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.
Adult Day Care
Namkee G. Choi
Adult Protective Services
Patricia Brownell and Joanne Marlatt Otto
Adult Protective Services (APS) are empowered by states and local communities to respond to reports and cases of vulnerable adult abuse, neglect, and self-neglect. While incorporating legal, medical, and mental health services, APS programs are part of the social services delivery system and incorporate principles and practices of the social work profession.
Various models and theories of adult development exist but they are more assumptions about development than theories. The most popular age and stage theories have lost favor to contextual theories that put more emphasis on interaction with the environment. It has also become recognized that adults are a diverse group and do not follow universal stages of development. The usefulness of chronological age is also questionable as it does not tell us much about any particular person. Instead, we have to know their concerns and the events they are dealing with, and their dreams and aspirations.
Adults: Group Care
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.
Advance Care Planning
Meredith Stensland, Sara Sanders, and Marla Berg-Weger
Advance care planning (ACP) is the process of determining and documenting desired wishes for the end of one’s life. Referred to by such terms as end-of-life planning, advance (health) directives, and living wills, ACP is a relatively new concept within our society, having emerged as a social, political, and ethical issue in the United States only since the 1960s. Researchers and legislators have been challenged in their efforts to examine healthcare decision-making and design appropriate policy to guide practice. This article will define ACP, provide an overview of the history and evolution of the process and the associated legal and ethical issues, and describe the process with three specific populations. In addition, it examines the role of the social work profession in working with individuals and families on planning for the end of one’s life.
Ageism in the Workplace
Older workers make important contributions to the workplace, its productivity, and its culture. Work remains important for older adults for financial security, to give meaning to later life, to maintain social networks, and to promote lifelong learning. However, ageist beliefs about the capacity of older adults to remain productive and contributing workers in the workforce can create barriers for older workers. Understanding how older workers experience ageist behavior in the workplace can help employers, policy makers, and social workers learn more about how to address this social problem. Organizations can become more age friendly through enabling workplace programs, supportive management, and proactive human resource managers. Social workers serving older adults in employee assistance programs and in private practice can help them to challenge ageism in the workplace. Finally, legislation such as the Age Discrimination in Employment Act protects the rights of older workers; however, more legislation is needed to address bullying and harassment of older adults in the workplace.
Ageism and Retirement
Retirement is a modest social institution that appeared in most industrialized nations near the start of the 20th century. The aim of retirement was to solve the societal dilemma of an increasingly aged labor force by moving older workers systematically out of their jobs so as to not cause them financial harm (Atchley, 1980, p. 264). Although retirement has been considered benign since its inception, the history of retirement indicates that it is one of the main progenitors of ageism in society today (Atchley, 1982, 1993; Haber & Gratton, 1994; McDonald, 2013; Walker, 1990). Retirement and its accompanying stereotypes have been used as a tool for the management of the size and composition of the labor force contingent on the dictums of current markets in any given historical era. Ever-changing ideologies about older adults that extend from negative to positive ageism have been utilized by business, government, the public, and the media to support whatever justification is required in a particular era, with little thought to the harm perpetrated on older adults. Unfortunately, society has subscribed to these justifications en masse, including older adults themselves. In this article the ageism embedded in retirement is examined to make what is implicit explicit to social work practitioners and policymakers in the field of aging.
Aging: Public Policy
Jeanette C. Takamura
Public policy advances in the field of aging in the United States have lagged compared to the growth of the older adult population. Policy adjustments have been driven by ideological perspectives and have been largely incremental. In recent years, conservative policy makers have sought through various legislative vehicles to eliminate or curb entitlement programs, proposing private sector solutions and touting the importance of an “ownership society” in which individual citizens assume personal responsibility for their economic and health security. The election of a Democratic majority in the U.S. House and the slim margin of votes held by Democrats in the U.S. Senate may mean a shift in aging policy directions that strengthens Social Security, Medicare, and Medicaid, if the newly elected members are able to maintain their seats over time. The results of the 2008 presidential election will also determine how the social, economic, and other policy concerns will be addressed as the baby boomers join the ranks of older Americans.
Aging: Racial and Ethnic Groups
Daniel S. Gardner and Caroline Rosenthal Gelman
Minority and immigrant elders constitute a greater proportion of the population than ever before and are the fastest growing segment of the older population. Within these racial and ethnic groups there is considerable variation with regard to age, gender, country of origin, language, religion, education, income, duration of U.S. residency, immigration status, living arrangements, social capital, and access to resources. The authors summarize research on older adults regarding racial and ethnic disparities, barriers to health and social service utilization, and dynamics of family caregiving. Implications are offered for social-work practice, policy, and research.
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.
Lisa A. Ferretti and Philip McCallion
Growth in the aging population and increasing concerns in terms of health issues and financial and caregiving challenges among older adults are well established. Historically, the Older Americans Act has provided the delivery structure and services for older adults in need. Agencies within these structures have also engaged with housing and health care providers and funders. The structures and relationships are not adequate to support the desires of older adults for self-determination and aging in place and remain too treatment oriented rather than preventative and supportive in focus. Macro social work must engage in building aging structures, services, communities, and resources more fit for changing purposes.
Aging: Practice Interventions
Lenard W. Kaye
Social workers address older adult issues at all levels of practice including program planning, policymaking, and service delivery and across a wide range of community and institutional settings. While various models of practice intervention with older adults exist, the focus has increasingly been on the integration of strategies that emphasize strength-based and person-centered perspectives to geriatrics and gerontological social work practice. The older adult population is expanding dramatically and becoming increasingly culturally, racially, and ethnically diverse, and social work services need to be responsive to the variety of issues faced by a more heterogeneous older adult population with complex needs who also bring a lifetime of intellectual and experiential assets and heightened expectations.
