Geriatric Social Work: 2020’s Guide to Social Work for Older Adults

In this article:

What Is a Geriatric Social Worker?

Gerontological social workers, also known as geriatric social workers, coordinate the care of older patients in a variety of settings, including hospitals, community health clinics, long-term and residential health care facilities, hospice settings, and outpatient/daytime health care centers.

The American Geriatrics Society projects that about 30% of Americans ages 65 and over will need geriatric care by 2030 (PDF, 500 KB). As the need for geriatricians grows, so will the role of social workers in elderly care.

In outpatient settings, geriatric social workers are advocates for the older adults, ensuring they receive the mental, emotional, social and familial support they need, while also connecting them to resources in the community that may provide additional support. In inpatient and residential care settings, they conduct intake assessments to determine patients’ mental, emotional and social needs; collaborate with a team of physicians, nurses, psychologists, case managers and other health care staff to develop and regularly update patient treatment plans; discuss treatment plan options with patients and their families; and manage patient discharges.

This guide features interviews with gerontological social workers. All interviewees were compensated to participate.

Role of Social Workers in Elderly Care

Those who work in geriatric social work help their clients manage psychological, emotional and social challenges by providing counseling and therapy, advising clients’ families about how to best support aging loved ones, serving as the bridge of communication between clients and the rest of the care team, and ensuring that clients receive the services they need if or when they move between inpatient and outpatient treatment programs, in-home care, day treatment programs, and the like.

The role of social workers in elderly care leads to unique opportunities, which include making deep and meaningful connections with clients and their families, changing problematic systems at both the personal and community levels, and the knowledge that their work has a direct positive impact on those in need.

Education Requirements

A bachelor’s degree in social work from an accredited university is the minimum education requirement for those seeking credentials in gerontology. Those who want to become a social worker for older adult clients often seek a Master of Social Work (MSW) with a clinical concentration. These programs help prepare students to become licensed clinical social workers (LCSW). In addition to foundation level social work courses, they focus on the skills needed to provide social work services and treatment to individuals (children, youth and adults) and small groups (couples and families).

Students learn about advanced assessment techniques, diagnosing and treating psychosocial problems, and developing, promoting and restoring mental health and social functioning. Students are also taught how to evaluate their own practice and intervention techniques.

Salary

According to the Bureau of Labor Statistics (BLS), the 2019 median pay for social workers was $50,470 per year. The highest-paid 10% of social workers earned more than $82,540, while the lowest 10% earned less than $31,790. The annual mean wage of health care social workers was $54,310 in 2019, the BLS reports. This is the average geriatric social worker salary as well, since the BLS considers geriatric social workers as part of the health care social worker group.

Employment of social workers is projected to grow 11% from 2018 to 2028, much faster than the average for all occupations, according to the BLS. Increased demand for health care and social services will drive employment growth, but the prospects of each specialization, such as geriatric social workers, will vary.

How to Become a Geriatric Social Worker

Below are six common steps to become a geriatric social worker:

  1. Earn a bachelor’s in social work or in a related field.
  2. Pursue an MSW with relevant coursework.
  3. Seek an internship in an adult health care setting and complete the required fieldwork.
  4. Take the licensing exam.
  5. Earn relevant certifications.
  6. Apply for state social work licensure.

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Due to the medical, social, emotional and mental health challenges that senior citizens face, those interested in entering the field of geriatric social work may need a master’s in social work degree from an institution accredited by the Council on Social Work Education, and to complete graduate-level field internships in settings that serve geriatric patients and older adults in need. Courses that may be helpful in this field include clinical social work modalities, family dynamics and social work in medical settings. Classes that focus on the physical, mental, emotional, financial and social issues associated with aging are also important. Students may wish to find MSW programs that provide a selection of gerontology-focused classes, or an academic concentration in gerontological social work.

“I highly recommend taking whatever gerontology-focused classes your program offers. A basic course in death and dying is a wonderful asset, even just for you personally,” noted Charis Stiles, MSW, who is a Friendship Line manager at the Institute on Aging (IoA) in San Francisco.

