Scottish Government

Brian Kerr, Jean Gordon, Charlotte MacDonald and Kirsten Stalker
ISBN 0 7559 2860 1
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As part of the 21st Century Social Work Review, the Scottish Executive asked the Social Work Research Centre at the University of Stirling to review the evidence base for effective social work with older people. This short piece of work (conducted during July and August 2005) involved a review of various key texts and recent research.

Main Findings

• Older people do not require social work support simply because of their age. Age in itself is not a problem, pathology or indication of need.
• Social work with older people cannot be considered effective unless older people themselves are satisfied with it. Service users want to be listened to and respected as individuals. Many older people share traditional social work values, such as a concern for relationships, and appreciate social work skills. The social work process is important, as well as the outcome.
• Social care for older people is more effective when its intended outcomes are identified at an early stage - during assessment - and built into care planning. Older people must be closely involved in the process, with outcomes based on their wishes and priorities as far as possible.
• Older people like services which support them in various aspects of their lives, not just personal care and relationship needs. Low level preventive services are valued.
• Effective social work with older people should focus on intensive care management with those who have complex, fluctuating and/or rapidly changing needs. Pressure to manage budgets and establish eligibility must not reduce social workers' capacity to engage with the older person and use the full repertoire of their skills in a holistic way.
• There is much scope for a positive, proactive approach to social work with older people, for example through income maximisation, promoting individual strengths and capacity, and helping people rebuild confidence and networks following loss or change. Anti-ageism is an essential element, while issues of gender, race, class and ethnicity must be taken into account.
• Social workers bring a unique mix of skills and expertise to situations of complexity, uncertainty and conflict. These include a 'whole system' view, engaging with the older person's biography, supporting individuals and families through crises associated with loss or transition, helping to ameliorate the practical impact of change and challenging poor practice.
• Social workers must work creatively with risk. They need finely tuned skills to achieve the 'right' balance between promoting self determination and independence for the older person while, at the same time, ensuring that vulnerable individuals have adequate protection.

Study aim

The aim of this study was to review, as far as possible in 6 weeks, the evidence about effective social work with older people.

Needs for social work

Older people do not require social work support simply because of their age. They are not an homogenous group with a single set of needs. This study has highlighted the potential limitations of categorising older people as a separate service user group, as if different from other adults. Many people come to social workers' attention for the first time following the onset of illness or frailty in old age. Others may have experienced difficulties during adult life which are exacerbated, or combine with adverse circumstances, as they grow older.

Process and outcomes

The effectiveness of social work, like other professional activities, is increasingly judged by its outcomes. However, meeting clinical and financial targets is not sufficient: social work cannot be considered effective unless older people themselves are satisfied with its outcomes. One approach which has proved effective is to involve older people, during the assessment process, in identifying desired outcomes and then to build these into care planning. Where possible, effective social work will aim to bring about positive change rather than simply maintaining the status quo. For older people, the social work process is also important. Many share traditional social work values, such as a concern for relationships.

Older people value services which can support them in all aspects of their lives, not just with personal care and relationship needs. Low level preventative help, like housework and gardening, enhances quality of life and helps maintain independence. However, these tasks do not require qualified social workers.

Key tasks, values and skills

Effective social work with older people should focus on the key tasks of assessment, intensive care management and review for people with complex, fluctuating and/or rapidly changing needs, as distinct from the provision of social services to the majority of older people who have relatively straightforward needs. Social work managers should ensure that, within care management, pressure to manage resources and establish eligibility does not reduce individual workers' capacity to engage meaningfully with older people, using the full repertoire of their skills in an holistic way.

There is much scope for social workers to adopt a proactive approach with older people. A substantial number of older people live in poverty or face financial hardship. Where appropriate, effective social work involves income maximisation, combined with a sensitive approach to discussing financial matters. Promoting individual strengths and resilience, and helping people to regain their confidence or rebuild social networks after periods of transition or change, are other examples of positive approaches to work in this field.

