Under Pressure: social work with older people

My friend’s mother had a stroke, and her memory is failing fast; the family is struggling to secure a dementia assessment and she is anxious at the prospect of needing care. Last week, a close neighbour fell and broke his hip; he had to wait overnight for an ambulance. Another just made the hard decision to seek residential care for her ailing father in a faraway city; she knows he needs more support than she can obtain at home. All of them waiting and worrying. 

The last few years have been brutal for older people, and for the health and care systems pushed to unprecedented stretch by the impacts of the Covid-19 pandemic. The Covid reporting is muted now but concern remains high among medical and care professionals facing the impending winter crisis alongside the backlog. According to Sarah McClinton, Director of the Association of Directors of Adult Social Services (ADASS), recent surveys of local authorities ‘confirm our worst fears for adult social care. The picture is deteriorating rapidly and people in need of care and support to enable them to live full and independent lives are being left in uncertainty, dependency and pain.’  

HOW SOCIAL WORKERS 'GET THINGS DONE'

In this way, social workers gently explain risks and rights to older people and their families, helping them to make sage decisions that work in their best interests. There is a constant effort to balance the desire for independence with the need to keep people safe and well. They explain in simple terms mental capacity law and other legislation that exists to protect the rights and wellbeing of citizens – matters that most people won’t know about until they find themselves faced with difficult decisions at a time of crisis.  

The work requires great communication skills, explaining complex processes and options in straightforward terms. Social workers help people navigate the often-opaque terrain of the adult social care system – the options available, financial costs and implications, available support, and range of possible outcomes. When necessary, they also seek compromise between the needs and concerns of older people and their family members or carers. 

So far, social workers tell us that their formal social work training couldn’t prepare them for all the practical multitasking they have to do: the endless phone calls, negotiating with care homes, bargaining for a suitable placement, pitching for funding approval, arranging drivers (of ambulances, taxis, and vans delivering furniture and mobility equipment), organising a house clean, and negotiating between family members. These are all part and parcel of the social workers’ daily activity. They shift gears constantly to “get things done” so that older people can be safe and well at home or leave hospital when physically ready.  

Any of us and anyone we love may need support in our later life. For many, it will be a crisis situation – a fall, a hospital discharge, a diagnosis of dementia – that will precipitate their first encounter with a social worker. In our research we are seeing how social workers help older people thrive, by supporting informed decision-making, signposting and navigating the care system and the options for funding, assessing and assuring their safety and wellbeing in the most appropriate place. They are the guide through a difficult and risky time: often an advocate and negotiator, or a family mediator, always a problem solver and lateral thinker, and a finder of practical solutions – despite the pressures and limited resources they grapple with every day.

Read more about the project on the SWOP website.