The point of this paper was for us to pick an organization or agency that deals with the field of social

work, and describe them in detail. For this assignment I chose to analyze the agency I had been interning for, Vitas hospice care. I feel that this paper helps us to reach the competencies of critical thinking, using research to guide us, and by helping us to respond to contexts that shape our practice. I feel that I was effective in this assignment as I clearly describe the agency, it s function, and how a social worker operates within it.

!icholas "ase #rganizational analysis $$%$&%$'

(hen I first came into the social work program at (ayne )tate, I was not sure exactly what it was that I wanted to do post%graduation. (hen we had our orientation for the program, I remember talking to different people that were starting the program as well and finding out where it was they wanted to go with their degree. )ome people had clear ideas of what they were intending to do, but most were *ust as unsure as I was, which was a fact that I found very reassuring. +ater during the orientation there was a volunteer fair where we were all supposed to go around and check out what sort of options there were on how to fill the re,uirements for our volunteer hours. It was there that I met two people that would end up playing big roles in my life for the next couple years. They were the staff social worker who later became my supervisor for my internship with them, and the volunteer coordinator from the organization known as VIT-), whom I would work with as a volunteer for the ma*ority of the two years leading up to my internship. I spoke with them for awhile, and to be honest, it sounded like it would be a pretty easy way to fulfill the re,uirements for the volunteer hours. The full title of the organization is VIT-) Innovative .ospice "are, and as it would turn out it was not nearly as simple as I/d had thought it would be. I fell in love with the work though, and grew to have a great respect for VIT-) as an organization. VIT-) is a public, for profit organization, and their services are paid for by 0edicaid, patients insurance plans, and1or through private payments. In order to be able to bill 0edicaid, VIT-) must follow the guidelines for the care detailed by the 0edicaid program. These guidelines are released by the #ffice of the Inspector 2eneral of the 3epartment of .ealth and .uman )ervices 4Taylor 0, $5556 and affect all hospice care organizations, as well as some other health care and home aide services. -mong these guidelines are rules against such behaviors as

7admitting patients who are not terminally ill or who have been diagnosed as having more than six months to live, offering fewer services to patients than they need, using high%pressure marketing, or creating improper financial and referral arrangements with nursing homes.84Taylor 0, $5556 -ccording to the organizations website, 7VIT-) Innovative .ospice "are9, a pioneer and leader in the hospice movement since $5&:, is the nation s largest provider of end%of%life care. #ur name is derived from the +atin word for 7lives8 and symbolizes the VIT-) mission; to preserve the ,uality of life for those who have a limited time to live. .ead,uartered in 0iami, Florida, VIT-) 4pronounced V<<%tahs6 operates => hospice programs in $: states and the 3istrict of "olumbia.8 4http;11www.vitas.com1-boutus.aspx 6. The website goes on to describe their mission1goal as being 7a growing family of hospices providing the highest ,uality human services, products and case management to terminally ill and other appropriate patients and their families with measurable advantages for the patient, the family, the medical community, the employee and the stockholder8. The vision that they describe behind their goal is that 7For over '? years, VIT-) has advocated for the rights of terminally ill patients and their families. (e believe that patients should be apprised of their clinical prognosis and be involved in the decision%making process that determines how their end%of%life care is provided.8 4http;11www.vitas.com1-boutus1Values.aspx 6. (hile these goals may seem vague, and according to (illard and @arber , 7(ithout clearly defined goals and supporting ob*ectives, goal displacement often occurs.8, VIT-) strives to attain these goals by offering patients and families any available service that they may benefit from. For example, VIT-) employs "haplains that go and visit patients, and provide spiritual support to both them and their family members or caregivers when needed. The social workers also step in for the patients, and family members, or care givers by linking them to services, such as help finding support groups or helping them find a temporary caregiver so that the family or primary care giver may take care of other matters or *ust get away from the house for awhile. The social workers also check up on the patients to

provide emotional support, make sure all of their needs are met, that they are being treated with dignity and respect, that they are not being abused or neglected in anyway, that they have all the necessary e,uipment they need and that it is functioning properly, as well as helping to fill out any necessary paperwork when needed and making sure all the proper paperwork is sent out to facilitate a change of living situation for a patient when they switch from home to somewhere such as a nursing home or hospital. @eyond the social workers and chaplains, they/re are also the marketers, the nurses, the home health aides, the volunteers, the doctors, the music therapist, and the office support staff. The marketers go around to conferences, hospitals, nursing homes, rehab centers, group homes, and adult foster care facilities. (hile at each of these places the marketers go around and give sales pitches to staff members and representatives of the different places, to try and get them to refer more clients onto our services. This promotes better cooperation between our organization and all of the different key systems involved in the hospice care process, which in turn promotes greater efficacy within the medical community, as well as further rewarding shareholders when new patients are brought on. The doctors don/t come around too often, but they are heavily involved in the beginning phases of hospice care as they must give the go ahead for new patients. They also come in on (ednesday every week for the team meeting where the whole staff comes together to discuss the needs of the clients, and any other matters that need to be attended to. The doctors also fill out prescriptions and sign off on different e,uipment orders when necessary, as well *oining in on the discussions and performing the evaluations on clients that determine whether or not they are fit for hospice services. The doctors are very important in making sure that all of the patients get the correct medicines, and that all of the rest of the staff are up to date on the health situations of each client. The nurses handle the day to day health care needs of the patients, such as checking blood pressures, tending to any first aid needs, checking the patients. Aulse and heart rate, and generally *ust make sure that the patients health situation has not decreased. The home health aides then come in and

