Chapter 16 Handbook of Health Social Work, 2 nd 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 condition  Hypertension 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 challenges  Comorbidity  Stereotypes about aging  Overlap 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 caregivers  Support groups  Behavior management training  Counseling  Personal care services  Respite/alternative living arrangements COGNITIVE CAPACITY

 Individuals ability to perform certain basic ADLs  Basic 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  Subjective  Ask individuals to report on their satisfaction with their social situation and their perception that support is available when needed  Objective  Social 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 care  Housing arrangements  Routines of everyday life  Religious Practices  Privacy  Safety 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 gender  Direct eye contact  Ask 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 tested  Items 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 clinics  Hospitals  Emergency rooms  Public health departments  Home healthcare agencies  Agencies providing home and community-based services  Residential 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 Coach  Facilitates medication management  Use of a personal health record  Knowledge 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