HIV/AIDS Prevention in New York City: Identifying Sociocultural Needs of the Community

This article is a call for those who design social work courses to recognize the complexity and richness of aged care social work in health care and to social workers to shake off ageist attitudes and consider working with older people as a positive option in this rapidly expanding area of social work practice. A mixture of practice experience together with findings from the literature, this article explores social work practice with older people in hospital settings. Social work with older people has both therapeutic and practical components. The importance of integrating a therapeutic approach into all aspects of social work practice with this population cannot be overestimated.     

A Social Work Practice Reflection on Issues Arising for LGBTI Older People Interfacing With Health and Residential Care: Rights,Decision Making and End-of-Life Care

This article is a social work practice reflection on issues arising for lesbian, gay, bisexual, transgender, and intersex (LGBTI) older people interfacing with health and residential care in Australia; focusing on clients, families, and carers in relation to rights, decision making, and end-of-life care. The article explores relevant case examples from social work practice in a health and residential care setting that highlight some specific complexities of working with this client group. This article brings greater attention to issues arising for older LBGTI when interfacing with health and residential care and has the potential to improve practice for social workers and other health professionals and improve outcomes for LGBTI older people.     

Social work and end-of-life care for older people: a historical perspective

End-of-life issues became increasingly complicated during the 20th century as profound shifts occurred in who died, how they died, and when they died. This article reviews societal changes related to death in the United States and chronicles the developments in social work practice with and for dying people and their families in the 20th century, leading up to the 1993 policy statement of the National Association of Social Workers on end-of-life decision making, which reinforced that client self-determination, a fundamental principle of social work, should apply to people planning for their deaths or undergoing a dying process. After identifying limitations in policies and practices, suggestions are offered to promote competent social work practice and enhance end-of-life care, particularly with reference to the dying process of older people.     

Social construction of the managerialism of needs assessment by health and social care professionals

Managerialism in community care has not only radically changed organisational structures delivering care, but the assessment of health and social care needs, the justifications for the assessments, and the experience of those who require publicly funded services. The present paper describes the social construction of the managerialism of needs assessment by health and social care professionals, and illustrates this through the identification of older people as a particular kind of client. The argument draws on 'third way', modernity and postmodernity thinking to show needs assessment as a socially constructed area of welfare. The empirical work in this study is based on the views of 38 health and social care professionals obtained by semi-structured in-depth interviews and a postal questionnaire. The views of these professionals show that the social construction of needs assessment takes place in managing the matching of eligibility criteria against types of services. The key to this process is the application of the concept of management that places health and social care professionals in roles where they are acting for state, voluntary or private agencies, and not in all contexts working together with older people. The study shows that professionals identify older people into two groups or 'classes', i.e. those having health needs as distinct from those with social care. The techniques used amount to an exercise of power by professionals over older people. Change is necessary to break down the dominance by professionals in the needs assessment process. A broader concept of the 'third way' vision by Giddens (1998) is also required to achieve greater relevance to how health and social care is organised, and how relations between professionals and older people are integrated into the idea and practice of participatory care. Therefore, the emancipatory side of modernity remains a largely unfinished project.     

Good practice in social care for disabled adults and older people with severe and complex needs: evidence from a scoping review

This article reports findings from a scoping review of the literature on good practice in social care for disabled adults and older people with severe and complex needs. Scoping reviews differ from systematic reviews, in that they aim to rapidly map relevant literature across an area of interest. This review formed part of a larger study to identify social care service models with characteristics desired by people with severe and complex needs and scope the evidence of effectiveness. Systematic database searches were conducted for literature published between January 1997 and February 2011 on good practice in UK social care services for three exemplar groups: young adults with life‐limiting conditions; adults who had suffered a brain injury or spinal injury and had severe or complex needs; and older people with dementia and complex needs. Five thousand and ninety‐eight potentially relevant records were identified through electronic searching and 51 by hand. Eighty‐six papers were selected for inclusion, from which 29 studies of specific services were identified. However, only four of these evaluated a service model against a comparison group and only six reported any evidence of costs. Thirty‐five papers advocated person‐centred support for people with complex needs, but no well‐supported evaluation evidence was found in favour of any particular approach to delivering this. The strongest evaluation evidence indicated the effectiveness of a multidisciplinary specialist team for young adults; intensive case management for older people with advanced dementia; a specialist social worker with a budget for domiciliary care working with psycho‐geriatric inpatients; and interprofessional training for community mental health professionals. The dearth of robust evaluation evidence identified through this review points to an urgent need for more rigorous evaluation of models of social care for disabled adults and older people with severe and complex needs.     

