N A S W S t a n d a r d s f o r

S o c i a l W o r k P r a c t i c e w i t h

FamilyCaregivers

of OlderAdults

N A T I O N A L A S S O C I A T I O N O F S O C I A L W O R K E R S

2010

NATIONAL ASSOCIATION

OF SOCIALWORKERS

750 First Street, NE

Suite 700

Washington, DC 20002-4241

202.408.8600

SocialWorkers.org

N A S W S t a n d a r d s f o r

S o c i a l W o r k P r a c t i c e w i t h

FamilyCaregivers

of OlderAdults

Contents

5 Introduction

7 Background

9 Goals of the Standards

10 Definitions

14 Guiding Principles

18 Standards for Social Work Practice

18 Standard 1: Ethics and Values

21 Standard 2: Qualifications

22 Standard 3: Knowledge

25 Standard 4: Cultural and Linguistic Competence

27 Standard 5: Assessment

30 Standard 6: Service Planning, Delivery, and Monitoring

32 Standard 7: Advocacy

33 Standard 8: Collaboration

35 Standard 9: Practice Evaluation and Improvement

37 Standard 10: Documentation

39 Standard 11:Workload

39 Standard 12: Professional Development and Competence

41 References

44 Resources

47 Acknowledgments

National Association of Social WorkersJames J. Kelly, PhD, ACSWPresident

Elizabeth J. Clark, PhD,ACSW, MPHExecutive Director

Family Caregiving and Social WorkPractice Standards Working GroupAmy Berman, BS, RNPatricia Brownell, PhD, MSWRita Choula, BSCatherine A. Clancy, PhD, LCSWJoAnn Damron-Rodriguez, PhD, LCSWSandra Edmonds Crewe, PhD,ACSW, MSWLorraine Hedtke, LCSW, PhDForrest Hong, PhD, LCSW, C-ASWCMJamie Huysman, PsyD, LCSWPhyllis Mensh Brostoff, CISW,ACSW, CMCNora O’Brien-Suric, MA, PhD-cSusan Reinhard, PhD, RN, FAANMiriam Sterk, LCSW, C-ASWCMCynthia Stuen, DSW/PhD,ACSW, LCSW

NASW StaffTracy R.Whitaker, DSW,ACSWChris Herman, MSW, LICSW

©2010 National Association of Social Workers.All Rights Reserved.

5

Introduction

The aging of the population presents social,economic, and political implications for families,the social work profession, and the globalcommunity. Social workers, other professionals,and the public increasingly recognize thatadvanced age is a time of continued growth andthat older adults contribute significantly to theirfamilies, communities, and society. At the sametime, many individuals face multiplebiopsychosocial challenges as they age: changesin physical and cognitive abilities; barriers toaccessing comprehensive, affordable, andhigh-quality health and mental/behavioralhealth care; decreased economic security; lack ofaffordable, accessible housing; increasedvulnerability to abuse and exploitation; and lossof meaningful social roles and opportunities toremain engaged in society. These challengesoften affect entire families, who struggle toprovide physical, emotional, financial, andpractical support to their aging members.

According to the Institute of Medicine (IOM)(2008), “Family members, friends, and otherunpaid caregivers provide the backbone formuch of the care that is received by older adultsin the United States” (p. 241)—care valued, forthe year 2007, at approximately $375 billion(AARP, 2008). Yet, their role is “oftenunderappreciated” (IOM, p. 263), and manyfamily caregivers support their loved ones atsignificant cost to their own physical, emotional,and financial well-being (National Alliance forCaregiving, 2009).

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Numerous studies have indicated that the needfor services for older adults, including socialwork, will increase exponentially as thepopulation ages (IOM, 2008; U.S. Departmentof Health and Human Services, 2006; Whitaker,Weismiller, & Clark, 2006). At the same time,strengthening relationships between familycaregivers and health care practitioners benefitsboth caregivers and older adults (IOM).

Social workers interact with family caregivers ofolder adults not only throughout the network ofaging services and across the health,mental/behavioral health, and long-term carecontinuum, but also in diverse settings such aschild welfare agencies, employee assistanceprograms, faith-based organizations, housingprograms, schools, and veterans’ serviceprograms. With its strengths-based,person-in-environment perspective, the socialwork profession is well positioned and trained toadvocate for and support family caregivers ofolder adults (NASW, 2009). These standards aredesigned to enhance social work practice withfamily caregivers of older adults and to help thepublic understand the role of professional socialwork in supporting family caregivers.Furthermore, although the challenges of caringfor an older adult may differ in some ways fromthose of caring for a younger person living withillness or disability, the standards may also beuseful in informing social work practice withfamilies caring for younger people.

Background

During the past decade, consumer advocacygroups, health professional organizations, andgovernment agencies have paid increasedattention to the role of family caregivers insupporting older adults and to the needs offamily caregivers. As a result, health careprofessions are focusing on their own ability totrain members of their respective disciplines andto contribute to the building of a knowledgebase for excellence in gerontology and insupporting family caregivers. Social work is noexception. The Council on Social WorkEducation (CSWE) developed a guide,Advanced Gero Social Work Practice (2009),which links gerontological social workcompetencies to

� Specific practice behaviors, outlined inCSWE’s 2008 Educational Policy andAccreditation Standards (EPAS), that arecommon to all social work practice

� Knowledge in aging for generalist practice� Advanced gerontological social workknowledge and practice behaviors

The guide also identifies course exercises,assignments to measure student attainment ofgerontological social work practice behaviors,and research articles providing evidence-basedsocial work practice. Content specific to familycaregiving is included in the document.

Social workers, nurses, family caregiveradvocates, and other experts in family caregivingmet in 2008 to identify the knowledge and skillssocial workers and nurses need to support family

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caregivers of older adults. This invitationalsymposium, State of the Science: ProfessionalPartners Supporting Family Caregivers, wasdeveloped under a grant from the John A.Hartford Foundation to the AARP Foundation.Meeting proceedings were published and widelydisseminated in both The Journal of Social WorkEducation (Kelly, Brooks-Danso, & Reinhard,2008) and The American Journal of Nursing(Reinhard, Kelly, and Brooks-Danso, 2008).

