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Despite extensive documentation of the adverse impacts of child sexual abuse (CSA), less is known about long-term effects of CSA, that is, the impact in middle and late adulthood, when one is further removed from the CSA. This study describes coping strategies and positive outcomes reported by adult female survivors of child sexual abuse ages 50+ (n = 58). Responses came from an anonymous online survey of adult survivors of CSA. We conducted a qualitative "RADaR" rapid analysis on the survey's open-ended questions. Survivors employed both internal attitudes and specific activities to cope with their childhood CSA. Most (n = 55) reported positive outcomes from CSA: self, others, and relational and/or emotive strengths. Due to survey limitations, we were unable to identify factors that contributed to survivors reporting positive outcomes and survivors who reported negative or no positive outcomes. This study suggests CSA survivors in middle and late adulthood may feel stronger as a result of abuse. More research is needed to identify factors that contribute to resilience.

Physical/cognitive limitations associated with the aging process place older adults at disproportionate risk of negative consequences during disasters. Guided by the profession's commitment to supporting vulnerable populations, gerontological social workers have long been on the frontlines supporting older adults during disasters. Yet, disaster social work practice remains an undeveloped and under-researched area. Thus, we asked "what is the current role of gerontological social workers in disaster preparedness with older adults in the United States, and potential areas for improvement?" This paper systematically reviews the literature discussing social work and disaster preparedness/response with older adults in the U.S., to identify needs and inform future directions. PRISMA guidelines were followed to conduct a systematic search across relevant databases for peer-reviewed-publications between January 1, 2009-June 12, 2020. Eleven articles met inclusion criteria. This body of literature is small and covers two broad areas: (1) charging the social work profession to engage in this work, and (2) describing current efforts and unique challenges of older adults during disasters. Only three empirical studies were identified. Future educational efforts should formalize training to prepare social workers for this practice area. Research should detail the roles of social workers in disaster preparedness/response, and factors that predict involvement.

Nursing home (NH) residents have high psychosocial needs related to illness, disability, and changing life circumstances. The staff member with the most expertise in addressing psychosocial needs is the social worker. However, federal regulations indicate that only NHs with 120+ beds need hire a social services staff member and that a "qualified social worker" need not have a social work degree. Therefore, two-thirds of NHs are not required to employ a social services staff member and none are required to hire a degreed social worker. This is in stark contrast to NASW professional standards. Reporting findings from this nationally representative sample of 924 social services directors, we describe the NH social services workforce and document that most NHs do hire social services staff, although 42% of social services directors are not social work educated. 37% of NHs have a degreed and licensed social worker at the helm of social services. The odds of hiring a degreed and licensed social workers are higher for larger NHs, especially if not-for-profit and not part of a chain. NH residents deserve psychosocial care planned by staff with such expertise. Quality of psychosocial care impacts quality of life.

Trauma is widespread, and its symptoms can adversely impact wellbeing at end of life, a time when hospice seeks to maximize quality of life. This article reviews research on trauma at end of life, provides an overview of trauma-informed principles, and explores possibilities for applying trauma-informed care through an illustrative case study of a patient at end of life. The case discussion applies findings from the literature using Feldman's Stepwise Psychosocial Palliative Care model as a roadmap. As shown in the case study, trauma-related symptoms may complicate care, making it an important subject of clinical attention for interdisciplinary hospice team members. As part of this team, social workers are particularly well suited to provide more targeted interventions where indicated, though all members of the team should take a trauma-informed approach. Lastly, this article reflects on the need for organizations to take a systems-level approach when implementing trauma-informed care and suggests implications for practice through a universal approach to trauma and the need for trauma-specific assessments and interventions at end-of-life, along with areas for future research.

Objectives Social work has a long history of responding to the needs of vulnerable populations during times of crisis and disaster. Social workers are working at the front lines responding to the current COVID-19 pandemic in a variety of health care practice settings, including nursing homes; however, it is unclear how social workers perceive their preparedness during this time. Methods This study employed a cross-sectional survey to nursing home social workers via social media on feelings of preparedness for COVID-19, what has been most professionally helpful for social workers during these times in their role in COVID-19, as well as demographic questions. Demographic data were analyzed using SPSS and qualitative data were analyzed using the rigorous and accelerated data reduction technique. Results Data are based on a sample of 63 (N = 63) nursing home social workers. Findings revealed that while some social workers felt prepared for the coronavirus, many respondents stated that they were unprepared to meet the demands and challenges they were facing. Moreover, participants shared that professional support was critically important to get through COVID-19. Discussion These findings are important, as social workers are tasked with ensuring each resident attains their highest level of psychosocial well-being, which can be achieved only when nursing home staff are supported. Findings from the present study suggest that additional support for nursing home staff ought to include peer mentoring and mutual support. Additionally, improved leadership across health care settings is worth assessing.

