Cultivating social work expertise with older adults in rural settings: Lessons learned from implementing the Hartford P

1. CSWE Annual Meeting: San Francisco, CA October 30, 2007 Cultivating social work expertise with older adults in rural settings: Lessons learned from implementing the Hartford Partnership Program for Aging Education Fran Wilby, University of Utah School of Social Work Linda Durham, The Ohio State University College of Social Work Nancy Kelly, University of Maine School of Social Work Jarmin Yeh, Social Work Leadership Institute, New York Academy of Medicine www.socialworkleadership.org

2. The Utah Hartford Partnership Program for Aging Education Challenges of Rural Implementation of the John A. Hartford Foundation Hartford Partnership Program for Aging Education www.socialworkleadership.org

3. Challenges/Opportunities Unique to Utah • Population 2,246,553 • Of 28 counties only 5 are urban • One predominant religion • 53% of population in Salt Lake City • 75% in rural areas • Overall lack of diversity in population • 95% white • Projected life expectancies higher than national projections www.socialworkleadership.org

4. Challenges Continued • Rural communities are aging • Limited access to public transportation, healthcare and other social services • Older adults falling through the “cracks” of social services • Youngest state in the nation • Isolation issues • Changing face of rural communities in age and diversity www.socialworkleadership.org

5. Benefits of Rural Settings • Social Workers have interpersonal ties with most government and private systems • Able to easily access and affect systems • Presence within community www.socialworkleadership.org

6. Neighbors Helping NeighborsHost site for HPPAE students The mission of NHN is to improve the health, safety and quality of life of older adults living in this community by promoting independent living by means of community partnerships among neighbors, local businesses, and neighborhood organizations. www.socialworkleadership.org

7. Interfaith Council and Neighbors Helping Neighbors Initiative • Host site, Neighbors Helping Neighbors will partner with Interfaith Council • HPPAE students will play integral role in assessment and provision of services to participants • Religious leaders will provide volunteers to assist in providing home-based care www.socialworkleadership.org

8. Action Plan • Receive call from a religious leader that a senior adult is having problems. • Send out one social work HPPAE intern to accompany the clergy to do an assessment which includes assessing both emotional and physical needs. • Social work HPPAE intern assumes role of care manager. • Make a decision about a care management plan which includes the older adult, family members, and community resources. www.socialworkleadership.org

9. Action Plan Continued • Support caregivers already working with senior adults. • Follow through with the plan and know what is happening each week! • Contact religious leaders to provide additional support through the use of volunteers. www.socialworkleadership.org

10. Rural States have Unique Opportunities • Focus on the positive • Optimize the resources available • Be open to innovative partnerships • Celebrate your rural heritage www.socialworkleadership.org

11. Careers in Aging Week • HPPAE students present highlights of their experiences during Careers in Aging Week • Possibilities are endless! www.socialworkleadership.org

12. Virginia E. Richardson Holly Dabelko and Lisa Durham The Ohio State University College of Social Workin partnership with theCentral Ohio Area Agency on AgingColumbus, Ohio www.socialworkleadership.org www.socialworkleadership.org

13. Goals of Partnership To enhance aging services in rural counties To train more geriatric social workers in culturally-competent rural social work practice To increase the number of geriatric social workers employed in Ohio’s rural counties To develop more geriatric field placements in these rural counties www.socialworkleadership.org www.socialworkleadership.org

14. Counties used for HPPAE Fairfield County - 15% are 65+ Fayette County - 19% are 65+ Licking County - 16% are 65+ Madison County -15% are 65+ www.socialworkleadership.org www.socialworkleadership.org

15. Characteristics and Needs Poverty rates Living alone Disability rates Scarce Services and Health Practitioners www.socialworkleadership.org www.socialworkleadership.org

