Adult day care centers provide important health, social, and support services for functionally and cognitively impaired adults and their caregivers. The adult day care services are underutilized, however, because of the shortage of centers, caregivers' lack of awareness of and resistance to using services, and the mismatch between the needs of potential consumers and their informal caregivers and the services provided by the centers. To foster and support the expansion of adult day care centers, lessons learned from national demonstration programs need to be disseminated, and social workers need to be trained to provide essential services at the centers.
Namkee G. Choi
This article presents information about group settings that provide residential long-term care for older adults, focusing on nursing homes and residential care/assisted living communities. It provides an overview of both settings and describes their scope of services, funding, and clientele. The section “Issues in Residential Long-Term Care” addresses issues of special relevance to social workers: dementia and other psychosocial care needs; quality of life and quality of care; access to and disparities in care; end-of-life care; family involvement; and abuse and neglect. The article ends with a section on the role of the social worker in residential long-term care.
Nancy Morrow-Howell and Leslie Hasche
Despite high levels of functioning among older adults, chronic health conditions lead to impairment and the need for help. Family members provide most of the assistance; yet formal services such as in-home personal and homemaker services, congregate and home-delivered meals, adult day services, employment and educational services, transportation, nursing homes, assisted and supportive living facilities, legal and financial services, and case management are available. Even with the growing number and type of services, unequal access and uneven quality persist. In these settings, social workers develop and administer programs, provide clinical care, offer case management and discharge planning, and contribute to policy development.
June Simmons, Sandy Atkins, Janice Lynch Schuster, and Melissa Jones
Transitions in care occur when a patient moves from an institutional setting, such as a hospital or nursing home, to home or community, often with the hope or expectation of improving health status. At the very least, patients, clinicians, and caregivers aim to achieve stability and avoid complications that would precipitate a return to the emergency department (ED) or hospital. For some groups of vulnerable people, especially the very old and frail, such transitions often require specific, targeted coaching and supports that enable them to make the change successfully. Too often, as research indicates, these transitions are poorly executed and trigger a cycle of hospital readmissions and worsening health, even death. In recognizing these perils, organizations have begun to see that by improving the care transition process, they can improve health outcomes and reduce costs while ensuring safety, consistency, and continuity. While some of this improvement relies on medical care, coaching, social services and supports are often also essential. Lack of timely medical follow-up, transportation, inadequate nutrition, medication issues, low health literacy, and poverty present barriers to optimal health outcomes. By addressing social and environmental determinants of health and chronic disease self-management, social workers who make home visits or other proven timely interventions to assess and coach patients and their caregivers are demonstrating real results. This article describes care transitions interventions, research into barriers and opportunities, and specific programs aimed at improvement.