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Introduction

IT WAS JUNE 30, 2015, the last official day of a career in social work
that had spanned 41 years. As I closed the door to my empty office and
took one last look at the familiar yellow walls, now minus their pictures
and plaques, I was overwhelmed by memories of my clients—their expres-
sions of pain, frustration, anger, and yes, even joy when learning how to
successfully live with their personal struggles. That room had borne wit-
ness to some amazing stories.
The decision to become a social worker was not one that I made
early in life. For many women graduating from high school in the 1960s,
career choices were limited, and most became secretaries, teachers, or
nurses. My passion was fashion, so after graduation from high school,
I entered the Fashion Institute of Technology. I worked as a bridal consul-
tant until I got married and moved to Maine, where my husband began
his graduate studies. Located in Orono, a small town outside of Bangor,
the University of Maine was situated in a wooded area, with the smell
of the local pulp mill permeating the air. The opportunities for employ-
ment were limited, particularly in the fashion industry, so I took a job at
the university bookstore. By this time, I was reconsidering my original
plan to pursue a career in the fashion industry. The war in Vietnam and
the rural poverty that I saw in Maine made me realize that fashion was
not high on the list of societal priorities.
When a position as an interviewer for a research project became
available at the university, I made the life-changing decision to apply
for the job. The project was designed to evaluate maternal healthcare
services available to low-income women living on the small islands near
the town of Bar Harbor. My job was to travel to these islands, some only
accessible by small ferries, and interview women who had given birth
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2 Introduction

within the past 2 years. As I knocked on torn screen doors; sat in sparsely
furnished homes; and talked to the wives of lobster fishermen, worm
farmers, and laborers, I began to develop confidence in my ability to
listen with empathy and to understand their needs and concerns.
Although the spark had been ignited, it would be another 2 years
before I would be able to take the necessary steps toward becoming a
social worker. It was 1972 when I entered the bachelor of social work
(B.S.W.) program at SUNY at Buffalo (now commonly referred to as the
University at Buffalo), where my husband had taken a faculty position in
the sociology department. At the end of my first year, the time had come
to arrange an internship. While most of my classmates were requesting
placements in mental health settings or children’s services, I made the
decision to work with older adults. My experiences with older family
members, friends, and neighbors over the years had led me to develop
an interest in this population. My parents, who were both healthcare
professionals, had also exposed me to healthcare settings, where I had
frequently observed the neglect and poor treatment of older adults.
This was a time before the social work profession had begun to sig-
nificantly address the needs of older adults. With few exceptions, most
social work education programs offered no courses on geriatric social
work, and students were not encouraged to pursue a career in this field.
Although the School of Social Work at SUNY at Buffalo did not offer
any courses on aging, there was one faculty member who had an interest
in older adults, and he arranged an internship for me in a nursing home.
I was the only student in my B.S.W. class who expressed an interest in
working with older adults, and I found the negative reactions of my fel-
low classmates disappointing. It was an attitude that I would encounter
throughout much of my career in geriatric social work.
My internship site, the Episcopal Church Home for the Elderly, was
a nonprofit home operated by the Episcopal Diocese of Buffalo, located
on the city’s west side. The home’s resident population was mostly female
and ranged in age from 66 to 97, with most residents in their 80s.
Although it was still the custom for most older frail and ill adults to be
cared for by their families at this time, the nursing home was often the
only option for those without family support. Alternative levels of care
for older adults, such as assisted living and specialized care programs,
did not exist. The Episcopal Church Home was originally intended to
be a home for older adults without illnesses or disabilities. Requirements
for admission included being ambulatory and in fairly good health.
The Practice of Social Work with Older Adults 3

But, as the residents aged, many developed dementia, incontinence, and


the inability to walk without assistance. To meet residents’ increasing
needs, the Episcopal Church Home built an adjoining nursing facility
that could provide a higher level of care.
Considering that there were few men in the social work profession
and even fewer working with older adults, I was surprised to find that my
internship preceptor was male. I could not have chosen a better teacher or
role model. My preceptor’s genuine concern and respect for the residents
made a lasting impression on me. My internship at the Episcopal Church
Home not only provided me with a greater understanding of older adults
and valuable social work skills, but also strengthened my desire to work with
this population. Many of us enter the social work profession with the goal
of “saving the world.” Though a lofty goal, it is one that can easily lead to
personal and professional burnout. As I soon learned, however, satisfaction
can be found in improving the life of just one person. Below is a story from
my first year at the Episcopal Church Home. Throughout this book, per-
sonal stories and experiences from my career are presented as shown here.

