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HCS103 Topic 9

  1. Ageing and Social Work HCS103 Topic 9 Acknowledgement: Some slides from Karen Bell
  2. 2 What do you think of when you hear the phrase ‘aged person’? What is an ‘aged person’? What do they look like? Where do they live? 2
  3. 3 When I searched for some ‘clip art’ for these PowerPoint slides using the search terms ‘old people’ and ‘elderly’ – the images below were the ones to pop up. Which stereotypes about ageing do you think most of them represent? What do you think these images convey about ‘old people’?
  4. Ageing and disease should not be equated (Hammond & Jilek 2003, cited by Wiles 2005, p.167) Less than 25% of elderly people (75+) have a disability requiring outside assistance (McCallum & Geiselhart 1996, cited by Wiles 2005, p.167) Age does increase vulnerability to a range of health problems though difficulties are not inevitable. 44
  5. ‘Older people do not require social work because of their age but because of disability, lifestyle and loss issues as they age. Social work responses can be as diverse as the older population itself. Social workers play pivotal roles in the provision of a range of social, health, housing and financial services, and in assisting older people in adjusting to the transitions and losses of older age. The work of our profession is an important component of government, commercial and not-for- profit programs for older people’ (Naughton & Schofield 2013, p. 207). 5
  6. Traditional settings for social work with elderly people • Hospitals • Community health centres/ aged care assessment teams (ACAT) • Nursing homes & hostels • Community care agencies 66
  7. 77 More recently… There’s been a growth in private sector – financial planning, retirement villages, user-pays aged care.
  8. Background – aged care policy and service provision 1901 – Federation – agreement on need for national support system for aged people 1909 – payment of age pension commenced 88 The old age pension ‘more than any other factor… defined old age in early 20th century Australia. In taking the pension an old person entered into an implicit contract to retire from the workforce’ (Davison, 1993, cited by Wiles 2005, p. 164).
  9. Mid 1950s Increased federal government funding for expansion in number of nursing home beds Aged care conceptualised as a medical problem and residential care as the standard response Some community / domiciliary support services (e.g. ‘Meals On Wheels’) developed 99
  10. 10 1975 – Henderson Inquiry into Poverty – aged people as the single largest group at risk of disadvantage 10
  11. 1980s Increased emphasis on community care 1982 – McLeay report – indicated the aged people were often in residential care for accommodation/social reasons rather than medical / health reasons. Argued community care to be a more humane and cost effective option. New ideology emerges – independence, community care, reduced institutional care – ideals still influential today 1985 – Home and Community Care (HACC) program started 1111
  12. Changing demographics… - Increasing proportion of aged people in Australian population - Increased awareness of aged care issues and consideration in social policy, more social work research and practice theory development Go to the Australian Institute of Health and Welfare website for an overview of changing demographics in Australia 1212
  13. 13 ABS – Population projections, Australia, 2002-2101 Increase in the number and proportion of people aged over 65 years: - Falling fertility - Increasing life expectancy - Effect of the baby boomer generation moving through older age groups This trend will grow over the coming decades, to such an extent, that the: - Number of people aged over 65 years will increase from the current 2.5 million to around 7.2 million by 2051 - Proportion of people aged over 65 years will grow from the current 13%, to one quarter of the population by 2051 - Proportion of people over 85 years will grow from the current 1.4% to approximately 6% by 2051 - Proportion of the population aged between 15 - 64 years (labour force age) will fall from the current 67%, to around 59% by 2051 13
  14. 14 ‘The ageing experience may be considered with according to a range of variables influencing the quality of life of the aged, including socioeconomic class, gender, disability, ethnicity, diversity, and living in rural regions. In terms of social class, there is little doubt that inequalities experienced over the life cycle continue or even intensify into old age’ (Wiles 2005, p.166) 14
  15. Gender - Women out-live men – world-wide trend - Much social policy based on men’s experiences of ageing, paid employment, parenthood, etc. - Recognition of gender aspect of ageing often neglected. 1515
  16. Cultural diversity In 2011, 36% of Australia's older people were not born in Australia (ABS 2011) Emergence of ethno-specific services & culturally appropriate practice guidelines 1616
  17. Psychosocial needs of aged people Economic- housing, income, etc Health – nutrition, exercise, health services Social – staying connected with wider society, family, friends, meaning in life Emotional – meaning in life, loss & grief issues, respect Cultural – lifelong learning, hobbies, communication, ethno- specific needs Environmental – transport, accessibility, safe & secure housing 1717
  18. Policy reform in aged care service delivery Go to this ABC online site and view the video of this story. Have a look at the latest aged care policy initiatives in Australia at the Department of Social Services website – 18