Building on this foundation, the NationalAssociation of Social Workers has developedStandards for Social Work Practice with FamilyCaregivers of Older Adults. The standards reflectcore elements of social work practice with, andon behalf of, family caregivers and are targetedtoward social workers who address familycaregiving needs in various professional settings.For many social workers, these standardsreinforce current practices. For others, theyprovide objectives to achieve and guidelines toassist in practice.

Goals of the Standards

These standards address family caregiving forolder adults as an expanding field of knowledgefor social workers. The standards are designedto enhance social workers’ awareness of theskills, knowledge, values, methods, andsensitivity needed to work effectively with familycaregivers.

Ideally, these standards will stimulate thedevelopment of clear guidelines, goals, andobjectives related to family caregiving andgerontology in social work practice, research,policy, and education. The specific goals of thestandards are

� To inform social workers about familycaregiving as an expanding field of social workknowledge

� To improve the quality of social work servicesprovided to family caregivers of older adults

� To provide a basis for the development ofcontinuing education materials and programsrelated to family caregiving

� To ensure that social work services to familycaregivers of older adults are guided by theNASW Code of Ethics (2008)

� To advocate for family caregivers’ right toself-determination, confidentiality, access tosupportive services, and appropriate inclusionin decision making affecting older adults

� To encourage social workers to participate inthe development and refinement of publicpolicy, at the local, state, and federal levels, tosupport family caregivers of older adults

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Definitions

Social worker

Within the United States, social worker refers toan individual who possesses a degree in socialwork from a school or program accredited bythe Council on Social Work Education.Although all 50 states and the District ofColumbia license or certify social workers,licensure and certification laws vary by state.Each social worker should be licensed orcertified, as applicable, at the level appropriatefor her or his jurisdiction.

Family, family caregiver, and family system

The terms family and family caregiver refer tofamily of origin, extended family, domesticpartners, friends, or other individuals whosupport an older adult. These individuals maycross the lifespan from childhood to advancedage; together, they constitute the family system.For the most part, family caregivers supporttheir aging family members without financialcompensation, although some family membersmay receive remuneration for their servicesthrough consumer-directed programs. However,for purposes of these standards, family does notinclude individuals whose primary relationshipwith the older adult is based on a financial orprofessional agreement.

In some families, an older adult designates oneindividual as a primary caregiver or decision-maker, or an individual voluntarily assumes sucha role. In many families, different individualsassume responsibility for a variety of caregivingtasks. For example, an adult daughter may assistan older parent with financial matters; a sonmay be designated to make health care

decisions; a spouse or partner may help withactivities of daily living; a grandchild may helpwith grocery shopping; a niece or nephew maytake an older relative to religious services; and aneighbor may provide transportation toappointments. For still other families, caregivingand decision-making roles are not clearlydefined—or there may be a discrepancy betweendefined roles and day-to-day fulfillment of suchresponsibilities.

The importance of assessment of familycaregiving roles notwithstanding, for thepurposes of these standards the term familycaregiver is not limited to individuals with eitherwell-defined or assumed primary caregivingroles. The term is also not restricted toindividuals who self-identify as caregivers,because many family members do not identifywith this label even though they support anolder adult in one or more of the ways outlinedin the next definition.

Family caregiving

Family caregiving may include a variety ofsupports and services that enhance or maintainolder adults’ quality of life:

� Emotional, social, and spiritual support� Assistance with decision making related tohealth care, financial matters, and lifespanplanning

� Assistance with physical tasks, such asbathing, dressing, or walking

� Support in navigating and negotiating healthand social service systems, such as dealingwith health and long-term care insurance,arranging and overseeing paid helpers in the

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home, communicating with health careprofessionals, or advocating for quality careand services

� Assistance with practical matters, such ashousekeeping, processing paperwork, orgoing to medical and other appointments

� Financial support, including direct financialassistance and help with bill-paying

� Shared housing

Caregiving may occur on an intermittent,part-time, or full-time basis. It includes supportprovided both from a distance and in an olderadult’s home or other setting. For the purposesof these standards, the term caregiving refers tothe supports and services provided primarily ona voluntary basis, not to professional orcontractual services—such as social work orhome health aide services—that are provided fora fee to the public.

Culture

Culture has been described as “the integratedpattern of human behavior that includesthoughts, communications, actions, customs,beliefs, values, and institutions of a racial, ethnic,religious, or social group” (Cross, Bazron,Dennis, & Isaacs, 1992). Cultural identificationmay include, but is not limited to, race,ethnicity, and national origin; migrationbackground, degree of acculturation, anddocumentation status; biological sex, genderidentity, and gender expression; sexualorientation and marital or partnership status;spiritual, religious, and political belief oraffiliation; physical, mental, and cognitiveability; literacy, including health and financialliteracy; and age.

Cultural competence

The process by which individuals and systemsrespond respectfully and effectively to people ofall cultures, languages, classes, races, ethnicbackgrounds, religions, and other diversityfactors (including, but not limited to, genderidentity and expression, sexual orientation, andmarital or partnership status) in a manner thatrecognizes, affirms, and values the worth ofindividuals, families, and communities andprotects and preserves the dignity of each(NASW, 2007).

can support family caregivers, attention tocaregivers’ contributions, assets, needs, andgoals remains critical.

