Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: The purpose of adult protection in the U.S. is to ensure the safety and protection of older adults from abuse and exploitation. In this endeavor, adult protective services (APS) workers face a variety of situations involving injury, serious illness, death, grief, and bereavement when working with older adults and their families. This study was designed to address concerns expressed by social work educators and practitioners about a lack of end-of-life care preparation for practice (Christ & Sormanti, 1999; Csikai & Bass, 2000; Kovacs & Bronstein, 1999), but with a specialized population of helping professionals: adult protective services (APS) workers. The purpose was to identify end-of-life care situations encountered by APS workers and their perceived educational needs for effective practice with end-of-life issues in this setting. No previous studies can be found that have addressed these issues.

Methods: All state-level adult protection agencies were invited to participate in the study through a partnership with the National Adult Protective Services Association. Eight-page surveys were mailed to a proportional sample of APS workers in 21 states by a primary contact person at each state office. One follow-up (postcard) was sent approximately 2-3 weeks after the initial mailing. Of 979 surveys mailed, 508 responses were received; a response rate of 52%.

Results: Ninety-four percent of the respondents had encountered situations involving clients with life-threatening illnesses. Other common situations included clients receiving hospice services (84%) and caregivers with life-threatening illnesses (72%). Three-quarters had worked on at least one case involving a client's death. Compared to other client situations, 42.6% believed the death of a client was the most difficult to handle. This difficulty was due to: little prior personal experience (92.5%); a belief they could have prevented the death (87.4%); little prior education (81.8%); and limited prior work experience with these issues (74.6%). Respondents believed that education and training programs about end-of-life issues in adult protection should include content regarding practical resources; advance directives; home care, hospice and palliative care; and the psychological and social needs of clients at the end of life.

Implications for Practice: While one can easily understand that social workers working in health care settings need to understand end-of-life issues, this study demonstrated that adult protective services workers also face a range of end-of-life issues for which they may be unprepared in terms of education and experience to handle effectively. Targeted educational resources should be developed and utilized in state APS agency training programs to assist APS workers intervene with end-of-life issues in practice. In addition, social work education programs need to include end-of-life content in social work courses to inform future practice in any setting.