This study found that only half of all nursing homes employed degree social workers. Even further, 61 percent of nursing homes in this study did not have a social worker with a license. Read more at Nursing Home Standards. For me it is  this is a pretty upsetting issue. When I try to critically think why this is happening in our nursing homes, I wonder, could this really all be about money? As the report suggests for-profit nursing homes are 31 percent less likely to hire a degreed social worker. Do nursing homes just want to find the cheapest way to meet the federal standards without regard for qualified employees? Or, is it that nursing home execs to do not see the necessity of Social Workers? Or perhaps both?

Let’s talk about who social workers really are. Social Workers are trained professionals with an understanding of the personal experience. Social Workers examine all aspects their clients be it  an individual, family, group or community. Each aspect is important in understanding the whole. Many social workers have training in mental health with the ability to identify depression, anxiety, risks for suicide, etc. Social workers understand how to handle a crisis, a major life transition, and family dynamics. Social Workers understand the growth of an individual, the life course. Social workers examine the physical, the emotional, and the social experience of their clients, and can identify the links between each of those aspects.

A call for standards for nursing home social workers is most definitely in order. Not only must nursing homes provide for their residents a social worker with a degree, but these social workers should be licensed. Nursing home social workers should have a case load that offers them a chance to work with each resident as much as needed, in order that all the needs of the older adults are met. This may mean that other qualified staff must also be apart of the social service department to assist the qualified social worker complete all the necessary paper work and reports needed for our overseeing government. With more qualified social workers nursing homes may see a change in their residents qualify of life, standards of living will be raised. But now the question is, will the federal regulators see this importance, and or will nursing homes see the importance themselves?

Picture courtesy of Zsuzsanna Schreck. View more of her photos at Rocketcat.blogspot

ScienceDaily (Nov. 24, 2008)  For many of the elderly, the golden years are anything but. Faced with health problems, financial issues and the death of a spouse or loved one, many adults 65 years and older suffer from depression. While research is emerging to help this group understand and treat the problem, another group – centenarians – has been left largely in the dark.

“Centenarians are still rare, and depression hasn’t been studied thoroughly in this group,” said Adam Davey, a developmental psychologist in the College of Health Professions at Temple University. “We’ve found that it’s a very under diagnosed condition among people over 100 years old, yet it’s one of the most easily treated forms of mental illness.”

…more than 60,000 people in the U.S. are 100 years old or over, and as baby boomers start to hit their 100-year mark, that number is expected to more than quadruple to 274,000. …a group of researchers have been studying this group more and more to learn about successful late-life aging…..Based on responses … by a sample of 244 centenarians, … more than 25 percent showed clinically relevant levels of depressive symptoms, yet only 8 percent reported having a current diagnosis of depression.

Davey notes that … a number of factors, including poor nutritional status, urinary incontinence, limited physical activity and past history of anxiety. “People who suffer from depression tend to have a high risk of mortality, so it’s puzzling to see higher numbers among the oldest old,” he said….researchers found that centenarians living in a community setting were found to have higher levels of depression than their younger counterparts. …it is important for doctors, nurses and even family members to focus on the larger picture to ensure a better quality of life.

“Caregivers often focus on the physical part of health,” he said. “Or, when they look at they mental health of older adults, they focus more on dementia. But depression is important to consider too – it’s not just something that younger people suffer from.”…

To read the complete article go to http://www.sciencedaily.com/releases/2008/11/081124080810.htm

MY COMMENTS:

When I came across this article I was oddly pleased. I was happy to see that the scientific community is taking interest in the oldest old, a population that is commonly forgotten. We talk so much about baby boomers, and forget that there are plenty of older adults here and now that need assistance with issues associated with aging. As this article is suggesting, more focus is needed on the oldest old for mental health issues that are appearing to be more prevalent then once thought.

Many times, I think, the underdiagnosis of depression occurs in not only those 100 years of age, but from 75 up. At this point, the older adult is experiencing a lot of changes physically, which is affecting them socially and functionally. They may be losing sight of their independence as they suffer physically, emotionally, and socially. The medical community comes in contact with this population more than any other. They should be able to pick up on signs of depression, right? I feel that the reason this is not the case, is the stigma faced by this population. The medical community may look at them, and think, “Well, their old, and in pain, why wouldn’t they be sad.” Ok, maybe, but this snap judgment of the sad, old age folks cannot be a part of the very vital medical evaluation these patients need.

Let’s take our time and view our clients as not an old person who has every reason to be sad, but as a person who may be severely affected by their mood changes. These changes may very well be connected to their current experiences as they age, though depressed should not be viewed as a normal part of aging.

Case management, to some, is a proficiency, which can be performed by those with skill levels ranging from a high school degree to a Bachelor in Social Work.  Many professionals describe this talent differently, I will argue that this under-appreciated skill should not go unrecognized, as it is essential when administering a clinical framework with the older adult population.

It’s 4pm, time for your session with Mrs. Janet Rogers. Where is she? You think. She is late again. What does this mean? This type of behavior should be assessed as perhaps her lack of dedication to our work, and her inability to trust people.

This type of interpretation is more than reasonable when working with a population without the common obstacles of aging. What happened to Mrs. Rogers? Well, she attempted to clean her house for her upcoming traditional condo holiday party. Though due to her weak legs, achy back, and her inability to recognize how she is physically changing, she overworked herself as she cleaned all day. She felt pressure to clean, and failed to eat enough food to regulate her irregular blood sugar levels. Janet was worn out! She fell asleep as she waited for her ParaTranist car to arrive in order to arrive at the weekly session with you.

It seems, as my colleagues discover in their young practice, that time must be devoted to the daily needs of the client including house maintenance, food preparation, and medical issues, social activity, etc. In some agencies providing mental health services to the older adult population are be met by another division of the agency specializing in case management. Though, more frequently these issues must be understood and dealt with by the clinician.

This is the work that must be done in order for the work to be done. Perhaps as geriatric social workers we deserve a model that can offer a case management and a clinical combination specific to the commonalities of the older adult population?

Picture courtesy of Zsuzsanna Schreck. View more of her photos at Rocketcat.blogspot