2013-2014 MSW Fellows in Aging
The Rutgers School of Social Work selected five MSW students as 2013-2014 MSW Fellows in Aging. These students were selected for their strong commitment to social work and aging, as well as their great potential as leaders in this field. The Fellows completed leadership projects in April of 2014 as part of their advanced MSW internship at aging-focused agencies throughout New Jersey.
An Assessment of the Services for Independent Living (SIL) Program
Megan Brozena-Creech, New Jersey Housing Mortgage Finance Agency (2013-2014)
Background: The New Jersey Housing and Mortgage Finance Agency’s (NJHMFA) Services for Independent Living (SIL) program provides or expands upon supportive services—such as case management and linkages to transportation, health screening, education, training, and assistance with housekeeping and shopping—for older adults living in subsidized senior housing developments. A guiding principle of the SIL program is that the promotion of independent living, as opposed to institutionalization, is not only cost effective, it also maintains self-respect and dignity in seniors as they become frail and/or weak. The SIL program requires social service coordinators to be hired by each housing development to be eligible for participation. The onsite SIL coordinator works with the NJHMFA staff to develop programs that can meet the needs of the residents living in that particular development.
Project Goals: The purpose of the project was to (a) provide the administration at NJHMFA and social service coordinators with findings and feedback from interviews with SIL coordinators across the state; (b) highlight areas of strengths and areas for improvement in the SIL program; and (c) describe the importance of social services in a non-social service host setting.
Outcomes: Over the period of six months, I conducted face-to-face or telephone interviews with 34 SIL coordinators across northern, central and southern NJ. The interview notes were analyzed and categorized into key themes, which were put into a final report and a PowerPoint presentation for both NJHMFA administration and the SIL coordinators at their regional meetings. SIL Coordinators identified many strengths of the program, including an overall understanding and value of social services in senior housing developments and enjoyment of the knowledge shared through trainings and conferences. They also identified several areas of improvement, such as internal concerns within housing developments, differential backgrounds of SIL coordinators, and concerns regarding the locations of trainings. Key recommendations from the stuy included expanding social services and SIL staff oversight within NJHMFA, developing training for all housing development staff, and standardizing the format of reports required for SIL and other programs.
Reflections: It has been a very fulfilling experience at NJHMFA through the Aging Fellowship Program. I was provided with great leadership and supervision, which has helped me to grow and expand my knowledge and experience both at the macro level of social work and in aging. Most of all, this fellowship has provided me with an opportunity to conduct social work research and provide an assessment of a program that has affected the lives of so many seniors throughout New Jersey.
Measuring Quality of Social Services at Parker Memorial Home
Katelyn Ciarelli, Francis E. Parker Memorial Home (2013-2014)
Background: Francis E. Parker Memorial Home offers a wide variety of services, including skilled nursing, assisted living, memory care, adult day services, and health and wellness community services in Central New Jersey. Social Services are offered as part of all of these services and provide support in many critical areas. These areas include adjustment, loss, mood, behavioral issues, cognitive issues, and family concerns. Although other consumer satisfaction surveys are administered with consumers, the social services department at Parker currently lacks a tool to ensure quality services are being provided to residents; currently, there is no mechanism for the department to receive feedback regarding their services.
Project aim: This leadership project aimed to strengthen the social work department by gathering and analyzing departmental performance measures from residents and families. An initial survey was created in the fall of 2013 and focused on evaluating recent changes within the department. The survey—to be administered by the organization in the near future—inquired about the responsiveness, helpfulness, satisfaction, and availability of social workers in the unit. The second piece of this leadership project aimed at creating a quantitative tool to assess the department’s overall effectiveness. The metric will be distributed to residents and families in skilled nursing. The survey was designed to gather feedback on the availability, responsiveness, approachability, helpfulness, supportiveness, and general satisfaction with social services.
Findings: The second instrument was piloted with 10 residents. All residents reported that they were satisfied or mostly satisfied. All residents responded that they would seek out social services in the future. When asked to give an overall rating, seven out of the ten participants rated the services excellent, while the remaining three rated the services good. The most common comment in regards to the survey was that they were pleased to have an outlet to express gratitude for the help they have received. The other variables that were expressed in high regards were helpfulness and availability of the staff. For future use, the survey will be distributed to cognitively able residents and family members within both of Parker’s skilled nursing locations.
Reflection on my leadership development process: This project has given me the opportunity to learn how metrics are created and what it takes to ensure quality services are being provided in agencies. At first, I was unsure as to how many residents and families would be interested in filling out another survey, but I was met with enthusiasm and a very positive response. Residents and families at Parker largely seek an outlet to express their gratitude and/or concerns with the social services department, and this survey allowed them to do so. The overwhelmingly positive responses contribute to the social work department’s morale as well, as it reinforces their role, offers valuable feedback, and expresses deep gratitude. In the future, Parker Memorial Home can offer this survey annually as a way to ensure quality services continue being achieved.
