Gerontological Social Work in Home Health Care

Rose Dobrof

• Publisher: Routledge
• Year: 2014
• eBook ISBN: 9781317735281
• Topic: Médecine
• Subtopic: Théorie, pratique et référence de la médecine

A variety of programs are described in this volume illuminating innovative approaches to service delivery.

Agency-Family Partnerships: Case Management of Services for the Elderly

Marsha Mailick Seltzer, PhD Kathryn Simmons, MSW Joann Ivry, MSW Leon Litchfield, MSW

Marsha Mailick Seltzer and Leon Litchfield are affiliated with Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215. Kathryn Simmons and Joann Ivry are affiliated with Jewish Family and Children’s Services, Boston, Massachusetts.

ABSTRACT. This paper describes a research and demonstration project in which partnerships are formed between agency social workers and family members of elderly clients. While the social worker retains responsibility for counseling and provision of support to the elderly client, the family member is taught by the social worker to assume responsibility for the case management of services provided to his/her elderly relative.

Practice issues which have emerged during the first year of this three-year project include: the generalizability of findings in light of the special characteristics of agency clients, the definition of the agency-family partnership, confidentiality in the context of this partnership, exceptions to family involvement, clients without families, and our experiences with research-practice collaboration. Each of these issues is discussed in this paper.

Currently, social agencies which serve the elderly are faced with the prospect of substantially increased client needs, as the number and proportion of elderly persons in our population rises. As people live longer, their need for basic support— economic, emotional, and functional— increases. At the same time, social service agencies must cope with constant or shrinking resources. This paper presents one strategy for improving social services for elderly clients, namely the involvement of family members of elderly clients of a social services agency as partners with the social worker in the case management of services to the elderly individual. The purpose of this paper is to report on a number of social work practice issues that have emerged in the course of our experiences with family involvement.

Literature Review

There is increasing concensus in the gerontological and social work literatures that it is desirable to support and involve the family of elderly clients. Hartman (1981) recently proposed that the family should be recognized as the primary social service institution, and Silverman and Brahce (1979) asserted that “the family is now considered to be the most important agency supporting the elderly” (p. 79). Monk (1981) went even further by stating that: “it is the function of social workers to…mobilize kin networks so that they take responsibility for those in the family” (p. 63).

There is widespread agreement among gerontologists that the family is often the basis of security for adults in later life (e.g., Lowy, 1977; Shanas, 1961; Callahan, Diamond, Giele & Morris, Note 1). As pointed out by Collins and Pancoast (1976), “were it not for the informal services of helping networks, social agencies…would be swamped. Besides carrying the bulk of the service load in many sectors…helping networks also carry out a widespread preventive program. They offer accessible, individualized services formal agencies could never match” (p. 25). Despite the decline of the three generational family in the U.S., meaningful family linkages can and do occur extensively. The family serves as a voluntary yet primary deliverer of material and affective support to the elderly (Sussman, 1965, 1976). As well, a number of studies have found a similar involvement of family with the disabled and/or chronically ill elderly, a particularly difficult segment of the elderly population (Brody, Poulschock, & Masciocchi, 1978; Shanas, Townsend, Wedderbum, Friis, Milhoj, & Stehouwer, 1968; Shanas & Maddox, 1976).

Less has been written about the role of friends and neighbors as sources of informal support. The limited data that are available suggest that the involvement of non-relatives in the informal support system is considerable, and that this often is a reciprocal arrangement (Atchley, 1980; Cantor, 1979; Lopata, 1975; Lowenthal & Robinson, 1976; Rosow, 1967; Sherman, 1975, Gore, Note 2; Morris, Sherwood, Kasten, & Miranda, Note 3).

When elderly persons need agency-based services, the role of the family in providing support to the elderly relative is not clear. As Shanas and Sussman (1977) have noted, there are no precise guidelines regarding who is in charge of coordinating the case of an elderly client— the elderly person him or herself, the family, or the formal service worker. Smyer (1980) noted “…there are certain functions which families perform better and certain tasks which are more appropriately the responsibility of society. At the current time, however, there is little information about the best collaboration between these two” (p. 254). The purpose of the research and demonstration project described in this paper is to determine whether family members (or non-family helpers) can be involved as partners with the social service agency, and if so, whether this involvement has a favorable effect on the elderly client and on the family. Specifically, the project entails training family members to function as case managers for their elderly relatives.

Case management has emerged in recent years as an attractive concept with which to respond to a fragmented and complicated service delivery system (Austin, 1983; Brody, 1979; Intagliata, 1982; Monk, 1981; Wylie & Austin, 1978, Beatrice, Note 4). Case management is a service coordination mechanism designed to provide multiple services to clients with complex needs. Among the activities included in the case management function are: screening, assessment, case planning, service arrangement, service provision, service monitoring, linkage, and reassessment. The essence of the case management approach is to establish responsibility for services within a single locus of control. Service control is retained by the case manager who acts as consultant and facilitator, integrates and individualizes services, and establishes a personal relationship with the client.

While case management is a legitimate professional social work function, it is also performed by para-professionals and, as Sussman (1977) has written, by family members as well. Additionally, as Monk (1981) noted, given the dramatic increase in life expectancy, it is unrealistic to expect that there will be enough social workers available to coordinate services for an expanded aged population.

Furthermore, and perhaps most important, it is debatable whether the professionalization of services such as case management is necessary or even advisable. Cantor, Rehr, and Trotz (1981) argue that “there is no question…that case management is and should continue to be a basic responsibility of the informal support system— a family member in particular” (p. 568).

