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Careers in Gerontological Social Work
Adult Protective Services
Social workers in Adult Protective Services investigate referrals
of elder abuse. Allegations may include physical abuse, neglect,
mental abuse, and/or financial exploitation. If the investigation
confirms abuse the social worker makes arrangements to resolve the
situation. Arrangements might include finding the victim an immediate
safe place to live or establishing a guardian who will provide advocacy
and legal protection for the older adult. This service arena requires
the social worker to travel into the community and conduct in-home
visits. Adult Protective Services is typically a state agency, divided
into counties or regions, and the social worker conducts investigations
within a specified geographic area.
Hospitals and Medical Centers
Social workers in hospital and medical settings are frequently
involved in discharge planning for older adults. Often, older adults
are admitted to the hospital following a medical crisis, such as
a stroke or a broken hip. Older adults may be discharged from the
hospital before complete recovery has taken place and may need continuing
care. Social workers arrange appropriate follow up care depending
on the patient's needs. Follow up care might be home health care
services or short term nursing home placement. Social workers may
also serve as educators to both the patient and family about the
health care system, the patient's existing condition, and the possible
implications of that condition. Social workers often consult with
other professionals in the hospital setting to fully understand
patients needs and to apprise coworkers of patient/family psychosocial
needs in relation to medical treatment. Additionally, medical social
workers may be involved in researching patient insurance options.
In the Emergency Room, social workers may come into contact with
elders in crisis. Crisis intervention often must address issues
of substance abuse, elder abuse, suicidal ideation or psychiatric
emergencies. Often, elder patients in the ER are those who are living
alone and have been unable to adequately care for themselves.
Outpatient Primary Care Settings
In outpatient primary care settings, social workers assess and
address psychosocial factors that complicate older adults' medical
conditions. Referrals are usually made by a primary care physician
in response to barriers in providing medical care. Such barriers
might be depression, family dynamics, failure to adhere to treatment
recommendations, or insurance problems. Social work interventions
may include patient and/or family counseling, arrangement of in
home care, assisting with Medicaid applications or making a mental
health referral. For older adults residing in nursing homes, the
clinic social worker may help plan coordination of care and consult
with nursing home social workers on client needs and appropriate
interventions. Outpatient settings are typically linked with a specific
hospital or insurance plan and may not available to all older adults.
Public Social Service Agencies
Public social service agencies typically serve older adults who
are eligible for Medicaid-related services. In Washington State
this agency is the Department of Social and Health Services (DSHS)
through the Division of Home and Community Services. The social
worker conducts in-home assessments to determine both the client's
needs and his/her qualifications for service. Qualification is typically
based on both financial need and level of care need. Atypical in
most social work settings, DSHS/HCS social workers assess physical
status by determining the client's ability to perform activities
of daily living, such as walking, eating, and toileting. The social
worker arranges necessary services as determined by the assessment.
Services might include helping to arrange in-home care, adult day
health, adult family home care, or assisted living care through
COPES, securing food stamps, transportation vouchers, emergency
alert systems, and/or chore services, or facilitating nursing home
placement. After conducting the initial assessment and putting initial
services in place, the worker provides case management services.
Cases are reviewed regularly to assure client needs are still being
met. DSHS/HCS social workers might be assigned to work with clients
in a nursing home settings as well as the community. She/He would
work with the facility social worker in arranging discharge services
for short term placements. These social workers typically spend
most of their workweek out of the office, have specific office hours,
and attend regular team meetings.
Veterans' Services
Social work with older adults through veterans' services resembles
work in general medical settings, except care options are specifically
geared toward issues of the veteran population. A common service
setting for social workers is the transitional care unit (TCU) which
serves as a nursing home within the veterans' hospital. Social workers
spend time counseling and educating veterans and families around
understanding and fully utilizing available services. Workers also
coordinate transportation to various medical centers as necessary,
and are responsible for finding temporary housing on behalf of patients
who must be away from home in order to receive treatment.
Mental Health Centers
Social workers in the mental health profession provide treatment
for older adults who may be suffering from depression, anxiety,
schizophrenia or other mental health problems. Some mental health
facilities have outreach services that provide in home services
within the greater community. Treatment may be provided in office
or home settings depending on clients' independence and mobility
needs. Social workers may also encounter older adults within the
context of inpatient psychiatric care, assisted living facilities
or nursing homes.
Child Welfare Agencies
Social workers in child welfare agencies may utilize older adults
as child placement options. Before placing a child who has been
removed from the home into the foster care system, social workers
advocate for placement with a relative. Often, grandparents serve
as primary caretakers who can eventually be granted full custody
of a grandchild. Social workers are responsible for monitoring the
logistics of this process, and for assessing the development of
the relationship between child and grandparent.
Private Geriatric Case Management
Case management firms have emerged in response to the needs of
both older adults and their families. The home and work responsibilities
of midlife often limit families' ability to meet all the care needs
of older loved ones. According to Gibelman (1995), social workers
in case management firms offer family and individual counseling;
housing and nursing home placement assistance; social, financial
and functional assessment; service referrals and monitoring; client
evaluation; and assistance with paperwork associated with obtaining
social services. (p. 217) These firms are typically independent
and self-managed, operating on a for-profit basis with a few staff
members. They charge by the hour, but may operate on a sliding-fee
scale or utilize rate-setting methods.
Adult Day Care Centers
Adult day care is a community-based service designed to provide
health and social support for functionally impaired adults during
a specified portion of the day (less than 24 hours). Examples of
social work roles in this environment include the development and
maintenance of a therapeutic environment, completion of functional
assessments, development of care plans, and facilitation of family
support groups. Directors of adult day care programs are responsible
for insuring continued program funding and the provision organizational
leadership.
Area Agencies on Aging
Social workers at the Area Agencies on Aging function at the macro
level of practice. Title III of the Older Americans Act allocates
federal funds to states and territories based on the size of their
population aged 60 and older. States then make grants to local Area
Agencies on Aging to administer a range of services for older people.
Area Agencies on Aging usually contract with providers for services
rather than providing services directly. Roles of a social worker
at an AAA include administration, planning, reviewing, and grantsmanship.
Additionally, social workers must be skilled in program development,
consultation, coordination, and client advocacy.
Alcohol and Substance Abuse Services
Substance abuse issues impact all populations. One recent government-sponsored
health survey found that 1 to 5 percent of elderly people who drank
more than occasionally reported psychological and/or physical dependence
on alcohol. Social workers in chemical dependency settings must
possess skills in assessment, diagnosis, counseling, planning, organizing,
program development, program administration, advocacy, and policy
development in order to meet the needs of the older adult in this
area. Additionally, social workers must avoid intervention based
on stereotypes such as older adults lack the mental capacity to
participate in treatment planning or older adults are fully dependent
on service providers or family. The worker needs instead to act
from a strength-based perspective, respecting individuality.
Family Service Organizations
Family Service Organizations focus on improving the overall environment
and welfare of the family unit. Within these practice settings,
social workers must often assess the roles and needs of older family
members. The worker must gain an understanding of how the older
adult fits into the family dynamics and how the older adult influences
the family's needs and choices. Resource coordination and advocacy
are especially valuable to effectively serving these families.
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