The Future of Case Management for Older Adults
An excellent article from Scharlach and associates (2000) details the educational requirements for the human services worker
dealing with the older adult in this century. It
says “…social work is not adequately prepared to practice in the aging society.” The authors give a number
of suggestions to create the comprehensive education that gerontological social workers will need in their daily practice.
They bemoan a shortage current workers and of students being trained to work in
this field, yet acknowledge that the needs are increasing with the demographic shifts of society. Their research shows a “lack
of competence” among current workers with regard to aging issues. Another quote from this article: “...all social
work students should receive basic information about working with older adults.” But they state that only two percent
of MSW students (outside of those specializing in aging) take courses on aging during their Master’s work. They blame
it partially on negative attitudes towards the elderly.
Therefore, this article strongly suggests that all social work students have at
least some of their practicum devoted to older adults. According to their research, this greatly expands the number of students
who decide to work in gerontological social work. They also suggest a purposeful recruitment activity begin on campus to find
students who will want to be trained to work with the elderly.
Safford (1988) made a similar plea and proposed a great need for gerontological
training for occupational social work. Clear back in the late 1980s the demographic shifts were acknowledged and understood
with regard for the need to train social workers in aging.
In
fact, this article suggests that the need is also found in the workplace. As some employers have child care centers today,
Safford suggests that adult day care facilities and educational opportunities in aging will be a normal part of the workplace
of the future. He sees training employees in the aging process as an important benefit that employers can provide. Of course,
retirement planning would be a part of this benefit, but only a small part of the holistic education that will be provided.
Unfortunately, there has been very little progress on these concepts over the past 16 years.
As seen in the Appendix, the Care Management Resources that are suggested on the
web site of the National Association of Professional Geriatric Care Managers, Inc vary greatly in their composition, suggesting
that Geriatric Case Management is not only for health issues of the elder. Empowerment issues have not been well addressed
by current systems of delivery. All too often the service is done for the older adult instead for helping the older adult
through education and information.
It is acknowledged that some older adults may have organic brain disease or otherwise
be incapacitated to the point that they can do little for themselves. Ethically, even these individuals should be consulted
with before changes are made, even if they are not able to answer or acknowledge the wisdom of such changes. This follows
after the medical model wherein the doctor describes what he is about to do to lessen the fear and anxiety of the patient.
Gerontological social work should do no less, even if the patient is considered not capable of understanding.
For the client who does have legal capacity, of course it is required to ask them
for their opinions, concerns, desires, and objections. A person who becomes old does not automatically become senile. They
have a right to refuse treatment and a right to be part of the decisions made for their situations.
Family members, who provide a great amount of care for many older individuals,
are a part of the client/patient’s world and need to be included in decisions, but the ultimate decision should not
ordinarily be theirs, unless they have legal standing. Whenever possible the client/patient should be respected and the team
that the case manager coordinates should be harmonious in helping them.
It is most probable that for-profit case management will grow very quickly in the
21st century as the American population grays. Many clients employ case managers to avoid the stigma of welfare
programs or the fact that they do not qualify for such programs. The World War II Baby Boom Generation is especially likely
to be interested in such privacy as they have a history of prestige seeking. They have shown a massive impact on the markets
of America and there is no reason to believe that will change in their older ages.
To meet these needs, and the increasing diversity that is also a demographic expectation,
current students in human services, social work, and the like must have added understanding above that which has been the
prior practice. Much more aging information needs to be mastered and a much greater understanding of diverse groups will need
to be learned and appreciated. Curriculums need to be reviewed to come up to speed on these important changes.
