Chapter 16

Handbook of Health Social Work, 2nd Edition

SOCIAL WORK WITH OLDER ADULTS IN

HEALTHCARE SETTINGS

Older Adults (persons 65 years or older) represent 12.8% of the population (about 1 in 8 Americans)

The life expectancy is an additional 18.6 years

19.6% are racial and ethnic minorities

CHARACTERISTICS OF THE AGING POPULATION- DEMOGRAPHICS

Most older persons have at least one chronic health conditionHypertension 41%Diagnosed Arthritis 49%Heart Disease 31%Cancer 22%Diabetes 18%Sinusitis 15%

CHARACTERISTICS OF THE AGING POPULATION- HEALTH AND HEALTH

CARE

38% of older persons reported having some type of disability

Spent 12.5% of total expenditures on health

CHARACTERISTICS OF THE AGING POPULATION- HEALTH AND HEALTH

CARE

Growth of Medical and Public Health Social Workers expected to increase 22%

Demand for social workers in nursing homes, long-term care facilities, home care agencies, and hospices

IMPLICATION OF DEMOGRAPHIC CHANGES FOR SOCIAL WORK IN HEALTH CARE

Comprehensive assessment of needs and resources for older adults performed by multidisciplinary team

CGA’s originated in England in 1930s

Use of CGA’s in US restricted to VA hospitals and academic centers

COMPREHENSIVE GERIATRIC ASSESSMENT

Assess medications, immunizations, mobility, cognition, and signs of anxiety or depression

Initiated by a primary care physician

Many recommendations made during assessment not followed by primary care physician or patient

COMPREHENSIVE GERIATRIC ASSESSMENT

GEM- Geriatric Evaluation and Management Approach adopted

Highly cost-effective

Consists of physician, nurse, and social worker

COMPREHENSIVE GERIATRIC ASSESSMENT

Initial at home assessment

Meetings with interdisciplinary team

Plan developed

Plan implementation by team

Follow up visit in home

Ongoing care/case management

Periodic reviews/reassessment

GERIATRIC RESOURCES FOR ASSESSMENT AND CARE OF

ELDERS

Reduced emergency visits

High levels of physician and patient satisfaction

Yielded cost savings in 3rd year for high-risk enrollees

“The key to good assessment is using a strong conceptual model”

RESULTS

Polypharmacy- individual may visit different doctors and receive prescriptions for different medications that may have significant interactions and side effects

Cost-related nonadherence with medication use associated with poorer health outcomes (in terms of worsening chronic conditions)

PHYSIOLOGICAL WELL-BEING AND HEALTH

Pathological disorders underdiagnosed because of several challengesComorbidityStereotypes about agingOverlap of symptoms

Substance abuse underdiagnosed

Suicide rates among seniors are among highest of all age groups

PSYCHOLOGICAL WELL-BEING AND MENTAL HEALTH

85% by males

More likely to have lived alone, be widowed, and have had a physical illness

Firearms used 73% of time

FACTS ABOUT SUICIDE AMONG OLDER ADULTS

Two types of cognitive changes

1. Small declines in memory, selective attention, info processing, and problem solving ability that occur with normal aging

-Amount of changes varies greatly

COGNITIVE CAPACITY

2. Progressive, irreversible, global deterioration in capacity that occurs as a result of dementing illnesses such as Alzheimer’s disease, vascular dementia, and subcortical dementia

COGNITIVE CAPACITY

SW find resources for caregiversSupport groupsBehavior management trainingCounselingPersonal care servicesRespite/alternative living arrangements

COGNITIVE CAPACITY

Individuals ability to perform certain basic ADLsBasic Activities of Daily Living (ADLs)

Dressing, bathing, cleaning, eating, grooming, toileting, getting in/out of bed, etc.

Instrumental Activities of Daily Living (IADLs) Cooking, cleaning, shopping, money management, use of

transportation, telephone, etc.

FUNCTIONAL ABILITY

Subjective and Objective components

SubjectiveAsk individuals to report on their satisfaction with their social situation and their perception that support is available when needed

ObjectiveSocial support, social networks, social activities, social roles

SOCIAL FUNCTIONING

Social functioning is both an outcome as well as a predictor of physical and psychological well-being

SOCIAL FUNCTIONING

Physiological changes in sensory perception, gait, reaction time, and strength may compromise an individual’s ability to negotiate the existing environment

Falls are the leading cause of injury deaths

35-40% of older adults fall at least once

Most falls occur in/around the home

PHYSICAL ENVIRONMENT

64% of older adults (living in the community) rely solely on family and friends for help

28% receive a combination of formal/informal care

8% use formal care or paid help only

ASSESSMENT OF FAMILY AND INFORMAL SUPPORT

Assess objective and subjective components of caregiver strain to gain a better understanding of the needs of the caregiver

Legal barriers may exist because of the legal definitions for who ‘family’ is (barriers for gay/lesbian couples)

Elder abuse/history of family abuse

ASSESSMENT OF FAMILY AND INFORMAL SUPPORT

Assessment of economic resources

ECONOMIC RESOURCES

End of Life Care (resuscitation, ventilator care, intubation, etc.)