Alzheimer’s Disease and Other Dementias
Carole B. Cox
Dementia is not a disease, but a group of symptoms so severe that they inhibit normal functioning. Alzheimer’s disease is the most common type of dementia in older persons, impacting not only the person with the illness but also the entire family. Obtaining an accurate diagnosis is essential to assure appropriate and timely care and to exclude reversible causes of dementia. Social workers can play key roles throughout the course of the illness as educators, therapists, supporters, and advocates for improved policies and services.
United States Social Security System
Eric R. Kingson and Nancy J. Altman
Social Security—the American people’s most important insurance—does more to maintain living standards and prevent poverty than any other social welfare policy or program, public or private. This entry discusses why our nation’s Social Security system was built, what it does, how it evolved and how it continues to do so. Contemporary challenges and related policy options are identified regarding program financing and the public’s need for expanded protections—retirement, disability, survivorship, paid family leave, and paid sick leave, among other protections. The analysis highlights messaging and political strategies used by those seeking to diminish the role of Social Security and those seeking to expand its protections. The entry suggests that the values and objectives of the American Social Security system comport well with social-work; and that both opportunity and need exist for social workers to shape Social Security’s future through application of policy analysis, advocacy, organizing and administrative skills.
Behavioral theory seeks to explain human behavior by analyzing the antecedents and consequences present in the individual's environment and the learned associations he or she has acquired through previous experience. This entry describes the various traditions within the behavioral perspective (classical conditioning, operant conditioning, cognitively mediated behavioral theory, and functional contextualism) and the clinical applications that are derived from them. Common criticisms are discussed in light of the ongoing evolution of behavioral theory and the fit of its tenets with the field of social work.
Blindness and Visual Impairment
Adrienne Asch and Nancy R. Mudrick
Significant visual impairment affects ~8 million Americans, 1.8 million of whom are blind and must find nonvisual methods of performing life roles. Social workers should not assume that people with visual impairment or blindness are unable to work, have families, or engage in sports or travel, or that vision limitations are necessarily a part of every presenting problem. Key roles for social workers include assisting in access to services and training and advocacy to combat discrimination and exclusion.
Care Transitions, Patient Health, and System Performance in the United States
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.
Community-Based Aging Services
As individuals age, their physical community continues to be a primary entry point of intervention because of their attachment to place, social connections, and limited mobility to travel as far and as often as they would like or desire. The environment provides a context for understanding an older adult’s social interactions and the availability of and access to supportive services that reduce isolation and increased risk for reduced health status. When individuals age in place, social workers need to understand how community-based services can work with older adults in their community where they have lived for some time and have developed social networks. This knowledge will better assist social workers in their ability to effectively connect clients with appropriate resources. Unfortunately, it is not uncommon for an older adult’s environment to not reflect or adapt to their changing health status and physical mobility. Healthy aging (also referred to as age-friendly) and NORC (naturally occurring retirement communities) initiatives have emerged as examples of how to provide supportive, community-based services that will enable older adults to remain engaged in their community as they experience changes in their health status, mobility, and financial security. These community-level interventions emphasize the adaptability to an older adult’s changing lifestyle factors that influence how they navigate their community. These initiatives engage older adults in planning and implementing strategies to connect older adults with services and activities that promote aging in place. Social workers play a very important role in the provision of community-based aging services because they can serve as a bridge between older adults and the local, state, and federal level programs that may be available to them.
Counseling Older Adult Victims of Ageism in the Workplace
Margo A. Jackson
Despite the significant life and work experiences that a growing number of older adults have to contribute to the workforce, pervasive ageism operates in overt and covert ways to discriminate against older workers in hiring and workplace practices. This article provides a current overview of definitions, prevalence, types, and effects of ageism in the U.S. workplace. For social workers counseling older adult victims of workplace ageism, this article discusses theories, foundational knowledge, and ongoing self-awareness and training needed for bias awareness. Counseling strategies and resources are highlighted, including coping and resilience strategies to counteract ageist stereotypes and discrimination, facilitate job-seeking support, and advocate for older workers by promoting awareness and serving as a resource for employers to reduce workplace ageism.
Deaf and Hard-of-Hearing People
Martha A. Sheridan and Barbara J. White
Effective social work practice with deaf and hard-of-hearing people requires a unique, and diverse, collection of knowledge, values, skills, and ethical considerations. Salient issues among this population are language, communication, and educational choices, interpreting, assistive devices, cochlear implants, genetics, culture, and access to community resources. Competencies at micro, mezzo, and macro levels with a deaf or hard-of-hearing population include knowledge of the psychosocial and developmental aspects of hearing loss, fluency in the national sign language, and an understanding of deaf cultural values and norms. In the United States, the use of American Sign Language (ASL) is the single most distinguishing factor that identifies deaf people as a linguistic minority group. This entry presents an overview of the practice competencies and intervention approaches that should be considered in working with deaf and hard-of-hearing people, their families, communities, and organizations. It introduces the knowledge base, diversity in community and cultural orientations, social constructions, and international perspectives, current research and best practices, interdisciplinary connections, trends, challenges, and implications for effective social work practice with this population. An integrative strengths-based transactional paradigm is suggested.