Social work with older adults in primary health – is it time to move our focus?

Abstract

Social work has made a significant contribution to the health care of older people for the last 60 years. At any one time, older people make up a significant number of our inpatient population in public hospitals. Social workers have not only had an integral part to play in discharge planning of this vulnerable population but also have played an important advocacy and support role with the patient and their families. Indeed, social work is traditionally the discipline that links the medical world to the patient’s world in the community. Recent data indicates the average length of stay (ALOS) in public hospitals is continuing to decline. Between 2001 and 2010, total ALOS decreased from 4.4 days to 4.1 days and in medical wards from 3.9 days to 3.5 days (Ministry of Health, 2011). (MOH).Ward managers have traditionally relied on social workers to provide safe discharges, particularly for older people who are vulnerable, but the pressure to concentrate on this service has increased as the pressure to manage very high bed occupancy also grows. Anecdotal evidence indicates that some social workers have been directed to attend to discharge planning only and any other issues that are identified are to be referred to their community colleagues. This demanding environment poses challenges for social work and raises the question whether more effective social work intervention for older people could be achieved in the community. Where should social workers concentrate their efforts in order to have the most effective outcomes? Would health social work be more effective if placed in the primary care sector? This article examines the skill base of health social workers in relation to working with older people, and argues that a move into primary care would result in a more effective use of our skill base which is after all centred in family work.