Types of home care services/posthospital careHousing arrangementsRoutines of everyday lifeReligious PracticesPrivacySafety vs.. Freedom

VALUES AND PREFERENCES

Religious and spiritual activity is known to influence an individual’s psychological and social functioning, ability to cope with stress, and overall quality of life

SPIRITUAL ASSESSMENT

Ethnogeriatrics- synthesis of aging, health, and cultural concerns about health care and social services for ethnic older adults

Adds cultural exploration/investigation into assessment

ETHNOGERIATRIC ASSESSMENT

Biomedical Model- uses definitions and explanations of health and illness that are based on scientific assumptions and processes, whereas ethnic older clients and families may consider factors such as balance, nature, or spirits in explaining their conditions

CULTURAL CONTEXT OF HEALTH AND ILLNESS

Acculturation- the degree to which individuals are influenced by and actively engage in the traditions, norms, and practices of one or more cultures

HISTORICAL CONTEXT AND COHORT EXPERIENCE

Family-Centered cultures, invite family members to participate in the assessment process in addition to the older adult

Family members can help obtain insightful info about clients’ problems and contribute to collaborative problem solving

ROLE OF FAMILY IN CULTURAL CONTEXT

Physical proximity Greeting and examination by opposite genderDirect eye contactAsk clients for guidance and about their

preferences

CULTURALLY APPROPRIATE NONVERBAL COMMUNICATION

Accurate assessment about preferred language and degree of English proficiency is essential

LANGUAGE BARRIERS

Ensure instruments have been testedItems on instruments may not have the

same meaning to all groups

USING STANDARDIZED ASSESSMENT INSTRUMENTS

Use of cultural liaisons or cultural brokers can help social workers solve difficult interactions and communications

IMPLICATIONS OF ETHNOGERIATRIC ASSESSMENT FOR SOCIAL WORK IN HEALTH CARE

Screening- done with a large group of people to identify individuals who may have difficulties or problems in certain areas of functioning

Individuals who meet certain “risk” criteria

Social workers screen “high-risk” individuals or those who may require earlier intervention and intensive attention

ASSESSMENT VS.. SCREENING

Outpatient clinicsHospitalsEmergency roomsPublic health departmentsHome healthcare agenciesAgencies providing home and community-based

servicesResidential and rehabilitation facilities

SOCIAL WORK WITH OLDER ADULTS IN HEALTHCARE SETTINGS

Primary Care- initial entry of the patient into the healthcare system

Older adults are referred to social workers from physicians or nurse care managers

Social workers then perform psychosocial assessment, provide info/available resources to patient

Goal is to facilitate comprehensive patient care

PRIMARY HEALTHCARE SETTINGS

Demand for social workers in hospitals will grow more slowly than in other areas

Hospital social workers are responsible for screening and case finding, psychosocial assessment, discharge planning, postdischarge follow-up, outreach, counseling, documentation and record keeping, and collaboration

INPATIENT HOSPITAL SETTINGS

Help inform and educate individuals about their conditions, hold support groups, develop short-term action plans

INPATIENT HOSPITAL SETTINGS

Care Transitions- movement of patients from one healthcare practitioner or setting to another as their conditions and care needs change

Primary goal to improve communication between care providers

Secondary goal to establish follow-up care plan

CARE TRANSITIONS SETTINGS

Transition CoachFacilitates medication managementUse of a personal health recordKnowledge of “red flags”Primary care and specialist follow-up

CARE TRANSITIONS SETTINGS

Major sources of funding are Medicare and Medicaid, then out-of-pocket payments

A physician has to refer an older patient for home healthcare services to receive Medicare/Medicaid reimbursement

Social workers assess/facilitate the caregiver’s involvement in the patient’s recovery and rehabilitation

HOME HEALTHCARE SETTINGS

Greater use of nursing homes for short stays

71% of nursing home residents are female

All Medicare/Medicaid certified nursing homes require a comprehensive assessment of residents within 14 days of admission

NURSING HOME SETTINGS

Social workers can help patients transition and adjust to life in nursing homes

Family involvement during admission/discharge is extremely important

Social workers act as advocates for patients and empower families to voice concerns and negotiate treatment for care/needs of older adult

NURSING HOME SETTINGS

Principal idea of managed care is to control costs of healthcare

Case management may become a referral service that fails to adequately address the needs of older adults and their families

ISSUES AND CHALLENGES TO SOCIAL WORK WITH OLDER INDIVIDUALS IN THE CURRENT HEALTHCARE

ENVIRONMENT