Conversely, family caregivers of older adultsmay constitute the primary clientele for othersocial workers using these standards. Forexample, a family caregiver who is struggling tobalance job and family responsibilities may bereferred, voluntarily or involuntarily, to a socialworker in an employee assistance program.Likewise, a family member may also turn to acaregiving support group when his or hermental or physical health is adversely affected bycaregiving responsibilities. When a familycaregiver of an older adult is the identifiedclient, the social worker’s contact with the olderadult may be nonexistent, limited, or extensive.Although biopsychosocial assessment of familycaregivers’ goals, life experiences, abilities, andneeds guides care planning and service delivery,understanding the abilities, needs, and goals ofthe older adults they support is also important.Family members often have years of experiencein caregiving roles and can readily provide thishistory. Social work solicitation of familycaregivers’ expertise and validation of caregivers’role as partners on the care team builds afoundation of trust. Having established thisfoundation, social workers can support familycaregivers not only in making informeddecisions and fulfilling caregiving roles, but alsoin identifying and addressing stress related tocaregiving responsibilities. In some cases, socialworkers help family caregivers modify theircaregiving roles to improve or maintain theirown health and well-being.

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Guiding Principles

The scope of social work practice with familycaregivers of older adults extends across manypractice settings and requires action at theindividual, family, group, community, andorganizational levels. These standards serve as abasic tool to guide social work practice withfamily caregivers of older adults, althoughpractice priorities may vary among settings.

Some practice settings prioritize the needs andgoals of the entire family system and encouragesocial workers to assess, and intervene on behalfof, both older adults and their family caregivers.For example, support for both patients andfamilies is inherent in the hospice model. Inother settings, however, older adults mayconstitute the primary clientele for many socialworkers using these standards. In such cases,social workers’ primary responsibility is usuallyto the well-being of the older adult, and socialworkers may have little or no opportunity tointeract with family caregivers.

On the other hand, many social workershave—or can establish (following appropriateethical and legal guidelines)—at least somecontact with their older clients’ familycaregivers. For example, home health socialworkers frequently encounter family caregiverswhen visiting older adults. When this occurs,social workers have a responsibility to supportfamily caregivers, both to maximize the qualityof life of their older adult clients and to enhancethe well-being of caregivers themselves.Although practice setting and funding sourcemay influence the extent to which social workers

Social workers also recognize that caregivingroles may not be clearly defined and thatcaregiving is often a reciprocal phenomenonwithin a family. For example, a middle-agedwoman supporting her mother may also rely onher parent for child care or financial assistance.Similarly, an older man may assumemanagement of household finances because hiswife is in the early stages of Alzheimer’s disease.At the same time, his wife may perform physicaltasks, such as carrying laundry to and from thebasement, that he cannot accomplish because heuses a wheelchair. In such cases, social workersmay find that the individuals identified ascaregivers and care recipients may, in fact, fulfillboth roles. Even in cases in which caregivingroles are clearly defined, emotional caregiving isoften reciprocal (though family caregivers maystruggle with the loss of such reciprocity as aparent’s dementia progresses, for example, or asa partner withdraws during the dying process).Thus, social workers can support both olderadults and family caregivers by affirming thatcaregiving relationships are partnerships withmutual benefits.

Social workers also play a critical role in helpingindividuals who support older adults, but do notself-identify as family caregivers, in naming theirroles. This recognition is often caregivers’ firststep in identifying and accessing supports, bothto care for their family members and tomaintain their own wellness. Validation of thecaregiving role can be especially helpful forcaregivers who have complicated relationshiphistories with the older adults whom theysupport.

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Even individuals and families who self-identifyas caregivers, however, may not be connectedwith social workers, turning instead tocommunity organizations (such as culturalcenters or religious communities) for support.Collaborative relationships between socialworkers and community organizations maypromote family caregivers’ understanding of andaccess to social work services.

Regardless of practice setting or primaryclientele, social workers who interface witholder adults or family caregivers of older adultsmust balance the needs and goals of bothpopulations and must recognize that those needsand goals may sometimes result in conflict.Conflicts among family members in variousformal or informal caregiving roles are alsoquite common. Assessment of the family system(to the extent possible), careful consideration ofsocial work values and ethics, and application oflistening, empathy, and conflict resolution andmediation skills can guide social workers infacilitating optimal outcomes for all involved.Again, practice setting and funding sources mayinfluence social workers’ ability to assess andintervene with both older adults and familycaregivers or to interact with all familycaregivers in a given situation. Nonetheless,attention to the contributions, strengths, needs,and goals of family caregivers of older adults isintegral to social work practice.

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Standards for Social Work Practice with FamilyCaregivers of Older Adults

Standard 1. Ethics and Values

Social workers practicing with family caregiversof older adults shall adhere to the ethics andvalues of the social work profession, using theNASW Code of Ethics (2008) as a guide toethical decision making.

Interpretation

The primary mission of the social workprofession is to enhance human well-being andto help meet the basic needs of all people, withparticular attention to the needs of people whoare vulnerable and oppressed. This mission isrooted in a set of core values that constitutes thefoundation of social work and relates closely tosocial work with family caregivers of olderadults:

� Service

Social workers apply their knowledge andskills to support the well-being of familycaregivers of older adults and to addresschallenges faced by family caregivers.

� Social justice

Social workers act on individual and systemiclevels to ensure access to needed information,services, and resources for family caregivers ofolder adults and to facilitate family caregivers’meaningful and comfortable participation indecision making.

� Human dignity and worth

Social workers treat family caregivers of olderadults in a respectful and caring manner.They promote family caregivers’self-determination, with sensitivity and

respect for the self-determination of olderadults when confronted with conflictingvalues and goals.

� Importance of human relationships

Social workers engage family caregivers, tothe extent possible, as partners in goalidentification, progress, and achievement.They strive to strengthen relationshipsbetween family caregivers and older adults soas to maintain and enhance the well-being ofthe family system.

� Integrity

Social workers use the power inherent in theirprofessional role responsibly, exercisingjudicious use of self and avoiding conflicts ofinterest. Their practice with, and on behalf of,family caregivers of older adults is consistentwith the profession’s mission and ethics.

� Competence

Social workers practice within their areas ofcompetence and continually strive to enhancetheir knowledge and skills related to familycaregiving and aging. Competence alsorequires that social workers recognize theimportance of, and attend to, their ownself-care.

