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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 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 a health care settings work with older patients, not all social workers have specialized training in geriatrics. This is changing rapidly, primarily through training efforts sponsored by the Hartford Foundation's initiative established in 1999. Such training enhances social workers' awareness of older people's needs and subsequently leads to better quality of care by helping social workers provide the appropriate services at the right time. 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 elders as well as facilitate linkages between service workers and agencies.

Table 27-1 The Roles Social Workers Perform

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