Geriatric Social Work

Geriatric social work in health care is the fastest growing segment of social work, involving about 49,000 social workers. These health professionals can locate or provide resources, services, and opportunities for the elderly and their families; enhance the problem-solving and coping skills of the elderly and their caregivers; and help develop social policy.

Scope of care: As part of the interdisciplinary team, social workers evaluate patients' cognitive, behavioral, and emotional status and their social support network (see Table 9-1). Social workers evaluate a patient's self-assessment of quality of life and the patient's economic resources, which often determine access to medical and personal care and influence options for living arrangements. This information helps the social worker develop a coordinated health care plan for the patient.

Geriatric social workers work directly with the elderly and their families to deal with social support factors that create or exacerbate problems in living. Social support (eg, family, friends, community resources) can maximize the patient's ability to adapt and cope, enhance self-esteem and self-control, reduce hospital admission and readmission rates, and promote recovery. Social workers evaluate the competence of present and potential caregivers, their willingness to provide care, and their acceptability to the patient. They note the caregivers' stress level, support network, and cultural, ethnic, and spiritual values. Family members who care for an elderly relative need support, especially because life span is increasing and more older adults are caring for even older relatives.

Social workers can help defuse the sense of crisis for family members by assisting in health care planning and by ensuring that the elderly person is included in decision making. As care coordinators, social workers can be crucial in maintaining the elderly in their communities.

As counselors, social workers help patients deal with illness, loss, and end-of-life issues. Counseling may take the form of individual counseling for the patient or family counseling. Social workers may also refer patients and family members to group programs to help them cope with the psychosocial effects of a particular disease or life crisis (eg, returning home from the hospital or long-term care facility, being unable to resume previous roles or functioning level, being placed in a long-term care facility).

A major function of social workers is helping the patient with discharge planning and managing the resulting psychosocial elements of care.

Patients most vulnerable to psychologic, social, and functional stressors during postdischarge recovery must be identified early. Arrangements for appropriate social and health services after hospital discharge can minimize the chances of early or recurrent readmissions. For example, a sick elderly person may require rehabilitation and a range of supportive services, including home health care, meal preparation, counseling, adult day care, respite care, and acute and long-term care. Social workers are increasingly involved in the allocation of services offered by federal or state programs to provide a continuum of care.

Settings: Social workers practice in a wide variety of settings (see Table 9-2). For example, all nursing homes with more than 120 beds must employ a full-time social worker. As hospital stays become shorter, more services are being provided in the home. Home-based social work intervention programs include short-term intensive therapies for distraught patients and family members (eg, due to an unwelcome diagnosis or bereavement).

Referrals: Elderly patients or caregivers who may benefit from social work consultation should be referred to a social worker as early as possible so that a crisis can be prevented. Social workers usually receive referrals from other health care professionals. Local chapters of the National Association of Social Workers are listed in telephone directories and may also offer referral information. In addition, local social work support services can be located by calling the Eldercare Locator at 800-677-1116. The Eldercare Locator, established in 1992, is a nationwide information and referral service sponsored by the Administration on Aging and the National Association of State Units on Aging.

Training: All states and the District of Columbia have licensing or certification laws regarding social work practice and the use of professional titles. Although these licensing requirements may vary, most states rely on Board examinations by the American Association of State Social Work. Typically, licensing allows a social worker to be employed by a professional clinical practice and to use a title such as Licensed Clinical Social Worker. A social worker with a Master of Social Work degree can also obtain, through the National Association of Social Workers, the credentials of ACSW (Academy of Certified Social Workers) and QCSW (Qualified Clinical Social Worker). There is no specific certification available for geriatric social workers.