16. Social Services and Health Practitioners www.socialworkleadership.org www.socialworkleadership.org

17. OSU HPPAE: Enhancing Elders and Development through Elder Rural Services (E.L.D.E.R.S.) Assign students to counties and rotate them through selected programs (see next slide) Expand the roles of field supervisors and faculty liaisons with in-county liaison meetings Offer team-taught didactic seminars Recruit appropriate MSW students to the program Evaluate the efficacy of the program www.socialworkleadership.org www.socialworkleadership.org

18. Rotations Rotation A: Orientation Rotation B: Well-Elderly Rotation C: Functionally-Impaired Rotation D: End-of-Life Care www.socialworkleadership.org www.socialworkleadership.org

19. Programs Involved Senior Centers PASSPORT (Pre-Admission Screening Providing Options and Resources Today) VGP (Voluntary Guardianship Program) NFCSP (National Family Caregiver Support Program Hospices www.socialworkleadership.org www.socialworkleadership.org

20. Central Ohio Area Agency on Aging (COAAA) VISION - a community leader that understands that complex issues involved with aging and offers a well-funded range of services offering choices in long term care that support a high quality of life. MISSION - to plan, coordinate and advocate for the development and delivery of services for older adults, families and the community. GOALS - to increase awareness of the aging process, aging issues, and COAAA program; to improve access to quality in-home care; to develop long-term care services; to expand community services; to ensure that minority elderly are aware of senior services offered with cultural competence. www.socialworkleadership.org www.socialworkleadership.org

21. PASSPORT Ohio Medicaid-Waiver Program Nursing Home Diversion Program In-home services to Eligible Seniors www.socialworkleadership.org www.socialworkleadership.org

22. NFCSP Information and referral Training Counseling Support groups Other related supplemental services. www.socialworkleadership.org www.socialworkleadership.org

23. VGP Matches qualified volunteers with people who need a substitute decision maker, but who are without family or assets. Volunteers become “guardians” of the person or individuals whose mental impairment incapacitates them and are unable to care for themselves or make sound personal decisions. Special emphasis placed on nursing home residents. www.socialworkleadership.org www.socialworkleadership.org

24. Successes and Outcomes Dispelling Myths Outcomes Challenges and Lessons Learned www.socialworkleadership.org www.socialworkleadership.org

25. Dispelling Myths A great deal of effort was put forth by our students to reduce the amount of misperceptions regarding rural communities Specifically, in relation to access to services and professional social workers Culture/diversity in each community www.socialworkleadership.org www.socialworkleadership.org

26. Challenges and Lessons Learned Variability across rural counties Dispel myths about rural aging Discontinuity in long term care in rural counties and emphasis on nursing home care; limited informal supports www.socialworkleadership.org www.socialworkleadership.org

27. Lessons Learned and Challenges (Cont.) Lack of knowledge and awareness especially among caregivers Dearth of social workers especially well-trained social workers Funding problems in rural areas and limited health and social services www.socialworkleadership.org www.socialworkleadership.org

28. Lessons Learned andChallenges (Cont.) Neglect of Mental Health Issues Limited Clinical Interventions More Advocacy Needed www.socialworkleadership.org www.socialworkleadership.org

29. University of MaineCenter on Aging/School of Social Work Cultivating Social Work Expertise With Older Adults in Rural Settings October 30, 2007 www.socialworkleadership.org

30. Maine’s Rural Nature • Third most rural state in country • Over 55% live in rural areas • 39th in geographic area • 40th in population (approx. 1,322,000) www.socialworkleadership.org

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32. Special Characteristics: Land • Approximately 5,000 miles of marine coastline, including hundreds of islands • Majority of inhabited islands are accessible by boat only • Northernmost county is east of Mississippi but has population of only 73,240 www.socialworkleadership.org

33. Economic Considerations • Maine is divided into 2 very different parts, “wealthier southern” and “the rest” • Maine is ranked as having the highest tax burden of any U.S. state • 11.5% Mainers are living in poverty www.socialworkleadership.org