The very term family is, in fact, rooted in ethicalvalues. For the purposes of these standards,family refers to family of origin, extended family,domestic partners, friends, or other individualswho support an older adult and whose primaryrelationship with the older adult is not based ona financial or professional agreement. Socialwork practice with family caregivers of olderadults begins with honoring the uniqueness ofeach family system.

Effective practice with family caregivers of olderadults requires social workers to identify theirown values and perspectives regarding aging andfamily caregiving, including their personalexperiences as family caregivers or with agingfamily members. Social workers have an ethicalresponsibility to assess how their ownexperiences influence their practice with familycaregivers of older adults, to ensure they are notimposing their own values on family caregiversof older adults.

Differences in the wishes, perceptions, andcapacity of older adults and family caregiverscan present complex ethical and legal challengesto social workers. Social workers must know andcomply with federal, state, local, and tribal laws,regulations, and policies related to older adults,such as reporting requirements for elder abuseand neglect, guardianship, and advancedirectives. Obtaining informed consent,maintaining confidentiality, and protectingprivacy are critical. Careful application of ethicalprinciples is especially important when olderadults or family caregivers have limiteddecision-making capacity or are experiencing orperpetuating mistreatment. Collaboration withcolleagues can also help resolve ethicaldilemmas.

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Standard 2. Qualifications

Social workers who practice with familycaregivers of older adults shall possess a degreein social work from a school or programaccredited by the Council on Social WorkEducation; shall comply with state-basedlicensing and certification requirements; andshall have knowledge, skills, and professionalexperience in aging and family caregiving.1

Interpretation

Social work degree programs provide educationand training in social work values, ethics,theories, practice, policy, and research. Thistraining is essential for any individual engagingin the practice of social work. Social worklicensing and certification laws vary by state. It iseach social worker’s responsibility to ensurecompliance with the licensing and certificationlaws of her or his respective state.

Social work practice with (or on behalf of)family caregivers of older adults requiresspecialized knowledge and skills as outlined inthese standards. Ideally, social workers attainsuch knowledge and skills during their degreeprograms through coursework and field practiceexperience related to aging and familycaregiving. Specialty practice certifications mayalso indicate expertise in areas relevant topractice with family caregivers of older adults,such as gerontological social work, geriatric caremanagement, case management, or health care.Whether through certification, continuingeducation, or professional experience, socialworkers should continually enhance their skillsand knowledge related to aging and familycaregiving.

caregivers of older adults. Social workers alsosupport family caregivers in navigating healthcare and social service systems, accessingresources, and identifying service gaps andbarriers.

Knowledge essential to social work with familycaregivers of older adults includes, but is notlimited to, the following areas:

• Aging

� Concepts and theories associated with aging,such as cohorts and lifespan development

� Physiological and cognitive processesassociated with healthy aging

� Grief, loss, death, dying, and bereavement� Effects of ageism on medical and socialservice delivery to older adults

• Physical health

� Physiological and cognitive processesassociated with acute and chronic conditionsand medication use and misuse

� Psychosocial effects of acute, chronic, andlife-limiting illness

� Psychosocial effects of physical and cognitivedisability

• Mental and behavioral health

� Depression, anxiety, and other mental healthconditions

� Addictive behaviors and their effect on thefamily system

� Elder abuse, neglect, and exploitation

• Family caregiving experiences

� Family systems, interpersonal dynamics, andthe complexity of caregiving relationships

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As the aging population grows and familycaregiving becomes increasingly central tohealth care and social service delivery, socialworkers will increasingly interface with olderadults and family caregivers, regardless ofpractice specialty or setting. Social workersspecializing in areas other than aging and familycaregiving should seek supervision, consultation,and continuing professional development, asdescribed in these standards, to ensure they havethe requisite knowledge of systems of care andskills for practice with older adults and familycaregivers (or to make responsible referrals toother social workers with expertise in this area).

1 Degree and licensure requirements are specific to social

work practice in the United States. NASW recognizes that

qualifications may differ outside the United States.

Standard 3. Knowledge

Social workers shall acquire and maintain aworking knowledge of current theory, practice,sociohistorical context, policy, evidence-basedresearch, and evaluation methods related toaging and family caregiving and shall integratesuch information into practice.

Interpretation

Social work with family caregivers of olderadults is a specialized practice area requiringfocused preparation and continuing education.Social workers apply knowledge about aging,resilience, disability, health conditions, andcaregiving to enhance the well-being of family

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� Interdependence in care partnerships (i.e.,between caregivers and care recipients)

� Family caregivers’ central role in health caredelivery

� Growth and rewards associated with familycaregiving

� Physical, emotional, and financial challengesassociated with family caregiving at variouspoints in the individual lifespan and family lifecycle

� Signs of caregiver strain� Reengagement and healing after death of carerecipient

• Resources

� Health care, long-term care, social service,and housing systems and programs

� Policies, eligibility requirements, and financialconcerns affecting family caregivers and olderadults

� Resources available to family caregivers andolder adults, such as respite care, familymedical leave, and assistive technology

• Professional social work role

� The multifaceted social work roles andfunctions related to family caregiving andaging

� Interdisciplinary collaboration� Appropriate professional boundaries and useof self, including managingcountertransference when social workers arepersonally involved in family caregivingoutside of the workplace

� Signs of, and strategies to address, ethicaldilemmas, compassion fatigue, burnout,secondary traumatization, and professionalgrief

Standard 4. Cultural and Linguistic

Competence

Social workers shall provide and facilitate accessto culturally and linguistically appropriateservices to family caregivers of older adults,consistent with the NASW Indicators for theAchievement of the NASW Standards forCultural Competence in Social Work Practice(2007).