help the patients to bathe and take care of any other personal hygiene issues, as well as assisting the patients with dressing themselves, and occasionally helping patients to eat when necessary. The music therapists are not available to all teams of VIT-) staff, but our team recently got one, and they bring the patients a great deal of *oy averagely. I have yet to have seen ours at work as she *ust *oined the staff recently, but it is to my understanding that she goes around to the different patients wherever they are, bringing musical instruments along, and she plays for them and sings songs to them to help lift their spirits. The music therapist also often makes team visits with the "haplains, and together they do religious music for patients who re,uest spiritual support. This leaves what I consider two of the most important groups of the staff at VIT-), the volunteers, and the office support staff. Alanalp and Trost describe hospice volunteers very well as being 7 trained to let the patient take the lead in either avoiding or engaging the topic of death, but they are prepared to approach the topic without fear and to be open and available to patients who do want to talk.8 4>??:6. The volunteers are essentially the filler between each other different discipline, and they will often play many different roles. )ome patients may need a volunteer to come by and stay with them while their caregiver makes a short trip out into town for groceries, doctor appointments and other day to day business that they must take care of. For other patients the volunteer might be a shoulder to cry on, a friend to play board games with, or *ust someone to sit with them and hold their hand to provide them comfort at the end. The office support staff is comprised of the secretary, and the office administrator, and they are absolutely indispensable. The two of them make sure that the office runs as smoothly as possible. They make sure we have all the supplies, and documents we need, and they handle all of the processing of our records. The most valuable service they provide in my opinion though, is that since they process the records, they are always able to help figure out any issues with patients receiving their e,uipment and necessary supplies, ,uickly and efficiently. For example, I recently ran into an issue where a patient had received the wrong type of e,uipment. (hat they had received was close to what they were

supposed to get, but was missing a piece. I asked around at the nursing home where the client lives, and no one knew what I was talking about. )o when I got back to the office, I stopped by to see the secretary and told her about the situation. In under five minutes, the secretary had identified which part had not been brought out with the delivery, and had placed a call to the medical supply company we deal with to have the part sent out immediately. -ll of the aforementioned members of the VIT-) staff act mostly on their own self direction, though most have at least one person that they report too, or are given tasks by. For example, in the social work department there are nearly always interns, and we all answer to our supervisor, who is an 0)( social worker for the agency. The nurses and home health aides then all answer to one head nurse, and the volunteers all answer to the volunteer coordinator. The music therapist, the "haplains, and the marketers though only answer to the Team 3irector, which is also the same person that the head nurse, the volunteer coordinator, the office support staff, and the non%intern social workers also report to. The Team 3irector then answers to the corporate executives, who are lead by the @oard of 3irectors for the organization. @eyond being given patients to see to, and the occasional ,uick task that may need to be done though, how each member of the team goes about their work is entirely up to them though. For example, when I get to the office in the morning, I go and see my supervisor, he fills me in on any information that might be relevant to my work for the day. .e will then sometimes tell me about a new patient that I need to go see that day, or he may ask me to stop by an existing patients home to check up on them, or take care of something that they need assistance with. -fter were done talking, I/ll head out and go do which ever task I feel should be completed first. (e don/t all show up at the same time though, and most members of the VIT-) team, including myself, are rarely in the office for very long on any given day. The only times the ma*ority of the staff is in the same place at the same time is during the weekly team meetings on (ednesdays, which is when everyone gets together and shares all of their

