Social Work Practice With Older Adults

An Actively Aging Framework for Practice

Jill M. Chonody, Barbra A. Teater

• Publisher: SAGE Publications, Inc
• Year: 2017
• ISBN:
  9781506334318
• Edition: 1
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

Social Work Practice With Older Adults by Jill Chonody and Barbra Teater presents a contemporary framework based on the World Health Organization's active aging policy that allows forward-thinking students to focus on client strengths and resources when working with the elderly. The Actively Aging framework takes into account health, social, behavioral, economic, and personal factors as they relate to aging, but also explores environmental issues, which supports the new educational standards put forth by the Council on Social Work Education. Covering micro, mezzo, and macro practice domains, the text examines all aspects of working with aging populations, from assessment through termination.

Chapter 1 Introduction to Aging

Learning Objectives

By the end of this chapter, you should be able to do the following:

• Define “old age” and critique the validity of this definition.
• Describe the demographic changes and social trends in the aging population.
• Identify different age cohorts and explain how birth cohorts can impact social work practice.

Introduction

The United States, as well as many other countries around the world, is experiencing an aging of the population. Trends indicate that global population growth is expected to continue to slow, and the number of older people will increase (Pew, 2014a). Overall life expectancy is longer, but birth rates are declining, creating a “greying” of the population (Pew, 2014a). The increase in both life expectancy as well as the greater number of older people has implications for economic and financial services, health and social services, and aging individuals and their families (Ortman, Velkoff, & Hogan, 2014).

Additional health and social services will be needed, and this, in turn, will require more social work practitioners (and other healthcare professionals) who are trained to work with older adults. In fact, this is the fastest growing practice area in social work, but the number of gerontological social workers is still insufficient to meet the rising demand (Hooyman, 2014). One possible explanation for this is that social work students tend to indicate less interest in working with older people, often believing that the work will be unchallenging or that older people cannot benefit from clinical interventions (Chonody & Wang, 2014a; Chonody, Webb, Ranzijn, & Bryan, 2014). However, research indicates that older adults do benefit from therapeutic interventions (e.g., Stanley et al., 2009), and practitioners in the field report that their work is rewarding (e.g., Webb, Chonody, Ranzijn, Owen, & Bryan, 2015).

One way in which to meet the growing demand for gerontological social workers is to educate and train students and practitioners on the aging population, including the characteristics, trends, and changing needs as individuals age. While the skills necessary for engagement with older people are not necessarily different than those used with clients from other age groups, a background and understanding of the aging process and the issues that impact older people are essential to gerontological practice. Such information allows social workers to practice more effectively whether working directly or indirectly with older adults. This growing field can offer many new challenges and opportunities for social workers, including direct practice, community work, and policy advocacy, which are explored throughout this book. In Text Box 1.1, learn more about working with older adults at senior centers.

Text Box 1.1: Occupational Profile: Working in a Senior Center

Lesa Sulimay, MSW, LSW, works for the Philadelphia Corporation for Aging as a supervisor for two senior centers in the area. Ms. Sulimay has been working in administration and management for the past 30 years and currently supervises 14 staff members at the two centers. While Ms. Sulimay started her career working with children, she later provided case management services for older adults, and after she completed her bachelor’s degree, she lived in a retirement home in Amsterdam and worked as a housekeeper (see Chapter 12 for more information on this type of program). After having a positive experience with her own social work supervisor, Ms. Sulimay decided to try out a management position. “When I started, I didn’t know what I was doing, but I had my social work skills and experiences,” said Ms. Sulimay. “So I asked the staff to teach me about the agency, and in turn, they could trust that I would support them in their work.” Ms. Sulimay indicates that being open, knowing that you do not know everything, and bringing your confidence to the table are essential for growing into a successful managerial position.

Ms. Sulimay continues to bring this positive attitude toward her work and delineates the following key skills for administration: coaching, connecting, collaborating, training, and holding people accountable for their work—not to be punitive, but to provide an opportunity for growth and change. “If you’ve learned something from the experience—even if you’ve failed—then it can be counted a success,” she states. A few others skills that are essential to her work are good communication (listening and keeping people in the know), strong problem-solving, critical thinking, a good understanding of human relationships, respect for diversity, team building, setting a positive tone, and a great sense of humor.

Ms. Sulimay’s primary tasks include supervision, team building, project management, grant writing, planning within the agency, and performance management. Working with her team, providing training, and thinking through new activities or services for the agency are a few of the positive aspects of her role. She also enjoys helping people grow and see their strengths and skills, and while performance management can be a challenge, Ms. Sulimay sees this activity as an opportunity. “This is a conversation that we can have about change,” she says. “Even if that change is realizing this isn’t the right job for you.” Another key challenge for administrators is funding. Resources are often quite scant, and changes in state and federal policy impact service delivery. Working with the community and organizations along with grants can help garner additional resources, but “it’s never enough.”