Interpretation

The increasing cultural and linguistic diversityof family caregivers and older adults requiressocial workers to strive continually for culturaland linguistic competence. Social workers’recognition and affirmation of cultural andlinguistic diversity are critical both to theformation of therapeutic alliances with familycaregivers and to cooperative workingrelationships with colleagues. Such diversityincludes, but is not limited to, race, ethnicity,socioeconomic class, biological sex, genderidentity, sexual orientation, religion, age, healthstatus, preferred language, migrationbackground, documentation status, degree ofacculturation, and literacy (including health andfinancial literacy). It can also include vocationalaffiliations, such as participation in the militaryor involvement in veterans’ services.

Cultural competence begins with each socialworker’s cultural self-identification. Culturalself-awareness is fundamental to recognizingand addressing how one’s own cultural values,beliefs, experiences, and practices affectinteractions with family caregivers andcolleagues. Social workers who practice suchself-assessment can then recognize how culturalidentity, in its multifaceted expressions, is central

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to the resilience of the individuals, families, andcommunities with which they interact.Specifically, social workers need to supportfamily caregivers’ resilience by appreciating andaffirming the cultural values, beliefs, andpractices of family caregivers with whom theywork, especially the ways in which cultureinfluences perceptions and practices related toaging, illness, and disability; physical andpsychosocial pain; health care treatments;providing care to, or receiving care from, familymembers; help-seeking behaviors; health care,financial, and other decision making; and deathand dying.

Social workers also need to recognize thatculture varies within families. These differencesmay manifest in multiple ways, such as differentperceptions of caregiving responsibilities orvarying levels of fluency in the dominantlanguage of the country of residence. In suchinstances, social workers should honor thedifferences within the family system andfacilitate maximal participation of all memberswith whom they interact—by using professionalinterpreters rather than relying on familycaregivers to interpret for older adults, forexample.

Cultural and linguistic factors influence not onlypractitioner-client relationships but alsoorganizational structures and societal structuresand dynamics. Social workers shouldcomprehend how systemic or institutionaloppression related to cultural and linguisticdiversity (such as ageism, racism, or sexism)affects family caregivers’ role in care, access toand utilization of resources, health careoutcomes, and well-being. Identification of

ageism in policy, the media, and systems of careis especially useful in helping familiescontextualize the challenges they face—and,sometimes, in identifying and addressing theirown ageism. Action to eliminate ageism andother forms of institutional oppression onorganizational, community, and broader levels isessential to optimizing family caregiving rolesand reducing economic, health, and socialdisparities experienced by family caregivers andolder adults.

Standard 5. Assessment

Social workers shall assess family caregivers ofolder adults on an ongoing basis, gatheringcomprehensive information to develop andamend plans for care or services.

Interpretation

Biopsychosocial assessment is the foundation ofsocial work practice and is conducted incollaboration with the family system.Assessment is a complex function requiringopenness to a wide variety of information, bothverbal and nonverbal, presented by the familysystem in the context of the social environment.Using empathy, client-centered interviewingskills, and methods appropriate to clients’capacity, social workers engage family caregiversof older adults in identifying their strengths,resources, and concerns. Because assessmentguides intervention, social workers need tocomplete initial assessments in a timely mannerand then reassess and revise service plans inresponse to caregivers’ shifting needs andaltered goals. Use of standardized assessmentinstruments, such as caregiver burden scales, canaid social workers in identifying and respondingto caregivers’ concerns.

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Social work assessments may vary based onpractice setting and specialty. Comprehensivebiopsychosocial social work assessments offamily caregivers of older adults may include thefollowing domains, as they pertain to serviceneeds:

• Family characteristics and dynamics

� Motivating factors in seeking social workservices, if applicable

� Family structure and roles, including the waysvarious family members provide care andidentified decision-makers (both legally andinformally designated)

� Communication patterns, conflictmanagement styles, and alliances within thefamily system, especially history ofrelationships between caregiver(s) and olderadult receiving care

� Living arrangements� Vocational history (e.g., work, school, orvolunteering) and lifespan development

� Language preferences and proficiency levels� Degrees of literacy, including health andfinancial literacy

� Cultural values, beliefs, and practices(including spirituality and religion) relatedto caregiving and aging

� Psychosocial strengths, protective factors, andpoints of resilience

� Family system experiences, includinggenerational patterns, related to illness,disability, loss, and death throughout the lifecycle

� Family’s relationships with community andreligious organizations

� Experiences specific to populations such asimmigrants and refugees, survivors of violence

or trauma, child or adolescent caregivers, andpeople who are homeless, and family system’sresponses to those experiences

• Risk assessment

� Physical, cognitive, and psychosocialfunctioning of older adults receiving care

� Older adults’ desire and capacity forindependence

� Degree of adherence to plan of care,including medications

� Household environment and need foradaptive equipment, home modification, oralternate living arrangements

� Family caregivers’ self-care capacity (physical,emotional, and cognitive)

� Family caregivers’ perceptions of older adults’capacity for independence and tolerance ofsafety risks

� Family caregivers’ physical, emotional, andcognitive capacity to fulfill caregivingresponsibilities

� Family system’s psychosocial supports, bothformal and informal, and barriers to access

� Family system’s financial resources andbarriers to access

� Family system’s ability to navigate health,long-term care, and social service systems

� Advance care planning, including use andcomprehension of advance directives andother legal documents

� Family system’s behavioral and mental healthfunctioning, including history, coping styles,crisis management skills, and risk of suicide orhomicide

� Risk of abuse, neglect, or exploitation by or offamily caregivers, and underlying causes forsuch mistreatment

• Goals and effects of family caregiving

� Caregivers’ goals for care of their older familymember(s)

� Indicators of caregiver burden, such asdepression, anxiety, deteriorating health,financial insecurity, and social isolation

� Impact of health conditions and caregiving onemotional intimacy and, if applicable, sexualrelationships between family caregivers andolder adults

� Impact of caregiving on caregivers’ otherrelationships and responsibilities

� Family caregivers’ need for physicalassistance, emotional or social support,respite, financial resources, or other services

� Changes in policies and programs needed tosupport family system

Standard 6. Service Planning, Delivery, and

Monitoring

Social workers shall collaborate with familycaregivers of older adults to plan, deliver, andmonitor individualized services that promotecaregivers’ strengths and well-being. Care plansshall be based on assessments and havemeasurable objectives.

