Like many countries, the United States is undergoing a vast demographic shift — with large increases in the number of older adults, one in five of whom will be at least 65 years old by 2030.
This means more social workers are needed to help with many of the issues older people face — like Alzheimer’s disease and other dementias, elder abuse, hunger, poverty, lack of housing, and social isolation. These are just a few of the challenges among the older population where social workers are involved, and where their skills will continue to be in demand.
Despite the need, there is a shortage of social workers trained in aging and a lack of interest in this area among social work students. On the positive side, the profession recognizes — and is working to correct — the workforce deficit.
Also positive are social work’s efforts to ensure older individuals remain active and engaged. That in itself not only supports those who are aging and helps them feel more vital and part of communities, it also can help change societal attitudes toward aging — which happens to us all.
Productive Aging
One of the American Academy of Social Work and Social Welfare’s
Grand Challenges for Social Work is to advance long, healthy and productive lives. Its goal is to “create opportunities, to acquire new knowledge and skills, and to utilize talents and resources in a variety of paid and unpaid roles that maximize health, foster economic security, provide purpose in life and enrich families and communities.”
Ernest Gonzales, MSSW, PhD, is an assistant professor at New York University’s Silver School of Social Work and a co-leader on that Grand Challenge, which is one of 12 challenges identified as inspirational objectives for society in the U.S. He said remaining active and involved is part of productive aging.
“The way we define productive aging is any activity by older adults that produces a good for society whether it’s paid or not,” Gonzales said. “For research purposes, we have to narrow that broad definition: employment formal and informal, volunteering and caregiving.”
Why it is beneficial is complicated, he said. “There is a growing body of evidence that certain aspects of health, including psychological health, can have some really good benefits for an individual.”
The U.S., along with every country around the world, is aging, and some are aging rapidly, Gonzales said. “Baby boomers formally volunteering saves the nation $60 billion per year, and it gives them purpose and drive.”
But work by family caregivers often is not acknowledged, supported or paid, he said. “Informal caregivers, according to two sources, provide anywhere from $100 (billion) to $600 billion a year in services. It’s very much valued, and it’s essential to the health and well-being of people who need help. But we could do a better job in supporting informal caregivers.”
Social workers educate people and help them embrace productive aging in varied ways, he said. They advocate for certain programs like the Older Americans Act, which supports a range of services like Meals on Wheels, and legal and in-home services. Social workers also help older adults gain employment and volunteer positions, Gonzales said. They assist veterans, those who are homeless, and those with low English proficiency in finding work.
“Social workers are on the front line assessing the capacity, needs and services this high-risk group needs,” Gonzales said. “They are right there in the trenches for them. A lot of students graduating from our (school) are out there developing programs. Social workers have a person-in-environment perspective and they see a number of ways to help create programs that help older adults.”
Their work is not without challenges, he said. “I think age discrimination is alive and well. Older workers take longer to find employment and likely have a salary that is lower. I think tackling ageism is really important.”
He pointed to an intergenerational AARP program, Experience Corps, that involves older adults tutoring and mentoring young people. “The program has documented more reading improvement, greater comprehension, and it’s better for the adults. It’s a demonstrated win-win solution.”
Many older adults want to continue to help, and many of them with higher incomes already do, Gonzales said.
“The challenge is how to get the others,” he said. “Experience Corps provides a small stipend that helps offset things like transportation. They were able to demonstrate that small stipend meant volunteers were more likely to complete the academic year, and their mental health improved. That’s a nice strategy and a triple win.”
Early Engagement
The productive engagement of older adults is a concept that came about 30 years ago, said Nancy Morrow-Howell, when people saw taking care of older adults as a drain — a dependency rather than a contribution.
Morrow-Howell, MSW, PhD, is the Betty Bofinger Brown Distinguished Professor of Social Policy at the Brown School of Social Work at Washington University in St. Louis. She teaches gerontology courses and a freshman course on aging, and is director of the Harvey A. Friedman Center for Aging. She also is a co-leader on the Grand Challenge to Advance Long, Healthy and Productive Lives.
“We focus on older adults working, providing service in communities, and formal and informal caregiving,” she said. “We focus on programs and policies that can support older persons in those roles.”
When thinking of older individuals, the attention often is on “medical conditions and all kinds of limitations,” Morrow-Howell said. “If we focus on volunteering and productive engagement, we get a different vision of the capacity of older adults. We’re looking at ways to involve people when they’re younger so they can continue that through their retirement. Getting somebody started in volunteering is easier when they’re younger, so when they separate from work, they continue volunteering.”
One of the most common ways for people to start volunteering is simple: someone asks them, Morrow-Howell said. “The benefits are clear — it’s more person power. They try to bring in people who tend to have attributes like high relationship skills and more experience generally.”
