2009
Aging Times, the CSWE Gero-Ed Center’s bi-monthly e-newsletter, provided an accessible and concise link to the Center’s programs, initiatives and curricular resources. Each issue featured a special topic with articles by faculty, students, and other members of the social work community.
If you would like to subscribe to our E-mail list in lieu of Aging Times, email us.
June 2009
Volume 4, Number 6 - June 2009
In This Issue: Elder Abuse Awareness
World Elder Abuse Awareness Day is June 15, and this issue of the CSWE Gero-Ed Center's Aging Times focuses on this troubling and prevalent problem.
Elder Abuse
Georgia J. Anetzberger, Cleveland State University
Anetzberger argues that social workers are uniquely positioned to intervene in cases involving elder abuse, which may affect up to 10% of older Americans.
Self-Neglect in Older Adults
Sarah McKay, MSW Student, Cleveland State University
McKay reflects on her first brush with hoarding, a type of self-neglect that calls for social work intervention.
Resources on Elder Abuse
National Center on Elder Abuse
This collection of resources from the Administration on Aging includes information on World Elder Abuse Awareness Day on June 15.
Role Play Vignettes: Self-Determination, Elder Abuse, and Kinship Care, Class Exercise (MS Word)
Spirit of Aging Rising (SOAR) Elder Abuse, Teaching Modules (Word doc)
CSWE Gero-Ed Center Updates
Torres-Gil to Kick-Off 2009 Gero-Ed Track
CSWE's 2009 APM will feature Fernando Torres-Gil, an expert on the Gero-Ed Track's theme of social justice and aging.
EWA Plans Day of Advocacy: Participate in a June 23 Call-In Day!
The Eldercare Workforce Alliance will visit Capitol Hill and organize a concurrent call-in day on June 23 to address the nation’s worsening eldercare crisis.
Update Your Curricula With MAC's Resource Reviews
These free, user-friendly tools can augment substance use, health, and mental health curricula with resources on gerontology.
Hokenstad Receives Educator of the Year Award From OAGE
M.C. "Terry" Hokenstad, Jr accepted the award at the 33rd OAGE Annual Conference & Meeting in March 2009.
Elder Abuse
By Georgia J. Anetzberger
Elder abuse represents the infliction of harm or threat of harm upon an older adult by a caregiver or trusted other, or the failure of a caregiver to protect an older adult or satisfy her or his basic needs (National Research Council, 2003). The National Center on Elder Abuse (2009) recognizes six forms: physical abuse, sexual abuse, emotional or psychological abuse, neglect, abandonment, and financial or material exploitation. It also acknowledges self-neglect, but distinguishes this from types of elder abuse where there is a perpetrator. Elder abuse is believed to affect 1-10% of older Americans. Although mandatory elder abuse reporting laws exist in nearly all states, it is estimated that as few as 1 in 14 situations are reported to authorities (Lachs & Pillemer, 2004). Almost two-thirds of elder abuse reports involve family members as perpetrators (usually adult children or spouses), and over half represent self-neglect and neglect as forms (Teaster, Dugar, Mendiondo, & Otto, 2005).
Social workers have led efforts to understand and address elder abuse for over 50 years. They spearheaded the development of “protective care,” as adult protective services (APS) were first called, during the 1950s and early 1960s. They conducted the first research on elder abuse during the late 1970s, noting the complexity and intervention difficulties associated with this problem. Today the majority of APS workers are social workers, and APS remains the only nationwide program dedicated to elder abuse intervention.
Social workers are ideally situated to identify and report elder abuse. They are among the professional disciplines most likely to be named as mandatory reporters in state laws. They also are in the top tier of actual reporters (Teaster, et al., 2005). As geriatric case managers and service providers, social workers frequently are in the homes of older adult clients and able to observe conditions that reflect or contribute to elder abuse. As members of interdisciplinary clinical teams in hospitals or residential care facilities, they generally coordinate activities for reporting suspected elder abuse situations to authorities.
Likewise, social workers play important roles in multiple systems involved in elder abuse prevention and treatment. Within the Older Americans Act Aging Network, they help heighten public awareness and provide professional education on the problem. They also offer supportive services that reduce the vulnerability of older adults to elder abuse. Within the justice system, social workers often provide victim assistance or guardianship services. Within health care, they may offer counseling or conduct support groups to deal with the psychosocial effects of elder abuse.
Consequently, it is essential that social work education incorporate curriculum content to help students understand elder abuse and its possible manifestations. This includes information on signs and risk factors along with available screening tools to promote detection. The varied roles that practitioners play mean that social work education must prepare students for navigating the multiple service systems available to address elder abuse, the potential contributions of social work in each system, and effective methods for promoting communication and coordination among distinct disciplines (Anetzberger, 2005).
Georgia J. Anetzberger is assistant professor of health care administration at Cleveland State University, editor of the Journal of Elder Abuse & Neglect, and vice president of the National Committee for the Prevention of Elder Abuse. She holds a doctorate from Case Western Reserve University and has spent over thirty years addressing elder abuse as a practitioner, administrator, researcher, and educator.
References
Anetzberger, G.J. (Ed.). (2005). The Clinical Management of Elder Abuse. Binghamton, NY: The Haworth Press.