Interpretation

Social work services should be designed to meetthe biopsychosocial needs of family caregivers ofolder adults and should be delivered in a mannerthat ensures confidentiality in accordance withthe NASW Code of Ethics (2008). Serviceplanning, delivery, and monitoring draw notonly on ongoing, comprehensive social workassessments but also, if appropriate andavailable, on the input of other service providersinvolved in supporting the family system.Collaborative engagement of family caregivers

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of older adults throughout the service planning,delivery, and monitoring process is critical toensure that services are mutually agreed upon,appropriate to caregivers’ circumstances, clearlycommunicated, and delivered in a timely manner.

Care plans should include short- and long-termgoals centered on family caregivers of olderadults. Service frequency and duration may beaffected by practitioner role and settingparameters but, ideally, should be in accordancewith the needs and goals identified in theassessment. Care plans also vary by the socialworker’s scope of practice and may incorporatethe following services:

� Education and coaching (e.g., wellnesspromotion, disease management, anddifferentiating normal age-related changesfrom behaviors that may warrant professionalevaluation)

� Lifespan and advance care planning� Individual counseling and psychotherapydrawing on a variety of modalities (e.g.,psychodynamic or cognitive-behavioral)

� Couples and family counseling� Family-team conferences� Group interventions (e.g., caregiver orbereavement support groups)

� Interventions addressing grief, loss,end-of-life issues, and bereavement

� Mediation and conflict resolution� Crisis intervention� Client advocacy and systems navigation� Team, organizational, and interorganizationalcare planning and collaboration

� Resource information and referral (e.g.,medical, psychosocial, financial, and legalresources)

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� Case/care management and care coordination� Planning for service termination or discharge,including planning for cessation of familycaregiving roles and supports associated withthat transition

Standard 7. Advocacy

Social workers shall advocate for the needs,decisions, and rights of family caregivers ofolder adults. The social worker shall engage insocial and political action that seeks to ensurethat family caregivers of older adults haveequitable access to resources to meet theirbiopsychosocial needs.

Interpretation

Effective advocacy involves helping familycaregivers of older adults identify and definetheir strengths, needs, and goals, and tocommunicate those needs and goals to serviceproviders and decision-makers. Social workersstrive not only to promote family caregivers’self-advocacy, but also to enhance the capacityof communities to integrate family caregivers’contributions. Creativity and flexibility arecentral to successful advocacy efforts with, andon behalf of, family caregivers of older adults.

Social work advocacy takes place on both microand macro levels and may involve the followingactivities:

� Adaptation of organizational policy,procedures, and resources to facilitate serviceprovision to multicultural clientele

� Advocacy with other service providers andorganizations to improve family caregivers’access to high-quality services

� Identification and development of strategiesto address service gaps, fragmentation,discrimination, and other barriers that affectfamily caregivers of older adults

� Inclusion of family caregivers of older adultsin advocacy efforts and in program design,planning, and evaluation

� Analysis of historical and current local, state,and national policies as they affect familycaregivers of older adults, especiallyhistorically marginalized or underresourcedpopulations

� Education of the public, the media,corporations, and policymakers regarding thestrengths, contributions, needs, and concernsof family caregivers of older adults

� Advocacy to foster age-friendly communitycapacity and to enhance the contributions offamily caregivers of older adults

� Use of multiple media, including writtenmaterials, oral presentations, and computertechnology, to achieve advocacy goals

Standard 8. Collaboration

Social workers shall promote interdisciplinaryand interorganizational collaboration to support,enhance, and create services delivered to familycaregivers of older adults.

Interpretation

Multiple service providers and organizations areoften involved in supporting family caregivers ofolder adults. Collaboration within care teamsand organizations, as well as amongorganizations and service delivery systems, isessential to continuity of care for familycaregivers of older adults. Social workers play anintegral role in fostering, maintaining, andstrengthening such partnerships.

resources on behalf of family caregivers ofolder adults

� Manage personal and interpersonal processesat the intraorganizational, interorganizational,and community levels to optimize services forfamily caregivers of older adults

Standard 9. Practice Evaluation and

Improvement

Social workers serving family caregivers of olderadults shall participate in ongoing, formalevaluation of their practice to maximize familycaregivers’ well-being, assess quality andappropriateness of services, improve practice,and ensure competence.

Interpretation

Evaluation entails soliciting and integratinginternal and external feedback on the processand outcomes of social work practice withfamily caregivers of older adults.

Practice evaluation is vital to ensuring thatservices provided to family caregivers of olderadults are appropriate, effective, timely, andefficient in helping family caregivers achievetheir goals. Such goals may include reduction ofstress, enhanced ability to fulfill caregivingresponsibilities, improved balance betweencaregiving responsibilities and othercommitments, or increased time and strategiesfor self-care. Moreover, outcomes fromevaluations are increasingly used for positionjustification, performance review, practicestandards, goal setting, and research efforts. Asin all phases of practice with family caregivers,caregiver involvement is essential, as isprotecting the privacy of the family system andother service providers.