Volunteering also is “very beneficial for those volunteering,” she said. “We have evidence it contributes to their physical, psychological and cognitive health as it supplies more person power to organizations that need it. I think when younger people are exposed to service — like utilizing them on a college campus — they are likely to continue it throughout their life course. As gerontologists, our role is supporting that through retirement.”
As corporations eye more involvement, Intel has what Morrow-Howell calls an innovative program where workers considering retirement can receive a stipend and continue heath benefits if they volunteer at a nonprofit in a part-time job or volunteer role.
“Donating your experience to a nonprofit is a way to ensure meaningful engagement,” she said, adding that social workers run many nonprofit organizations that are a critical part of using volunteers — and they are reaching out to older adults. They also can deliberately develop programs that recruit and benefit from older adults.
“We’ve been pushing this concept for 20 years, so it’s not new,” Morrow-Howell said. “There is more awareness now that people need to be purposely and meaningfully engaged to have a healthy life. Now we can help by making sure those people are engaged.”
There are some new ideas about how to support older people in these roles, she said. “We need to focus on what older Americans can and want to do. It’s a contribution I think we need to keep growing. I think productive engagement works. We need to — and want to — work longer.”
Social workers interested in this can first figure out what is going on in their communities. United Way, for example, has a lot of volunteers. Area Agencies on Aging also know what's happening, and they have experience surveying communities to determine where there are volunteers and where they are needed, she said.
Workforce Support
The Eldercare Workforce Alliance has 35 members, including NASW and other national organizations representing consumers, family caregivers and health care professions. It addresses workforce issues like recruitment, training, and compensation and retention; and provides information and support to consumers and family caregivers, its website states.
Amy York, executive director of the alliance, said her organization was established more than 10 years ago after a National Academies of Sciences, Engineering and Medicine report stated the country was underprepared to care for older adults and the baby boomer population.
The federal government’s Health Resources & Services Administration’s Geriatrics Workforce Enhancement Program also was established then, she said. “A lot of the workforce is not trained in geriatric care. Because the health care system is so siloed with specialists on specific diseases, it makes it much more difficult to care for the whole person. All the money flows toward the acute side and little flows to the social and long-term needs.”
“That’s key here,” York said. “What needs to change is we need to fund the social needs of adults. That’s where social workers have a critical role.”
Social workers play an important part in older adult care, including care coordination and mental and behavioral health, she said. “There are not enough psychologists, psychiatrists and social workers trained in this, especially as the baby boomers continue to age.”
Mental and behavioral health is an important area, as is dementia, she said. Research around what the best models for care are — and getting those implemented community-wide — is also vital.
“When we get to 85 and older, that’s when we get to the need, and social workers will be key to making that work,” York said. “The models that do best are the ones that are connected with communities. I think social workers are an important piece for that.”
York believes the issue of caring for older adults is a crisis all over the country and deserves national attention.
“I think we need to urge caregivers to talk about their experiences, because they’re the voices who are going to make the biggest difference for most of us at some point in time,” she said. “Ultimately, to address this issue, elected officials have to hear that this is a problem. …The general public needs to be more aware of it. Most people, unfortunately, become aware of it when it becomes a crisis in their own life.”
Student Perceptions
Former NASW President Gary Bailey, DHL, MSW, ACSW, is the assistant dean for Community Engagement and Social Justice and a professor of practice at the College of Social Science, Public Policy and Practice at Simmons University in Boston. He said there are not as many social workers going into working with older adults “as the population data would indicate we need.”
Bailey himself initially wanted to work with children, so that he might have his summers off. But when Massachusetts passed a law capping property taxes, that meant less money in municipal budgets, including schools. A grad school classmate suggested a program that worked with older people at risk, and Bailey jumped at the opportunity.
He says moving into the aging field was the best thing he ever did, and he now normalizes aging as part of life with his students. This has meant not to be afraid of his own aging and to focus on starting where people are — whether they’re 100 or 63 years old.
A lot of young people may tend to shy away from older people, saying they sit around reminiscing, Bailey said. But he added that everyone reminisces, including young people who may share stories from high school or college — of times when life made sense, and they felt safe and happy.
Morrow-Howell and Gonzales also say not many students consider working with older adults.
Gonzales said students do not receive a wide-ranging background in aging, because of the tendency to focus on disease, disability and decline.
“The Grand Challenge has a balanced perspective: Aging is not a sign of disease,” he said. “I think as social workers we need to emphasize the strengths of aging adults. I think if we emphasize that, students would be more interested in aging and how they can help not only their lives but the entire family’s life. It’s a great opportunity to get into the aging field.”
Leigh Glenn contributed to this article.