National Center on Elder Abuse. (2009). Major types of elder abuse. Retrieved May 11, 2009 from http://www.ncea.aoa.gov/ncearoot/Main_Site/FAQ/Basics/Types_Of_Abuse.aspx
National Research Council. (2003). Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press.
Lachs, M. S., & Pillemer, K. (2004). Elder abuse. The Lancet, 364, 1192-1263.
Teaster, P.B., Dugar, T.A., Mendiondo, M.S., & Otto, J.M. (2005). The 2004 Survey of State Adult Protective Services: Abuse of Adults 60 Years of Age and Older. Washington, DC: National Center on Elder Abuse.
Self-Neglect in Older Adults
By Sarah McKay
As I entered the small apartment, I was met immediately with piles of books and bags of clothes that I needed to walk sideways to fit through. The living room was surrounded by different sets of dishes and china; the couch was being used as a bed; the bath tub was filled with shoes and the shower was used to hang clothes. The toilet and sink were covered with items and neither seemed functional. Everywhere I turned, I needed to be careful not to trip over anything. There was a distinct odor of spoiled food and garbage. I left the apartment feeling as though what I had seen could not have been real.
I experienced my first hoarding case during my internship at an Office on Aging. The woman who lived in the senior living apartment was in her 80s and had a history of hoarding, along with other psychological problems. She was known for wrapping her food in napkins from the dining hall and storing it in her room; she also used the public restroom for bathing. She eventually was evicted due to the poor living conditions and moved in with a family member. The social worker who had worked with this client in the past explained that her hoarding behavior was the result of a tumultuous childhood filled with abuse. The social worker was able to assist the client in sorting through her collections and explaining the need to have a safe living environment, but eventually those hoarding habits would arise again. It fell to the social worker with whom I was working to make the necessary calls to family members and come up with a plan for the client.
This type of situation is an example of self-neglect. Self-neglect is a form of elder abuse that is three time more likely to occur than physical abuse or caregiver neglect (Pavlik et al, 2001). Self-neglect in older adults is becoming more widespread as people live longer and stay in their homes longer. Hoarding is the extreme case of self-neglect that threatens the health, safety, and dignity of older adults (Poythress et al, 2006). The private nature of hoarding poses a threat because this type of behavior can remain unseen by the general public. Social service agencies in the community that service older adults can help monitor this behavior before it becomes harmful to the client.
As a graduate student pursuing a Masters in Social Work and a concentration in Gerontology, I learned a valuable lesson from this case. The social worker with whom I was working made the necessary calls to family members and came up with a plan for the client. During this internship I learned to distinguish between situations where there is self-neglect—and therefore a need for social work intervention—and those where the behavior represents a life style decision rather than compulsive hoarding that threatens a client’s safety. In the field of gerontological social work, each client, without exception, has an extensive life history that social workers must understand and respect. My goal as a social worker is to maintain and improve the story of the clients with whom I work.
Sarah McKay is an MSW student at the Cleveland State University School of Social Work. She holds a BA from John Carroll University in Sociology with a Concentration in Gerontology. In 2005, Sarah was awarded the Susan Friedland Gerontology Award for dedication in field work on aging studies. Sarah will be interning at the Louis Stokes V.A. Medical Center in Cleveland in their geriatric assessment unit.
References
Pavlik, V.N., Hyman, D.J., Festa, N.A., & Dyer, C.B. (2001). Quantifying the Problem Of Abuse and Neglect in Adults-Analysis of a Statewide Database. Journal of the American Geriatrics Society, 49, 45-49.
Poythress, E.L., Burnett, J., Pickens, S., & Dyer, C.B. (2006). Severe Self Neglect: An Epidemiological and Historical Perspective. Journal of Elder Abuse & Neglect 18, 5-12.
Torres-Gil to Kick-Off 2009 Gero-Ed Track
Social justice and aging will take center stage when Fernando M. Torres-Gil kicks off the 2009 Gero-Ed Track at the Council on Social Work Education (CSWE) Annual Program Meeting (APM) in November.
Torres-Gil is the director at the University of California, Los Angeles Center for Policy Research, associate dean of academic affairs, and a social welfare and public policy professor. He served as the first assistant secretary for aging at the U.S. Department of Health and Human Services under the Clinton Administration. At the Kick-Off Event on Saturday, November 7, he will speak to the theme of “Aging and Social Justice: Honoring the Past and Preparing for the Future.”
Registration is now open for CSWE’s 2009 APM, which will host the third annual Gero-Ed Kick-Off Event and related programming such as the Hot-Topic Panel and Rosen Panel for Best Practices in Gerontological Infusion. Early bird registration rates end Friday, September 18.
EWA Plans Day of Advocacy: Participate in a June 23 Call-In Day!
The CSWE Gero-Ed Center is a member of the national Eldercare Workforce Alliance (EWA) whose mission is to address our nation’s worsening eldercare crisis by building a caring and competent eldercare workforce. Several important bills have been unveiled by members of Congress that would affect the social work workforce. The Alliance will conduct visits to Capitol Hill on June 23, 2009 to advocate for these efforts.
