As a medical social worker, I work with older adults from varied backgrounds and life circumstances. Some are fortunate enough to have help from family, and these family members share the desire to support their elders' wishes for preserved independence and dignity through ever-changing health and personal needs.

Today there are more caregivers for older adults than ever before. This group will continue to grow as the baby-boomer generation enters old age and develops new needs for support. The "sandwich generation" refers to individuals who are raising their children while also providing support to their aging parents. The "club sandwich" more specifically describes individuals who are caring for their aging parents, while caring for their grandchildren as well.

In some ways, this “sandwiching” of care is a return to the multigenerational family structures of previous eras, but with added modern complexities. These challenges include greater geographic distances between family members, increased financial burdens on seniors and caregivers, and the harried pace of today’s society. In many cases, the sandwich generation can hold their families together, but it is extremely difficult to meet everyone’s needs simultaneously.

What Do Social Workers Do?

Medical social workers are a crucial part of any health care team. These professionals collaborate with patients, their family, and other members of their interdisciplinary team (including physicians, nurses, therapists, etc.) in order to promote physical and mental health and functionality following an illness, hospitalization, or other medical event. Healthcare social workers specialize in case management, educating patients and their loved ones about health issues and treatment options, counseling, and connecting or referring patients to community resources.

The following are some of the important and pressing age-related questions my colleagues and I have helped families answer.

  • What will happen to my older loved ones if their needs become too great for me to manage?
  • Does my loved one qualify for community support programs?
  • My family lives out of state and cannot continue to travel at a moment’s notice when I have a medical crisis. What options do we have?
  • How can I help my aging loved ones prepare for the possibility of illness, hospitalization, and death? I don’t know how to have this conversation, but I know it is important.
  • I am at my breaking point, being spread too thin between the family members for whom I provide regular support. How can I cope better with the stress of being a caregiver?

We partner with the caregiver and the older adult, helping to address these and many other concerns. Social workers are uniquely skilled at identifying both the older client’s needs and ensuring the well-being of their entire support system, which includes looking after the caregiver’s needs in order to prevent burnout. Here is how social workers help address these concerns:

  • We ask questions to gain a holistic understanding of our older adult clients. Who they are at their core? What do they value most? What are their experiences with aging and their needs for support?
  • We understand the caregiver’s unique point of view, which includes concerns for the loved one’s well-being along with the caregiver’s priorities and personal goals.
  • We help develop care plans that meet everyone’s needs and wishes, which might include counseling on strategies to manage stress, facilitating a conversation about end-of-life care and concerns, suggesting financial assistance programs, or referring them to community supports and resources.

Working With a Social Worker

I have provided this support to older adults and their caregivers as a social worker in hospitals, outpatient medical clinics, and public housing settings, where it is often standard practice for individuals to work with a social worker. These professionals can also be found in primary care practices, rehabilitation and long-term care facilities, and community agencies that serve the older adult population. In many of these settings, an individual must be referred to or request a meeting with a social worker.

When approaching questions and challenges regarding aging, I encourage older adults and their families to think of themselves as their own best advocates. If they have not yet been referred to a social worker, I urge them to speak up and ask for one. This is a critical first step toward resolving any concerns they may have.


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A helpful way to approach working with a social worker is to view it as a collaborative partnership. The older adult and family are the experts in their own lives, challenges and preferences, while the social worker has the expertise to address needs associated with aging, stress, and improvement in quality of life. While I know it can be difficult, open and honest communication will enable them to facilitate better outcomes for all.

With the complexities of modern life come the benefits of specialized professionals and resources to manage life’s challenges. Social workers are nonjudgmental and holistic listeners and problem-solvers, and are an essential ingredient in the sandwich that is family caring.


Cassandra Spies, LICSW, is a clinical social worker and a graduate of the Simmons School of Social Work. Her clinical interests include chronic illness, end-of-life care and family systems. Recently, Cassandra has joined the SocialWork@Simmons team as a member of the admissions committee and freelance writer. She is delighted to be lending her skills to the development of the next generation of social workers and to be writing for the public sphere for the first time.