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As members of teams and organizations servingolder adults and family caregivers, social workersshall demonstrate the following abilities:

� Differentiate social work perspectives, values,and interventions from other disciplines

� Describe and support the roles of otherdisciplines and organizations involved insupporting family caregivers of older adults

� Articulate and fulfill the missions andfunctions of their employing organizations

� Communicate effectively with allprofessionals, direct care workers, andvolunteers involved in supporting familycaregivers of older adults

� Advocate for family caregivers’ integral role inteam communications and service planning,delivery, and monitoring

� Communicate family system information in arespectful, objective manner while protectingclients’ confidentiality and privacy

� Promote the strengths, contributions, needs,and goals of family caregivers of older adults

� Facilitate communication between familycaregivers and providers/organizationsinvolved in supporting the family system

� Share team leadership in planning andproviding services to family caregivers ofolder adults

� Create organizational culture that promoteseffective, coordinated services for familycaregivers of older adults

� Foster and maintain partnerships acrossdisciplines, organizations, and the servicespectrum to enhance access to and continuityof care for family caregivers of older adults

� Integrate a strengths perspective in programand organizational administration tomaximize and sustain human and fiscal

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Evaluation practices may include the followingactivities:

� Solicitation and incorporation of feedbackfrom family caregivers of older adultsregarding the extent to which social workservices helped caregivers identify and achievetheir goals

� Strategic planning to reach measurableobjectives in program, organizational, orcommunity development for family caregiversof older adults

� Development of program budgets that takeinto account diverse sources of financialsupport for family caregivers of older adults

� Application of appropriate tools such asclinical indicators, practice guidelines, familycaregiver satisfaction surveys, andstandardized performance assessments

� Measurement of both process and outcomeobjectives

� Use of external practice or programevaluators, as appropriate

� Practitioner, program, and organizationalself-evaluation

� Use of peer review, supervision, andconsultation with other social workers andacross disciplines

� Incorporation of evaluation practices in theservice transfer or termination process

� Participation in social work research,including qualitative research

� Application of evaluation and researchfindings (including evidence-based practice,when available) to enhance practice andprogram outcomes

� Dissemination of evaluative data to clients,payers, and other professionals on request,and with consideration for privacy rights

Standard 10. Documentation

Social workers shall document all practice withfamily caregivers of older adults in theappropriate client record. Social workdocumentation may be recorded in writing orelectronically and shall be completed,maintained, and disclosed in accordance withregulatory, legislative, statutory, and employerrequirements.

Interpretation

Clear, concise, and ongoing documentation ofsocial work practice facilitates clearcommunication with other service providers andorganizations, thereby promoting continuity ofcare and services. Documentation also serves asa foundation for practice and programevaluation and for creating new service deliverymodels on behalf of family caregivers of olderadults.

The purpose of documentation is not tosupplant but, rather, to foster strong workingrelationships with, and services for, familycaregivers. Thus, documentation should reflectfamily caregivers’ involvement in, andconcordance with, all phases of social workpractice: assessment; service planning, delivery,and monitoring; practice evaluation andimprovement; and termination or transfer ofservices. Social workers can ensure their practicecenters on family caregivers by incorporating intheir documentation caregivers’ own words,stories, goals, and feedback.

Social work documentation should reflect thefollowing elements:

� Dates, times, and descriptions of contact withfamily caregivers, other members of thefamily system, and other service providers ororganizations

� Initial and subsequent psychosocialassessments of family caregivers

� Concerns and services discussed with familycaregivers

� Plan of care, services, or treatment� Services provided, including education offeredand written information presented to familycaregivers

� Outcomes of service provision� Referrals to or from other providers,organizations, or resources, includingrationale for referrals

� Supervision or consultation sought orprovided to enhance practice with familycaregivers

The client record should also include thefollowing elements:

� Follow-up and recommendations fromexternal providers or organizations

� Written permission, when appropriate, torelease and obtain information

� Compliance with confidentiality and privacyrights and responsibilities

� Receipts and disbursements related to clientservice provision

� Rationale for termination or transfer ofservices

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Standard 11. Workload

Social workers shall advocate for a workload thatallows for efficient, high-quality service deliveryto family caregivers of older adults. The size ofthe social work staff shall represent both thescope and complexity of the organization andthe nature and numbers of the populationsserved.

Interpretation

Social workers, social work managers, andorganizations have joint responsibility forestablishing and maintaining a workload thatallows for adequate and appropriateinterventions and monitoring of services andoutcomes. A workload consists of any socialwork function, such as direct practice,administration, policy, research, or education,performed for the purpose of the social workposition. The workload also reflects the needsand goals of the population served and mayinclude social work coverage outside of regularoffice hours.

Standard 12. Professional Development and

Competence

Social workers practicing with, or on behalf of,family caregivers of older adults shall assumepersonal responsibility for their professionaldevelopment and competence in accordancewith the NASW Code of Ethics (2008), theNASW Standards for Continuing ProfessionalEducation (2002), and state licensure orcertification requirements.

Interpretation

Aging and family caregiving are rapidlyexpanding specialties that cross all practicesettings. Social workers must engage in ongoing

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professional development to maintaincompetence in their practice with familycaregivers of older adults. Employingorganizations should encourage and supportsocial workers’ participation in professionaldevelopment activities. Such activities mayinclude receiving or providing continuingeducation, training, supervision, or mentoring,as well as participating in peer review, research,and publication activities. Numerousopportunities for professional development existwithin NASW, other professional organizations,schools of social work, and organizationsproviding services to or on behalf of older adultsor family caregivers at the local, state, national,and international levels.

Professional development activities relevant topractice with family caregivers of older adultsmay address the following topics:

� Developments in social work theory, practice,and research

� Policies and legislation affecting familycaregivers of older adults

� Community resources available to familycaregivers of older adults

� Issues and experiences specific to aging,family systems, caregiver health and wellness,disability, grief and loss, death and dying,elder mistreatment, and ethics

� Cultural and linguistic competence� Assessment of professional and personalstrengths, learning needs, and goals as relatedto social work practice

� Professional and personal self-care

References

AARP. (2008). Valuing the invaluable: Theeconomic value of family caregiving, 2008 update.Washington, DC: Author. [Also available athttp://assets.aarp.org/rgcenter/il/i13_caregiving.pdf]

Cross, T. L., Bazron, B. J., Dennis, K. W., &Isaacs, M. R. (1992). Towards a culturallycompetent system of care: Vol. 1. A monograph oneffective services for minority children who areseverely emotionally disturbed. Washington, DC:Georgetown University Child DevelopmentCenter. (Original work published 1989)

Council on Social Work Education. (2008).Educational policy and accreditation standards.Retrieved from www.cswe.org/File.aspx?id=13780

Council on Social Work Education. (2009).Advanced gero social work practice. Alexandria,VA: Author. [Also available atwww.cswe.org/File.aspx?id=25501]

Institute of Medicine (IOM). (2008). Retoolingfor an aging America: Building the health careworkforce. Washington, DC: NationalAcademies Press.

