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Are social workers on staff at care facilities or part of a physicians staff? I'd love help in working through the challenges and emotions of moving my soon to be 95 year old Dad with increasing dementia out of his home of 50 years. We will need help in managing the conflicting emotions I feel and those of my siblings. How do we communicate to him what is happening or do we? There has to be tried and true methods for managing this enormous change for him and not lose our sense of balance as a family in the process.

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I think doctors can refer you. Also talk with the local hospitals and seek out county Area on Aging offices. Also ask your local library to give you information as to whom to call for help. They are out there.
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Oh how much I agree with your answer Mystery you cannot image. One social worker specifically said my dad would never walk again, I refused to accept it and hired a private PT, she disagreed and she was right, he is walking (with a walker) but walking. The social workers 3 separate ones, hospital, recovery center and MC were worthless for us. Yes over worked, inexperienced and downright did not care. Unfortunately no matter what we as a collective states will smooth the journey, in reality it will not help smooth things out, this journey is different for all of us and it is a grueling one. We can provide tips, pointers, suggestions from our experience but each experiences it differently.

I would love to say do A, B, C and our lives would return to what it was, in reality it will not. We have to gather information, try it muddle through it.
One thing I can tell you, it will get easier in ways and more difficult in others, it is a “growing” or “learning” experience.

The most important thing you need to keep in the front of your mind is you first, this situation will consume you otherwise, find a balance and stick to that balance if you are planning to stay and survive to course.

Best wishes to you
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They're everywhere! Try your local city hall (or his) and see if they have a local office on aging or look up area agency on aging for his or your zip code/city. Try the local Alzheimer's Assn. Some social workers practice independently (but need a license to do so). Your physician's office or the hospital affiliated may have suggestions or contacts. Or you might just want to find a private psychologist or mental health professional....
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Imho, your father's town's Council on Aging should have on staff a social worker as well as an elder case worker. Start there.
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"I'd love help in working through the challenges and emotions of moving my soon to be 95 year old Dad with increasing dementia out of his home of 50 years."

This sounds more like you need counseling with a family therapist. The next sentence says "We will need help in managing the conflicting emotions I feel and those of my siblings.", so this may be much more in the balliwick of a family therapist or mediator than a social worker.

Are you and your siblings in sync, aka not fighting over whether to keep dad at home or find a facility or is that the dissention? It sounds like you yourself are fluctuating between these two options, and if your siblings are in the same or similar boat, you all need to take stock and decide what's best for DAD, not what makes any of you happy.

Is he safe in his home? Does someone live with him? Who is providing his care and/or oversight, hired help or family? Does he wander? Does he fall or need a lot of help getting around, toileting, bathing? Are those assisting running into burnout? Then hiring help or a facility would be the choices. Does anyone have POA? NOTE: POAs are not sufficient for making someone move to a facility, however they ARE important when the move happens so that you can sign as POA, not yourself, otherwise the signer can be accepting financial responsibility. If no one has POA, guardianship should be the next step.

Y'all need to resolve and agree on how to handle dad's situation first. If there's no agreement, life will be hell no matter what anyone does! This is where some family therapy or a mediator might help. If no agreement can be settled on, someone needs to take the bull by the horns and make a decision, which will require applying for guardianship. Once approved, that will override any POAs that might exist. Family therapy may need to continue, if all parties are willing. Dissention in the ranks cause more problems than they will ever solve!

Dealing with the family, coming to agreement, the decision, and determining "who's in charge" has to come first. Once that is resolved, then the move can be planned and "discussed" with dad.

"How do we communicate to him what is happening or do we? There has to be tried and true methods for managing this enormous change for him and not lose our sense of balance as a family in the process."

Personally I would have to say there are no "tried and true methods" for managing anything to do with dementia. Each person's journey is unique, although many share similar symptoms and/or behaviors. Different types of dementia present different challenges and even different progressions and manifestations. It may not be easy, but the change will need to happen. It might work with fibs, it might take some medication to tone down his anxiety, and it will take a lot of cooperation between siblings.

How you handle it depends a lot on where he is on this "journey" and what you feel you all can manage. Some people have a very difficult time with fibs, aka little white lies, and insist on the truth. But often these fibs can facilitate what needs to be done. Bending the truth sometimes works as well. The truth can very often be unreal to the person as well. They either won't accept it or will forget it shortly after the "discussion." We were advised by the EC atty that we couldn't force mom to move to MC (she was refusing to consider any move.) He suggested guardianship, but 1) I don't think she was far enough down the dementia path to get that granted and 2) the facility chosen didn't accept "committals." So, fibs it was. YB wrote a letter from 'Elder Services' at the hospital that treated her cellulitis, stating she moves to a place we choose or they will place her. Madder than a wet hen but she went with my brothers (I did all the up front work.)