Broadening the Continuum of Care through Social Work in Primary Care
Amanda Lazzarotti, Saint Peter’s University Hospital/Central Jersey Internal Medicine Associates, PA (2013-2014)
Background: Older adults may experience many transitions throughout the course of their lifetime, such as changes in personal care needs, social relationships and health. These changes can lead to repeated emergency department visits or hospitalizations, which can be stressful for individuals, families and the healthcare system. To address these challenges, Saint Peter’s University Hospital is a healthcare system seeking new ways to provide a holistic approach to care that is person-centered and emphasizes the physical, mental, and social aspects of the person. One of these innovations involves piloting social work in a primary care office, Central Jersey Internal Medicine Associates, PA.
Project Aims: This project addressed psychosocial issues experienced by patients, families and caregivers in an outpatient medical setting. Goals of the project included improving care transitions, reducing unnecessary hospitalizations or emergency room visits due to psychosocial risk factors, and improving accessibility to community resources such as behavioral health and support services. My role included performing psychosocial assessments, interventions, and planning tailored to specific needs of the patient. Through this project, social work became a valuable component of interdisciplinary team collaboration at the clinic. I also had the opportunity to share my experiences as a panelist for Behavioral Health Awareness and Career Pathways Day at Brookdale Community College, in addition to submitting articles about social work in primary care to the publication of the New Jersey Foundation for Aging and the Rutgers School of Social Work Alumni Newsletter.
Findings: The opportunity to network with various healthcare professionals about innovations in primary care and the role of social workers was invaluable. Conversations surrounding social work in primary care were full of interest and excitement. These discussions raised awareness surrounding the need for person-centered care and how the social work profession can have an impact. Through my experiences, networking with healthcare consumers across disciplines about the importance of social work in primary care resulted in meaningful discussion and advocacy. By participating in outreach, such as becoming a panelist or submitting articles for publications, healthcare professionals and the public can learn about the value and the role of social work in a nontraditional setting, for example, a primary care office.
Reflections: The development and implementation of this integrative project encouraged me to examine extending the social work role beyond the acute care setting and addressing psychosocial issues in a primary care office. Moreover, I recognized how networking and outreach advocates for the value of social workers across the healthcare continuum and highlights career opportunities in the evolving realm of healthcare. The knowledge gained from this project as well as the skills I developed in effective communication, leadership, and interdisciplinary collaboration will be applied throughout my professional social work career.
Intergenerational Programming: Ascertaining Benefits and Feasibility at a Community Social Service Agency
Stephanie Olsen, Jewish Family Service of North Jersey (2013-2014)
Background: Jewish Family Service of North Jersey (JFSNJ) is a community social service agency that serves clients in parts of Passaic, Bergen, and Morris counties in New Jersey. The agency provides an array of services for youth and senior clients, but there is little programming overlap with these two populations. Many of JFSNJ’s senior clients are homebound and have diminished ability to engage in socialization activities. The goal of intergenerational programming is to provide programs and activities specifically designed to facilitate interaction between older and younger generations. Research has found that such programs have the potential to increase intellectual growth, self-worth, and acceptance in both youth and seniors.
Project Aims: The overarching goal of this project was to determine the potential for initiating and sustaining intergenerational programming at JFSNJ. This was carried out through the following activities: (a) A literature review was conducted that provided a framework for the research at the agency; (b) The JFSNJ social work staff was administered surveys to elicit their feedback about possible intergenerational programming ideas; (c) The JFSNJ Executive Director was interviewed to discuss the staff’s ideas as well as the guidelines for conducting interviews with the agency’s senior clients; (d) Appropriate senior clients were identified and interviewed to determine their socialization patterns and needs, and (e) A search was conducted for possible funding sources that might support intergenerational programming at JFSNJ.
Outcome/Findings: Existing literature cites the increased need for intergenerational contact since there is a dearth of these relationships occurring naturally within families or communities. The literature review also elucidated the plethora of favorable outcomes that generally occur as a result of intergenerational connection. For instance, intergenerational programming facilitates the exchange of wisdom and values between participants as well as promotes successful aging in seniors.
Staff survey results were compiled and two main ideas were highlighted. The first was the potential for young adults to act as volunteers with older adult clients. The second was to coordinate socialization between young children and senior clients. The ideas generated from the staff surveys were discussed and feasibility issues were addressed with the executive director. It was determined that homebound senior clients should be the focus of the interviews, as they are a client group that is at especially high risk for social isolation and loneliness.
