Social Work and Transitions of Care: Observations from an Intervention for Older Adults

Making the transition from hospital to home can be challenging for many older adults. This article presents practice perspectives on these transitions, based on a social work intervention for older adults discharged from an acute care setting to home. An analysis of interviews with clinical social workers who managed 356 cases (n?=?3) and a review of their clinical notes (n?=?581) were used to identify salient themes relevant to care transitions. Concepts developed and discussed identify the role of surprises after discharge, an expanded view of the client system, and relationship building as instrumental in carrying out effective care transitions.     

How Effective are Helpers to Older Adults’ Life Satisfaction?

The effectiveness of help received from home care workers and volunteers to the life satisfaction of community-dwelling older adults is vital but uncharted. To address the effectiveness, this study aims to optimize the use of social resources for the older adults’ life quality. The study thus surveyed 398 community-dwelling older adults in a city of China about the help and life satisfaction. Results showed a significant positive effect of help from home care workers, but not that from volunteers, on the older adult’s life satisfaction. Moreover, the effect of help from volunteers was significantly greater when the older adult had higher education or lower family income. These effects are explicable with resource theory and need fulfillment theory. They imply the worth of promoting help from home care workers generally and volunteers conditionally to champion older adults’ life satisfaction.     

The FACES Project: an academic-community partnership to improve end-of-life care for families

This article reports on a research partnership between a community-based hospice and a graduate school of social work. The purpose of the collaboration was to design and test a tool for assessing caregiver strain and resources in families caring for older adults receiving hospice home care services. Eighteen hospice home care social workers interviewed 162 caregivers for the study and provided their own assessment of the tool's clinical utility. Both strengths and challenges of the collaboration are evaluated and implications are discussed for social work practice and research, particularly academic-community research partnerships.     

Exploring “Home” Through Residents’ Lenses: Assisted Living Facility Residents Identify Homelike Characteristics Using Photovoice

An increasing number of older adults are moving into assisted living facilities when living independently becomes difficult. These facilities afford older adults a home-like environment with opportunities for social activity and a minimal level of professional care, although relocation can negatively impact well-being. Because it is important to study home environments of aging adults, 10 residents of an assisted living facility were engaged in Photovoice to explore perceptions of the facility as home. Through photographic expression, residents identified environment enhancements for home at an assisted living facility. Findings of this study have implications for program planning at long-term care facilities.     

Social work knowledge of community-based services for older adults: an educational model for social work students

Social workers are often the key link between older adults, their families and community-based services. Thus, knowledge about older adults and community-based care is imperative for social work practice. Evaluation data are provided on a national multisite effort (N = 353) from 35 schools to assure graduate social work student's competency related to community services for older adults. Results suggest that the educational model as described in this article sets forth positive outcomes in the education of aging savvy social workers. Ongoing social work education is needed to meet the burgeoning needs of the geriatric population.     

Social Work Knowledge of Community-Based Services for Older Adults: An Educational Model for Social Work Students

Social workers are often the key link between older adults, their families and community-based services. Thus, knowledge about older adults and community-based care is imperative for social work practice. Evaluation data are provided on a national multisite effort (N = 353) from 35 schools to assure graduate social work student's competency related to community services for older adults. Results suggest that the educational model as described in this article sets forth positive outcomes in the education of aging savvy social workers. Ongoing social work education is needed to meet the burgeoning needs of the geriatric population.     

Pathways to Service for Older Persons

Abstract

As services for older persons continue to shift from hospital and nursing home care to greater reliance on support for care at home, the need to understand the ways older persons obtain services becomes more important. This study examines the use of home-delivered meals as a case study to gain insight into the process of service use from the recipients' point of view. It explores the research question: What are the pathways by which older persons acquire home delivered meals? Narrative analyses of structured and unstructured questions asked of thirty frail older persons suggested that the process of acquiring home delivered meals was accompanied by patterns of adjustment in shifting between independence and dependence in managing loss of physical function, and themes of isolation, loss, and abandonment. The results provide insights for social workers in providing the support needed for the role transition that service acceptance symbolizes for older adults.     

