Under Pressure: social work with older people
Laura Noszlopy (University of Birmingham)
This winter social workers are facing huge challenges to support over 65s, dealing with complex cases at the intersection of our health and social care systems. Laura Noszlopy, Research Fellow at the University of Birmingham, shares emerging findings from fieldwork currently being undertaken by her and colleagues on the Social Work with Older People (SWOP) project.
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.’
ON THE GROUND WITH SOCIAL WORKERS THIS WINTER
Social workers are at the heart of health and care, working with people as they face their biggest health and personal struggles. Our Social Work with Older People project is in a unique position to observe how social workers respond to mounting pressures as we head into winter 2022/23. For six months between August and January, we are shadowing a cohort of social workers who work with the largest group of NHS and social care users – people over 65.
We are in hospitals, community services and homes, observing what social workers do, listening to their perspectives and to the experiences of the older people with whom they work; we’re also meeting and speaking with family members and carers, and the other professionals involved in often complex situations. Through a series of snapshots, we hope to get a full 360° view of what social workers do, and to explore the difference this makes to the lives and wellbeing of older people.
It’s early days for the research, but we are already starting to understand the extent of a social worker’s workload. Somehow, despite working with multiple situations at any given time, they ask the right questions and listen carefully to get to know the personal needs, desires, and context for each individual. They keep in mind medical concerns, family relationships, and financial circumstances, as well as sources of support –religious communities, hobbies, friendships – that can help people to lead a fulfilling life for as long as possible. There are assessments, reviews, and forms to complete, but talented social workers blend these into informal conversations, removing some of the worry from unfamiliar and potentially unwelcome situations.
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.
L Noszlopy (2022) Under Pressure: social workers and older people, NIHR School for Social Care Research Blog, 12 December 2022