Social Workers

While not all elderly persons will require long-term care services, age is a very strong predictor of the need for both acute health and long-term care services, and the number of persons aged 85 and over is projected to increase five-fold by 2050. If recent trends continue, experts predict that the number of persons requiring long-term care services (i.e., skilled nursing care, alternative residential care, or home and community-based care) could increase from approximately 8 million to 19 million in 2050.2, 3 This will no doubt increase demand for long-term care workers, in general, and for professional social workers specifically, because they provide critical services such as care coordination, case management, mental health services and supports, government program eligibility determination, care giving support and counseling.

DEFINITION OF LONG-TERM CARE

Long-term care is generally defined as the array of medical, social, personal care and related services designed to meet the needs of people living with chronic health problems that limit their ability to perform everyday activities. The need for long-term care services is frequently determined by one’s need for assistance with activities of daily living (ADLs) and/or instrumental activities of daily living (IADLs). ADLs refer to the basic self-care tasks of everyday life, such as eating, bathing, dressing, toileting, and transferring.6 IADLs refer to more complex tasks associated with independent life such as shopping, housekeeping, doing the laundry and money management. Long-term care may also be defined in terms of the settings associated with care delivery–institutional, residential, community or home–although what specific services or entities are included in each category may vary widely. For the purposes of this report, long-term care settings are comprised of nursing facilities, other residential care (e.g., assisted living, group or congregate living facilities), home health and selected community-based settings (e.g., adult day health and multi-purpose senior centers as specified in the North American Industry Classification System or NAICS).

PROFESSIONAL SOCIAL WORKERS AND THEIR ROLES IN LONG-TERM CARE SETTINGS

Social workers who have completed specific course work and field work in aging (typically at the master’s level) represents one of the fastest growing segments of the profession. These workers address a broad array of problems uniquely facing elders and their families, including functional impairment, psychological problems or cognitive impairments, grief and loss, legal and ethical issues, and end of life concerns.⁷

Social workers with a bachelor’s degree in social work tend to be employed in long-term care settings at a higher rate than those with an MSW. A 1995 survey of social work practitioners revealed that 1% of respondents with an MSW were employed in nursing homes or hospices and that 3.7% identified services to the aged as their primary practice area.⁸ In contrast, respondents with a BSW indicated that 11.5% worked in a nursing facility or hospice setting and 16.5% identified services to the aged as their primary practice area.⁸ Although there is no clear explanation for this differentiation in the literature, it is most likely related to the complex interplay of financing and reimbursement of social work services in general and/or the lack of a statutory distinction between BSW and MSW in fulfilling Medicare and Medicaid Conditions of Participation. In general, MSW-level social workers are specifically trained to provide counseling for complex problems, complete assessments, improve organizational functioning and perform other complex tasks that social workers with a BSW are not trained to do.

Social worker responsibilities vary widely, depending upon the setting, and their role(s) in that setting. Social workers seek to help people across the life span function better in their environments, identify and cope with problems and improve relationships with others.^5, 7 Social workers may be distinguished from other “helping professionals,” including nurses and psychologists, through their knowledge of community resources, their focus on client strengths (rather than pathology), skills in engaging the client and use of the person-in-environment (P-I-E) framework^c for assessing and addressing psychosocial, psychological and social problems,⁹ and their pursuit of social change on behalf of vulnerable populations, such as long-term care residents.

According to standards promulgated by NASW in 2003,¹⁰ social workers in long-term care settings should focus on several key areas, including:

• the social and emotional impact of physical or mental illness or disability,
• the preservation and enhancement of physical and social functioning,
• the promotion of the conditions essential to ensure maximum benefits from long-term health care services,
• the prevention of physical and mental illness and increased disability, and
• the promotion and maintenance of physical and mental health and an optimal quality of life.

When bachelors and masters-level social workers are employed in the same long-term care setting, it has been reported that BSWs and MSWs typically have different, yet complementary responsibilities. Barth’s 2001 study of BSW and MSW employment markets indicates that these workers rarely compete with one another for jobs.¹¹ For example, a social worker with a BSW in a nursing home might serve as a discharge planner for short-stay residents in a post-acute unit, while a social worker with a MSW might provide clinical supervision of the BSW as well as counseling and other behavioral interventions to long-stay residents and their families.

Source: https://aspe.hhs.gov/basic-report/supply-and-demand-professional-social-workers-providing-long-term-care-services-report-congress