EWA and the CSWE Gero-Ed Center invite you to participate in a Call-in Day that will be held on June 23, 2009, concurrently with EWA’s day on the Hill. Your participation will help maximize the impact of this advocacy effort. More information will be distributed in the next two weeks, including core messages and talking points. You will also receive access to a congressional call-in system that will help connect you to your Representatives on the Energy and Commerce; Ways and Means; and Education and Labor Committees.
Your help is needed! Information will be posted on the Gero-Ed Center home page in the next week. For more information on the overall efforts of the Alliance visit the EWA Press Room.
Update Your Curricula With MAC's Resource Reviews
Are your students informed in the areas of substance use detection, schizophrenia, palliative care and other issues affecting older adults? Future social workers must be equipped to manage the unique circumstances facing our aging population. The Master’s Advanced Curriculum (MAC) Project recently expanded the evidence-basedResource Reviews on substance use, mental health, and health care. These free tools provide faculty with an innovative way to infuse gerontology into advanced level courses. Access the user-friendly Resource Reviewstoday!
Hokenstad Receives Educator of the Year Award From OAGE
M.C. "Terry" Hokenstad, Jr received the 2009 Educator of the Year Award from the Ohio Association of Gerontology and Education (OAGE).
The 2009 Educator of the Year Award was presented at the 33rd OAGE Annual Conference & Meeting, attended by 300 educators in March. The award is given to an Ohioan "who has significantly advanced gerontological education and fostered greater understanding about aging or the issues and concerns of older people."
Hokenstad is the Ralph S. and Dorothy P. Schmitt Professor at the Mandel School of Applied Social Sciences, Case Western Reserve University, in Cleveland, Ohio.
April 2009
Volume 4, Number 5 - April 2009
In This Issue: Careers in Aging
For Careers in Aging Week (April 12—18), a national awareness initiative sponsored by GSA and AGHE, this issue of Aging Times features reflections from stakeholders involved in attracting students to gerontological social work.
Recruiting Students to Gerontological Social Work: An Admissions Perspective
Tim Colenback, University of Michigan
The assistant dean for student services at the University of Michigan describes how the School of Social Work recruits 10% of each MSW class to gerontological social work.
Highlighting Gerontology: A Career Services Perspective
Carol Doelling, Washington University in St. Louis
The director of career services at the Brown School of Social Work at Washington University in St. Louis provides advice for including career services as part of gerontological social work outreach.
Discovering Gerontological Social Work: A Student Perspective
Michelle Fucci, MSW Student, University of Michigan
One student describes how spending time with an older adult led her to change careers.
Resources on Careers in Aging
New Student Web Site from the CSWE Gero-Ed Center
The new Web page from the CSWE Gero-Ed Center features information on careers, research, and news regarding social work and aging geared towards students.
2009 Careers in Aging Week
From April 12—18, social work programs across the country celebrate Careers in Aging Week, a national event sponsored by the Gerontological Society of America and the Association for Gerontology in Higher Education.
Gero-Ed Center Updates
Rosen Panel Will Debut at CSWE's 2009 APM: Submit Your Nomination by May 1!
The newest offering of the Gero-Ed Track will feature three programs that have made great strides in infusing gerontology into their social work curricula.
CSWE Joins Eldercare Workforce Alliance
The newly formed alliance aims to build awareness around and propose solutions for eldercare workforce issues.
CSWE Press Publishes New Book on GSWI
Edited by Nancy Hooyman, Transforming Social Work Education: The First Decade of the Hartford Geriatric Social Work Initiative celebrates a decade of funding from the John A. Hartford Foundation.
Joy Ernst Wins Mit Joyner Gerontology Leadership Award
Presented at the 2009 Association of Baccalaureate Social Work Program Directors Annual Conference, the award promotes leadership in gerontological social work practice for undergraduate students.
Recruiting Students to Gerontological Social Work: An Admissions Perspective
By Tim Colenback
Exciting options abound in the field of gerontological social work. Difficult economic times highlight the usefulness of having more talented and trained social workers ready to work in this underserved area of social work. Given the current tight job market, admissions departments have an important opportunity to advise prospective students to fully investigate the intriguing options available to social workers working with and on the behalf of aging people.
At the University of Michigan, our admissions department has long highlighted the rewarding nature of gerontological social work and the need for talented people to develop the skills necessary to provide quality services in this area. We have been successful in consistently attracting on average 30 new MSW students each year (10% of our incoming MSW class) to our Aging in Families in Society concentration by highlighting the following:
- The rewarding nature of working with older people. Rarely do social workers receive more positive feedback from their clients than those working with this population.
- An opportunity to work with prominent faculty members. Students work to improve skills, knowledge and research related to working with or on the behalf of older adults with distinguished faculty such as Lou Burgio, Letha Chadiha, Ruth Dunkle, Berit Ingersoll-Dayton, Lydia Li, and Robert Taylor.
- Several focused curricular options, including the concentration in Aging in Families in Society, an interdisciplinary Certificate in Aging and a well funded geriatric scholarship program. Specific promotional materials have been developed highlighting the Geriatric Scholarship Program, which provides scholarship aid ranging from $20,000 to $40,000.