Interviews with the agency’s homebound senior population proved congruent with the findings of the literature review in that most people experienced a lack of intergenerational connection. Many respondents also expressed an interest in forging relationships with younger people as a way of staying connected and feeling younger. Oftentimes, the client’s own health problems precluded them from leaving the house and having face-to-face contact with others. Most clients stated that they would prefer to leave their home more often than they currently do. Overall, clients interviewed saw positive aspects of increased socialization opportunities.
Using the Foundation Center website, five potential funding sources were identified. All of these donors expressed an explicit interest in serving the older adult population and/or intergenerational groups.
Reflections on my leadership development process: Engaging in a multi-faceted research project made me see how all the pieces need to come together in order to form a cohesive whole. Along the way, I learned much about interpersonal communication and the importance of having a well-informed knowledge base via the input of all involved parties. Taking charge of the planning and implementing of this project increased my self-confidence and bolstered my leadership skills. Additionally, conducting face-to-face interviews with older adults increased my understanding of this population and made me more keenly aware of their attitudes and needs. I feel a real sense of accomplishment in seeing my year-long project come to fruition. Being given the opportunity to participate in this fellowship program was a true gift. The knowledge I gained from this experience will be carried with me into my future career as a social worker.
Advance Directives and End-of-Life Planning: Creating a Checklist Tool for Care Managers
Julia Sameth at Jewish Family & Children’s Service of Greater Mercer County (2013-2014)
Background: The Jewish Family & Children’s Service of Greater Mercer County (JFCS) is a non-profit organization serving over 3,000 community members of all backgrounds. The agency’s official mission is to “strengthen individuals and families by empowering people to care for themselves and others.” A major focus of the agency is supporting seniors who wish to age in place. Care managers—including master’s level gerontologists and MSW clinical interns—work to connect over 250 older adults to services as well as to provide programming and support, information and referral, and advocacy and education.
Project aims: This project sought to enhance care managers’ focus on early advance care planning for older adults. Early advance care planning refers to the use of documents including the Do Not Resuscitate Order (DNR), Living Will, Health Care Proxy, Medical Power of Attorney, FIVE WISHES Document, and Physician’s Orders for Life Sustaining Treatment (POLST). Research indicates that older adults with lower levels of income and education are less likely to have such documents in place. To better understand the needs for advance care planning at JCFS, I conducted a survey of seniors from the two distinct client groups that JFCS serves (Secure@Home--S@H and United Aging and Disability Partnership-UADP) to determine the level of clients’ preparedness and areas of educational needs in end-of-life planning. S@H clients typically have higher levels of education and economic resources in comparison to UADP clients. Results were used as a guide to construct a checklist tool for care managers to use in facilitating discussion and education around advance care planning with clients and their families.
Findings: Responses were more easily obtained from the S@H group, with 89 completed web-based surveys (versus 15 UADP telephone-based surveys). In the S@H group, almost 97% had completed financial wills with the preponderance (90%) having some kind of advance directive in place, usually a living will. About 15% had a POLST in place. Comments included concern about the documents not being readily available in an emergency and the documents being incomplete or out of date.
Interestingly, although over 80% of respondents reported having had conversations with their significant others and family around their care in the event of long-term or terminal illness, only about half of respondents had communicated to loved ones their wishes on where they would want to spend their last days. Those who had not had conversations with loved ones reported that the subject matter was “too fraught” or that they were not sure what they wanted.
Respondents overwhelmingly (81%) indicated that they would be interested in knowing more about at-home care in the event of long-term or terminal illness-. Nearly 90% of respondents reported that their doctors had not discussed the issue of advance directives, nor had they, on the whole (70%), discussed hospice or palliative care as an option in the event of terminal illness. Seventy percent of respondents indicated they have some type of long-term care insurance in place. Responses to open-ended questions revealed a prevalent theme regarding the desire to die at home.
These results further underscore the need to create a simple tool to help clients clearly articulate their end-of-life preferences and to furnish their loved ones with a central document that they can use as an easy mechanism for reference and as an aid to locating essential documents during times of crisis. Given that the literature reveals traditional advance directives have limited efficacy in the event of emergencies, and they often cannot be easily located, education on alternative documents designed to address these limitations, such as the POLST, will be an important addition to care managers’ discussions in end-of-life and serious illness planning. It is therefore essential that clients understand the differences between the available documents and employ as many as are applicable to their situations with a mind toward appropriate updating.
Reflections on my leadership development process: Embarking on this research has afforded me a deep learning experience. It was particularly challenging to approach the topic of death and dying with the UADP population—one whose clientele is often in crisis. Often other, more pressing matters presented or clients were already overwhelmed with such serious issues that it was not the right time to conduct surveys. It became clear that the UADP group is in need of particular attention to this topic at initial assessment and at regular intervals when clients are not in crisis and that the checklist tool could act as a good catalyst to begin this sensitive but imperative discussion.