We spend years learning a language that is part of what makes us a social service provider or a professional. That is quickly followed by employment that requires an additional language laced with acronyms. Oh how good it feels to use that terminology with our coworkers. Ah, but then as we begin to provide direct service, we quickly have to learn another language – that of the people we work with if we expect to be understood.

Can excellent verbal skills be misleading?

As a social service administrator for many years in several settings, part of my success may be attributed to quickly adapting to cultures and language. From quickly learning to lose the multi-syllable vocabulary when confronted with a blue collar/rural community, to the ethnic variances in Chicago through learning some of the nuances of Black English to now – which brings me to the focus of this blog… when the written word is not understood. Examples include caregivers who work with aging individuals and individuals from the community who seek assistance to apply for benefits including completion of required forms.

Highly verbal but uncomfortable with the written word?

For many years, I had the pleasure of working with the most caring and considerate people possible who were caregivers for elderly clients. Those who provide the frontline services to the aging community have a deeply rooted sense of caring and respect. Often, they are the first to become aware of changes in cognitive skills, an onset of illness or other condition of their client. Para-Professional Caregiver/Companions are often highly verbal and personable… BUT many of them have learned to use their oral skills to mask the fact that the written word is a mystery to them. It becomes apparent when their client makes out a grocery list and what is purchased is far from what is requested…. Completing simple forms, such as a time sheet, may be a puzzle to them.

When confronted with this dichotomy, checking their employment application often reveals misspelled street names and several other examples… sometimes including the name of a child. It is necessary to be certain the person completes the initial application in person without assistance. It is important that these highly skilled people continue to find employment where they can be so effective. It is also important to be certain that they are not placed in the awkward position of having to read beyond their capability. Recognition of verbal strengths while accepting limitations in the ability to read and write should not be a barrier to appropriate employment which can be a win-win situation. Rather, we need to be sensitive to the limitations, not cause embarrassment, and build on their strengths.

Helping with Paper Work

As someone who meets in person with several individuals each week to assist them with applications for Medicare D, IL Circuit Breaker, Medicaid, Senior Freeze and whatever other issues they may present, I find it requires adapting to each individual’s language comprehension and culture. If the clients were able to read and write easily or use a computer, the need for assistance to complete forms would not be necessary. Appointments are made with some indication of why the person is seeking assistance. It is essential when they arrive that there be a conversation about what they hope to achieve that day. Often, the stated purpose for making the appointment and their real needs are vastly different. Again we see the importance of language and understanding what our clients need no matter how we are working with them.

The simplest of forms can prove overwhelming and the computer is a puzzle. Returning clients have become incensed at the notion they have to bring information annually because they are convinced it is stored in the computer from year to year.

Some clients are hostile until a relationship has been established. Due to a lack of comprehension, they are justifiably afraid of being taken advantage of. A letter that only requires a signature may have been seen as a threat because they only read the first paragraph and panicked. Rather than reading a bit further, they quickly make an appointment to have the letter interpreted. Sometimes a part of the time I spend with client is on the phone/computer obtaining essential information which they didn’t think it was necessary to bring in order to complete an application. Whether in person or over the phone, interpreting the questions on government forms can present its own set of language challenges.

Due to lack of information, perhaps two of the most difficult clients to work are 1) the person who has a sense of entitlement, resulting in the person being very demanding, often because of severe deprivation which conditioned them to function in this manner, and 2) The other extreme and perhaps the most painful, in my opinion, is the elderly person who has been paying high taxes on a small home, never realizing that s/he is eligible for tax relief, assistance with utility bills, food and other benefits. The key to successful service is to constantly be aware of and sensitive to what the client brings to the table. A goal for every client is to enable them to do as much as they can for themselves… often a very fine line in determining their comfort level in the process.

Enabling our neighbors to become aware of what they may be eligible for and then to assist them obtain those benefits often means constant probing, an exhausting challenge and at the end of the day… the reward of knowing we helped them access important resources. Yet, I often ask myself, did I fully comprehend his/her needs and help in every way possible? In the listening process, did I cull the essentials from the flow of expressed concerns?