While Ms. Sulmay’s role is primarily administrative, she indicates that all of your social work skills will be utilized at a senior center. “We’re a community, and we have a passion to connect older adults to the best programs, services and supports (or resources) that we can,” she says. Sometimes this requires difficult conversations with older adults who have “aged out” of their services. She continues, “To visit the Senior Center, an older person has to be independent—we are kind of like the YMCA for adults over 55—and we are not staffed to take care of those who may require additional supervision and assistance.” Training the social work staff on how to have uncomfortable conversations such as this one is one of the many trainings and coaching activities that she does in her work. “I remind my staff that we must always balance self-determination with safety,” she states. In sum, senior centers offer a number of different roles that social workers may engage, and directing a senior services agency is one way to utilize your training and skills.

As a social work student, practitioner, or educator, we aim to provide you with the information and tools needed to work with older adults. In particular, we take a positive, realistic, strengths-based approach to working with older adults that is underpinned by the Actively Aging framework, which is a new framework presented in this book (Chapter 3). We also see aging as a normal process that each individual, regardless of age, is experiencing on a daily basis and is something to embrace versus something to fear and avoid. We do not see older adults as a homogenous group but rather as individuals that should be viewed as having individually based experiences and meanings of their world around them. Despite the individuality of older adults, we do acknowledge that there are some common characteristics and experiences that many older adults may share, and that is explored throughout this book.

We begin your journey in this chapter by discussing the demographic and social changes that are occurring as the population ages, including a consideration of cohort effects and their impact on practice. In Chapter 2, we examine ageism, which we see as the antithesis to Actively Aging. The impact of ageism on older adults as well as everyone, the theories that help explain ageism, and ways to combat it are detailed. In Chapter 3, we present the Actively Aging framework to underpin social work practice with older adults. This framework illustrates how aging actively is influenced by six determinants: health, behavioral, personal, physical, social, and economic. The next six chapters (Chapters 4–9) delve into each of the six determinants individually by focusing on the prevalence, knowledge, and research around each determinant and ways in which to work with older adults when considering each of the determinants. Each chapter will consider social work practice and policy issues along the micro–macro continuum. Although the determinants are presented in separate chapters, practicing from an Actively Aging framework involves considering all of the determinants together through a holistic assessment. In Chapter 10, we consider ethical issues relevant to social work practice with older adults, such as dignity in care and euthanasia. Case studies, presented in Chapter 11, provide an opportunity to apply the Actively Aging framework in social work practice through the use of a detailed assessment instrument that can guide practice. Finally, Chapter 12 concludes the book with an exploration of contemporary, creative, and future-oriented approaches that support social work practice from an Actively Aging framework. Before we discuss the demographic and social changes that are occurring in our “aging” population, we first address what is meant by “old age.”

What is “Old” Age?

What is meant by “old”? According to the Merriam-Webster (2015) dictionary, “old” is an adjective and is defined as “having lived for many years: not young.” But, when does someone reach “old age”? How many years does someone have to live to be defined as old? The most basic answer is when someone describes her/himself as “old” or when someone is defined as old by external sources, such as the government or agencies who provide services based on a person’s chronological age. In this sense, old age is individually and socially constructed. That is, there is no magical chronological age that tips someone over from “young” to “old,” but rather individuals often choose when to define themselves as old and attach their personal meaning to this definition, or are told they are old by society and therefore choose the extent to which they take on that label.

In regard to the definition as provided by external sources, the marker for “old age” is when one has reached the final stages of the normal life span. Governments and external organizations, such as the World Health Organization (WHO) and the United Nations (UN), establish a chronological age at which they define someone as an “older” adult , which is often based on the life expectancy of the population within that geographical area. For example, WHO and the UN use the age of 60 to define someone as an older adult. This may seem quite young to you, and we imagine if you were to tell a 60-year-old woman that she is “old,” she may adamantly deny it! The reason for WHO and the UN’s established age of 60 as an older adult is due to the average life expectancy of the global population. In 2015, the global population life expectancy was 71.4 years old (73.8 for women and 69.1 for men) and ranged from 60 years in the WHO African Region to 76.8 years in the WHO European Region (WHO, 2017). In the United States, the average life expectancy in 2014 was 78.8 years old (Centers for Disease Control and Prevention [CDC], 2016a).

The U.S. Census uses the age of 65 years to classify someone as an “older” adult, and the U.S. population has generally accepted this chronological marker as the movement into old age. We tend to use the age of 65 to mark other significant transitions that socially align with old age, such as retirement; although the age at which you can receive social security will depend on the year in which you were born. For example, individuals born after 1960 can have a full retirement when they reach the age of 67 (Socia...