Religious congregations as social services providers for older adults

A large proportion of older adults are affiliated with congregations. The literature suggests that, in general, religious participation among the older adults enhances their quality of life and provides a network of social care. In this article, we explored the relevant literature on organized religion and social support for older adults. Based on a census study of congregations in Philadelphia (N = 1,393), we documented the following: (1) the number of congregations serving older adults, (2) the types of services provided, and (3) the number of beneficiaries. The study also identified the organizational factors that predict the provision of congregation-based services for older adults. The findings suggest that serving older adults is not a top priority for most congregations. Most senior programs are small and often informal. Approximately half (48%) of the congregations do not provide a formal social service. However, those congregations that are more likely to serve older adults have larger budgets, more members over 65-years-old, and a moderate political orientation. We recommend that congregations, social service providers, and older adults explore ways to maximize this underutilized resource of congregational services to meet the needs of the increasing number of older adults.     

Older Workers in Intergenerational Child Care

Thirty-four older workers in one of five intergenerational child care settings participated in a study exploring the effects of their participation in intergenerational child care programs. The purpose o the study was (1) to identify and describe a sample of older child care workers and (2) to identify characteristics of the older child care workers or the work experience which significantly impact on their lives. The older workers completed a written questionnaire, standardized life satisfaction scale, and interviews. The results suggest that participation in intergenerational child care programs supports the notion of generativity and enhances productive aging. Older workers reported increases in feeling needed, valued, and a sense of self-worth, and increased social contact. Over 90% of the older workers reported that their job expectations were met and that they felt the children had benefitted from their work. Positive changes in attitude about children's growth was positively related to the older workers' personal growth. Older workers also reported greater personal growth when they worked in excellent child care centers as compared to good or fair quality centers. Younger teachers reported positive changes in the classroom environment with the presence of older workers. These findings have implications for training older adults as child care workers and for social policy issues concerning older citizens' roles in our society.     

Depression and caregiver burden among rural elder caregivers

Family caregivers of older adults frequently experience feelings of burden and depression though they may not come to the attention to health and service providers until they are at a point of crisis. Through a simple screening tool, the Maine Primary Partners in Caring (MPPC) project identified individuals providing care to older adults through rural primary care practices, in order to provide upstream interventions before caregivers were in crisis. This paper describes a sample (n=62) of rural family caregivers identified through their physicians' offices. High levels of caregiver burden and depression were reported. Family support and knowledge of caregiver tasks predicted decreased caregiver burden and depression, while isolation predicted increased caregiver burden. Implications of these results for gerontological social workers are outlined.     

Facilitators and Barriers to Implementing Transitional Care Managers Within a Public Health Care System

Transitional care is crucial to ensure quality of care and safety for elderly patients. In the context of health care reforms promoting a shift from a hospital-centered approach to a home care approach, transitional care becomes a vital component and social workers can play an important role in easing transitions. Most recent studies have focused on the development or improvement of transitional care intervention models or tools, but few have addressed implementation issues. In this study, the implementation process of an innovative intervention aiming to integrate transitional care managers (TCMs) from Health and Social Services Centres (HSSC) within two Canadian hospitals was evaluated. Data collection comprised focus groups (n = 8), direct observations, meeting minutes, activity grids and logbooks. To facilitate the implementation of TCMs, decisions were made to clearly indicate their involvement in patients’ files and concentrated their efforts on a restricted number of units. Barriers included confusion about target clientele, inequitable information exchange between partners, limited powers regarding coordination of care, and organizational constraints limiting additional measures to improve transitional care. Evaluating implementation processes is crucial to efficiently identify obstacles and apply additional implementation strategies to promote the integration of new practices within the health care system.     

A community treatment intervention advancing active treatment in the elderly (ACTIVATE): a pilot study

A growing population of older adults receive treatment for depression but remain symptomatic. We report on a feasibility pilot study of an intervention (ACTIVATE) to improve depression care by encouraging the older person to take a step to intensify the existing treatment. Older adults (N = 43) receiving home-meal service and in depression treatment, but still symptomatic, participated in the ACTIVATE intervention. Assessments were conducted to evaluate change in treatment. Many (66.6%) participants took a step to change their treatment; the rate (88.2%) was higher among individuals with major depression. ACTIVATE may be a useful social work intervention to improve depression care.     

The effect of housing on perceptions of quality of life of older adults participating in a medicaid long-term care demonstration project

As the nation struggles with the great increase in the numbers of older adults, many questions arise about how to provide housing and long-term care options that will ensure the quality of life of older adults. This study demonstrates that older adults and their families perceive quality of life more positively once moved from a nursing home to an assisted living facility using Medicaid funds. Results of this exploratory study are promising and suggest that having housing options available across the continuum of care with individualized case management offers older adults the hope for "quality living".     