The assisted living (AL) environment plays an important role in supporting residents’ satisfaction and helping them to age in place. The AL environment is multidimensional and has many interrelated components including staffing (e.g. direct care workers, nursing, activity staff), services provided (e.g. medical, mental health, pharmacy), amenities offered at the setting (e.g. beauty salon, library, exercise facilities), and the physical environment. Evidence suggests that aspects of the AL environment can enhance or detract from the physical function, well-being, social engagement, and behavioral outcomes among residents. The purpose of this study was to develop and test a multidimensional AL environment measurement model that includes indicators of staffing, services, amenities, and the physical environment. Baseline data was used from a study testing the Dissemination and Implementation of Function Focused Care in AL. A total of 54 AL facilities across three states were included in the sample. Settings ranged in size from 31 to 164 beds with an average size of 82.2 (SD=26.2) beds and the majority were for profit facilities (n=41, 74.5%). Structural equation modeling was used to test the proposed model. Results showed that the model fit the data (χ(2)/df=1.861, p

Nursing home culture change moves facilities toward person-centered care. The current study examined how people in different roles experienced choice and autonomy in four areas addressed by culture change: consistent assignment, food choice, waking/bedtime routines, and bathing. This descriptive qualitative study included 32 participants from one continuing care retirement community: 10 residents, eight family members, nine direct care workers, and five managers. Interviews were audiotaped, transcribed verbatim, and coded. Codes were grouped around the practice areas and cross-cutting themes. All groups reported choice in all areas. Challenges arose when patient choice and nursing home functions conflicted. Stakeholders disagreed when care needs should supersede choice. Findings suggest that it is difficult to balance resident choices with (a) the diverse needs/wants of other residents and (b) safety. Leaders, such as nurse managers, should provide ongoing education to residents, family, and staff to help negotiate these challenges. [ Journal of Gerontological Nursing, 46 (5), 9–13.]

The home care industry experiences similar problems with the recruitment and retention of direct care workers (DCWs) as those faced by institutions, and it is important to identify strategies to help retain and grow this important workforce. The empowerment of DCWs has been shown to be an effective strategy for increasing job satisfaction and decreasing turnover in nursing homes but has not been studied in home care. Using Kanter's organizational theory of empowerment, including structural empowerment (structure of opportunity, access to resources, access to information, and access to support) and psychological empowerment (meaning, competence, self-determination or autonomy, and impact) this study examined whether home care workers (HCWs) feel empowered in carrying out their jobs. An exploratory, qualitative study of 12 HCWs, recruited from two states in the United States, found high levels of both structural and psychological empowerment among research participants, as well as a number of disempowering aspects of their job. Findings suggest ways to support elements of the work that HCWs find empowering and decrease elements that contribute to job dissatisfaction and turnover.

End-of-life and palliative care in the United States is influenced by a web of policies that impact access to—and payment for—curative, life-extending, and comfort-based treatments. This chapter examines three specific sets of policies: Medicare Part A and its influence on access to curative, restorative, and hospice services; the Patient Self-Determination Act and its role, and related policies in healthcare decision-making; and state-specific policies that allow access to medical aid in dying for people who meet specific criteria. The chapter concludes with an overall view of the ways social workers and other healthcare workers can influence policy to eradicate barriers and enhance care along the continuum of illness and at end of life.

Medical aid in dying (MAID) reflects the legal provision for qualifying, terminally ill individuals to receive a prescription from their medical provider for self-ingestion to hasten death. This policy analysis examines current MAID policy with a focus on MAID’s intended relief of suffering. Using Wallace’s (2015) policy model, we evaluated MAID on: policy description, historical context, development of the policy, efficiency, alternative programs, effectiveness, and unintended consequences. Policy description: Currently legal in 10 jurisdictions (nine states and Washington, DC), common goals include relieving suffering and promoting self-determination. Historical context: Following a failed attempt at federal legalization, the U.S. adopted an incremental, jurisdiction-based approach to legalization beginning in Oregon (1994). Development of the policy: Although all statutes imitate Oregon’s model, subtle differences exist. Efficiency: Although each policy includes waiting periods that vary in sequential order and duration, revisions have targeted waiting periods to improve efficiency. Alternative programs: Frequently considered an alternative to MAID, existing statutes encourage providers to discuss palliative options. Effectiveness: Despite appearing effective in promoting self-determination, MAID-related complications (e.g., vomiting) may exacerbate suffering. Unintended consequences: MAID’s requirement of clinician participation may place providers in situations that challenge their self-determination and provoke distress. In sum, many questions remain unanswered regarding MAID’s effectiveness and efficiency. Thus, more data are needed. Ethical implications will continue to be debated, though policy implications (e.g., who uses MAID, the number of unique providers, the emergence of complications, those present during death) greatly impact implementation and overall choices to limit suffering at the end of life.

