Welcome to the 2003-2004 Social Work Interns' Information Page on addressing age-related issues

There are many reasons why people are faced with the major decision of entering a nursing home. Very few people, if any, enter a nursing home because they want to. Usually there is a factor beyond their control which forces this decision on them and/or their families. The negative feelings and thoughts that arise from the need to enter a nursing home are not necessarily because of the nursing home, but because of the possessions and freedoms that must be given up in order to enter. Also significant is the fact that there are very few people, if any, who are ever able to go back home after entering a nursing home facility. They have just sort of reached a point of no return, and this is hard for anyone to accept.

One of the major reasons for entering a nursing home is that the person’s health is poor, requiring nursing care that is not available to them at home. Due to unpredictable changes in insurance and hospital policies, many elderly people are forced to leave the hospital after a very short stay but are still in need of care, leading them into a nursing home situation. Home nursing care is not available in every area of the country, and sometimes, even if it is available, people cannot afford it and/or their insurance does not cover it. These situations leave the person with no other choices.

Tips

When a person moves into residential care, the role of the family/friends does not usually come to an end. Many choose to stay involved with the person.

Visiting

Visiting is the main way the family can stay connected with their loved one, even though they may no longer provided the day to day care giving Visiting can be sometimes difficult.

Things to bring

Newspapers and magazines to look at together.

Play games that they enjoyed in the past.

Help decorate and tidy the person's room.

Help with personal grooming.

Bring pets if it is allowed.

Bring others to visit.

Leaving

Leaving may be difficult, let resident know at the beginning of the visit how long the visit will be and reinforcing when the next visit will be.

Time the departure to coincide with an activity or meal.

Keep farewells brief and leave right away. Lingering or staying a little longer can make future farewells harder.

What if the resident wants to go home.

Reassure with touching and holding.

Reassure the person that they will be safe.

Don't disagree with the person waiting to go home.

Try to redirect them with food or other activates such as a walk.

Works Cited: Alzheimer's Association Website

What are the roles of social workers in nursing homes?

THE SOCIAL WORK ROLE AND OPPORTUNITY by: Anita Rosen, MSW, PhD, and John O’Neill March 1998

With physicians, admissions representatives, and many other health care workers lacking the training, time, or desire to promote advanced directives, social workers, who have the education and training, should become central to this process. Where physicians are taught to look at people from the standpoint of medical problems to be solved, social workers are educated to look at the entire person—biopsychosocial and spiritual. Social workers are accustomed to working with people whose cultural and ethnic backgrounds might make them hesitant to write advanced directives. Also of importance is that social workers have the tools and training to deal with people who have difficulty expressing their emotions, and with families in distress.

Social workers with health care experience understand both the medical terminology and how to explain it to clients. In one study patients in a geriatric outpatient clinic were offered information and counseling over several months by an interdisciplinary team of a social worker, physician, and other professionals. This allowed sufficient time for understanding of the forms and for trust to develop. As a result, 71 percent signed advanced directives (Luptak & Boult, 1994). Others have developed questionnaires about people’s deeply held beliefs and values that are then discussed and used as a basis for writing advanced directives (Doukas & McCullough, 1991; Gibson, 1990). Processes like these suggest there should be a large role for social workers in the steps that lead people, especially elderly and seriously ill individuals, to make end-of-life choices in advance. Anticipating all medical contingencies is a daunting, perhaps impossible, task. For that reason, some ethicists focus on the importance of discussing values rather than specific instructions (GAO, 1995).

Social workers in all areas of practice can be proactive with their adult clients and the general population to promote the concept of advance directives. If they do, assistance with advance directives can become strongly associated with social work practice. The social work role as part of health care teams in hospitals, nursing homes, and primary care should extend to educating both health care professionals and patients about advanced directives. Social work skills in family dynamics should be used to provide information and broach the issue of advanced directives and DPAHCs with people of all ages in a variety of settings, including family practice and work in mental health, developmental disabilities,adult protective services, HIV/AIDS, employee assistance programs, substance abuse,rehabilitation, as well as geriatric case management.

Social workers understand that advanced directives are a psychosocial decision, a right of self-determination as much as a medical choice. Some attorneys who work in estate planning contract with social workers to assist clients in making these choices. Social workers who are in geriatric practice and health care or are consultants need to reach out to the legal and financial communities to offer needed services in these areas. In addition, there are numerous opportunities for social workers to reach out to the public and to enhance the social work role in promoting advanced directives. Among them are the following:

one-to-one with adult clients—for themselves and their adult parents at senior center informational or support programs with adult day care center staff and clients and their families at assisted living facilities, retirement communities, and group home services with consumer groups and social organizations at work sites or through employee assistance programs (EAPs) by consulting with various health care provider organizations and managed care companies.

REFERENCES

Doukas, D., & McCullough, L. (1991). The values history: The evaluation of the patient’s values and advance directives. Journal of Family Practice, 32, 145–153.

Emanuel, L. L., Barry, M. J., & Stoeckle, J. D. (1991). Advance directives for medical care—A case for greater use. New England Journal of Medicine, 324, 889–895.

Evans, S., & Clarke, P. (1992). Rethinking how we communicate about advance directives: Hidden errors in our assumptions about planning for care. Paper presented at Annenberg Washington Program and the American Association of Critical Care Nurses.

Gibson, J. M. (1990). National Values History Project. Generations, 14(Suppl.),52–64.

Hofmann, J. C., Wenger, N. S., Davis, R. B., Teno, J., Connors, A. F., Jr., Desbiens, N., Lynn, J., & Phillips, R. S. (1997). Patient preferences for communication with physicians about end-of-life decisions. Annals of Internal Medicine, 127, 1–12.

Luptak, M., & Boult, C. (1994). A method of increasing elders’ use of advance directives. Gerontologist, 34, 409–412.

Safford, F., & Krell, G. I. (Eds.). (1997). Gerontology for health professionals: A practice guide (2nd ed.). Washington, DC: NASW Press.

Suhl, J., Simons, P., & Reedy, T. (1994). Myth of substituted judgment: Surrogate decision making regarding life support is unreliable. Archives of Internal Medicine, 154, 90–96.

U.S. General Accounting Office. (1995). Patient Self-Determination Act: Providers offer information on advance directives but effectiveness uncertain. Washington, DC: U.S. Government Printing Office.

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Terry and Marsheika UNCG 2003-2004 Social Work Interns