A Community Treatment Intervention AdVancing Active Treatment in the Elderly (ACTIVATE): A Pilot Study

A growing population of older adults receive treatment for depression but remain symptomatic. We report on a feasibility pilot study of an intervention (ACTIVATE) to improve depression care by encouraging the older person to take a step to intensify the existing treatment. Older adults (N = 43) receiving home-meal service and in depression treatment, but still symptomatic, participated in the ACTIVATE intervention. Assessments were conducted to evaluate change in treatment. Many (66.6%) participants took a step to change their treatment; the rate (88.2%) was higher among individuals with major depression. ACTIVATE may be a useful social work intervention to improve depression care.     

Predictors of Depression Among Caregivers of Older Adults With Severe Mental Illness

Caregivers of older persons with severe mental illness (SMI) contend with the double challenge of providing assistance related to both the psychiatric condition and older age of their family member. Study explored factors influencing negative psychological outcomes experienced by caregivers (n = 96) of older adults with SMI. One-quarter of caregivers scored at or above the clinical point for depression. Low income, care recipient gender, poor health, problems dealing with care recipient’s symptoms and the interaction of health and problems dealing with symptoms were associated with higher rates of depression. Implications for service provision and future research are discussed.     

Trauma and stress among older adults in the criminal justice system: a review of the literature with implications for social work

The purpose of this article was to review the empirical literature that investigated trauma and stress among older adults in the criminal justice system. Nineteen journal articles published between 1988 and 2010 were identified and extracted via research databases and included mixed age samples of adjudicated older and younger adults (n = 11) or older adult only samples (n = 8). Findings revealed past and current trauma and stress, consequences and/or correlates, and internal and external coping resources among aging offenders. The implications and future directions for gerontological social work, research, and policy with older adults in the criminal justice system are advanced.     

Integrating mental health parity for homebound older adults under the medicare home health care benefit

Despite high rates of mental illness, very few homebound older adults receive treatment. Comorbid mental illness exacerbates physical health conditions, reduces treatment adherence, and increases dependency and medical costs. Although effective treatments exist, many home health agencies lack capacity to effectively detect and treat mental illness. This article critically analyzes barriers within the Medicare home health benefit that impede access to mental health treatment. Policy, practice, and research recommendations are made to integrate mental health parity in home health care. In particular, creative use of medical social work can improve detection and treatment of mental illness for homebound older adults.     

New Directions for the Study of Incarcerated Older Adults: Using Social Capital Theory

As the population of older adults continues to rise, so, too, does the population of older adults in prison. The body of literature on older adults in corrections is scant, particularly with regard to health and social functioning. Past studies of aging inmates primarily focus on health care and related costs. The purpose of this article is twofold: (a) outline and synthesize the research on older adults living in prison; and (b) propose a framework for future research and intervention development based on social capital theory. Recommendations for social work practice, programs, and research are discussed.     

Integrating Mental Health Parity for Homebound Older Adults Under the Medicare Home Health Care Benefit

Despite high rates of mental illness, very few homebound older adults receive treatment. Comorbid mental illness exacerbates physical health conditions, reduces treatment adherence, and increases dependency and medical costs. Although effective treatments exist, many home health agencies lack capacity to effectively detect and treat mental illness. This article critically analyzes barriers within the Medicare home health benefit that impede access to mental health treatment. Policy, practice, and research recommendations are made to integrate mental health parity in home health care. In particular, creative use of medical social work can improve detection and treatment of mental illness for homebound older adults.     

The Productive Aging Concept and Social Work Students’ Perceptions Toward an Older Population

Social work curriculum that offers an optimistic perspective on aging has the potential to help social work students go on to practice in a nondiscriminatory way with older adults. This study introduces social work students to the productive aging concept, an optimistic view to social potential in later life, in lecture format and assesses postlecture changes in their perceptions of older adults. Seventy-two students (16 BSW; 56 MSW) were recruited from a large university in the southeast United States to participate in a lecture on productive aging. A one-group pretest–posttest design was used, and a paired samples t test (n = 72) was used to analyze changes in social work students’ perceptions toward older adults. Negative attitudes toward older adults decreased and positive attitudes toward older adults increased among students following their participation in the lecture on productive aging. This finding suggests the productive aging concept may favorably influence student perceptions of older adults. Future research should aim to investigate ways in which these changes in perception at the college level can translate and self-sustain in social work practice for social work students postgraduation.