Kelly, K., Brooks-Danso, A., & Reinhard, S. C.(2008). State of the science: Professional partnerssupporting family caregivers. Journal of SocialWork Education, 44(3, Suppl.). [Also available atwww.cswe.org/CentersInitiatives/GeroEdCenter/GECPublications/27835/16629.aspx]

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National Alliance for Caregiving (with AARP).(2009). Caregiving in the U.S. 2009. Retrievedfrom http://assets.aarp.org/rgcenter/il/caregiving_09_fr.pdf

National Association of Social Workers. (2002).NASW standards for continuing professionaleducation. Washington, DC: NASW Press. [Alsoavailable at www.socialworkers.org/practice/standards/NASWContinuingEdStandards.pdf]

National Association of Social Workers. (2007).Indicators for the achievement of the NASWstandards for cultural competence in social workpractice. Washington, DC: NASW Press. [Alsoavailable at www.socialworkers.org/practice/standards/NASWCulturalStandardsIndicators2006.pdf]

National Association of Social Workers. (2008).Code of ethics of the National Association of SocialWorkers. Washington, DC: NASW Press. [Alsoavailable at www.socialworkers.org/pubs/code/default.asp]

National Association of Social Workers. (2009).Aging and wellness. Social work speaks: NationalAssociation of Social Workers policy statements,2009-2012 (8th ed., pp. 14-21). Washington,DC: NASW Press.

Reinhard, S. C., Brooks-Danso, A., & Kelly, K.(2008, September.) State of the science:Professional partners supporting familycaregivers [Special issue]. American Journal ofNursing, 108 (Suppl. 9).

U.S. Department of Health and HumanServices, Assistant Secretary for Planning andEvaluation, Office of Disability, Aging andLong-Term Care Policy. (2006.) The supply anddemand of professional social workers providinglong-term care services: Report to Congress.Retrieved from http://aspe.hhs.gov/daltcp/reports/2006/SWsupply.htm

Whitaker, T., Weismiller, T., & Clark, E.(2006). Assuring the sufficiency of a frontlineworkforce: A national study of licensed socialworkers. Executive summary. Washington, DC:National Association of Social Workers. [Alsoavailable at http://workforce.socialworkers.org/studies/nasw_06_execsummary.pdf]

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Resources

AARP

www.aarp.org

Administration on Aging

www.aoa.gov

Agency for Healthcare Research and Quality

www.ahrq.gov

Alzheimer’s Association

www.alz.org

American Society on Aging

www.asaging.org

Association for Gerontology in Higher

Education

www.aghe.org

Centers for Disease Control and Prevention

www.cdc.gov

Centers for Medicare & Medicaid Services

www.cms.gov

Centers for Medicare & Medicaid Services Ask

Medicare Caregiver Resources

www.medicare.gov/caregivers

The Commonwealth Fund

www.commonwealthfund.org

Council on Social Work Education

www.cswe.org

Council on Social Work Education National

Center for Gerontological Social Work

Education (CSWE Gero-Ed Center)

www.cswe.org/CentersInitiatives/GeroEdCenter.aspx

Family Caregivers Alliance

www.caregiver.org

Geriatric Social Work Initiative

www.gswi.org

Gerontological Society of America

www.geron.org

Hartford Partnership Program for Aging

Education (HPPAE)

www.hartfordpartnership.org

Health and Aging Policy Fellows Program

www.healthandagingpolicy.org

Institute for Geriatric Social Work

www.bu.edu/igsw/

The Jacob & Valeria Langeloth Foundation

www.langeloth.org

MetLife Mature Market Institute

www.metlife.com/mmi

National Alliance for Caregiving

www.caregiving.org

National Association of Professional Geriatric

Care Managers

www.caremanager.org

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National Association of Social Workers

www.SocialWorkers.orgwww.HelpStartsHere.orgwww.naswpress.org

National Council on Aging

www.ncoa.org

National Family Caregivers Association

www.thefamilycaregiver.org

National Institute on Aging at the U.S. National

Institutes of Health

www.nia.nih.gov/

National Quality Forum

www.qualityforum.org

Practice Change Fellows: Leaders in Geriatric

Care

www.practicechangefellows.org

Social Work Leadership Institute at the New

York Academy of Medicine

http://socialworkleadership.org

Acknowledgments

Development of the NASW Standards for SocialWork Practice with Family Caregivers of OlderAdults is part of Professional Partners SupportingFamily Caregivers, an initiative done inpartnership with the AARP Foundation, theU.S. Administration on Aging, the FamilyCaregiver Alliance, and the National Associationof Social Workers, and made possible byfunding from the John A. Hartford Foundation.

NASW gratefully acknowledges the work of thefollowing social work expert panelists and otherexternal advisors for their contributions to theNASW Standards for Social Work Practice withFamily Caregivers of Older Adults:

Amy Berman, BS, RN

Patricia Brownell, PhD, MSW

Rita Choula, BS

Catherine A. Clancy, PhD, LCSW

JoAnn Damron-Rodriguez, PhD, LCSW

Sandra Edmonds Crewe, PhD,ACSW, MSW

Lorraine Hedtke, LCSW, PhD

Forrest Hong, PhD, LCSW, C-ASWCM

Jamie Huysman, PsyD, LCSW

Phyllis Mensh Brostoff, CISW,ACSW, CMC

Nora O’Brien-Suric, MA, PhD-c

Susan Reinhard, PhD, RN, FAAN

Miriam Sterk, LCSW, C-ASWCM

Cynthia Stuen, DSW/PhD,ACSW, LCSW

NASW also thanks its aging specialtycertification holders, aging specialty practicesection members, and other members for theirinput in the standards development process.