Even if a program does not have many gerontology-specific courses, thinking proactively about the therapeutic modalities and social work concepts that might be most useful in your work with geriatric clients, and taking courses that focus on these areas, may help you prepare.

“My favorite class in social work school was motivational interviewing, which is a technique of counseling where you use open-ended questions and don’t provide people with answers to their problems, but rather have them come up with the solutions themselves,” said Laura Burns, MSW, a medical social worker at On Lok Lifeways, a PACE program in San Jose, California. “In motivational Interviewing, the counselor mirrors the clients’ ideas back to them. This is a technique that I have used a lot in the hospital setting as well as my current job.”

Gaining experience working closely with geriatic clients and older adults through one’s graduate field placements and volunteer work and jobs is also an important part of preparing for a career in geriatric social work.

“I think some people really find it fascinating, and for others, it’s just not their cup of tea,” Burns said. “There are tons of ways to gain experience: reading books, watching movies, taking classes or training, and just talking with your own family. If you’re interested in geriatric social work, talk with your grandparents about their lives and their health problems.”

Burns also recommends students advocate for the types of field placements they want during their MSW program. “Field placement is a good way to get a variety of experience, but really if you know the type of work you want to do, be really, really clear about that during your program,” she said. “I knew that I wanted to work in health care, so I went and found internships in health care. I know some schools won’t let you do that, but thankfully, my school did.”

Stiles similarly advises social work students to gain relevant internship experiences during their graduate education, and to engage in extracurricular and volunteer work to interact with aging populations. “If you can find a placement with older adults, I highly recommend it. Adult day health care is a good first placement because you will get to interact with a large variety of older adults,” she said, adding, “Volunteering in settings like hospice, senior centers, or even the library may also be a good introduction to this population.”

Stiles and Burns also explained how the field of gerontological social work requires a degree of emotional preparation and skill in talking about weighty or disconcerting issues such as death and terminal illness.

“One aspect of geriatric social work that may be different than other kinds of social work is that death is a more constant presence in our participants’ lives,” Burns explained. “Everyone has a different level of comfort thinking and talking about death. Some of our participants think more about their deaths than others, yet we discuss it with all of them. We often begin these conversations by asking questions such as, ‘How do you want the end of your life to be?’ and ‘What would your goals be for the last weeks or last days here?’”

Stiles advised social work students to be self-aware and open to evaluating and changing their preconceived notions about older populations and geriatric care. “I recommend reflecting on your own attitudes toward older individuals and being honest with yourself about your assumptions about the later stages of life,” she said. “Many of us have some degree of internalized ageism even if we don’t recognize it, and this exploration will help us in any field we go into. As much as we don’t think about it, we are aging all the time.”

Those who enter geriatric social work need to know about the issues that aging populations encounter and have relevant experience working with aging populations. While working as a social worker for elderly patients, they will employ problem-solving skills, patience and compassion daily and contend with challenges such as the complexity and severity of the conditions, stubborn systemic barriers to care and family conflicts that can interfere with clients’ treatment. Despite these challenges, however, gerontological social workers experience the satisfaction of granting a voice to a marginalized population in need, and also enjoy deep and rewarding connections with clients who have led rich and intriguing lives, and who deeply appreciate the compassionate care that gerontological social workers provide.

What Does a Geriatric Social Worker Do?

Geriatric social workers support clients and their families through a combination of psychosocial assessments, care coordination, counseling and therapeutic work, crisis management and interventions, and discharge planning.

Psychosocial Assessments

Gerontological social workers conduct psychosocial assessments to determine their clients’ mental, emotional and social needs, and to understand how these needs connect with their physical health and medical conditions. Mental and physical health are closely linked, and by gaining a holistic picture of clients’ mental, emotional and social circumstances, social workers help clients’ medical care providers and their families better understand how to develop a care plan as comprehensive and compassionate as possible.

Psychosocial assessments gather information on a client’s:

  • Mental and emotional health, including past and present psychological conditions.
  • Behavioral health challenges.
  • Social, financial, familial, educational and occupational history and current situation.
  • Medical and mental health treatment history.
  • Current medications and adherence to treatment plans.

