Elder Statesmen

Published in the Spring 2009 issue of SSA Magazine

Social work education is exploring how to prepare for the complex needs of an aging population

As a first-year student at SSA three years ago, Cynthia Phon was thrilled when she received her field placement at the Council for Jewish Elderly on the North Side of Chicago.

Phon, a career-changer who'd worked in communication consulting for 17 years before entering graduate school for her master's degree, enrolled in SSA because she liked its older adult program. "I came to social work specifically wanting to work with older adults," she says.

That interest was a pleasant surprise to her supervisor at the agency, which has since changed its name to CJE SeniorLife. "They were used to getting students who would say, 'I want to work with pre-schoolers or I want to work in an elementary school.' So my supervisor said it was amazing to have someone come in and say 'I want to work with older adults,'" recalls Phon, who has worked as a case manager at the North Shore Senior Center in Northfield, Ill. since graduating in 2007.

Phon's enthusiasm for working with the elderly is rare among those entering social work. "Many of our students are of an age where, unless they've had someone in their family or in their personal lives who is older and dealing with those issues, they just don't tend to think much about the later phase of life," says Karen Teigiser, SSA senior lecturer and the School's deputy dean for curriculum.

Yet the need for social workers who focus on older adults is ballooning, particularly because we're approaching what some have dubbed a "senior tsunami" with the graying of the voluminous Baby Boom generation. The Brookings Institution estimates that by 2011 more than 10,000 Americans will turn 65 every day for the next 20 years. By 2030, more than 20 percent of the U.S. population will be 65 or over.

The sheer size of the aging Baby Boom generation and their longer life expectancies will have far reaching implications. Older adults have different needs in terms of health care, family issues, community dynamics, and more. Not only will a generation need support adjusting to these new realities in their own lives, but their impact will be felt throughout society. The field of social work is gearing up to address the repercussions.

"Whatever you do in the field, you will be likely to be working with the elderly," says Phyllis Mitzen, coordinator of SSA's Older Adult Studies Program. "If you're working in a hospital, you're working with the elderly. If you're working with families, you're working with the elderly. If you're doing community work, you're working with the elderly. So you'll use the strengths and insights that you get from working with this population over and over again."

For example, more and more family caregivers— usually women—are caught in the squeeze of looking after children and older parents. "What happens to a woman," Mitzen asks, "who has a gap in her career because she raised children, then at age 50 has to stop work to take care of her mom? So many women are financially unprepared for their old age due to taking on the caregiving roles that society expects of them."

The cost of establishing and maintaining a quality lifestyle for the elderly is also a growing concern. "Most of us would say that we don't want intensive curative services at the end of life, but we know that we do need some kind of medicalized environment. It's a huge challenge for us to figure out what kind of medicalized environment will keep frail, elderly people comfortable and safe," says SSA Associate Professor Colleen Grogan, director of the University's Graduate Program in Health Policy and Education. "What does it look like? How do we make it affordable?"

There are many facets to gerontological medical issues that go far beyond dealing with death and the end of life, even though that might be the first thought when it comes to geriatric care. For example, one out of every two people over the age of 85 is projected to suffer from some progressive cognitive impairment that will require care. Malitta Engstrom, an assistant professor and Hartford Faculty Scholar at SSA, points out that nearly one in four people living with HIV /AID S is over the age of 50.

"Research with older adults who use drugs suggests that their HIV sexual risk behaviors are comparable to their younger counterparts and that they underestimate their risks. There is a great need to recognize that older adults are at risk for HIV and to provide HIV prevention and intervention strategies that are created with older adults in mind," Engstrom argues.

Geriatric researchers and clinicians also warn about the increasing number of primarily low-income individuals who have battled chronic illnesses like diabetes and asthma over the course of their lifetimes. The result could be an explosion of younger "old people." An individual who has diabetes and not had access to good medical care, for example, could find herself impaired by the time she reaches 40 and might need to be institutionalized by the time she reaches age 60.

"These chronic illnesses could be one of our more difficult policy, social work, and medical challenges," Grogan says. "We really need to be looking at what we should be doing to ensure that there is a public health infrastructure to help people live and age better." And who better to explore these issues than social workers? "A lot of chronic disease management is not high-technology medicine," Grogan points out. "I think social workers can be the key people to help individuals with chronic illness connect with the kinds of disease management systems that work for their current life circumstances. That's the work we're trained to do."

When SSA lecturer Darby Morhardt launched an "Intro to Aging" class for first-year master's students in the fall of 2007, most of her students confessed that they had only enrolled because virtually every other course was full. But by the end of the term, Morhardt, who is also a research associate professor in the Cognitive Neurology and Alzheimer's Disease Center at Northwestern University's Feinberg School of Medicine, had won a great many converts. She emphasized the growing role the elderly play in modern intergenerational families, the strength that many people display as they age, and the many ways in which social workers help older people lead meaningful lives, even as they cope with chronic illness.