- The demographic reality that will lead to continued fun, challenging, and rewarding opportunities working with or on the behalf of aging populations as clinical social workers, case managers, supervisors, managers, program planners, community organizers, policymakers and evaluators.
Given the rewarding nature of this work and the needs of our citizens now and in the future, society would benefit if social work as a profession and schools of social work attracted more talented social workers into this field. By effectively highlighting the rewarding nature of this work and providing funding for interested and talented prospective students, admissions departments can use their unique position to help the social work profession meet the social work needs of an aging society in the future.
Tim Colenback has been the assistant dean for student services at the University of Michigan for the past decade. His work over the past 16 years has focused on providing student services, recruiting new social workers to the profession and providing career guidance. In his free time, he also enjoys political organizing.
Highlighting Gerontology: A Career Services Perspective
By Carol Doelling
The expansion of gerontological social work has been an exciting development for the career services department at Washington University’s George Warren Brown School of Social Work to support. Over the years, faculty research projects added new life, training grants spurred new community relationships, and collaborative initiatives enhanced field infrastructure. As our gerontology curriculum took shape, career services deliberately incorporated aging content to increase interest among all students and support our students seeking careers in aging.
From new student orientation to alumni surveys, career services collaborated with faculty, gerontology student leadership, and curriculum advisory committee members. During new student orientation, we used the pre-MSW and post-MSW resumes of a recent gerontology graduate to demonstrate how new master’s students can use the resume as a tool for career planning and professional development during their academic program. In job search workshops we focused on gerontology examples of job descriptions, skills lists, job search resources, elevator pitches, and talking points for interviews.
We worked with the gerontology student group to co-sponsor their career panels and attended their annual capstone project presentations and other events. As part of the career services all-school professional development days, gerontology students hosted sessions and moderated panels. Our local professionals from the aging services community are organized in a dynamic coalition as well as specialty groups. These groups are gifts that support our gerontology program and Career Services, always welcoming and willing to participate in programs and training for students.
Whether your social work program has its own career services office or your campus career center supports your students, ask those staff members to collaborate with you on programs and materials. Educate them on the specifics of the gerontology field, request workshops just for your students, and introduce career staff to your community professionals. Provide them with aging-specific resources and samples; ask them to use those in routine workshops to increase awareness of gerontology social work careers. Career specialists are eager to work with you in preparing your students for transitions into the field.
Carol Nesslein Doelling is director of career services at the George Warren Brown School of Social Work at Washington University in St. Louis. She provides comprehensive career services for students and alumni, recruitment services for employers, and information on the social work job market to faculty. Her book, Social Work Career Development: A Handbook for Job Hunting and Career Planning, NASW Press, was published in 1997 and 2005. She co-founded and serves on the steering committee of The National Career Development in Social Work Education Group.
Discovering Gerontological Social Work: A Student Perspective
By Michelle Fucci
It was supposed to be just one hour a week. I had decided to volunteer as a “friendly visitor” for one hour a week—leaving the office on my lunch break to sit with legally-blind Margaret and keep her company in her too-small apartment. Besides the occasional afternoon playing billiards at my grandmother’s housing complex, I had not spent any extensive time with older adults. On a whim, I decided to give friendly visiting a chance.
Before I knew it, one hour each Thursday had turned into one and a half hours, which soon became two hours. Sneaking away from my cubicle each week felt like I was cheating on my day job as an administrative assistant in a collegiate fundraising office—I was having an illicit fling with geriatric social work.
My lunches with Margaret were invigorating, but that alone is not the reason I decided to work with older adults. Yes, Margaret would give me advice on how to cook authentic Italian food or regale me with stories about working in New York City as a telegraph operator. But she also made me think, for the first time really, about some of the painful issues that can face older adults: social isolation, financial insecurity, and what can happen when an older adult just wants to give up.
Over the course of the year and a half that I got to know Margaret, I also met Andrea, the social worker in Margaret’s senior apartment building. As Andrea described how she saw her role—simply as a helper—I realized social work with older adults was the field in which I wanted to work.
It did take me a while to break it off with my day job, but eventually I was accepted to the University of Michigan School of Social Work. There I met an exceptional group of like-minded students all with a passion for working with older adults. Instructors like Karen Staller and Janet Ray encouraged and engaged me to see the connections between the classroom and the community. Each learning experience brings with it both challenge and opportunity.
Looking back, I wish that I had had more knowledge, more information, and more fully-developed skills to talk Margaret through what was troubling her. Now, with the education that I am receiving from the University of Michigan, I know that soon I will possess those skills. What started as just one hour a week has turned into a lifetime, and that is just fine with me.
Michelle Fucci is an MSW student and geriatric scholar at the University of Michigan School of Social Work. She holds a B.A. from Hamilton College in English Literature and an MS from Boston College in Administrative Studies. Michelle is currently completing her field placement at the Luella Hannan Memorial Foundation in Detroit, MI.
New Student Web Site from the Gero-Ed Center
Continuing to promote gerontological competencies among graduates of BSW and MSW programs, the CSWE Gero-Ed Center has created a new student-centered Web page called the Student Corner.
