Guest columnist Nancy Hooyman

A guest column by Nancy Hooyman, a gerontology professor and dean emeritus at the University of Washington’s School of Social Work.

As a Council on Social Work Education representative on the national Eldercare Workforce Alliance (EWA), I am impressed by direct-care workers’ strong presence and how they ensure that their priorities are heard.

The alliance — involving a range of professions, constituencies, and families who care for older adults — seeks to address the need for a better-prepared and more robust eldercare workforce for the 21st century. We seek consensus across disciplines, among at least 75 percent of our members, for legislative action because we believe that what benefits one stakeholder group will benefit all, even if indirectly.

Because of my experience with EWA, I have become increasingly concerned that social workers — often members of interdisciplinary teams of medicine, nursing, and pharmacy — have generally failed to partner with direct-care workers.

Yet in long-term services, social workers and direct-care staff are often the providers who interact most with older adults, sharing the goal of quality care but typically not building on our interdependence.

Work Undervalued, Workload Heavy

Such partnering is critical to address the crisis in eldercare. Both formal and informal sectors provide essential care work that is undervalued by society.

This work is undervalued in part because elders are often socially invisible, the “least desirable and lowest status clients.” In addition, the intersecting forces of ageism, sexism, racism, and classism lower the status of informal and formal geriatric care providers.

Women predominate among the three types of caregivers — social workers, direct-care workers, and informal caregivers (usually family members).

The salaries of geriatric social workers, most of whom are female and many nearing retirement, are lower than other fields of practice; those of direct-care workers, the majority of whom are women of color, are barely enough to live on. Informal caregivers experience few economic rewards, and in fact, often give up paid employment to care for family members.

All three carry disproportionately heavy workloads, involving physically and emotionally challenging tasks. Given these shared characteristics, it is especially puzzling that social workers are rarely advocates for, or partners with, direct-care workers.

Benefits of Collaboration Overlooked

This failure results partially from professional socialization of social workers.

Professional identity, while essential, can create “blinders” to others’ contributions. Social workers are trained that professional education is essential for quality eldercare. Some refer to direct-care staff as paraprofessionals, implying “less than.” Social workers often invest energy to elevate their status in interdisciplinary health care teams, but distance themselves from lower-status workers.

Yet effective collaboration between geriatric social workers and direct-care staff, the “eyes and ears” of long-term services, is essential for quality elder care.

Since elders and families are more likely to be satisfied with care by competent direct-care staff who feel valued, less hierarchical models of supervision that enhance direct-care workers’ decision-making autonomy would likely benefit all providers. However, the potential for such collaboration is rarely discussed in social work curriculum, particularly compared with the time devoted to team building with higher-paid, higher-status providers.

Admittedly, some social workers, especially in skilled nursing facilities, do recognize the value of direct-care workers and partner as advocates for this type of systemic change. Undoubtedly, innovative team models of social workers and direct-care staff exist and could be infused into social work curricula.

Sharing Partnership Models

I am eager to learn of such collaborative models to disseminate through our Center’s curriculum change initiatives. If you have collaborative models to share, please post your comments or e-mail me directly.

– by Nancy Hooyman

Co-Principal Investigator
Council on Social Work Education’s Center for Gerontological Social Work Education

Dean Emeritus and Hooyman Endowed Professor in Gerontology
University of Washington School of Social Work