"Many of the students remarked that they felt that the course should be required of everyone," Morhardt recalls. "They may not go into quote unquote aging, but they now have a sensitivity to the issues and a more holistic perspective."

Morhardt's class is part of a systemic effort at SSA to help prepare social workers for the growing need for gerontological social work. "The mismatch between the anticipated service needs of older adults and the availability of social workers trained in gerontology has been deemed a crisis by some scholars," Engstrom says.

"There is this notion in both medicine and social work that gerontology is all about working in nursing homes, that it's only end-of-life care," Grogan says. "But even if you are working in a nursing home or in hospice, it's not just about helping people to die. It's about understanding people's connection to life as well as death. It's about the kind of intergenerational care that happens across a lifespan. The trick is figuring out how to expose students to this without forcing it down their throats."

One of the keys, says Teigiser, is to provide students with information about the issues surrounding care of the elderly early and often in their education. "What's clear is that when they have the opportunity to think about and connect with issues facing older adults— whether it's in the classroom or in a field experience—that makes the difference. Once we expose them to the challenges and issues of working with this population they tend to be committed," she says.

Teigiser has helped facilitate that exposure at SSA by making structural changes to the curriculum that introduce aging issues to students earlier in their course work. The class on working with older adults is now available in the first quarter, for instance, when students are required to take a course in human behavior.

The change is one example of the impact of SSA's Older Adult Studies Program, which is the incubator and launchpad for an infusion of elder care issues into the SSA curriculum. In addition to new coursework, the program's members have persuaded colleagues to introduce gerontological issues in a variety of courses. "We encourage the use of older adult case examples in both the first and second year as a way to engage students in this area," says Robyn Golden, director of Older Adult Programs at Rush University Medical Center, who teaches "Aging and Mental Health" at SSA as a lecturer.

SSA has also introduced a fellowship program specifically designed around geriatric issues, part of a national initiative sponsored by the John A. Hartford Foundation and administered through the New York Academy of Medicine. The foundation is a leading champion of gerontological research and the training of scholars and clinicians in the field. Through the foundation's support SSA paired with the Loyola University School of Social Work in 2006 to form the Chicago Area Gerontological Social Work Education Consortium. By the end of the grant in 2010, each school will have conferred 30 Fellowships to second-year master's degree candidates, including a $5,000 scholarship.

The program's Geriatric Leadership Fellows are engaged in seminars, courses, and fieldwork, including rotations designed to give the student a broad exposure the diverse needs of older people and to the programs and services designed to meet these needs. A clinical student, for example, may spend time in an institution's grants department to gain a different perspective on the issues. The goal of the program is to enable the Fellows to become leaders in the field.

Cynthia Phon, who was in the first class of Hartford Fellows at SSA, says that the program provided a cohort of like-minded students. "There's not a lot of understanding [among social work students] about the various things you can do with older adults," she says. "The Hartford fellowship provided validation that there are other people out there who are really interested in this and wanted to talk about the issues and the career options."

The Older Adult Studies Program has also introduced several courses on working with the elderly in the School's Professional Development Program (PDP), which provides diverse continuing education opportunities for social workers. The program is now looking into creating a comprehensive set of courses around working with older adults.

"The reality in the master's program is often young people only want to work with kids or with people their age," says Golden, who also works with SSA students in field placements. "But then they get out and they're in their 40s and suddenly the idea of working with the elderly isn't so distant. It's their parents and their friends' parents, and they begin to realize that this might be the next phase of their work. PDP courses allow them to get back in the classroom to understand the theory and get a better grasp of the issues."

Ultimately, more social workers, administrators, and policymakers informed about and involved with elder care are needed to design and advocate for new models of care. Much of the geriatric care in the country it perceived to take place in nursing homes, but that perception fails to address the realities of how people age in their communities and the expectations of contemporary seniors.

Golden says that despite all the talk about the coming senior tsunami, little is being done to develop new models of care. "Right now, the money is not following the people," she says. "We need to develop policy and care models for a range of new issues related to aging—things like people leaving or being forced out of the workforce earlier or having to hang on to their jobs longer because their 401(k) has been decimated. The new models of care need to have a bio-psycho-social framework if we're going to really take on the issues of aging."

Mitzen, a 1980 SSA alum, envisions a return to a more collaborative, interdisciplinary approach to the study of aging at the University. "When I went to graduate school, there was robust research going on across the campus addressing aging issues," she says. "Bernice Neugarten and Shelley Tobin [both scholars in human development and psychology] conducted seminal research on aging at the U of C. Today we have some pieces in place to develop that kind of synergy again."

Golden envisions an even grander mission. She would like to see SSA promote a collaboration with the City of Chicago to take on elder care in the same way that the University has worked with Chicago Public Schools on education initiatives. "If we could pull together all of the intellectual and clinical resources of the University and create a 'town/gown' partnership to think about these issues," she says, "think of the great role we could play."