By Karen Graziano, LCSW
It may surprise you that "the elderly" are you and I. As C.S. Lewis has observed, “The future is something which everyone reaches at the rate of 60 minutes an hour, whatever he does, whoever he is.” It is one of the great equalizers. According to one of the most insightful raconteurs of our time, George Carlin, “There’s no present. There’s only the immediate future and the recent past.” Although it may be tempting to get lost in the moment, for the Boomers, the future is now. This segment of society, those over 60 years of age, is expanding exponentially, with the group over 85 years old, experiencing the most significant increase. Social workers will play an increasingly visible role in this compelling dimension.
The opportunities for gerontological social workers seem extensive. As we devote our talents to health and homeostasis of every system, let us remember a poignant one liner of George Burns, a most famous and clever centagenerian: “I look to the future because that’s where I’m going to spend the rest of my life.”
Offering a somewhat broader perspective, anthropologist Otto von Mering proclaims a worldwide mission: “Think globally, act locally. Think future, act now.” The need for intervention, moreover, transcends socioeconomic boundaries, incorporating the wealthy—historically, a rather unique group to the world of social work. A common occurrence across the board is isolation, a factor contributing to exaggerated vulnerability, especially financial exploitation.
Social service agencies are scrambling to meet the onslaught of demands unfolding over the coming years. They are faced with increasing obstacles. Healthcare spending is out of control. Statistics are astounding, and given the current state of the economy, the picture seems bleak. To further add to the mix, in the inimitable American way, elders seem to bear the burdens of society as youthfulness is worshiped and old age scorned. As Oscar Wilde captured in the Faustian protagonist of his novel, The Picture of Dorian Gray, our elders seem to be characterized in that chilling portrait of society as the graphic “id,” relegated to scapegoats, marred and gnarled as time goes by. Not only is there a call to action in the fight against ageism and elder abuse, but strategic planning and invigorated policy is long overdue.
“Aging gracefully” has taken on new meaning. Inherent in this phrase was the implied message that one should “grin and bear it.” Now, the expectation is empowerment and action—a take charge attitude and assumption of responsibility for one’s own life. As seniors jog along the exercise trail of this developmental stage, both literally and figuratively, practicing mental gymnastics to retain alertness, there is a good chance a coach could bolster the team spirit. As life coaches, social workers enter during many detours along that well worn path. The aging process is only one of many examples that bring change and challenge. Those who can readily adapt to change fare well; others may have difficulty coping. While I was still an intern in the field, a learned psychologist once taught me, “As one ages, whatever issues were operating before, just got worse.” This has, at times, borne out in practice. Since then, noteworthy advances have occurred. We are fortunate to be the recipients of the work of visionary change agents, such as Aaron Beck (Cognitive Behavioral Therapy), Martin Seligman (Positive Psychology), and D. Saleebey (Strength Based Perspective). Coping abilities seem to be specific to certain families, yet for the ill-equipped, skills can be learned and enhanced, a goal for many social workers to set. Cognitive Behavioral Therapy is a model most successful with our elders, so if possible, it would be advisable for social workers to seek training and supervision in this modality.
Aging, being a series of continual losses, can be keenly depleting. There is the loss of physical faculties such as vision, hearing, and mobility. Sometimes there is debilitating chronic pain. The neighborhood changes, finances erode, friends and maybe even their own children die. Elders become depressed, and the downward spiral of illness begins. When working with large groups of seniors, they may present as needy. On some level, they experience degrees of emptiness and loss and try to adjust for it, often ineffectively. Seniors can be perceived in an unflattering light. Somatization, eating, and sleeping problems and falls are common. With knowledge and skill, social workers, as part of the clients’ healthcare team, may foster fulfillment and ensure safety.
We are fortunate for the work that has been done in the field, in part by social workers, in reframing the image of aging. Merely a generation ago, seniors were expected to retire, sit back and relax and watch the world go by. However, marvel the occurrence of innovative thought that yielded a paradigm shift of the medical model. The focus flipped from the emphasis on disease to preventive medicine, health and wellness, and subsequently, healthy aging. The course of the future has been restructured, as the ripple effect throughout the societal realm now conveys a positive, upbeat, involved, and active ideal—that of one whom continues to contribute to society through participation in work or volunteerism, using technology and other supports to remain independent.
Not long ago, nursing home placement was ubiquitous, akin to the institutionalization of children with developmental disabilities and the practice of total hysterectomies and mastectomies of ignominy. Today, people are living longer, more successfully and with substantial quality of life. J. William Fulbright comments on such a scenario, when he so aptly recognizes: “We must dare to think ‘unthinkable’ thoughts. We must learn to explore all the options and possibilities that confront us in a complex and rapidly changing world.” One of these options is the overarching desire to reside in one’s own home as long as possible. Social workers are instrumental in making this a reality.
