Bridging gaps beyond physical care needs

Social work is central to integrated holistic health and wellbeing, contributing to the overall quality of life of older adults living in aged care facilities. We have supported aged care homes in enhancing the holistic wellbeing of the individuals within their facilities by addressing the biopsychosocial-spiritual needs of the whole person.

Investing in support for new aged care residents helps to address Aged Care Quality Standards 2 and 3. Transitioning into an aged care home marks a significant life event, often coinciding with major life changes, such as declining health, dementia, or the death of a spouse. Departure from the family home and altered family dynamics can also profoundly impact the wellbeing of older adults.

Social workers, skilled at supporting complex social issues and life transitions, can provide early intervention and expertise that not only navigate multifaced challenges but also prove to be preventative, ensuring older adults receive comprehensive and person-centred support early in their transition to aged care. 

Social workers approach their role with a systemic perspective, valuing the autonomy, social connectedness, and competence of older adults. Jane, an older adult in a Melbourne aged care home, received support from a social worker soon after moving into the home. Collaboratively, they identified strategies that gave Jane a sense of purpose, allowing her to spend her days crocheting toys for donation. She expressed, “with the support of my social worker…all of my creative genes are coming back”.

Promoting consumer dignity and choice

For residents, the first standard is about feeling treated with dignity and respect and being able to maintain their identity. But older adults transitioning to aged care commonly experience a loss of personhood, autonomy, and independence. “Just because I moved into aged care does not mean I am stupid or useless,” said one female resident.

Assumptions about their cognitive abilities influence how others speak to them, leading to feelings of invisibility and distress. One woman stated, “When I moved into [the facility], the care staff automatically assumed I had dementia”, which caused considerable anguish.

Infantilisation, a facet of ageism, poses a challenge; older adults express frustration when told what to do, when to do it, not being heard, or addressed with terms like “dear” and “love.” This frustration intensifies when feedback is disregarded, especially when it is assumed they have a cognitive impairment. These experiences compromise dignity and choice, fostering disempowerment. Recognising that cognitive impairment doesn’t erase one’s emotions, experiences, or the right to be heard is crucial.

Social workers support and advocate for older adults through facilitated group work and individual support, providing a safe space for sharing stories, expressing feelings of loss, sadness, anger, and frustration, thus validating their experiences. Social workers communicate these concerns to the facility and offer staff training and education to address knowledge gaps.

Social connection

Understanding the person, their needs and individualised support targets standards 1 and 3. Social connection is crucial to overall wellbeing and quality of life. Social workers focus on individuals and their social networks to identify support for their social, emotional, and mental health.

Family can encompass chosen friends rather than the blood that flows through our veins – a bond of mutual affection, reciprocity, respect, kindness, and honesty. Social workers support a person to remain connected with their identified positive social network, which is invaluable for their mental health and wellbeing.

Each individual embodies a complex web of values, experiences, emotions, cultural perspectives, and unique worldviews. Care staff may lack the expertise or time to delve into these individual stories.

When an older person exhibits anger, tears, outbursts, or care-related grievances, they might be perceived as displaying behaviours and subsequently ignored to prevent reinforcement.

Social workers aim to understand the root causes of a person’s behaviour, exploring situations holistically and systemically to enable individuals to feel heard, potentially resolving issues, and helping care staff understand the context.

Social workers are skilled in listening, which sounds simple but requires knowledge and expertise. An older veteran with little time left to live shared to staff before he died, “that woman [social worker] who came to visit listened to me and it made a difference”. This is critical to person-centred care for quality of life.

Facilitating independence

Supporting an individual’s autonomy addresses standards 2 and 4. Experiencing legal or financial concerns can induce anxiety, especially when one lacks support.

One man fearing financial abuse by his enduring power of attorney had his concerns assessed by the social worker who worked with the facility manager, leading to external advocacy intervention. Social workers empower older adults, providing practical interventions outside the scope of other staff members.

Supporting staff creates a win-win situation

Social workers play a crucial role in identifying issues related to self-determination and the importance of autonomy regarding medical processes, access to information and medical care.

An older adult expressed frustration with medication management, highlighting a lack of involvement in the process. In the community, she had full insight and control but in residential care, this autonomy was lost, causing frustration and a sense of powerlessness. With social work support, she was able to regain self-determination.

Social workers educate staff about grief, loss, trauma, mental health and suicidal ideation. Reflecting on her experiences, a social worker conveyed that staff often express uncertainty about navigating situations involving the death of a spouse or close relative or when an older adult reveals a desire to die.

Supporting staff creates a win-win situation, ensuring they feel safe and supported while enhancing emotional support for older adults.

Overall, social workers offer value-added support that ultimately enhance the service offerings of aged care homes as well as facilitate the achievement of better-quality outcomes that align with the aged care quality standards.

Erin Beatson is working as a mental health clinician for Lutheran Services, providing onsite therapy to residents at six aged care homes in central Queensland

Merrilyn Bowers provides contract individual and group social work services in residential aged care, where she also supervises social work students

Judith Groube is a mental health social worker in private practice working across Far North Queensland, whose roles include providing the psychological therapies program in residential care

Dr Fotina Hardy – who has over 40 years’ social work experience in direct practice, research, policy and academia –  provides contracted social work services in residential aged care, where she also supervises social work students

Felicity Savage is a residential and community aged care social worker with Lutheran services in Brisbane

Jo Wood – a clinical social worker specialising in palliative care, mental health and bereavement – provides counselling and casework support to aged care residents, and supervises master’s students at Swinburne University

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