The Student Corner portal of the CSWE Gero-Ed Center Web site provides information specifically geared towards students concerning the field of gerontological social work. Some resources on the new Student Corner include:
- Lists of professional aging-related organizations
- Resources for finding a job, including articles on gero careers and links to job listings
- Catalog of social work programs offering gerontology
- Reasons to consider gero social work
- Updated links to funding opportunities, activities, and current events concerning aging
- Ideal for educating students about this important field and for providing graduates with career information, the Student Corner is a new and exciting resource for admissions departments, career counselors, and BSW and MSW social work departments.
Rosen Panel Will Debut at CSWE's 2009 APM: Submit Your Nomination!
Nominations are now being accepted for the 2009 Anita Rosen Panel Session for Best Practices in Gerontological Infusion at the CSWE Annual Program Meeting.
Three BSW, MSW, or joint BSW/MSW programs, each represented by one faculty member and one student, will be selected to present and discuss their exemplary curricular changes at the Rosen Panel. Each panel participant will receive a conference attendance stipend of $500. The three selected social work programs will also receive a Best Practices Award from the CSWE Gero-Ed Center.
For more information and information on the nomination process, please visit the Rosen Panel page. The deadline to nominate a program is Friday, May 1.
The Rosen Panel takes the place of The Anita Rosen Gerontology Awards for Outstanding Student Poster, which ended in 2008.
CSWE Joins Eldercare Workforce Alliance
In an effort to ensure that our nation can meet the need for appropriately trained healthcare providers, direct-care workers, and family caregivers to care for the growing number of older Americans, the Council on Social Work Education recently joined the newly formed Eldercare Workforce Alliance (EWA).
EWA was formed in direct response to the groundbreaking report "Retooling for an Aging America: Building the Health Care Workforce" from the Institute of Medicine (IOM). This publication concluded that America’s eldercare workforce is dangerously understaffed and unprepared to care for the rapidly growing number of older adults in the United States.
EWA's goal is to educate policymakers and the public about the burgeoning eldercare crisis and propose practical solutions to strengthen our eldercare workforce and improve the quality of care provided to older Americans. A project of the Tides Center and the Tides Advocacy Fund and supported by grants from the Atlantic Philanthropies, Inc. and the John A. Hartford Foundation, the Alliance includes 28 leading organizations concerned about education, training, and provision of quality care that represent consumers and their families as well as healthcare providers and direct-care workers.
For a full description, visit the EWA Web site.
CSWE Press Publishes New Book on GSWI
CSWE Press has just released Transforming Social Work Education: The First Decade of the Hartford Geriatric Social Work Initiative, edited by Nancy Hooyman.
Celebrating a decade of funding from the John A. Hartford Foundation, each chapter of this book highlights various aspects of the Geriatric Social Work Initiative (GSWI), including competency-based education, faculty and doctoral student scholarly development, models for curricular and organizational change, community partnerships, and strategies for sustainability.
This book is available through the CSWE Press Bookstore.
Joy Ernst Wins Mit Joyner Gerontology Leadership Award
Joy Ernst, associate professor and director of the undergraduate social work program at Hood College, was awarded the Mit Joyner Gerontology Leadership Award at the 2009 Association of Baccalaureate Social Work Program Directors (BPD) Annual Conference in Phoenix, AZ.
Ernst, who holds a PhD from the University of Maryland, Baltimore and an MSW from Rutgers University, also received a John A. Hartford Geriatric Social Work Faculty Scholars award in 2006. In 2002, she was part of the team who helped Hood College receive a Geriatric Enrichment in Social Work Education grant. She later became a mentor to faculty participating in the first Curriculum Development Institute.
The Mit Joyner Gerontology Leadership Award was created in 2005 by BPD and the Association for Gerontology Education in Social Work in honor of Mildred "Mit" Joyner in order to promote leadership in gerontological social work practice for undergraduate students through scholarship, best practices and/or community connections.
February 2009
Volume 4, Number 4 - February 2009
In This Issue: Healthcare
Healthcare affects everyone, but older adults bear the brunt of a difficult-to-navigate system while often facing their own declining health. This issue of Aging Times addresses these challenges from the perspectives of public policy and caregiving.
Health Care: Implications for Policy and Practice
Rob Hudson, Boston University
The keynote presenter at the 2008 CSWE APM, Hudson recaps his electrifying talk on reforming healthcare policy and motivating the social work profession to seize the political moment.
Policy Dilemmas in Aging and Chronic Illness
Gunnar Almgren, University of Washington
Almgren details Medicare’s imminent failures and discusses the restructuring challenges confronting President Obama and the 111th Congress.
Elders and Their Caregivers: A Student’s Reflections
Thao Phan, MSW Student, University of Washington
An MSW student discusses her experiences with minority elders and veterans and discovers the difficulties their caregivers face.
Resources on Older Adults and Health Care
MAC Project: Resource Reviews on Healthcare
Recommended References: Ascertaining Health Status/Assessing Physical Functioning of Older Clients (MS Word)
Case Study: Hospice Social Work (MS Word)
Case Study: Selecting a Medicare Prescription Drug Plan (MS Word)
List of Suggested Readings: Health and Long-Term Care Policy (MS Word)
Gero-Ed Center Updates
Specialized Gero Funding Applications Due in April
Don’t forget to apply for this new opportunity to develop, implement, and institutionalize a minor, area of emphasis, certificate, specialization, or concentration in gerontological social work.
