Evaluation of the social needs of nonhospitalized chronically ill persons. 1. Study of 47 patients with multiple sclerosis.

Abstract The social needs of 47 nonhospitalized multiple sclerosis subjects were assessed as part of an interdisciplinary study of these subjects. During the study process the investigators were impressed with the subjects' discussion of their social problems, particularly in relation to the disease and impact of it on the family. A questionnaire was developed with definitions based on a pilot social needs evaluation, a simple questionnaire asking subjects their needs and in-depth knowledge about the subject. The final instrument based on definitions, both objective and subjective, focused on the following categories: social casework included the subject's reaction to his illness, the spouse's reaction to the illness, the marital relationship and children's adjustments, which all related to the intrapersonal and interpersonal relationships in the immediate family. The remainder of the categories were financial status, general and medical, homemaker service, nursing care, vocational rehabilitation, family social problems, household help, transportation, recreation, and friendly visitor. Major findings revealed that only one subject had no need for help in any of the categories. Forty-six subjects had 277 social needs. Forty-eight per cent of the needs were left unmet. Fifty-two per cent were met, with only 20 per cent met by the community. The fact that a community agency is actively helping a family in one area does not guarantee that the social needs are being met in other areas. The greatest number of needs were found in the subjects' and spouses' reaction to the illness, the marital relationship and children's adjustment, in that order. The remainder of the social needs according to frequency of need were household help, recreation and general financial help. Friendly visitor and transportation for medical care categories showed the same number of needs. Nursing, financial help for medicine and supplies, and transportation for recreational purposes followed. Family social problems, vocational rehabilitation and homemaker had the fewest needs. Fifteen subjects had some needs met by the community. In addition, 53 professionals were used for short term advice. Subjects were classified according to the Kurtzke Disability Rating Scale and the Katz Activities of Daily Living Scale. Social needs appear early in the disease process, before disability has progressed and dependence appeared. Assessment of social needs and meeting of need should begin soon after diagnosis, as well as periodically thereafter. Social needs increase in frequency as disability and dependence increase. Specific approaches for assisting the multiple sclerosis patient depend on the social diagnostic assessment, including an evaluation of social needs. The patient and family should be encouraged to verbalize feelings for a better understanding of the disease and its implications. Although the condition can be debilitating, positives including hope and activity, should be emphasized and used therapeutically. The results of this study are consistent with others and support the method used to assess social needs. It is suggested that the method be used for further research to stimulate caring professionals to meet these needs.