This study explored nursing home social services directors’ interest in pursuing trauma-informed care (TIC) training, and individual and organizational characteristics associated with their interest. Data from the 2019 National Nursing Home Social Services Directors Survey, a national cross-sectional survey, were used. Measures sought information on participants’ interest in TIC training, sociodemographic characteristics, and characteristics of employing nursing homes. Descriptive statistics and multivariate binary logistic regression analyses were used. Of the 924 respondents, 880 (95.2%) were included in the analysis. Most (71.7%) expressed high interest in TIC training. Younger age, fewer years of nursing home social services experience, being degreed and licensed in social work, and being a person of color were associated with greater odds of high interest in TIC training. Neither nursing home ownership nor social services staffing ratio was significantly associated with interest in TIC training. As policy requires TIC in nursing homes, these findings present a first step towards understanding implementation.

While there has been great deal of research conducted on the effects of child sexual abuse (CSA) on trauma symptoms in children and adults, there is less knowledge on the effects on trauma symptoms in female older adult CSA survivors. The aim of this study was to investigate current symptoms of trauma in adult female survivors of child sexual abuse across each successive decade, beginning with eighteen year olds. This retrospective, anonymous online study gathered a sample of 223 adult female survivors of CSA (38 of whom were aged 50-59 (17%), and 20 of whom were 60+ years of age (9%)), and surveyed their trauma history and their current symptomology. In our sample, the survivors with the most severe trauma symptoms were between 18 and 29 years old. Each subsequent decade reported fewer trauma symptoms, with respondents in the 60+ age group reporting the lowest trauma symptom severity. While a cross-sectional study does not allow us to evaluate individuals' experiences over time, these results suggest that the negative impacts of CSA may abate over the life course. Future research should consider these questions longitudinally to explore whether these results are related to survivorship (those with worse outcomes dying younger) and whether these effects endure as female older adults experience physical and mental challenges in later life.

This study investigates nursing home residents' and care partners' experiences during COVID-19 visitation restrictions. A nonprobability purposive sample of care partners was recruited via social media and email listservs. Care partners completed surveys (N = 30) and follow-up interviews (n = 17). Before COVID-19, care partners visited residents 3+ times per week for socialization and care. After restrictions, communication between care partners and nursing homes deteriorated. Families experienced reduced communication about residents' health statuses and little COVID-19 case information. Care partners expanded their advocacy roles, proposing policies to protect residents' rights. Care partners reported losing irreplaceable time with residents during restrictions. In future emergencies, we must balance the value of family visits with public health protection such as personal protective equipment (PPE).

Nursing home social workers are on the frontlines during COVID-19 responding to individual resident needs, the needs of staff, and larger health needs of the nursing home. However, it is unclear whether nursing home social workers feel adequately trained and prepared in responding to disasters, such as COVID-19. To explore this, we used a study cross-sectional survey distributed via social media focusing on 1) prior training on disaster preparedness, 2) any content social workers wish had been a part of their education, and 3) suggestions for educators/academics to serve social workers on the frontlines. Data in this study are based on a sample of 63 (N=63) nursing home social workers. Demographic data were analyzed using SPSS and qualitative data were analyzed using the RaDar (rigorous and accelerated data reduction) technique. Findings revealed that most social workers had little to no training in disaster preparedness, and shared areas of future education initiatives. Participants also shared the need for bridging the research to practice gap through open access articles and support from academics. Findings from the present study reveal areas social work programs can expand gerontology-focused course offerings. Additionally, developments promoting practitioner support from academics is worth consideration.

Professional networks are important for the success of doctoral students and early career faculty members, yet there is little research about what types of experiences help emerging scholar...

Developing faculty interested in aging may help social work meet the needs of our growing aging population. However, doctoral students need a variety of supports to complete PhDs and become gerontological social work faculty. This study explored one program’s role in supporting the development of social work doctoral students to faculty in gerontology. An e-mail invitation was sent to all former participants (2010–2016 cohorts) of the Association for Gerontology Education in Social Work (AGESW) Pre-Dissertation Fellows Program (PDFP). The 38-question online survey consisted of Likert-type scales, multiple answers, and one open-ended question per section about the program’s impacts on their academic career development in teaching, research, mentoring, and support. Forty-five respondents, representing all six cohorts, completed the survey. More than half reported that the PDFP contributed to their ability to publish their research (64.4%, n = 29), grow their professional network (86.7%, n = 39, and teach (55.5%, n = 25). Doctoral programs provided different experiences than the PDFP, including mentoring, methodological training, professional development, networking, and peer support. Results suggest the PDFP provides content recipients value that supplements instruction received in their institutions. The program’s ability to connect students to each other and to national leaders enhances their career development and socialization into academic roles.

