CADD CORNER: Alzheimer’s and Dementia (AD) Service: A Social Work Priority

By Evaon C. Wong-Kim, MSW, MPH, LCSW, PhD

Dementia is a progressive, degenerative condition that affects memory, thinking, behavior, emotion, and day-to-day functioning. Alzheimer’s Disease (AD) is the most common cause of dementia and accounts for 50 percent to 60 percent of all cases. It is caused by abnormal brain tissue changes—known as “plaques and tangles” that were identified by Alois Alzheimer, a German psychiatrist and pathologist in 1906. Across the globe, more than 35 million people are living with dementia. According to a recent World Health Organization (WHO) report, this number is expected to more than triple and will reach 115 million by 2050 in the wake of world population aging (WHO, 2012).

The Shrinking of the Geriatric Frontline Workforces
The projected increase of utilizations and demands of health, home and community-based services of older adults is of a concern in the already atrophic geriatric workforce (Congressional Budget Office, 2013; Sloane, Zimmerman & D’Souza, 2014). To account for this large aging population, the medical system will require a large frontline workforce, including nurses and social workers who specialize in geriatric and long term care. However, the trend is a shrinking workforce that is far from meeting the needs of the growing aging population.

Social workers in long-term or geriatric care are also facing similar shrinkage. According to 2006 U.S. Department of Health and Human Services (DDHS), approximately 36,100 to 44,200 professional social workers were employed in long-term care settings, which were defined as nursing facilities, other residential care, home health, and selected community-based settings.

The report anticipated that approximately 110,000 social workers would be needed in long-term care settings by 2050. This number will likely to increase as home and community-based long-term care options grow. However, a study conducted by Whitaker, Weismiller, & Clark and the National Association of Social Workers in 2006 showed that only nine percent (or 30,000) of respondents reported their primary practice area as aging, although the majority (73%) provided some services to adults 55 and older.

In its 2008 report, Retooling for an Aging America: Building the Health Care Workforce, IOM reaffirmed the growing need for gerontology social work and the low level of interest among social workers, especially those at the Master’s level, in working with older adults—despite several initiatives to promote education and training in gerontology social work.

Shrinkage in gerontology social workers is of serious concern and poses threats to the well-being of the older populations. Such a problem is exacerbated by lower paid workers and the association of working with old, frail people (Stone & Harahan, 2010). Training, mentoring, increasing, and sustaining frontline workforces are imperative in the U.S. healthcare system. As social workers play a critical role in the frontline care for the aging population, the exigency of the shrinkage in the geriatric workforce is a pressing issue and must be addressed immediately.

Minorities face extra challenges in accessing care and dementia services. For example, many Asian populations are foreign-born and unfamiliar with the Western health system. In the Chinese community, partial or complete gaps were identified in the lack of diagnostic and treatment centers, community and caregiver education, support groups, legal/financial services, day care, and end-of-life services. Other communities also faced similar barriers when accessing care and treatment in dementia.  The demand for a larger and culturally competent frontline workforce, more trained caregivers, accessible community-based services, and education for caregivers, families and patients will continue, but are social workers ready to take the lead if we are reluctant to serve this vulnerable population? 

REFERENCES
Centers for Disease Control and Prevention (2004-2007). Health Characteristics of Adults Aged 55 Years and Over: United States. Retrieved February 2, 2015.

Congressional Budget Office (CBO). (2013). The 2013 budget outlook. Retrieved February 2, 2015, from https://www.cbo.gov/publication/44521.

Sloane, P., Zimmerman, S., & D’souza, M. (2014). What will long-term care be like in 2040? N C Med J, 75(5), 326-30.

Stone, R., & Harahan, M. (2010). Improving the long-term care workforce serving older adults. Health Affairs, 29(1), 109-115.

Whitaker, T., Weismiller, T., & Clark, E. (2006). Assuring the sufficiency of a frontline workforce: A national study of licensed social workers. Washington, DC: National Association of Social Workers. Also available online at http://workforce.socialworkers.org/ studies/nasw_06_execsummary.pdf

World Health Organization (WHO) and Alzheimer’s Disease International, Dementia: A Public Health Priority (Geneva: WHO, 2012).