Healthcare , the Elderly, and HospiceUnit 7

Dr. Bradley

Did you know that Human Service workers can work in the Health Care Industry?

Examples?

Human Services in Hospitals Psychosocial assessments Post discharge follow up Providing information and referrals Consultation Pre-admission Planning Outpatient care Discharge Planning Patient and family

conferences Psychosocial Counseling Case

management Financial Counseling Referrals to

support groups Health Education Trauma response

Crisis and Trauma Counseling

A big part of a medical social worker’s job is to provide crisis and trauma counseling to patients and their families.

Maslow’s Hierarchy of Needs is a good model for how to approach a family in crisis

Why?

When people are facing crisis they feel the need to have their most basic needs met

In this case, they NEED information about their loved one

Each family handles crises differently

You must figure out coping styles and read between the lines

Adjustment, advocacy and resources

The ElderlyWhat is gerontology? Have you ever thought of

working in this field as a Human Service Professional?

“Gerontology is working with the various aspects of physical, social, and emotional development commonly individuals in the last quarter or so of their life.” (Martin, 2007).

Today we have changed the role of the Human Service Worker in gerontology since individuals are living longer and are aging in healthy ways.

Senior’s are adding years on to their life and getting more out of it with better health care, being highly active, exercising, and enjoying many hobbies.

One must remember that employment was the socialization that kept many people active. Now that they are retired they must find new ways to interact with others.

At this time in life there are physical limitations starting to set in with the body.

This can be a very discouraging time of life for many and they need the support to begin dealing with many new challenges in this last quarter of life.

Many elderly are dealing with major loss of a spouse, friends, and siblings.

Others need to move out of their home and move into an Assisted Living Center, Group Home, or even a Nursing Home.

One important concept to remember when working with the elderly is if they had poor coping skills when younger, they will have a more difficult time in dealing with all the transitions that happens during this period of life.

For years the senior citizen was seen as a drain on society.

The media reinforced this stereotype along with society.

Finally in the early 20th Century, attitudes started to change and the elderly were now seen being respected for their wisdom and value they still have to give to the community.

As a Human Service Professional we all must work to not hold on to the beliefs of many. It is when we fall into that old trap of thinking that has been reinforced by society that we start to learn many new and interesting concepts about the elderly.

We immediately think that all elderly people need to be placed out of their home and into a community facility for care. Many elderly adults live in their home until death and are cared for by family members.

The elderly or Senior Citizens are still very proud and want to do as much as they can on their own. When we take this away from them, we also take away their life.

Sometimes Senior Citizens move into an Assisted Living facility to make their life a little easier. They still have their own apartment, kitchen, bedroom, and bath but when help is needed someone is there to assist.

It is here that the Human Service Professional provides the same type of service as if the person was still living in their own home or retirement community.

With many Baby Boomers starting to retire this is a growing area in Human Services.

Many times the Human Service Professional comes in contact with a Senior Citizen shortly after they retire. This is a time of change and the adjustment for some can be very difficult. It is here that you will begin the process of helping them to seek out new opportunities, hobbies, social groups, and help them to adapt to a whole new schedule in life.

What is different today for many senior’s is that they are grandparents who are raising their grandchildren.

Ethic and minority children are more likely to be raised by a grandparent than Caucasian children but there is no strict rule that it does not happen in all cultures.

Children are returning home to live with their parents due to the economy, high divorce rate, along with parents taking in their grandchildren due to an increase in child abuse.

What once was a time of relaxation and fun for Seniors is now another new adjustment as they grow older.

What is interesting for the Human Service Professional is they could be working with grand parenting, parenting, school issues with the child, behavior issues, foster parent issues and the issue of senior care.

Think of all the different roles you could play in one family as the Human Service Professional assigned to this case. It is not what we would expect to be working with but welcome to the real world of today.

How would you deal with all of these issues if you were the professional assigned to this case?

Aging and DisordersThis is a time in life when seniors many also be affected by

psychological disorders.

Depression, according to NIMH affects over 2 million individuals over the age of 65. They believe that depression is a part of the aging process.