Conception of a Psychosocial Group

The School of Social Service Administration at the University of Chicago requires that all first year master of social work student interns complete a macro project during their first year field placement. As a first year master of social work student at the University of Chicago, I got the idea of doing a psychosocial group for my macro project. A fellow social work intern, Lyndsey Shaner, and I both had an interest in sexuality and relationships in the nursing home milieu. Moreover, we were interested in intergenerational differences regarding sexuality issues, like what the nursing home residents were taught about sex, contraception, and sexually transmitted infections. A psychosocial group is meant to provide social and emotional support through discussion, so we developed “Tea Time.”  Tea Time is a psychosocial group that meets weekly in a Chicagoland skilled nursing facility. The group is facilitated by two master of social work interns, myself and Lyndsey Shaner, a master of social work student at DePaul University. Tea Time is a closed group consisting of carefully selected residents based upon personality characteristics and cognitive functioning.

Facilitating Conversations about Romantic Relationships

To facilitate exploration of issues surrounding romantic relationships and sex, Lyndsey and I selected several worksheets from a workbook entitled This Is My Life, My Autobiography. Included in the selection of worksheets are: Youthful Experimentation & Coming of Age, Dating After Widowhood and/or Divorce, and Birds and the Bees. These worksheets allowed for interesting discussions of important life experiences such as first dates and first kisses. The worksheets also facilitated a lively debate of personal values, provided insight into the resident’s self images, and encouraged members to share very personal, and often funny, stories of what they were taught (or not) about sex, where they learned what they know, and what they taught their children.

No Topic is Off Limits

Contrary to preconceived assumptions we made, the members have been rather candid and happy to share their personal experiences with the group and no topic has been off limits. The members enjoy comparing and contrasting their respective experiences and views with each other and with us. Starting with the very first session, the group members shared very personal stories of unfaithful husbands, the pain of divorce, sexual orientation, miscarriages, and looking for, but not often finding, love in the skilled nursing facility. Through personal narrative, we have learned that the members are still very much aware of and interested in romantic attraction. Furthermore, the members’ self-perceptions far supersede the reality of their physical condition when it comes to their interest in sex as well as their feelings about aging.

Continuing to Learn

There is a wealth of research showing us that psychosocial groups can affect participants’ quality of life in many ways, particularly in a long term care setting. It is important to continue to explore controversial ideas in a group setting because it engages new populations of older adults living in care residences. As a new generation ages, trends and topics discussed within aging communities will encourage professionals to rethink and reshape the provision of supportive services. What are some other some other hot topics that will need to be addressed within long term care residences? Sexually Transmitted Infections? Technology needs of the residents? Can you think of any other topics that would be considered “hot” that may become more common as we see a new generation age in community settings? Please feel free to post your comments.

This post written in collaboration by both Lyndsey Shaner and Carmen Wyttebach and was edited by Abby Smith

Thanks to adwriter for making this picture available.

But the question becomes: what effect does Hoarders have on the nation’s perception of this professionally recognized compulsive disorder. Hoarders has profiled over 40 individuals thus far in its first two seasons. What role do these 40 people and their families play for the country’s estimated 2 million hoarders? What image do these people portray for the public tuning in for weeknight entertainment? The answers to these questions are not entirely clear.

Hoarding: An Aging Issue

According to the Los Angeles Department of Public Health, hoarding is the excessive collection and retention of things or animals until they interfere with day-to-day functions such as home, health, family, work and social life. Severe hoarding causes safety and health hazards. Mental health professionals agree that hoarding is closely linked to certain mental health issues such as obsessive-compulsive disorder, trauma, and depression.

As America ages, the prevalence and consequences of hoarding will increase. Demographics of people who hoard are hard to quantify due to the hidden nature of the problem, however experts agree that hoarding tendencies increase with age and older adult hoarders face unique challenges due to the disorder’s health and safety implications. Older adult hoarders with limited mobility may face increased difficulties moving around their home, and those with cognitive limitations may not have the judgment or critical thinking skills required to recognize fire hazards. The combination of older age and hoarding can be deadly.