2009 APM Call for Proposals Now Open
Proposals for the Gero-Ed Track are due by Sunday, March 29 at 11:59 pm.
Events Commemorate GSWI 10th Anniversary
Events at two upcoming conferences will celebrate a new book edited by Nancy Hooyman, co-Principal Investigator of the Gero-Ed Center.
Master's Advanced Curriculum (MAC) Project Celebrates Second Successful Year
The MAC Project looks back on the Gero Innovations Grant, the Resource Reviews, and successful meetings and presentations.
Join AGE-SW or Renew Your AGE-SW Membership
There's still time, says Tracy Schroepfer, AGE-SW Membership Coordinator.
Health Care: Implications for Policy and Practice
By Rob Hudson
A new era for aging and health policy presents both challenges and opportunities for social work practice. The Obama administration will pursue an aggressive health policy agenda, focusing primarily on access and cost tied to acute care needs. While social work can certainly promote and celebrate such initiatives, its more important role is in the arena of community-based long-term care. Millions of care recipients and providers live in a pubic policy netherworld, one principally associated with Medicaid. To avoid an oversight in emerging health care and economic policy initiatives, I propose the following five-point strategy to expand the agenda to include home and community-based services in long-term care (HCBS).
1. Policymakers must address the structural lag in HCBS-related policies, such as Medicaid, the Older Americans Act, and Medicare. Medicaid must continue to move toward supporting community-based alternatives, the aging network must determine how singularly and aggressively to participate in the HCBS arena, and Medicare must move beyond its acute care emphasis. Long-term care must shift from a residual to an institutional element of these policies.
2. Social work must resist continued “risk-shifting” from the public to private and formal to informal sectors. In this vein, long-term care must be recognized as a critical contemporary issue to be directly addressed through a social insurance mechanism. Difficult as it will be, we must extend the relative successes of Medicare and Social Security in addressing age-related income and acute health care needs to long-term care. Such a move augments traditional family efforts and responsibility with an institutionalized and non-means-tested public presence.
3. Although promising “cash and counseling” and consumer-choice innovations serves to promote client autonomy, social work must help assure the protection of other elements of clients’ interests. At the delivery level, these interests center on concerns of fraud, abuse, and services availability; at the policy-level, they focus on not allowing the appearance of consumer choice to be a stalking horse for further risk-shifting onto families. For example, defined-contribution-type Long Term Care/HCBS vouchers can risk the public sector fading away in the wake of cash or voucher delivery. These initiatives also represent a profound paradigm shift in the financing and delivery of in-kind benefits in a manner not previously seen. Social work should take a lead in the design of this new paradigm, where concerns of autonomy, security, accountability, and flexibility are being fundamentally rethought.
4. Social work can play a critical role in mobilizing caregivers to be an active constituency in long-term care policy reform. The 34 million caregivers to frail older adults represent a latent social movement of immense potential. Most caregivers, for understandable reasons, have not mobilized politically and lack awareness of legislative possibilities to change the conditions they face. Social work is better prepared than any other profession to move these individuals and their concerns onto the political agenda.
5. The social work profession must apprise and seize the political moment. The magnitude of potential change represented by the simultaneous appearance of a new administration and an economic crisis may be a once in a lifetime occurrence. This unprecedented reshuffling of the political deck means that alternatives that were pipe dreams a year ago might now be viable policy options. As an example of major policy breakthroughs occurring at the most unlikely times and places, mental health parity provisions were enacted as part of the $700 billion financial bailout in December. Even in these circumstances, major new long-term care initiatives will be a tough sell. But if not now, when?
At the very least, gerontological social work must ensure that age-related issues are not seen as already having had their day. Economically stressed agencies and caregivers should work to be part of a national stimulus package in which caregiving is defined as both an economic and health-related contribution to national well-being.
Rob Hudson is professor and chair, Department of Social Welfare Policy, Boston University School of Social Work. He has written widely on aging policy and politics, and his book The New Politics of Old Age Policy is used widely in social work and allied programs around the country. He also serves as editor of The Public Policy and Aging Reportand chairs the John A. Heinz Dissertation Award Committee for the National Academy of Social Insurance.
Policy Dilemmas in Aging and Chronic Illness
By Gunnar Almgren
By the year 2020, nearly 160 million Americans will have one or more chronic conditions, which will account for 80% of health care expenditures (Anderson and Knickman 2001). Because of the relationship between number of years lived and the accumulation of chronic health conditions, older adults are disproportionately represented in health care utilization for chronic and disabling conditions and the resultant health care expenditures. With the aging of the U.S. population, expenditures have escalated to the point where the fiscal sustainability of the public programs essential to the care of persons with chronic illness and disability are in jeopardy. The Obama administration now confronts projections that Medicare’s Hospital Insurance Trust Fund will be exhausted by the year 2019 (Social Security and Medicare Boards of Trustees 2008).
