The Problem:

• Shortage of social workers with experience in aging care.
  
  The National Institute of Aging estimates that 60-70,000 professionally trained social workers will be needed by 2020 to work with the older population. This is a 43% increase over the current workforce, which is estimated to be at 49,000.
  
  As older adults become one-fifth of the general population, all social workers are likely to work with older adults at some point in their careers. Even now, over 60% of social workers say that knowledge of aging is required in their work. Clients including the mentally ill, drug abusers, and the disabled will grow older, which means their social workers will need to gain competencies in handling the physical and psychological issues that come with aging.
  
  In addition, new roles for social workers will open up and expand. For example, they are well-positioned to educate, support and supervise direct care workers and family caregivers who bear the heaviest load in caring for the aging. These individuals are often unpaid or underpaid, and are themselves getting older and not in the best of health.

The Solution:

• At every level, the geriatric content of social work education must be expanded and strengthened.
  
  College and university programs that offer degrees in social work will be on the front line of educating the new generation of social workers to be aging savvy and prepared for the changing demands on the workforce.
  
  Aging-related content must be infused into the core curriculum. For example, courses on the mentally ill should include information on the exacerbated problems of these populations as they age. A course on the child welfare system should include information on the role of older people who care for their grandchildren when the children’s own parents cannot. Classes on the health care and government entitlement systems should include information on Social Security, SSI, Medicare and Medicaid.
  
  For more information on the Hartford Partnership Program for Aging Education, geriatric education program developed by the Social Work Leadership Institute, click here: [link to HPPAE]

The Problem:

• Shortage of social workers who specialize in aging care.
  
  Geriatric care attracts fewer specialists in all professional disciplines, and social work is no exception. According to the National Association of Social Workers, only 5% of its members identify aging as a primary practice area and only another 5.5% identify aging as their secondary practice area. In addition, a higher proportion of social workers specializing in aging care than in other fields of practice, are themselves over 50 and nearing retirement.
  
  As of late 2005, only a third of accredited graduate schools of social work offered specialized concentrations in aging or gerontological social work, and only 3% of graduate level social work students specialize in these areas.

The Solution:

• Expand opportunities for specialization in geriatric social work.
  
  Master’s and doctoral level opportunities for geriatric specialization must be developed beyond what is currently offered in social work programs nationwide, particularly if much-needed leadership in both practice and education is to be advanced.
  
  An increase in the number of master’s level social workers who specialize in aging is critical because it is they who will supervise bachelor’s level graduates and paraprofessionals in agencies that serve older adults, and who become field instructors in their agencies. Moreover, some of them will become leaders of public and private service agencies and policy organizations in the field of aging. Others will decide to return for DSWs or PhDs in gerontology and related fields, thus passing on their knowledge to future generations of social work students.

The Problem:

• Recruitment and Retention
  
  Recruiting and retaining social work students to the field of aging remains a challenge, partly because of persistent biases and assumptions that many people have about older adults and geriatric work. The pay for geriatric workers is also often lower than that for peer professionals. Many people are also not aware that social workers can play a critical role in aging care, or what that role entails.

The Solution:

• Recruitment into geriatric social work requires these practices:
  
  Institutional commitment: A school-wide commitment to geriatric social work education by the dean, faculty committees, admissions, and development office can go a long way to recruiting students. A close partnership between the field education office and the school’s admissions office is crucial.
  
  Rotate field placements: An educational model developed by the Social Work Leadership Institute has found that students who rotate through multiple settings for their field placements gain a broader and richer experience working with older adults, which deepens their interest and commitment to staying in the field.
  
  Stipends: The availability of stipends (or fellowships) is also a critical factor. The stipend should be at a level necessary to secure and motivate, rather than establish, interest. Loan forgiveness programs are also essential.
  
  Peer endorsements: Word-of-mouth testimonials from former geriatric social work students are extremely influential. These graduates can be tapped to speak at Many at field placement days and special events at school and in the field.
  
  Improved pay: Given the cost of graduate school education and the rising cost of living, better pay will contribute to the decision of social work students to specialize in geriatrics, both for practical reasons and because of the respect it accords work with the aging.

Recommendation 3: Improve the Way Care is Delivered to the Aging.

The Problem:

Most Americans approaching retirement believe that Medicare will cover their future health care costs, including the cost of long-term care at home or in a nursing home. However, Medicare was set up for acute care in hospitals and by physicians, not for long-term care. Medicaid, the U.S. Administration on Aging and state programs cover a small portion of long-term care, but it is a patchwork with many patches missing. In fact, health care and social service systems have become more fragmented over the last several decades.

This fragmentation puts vulnerable older adults and their caregivers at increased risk of declining health and functioning, unmet psychosocial needs, unnecessary suffering and excessive healthcare costs. The time-consuming and frustrating process of coordinating services puts even the savviest family caregivers at risk of burn-out, which can accelerate their decision to institutionalize an older relative rather than care for him or her at home.

The Solution:

The IOM report stresses the importance of interdisciplinary teams for patient and client care. Within those teams, social workers can have a central role as they help older adults and their caregivers navigate the vast and often bewildering array of health and social services. They deliver and coordinate services for their clients, smooth their transitions between different care settings, and provide additional support that may make the difference between an older person staying at home and moving to an institution.

While social workers often fill this role, there are larger structural problems that must be fixed to improve overall care delivery to the aging.

Meeting this challenge head on will require care coordination, an assessment-based, interdisciplinary approach to healthcare and social services that puts the needs and preferences of older adults and their caregivers at the center. Delivered by professionals (including social workers) following set standards of care, care coordination integrates and streamlines health and long-term services effectively and efficiently. It improves the quality of care and life for older Americans and helps them stay in the community. It is particularly important for vulnerable, frail individuals with chronic conditions or those who have recently been hospitalized, two groups which are particularly at risk of being re-hospitalized or moved to nursing homes. Care coordination has the potential to produce considerable savings by reducing acute care and long term institutionalization. Care coordination also relieves caregivers so they don’t lose work days to care for older loved ones and are able to maintain their own well-being.

Care coordination provides older adults with a degree of control over their lives and helps them maintain their independence for as long as possible in the community instead of relying on institution-based care.

Social workers are ideally qualified to be care coordinators. Social work is historically the only profession that has developed and maintained expertise in navigating multifaceted systems of care - medical, social, economic and psychological. Social workers see themselves and function as care coordinator by reason of both education and professional mission.