experiences with the patients, share all the different things that are relevant towards the patients/ situations , and come up with different interventions to help better serve each patient. 0ost of us also show up to the different team building events that the organization sponsors as well. These events are less about building a new skill set though, and they are more about promoting a strong bond between the different members of the staff so that we all work better as a team together. These events are often very informal and are never mandatory. "ommon events are activities such as Tigers games and picnics during the warmer months, and holiday parties during the colder months. I feel that these activities are really good for getting the team together to relax and have fun together, while also discussing aspects of the *ob as a group, and individually with each other, throughout our time together. VIT-) also has a very diverse staff of people from all over the world, of different races, of different religions, of different socioeconomic status, different ages, or different sexual orientations. The women on the staff outnumber the men by a fairly wide margin, and on average hold the higher positions of power on the staff, but here is still a good amount of men on staff as well. <veryone gets along very nicely too, and it/s always en*oyable to hear opinions and ideas from such a diverse group of individuals. The only group of persons I have never seen represented on the staff at VIT-), people with disabilities. There are no policies against hiring a person with a disability at VIT-) though. -s far as I know it/s *ust that no people with disabilities have tried to work with us. I feel that the organizational style that fits VIT-) best is the bureaucratic structure. The first indicator towards this is how the textbook describes how in a bureaucratic structure, 7positions in the organization are grouped into a clearly defined hierarchy.8 4!etting, Bettner, 0c0urty, Thomas. >?$>, Ag >$'6. This is very to clear to me as each of us, right up to the executives has someone above them that they answer too. -lso 7Cob candidates are selected on the basis of their technical ,ualifications8 4pg >$'6 and 7each position has a defined sphere of competence.8 4>?$> pg >$D6. I feel that these are both very important aspects of the organization as it would not be appropriate, or in some cases legal, to have any one of us doing the *obs of the other.

-long with the bureaucratic structure, I feel that VIT-) applies a management theory that !etting, Bettner, 0c0urty, and Thomas call scientific and universalistic management4>?$>, pg>$&6 . VIT-) has a single decision maker, the Team 3irector, passing orders down to single supervisors who all have a restricted span of supervision4>?$>, pg>$:6. The supervisors then divide the *obs up and take the more difficult tasks themselves, and pass the less difficult tasks down to their subordinates. For example, the Team 3irector gives a broad *ob to my supervisor, who then divides the *ob into separate tasks, giving me the less difficult ones. -lso I feel that the aspect of this style that the text describes as having line functions being central to the completion of core organizational tasks4>?$>, pg>$&6, such as a "haplain visiting a patient for some bible study, as well as staff functions which are supportive or advisory4>?$>, pg>$:6, such as the office support staff helping to find missing e,uipment. I feel that having the bureaucratic structure and the scientific and universalistic management style are very useful for VIT-) as it simplifies the chain of command and allows more freedom in each staff members day. VIT-) is somewhat uni,ue due to the fact that they practice micro level work in a macro level environment. For example, since VIT-) does not have their own facility for patients, the staff travels all around going to care facilities, patients homes, hospitals, and group homes in the 3etroit and 0etro%3etroit area and even further downriver. )ince each person has their own area of expertise and the ma*ority of the staff does not spend much of their days in the office, most of us have fairly set routines. For me, on Tuesdays I see a group of patients who all live near each other out by (estland, and on Thursday I go out to the Epsilanti area for one patient, and then on my way back to the office in )outhfield, I stop by "anton, and +ivonia to see two other patients. .aving the freedom to choose who I see and when is important when driving all throughout three counties, so that there is not an excess of having to drive to and from the same areas repeatedly, wasting time as well as money on gas. (hile I do think it is a good thing that we get to choose how we go about our workday at VIT-), there is at least one problem that it creates. )ince were all out in the field following our own schedules,

and since we cover such a large area it is often uncommon to run into other members of the staff, and when we do it/s often >%D of us showing up at the same place. This causes a couple problems on it/s own as well though. For example, if one of my patients falls and becomes in*ured and I need one of the nurses, but she/s on the opposite side of the county, we have to wait there for her to make it across unless it/s serious enough for an ambulance to be called. -lso when too many of us show up in the same place, it can confuse some of our patients and cause them to become withdrawn if too many people are all around them. I feel like a possible fix to these issues would be to schedule two extra team meetings, one on 0ondays, and the other on Fridays. This way, the staff members can coordinate their visit times better, set up more effective team visits with each other, and provide one another with more information about the patients during each meeting, To me this idea makes perfect sense, but I could see members of the staff being unhappy with more constraints to their schedules, instead of them having full control of when they go to each patient. -ltogether though, I feel that VIT-) is a very strong organization. They are great at working as a team, and are kind and supportive to one another. -fter spending the ma*ority of the program with them, I feel like while I may not have known where I wanted to go in the field of social work when I first started, I am now certain that I would like to stay in .ospice after graduating.

@ibliography

Textbook; !etting, Bettner, 0c0urty, Thomas. 4>?$>6 )ocial work macro practice,Aearson education, pgs >$', >$D, >$&, >$:.

-rticle sources; Taylor, 0. 4$5556. ..) issues guidelines for hospice care. Modern Healthcare, 294D?6, >>.

Alanalp, )., F Trost, 0. G. 4>??:6. "ommunication Issues at the <nd of +ife; Geports from .ospice Volunteers. Health Communication, 234'6, >>>%>''

(illard <. @arbera F Cohn !. Taylor 4>?$$6. The Importance of 2oals, #b*ectives, and Values in the Fisheries 0anagement Arocess and #rganization; - Geview. !orth -merican Cournal of Fisheries 0anagement Volume $?, Issue D, $55?

(eb sources; http;11www.vitas.com1-boutus1Values.aspx

http;11www.vitas.com1-boutus1.istory.aspx