SOcial workers bring many skills to long term care homes, including advocacy, mediation, counselling and liaison work. Traditionally, elderly persons admitted to acute care facilities remained in hospital until a suitable ‘bed’ in a long term care home could be found. During these often lengthy hospitalizations, the social worker or discharge planner worked with the individual to help them make the transition to long term care. The social worker also helped families navigate the change from home to hospital to long term care. Today, hospitals are under pressure to treat acute cases and then move patients through the system so that the next person can be admitted for treatment. Elderly patients who can no longer return home are moved as quickly as possible into long term care. The focus has shifted from acute care to long term care, not only in the context of the residents’ medical and physical needs but also their psychosocial needs. Moving into long term care can be overwhelming, especially since the average age of new residents is 85—a time of life when people are unlikely to embrace change. For the resident, there is a huge sense of loss associated with such a move, as well as feelings of grief and anxiety. For families, there is often guilt. At the very least, the family structure is forever altered. Social workers can help to ease the transition to long term care. Involved at admission, social workers have the opportunity to immediately establish a relationship with residents and their families. They can also learn more about the individuals being admitted—can develop an understanding of their history—which gives them a better awareness not only of the person but also of the family dynamic. This relationship is valuable to new residents and their families and also to the long term care home. Creating a protocol for reaching out to ‘newcomers’ helps to shift the balance of power in the resident’s favour and creates A more level playing field between the home and the individual. It is a way of saying, “We value you, we want to know about you and we want to know how we can help to make this your home. Not only are you important to us, but you are now a part of us.” And this is just the beginning of a relationship that lasts as long as the resident lives in the home and can even extend beyond. The social worker can establish a therapeutic relationship from the outset, counselling residents through the transition to long term care and making the life change easier and more palatable. The social worker can also integrate new residents into an existing support group. By giving newcomers the opportunity to meet others who have already made the transition, the social worker is introducing another means for managing fear and uncertainty. In a group setting, residents who have made the adjustment to long term care share important information and coping strategies with new residents. Support groups also hold tremendous value for the spouses of residents and for family members accustomed to acting as the primary caregiver. Lessons learned are far more relevant and have a much stronger impact when they are imparted by people who have actually managed this difficult change. A sympathetic response from staff is certainly necessary, but there is a power in numbers, particularly when it involves a homogenous group of empathetic people sharing similar stories and experiences. The social worker’s involvement, whether on a oneto- one basis or in a group situation, is also useful in assessing the ability of residents and their families to adjust to long term care. The social worker is in a unique position to determine whether individuals are coping or having difficulty with this life-altering change. Based on the evaluation, the social worker can offer more intensive intervention to the individual or family members and, if necessary, make referrals to mental health agencies or teams in the community. Early intervention is critical for the elderly, especially when it comes to helping to resolve adjustment issues. The social worker’s ability to liaise with outside resources for timely intervention and treatment is crucial, but keeping worried family members informed is equally important. Informed families are far more likely to work cooperatively and productively with the team than families who are not “kept in the loop.” This type of liaison work is proactive and has a positive outcome on the health of the resident. Open communication and positive relationship-building with families is an important element of quality care. Families “in the know” are less likely to question the treatment of their loved one and more inclined to become part of the solution. They are more inclined to focus on options instead of criticizing current practices. The social worker acts as the home’s “link” to building strong communication between residents, family members and the various groups operating within the facility and the wider community. This positive relationshipbuilding can have far-reaching effects that range from supporting frontline staff in their interaction with residents to mediation between residents, families and management for a more healthy approach to living. Social workers: creating balance Homes that have social workers on site are seeing the value in their work. “Social work services have enhanced the quality of services we can provide to our residents and families immensely,” says Doris Bilitz, the administrator of Meaford Long Term Care, located in Meaford, Ontario. Long term care homes are complex environments. They are both workplace and home, and this dynamic can make difficult situations, should they arise, even more difficult to manage. Getting to know residents and their families is a good place to start, and clear communication at all levels within the home promotes a healthy living and working environment. Social workers —as advocates, mediators, counsellors and liaisons — help to create a balance in the long term care home. And balance makes the long term care home a better place to live and work.v Reprinted with permission from Long Term Care, March/ April 2008 Mary T. Varey, BSW, MSW, RSW, is co-founder and managing director of clinical services at Age-Wise Solutions Inc. She can be reached at mvarey@agewise.ca. Common issues that can be addressed by the social worker n The elderly are postponing their admission to long term care and thus have greater needs—physically, cognitively and from a mental health perspective. N A husband or wife is often admitted to the long term care home while the other remains in the marital home. After a life together of many decades, living apart is a huge transition. N Residents and families are more educated about aging and their rights as long term care consumers. They feel comfortable challenging the ‘status quo’ and investigating their options. N Families are living further away from their loved ones in long term care and live increasingly hectic lives, which makes “connecting” with their relatives in long term care difficult. N Health care professionals and management teams are challenged to be more informed, educated, sensitive and forward thinking. N Frontline staff—overwhelmed by high care needs and securing the resources that allow them to do their job well—are truly the “frontline” for residents and their families.