A new admission to the Episcopal Church Home, Margaret had been


moved from her home in another state to Buffalo by her son. He had
promised his mother that her stay there was only temporary and that he
would eventually be moving her into his home to live with his family. After
several weeks went by, there were fewer and fewer visits by her son, who
kept postponing his mother’s move to his home. Margaret soon realized
that her son never intended to keep his promise and that his plan was
for her to remain at the nursing home. Feeling depressed and hopeless,
Margaret began refusing to get out of bed, get dressed, or eat.
Determined to brighten Margaret’s mood and facilitate her adjust-
ment to her new residence, I thought that taking her out for an after-
noon would give her some pleasure. The idea was not welcomed by
the nursing staff, as this was outside of the norm and they considered
it a lot of unnecessary trouble, but I persuaded them to get Margaret
dressed and help her into my car. As we drove away, I asked Margaret
where she wanted to go. She replied, “Take me to the water.” So off we
went, heading for the park at Lake Erie.
4 Introduction

On the way, Margaret asked if we could stop to pick up a soda and


a pack of cigarettes, pleasures that she had been denied at the nurs-
ing home. For about an hour, the two of us sat in the car on the water’s
edge, enjoying one of Buffalo’s rare sunny afternoons. Margaret spoke
very little as she looked out at the lake, sipping her soda and taking
puffs from her cigarette.
Later, when we returned to the nursing home, Margaret didn’t want
to budge from the car and end our afternoon. It was a struggle to get
her back inside that building, even with the assistance of nursing staff.
Two weeks later, Margaret died. Still, I took solace that she had enjoyed
some of life’s simple pleasures and a taste of freedom shortly before
she passed.

My desire to improve life for people like Margaret helped solidify


my resolve to embark on a career in geriatric social work. Following
graduation, I accepted a casework position at the Erie County Office for
the Aging. Several years later, when searching for a social work gradu-
ate program, I found that little had changed when it came to programs
that offered courses in geriatric social work. The year was 1977, and the
social work profession still had not embraced the geriatric client popula-
tion. Although it did not offer courses in geriatric social work, I chose
to attend Catholic University in Washington, D.C. to obtain my mas-
ter of social work (M.S.W.) degree. The incentive of a scholarship and
an advanced M.S.W. program for B.S.W. graduates (which meant that I
could complete my degree in 12 months) ultimately convinced me that
this school would be a good choice for my graduate studies.
Although I was unable to take courses on aging, I did have the oppor-
tunity to complete an internship at the Fairfax County Area Agency on
Aging, located in Fairfax, Virginia, where, as the agency’s first intern, I
participated in the development of several programs for older adults. Dur-
ing my internship, I also had the opportunity to produce a consumers’
guide to housing alternatives in northern Virginia and to develop and
conduct a research project that became the basis for my master’s thesis,
A Needs Assessment of the Elderly by Community Agencies and Organizations.

