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This chapter addresses the following Geriatric Fellowship Curriculum Milestones: #1, #23, #28, #35, #36, #38, #45


Learning Objectives

  • Understand the roles that social workers play in various health care settings, including direct service work, linkage roles, and support services.

  • Identify key populations that social workers serve and some of the practice issues that arise with older adults in these groups.

  • Determine health care settings where social workers practice and some of the issues that may arise for social workers in nursing homes, community mental health facilities, hospitals and health care facilities, hospice and palliative care, and home care.

Key Clinical Points

  1. Identify some of the practice issues that arise in older groups in key populations that face particular vulnerability because of oppression and/or poverty due to race, ethnicity, immigration status, sexual orientation, gender identity, or HIV/AIDS diagnosis.

  2. Recognize some of the core issues that emerge when working with people who face abuse, neglect, mental health concerns, cognitive impairment, and substance or alcohol misuse.

Social workers provide services to older patients across a continuum of care needs that range from supporting community living to providing palliative care services at the end of life. This occurs in many different health care arenas including institutional settings, such as acute care hospitals, chronic care settings, and nursing homes, as well as in patients’ homes in the community. Social workers support and enhance the adaptive capacities of patients within their living environments and are knowledgeable about interviewing, assessment, and intervention in social problems faced by individuals, couples, families, and groups. Using negotiating skills, social workers also mediate conflicts and obtain resources for clients and their families. Knowledge of group process makes social workers effective in forming natural helping networks and serving as members of interdisciplinary teams. Their expertise in coordinating services within a single organization or across different agencies or settings helps to ensure appropriate and adequate care for older patients.

While 76% of social workers in health care settings work with older patients, not all social workers have specialized training in geriatrics. Proper care provided by gerontologically trained professionals including social workers can reduce the cost of care by 10% each year in hospitals, nursing homes, and patients’ homes as well as improve psychosocial outcomes and reduce mortality.

This chapter describes the key roles for geriatric social workers, the practice issues they face, and the settings in which they work.


The roles social workers play vary within health care settings (Tables 27-1 and 27-2). Social workers provide direct service to older adults and facilitate linkages between service workers and agencies.


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