Good mentoring is a key variable for determining success in completing a doctoral program. The Association for Gerontology Education in Social Work (AGESW) provides leadership in the areas ...

This mixed-methods presentation will examine the role of social services directors in supporting the family members of nursing home residents. A logistic, hierarchical regression (n= 924) found a positive association between the social services director having a degree in social work and strong agreement with "family members regularly engage the expertise of the social services department." A qualitative analysis of written-in comments to the question, “What do you like about your job?” identified 234 comments that described directors’ view of the importance of working with and supporting families. A content analysis revealed that two types of support are provided to families, instrumental and emotional. Instrumental support includes connection to resources for adjustment, financial needs, and discharge planning. Emotional support includes activities such as helping people through transitions, and coping with grief and loss. Appropriately trained social services directors can offer different types of support and be valued resources for families.

Nursing homes (NHs) provide care to medically complex residents. Social services (SS) are primarily responsible for addressing residents’ psychosocial needs. High staff turnover in nursing homes is a significant problem. When SS staff leave, training and experience goes with them. Much research has explored nursing staff turnover, far less about SS staff turnover. Social service workers who are thriving are more focused, innovative, and engaged. This study explored characteristics contributing to NH SS directors reporting thriving at work. We surveyed 924 NH SS directors from randomly selected nursing homes. Guided by Spreitzer’s model, a hierarchical logistic regression was conducted utilizing unit contextual factors and individual agentic behaviors to examine likelihood of thriving. Unit contextual factors, i.e. being valued, feeling influence, and the NH providing quality care had the greatest influence on SS directors reporting thriving at work. These results suggest great potential for NHs to foster thriving in SS directors.

Direct care workers (DCWs) provide personal care, emotional support, and companionship, helping older adults maintain quality lives. DCWs earn low wages, have little training, and experience high turnover rates. While the demand for DCWs grows, real wages continue to fall. Undervaluing DCWs threatens the continuity and quality of care that older adults receive. Through the social work grand challenges lens, this article discusses two qualitative studies, in home care (n = 24) and nursing homes (n = 23), that demonstrate that while DCWs help advance long and productive lives, they experience extreme economic inequality and lack equal opportunity and justice. The article concludes with a discussion of social work’s role in advancing opportunity and justice.

Nursing home residents are an at-risk population during disaster situations, and nursing homes face unique challenges in managing disasters. Nursing home social service departments can support their nursing homes in meeting the needs of residents during disasters, yet there is little research exploring their involvement. To address this gap, we use secondary data from the 2019 National Nursing Home Social Service Directors' study to explore social service directors' and their departments' involvement in disaster preparedness and response, and personal- and nursing home-level characteristics that predict involvement. Results show that nursing home social service directors and their staffs are predominantly involved; 61.9% (n = 562) of respondents stated always participating, and an additional 20.3% (n = 184) usually participating in disaster planning. The age of the director significantly predicted involvement, with older directors being most likely to always be involved. Further research is needed to understand why some nursing homes involve their social service directors in disaster planning and others do not, what roles those directors play, and to identify strategies to increase involvement within this role.

Oregon was the first state to legalize medical aid-in-dying (MAID), in 1994. Since then eight states and Washington, DC have legalized MAID through legislation. Despite literature exploring the legal and ethical aspects of MAID, very little research examines MAID policy at the federal level. This study aimed to 1) examine the objectives of MAID legislation introduced to the US Congress, and 2) investigate whether these bills increase or decrease access to MAID. This study used the congress.gov website to search for bills related to MAID introduced by the US Congress between 1994 and 2020. From the 98 bills identified, we excluded bills that were not directly related to MAID or were introduced in subsequent congresses. In total, 23 bills were retained and analyzed. The greatest number of bills aimed to restrict funds for MAID, followed by bills that sought to regulate the drugs used for MAID. Other bills prohibited the development of policies supporting MAID, regulated penalties for practitioners related to the drugs used for MAID, and restricted legal assistance for accessing MAID. These bills intended to block or limit patient access to MAID by restricting drugs, funds, health care services, legal assistance, policy, and research. These findings suggest that the federal approach is incongruous with the growing numbers of states that have legalized MAID. Federal policymakers must develop policies to 1) prevent discrimination against vulnerable groups, 2) support funds to study MAID, and 3) build a system to allows eligible individuals to access MAID equally.

