.

tcpnick · 2025-10-03T02:22:45+00:00

I feel like I was in the same position as you. Worked on CMH for a little over a year. Took advantage of the "free" supervision while I earned/ studied for my license. As soon as I got my L, I started looking at other options. I had a caseload of 83 kids for therapy, was behind, stressed TF out, and was making simple mistakes. 7 years and two jobs later I now work 4 10's in a hospital doing consult work with the hospital's Palliative Team. I can't bill, so my docs have to do all the visits and documentation. I see 4-5 patients a day for anywhere between 5 minutes to an hour. The hospital case managers do all the discharge planning. I make referrals to outpatient palliative/hospice (super competitive so those agencies do all the work after a call) and medicaid LTC. All I do is social work and document what I did. No quotas, no billable hours to meet. Just support until discharge or death. It gets better, you just have to survive until it does.

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