In her job as a VHAN social worker, Amber Colbert has helped countless patients make the transition from hospital to a skilled nursing facility. Typically, Colbert works with Medicare patients 65 or older, monitoring their health care journey and helping them find the right facility when needed. That experience served her well in her care for an Alzheimer’s patient and his caregiver wife. Read the full story to learn how VHAN social workers help patients and their families at every stage of life.

While VHAN Social Worker Mary Brooks has worked on dozens of memorable cases, a recent experience with one particular patient stuck with her. The patient was discharged from the hospital with an open wound and a significant recovery ahead. Unfortunately, when she arrived home, she found that her air conditioning was no longer working in the middle of a heat wave in West Tennessee. Read the full story to learn how Mary found a way to get the air conditioning fixed and built trust with her patient.

While caregivers make a significant difference in the lives of patients, the hard work and dedication of caregiving can take a serious toll. The many-pronged tensions of caregiving are illustrated by a young parent who recently gave birth to a female with Down syndrome. Read the full article to learn how VHAN’s Care Management team worked with the parent to ease her anxiety and connect her to childcare resources.

Many who have cared for a loved one at the end of their life understand the role social workers can play in helping patients and families make their way through a stressful and emotionally charged time. Providing social work services for palliative and hospice care can be extra challenging, but for VHAN social worker team manager Cate Mart, LCSW, the connections she establishes with patients and their families make her job gratifying and worthwhile. Read the full article to learn how Cate helped one family make important end-of-life decisions.

Adolescence, those formative years between childhood and adulthood, can be a confusing and sometimes challenging time as young people go through changes both emotional and physical. It’s also a time of discovery as they learn to form their individual identity. A big part of that journey is sexuality, finding where they fit in and how they identify on the spectrum. VHAN Social Workers support young patients through all stages of life, providing behavioral health referrals when needed along the way.

For patients recovering from a recent hospitalization, trying to better manage a chronic disease or navigating a complex medical condition, VHAN’s Care Management program offers personalized care that goes beyond simply addressing physical symptoms. VHAN’s team of care navigators consider their mental, emotional and psychosocial needs as well, improving the patient experience and producing more positive outcomes. Read the full article for a real-world example of how VHAN Care Navigators go above and beyond to help patients.

VHAN’s RN Care Navigators are trained to help patients find their way through a complex health care system. But beyond untangling health care’s confusing details, these professionals also exhibit compassion for every patient they encounter, listening and showing genuine concern that’s as powerful as any prescription. In the case of one patient, the care management team’s ability to listen closely had potentially life-saving results.

Coordinated care provides multiple touchpoints to ensure that no symptom goes untreated, and no patient falls through the cracks. At Vanderbilt Health Affiliated Network (VHAN), clinical pharmacists, social workers and nurse care navigators collaborate to deliver proactive, timely care to patients who need it most. 

For Population Health Clinical Pharmacist Lauren Cook, PharmD, BCPS, BCACP, VHAN’s cooperative approach means staying alert for complications that may arise unexpectedly with patients. Cook’s vigilance recently helped a 64-year-old blind patient avoid a potentially catastrophic health event.

VHAN’s Care Management team often steps in to provide relief and assistance to overworked caregivers. Recently, this coordinated approach benefited an overwhelmed daughter caring for her 75-year-old mother with a history of vascular dementia and multiple strokes. The patient came to VUMC with increased blood sugars, along with weakness and confusion that had resulted in a fall at home. The VHAN Care Management team not only help patients cope with complex conditions, but they also provide compassionate service and a listening ear to caregivers, reminding them not to neglect their own health while in pursuit of their loved one’s healing.