Older persons’ experiences and perspectives of receiving social care: a systematic review of the qualitative literature

The topic of social care for older people has gained increasing attention from the part of academics, professionals, policy makers and media. However, we know little about this topic from the perspectives of older persons, which hinders future developments in terms of theory, empirical research, professional practice and social policy. This article presents and discusses a systematic review of relevant qualitative research‐based evidence on the older persons’ experiences and perspectives of receiving social care published between 1990 and September 2014. This review aimed to obtain answers to the following questions: How is the reception of social care experienced by the older persons? What are the negative and positive aspects of these experiences? What are the factors which influence the experiences? The synthesis of the findings of reviewed papers identified six analytical themes: asking for care as a major challenge; ambivalences; (dis)engagement in decisions concerning care; multiple losses as outcomes of receiving social care; multiple strategies to deal with losses originated by the ageing process; and properties of ‘good care’. These themes are discussed from the point of view of their implications for theory, care practice and social policy, and future research.     

The costs of care: An ethnography of care work in residential homes for older people

The cost of social care, the work conditions experienced by care workers and the quality of care provided by residential homes for older people are all linked, yet we know very little about how this relationship works in practice. Drawing upon an ethnography of two differently priced residential care homes for older people in Southern England, I examine the implications of different financial regimes for care-giving practices. I show how the scheduling and allocation of resources—conveyed, for example, in formal routines and staffing levels—structure the care workers’ time, tasks and activities in each setting. This acts to symbolically demarcate what, or who, is valued. I argue that the availability of resources facilitates and impedes the symbolic culture of care work, shapes care workers’ ability to afford dignity to the individuals in their care and affects how care workers experience, and relate to, their labour. I conclude by discussing how current practices of funding and pricing social care have effects seeping beyond the practical and measurable, and into the realm of the symbolic.     

Effective Therapeutic Approaches within Specialist Residential Childcare Settings

The introduction of intensive support units in Glenmona Resource Centre has provoked a radical review of social work practices in a group care environment. In this article, traditional support within residential care has been reviewed, strengths identified and outcomes from greater understanding and relationship building defined, in a multi-disciplinary and inter-agency model of intervention. This paper presents the outcomes from this review of practice, to encourage discussion about effective intervention in a residential environment with young people assessed to be at high risk. The review defines the theory and rationale behind intensive support. The theory has been applied in practice and reflected upon through the range of interventions that have been utilised since the Intensive Support Model was introduced at Glenmona Resource Centre in April 2005. This includes a review of relationship work, understanding and responding to the traumatic experiences of the young people, application of therapeutic crisis intervention, restorative practices and recognition of the importance of supporting staffing. The benefits of the intensive support unit model in terms of positive experiences and outcomes for young people and staff are illustrated throughout by case examples.     

Primary care. Social skills

A scheme attaching social workers to general practices to improve services for older people is thought to have cut delays and increased communication between social services and primary care. The engagement of practice managers is key to the success of the venture. Seeing a social worker in general practice is thought to lessen the stigma some older people feel about referral to social services.     

Methods used to identify and measure resource use in economic evaluations: a systematic review of questionnaires for older people

This paper presents the findings of a systematic review of full or partial economic evaluations that included questions to service users or their carers to elicit information on the types, amounts or costs of community-based formal social care support provided to people 65 years and older. We have found that studies seldom report use of published validated questions for eliciting information from older people in the UK about their use of formal social care services. Given the political prominence of the debate over funding social care for older people, there remains a need for analysis of policy options. This requires reliable data on the receipt and payment for care. We recommend the development of improved questions on care that are clear, robust and up-to-date with developments in policy and practice.     