Gerontological social workers complete psychosocial assessments at the time of a client’s admission into a given care program (this type of psychosocial assessment is called an intake assessment), and also conduct regular assessments throughout a client’s time in the program.

Burns explained to OnlineMSWPrograms.com how social workers evaluate multiple facets of clients’ cognitive, emotional, and behavioral health. “The social workers’ intake of a candidate is focused on the person as a whole and explores their support systems, psychosocial risks, cognition and mood,” Burns said. “The three main things that we assess for are changes in mood, behavior and cognition. We test for changes in cognition and mood every six months.”

Burns also noted that interacting closely with clients and connecting with them regularly allows her to evaluate their emotional and cognitive health at any point, and to convey any concerning changes to the treatment team. “[E]ach time I’m checking in on someone, even if it seems just like a social visit, I’m also checking in on their emotional well-being,” she said. “As social workers, we don’t just do formal screenings; we also do informal check-ins with the participants all the time. Also, we don’t have to wait until a participant is due for a formal assessment to make an adjustment in their care plan; we are able to modify it at any time.”

In addition to being essential for the development and improvement of a client’s care plan, psychosocial assessments help social workers determine whether a client is at risk of experiencing adverse mental, physical, and/or behavioral health outcomes—for example, if a client shows signs of depression, has suicidal tendencies, or is neglecting his or her medication. These evaluations of risk to clients, also known as risk assessments, help social workers and other members of a client’s care team determine the appropriate courses of action to address factors that may seriously compromise a client’s well-being.

Care Coordination

Another responsibility that gerontological social workers have is care coordination, which is the purposeful organization of different teams and services to effectively address a client’s overall health care needs (physical, cognitive, emotional, and social). Care coordination involves completing psychosocial assessments to inform the larger treatment team of a client’s needs. It also means participating in or facilitating meetings between different providers to discuss patient treatment and health outcomes; conveying the concerns and desires of the patient and his or her family to the teams involved in their care; and connecting clients and their caretakers with resources within the larger community that may provide additional support.

Counseling and Therapy

Gerontological social workers provide counseling and therapy to clients to help them cope with the psychological, emotional, social and financial challenges that come with aging. They also provide therapy and advise clients’ families and loved ones as necessary. During sessions with clients, social workers may employ a variety of psychotherapeutic techniques to help them manage negative emotions, set objectives for life improvement, address behavioral problems or psychological barriers to meeting certain goals, and (where applicable) make end-of-life preparations.

When working with the families of their clients, gerontological social workers may help them manage the difficulties they may encounter caring for an aging loved one, including strains on financial resources and relationships, and processing grief and other emotions around loss.

Specific therapeutic techniques gerontological social workers may use in their work with clients and families may include cognitive behavioral therapy and dialectical behavioral therapy, problem-solving therapy, motivational interviewing and mindfulness-based stress reduction. For more information about these and other therapeutic modalities social workers may use when providing clinical therapy to clients, see our Guide to Clinical Social Work or check out the National Association of Social Workers website.

Crisis Management and Interventions

Depending on their role and work setting, gerontological social workers may encounter a variety of client crises. Some clients may struggle with depression, suicidal desires, acute dementia that renders them unable to care for themselves, family conflicts about treatment decisions, traumatic experiences that require immediate support, or mental or emotional disorders that pose a danger to themselves or others. Clients may also be the victims of neglect, domestic abuse, exploitation and other crimes.

In these instances, gerontological social workers may have to intervene with a number of measures to ensure client safety and well-being. These may include providing emotional support and counseling to clients and their family members; managing difficult conversations among client, family and care providers; contacting relevant organizations and/or authorities in the case of elder abuse; and developing a short- and long-term support plan for clients and their loved ones.

Burns explained some of the crisis intervention services she provides at On Lok Lifeways. “Since we screen for changes in mood, if someone is doing fine emotionally and then all of a sudden they’re severely depressed or suicidal or homicidal, that’s obviously something to communicate immediately to the medical team and the participant’s family,” she said. “We consult with Adult Protective Services to report cases of abuse or neglect. We let their doctor know to see if they need to have a medication adjustment, and we’ll usually also recommend meetings with the chaplain or the mental health counselor who works on site as well.”

