Transcript Social Work With Older Adults In Healthcare Settings

SOCIAL WORK WITH
OLDER ADULTS IN
HEALTHCARE
SETTINGS
Chapter 16
Handbook of
Health Social
Work, 2 nd
Edition
CHARACTERISTICS OF THE AGING
POPULATION- DEMOGRAPHICS
 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- HEALTH AND HEALTH CARE
 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
IMPLICATION OF DEMOGRAPHIC CHANGES
FOR SOCIAL WORK IN 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
COMPREHENSIVE GERIATRIC
ASSESSMENT
 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
GERIATRIC RESOURCES FOR
ASSESSMENT AND CARE OF ELDERS
 Initial at home assessment
 Meetings with interdisciplinar y team
 Plan developed
 Plan implementation by team
 Follow up visit in home
 Ongoing care/case management
 Periodic reviews/reassessment
RESULTS
 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”
PHYSIOLOGICAL WELL-BEING AND
HEALTH
 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)
PSYCHOLOGICAL WELL-BEING AND
MENTAL 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
FACTS ABOUT SUICIDE AMONG
OLDER ADULTS
 85% by males
 More likely to have lived alone, be widowed, and
have had a physical illness
 Firearms used 73% of time
COGNITIVE CAPACITY

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
FUNCTIONAL ABILITY
 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.
SOCIAL FUNCTIONING
 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
PHYSICAL ENVIRONMENT
 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
ASSESSMENT OF FAMILY AND
INFORMAL SUPPORT
 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
ECONOMIC RESOURCES
 Assessment of economic resources
VALUES AND PREFERENCES
 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
SPIRITUAL ASSESSMENT
 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
ETHNOGERIATRIC 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
CULTURAL CONTEXT OF HEALTH AND
ILLNESS
 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
HISTORICAL CONTEXT AND COHORT
EXPERIENCE
Acculturation- the degree to which individuals
are influenced by and actively engage in the
traditions, norms, and practices of one or
more cultures
ROLE OF FAMILY IN CULTURAL
CONTEXT
 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
CULTURALLY APPROPRIATE
NONVERBAL COMMUNICATION
 Physical proximity
 Greeting and examination by opposite gender
 Direct eye contact
 Ask clients for guidance and about their preferences
LANGUAGE BARRIERS
Accurate assessment about preferred
language and degree of English proficiency is
essential
USING STANDARDIZED ASSESSMENT
INSTRUMENTS
Ensure instruments have been tested
Items on instruments may not have the same
meaning to all groups
IMPLICATIONS OF ETHNOGERIATRIC ASSESSMENT
FOR SOCIAL WORK IN HEALTH CARE
Use of cultural liaisons or cultural brokers
can help social workers solve difficult
interactions and communications
ASSESSMENT VS.. SCREENING
 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
SOCIAL WORK WITH OLDER ADULTS
IN HEALTHCARE SETTINGS
 Outpatient clinics
 Hospitals
 Emergency rooms
 Public health departments
 Home healthcare agencies
 Agencies providing home and community -based
services
 Residential and rehabilitation facilities
PRIMARY 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
INPATIENT HOSPITAL 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
CARE TRANSITIONS 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
HOME HEALTHCARE 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
NURSING HOME 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
ISSUES AND CHALLENGES TO SOCIAL WORK WITH
OLDER INDIVIDUALS IN THE CURRENT HEALTHCARE
ENVIRONMENT
 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