Low Health Literacy and Older Adults: Meanings,Problems, and Recommendations for Social Work

Many older adults struggle to manage their health care problems. Low health literacy exacerbates such struggles and contributes to a variety of adverse health behaviors and outcomes. Addressing how health literacy impinges on the lives of older adults is a neglected area of social work practice and knowledge. This article explores seven areas: defining health literacy, the problem and prevalence of low health literacy among older adults, health inequalities and health literacy, a brief literature review, neglected issues in the literature, suggestions for macro and micro social work interventions to improve health literacy for older adult populations, and conclusion.     

The coming of age for assisted living care: new options for senior housing and social work practice

As the United States experiences substantial growth in its population that is 65 years and older, development of safe housing and compassionate care for seniors is becoming a priority domestic issue. Assisted living is one of the fastest growing types of senior housing in the nation, attracting residents with a perceived combination of security, personal care services, less restrictive homelike environments and emphasis on independence, privacy and personal dignity. As there is limited reference to assisted living in the social work literature, this article selectively reviews the broader literature on the aging U.S. population and their need, assisted living as a senior housing and care option, the characteristics of this approach and the potential for social work practice in this evolving arena.     

Moving evidence-based interventions to populations: a case study using social workers in primary care

This article describes a study to expand a proven evidence- based practice for depression to a population-based intervention for frail older adults. Problem-Solving Therapy (PST) has been proven effective in reducing depression and other mental health conditions in cognitively intact adults in many studies. The current study employs a randomized controlled trial to test the effectiveness of a social work intervention for frail older adults that uses PST to address depression and other psychosocial issues. The intervention employs Master's trained social workers integrated into a large primary care practice. The study population is comprised of home-dwelling older adults with multiple chronic conditions, a recent history of unnecessary hospitalizations, and no more than mild cognitive impairment.     

Tearing down the Berlin wall: social workers' perspectives on joint working with general practice

BACKGROUND: The arrangements for delivering social work and primary health care to older people in England and Wales are currently subject to rapid re-configuration, with the development of integrated primary care and social services trusts. OBJECTIVE: To investigate perceptions of joint working in social services and general practice. METHODS: The study setting was two London boroughs covered by one health authority, one NHS Community Health Services Trust, four Primary Care Groups and two social services departments. All social work team managers in both areas were interviewed together with a purposive sample of social workers with a high number of older clients on their caseloads. A sample of GPs was sought using a sampling frame of practice size in each borough. Structured interviews with open and closed questions were used. Tape-recorded interviews were transcribed and subject to thematic analysis. Analysis of emergent themes was aided by the use of Atlas-ti. RESULTS: Social workers and GPs agree on the need for joint working, but have different understandings of it, each profession wanting the other to change its organizational culture. Co-location of social and health care is seen as desirable, but threatening to social work. Concerns about differences in power and hierarchical authority are evident and explicit in social work perspectives. Conflict resolution strategies include risk minimization, adopting pragmatic, case-specific solutions rather than remaining consistent with policy, using nurses as mediators, and resorting to authority. CONCLUSIONS: Although this is a study from urban areas in England, its findings may have wider significance since we have found that resources and professional skills may be more important than organizational arrangements in collaborative working between disciplines. Primary Care Trusts in England and Wales should promote awareness of these different perspectives, perceived risks and conflict minimization strategies in their work on clinical governance and professional development.     

Falls in older people

Thirty per cent of people aged over 65 fall each year in the UK. This number increases to more than 60% in those in care homes, illustrating the contextual nature of falls. The social consequences (apart from any injury) are considerable, with fear of falling among the most common. Fear of falls reduces the patient's quality of life and increases dependency. This has a significant knock-on effect for social and community care. For GPs, the frequency of falls presenting depends on the nature of the practice and the environment. But if you ask patients, you will find falls. As a consequence, they form part of the single assessment process (SAP) introduced in the national service framework for older people, which is used to determine a patient's health and social care needs. To manage falls more effectively, this contribution assesses how Southwark and Lambeth Integrated care pathway for older people with falls (SLIPS Project) has been developed as a fully integrated pathway linking acute care with primary, community and social care.     