In seeking out career choices, one might ask what qualities are needed to make a meaningful impact on this population. It seems that most skills and talents endemic to solid social work client centered practice—compassion, understanding, listening skills, respect for privileged communication, sense of humor, not to mention positive memories of grandparents and other elders—are important. It is, very clearly, never a viable stance to underestimate seniors, as the missing link in this evolutionary process is sincerity. Some seniors are gullible, trusting scam artists only too often. They are, however, unerringly perceptive of trusting relationships with professionals. It is always wise to apply the aphorism “Know Thyself” when it comes to practice. It is important so that our own prejudices, biases, and leanings do not taint the relationships, and furthermore, that we recognize our strengths and weaknesses. Entrenchment in the self, consumption of self as a result of self importance or insecurity, strangles empathy. For wisdom to prevail, a respectful curiosity of self and others, and the capacity for honest assessment of successes and failures should be readily accessible. A “genuine” approach is indicated. Confidence, based on peak performance, intertwined with feelings of competency, is a satisfying experience being well defined at a mastery level.
Appropriate and thoughtful self assertion unlocks talent, setting achievement in motion. Furthermore, through involvement in writing, graphics, computer literacy, advanced clinical training, advanced degrees, staying informed of cutting edge developments within the field via online and hard copy publications, supervision, workshops, mentors, networks, organizations, Web casts, online forums and chat rooms (Socialworkchat.org is sponsored by the National Association of Social Workers and The New Social Worker®), we attempt to stay current and garner expertise. It is important to seek out learning opportunities, especially feasible when offered as a benefit, at the workplace. These enhancements will lead to professional growth and advancement.
What about age difference? Some older clients state that they do not feel comfortable speaking to younger workers, because of a disconnect of the “red badge of courage,” or in other words, living life. This, however, seems to be more of a transference issue and should be explored within the context of the relationship. With empathy and focus on a feeling level, we can all relate to the common ground of mutuality of emotions. Fear is fear, anger is anger ad infinitum, as a relationship blossoms via spoken and unspoken communications.
So, given this immense backdrop, where does a social worker begin in establishing a career? One of the first roles might be as a geriatric care manager. Through psychosocial assessments, a good understanding of the client in his/her situation will be grasped. As with all environments, a reliable resource directory is established, as the mire of agencies is networked and instrumental contacts are earmarked. Once a comfort level with seniors is established, an understanding of the dynamics absorbed and astuteness at developing plans of care is in place, we are ready to apply skills, cognizant that client centered focus is always tantamount, to many ventures. As social work is a very “giving,” flexible profession, with the possession of core competencies, we can translate our talents to many diverse areas in the nonprofit world or corporate sector.
Settings and/or areas in which to apply skills include grant writing, home care, senior centers, faith based organizations, hospice, palliative care, housing entities, research, NORCs, policy and planning, program development, publishing, teaching, marketing, supervisory roles, administration, caregiver programs, hospitals, rehabilitation agencies, mental health agencies, social and medical adult day programs, or geriatric care management agencies. In addition, older clients of vulnerable populations, such as veterans and persons with developmental disabilities, are rife with need. Bureaucracies seem to take on a life of their own and may engender much frustration when trying to negotiate the boondoggles of red tape and molasses. With accountability and transparency at the forefront, it might be refreshing to find a setting wherein the structure is conducive to flexibility.
So, is the field of gerontology a plausible pursuit? Given a crisis intervention model, it appears that much energy, funding, and, as Rollo May urges, courage (to create), needs to be diverted to older adults. Jobs in healthcare remain stable. The juxtaposition of younger workers and older clients mirrors positives of family dynamics; the interaction can be a very rewarding experience. Although losses are shared, when the well-springs of joy gleam through dulled and distant eyes in remembrances of things past, the vibrancy of the moment cannot be denied. The spark of generosity of spirit is a gift that comes from within. It should be showered on clients and colleagues with abundance. As Albert Camus so eloquently states, “Real generosity towards the future lies in giving all to the present.”
The intriguing field of narrative medicine marries anecdotal and medical events speaking to the substance and complexity of life. Cases in point, so poignant and healing, are the living histories social workers sculpt. We are fortunate to discover the richness and mystery of life endemic to seniors, society’s well traveled journeymen, through their stories. Not only do famous comedians, scholars, and other talents of our time beckon as the shamans of culture, but we ponder whether seniors might be the modern storytellers stringing the threads of transitioning eras, connecting and bridging past, present, and future? The unraveling of a sometimes tangled web propels our work, in tandem, through the realization of their individuality. In any event, as a social worker, it is a pleasure and an honor to share their stage. There is room for a full supporting cast, if you care to join us.
Karen Graziano, LCSW, is affiliated with the Cornell Institute for Translational Research on Aging as a member of the Persistent Pain in Older Adults work group. She is also an adjunct faculty member at Adelphi University and is involved in post traumatic stress treatment of Iraqi and Afghanistan veterans.