Nationwide, older adults and their families confront the reality of hoarding in their daily lives. Professionals around the country respond to the growing imperative by creating hoarding task forces to study local hoarding patterns and intervene with identified hoarders. Meanwhile, A&E delivers images of hoarding to 1.4 million televisions for 60 minutes once a week.

Hoarders Fights the Stigma of Compulsive Collecting

Each week, A&E brings the issue of compulsive collecting to the national consciousness, normalizing hoarding behavior without painting it as an acceptable lifestyle decision. Viewers witness the heartache the profiled hoarders feel with the loss of each newspaper, item of clothing, or trinket. They can see the humanity of the hoarders and understand that hoarders are somebody’s mother or father, sister or brother, or child. They recognize the difficult path that led to the hoarder’s current situation and begin to see the uphill battle each family must forge as they work to dig out from under an oppressive pile of garbage and emotional damage. Viewers see how fervently people live the adage, one man’s trash is another man’s treasure.

But A&E’s influence is not contained to the television. The network proudly boasts a robust website for the show, complete with hoarding treatment resources and an online discussion forum about Hoarders and hoarding. Professionals and lay people come together to tell stories of their personal experiences with hoarding, to seek support from others, and to share resources and research with one another.

That’s Entertainment: The Sensationalizing of Compulsive Hoarding

While Hoarders draws attention to a growing problem, it also serves another function: entertainment. The show gives the casual Monday night viewer the opportunity to unwind while watching someone else’s drama unfold on screen. Armchair psychologists can kick back after a long day and indulge in a generous dose of schadenfreude: “My apartment may be messy, but at least I can still sit on my couch.”

Hoarders turns pain into amusement, capitalizing on the American audience’s lust for the extreme. This extends to the show’s website, as well. Nestled among the resources and community forum is a photo gallery of hoarders homes where viewers can relive their favorite Hoarders moments. There seems to be reason to believe that A&E, which seemed so well-intentioned and mission-driven, may be similar to all other cable networks in their quest for the bottom line.

Attention Must Be Paid to Hoarding as Prevalence Increases

While the long-term implications of A&E’s Hoarders can be debated, its value in drawing immediate attention to the issue of hoarding is indisputable. The show offers a glimpse into a world unfamiliar and unfathomable to millions nationwide: the world of hoarders and their families. As aging professionals come together in task forces to address compulsive collecting in older adults, A&E’s Hoarders serves as an innovative method for placing hoarding in the national consciousness, particularly as the disorder’s prevalence grows in the years and decades to come.

Photo courtesy of: Grap on commons.wikimedia.org

Previous experiences color reactions to referrals

Based on my experiences discussing hospice, patients and families tend to fall into one of three categories. First, they may have never heard of hospice. If they have, they have had either a wonderful or negative experience. It seems that those who have had a positive experience were referred to hospice with enough time prior to their loved ones passing. They were able to get to know the staff, become adjusted to the idea of the death of a loved one, and had the time to react accordingly.

Those who had negative experiences tend to have only learned of the need hospice within weeks or days of their loved one’s death, leaving families unprepared for what lay ahead. They often feel that the pain medication hastened death. They may also have been given conflicting information regarding their loved one’s medical outlook and may feel that their needs went unmet.

Making the referral

A hospice referral is filtered through these experiences. Even with positive experiences, it is a tough pill to swallow. Approaching patients at the right time is imperative. A good way to assess whether it is the right time is through the use of a Power of Attorney because they can help to determine a patient’s preferences. Even if they would like aggressive treatment, they can still be informed of the services of hospice.

In fact, approaching a referral by simply providing information is an excellent way to initiate a conversation about hospice with patients and their families. If resistance comes up, one can simply sidestep it by letting them know you wanted to inform them of all their options. If they are not interested in hospice, you can assure them you will not bring it up again.

Financial motivation

Unfortunately, there are times when resistance does not come from the patients or families, but from physicians themselves. Some feel that by referring patients to hospice they are giving up, some are uncomfortable talking about death, while others have a cultural opposition. One may not be completely off the mark to suspect that a physician does not refer to hospice because they will no longer follow a patient and therefore cannot bill for services.