  19. Policy directions and issues in aged care in Australia 1. Encourage self-funded retirement 2. Continued marketisation of aged care – user- pays, community care a cheaper & preferred option 3. Health promotion for healthy ageing 4. Promotion of positive ageing 1919
  20. Theoretical perspectives on ageing (1) Disengagement (1950s) - detachment from paid work and community / public life in preparation for death, segregation into ‘old people’s homes’ - e.g. Cumming & Henry 1961. Activity theory (1960s -70s) – successful adjustment to ageing, continuing activities, health promotion & prevention, positive productive retirement, increased community care – e.g. Havighurst 1963. 2020
  21. Theoretical perspectives on ageing (2) Continuity theory – commonalities across the lifespan, each person unique, ageing increasing integration of life experiences, e.g. Atchley 1976 Life review – (Butler 1963) – normal, constructive part of ageing, the past is evaluated and reconstructed through storytellling 2121
  22. Depression - Often goes unrecognised and untreated in elderly people - Some might be organic, some might be reactive (to situations, experiences) - Peak in suicide rates for elderly males 75+ 2222
  23. Care ‘The modern emphasis on family care, typically recognised as per of the support offered by the family, and especially female carers, is also acknowledged as a product of the retreat from state responsibility for aged care’ (Wiles 2005, p.171). 2323
  24. The future of social work and human services with elderly people - Centrality of bio-psycho-social model - Casework and group work - Need for advocacy on social justice principles to advocate for the marginalised - Awareness of policy context, program reform, political action 2424
  25. Core social work, welfare and human service roles in working with older people • Counsellor – dealing with major life transitions, losses, chronic health issues • Information provider / referrer – complex service systems, information needed on options and associated costs, referrals to community service agencies • Advocate – to get the best outcomes for clients, SWs often need to negotiate with service providers and/or take action to advocate for an older person’s rights • Assessor – assessment of need, making judgements about the capacities of carers and social network to support the older person, thorough knowledge of services and resources available • Case manager – identification of needs, establishment and monitoring of service plan to meet older person’s requirements to live at home. Managing complex care situations, regular review. • Service broker – selection and purchasing of most cost effective ‘packages’ of services to meet client requirements, identification of individual service solutions, focus on achieving maximum purchasing power (Naughtin & Schofield 2013). 25
  26. Specific areas of practice People with dementia Medical aspect – understanding the physiological and behavioural changes of the dementia diseases. The social aspect – how dementia is experienced by the individual and their social network in the context of their cultural and community context. Citizenship aspect – promoting the rights of people with dementia and recognising their contributions as citizens, people with dementia as experts in dementia. Expected increase in numbers of people with dementia – 220,000 in 2007 to 730,000 in 2050 (Access Economics 2009). ‘Whether practising with older people in the community or an institutional setting, social workers are likely to be involved in the assessment and support of people with dementia and their family carers across the spectrum from pre- diagnosis to end-of-life care’ (Naughtin & Schofield 2013, p.215). 26
  27. Specific areas of practice Palliative care – the holistic response to people with life-threatening illnesses or conditions when there is no cure; a team approach to fostering maximum autonomy until death. SW and human services roles include – Supporting the person and/or their family through loss and bereavement – Taking a system perspective – including responding to practical issues, emotional and spiritual issues – Counselling related to end-of-life decisions (Naughtin & Schofield 2013). 27
  28. Specific areas of practice • Elder abuse – emerging as a significant issue requiring assessment of risk and vulnerability. • SW practice in risk assessment, protection planning, advocacy, criminal justice issues, social change • Multi-agency collaboration, team work • Mistreatment of elderly people is widely under-reported. (Naughtin & Schofield 2013). 28
  29. Watch this… from the ABC in 2013 29 /content/2013/s3804571.htm
  30. Other resources Australian Human Rights Commission (2012) Respect & choice: A human rights approach to ageing and health ageing-and-health-respect-and-choice-home-based-and- residential-care-older COTA - Connecting Over 50s Throughout Australia: Alzheimer’s Australia. Department of Social Services – Media Hub – aged-care/aged-care-media-hub
  31. References Australian Bureau of Statistics – Access Economics 2009. ‘Keeping dementia front of mind: Incidence and prevalence 2009-2050’, report for Alzheimer’s Australia. Chenoweth, L. & McAuliffe, D. 2015. The road to social work and human service practice. French Forest, Thomson. Giles, R., Irwin, J., Lynch, D. & Waugh, F. 2010. In the field: From learning to practice. OUP. Naughtin, G. & Schofield, V. 2013. ‘Working with older people’. In Connolly, M. & Harms, L. (eds) 2009. Social work contexts and practice. Melbourne, OUP, chapter 14. Wiles, D. 2005. ‘Gerontological social work’. In Alston, M. & McKinnon, J. (eds) Social work fields of practice. Melbourne, OUP. 3131