Beyond measurable outputs: What matters in social work practice with older people?

Valerie D'AstousVal D’Astous is a PhD candidate at the Institute of Gerontology, King’s College London. (969 words)

As I walked past a small group of men for the second time, in search of the location, a cheery, ‘Can we help you luv?’ was offered. Paper in hand with the address, I knew I was close, but gladly accepted their offer. Two gentlemen ended up walking me around the corner to the place I was seeking, the Burrell Street Sexual Health Clinic. ‘Hope all goes well for you,’ one gentleman wished me, as I thanked them and said goodbye. I laughed as I entered the building, the site for the Making Research Count Conference: Rethinking Social Work Practice with Older People: Threats and Opportunities. I knew I was in for a great day!

Diversity, demographics and discrimination

The focus of the day was the important and essential contribution social workers bring to lives of older people and their families. Alisoun Milne, Professor of Social Gerontology and Social Work at the University of Kent set the stage for the day by identifying the diversity of older people, including their widely differing life experiences, the range of social inequalities, disabilities, cultures and sexual orientation. The older people with whom social workers engage often have multiple, complex, fluctuating or rapidly changing needs and may themselves be carers.

Although this rapidly expanding older population forms a majority in society, a minor amount of support and resources is allocated towards their care. Additionally, the demographic shift in age of the population is set within the context of an ageist society that serves to further disadvantage and discriminate against older people. Correspondingly, old age stigma is transferred to the people who work with and for them, in that their work is not valued, visible or understood by others.

Social worker skills

Sally Richards took up the torch to illuminate the important role and specialized skill set social workers bring to their engagement with older people. Social work education, research and practice inform individualised, integrated care of the older person, set within the individual and family context, considering diversity, heterogeneity and a lifecourse holistic perspective. Social workers’ engaged communication and ability to hear what is and is not said, forms a user-centred approach to understand the strengths, limitations, preferences and aspirations of the older person. Skills of assessment, support planning, negotiation with other agencies, reviewing needs, practical guidance, psychotherapeutic care and advocacy place social workers at the heart of older people’s best interests.

Social workers’ inter-professional working ability make them effective, essential members of the multidisciplinary team working to maintain and enhance the wellbeing of older adults. It is the unique partnership with individuals, families and the collaborative nature with other community resources that enable social workers to achieve an unparalleled imaginative response to the needs of older people. Moreover, having a social worker as a consistent single point of contact with a familiarity with the individual situation is highly valued by older people, carers and families.

Research Bites

The afternoon ‘Research Bites’ connected research to practice, presenting findings with applicability. Fifteen minute presentations on the topics of loneliness, enhancing lives of older carers, the Developing Evidence-Enriched Practice (DEEP) project, dignity and self-funding care offered energising take-away knowledge.

Mary Pat Sullivan’s research emphasized that loneliness is difficult to define and measure; is not a constant state and means different things to different people. She identified the consequences of being lonely in later life and reported there is limited evidence that current interventions are effective.

Alisoun Milne addressed the role older carers provide and the impact of caring in later life, as well as the evidence of efficacy and support. Of particular significance was recognising that older carers often view their lifecourse as a ‘shared’ one in which their relationship is embedded. Supporting both the carer and cared-for requires the specialized skills, nuanced assessment and depth of knowledge social workers have to ensure effective, personalised support and safeguarding are delivered.

Nick Andrews presented findings from his appreciative-action research in health and social care services for older people across six sites. This captured the voice of service users and carers in accessible, engaging formats focusing on what mattered to participants. He highlighted the value of seeing the person behind the diagnosis and the opportunity for older people to give as well as receive.

Through qualitative quotes Liz Lloyd’s research on dignity presented the effects of age and illness on dignity and how the knowledge, skills and values of social workers have a positive impact on understanding and maintaining the dignity and respect of older people. Moreover, social work core values of human rights and advocacy contribute to raising awareness and understanding of the complex challenges of ageing.

Denise Tanner’s presentation concluded the ‘Research Bites’, underscoring the difficulties experienced by older people of self-funding care in later life. She stressed the complexity of navigating the system alone and called attention to social work duties of assessment, carer support, information and advice that may be needed by older people who are self-funding.

What matters

So, at the end of the day, ‘What matters in social work practice with older people?’, the message was loud and clear. It’s the big things and little things. The social worker’s role of advocating and safeguarding the wellbeing of older people, and their knowledge, places them in a leadership role as a member of the multidisciplinary support team. Yet it is also their exceptional skill set and fundamental values that are unparalleled in providing persistent, committed, reliable, respectful and empathetic support for older people. The listening and the efforts made to meet preferences and needs exceed measurable outcomes and are often what matter most to the individual and family. Moreover, the evidence gathered from older people and carers, organisations, and research echoes the value of the quality of the relationships, the knowledge and skills social workers bring to working with to older people.

Val D’Astous is a PhD candidate at the Institute of Gerontology, King’s College London. Her research focuses on the support needs of adults with autism post-parental care. She is passionate about translating research into practice. Val is also chair of the Emerging Researchers in Ageing (ERA) at the British Society of Gerontology. Follow @Valdastous