Educational approaches for preparing social work students for interdisciplinary teamwork on geriatric health care teams.

Interest in teamwork has fluctuated over the last several decades, with recent renewed interest. As social workers become more involved in working with older people in the coming years, their success will hinge on collaboration with other health providers. Schools of social work and clinical sites must address this through the development of educational curricula and clinical programs which prepare social workers to work on interdisciplinary geriatric health care teams. Based on the experience of the national Geriatric Interdisciplinary Team Training (GITT) Program, this article presents an overview of the necessary team skills for social workers, educational methods for teach ing teamwork developed at the GITT sites, and some teaching challenges.     

Hospice social work: a search for identity.

This article describes social work's contribution to hospice philosophy and practice, calls attention to the lack of a distinct social work function on hospice teams, and examines various ways to resolve the problem of social work identity in hospice care. Insights from recent peer discussions of hospice social workers tend to support Kulys and Davis's (1986) earlier findings that psychosocial care is provided regularly by hospice team members other than social workers. Options for strengthening the hospice social work role are discussed, including the development of more specific therapeutic techniques and social work leadership in conducting applied research. The importance of maintaining a value-based, critical perspective is stressed.     

Moving Evidence-Based Interventions to Populations: A Case Study Using Social Workers in Primary Care

SUMMARY

This article describes a study to expand a proven evidence-based practice for depression to a population-based intervention for frail older adults. Problem-Solving Therapy (PST) has been proven effective in reducing depression and other mental health conditions in cognitively intact adults in many studies. The current study employs a randomized controlled trial to test the effectiveness of a social work intervention for frail older adults that uses PST to address depression and other psychosocial issues. The intervention employs Master's trained social workers integrated into a large primary care practice. The study population is comprised of home-dwelling older adults with multiple chronic conditions, a recent history of unnecessary hospitalizations, and no more than mild cognitive impairment.     

“They’re always in a hurry” – Older people´s perceptions of access and recognition in health and social care services

The article examines older people's perceptions of quality of life from the perspective of access and use of health and social care services. The data include focus group discussions with older people living alone. The data were analysed using thematic analysis focusing on the older people's collective views on health and social care services as supportive or restrictive factors for their quality of life. Two central themes were present in all the focus group discussions: the importance of accessing services and information regarding the services, and need for recognition within the services/by the professionals. Both themes were connected to the older people's desire to maintain autonomy in their everyday life despite increasing functional disabilities, which was seen as an important factor of quality of life. The older people felt that accessing and finding information about the services was difficult, and dependent on the professional's good will and the older person's own financial resources. Within the services, older people experienced a lack of recognition of their own personhood and individual needs. The participants felt that they were easily bypassed and left out of negotiations regarding their own care. The article highlights the importance of developing health and social care services and practices towards a more holistic approach recognising older people's individual needs.     

Frail bodies, courageous voices: older people influencing community care

Involving frail older users of health and social care services in decision making presents particular challenges for those committed to hearing the voices of service users. Age Concern Scotland initiated a project in Fife, the User Panels project, intended to enable older people who were unable to leave their homes without assistance to meet together to develop a collective voice expressing the needs and experiences of older service users. This paper reports on an evaluation of that project. It considers methodological questions posed by the evaluation of projects which aim to empower users, as well as discussing key findings from the evaluation. Older people were recruited through contacts in service agencies and other local organizations. The largest group was aged between 86 and 90 years and all were experiencing difficulties relating to poor health, physical frailty or disability. The project was based on a belief in the value of meeting together as a means through which people could develop the confidence to express their views. Those who became members of the panels valued this experience and reported intrinsic benefits related to the social contact, opportunities for learning and development of self-esteem. Evidence concerning enhanced capacity to exercise control over key aspects of their lives was less convincing. The work of the panels was generally well received by local social work and health agencies and had influenced local action in some areas. Responses to some issues raised by the panels generated a less positive response and the article considers reasons for this. The model is considered to demonstrate benefits both for the older people who become involved and for officials seeking to improve the sensitivity of services to the needs of older people.