Gerontological social workers may also provide crisis support and interventions in non-medical settings. Stiles also helps the older adults during crisis situations by coordinating volunteer services for the IoA’s suicide prevention and grief support hotline.

“The Friendship Line at the Institute on Aging provides suicide prevention and trauma grief support to older adults and adults with disabilities. It’s a 24-hour hotline that operates from 8 a.m. to 8 p.m. in the office and after hours remotely,” she said “Callers are primarily over the age of 60 and are dealing with isolation, loneliness, depression, grief and illness. Many have mental health conditions, some treated and some untreated, and many also have a history of trauma. We have between 50-70 volunteers who are the primary hotline counselors.”

Resource Navigation and Benefits Application Guidance

Gerontological social workers also help clients and their families understand and apply for health care benefits and other financial or social assistance at the federal, state and local community levels. Clients and their loved ones may have a hard time navigating health insurance benefits, social security, and making use of community support systems. Social workers may guide clients through these steps and connect them with local support systems, such as senior centers, discounted or pro bono counseling, free community clinics, and subsidized food and housing if necessary.

Discharge Services

Consistent with their role as care coordinators, gerontological social workers often develop and coordinate a discharge plan for clients when the time comes for them to transition from one care setting to another—for example, from inpatient to outpatient care, or from residential care to home care. When coordinating a client’s discharge from a care setting, social workers typically contact the relevant parties involved in the transition and organize logistics such as transportation, health insurance and medical financial aid, and paperwork and documentation. They may also consult with the client and his or her family to prepare them for the change.

Where Do Geriatric Social Workers Work?

Geriatric social workers work with older populations in many settings. At any organization that serves the physical, mental, emotional and social needs of senior citizens, geriatric social workers may play a crucial role providing direct care (counseling and advising, resource navigation services, etc.), as well as care coordination (contacting different departments, care providers, and organizations to ensure clients get the inpatient or outpatient support they require). Common work environments that employ gerontological social workers include medical settings, adult health programs, programs for all-inclusive care for the, hospices, nursing homes and residential care facilities.

Hospitals and Medical Centers

Hospitals and medical centers typically have inpatient and outpatient divisions to support older patients who suffer from chronic or acute health conditions. For example, hospitals may have geriatric acute and emergency care units, fracture care centers, palliative care, and a geriatric oncology unit. Gerontological social workers may work in the geriatric departments of hospitals and medical centers as part of a specific unit or across multiple units.

Gerontological social workers who work at hospitals and medical centers collaborate with a larger medical team of physicians, nurses, medical assistants, psychologists and other staff. They evaluate patients’ needs, develop a treatment plan, coordinate geriatric patients’ care, and maintain and submit patient records and documentation. They also counsel patients and their families and help them navigate resources.

Some medical centers also have adult day health programs that provide daily activities, counseling and social support services to patients so they may remain at home instead of transitioning to a nursing home. Social workers in these settings may coordinate activities, programs and other services for their clients, provide counseling services and connect clients and their families to resources within or outside the program.

Programs of All-Inclusive Care for the Elderly

Programs of All-Inclusive Care for the Elderly (PACE) provide comprehensive medical, mental health and behavioral health care to people who are eligible for Medicaid or Medicare. These programs employ an interdisciplinary team of medical, mental health, behavioral and social service specialists who provide patients with care in their homes and/or at day treatment centers.

“We have a day health center where participants come to receive different types of activities, socialization and cognitive stimulation including pet therapy and bingo,” Burns said about On Lok Lifeways. “There’s also a clinic on site with three doctors and one nurse practitioner and several nurses. All of our participants are given a full physical exam before they are enrolled and they are evaluated every six months, or as health conditions occur. We also have a rehab team, which includes occupational therapists and physical therapists. We have a home care team of nurses and aides who provide people with showers, assist them with meals, provide medication reminders, and help them with chores and laundry in their home.”

Burns said social workers are an important part of PACE programs’ interdisciplinary team, serving as patient advocates and as the bridge of communication between patients and caregivers, and between different health providers and teams.

