Society has changed a great deal since churches and monasteries started
a kind of desultory social service for the elderly about a thousand years
ago. There are now many more old people in our society both in relative and
absolute numbers and their impact on the caring services steadily increases.
There are fewer young people to look after the aged and more women now marry
and have jobs than in the past so that as the old people become, increasingly,
the very old (Coni, Davidson and Webster 1980) there is a need to plan and
examine the roles of all who care for this group of people whose contribution
to making our present welfare -oriented society is not the least of the reasons why their care should demand our close scrutiny.
Social Work in Scotland was united from diverse areas under the Social
Work (Scotland) Act, 1968. With the increasing number of old people in
society there has been a growth of discussion among social workers that has
attempted to define their own role in a specialty where so many other caring
professions are involved. I hope that I can show that while the role of the
social worker is an important one there is a great deal of role defining to
be done in that there is little agreement about what a social worker does or should do for his elderly client.
Social work with the elderly, not unlike geriatric medicine, is not a popular speciality (Brearly 1975, 1976; Rowlings 1981). These authors
indicate that the huge demand for resources can depress a social worker who
finds that the better he is in discovering need the greater is the difference
between that need and what he is able to provide. Other discouraging aspects
of the work are that the social worker is often called in only when the
family of the old person is in crisis and the worker becomes involved in a great deal of stress; the forming of satisfactory relationships can be
difficult with an old person suffering from sensory loss and who is culturally
and linguistically strange to the worker; old people are often slower (Charman
1979, Rowlings 1981) and need more cues to take action than other client groups;
and the worker may hide his fear and anxiety of death and age behind
euphemisms such as 'senior citizen' or 'OAP'. Perhaps due to these factors
social workers tend to take an inactive role in the problems of old clients
and aim to preserve the status quo rather than aim for growth, (Rowlings 1981).
But there are positive sides to the work: the social worker's prime
concern is not with the pathology of the old but the life forces that are
still intact and capable of restoration (Milloy 1964). Prinsley (1982)
agrees with this supportive role, opining that "Frailty needs support - sickness
needs treatment." He also encourages the worker that flexibility of responses
are appropriate - alternative solutions must be sought to seemingly similar
problems e.g. the very different needs of an old man who is isolated and
failing to cope with those of a woman in the family home who has gone off
her feet and is incontinent, Fixed attitudes towards the provision of resources, Prinsley says, have lamentable long -term effects,
The richness of the work is also emphasised by Brearley (1975, 1976)
when he indicates the information- collecting role of the worker as a member
of the caring team; the different needs of each client in different situations;
the need.for the worker to see old age as a time fol.change and progress and
his ability to break down the barriers to theses advances; and the challenge
of an enlightened approach that tries to support the old person in his own
home whenever possible.
This flexibility, though, should not prevent the worker from asking
precise questions and relevant questions - Rowlings (1979, 1981) suggests
a core set of questions to all clients and also recommends that all old
people should have access to, if not assessment for, social work. Despite
this attitude of general availability Hunt (1978) was still able to report
that one quarter of the elderly living in the community had had no visits
in a six month period from any health and social service worker. Even of
the bedfast and housebound one third saw the GP less than once per month.
The social worker had not even been seen by one in ten of the isolated
elderly who were bedfast. A majority of every group studied, even the most
ill, did not have home helps. The challenge for social work has still to
be met. We will now examine the various areas in which the social worker
can support and care for the elderly client.