Dementia, a progressive illness affects about 4 out of 10,000 people according to NIMH.

Human Service Professionals work directly with the person who suffers with dementia and the caregiver who is usually a family member.

An area that is on the rise is Elder Abuse. It is underreported but when it is the Human Service Professional will need to protect their client and help the caregiver through counseling and support groups.

Careers in GerontologyWHAT JOBS AND CAREERS ARE AVAILABLE?

“Some professionals work directly with older persons. Their activities may include:

developing programs such as health promotion, senior theater groups, or intergenerational activities for older persons in senior centers, community agencies, or retirement communities;

providing direct care to frail, ill, or impaired older persons in hospitals, clinics, nursing homes, or through adult day care or home care programs;

counseling older persons and their families about issues of care giving, employment, death and dying, or mental health; and

advising older clients about estate planning and investments, financing long-term care, or housing options.

Careers in Gerontologyplanning, administering, and evaluating

community-based services and service delivery systems for older persons;

teaching courses on aging to college and university students, health care professionals, and older adults;

advocating with or on behalf of older persons before legislative bodies or in institutional settings;

designing products to meet the special interests and needs of older persons; and

advising business, industry, and labor regarding older workers and consumers.

Careers in GerontologySome professionals devote themselves full-

time to the field of aging; others divide their time between aging and other areas of interest within their disciplinary, professional, or clinical areas. “(The Gerontological Society of America, 2010).

How would you like to work in this field? If you are interested here is a site that will show you the different jobs available in gerontology.

http://www.agework.com/agework/ 

Working with Patients with HIV/AIDSOriginally was crisis intervention and dealing

with death

Now it is seen as a chronic, rather than terminal disease

More focused on the psycho-social issues of dealing with chronic and sometimes terminal disease.

Also fear of discrimination, not receiving proper medical care, jobs and housing.

The Hospice MovementProvided to the terminally ill

Focuses on physical, emotional, social and spiritual needs.

Addresses the psych-social and spiritual needs of the dying patient.

The History of Hospice: The Neglect of the Dying

Dame Cicely Saunders is the founder of the modern hospice movement.

The medical community’s failure to address the comprehensive needs of terminally ill patients.

Wanted to develop a system of care committed to the dying process that was without pain and one that maintains the patient’s sense of dignity.

The Hospice PhilosophyDying is not failure, but a natural part of life.

Every human being has the right to die with dignity.

Palliative (soothing, painkilling) care rather than curative care.

Highly supports patients remaining in their homes whenever possible.

The Hospice TeamThe Hospice PhysicianRegistered NurseChaplainHome health aidTrained volunteersBereavement Counselors

The Role of the Hospice Human Service Worker: The Psychosocial Assessment

Basic Demographic InformationAssessment of the current crisisAssessment of physical surroundingsAssessment and development of a safety planAssessment of patient’s current mental stateAssessment of family relationshipsAssessment of patient’s social support system

Intervention Strategies

Placement in residential facilityContracting a home health agencyEstablishing Day respite careGovernment assistance and Medicare

Case Management and Counseling

Dealing with the terminal illnessThe loss of control because of increased

debilitationImpending deathHelping and assisting family membersIncreasing the comfort levels

Resisting the Reality of DeathEmbracing death does not have to let go of

life.Not losing hopeConfronting denialResponding affectionately and

compassionately

Planning for the DeathThe practical plans and detailsAdvanced directivesDNRFuneral arrangementsWho will take care of what?

The Spiritual Component of DyingPraying with the familyAre you comfortable in this role?The spiritual tone of counseling

The Journey Through GriefAcknowledging the reality of the deathEmbracing the pain of the lossRemembering the person who diedDeveloping a new self-identitySearching for meaning in the lossReceiving ongoing support from othersReconciling the grief

Multicultural Issues

Hospice workers must remain flexible enough to meet the needs of all cultural groups

Policies that discriminate against ethnic minority groups, such as admittance requirements, be challenged and changed if needed.

Ethical Dilemmas

Family denial of illnessDenial of services to those unable to payCounseling patients regarding euthanasiaPoor Pain ManagementDischarge of terminal patients