“Social workers are connected to all of the aforementioned teams. It is our job to connect our patients with the services that these teams provide, and to connect the teams with one another as necessary to ensure proper emotional, mental and physical care for our participants,” she said. “We also are the primary point of contact for our participants’ family members. Social workers at On Lok also play an important role in the initial assessment of patients, and in the development of their care plan.”

Social workers who work at PACE programs typically have similar work settings and responsibilities as social workers who work in geriatric departments of hospitals and medical centers. However, PACE programs provide more comprehensive services, combining medical, mental and behavioral health care, and serve clients who are eligible for Medicare or Medicaid. Therefore, social workers at such programs may connect with more organizations, provide a wider range of care coordination services and travel across different settings. For example, they may also conduct home visits, help patients and their families navigate the process of applying for medical benefits, and communicate with medical, mental health and behavioral, and social services departments within their program.

Specialized Senior Assistance Programs

Gerontological social workers may work for specialized programs that support senior citizens in a certain area of their life, such as financial literacy, community engagement, housing coordination and low-income support services. For example, social workers may work for a community service organization that serves low-income older adults and helps them find stable housing, health care or disability assistance, or they might work for an organization that provides financial advice, subsidized nutrition programs or home care services.

Some larger organizations, such as San Francisco’s Institute on Aging, fund a wide range of programs and conduct research on how society and local, state and federal governments may better support older populations. Social workers may work for these larger organizations, within one or more programs.

Hospices

Hospices provide palliative and end-of-life care to people suffering from terminal illnesses or conditions. Gerontological social workers in hospice settings work with patients and their families, providing emotional support, grief and bereavement counseling, resource navigation and care coordination. Hospices typically provide patients with symptom and pain management (palliative care) and assistance in end-of-life planning. Hospice social workers engage in all the non-medical aspects of a patient’s care, including coordinating community resources, answering patients’ and family members’ questions, helping family members cope with the loss of a loved one, and assisting clients in managing their family and social relationships during their time in hospice care.

Nursing Homes and Residential Care Facilities

Nursing homes provide residential support to people who cannot live independently due to mental or physical conditions such as dementia or disability. The transition to a nursing home or a residential care facility may be psychologically, emotionally and financially challenging. Gerontological social workers in these settings help clients and their families during this transition and ensure they receive the services they require both during their admission and throughout their stay. They may also help develop and review nursing home policies and procedures to ensure that residents receive the care and attention they need.

The Challenges and Rewards of Gerontological Social Work

Gerontological social work provides the opportunity to connect deeply with those in need who are often appreciative of the support, and who have a wealth of life experiences and perspectives to share. Serving as an advocate for clients who would not otherwise have a voice in their care may also be gratifying and empowering. In addition, this field of social work involves working with clients’ families and loved ones, which may form unique and rewarding connections.

“One of the most rewarding experiences are the long-term relationships I have with my participants and knowing that I am able to make a difference in their lives,” Burns said. “I find it very rewarding to build relationships with my participants and know that part of my treatment plan is to check in with them. I feel really blessed that I get paid to do this work, to connect and learn about people who have lived very interesting lives—very different, often, from the life that I have led.”

She also noted how her role as a geriatric social worker enables her to share more about herself with her patients, relative to other types of medical settings, which at times allows for deeper and more rewarding connections.

“I think one thing that I’ve noticed in geriatric social work is because I have such long-term relationships with people, I’m able to share a little bit more of myself,” she explained, “In hospitals you’re working with someone for a short amount of time, and you just need to focus on them, and they don’t get as much of an opportunity to also learn a little about you.”

In addition to her work at the Institute on Aging, Stiles worked as a medical social worker, bereavement coordinator, and bereavement and volunteer manager at Odyssey Healthcare, a hospice setting in which she served geriatric patients and their families. She said it has been very fulfilling to have a positive impact on patients’ well-being and relationships, and helping them preserve their comfort and dignity as they manage difficult health conditions.

“I have had so many rewarding experiences with clients—so many frail, dying individuals I’ve had the honor of working with and being present for, so many people I’ve been privileged to advocate for when they were not able to speak for themselves, so many grieving families I’ve been able to comfort and counsel,” she said. “It’s been really incredible how many clients have really touched me.”