This policy dilemma is often mischaracterized as an entitlement crisis—there are simply too many older adults becoming eligible for Medicare relative to its fiscal resources. The reality, however, is far more complex, and has as much to do with the organization of the U.S. health care system and the culture of American medicine as with social and biological processes of aging and the age distribution of the national population. Two distinct policy challenges are embedded in the Medicare’s fiscal sustainability. One challenge is directly tied to the dramatic increase in Medicare enrollments as an ever larger share of the Baby Boom generation crosses the Medicare age eligibility threshold of 65. The financial structure of the Medicare program, from its very beginning, has failed to adequately account for the growth of enrollments tied to population aging (CRS 2008).
The other very different policy challenge has to do with Medicare’s antiquated benefit structure—one designed nearly 50 years ago to insure against expenditures for the treatment of acute illness within a system of unfettered medical free enterprise. This made sense in the demographic context of 50 years ago, when acute and infectious diseases were the dominant threats to health and reasons for seeking medical care. However, the largest share of Medicare expenditures today is for the management of chronic diseases. Despite this fact, the Medicare program’s benefit structure and criteria for provider payment remain enmeshed in the acute care paradigm of 1965—with all of its embedded inefficiencies and inflationary incentives.
The Obama administration and Congress now confront three basic policy choices: 1) dramatically reduce Medicare benefits and provider payments, 2) raise Medicare payroll taxes, or 3) reform the Medicare program’s benefit and payment structures in ways that promote more effective and cost-efficient approaches to the care and management of chronic disease. For a variety of reasons, the latter choice is far preferable, but how realistic is it?
Clinically, it is quite realistic to reform Medicare, particularly if one considers the striking regional variations in Medicare’s average lifetime expenditures per enrollee to achieve identical health outcomes. In Miami, these expenditures are $50,000 more per typical enrollee than in Minneapolis (Wennberg 2002). The question is not one of clinical efficacy, but one of political choice. Shall we bail out the Medicare Trust fund with dollars that might be allocated to education, health care for children, or roads and bridges? Shall we instead shift a significantly larger share of health care expenditures to the Medicare program’s beneficiaries? Or shall we shape Medicare’s benefit and provider payment structures in ways that accommodate a chronic disease paradigm?
Gunnar Almgren holds a PhD in Sociology (Demography/Medical Sociology) from the University of Washington, an M.S.W. from Portland State University, and an M.A. from Pacific Lutheran University. He is an associate professor and director of the PhD Program in Social Welfare at the University of Washington. His primary research and teaching interests are in social stratification, health, and health care policy.
References
Anderson, G., & Knickman, J. R. (2001). Changing the chronic care system to meet people's needs. Health Affairs, 20(6), 146-160.
Social Security and Medicare Boards of Trustees. (2008). Status of the Social Security and Medicare Programs: A Summary of the 2007 Annual Reports. Retrieved February 11, 2008, from http://www.socialsecurity.gov/OACT/TRSUM/trsummary.html
Congressional Research Service. Medicare Part A: History of Trust Fund Insolvency Projections. Report Order Code RS20946. Library of Congress, Washington D.C. March 28, 2008
Wennberg. 2002. Geography and the debate over Medicare reform. Health Affairs. Suppl Web Exclusives: W96-114.
Elders and Their Caregivers: A Student’s Reflections
By Thao Phan
I began my journey in working with older adults and their health care at Asian Counseling and Referral Services in Seattle. In the Aging and Adult Services department, I saw many Vietnamese elders in the community who needed in-home care services and case management because their families were too busy and/or did not speak English to advocate for them through the complex systems of hospitals, nursing homes, Medicare, and Medicaid. This showed me that there was a great need for social workers to work with elders, especially those who did not speak English.
It also made me aware that for my professional development, I needed to learn about different settings and environments, such as nursing homes, assisted living facilities, and hospitals serving elders with complex health care needs. This would allow me to see the full picture of what elders may experience and the kinds of advocacy needed when navigating through health care systems. I next sought out the opportunity to acquire the experience in working with a new population in the Department of Veterans Affairs (VA).
My advanced practicum placement is currently at the VA Puget Sound Health Care Geriatric Research Education and Clinical Center (GRECC). The GRECC seeks to integrate psychiatry, primary care, and research to provide comprehensive care for older veterans. I work with patients who are using primary care and/or psychiatry. The veterans benefit from doctors and psychiatrists who are knowledgeable in geriatrics and who work together for the patient’s care.
At the VA, I have learned about not only the inner workings of a hospital and the latest research on diseases and other issues related to aging, but also the connection between policy and patient services and care. For example, because of ongoing budgetary issues, the primary care clinic is being phased out, which will negatively affect both veterans and their caregivers. I believe that policy makers in the future will likely recognize the importance of having this primary care clinic and may want to re-open it. I have also benefited at the VA from the different ways of communicating and connecting with patients who are not similar to me.
One of the things that I often notice is how caregivers of veterans do not identify themselves as caregivers. They focus so much on the veterans that they put themselves second. For example, when I call caregivers to ask how they are doing, the conversation shifts back to the care and well-being of the veterans. I believe this is an unbalanced partnership.