In the design of agency and family roles in the delivery of services to the elderly, it may be most appropriate for social workers to channel some of their expertise into strengthening the family’s helping and case management capacities and serving as a trainer and consultant to the family. The project that is described in the discussion which follows is an attempt to operationalize Cantor et al’s (1981) above argument along these lines.

Family-Centered Community Care for the Elderly

The Jewish Family and Children’s Services (JFCS) of Boston and the Boston University School of Social Work have collaborated on the development and implementation of the Family-Centered Community Care for the Elderly Project. The goal of this intervention is to utilize, strengthen, and enhance family capacities so that ultimately the agency’s role in case management can be reduced. Specifically, since January 1, 1982, new elderly clients of JFCS have been randomly assigned to two groups: innovative family involvement (the experimental group) and traditional family involvement (the control group). When an elderly client is assigned to the experimental group, an attempt is made to involve the client’s family (or a non-family helper) as a partner with the social worker, specifically in the role of case manager. In the control group, no such special effort is made to involve the family in the process of planning and monitoring the services provided by the social worker. Instead, the traditional approach to service delivery is employed. As part of the traditional approach, the family may or may not be involved, depending upon the interest and judgment of the social worker, the client, and the family member.

It should be noted that the partnership that is proposed here is distinct from traditional forms of family involvement. Casework with elderly clients and families has always aimed to involve families. Partnership, however, involves the integration of the formal and informal support systems in sharing responsibility for the coordination of services to the elderly person. While the professional literature is full of exhortation to professionals and agencies to foster strong links with families and to strengthen the interface of the formal and informal support networks, very few articles present concrete practice guidelines for developing partnerships in which responsibility is shared between agency personnel and family members.

Family-Centered Community Care for the Elderly defines partnership as the mutual sharing of responsibility between the agency and the family in planning for the case management of services to the elderly. Many family members in fact are already providing case management services for their relatives and many more could be assisted to do so. In this demonstration project, social workers in the experimental group introduce a series of interventions designed to maximize the family’s ability to assume responsibility for formal service planning and monitoring. Such interventions are not used with the control group. This experimental intervention includes four components:

1. the expectation that the family will assume some case management responsibility.
2. collaboration between the family member and the social worker as true partners on the development of the client’s service plan.
3. the provision to the family of informational manuals which include information about entitlements, strategies for locating and utilizing resources, and descriptions of federal, state and private programs for the elderly. Five informational manuals have been developed for this project on the following topics:
   • In-Home Services and Nutrition
   • Housing, Day Care Centers, Respite Care, and Nursing Homes
   • Transportation and Social Opportunities
   • Financial Entitlement and Legal Protective Services
   • Advocacy
4. regular meetings and/or telephone contacts between the family member and the social worker to discuss the case management needs of the elderly person, to assign tasks, to monitor the completion of case management tasks, to monitor the provision of services, and to identify additional problems that warrant attention. These contacts occur at least bi-weekly.

Both experimental and control group clients and their families are systematically assessed periodically during the course of service. Specifically, the elderly clients are assessed at intake with respect to their background characteristics, health status, functional abilities, cognitive and emotional status, formal services received, and extent of informal support. In addition, interviews are conducted with family members.¹ Following the completion of service, both experimental and control group clients are re-assessed in order to determine the extent to which they have changed in functioning and in status since the intake assessment. In addition, an assessment is conducted of the extent of family involvement in providing support to the elderly client and in assuming case management responsibilities.

The purpose of the control group in this study is to provide an indication of how the members of the experimental group (and their families) would have functioned had they not received the intervention. Simply observing change over time in experimental group clients and their families is not a sufficiently rigorous research design for our purposes. One reason that a control group is necessary in gerontological research is that there are times when deterioration is observed in an elderly person’s functioning as part of the natural course of events. Without a control group with which to compare the experimental group, any deterioration in the experimental group could be mistakenly interpreted to indicate negative effects of the intervention.

The control group is also important when examining the effect of the intervention on the families. Most families perform some case management task for their elderly relatives, without the benefit of any special agency involvement. The question examined in this demonstration effort is whether the experimental intervention can raise the level of family involvement beyond where it would have been in the absence of this intervention. The control group provides the estimate of the extent to which experimental families would have performed case management responsibilities had they not been trained.

Thus, the impact of the Family-Centered Community Care for the Elderly project will be observable in the difference between experimental and control group clients in their level of functioning at case closing and in the extent and type of involvement on the part of their family members throughout the intervention. Specifically, by comparing the experimental with the control groups, it will be possible to determine whether the innovative family involvement makes a difference with respect to the following eight outcomes:

1. the extent to which the families of elderly clients actually are involved in the planning and monitoring of services delivered to their elderly relatives (i.e., the extent to which they assume case management functions);
2. the strength of the informal support network of the elderly clients;
3. the number and types of services planned for and delivered to the clients;
4. the rate of institutionalization and other measures of residential stability (e.g., number of moves)
5. the functional abilities of the elderly clients;
6. the extent to which elderly clients feel that they can rely on their r...

Table of contents

• Cover
• Title
• Copyright
• CONTENTS
• FROM THE EDITOR
• Sustaining Frail Disabled Elderly in the Community: An Innovative Approach to In-Home Services
• The Continuum of Care Within Psychogeriatric Day Programming: A Study of Program Evolution
• A Comparison of the Effectiveness of Various Approaches to Visiting Isolated Community Elderly
• Church-Based Programs for Black Care-Givers of Non-Institutionalized Elders
• Agency-Family Partnerships: Case Management of Services for the Elderly
• From Hospital to Home Health Care: Who Goes There? A Descriptive Study of Elderly Users of Home Health Care Services Post Hospitalization
• A New Look at Home Care and the Hospital Social Worker
• Foster Family Care for Frail Elderly: A Cost-Effective Quality Care Alternative