34. Demographics • Oldest state in nation with average age of 41.2 years • 14.6 % of Mainers 65+ ( app. 193,000) • 96.5% non-Hispanic white - tied with Vermont for the most homogeneous state in nation • Three Native American reservations in eastern Maine representing 4 distinct tribes, one within a few miles of university www.socialworkleadership.org

35. Special Characteristics: People • Professional community is generally non-competitive and friendly • New programs like HPPAE are generally met with enthusiasm rather than distrust • Large percentage of supervisors in agencies have ties to UM SSW • Most graduates stay in Maine to work • Implementing change often not overwhelming challenge www.socialworkleadership.org

36. School of Social Work • Relatively small school with 60-70 full and part-time advanced year MSW students between main campus and satellite program in Belfast, Maine • Students from all over the state, including the Maritime Provinces in Canada • One of 3 MSW programs in Maine www.socialworkleadership.org

37. Rationale for HPPAE Model • Advanced generalist program training students to work in settings where practitioners assume many roles • Very few specialized agencies • Wide based knowledge of needs and services critical to best serving Maine’s geriatric population • Need to train students to be “watchdogs” for clients and therefore essential to understand political processes as well as policies www.socialworkleadership.org

38. Realities of Social Work Practice in Rural Maine • Agency staff assume multiple roles • Lack of collegial support in many settings due to isolation • Few professional and educational opportunities exist • Lack of services for clients results in staff frustration • Lack of transportation is a major issue for clients trying to access services www.socialworkleadership.org

39. Challenges : Field • Few agencies deal primarily with older adults • Budget cuts result in fewer staff to supervise students • Rotation model involves many agencies from wide geographic area www.socialworkleadership.org

40. Challenges : Field - cont. • Model is labor intensive • Geography can be a barrier to student participation • Experiences with diverse groups must be sought out www.socialworkleadership.org

41. Field : Lessons Learned • Be creative • Start small and expand in succeeding years • Program’s reputation brings new supervisors on board www.socialworkleadership.org

42. Field: Lessons Learned - cont. • Supplement diversity experiences via guest speakers and field trips • Still labor intensive but making contacts all over state • Develop alternative ways of letting students participate for whom geography is an issue www.socialworkleadership.org

43. Challenges : Academic • Due to size of school and budget, there is an identified need for more electives in aging • Size of school hasn’t allowed for gerontology specialization www.socialworkleadership.org

44. Academic : Lessons Learned • HPPAE has provided opportunity for gerontology specialization • HPPAE recruitment easy due to word of mouth and access to student body • Many more students than we thought are interested in aging www.socialworkleadership.org

45. Academic : Lessons Learned • Because of HPPAE, SSW now has a geriatric field seminar and will be offering clinical geriatric courses • Use outside speakers such as members of consortium and others • Sponsor conference annually and invite HPPAE students at no charge www.socialworkleadership.org

46. Challenges: Consortium • Consortium members from southern to northern parts of state • Transportation and weather can provide obstacles to onsite meetings • How to get practitioners to see involvement in HPPAE as a support and benefit to them and their agencies • Members wear many hats in agencies which makes time for involvement difficult www.socialworkleadership.org

47. Consortium: Lessons Learned • Geographic distance among members means extensive network • Don’t make assumptions about consortium members’ interest in traveling to meetings • The many roles each member plays within agencies can result in rich discussions • Make use of listserv and websites to keep those involved who can’t travel to meetings • Include students at consortium meetings www.socialworkleadership.org

48. Consortium : Lessons Learned - cont. • Provide as many forms of appreciation as possible to consortium members • free continuing education • university “perks” • publicity for agency through “featured site” on HPPAE website • letters of support to agency administrator on member’s behalf www.socialworkleadership.org

49. Consortium : Lessons Learned - cont • Have different agencies host consortium meetings • Consortium has created referral and professional network throughout state www.socialworkleadership.org

50. Final Reflections • A truly exciting and rewarding endeavor • Becoming a vibrant statewide program • New field agencies for SSW as a result of consortium • Generating interest in looking at unique needs of older clients among practitioners www.socialworkleadership.org