Social workers, care providers, and caregivers need to recognize that caregivers themselves need care. Without caregivers, many care plans for elders would easily unravel. I hope that in the future, I will have a chance to be involved in a program that recognizes the importance not only of elders, but also of their informal caregivers - family, friends, neighbors—who are central to their care and that will conduct comprehensive assessments of the family unit instead of only the individual.
Thao Phan is a current MSW Advance Standing student at the University of Washington School of Social Work. She is in the direct practice concentration specializing in gerontology. She is completing her practicum placement at the VA Puget Sound Health Care in Seattle, WA.
Specialized Gero Funding Applications Due in April
The Friday, April 10, 2009 deadline to apply for the Specialized Gerontology Program, the newest funding opportunity from the CSWE Gero-Ed Center, is only two months away!
The Specialized Gero Program, a 2-year program starting July 1 2009, provides funding to BSW, MSW, and BSW/MSW programs to develop, implement, and institutionalize a minor, area of emphasis, certificate, specialization, or concentration in gerontological social work. Applications will be accepted from CSWE-accredited BSW, MSW, and combined BSW/MSW programs that have gero content currently infused in foundation courses.
For program and application details, download the Request for Proposals (RFP) and Frequently Asked Questions (FAQ) from the Specialized Gero Program Web Page.
2009 APM Call for Proposals Now Open
The CSWE Gero-Ed Center encourages you to submit your aging-related proposal to the 2009 CSWE Annual Program Meeting (APM) Gero-Ed Track. Proposals are due by Sunday, March 29 at 11:59 pm, EST. Only online proposals will be accepted. To have your proposal considered for the Gero-Ed Track, select the “Gero-Ed (Aging and Gerontology) Track” option. We recommend that you review the updated Gero-Ed Track description when considering your proposal.
The 55th APM will be held in San Antonio, TX, November 6-9. The Gero-Ed Center will continue its tradition of hosting several special sessions and exciting events, including the popular Film Festival. For more information on the Gero-Ed Track, visit the APM Gero-Ed Track Page.
Events Commemorate GSWI 10th Anniversary
Since 1998, the John A. Hartford Foundation has invested $64.5 million in the Geriatric Social Work Initiative (GSWI). CSWE Press is publishing Transforming Social Work Education: The First Decade of the Hartford Geriatric Social Work Initiative, a book edited by Nancy Hooyman in recognition of the Hartford Foundation's 10 year commitment to gerontological social work through the GSWI.
The book will be released at The National Association of Deans and Directors of Schools of Social Work (NADD) Spring Conference with a luncheon sponsored by the Hartford Foundation on Monday, March 16 from 12:00 pm -1:30 pm.
GSWI will further celebrate the book release at The Association of Baccalaureate Social Work Program Directors (BPD) Annual Conference during the Workshop and Special Session for the Mit Joyner Gerontology Award on Saturday, March 21 from 3:00 pm – 4:15 pm.
For more information on this milestone, read History of Hartford GSWI at CSWE, published in the June 2008 issue of Aging Times.
Master's Advanced Curriculum (MAC) Project Celebrates Second Successful Year
The MAC Project achieved remarkable goals in its second year, which ended December 31, 2008. Through two initiatives, the Gero Innovations Grant (GIG) and the Resource Reviews, social work educators and researchers across the country have worked successfully to enhance the advanced curriculum areas of mental health, substance use, and health with aging-related competencies.
The 14 GIG grantees continued to create and implement innovative curricular resources for the three MAC Project specialty areas, which will be widely disseminated in the future. A paper session at the 2008 CSWE Annual Program Meeting (APM) showcased a selection of the innovations including videos, case studies, and other pedagogical resources that will be posted on the MAC Project Web site.
At the same time, national experts in health, mental health and substance use joined forces to review the available resources in the three MAC specialty areas. The results of their work are available as Web-based Resource Reviews that include evidence-based curricular resources such as teaching modules, case studies, lecture notes, PowerPoint presentations, and annotations of teaching videos and online curricula. The MAC Project also sponsored a Faculty Development Institute at the CSWE APM with SAMHSA, showcasing these resources and demonstrating how faculty can include the evidence-supported content in their courses.
Now in its third and final year, MAC Project grantees, faculty, and staff look forward to disseminating and publicizing their work on advanced content areas and gerontological competencies. More resources will be launched at the 2009 APM!
Join AGE-SW or Renew Your AGE-SW Membership
There is still time to renew your The Association for Gerontology in Social Work (AGE-SW) membership for 2009 or sign up as a new member and receive the new membership benefit: 8 issues of the Journal of Gerontological Social Work (JGSW). In addition, you will also have access to the new “members only” section of the AGE-SW Web site, which contains a membership database, information on aging-related funding sources, and a job site where programs seeking faculty with aging relate backgrounds can post their job announcements for viewing by doctoral students on the job market.
Along with these exciting new benefits, two changes have been made concerning membership renewals. AGE-SW’s membership cycle will now be January through December and dues have increased slightly: $65 for new and renewing members, $35 for renewing student members, and $25 for new student members.
To renew your AGE-SW membership, please download and send in the membership form. For questions about membership, E-mail Tracy Schroepfer, Membership Coordinator for AGE-SW, or call her at +1.608.263.3837.