The evidence shows that older people routinely face discrimination, for example, through stereotyping and denial of opportunities available to other adults. Anti-ageism is an essential part of effective social work, along with consideration of issues of gender, race, disability and sexual orientation.

Social workers routinely operate in situations of complexity, uncertainty and conflict. These call for a mix of practical skills - such as securing resources, co-ordinating care packages, negotiating contracts with service providers - and 'people' skills, including sensitive communication and listening, starting where the older person is, taking time, and supporting people through crises.

Old age may be marked by experiences of loss, change and transition. Social workers need a good understanding of the significance and impact of life course transitions and should see the older person in the context of his or her life history. Work with older people requires of social workers an ability to engage sensitively and effectively with people approaching the last years of their life, and who may be near to death. The social work contribution to palliative care includes supporting the older person and the family through loss and bereavement, taking a 'whole system' perspective, ameliorating the practical impact of change and attending to emotional and spiritual struggles.

Social workers engage with older people facing various types of risk, including those who are being abused and those who, because of dementia, are no longer aware of everyday dangers. Effective social work in these situations demands a finely tuned balance between promoting independence and self determination - core social work values - while simultaneously providing adequate and sensitive protection. Here, social work tasks include building trust and support, assessing risk and vulnerability, and providing information about - and opportunities to discuss - different options.

There are various situations where social workers are legally required to intervene in people's lives, for example, under the new mental health legislation, the Adults with Incapacity Act and other initiatives to improve the protection of vulnerable adults: the evidence suggests that these statutory duties are generally performed well.

There is evidence about the effectiveness of social work in a range of settings. For example, social workers in hospitals and other health care settings are well placed to identify and respond to the needs of older people. Research has shown that deploying social workers in Accident and Emergency wards is of benefit to older patients. In health care settings, it has been found that multi disciplinary teams led by social workers are particularly effective in matching individual needs to services.

The context of social work with older people

The Scottish Executive has not issued a framework specific to working with older people, as it has for other service user groups, but integrated services and teams have developed nationally. Critics have warned that there is little theoretical basis for this approach. The Interim Report of the 21st Century Social Work Review notes that social workers in integrated teams have varied experiences of their effectiveness and that clarity of roles and responsibilities, coupled with good support, are essential.

Conclusion

Social workers with older people require a strong core base of generic social work skills and values on which specialist knowledge and skills can build. Their distinctive and effective contribution to work with older people lies in an ability to address complexity of need, combined with a holistic approach and anti-ageist value base. This combination provides a solid foundation for one of the most stimulating and rewarding of all the fields in which social workers practice.

About this study

The objectives of this short study were as follows:

• to identify effective and desirable outcomes for older people, including outcomes desired and defined by older people themselves.
• to identify the distinctive skills required by social workers in order to achieve desirable and effective outcomes
• to draw out and discuss the implications for future policy and practice in this field.

The researchers looked at effective social work with older people with a range of needs and conditions. Desirable outcomes in a variety of domains and settings were considered.

The work involved a review of various key texts and recent research. In the short time available, it was not possible to conduct a systematic study nor a comprehensive literature review.

If you have any enquiries about Research Findings please contact:

Tel: 0131 244-0316
Fax: 0131 244-5581
Email: recs.admin@scotland.gsi.gov.uk
Website: www.scotland.gov.uk/insight

On-line copies

This Research Findings along with a full report
also web only which accompanies this Research Findings can also be downloaded from the Publications section of The Scottish Executive website www.scotland.gov.uk.

Other Research Findings and Reports and information about social research in other departments of the Scottish Executive may be viewed on the Internet at: http://www.scotland.gov.uk/socialresearch

The site carries up-to-date information about social and policy research commissioned and published on behalf of the Scottish Executive. Subjects covered include transport, housing, social inclusion, rural affairs, children and young people, education, social work, community care, local government, civil justice, crime and criminal justice, regeneration, planning and women's issues. The site also allows access to information about the Scottish Household Survey.