Several months after my retirement from social work, I received an


invitation to give a guest lecture at the University at Buffalo (UB), where
I had earned my bachelor’s degree in social work in 1974. The UB School
The Practice of Social Work with Older Adults 5

of Social Work had made a commitment to train social work students to


work with older adults and thought that, in sharing my experiences in
the field of aging and healthcare, I could provide some insight into the
many job opportunities that existed in this field.
To announce a retirement is on some level a way of stage-managing
one’s own legacy. As I prepared my lecture, I realized what a diverse and
wonderful social work career I had enjoyed and the changes that had
taken place in the profession of social work over the preceding 41 years.
Many memories, long forgotten, surfaced during those 4 days that I spent
in Buffalo. As I walked into the classroom to give my first lecture to the
small group of graduate students who were planning to work with older
adults, I realized that this was the same building where I had taken my
first social work classes over 43 years ago.
For the next 3 days, I had the opportunity to talk to the faculty, stu-
dents, and social workers from Buffalo’s community aging services and
programs. In addition to my presentation to the M.S.W. students, I also
gave a lecture to an undergraduate class, taped an interview with a fac-
ulty member for future use in the classroom, and met with advanced stu-
dents in the UB School of Social Work’s Hartford Partnership Program
for Aging Education. Driving through the city brought back additional
memories of the clients whose lives I had been inspired to improve with
my newly learned social work skills, people who had taught me lessons
that I would remember throughout my career. I started to write some of
these stories down, and the idea for this book was born.
My purpose for writing this book was to create an awareness of the
rewards and challenges of working with the geriatric population and the
opportunities that exist for social workers to improve the quality of life
for older adults. The book is written for social work students who are
making decisions about a practice specialty, as well as social workers who
are considering a move to geriatric practice or are now working with cli-
ents who are aging or caring for older family members. This book is also
a salute to and a resource for other social workers who are proud to call
themselves “geriatric social workers.”

About this Book


The chapters that follow provide a brief history of the social work profes-
sion and the development of geriatric social work (Section I); principles
for professional work with older adults (Section II); issues faced by older
6 Introduction

adults, about which the social worker must be knowledgeable to engage


in a successful and ethical practice (Section III); and settings and oppor-
tunities for geriatric social work (Section IV).
Following are some terms used commonly throughout the book:
• Aging: the lifelong process of growing older.
• Alzheimer’s disease: a degenerative disease that attacks the brain and
results in impaired memory, thinking, and behavior. Alzheimer’s
disease is the most common cause of dementia.
• Average life expectancy: the age at which 50 percent of the members
of a population have died, when plotted on a standard survival
curve. This statistic is normally calculated from birth but may be
recomputed in terms of expected years remaining at any age.
• Dementia: a syndrome characterized by a decline in intellectual
functioning. Dementia may be caused by more than 70 diseases,
the most common being Alzheimer’s disease.
• Demography: the study of a population and those variables bring-
ing about changes in that population. Variables studied by demog-
raphers are age, sex, race, education, income, geographic trends,
birth, and death.
• Generation: often used as a synonym for cohort, the term is also
applied within the context of the family (e.g., children form one
generation, their parents another, their grandparents a third).
• Geriatrics: the branch of medicine specializing in the healthcare
and treatment of older adults. It is defined by the World Health
Organization as the branch of medicine that is concerned with the
health of older adults in all aspects: preventive, clinical, remedial,
rehabilitative, and continuous monitoring.
• Gerontology: the multidisciplinary study of all aspects of aging,
including health-related, biological, sociological, economic, behav-
ioral, and environmental.
• Lifespan: the maximum lifespan of a population is the characteristic
observed age of death for its very oldest individual(s). Average lifes-
pan is the age at which 50 percent of the members of a population
have died.
The Practice of Social Work with Older Adults 7

• Longevity: the condition or quality of being long-lived.


• Medicare: a federal entitlement program of medical insurance
for persons aged 65 and over or with disabilities that is provided
through the Social Security system.
• Retirement: the period or life stage following termination of and
withdrawal from a regular job and from income from employment.
Retirement is often difficult to determine because some older per-
sons retire from one job and take another full- or part-time job.
• Social Security: a national insurance program that provides income
to workers when they retire or if they have disabilities and to depen-
dent survivors when a worker dies. Retirement payments are based
on workers’ earnings during employment.
The successes and challenges encountered in the practice of geriatric
social work are illustrated using practice experiences and real-life client
stories. Identifying information about clients has been changed to pro-
tect confidentiality.