Social Work in Long-Term Care

Social Work in Long-Term Care Social work has a long history of playing a significant role in the provision of care for persons in long-term care (primarily, however not exclusively, for the elderly within personal care homes, chronic care facilities, and rehabilitation centres). Social workers practice collaboratively with various professionals within a health care setting.

In most regions, health care facilities employ social workers with a minimum Bachelor of Social Work degree. Most social workers participate in ongoing professional development to enhance their knowledge and skill base.

The primary mandate of social workers within long-term care is to advocate on behalf of residents and their families. Their focus is on the social and emotional impact of physical and mental impairment, preservation and enhancement of physical and social functioning, and promotion of physical and mental health towards and optimal quality of like. Emphasis is on building upon existing strengths, enhancing adaptations, and modifying risks that interfere with optimal quality of life.

Social workers play a key role by:
• Responding to enquiries and providing education to persons in the community regarding the current health care system as well as assisting clients in navigating services;
• Providing psychosocial expertise in aspects of care (for example, in helping staff and resident alike to deal with the difficult issues of dying and death as well as emotions such as guilt, anger, and fear);
• Supporting, developing, or implementing innovative programs;
• Enhancing residents’ care, including promoting holistic approaches, maintaining therapeutic relationships with residents and families and providing specialized individual and family counseling, engaging in resident advocacy, family support groups, family councils, and resident councils, and co-ordinating with other community services;
• Promoting a positive atmosphere and attitudes and playing a leadership role in counteracting stereotyping, stigmatization, and discrimination;
• Sharing responsibility for educating residents, families, and staff colleagues and for challenging the status quo when advocating on behalf of residents.

Social work services provided during the various phases of residency – pre-admission, admission, residency, and discharge, transfer, or death – are essential to the well-being of residents in long-term care and their families.

Pre-Admission Phase
The social worker is often the first contact a resident or family will have with the facility. The prospective resident and family members are beginning the difficult task of dealing with their feelings about long-term care placement. The social worker provides a tour and information about the facility, assesses the resident’s needs, and begins to establish relationships with the resident and family members that will evolve over the course of admission through to discharge.

Admission Phase
Helping the resident and family members become familiar with the facility and its resources is essential to their future adjustment and well-being. The social worker co-ordinates the admission process for all new residents, acting as a liaison between the resident/family and any involved community agency. During the post-admission period, many residents and family members need adjustment counseling. Intensive social work intervention may be required at this stage:

• Providing support (counseling, mediation, advocacy) to a resident and family members who are struggling with placement;
• Helping families redefine their role and relationship;
• Completing social history and psychosocial assessment;
• Providing education to residents and family members regarding advance care directives and health care decision making;
• Assisting in mediation and conflict resolution as issues arise;
• Facilitating and ensuring participation of the resident and the family in the initial care conference and in care planning.

Residency Phase (ongoing care)
The social worker’s role in working with residents and their families during this phase is to facilitate the resident’s comfort within the new environment as he or she strives to retain identity and maintain autonomy:

• Advocating planning centred on residents and their families;
• Working with the client and the team proactively to solve interpersonal or behavioural issues a resident may be experiencing;
• Locating and arranging resources, utilizing the social worker’s ability to understand how systems interact and what resources are available for the resident;
• Mediating concerns that may arise between the resident and family or team.
• As a multidisciplinary team member, participating in ongoing care planning, involving the resident and family as much as possible.

Discharge/Transfer/Death
The social worker facilitates the resident’s return to the community or transfer to another facility where applicable. The resident and family members may also require grief counselling during the final stages of life or at death.

Prepared by:
Manitoba Association of Personal Care Home Social Workers