Billing and increasing business is clearly an agenda of hospice agencies, particularly the for-profit ones. However, for non-profits and for-profits alike, if business were not made a priority then hospices would not be able to exist. The priority for increasing an agency’s census is not a malevolent one. But if this agenda supersedes that of providing excellent patient care, then there is a real problem.

Balancing business with the mission of hospice

Marketing is essential to spreading the word about hospice. The marketing liaison may be the first person at the agency that a patient and family meet. A social worker or other professional in the position of referring to agencies may want to observe how the marketing liaison interacts with staff and patients. By doing this and by following up with families to learn about their experiences with different agencies, one is able to build a list of reliable referral sources. Understanding the nuances to this delicate situation and having trusted resources will assist professionals in the field of aging and those they serve when coordinating a hospice referral.

Photo courtesy of Seattle Municipal Archives

Right now I am in the hospital being treated for an acute breathing problem. The hospital social worker just told me that my physician wants me to move to a nursing home. The social worker shared this information with my housing case manager before speaking with me, prompting my case manager to threaten me with eviction if I do not go to a nursing home. I am beside myself with anger, disbelief, and fear. I call one of my volunteers and tell her that I don’t have a reason to live anymore, that I simply can’t go on living if it means moving to a nursing home. Fortunately, my volunteer is a social worker too, and she jumps to action by advocating on my behalf with the discharge planning team. Together, we develop a successful discharge plan enabling me to go home. Without her and my in-home care services, I don’t know where I would be right now.

In-Home Care Valuable Resource for Seniors ‘Aging in Place‘

Despite the barriers facing seniors who want to age in place, many seniors prefer not to give up the independence and privacy of their own homes. According to AARP, 82% of people want to remain in the comfort and familiarity of their own homes as opposed to an institutional setting. For seniors dealing with chronic health conditions who want to age in place, in-home care serves as a valuable resource.

Types of Home Care Services for Seniors

Home care services provide seniors help with household chores, health care, relief for caregivers, and linkage to community resources. Two different types of agencies can provide in-home care: home care agencies and home health agencies. Home care agencies typically assist seniors in meeting their day-to-day needs such as grocery shopping, laundry, and cleaning. Home health agencies provide a wide range of services such as nursing care, home health aides, physical therapy, or medical social work services. Most importantly, in-home care provides personalized support to seniors in the least restrictive environment, while allowing seniors to maintain their dignity and independence in a setting of their choice.

Social Workers Help Seniors Transition from Hospital to In-Home Care

In-home care enables seniors with chronic health conditions to transition back home after hospital discharge, in hopes of preventing readmission and nursing home placement. Social workers play an integral role in helping seniors develop an in-home care program during the discharge planning process. Robyn Golden, LCSW, director of the older adult programs at Rush University Medical Center, explains how effective social work intervention can determine the success of the discharge plan:

Social workers possess extensive knowledge of community resources, expertise in navigating complex social systems, experience using a framework of practice that focuses on the person in the environment, and training in case management and care coordination. Social workers are also able to use psychosocial assessment skills to explore family dynamics or resources that may affect the success of the discharge plan.

Utilizing Person-In-Environment Framework to Develop a Successful Discharge Plan

Within the person-in-environment framework, social workers can coordinate a discharge plan that takes into consideration the unique relationship between a senior and their environment. In creating a successful discharge plan, it is imperative that hospital social workers include seniors as part of the discharge planning team from the onset of the discharge planning process. When social workers fail to include the senior on the discharge planning team, they may feel helpless, isolated, and stripped of their dignity and independence as illustrated in the case example above.

Completing an accurate psychosocial assessment is also fundamental to the discharge planning process. Utilizing the person-in-environment framework, a social worker can assess how a senior interacts with their environment to determine if adequate supports are in place to ensure safety at home upon discharge. Once an assessment has been completed, the social worker can coordinate an in-home care plan by linking the senior to the appropriate services and community-based resources. Furthermore, this case example calls aging professionals and social workers alike to use their expertise in navigating complex social systems to ensure seniors can return home with adequate support while maintaining their independence and quality of life.

Photo courtesy of tweng on flickr.com