Some of the primary challenges of gerontological social work include the complexity and severity of some clients’ challenges (which at times necessitate difficult conversations about end-of-life care and planning), instances of elder abuse or neglect, age-based discrimination, family conflicts that interfere with appropriate or sufficient care, and the challenges and limitations within the health care system that may prevent older patients from receiving the medical attention and resources they need.

Stiles said older clients can often face a combination of challenges, including prejudice against people who are aging, senior citizens’ changing occupational and/or financial status, and the physical and mental declines that tend to come with aging.

“Older adults face many of the same concerns and issues as any adult-limited resources, mental health issues, substance abuse, history of trauma, systemic racism, homophobia, classism, etc.,” she said. “What makes older adults ‘unique’ is that they are dealing with these concerns with the added pressure of ageism (discrimination against people based on their age) and ableism (discrimination against those with disabilities), as well as potential physical health changes and accumulated losses.”

Managing family members’ concerns—or their lack of concern—can also prove challenging. “While many families are wonderful to work with, other families are very difficult to work with,” Burns noted. “Families often are at one end or the other of the spectrum, very, very involved and high maintenance, and then there are other families that you call and call and cannot get them to call you back. It is important to have strong relationships and build trust with all families that you work with.”

Encountering systemic injustices that particularly hurt elders can also be a challenge that gerontological social workers encounter on the job. “Many of the challenges I’ve faced with clients are primarily due to longstanding, often untreated mental illness that clients have been dealing with for decades,” Stiles noted. “Often, there are systematic issues like generational poverty, lack of services in the community and a general lack of concern for older adults unless in a medicalized setting.”

To manage the challenges of the work, social workers suggested that students manage their expectations about what they are able to do to help clients, and appreciate their successes while learning from their mistakes.

“For new social workers, I recommend keeping perspective and understanding the limitations placed on people in this profession,” Stiles said. “Many issues an older client is dealing with are issues they’ve been dealing with for decades. We cannot solve family discord, we cannot solve poverty, we cannot solve regrets or mental illness or a lack of services. This is incredibly difficult and takes years of practice and self-reflection.”

Burns said she remains optimistic and turns the challenges she encounters into opportunities to connect with her clients and their families, and to better meet their needs and concerns. “It’s very rewarding when you are able to build trust with a family that is hard to reach or get them to agree to provide care that they have been resistant to provide,” she noted.

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FAQs

When should a geriatric social worker be consulted?

A geriatric social worker may be brought into a case if a patent has physical or emotional needs, conflicts or resistance, or unresolved safety concerns. Geratric social workers may also assist with discharge and follow-up after a hospital visit. They may even help make sure the details of patients’ end-of-life decisions are in order.

Why are geriatric social workers needed?

Geriatric social workers are a patient’s advocate and may help them receive the care they need. They distinguish between normal and abnormal aging and help connect clients to community resources available in the area. For example, a geriatric social worker refer older adults for home care services if safety oversight or assistance with personal care is needed.

How much do gerontology social workers make?

The median annual wage of social workers was $50,470 in 2019, the BLS reports. The BLS categorizes social workers who specialize in a geriatric setting as health care social workers. So, to find the average geriatric social worker salary, analyze BLS data for health care social workers. According to BLS data, the 2019 mean wage of health care social workers was $54,310. Employment of social workers is projected to grow 11% from 2018 to 2028, per the BLS, faster than most fields.

What type of social worker gets paid the most?

According to 2019 annual mean wage data from the BLS, health care social workers earn the most, an average of $54,310. This classification includes gerontological social workers. Here are the mean wages of other types of social workers, as reported by the BLS:

  • Child, family and school social workers: $51,650
  • Social workers, all other: $48,760
  • Mental health and substance abuse social workers: $48,570

What is the difference between a geriatric social worker and other social workers?

All social workers are committed to the well-being of individuals, families and groups. Geriatric social workers focus on the health of older patients and those who are most vulnerable. They are specially trained in the issues commonly facing older people, including anxiety, dementia, depression, financial instability, isolation, and other emotional and social challenges. They are also trained in providing clients with access to other care and support programs they need.

Last updated: July 2020