In the Summer of 2020, years of racial inequity and the evidence of the racially motivated deaths of Ahmaud Arbery, Breonna Taylor, George Floyd, and others sparked a renewed movement toward action...

Throughout her career, Rosalie Kane made a major impact in her efforts to improve quality of life for persons living in nursing homes. Near the end of her career, she suggested that it was time to "re-imagine long term care and to produce livable age-friendly nursing homes." This brief review focuses on the role of meaningful engagement and person-centered care as the next step in enhancing nursing home care. The importance of activities that strengthen cognitive and/or physical function is stressed, as well as improving socialization to reduce loneliness.

This essay was written by my mother, Santina D'Angelo, as she battled stage IV pancreatic cancer. While it is impossible to know in advance how any of us would deal with a terminal illness, my mom ...

The COVID-19 pandemic is putting a spotlight on older adults, a population that many social workers, ourselves included, devote entire careers to. Whether in research, teaching, or community progra...

Understanding satisfaction with assisted living (AL) from the residents’ perspective is essential for creating supportive environments that are targeted toward the needs and desires of residents. Few measures have been tested to evaluate residents’ satisfaction with AL. This study tested the reliability and validity of the Resident Satisfaction Index (RSI) in a sample of 501 AL residents. Based on Rasch analysis, there was support for item reliability and construct validity. Differential item functional (DIF) analysis was done to examine differences in item responses by age, gender, and cognition. Significant and substantive differences were identified for five items by gender, one item by cognition, and no differences were found by age group. Findings suggest the RSI is a reliable and valid measure to assess residents’ satisfaction with AL and can be used to guide administrators and clinicians in making changes in these settings to increase residents’ satisfaction.

Dear Editor, As the impacts of COVID-19 on nursing facilities became apparent, the members of the U.S. based National Nursing Home Social Work Network (NNHSWN) immediately considered what it could ...

In response to needs identified by the Institute of Medicine and the National Association of Social Workers, this article describes an experiential assignment to increase BSW students’ skil...

This paper describes a qualitative study of individual client interviews (n = 26) from four social service agencies to understand how clients experience trauma-informed care services and implementa...

Dear Editor-in-Chief,While natural and manmade disasters have always existed, the increase in the frequency of disaster events, growing evidence that older adults are disproportionately negatively ...

Traumatic events are widely acknowledged to have long-term impacts on individuals, yet only recently have health-care professionals begun to assess for and gain an understanding of trauma in the lives of older adults. For many older adults, trauma is often disenfranchised and overlooked as being either a distant past event (e.g., child abuse) or a normal part of aging (e.g., widowhood). Trauma-informed care, on the other hand, calls for health-care professionals to acknowledge that past and recent events may have been traumatic for older adults and to assess and care plan to reduce or prevent re-traumatization. In this article, we explore the impacts of trauma in later life through a case study of a patient admitted to a long-term care facility. Analysis of this case study suggests several important implications for social work practice in long-term care and the use of person-centered care practices in the care of older adults in general.

In the fall of 2009, a group of scholars met over dinner to catch up after a day of sessions at the Gerontological Society of America (GSA) annual scientific meeting. One of the topics of conversat...

The editorial staff of the Journal of Gerontological Social Work is pleased to announce the re-introduction of the Book, Media, and Resource Review section of the journal. This section will provide...

As a result of COVID-19, the Centers for Medicare and Medicaid Services (CMS) suspended all outside visitors from entering nursing homes on March 13, 2020. For more than six months, care partners were only permitted in compassionate care situations, so adult children of residents were only able to contact their parents via phone calls, video chats, window visits, and in some cases, limited outdoor visits. Experts have written on the adverse, detrimental impact of this lack of connection and isolation has had on residents. However, the lived experiences from the perspectives of residents’ adult children remain largely absent from the literature. To uncover the experiences of these care partners, semi-structured interviews were conducted (N=12) from December 2020 to February 2021. Adult children shared witnessing their parent’ physical and cognitive decline which they attributed to the lack of visitors. Care partners expressed feeling frustrated that they were unable to observe their parent’s health condition, and could not provide support. Also, many rightfully worried they would never see their loved one again. Findings from this study reveal implications for nursing home leaders and policymakers, such as building infrastructure and systems that both ensure safety and allow care partners to regularly see their residents in long-term care to avoid the unintended adverse consequences of these policies. Further, findings from this research indicate the need for future programs to mitigate and lessen the long-term consequences this isolation has had on both residents and their adult children.