Linda P. Darrell
The perspective of end-of-life care has changed over the years. People are living longer, fuller lives due to advanced medical care and technology along with an increased interest in healthier lifestyles. The focus of end-of-life care has expanded to include accidental and sudden, unexpected death, chronic illness, anticipated death from longevity, and illnesses impacting children. An expanded perspective of end-of-life care must account for the challenges and changes of service delivery within a multi-cultural 21st-century milieu. The significance of advanced medical technology and improved lifestyles is an important component of a primary multidisciplinary assessment to understand the impact of such a life-altering occurrence as end-of-life care. Equally as important is a culturally inclusive perspective to accommodate the significance of longevity due to improved lifestyles, advanced medical technology, ethnicity, spirituality, and racial awareness. This article will explore the multiple concerns surrounding end-of-life care issues from an expansive worldview.
Meredith Stensland, Sara Sanders, and Marla Berg-Weger
Advance care planning (ACP) is the process of determining and documenting desired wishes for the end of one’s life. Referred to by such terms as end-of-life planning, advance (health) directives, and living wills, ACP is a relatively new concept within our society, having emerged as a social, political, and ethical issue in the United States only since the 1960s. Researchers and legislators have been challenged in their efforts to examine healthcare decision-making and design appropriate policy to guide practice. This article will define ACP, provide an overview of the history and evolution of the process and the associated legal and ethical issues, and describe the process with three specific populations. In addition, it examines the role of the social work profession in working with individuals and families on planning for the end of one’s life.
June Simmons, Sandy Atkins, Janice Lynch Schuster, and Melissa Jones
Transitions in care occur when a patient moves from an institutional setting, such as a hospital or nursing home, to home or community, often with the hope or expectation of improving health status. At the very least, patients, clinicians, and caregivers aim to achieve stability and avoid complications that would precipitate a return to the emergency department (ED) or hospital. For some groups of vulnerable people, especially the very old and frail, such transitions often require specific, targeted coaching and supports that enable them to make the change successfully. Too often, as research indicates, these transitions are poorly executed and trigger a cycle of hospital readmissions and worsening health, even death. In recognizing these perils, organizations have begun to see that by improving the care transition process, they can improve health outcomes and reduce costs while ensuring safety, consistency, and continuity. While some of this improvement relies on medical care, coaching, social services and supports are often also essential. Lack of timely medical follow-up, transportation, inadequate nutrition, medication issues, low health literacy, and poverty present barriers to optimal health outcomes. By addressing social and environmental determinants of health and chronic disease self-management, social workers who make home visits or other proven timely interventions to assess and coach patients and their caregivers are demonstrating real results. This article describes care transitions interventions, research into barriers and opportunities, and specific programs aimed at improvement.
Social workers working with individuals with intellectual disabilities and their families require an understanding of the disabilities themselves as well as the larger context of disability in society. Individuals with disabilities face particular risks for poverty and poor healthcare, and it is essential for social workers to understand the complex web of social services available. Furthermore, social workers often work not only with the person with a disability but also with their caregiving families.
Margo A. Jackson
Despite the significant life and work experiences that a growing number of older adults have to contribute to the workforce, pervasive ageism operates in overt and covert ways to discriminate against older workers in hiring and workplace practices. This article provides a current overview of definitions, prevalence, types, and effects of ageism in the U.S. workplace. For social workers counseling older adult victims of workplace ageism, this article discusses theories, foundational knowledge, and ongoing self-awareness and training needed for bias awareness. Counseling strategies and resources are highlighted, including coping and resilience strategies to counteract ageist stereotypes and discrimination, facilitate job-seeking support, and advocate for older workers by promoting awareness and serving as a resource for employers to reduce workplace ageism.
Priscilla Gibson and Valandra
Little attention has been paid to the role of grandparents, yet this intergenerational family role has shifted both inside and outside of the family. Social policies have pushed it into public debate on the rights of grandparents. Although traditional characteristics remain, new contemporary aspects of the role have emerged. This entry provides content on the significant factors that prompted the diversity in grandparenting and its social construction by adult children, grandchildren, and society.
Older workers make important contributions to the workplace, its productivity, and its culture. Work remains important for older adults for financial security, to give meaning to later life, to maintain social networks, and to promote lifelong learning. However, ageist beliefs about the capacity of older adults to remain productive and contributing workers in the workforce can create barriers for older workers. Understanding how older workers experience ageist behavior in the workplace can help employers, policy makers, and social workers learn more about how to address this social problem. Organizations can become more age friendly through enabling workplace programs, supportive management, and proactive human resource managers. Social workers serving older adults in employee assistance programs and in private practice can help them to challenge ageism in the workplace. Finally, legislation such as the Age Discrimination in Employment Act protects the rights of older workers; however, more legislation is needed to address bullying and harassment of older adults in the workplace.
Paula S. Nurius and Charles P. Hoy-Ellis
Evolving understandings of stress have literally transformed how we think about health as contextualized within complex and multilevel transactions between individuals and their environment. We present core concepts of stress through the lens of life-course and life-span perspectives, emphasizing appraisal-based and biobehavioral models of stress response systems. We describe theories of allostatic load, embodiment, epigenetics, weathering processes, and accelerated aging that operationalize mechanisms through which stress affects health and contributes to health disparities. In addition to social determinant and life-span developmental perspectives on stress and health, we emphasize the value of health-promotive factors that can serve to buffer stress effects. Social work has important roles in targeting health-erosive stress from “neurons to neighborhoods”.
Family estrangement—a concept similar to emotional cutoff in Bowen family systems theory—is the unsatisfactory physical or emotional distancing between at least two family members. It is attributed to a number of biological, psychological, social, and structural factors affecting the family, including attachment disorders, incompatible values and beliefs, unfulfilled expectations, critical life events and transitions, parental alienation, and ineffective communication patterns. Family estrangement is often experienced as a considerable loss; its ambiguous nature and social disenfranchisement can contribute to significant grief responses, perceived stigma, and social isolation in some cases. The social-work profession has a role to play in raising social and political awareness of the prevalence of, contributors to, and effects of estrangement on the intergenerational family, with clinicians working to assess and address the impact of estrangement on individuals and the family system.
Philip McCallion and Lisa A. Ferretti
The definition of retirement has become increasingly complex. Freedom from work, autonomy, and the pursuit of new interests are mediated by a sense of loss of value when employment ends, by the resource picture in retirement, and by the likelihood that current and boomer retirees are likely to spend more years in retirement. The viability of Social Security, Medicare, Medicaid, and pensions is also of influence, and stereotypes of carefree years are thwarted by caregiving responsibilities and avoided by those continuing to seek fulfilling roles. Finally the experience of retirement continues to be different for important groups in society.