So, family therapy unless you can all agree on what's best for Dad and is least negative for everyone. The facility chosen can also assist with the move. Often it's best to stay away for a week+.
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In my experience, each patient in hospital, rehab, or long-term care are assigned a social worker. They usually schedule care meetings in a LTC facility and attend those meetings. I found that they were usually the best "go to" person when there was a problem. But it is my understanding that they are there to work on behalf of the patient, not really the family. I worked as the advocate for my mother and father but in regard to their needs not mine. Before a nursing home was necessary for mom and dad, I was assigned a social worker when I connected my parents to their county elder services who would provide in-home assistance (like meals on wheels, housekeeping, and personal care). I remember being surprised that I would be assigned a social worker but she sat down with me to explain all services and answer questions. The first session took place in a coffee shop (away from mom and dad) and it happened to be my birthday. She was very kind and as we spoke she recognized the herculean task ahead of me. So, I would recommend reaching out to your local and county elder services to see if they have a similar offering. Other than that, a family therapist who specializes in geriatric issues might be of help to you.
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in a hospital or rehab facility there are social workers..they help in placement. Hugs 🤗
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There are companies that specialize in the kind of professional assistance you seek. They can advise and counsel in all types of elder care and especially Alzheimers. They function independently, but are knowledgeable about the various services available in any given community.
However, their services are not free of charge!
If finances are not one of your major worries, you might try contacting one of them. I'm not in a position to recommend any one organization, but the one with which I'm personally familiar (and whose services I've used) is called MIR Senior Management and Care Consultants, available in many cities nationwide.
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Contact you local Area Agency on Aging (AAA) or Aging Service Access Point (ASAP) and ask about Caregiver Support.
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The VA hospital here provided two social workers for us. One was in the "regular" part of the VA where they worked with us on what kinds of VA benefits dad was entitled to. And the other was in the "geriatric" part of the VA and she helped us in other ways. Additionally, the hospital helped us with a caseworker as well as another social worker to negotiate hospice. The pallative care people sat everyone in the family down to help us make decisions about whether or not to do hospice.

You can try to tell dad whats going on but every case is different. I would just tell him once, giving him an overview and then only bring it up again if he asks. In our case my dad doesn't really want to know or talk about his health and dying.

Good luck and God bless you
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It sounds like you want someone to make decisions to maintain “balance as a family” for “conflicting emotions.” I would expect a social worker or MD to make general recommendations - not referee sibling personalities and opinions, emotions and delusions (that they’re being reasonable when they’re not).

It sounds like you want a third party negotiator to set rules, tamp down emotions and have the patience to make sure everyone feels heard. Maybe a pastor or group therapist? If it lands on your shoulders, you might want to google “crisis negotiation techniques.”

It may come down to who has power of attorney and/or a voting process (I like this one: Lets say there are 4 options. You vote only if you want 1 or 2. Let’s say 1 wins. The next vote is 1 or 3. If 3 wins, the next vote is 3 or 4. The goal is to vote only the better option against the next option).

And you may have to accept you can’t maintain harmony when siblings choose emotional reaction over logical thinking.



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If your Dad is in a hospital you would have immediate access to a social worker there to help you plan a safe discharge but they generally will not be available to help you work through the family's response to his health situation. I recommend you Google "geriatric case management" in your area. You can also try your local Office on Aging for a referral. In NJ we have access to excellent services from Jewish Family Services and Catholic Charities (you don't have to be Jewish or Catholic to use them). Also be advised that while social work services secured when your Dad is in a hospital or a memory related facility will probably fall under the payment of Medicare, it is very likely that Medicare may not pay for social work service revolving around the family response.
Wishing you peace and good fortune in helping your Dad and family through this phase of the journey.
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We moved my mom into Assisted Living and also signed her up for Hospice care with a local care company. Anyone with Alzheimer’s qualifies for hospice care, even for years. It is paid for by Medicare and includes a social worker as well as lots of other benefits. They are a godsend, providing all supplies (disposables, medical equipment, Ensure drinks, etc.). A nurse checks on her 2-3 times weekly, takes blood & urine samples when needed, works with Mom’s doctor quickly and efficiently. The social worker helps me understand Alzheimer’s, provides me with support, and brings me peace of mind. It’s an awesome resource I highly recommend.
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disgustedtoo Jul 2021
"Anyone with Alzheimer’s qualifies for hospice care..."

I wouldn't make such a blanket statement. My mother had dementia and was into year 4 at a MC facility. We had not requested hospice as it wasn't necessary and likely wouldn't be approved. When she had a stroke around Labor Day last year, the MC nurse called hospice. She expected delay, due to the holiday. Nope, someone showed up Sunday evening, with the regular nursing staff off duty. She looked at mom's "records", which were out of date due to the virus and the big reason I was quoted after denial of service was she "hadn't lost weight in the previous 6 months." Seriously. She JUST had the stroke. Not only that, but this person didn't even make note of the fact that her records were over 1.5 years old!

The MC nurse made them come back. The initial denial was based on the old records. The second came because of no weight loss. AAAARGH! The stroke impacted mom's right/dominant side, so she had trouble feeding herself, couldn't assist with pivoting out of her wheelchair and had difficulty swallowing and speaking. THAT still wasn't enough for them. The MC nurse scheduled a TeleHealth with the doctor (we hadn't done that for her missed regular checkups due to dementia, hearing loss and generally confusion about "technical" stuff like that. I didn't even set her up with a TV or phone in her room, as she couldn't really manage them.

So, once the nurse could prove weight loss, they accepted mom into hospice. Dementia certainly was NOT enough. If that were the case, every resident in MC would be on it. Perhaps once they are farther into the progression or depending on the type of dementia, it might help, but all the online hits show something like this:

"To qualify for hospice care, a hospice doctor and your doctor (if you have one) must certify that you're terminally ill, meaning you have a life expectancy of 6 months or less. When you agree to hospice care, you're agreeing to comfort care (palliative care) instead of care to cure your illness."
Source: Medicare.gov

Despite this, yes, there are many who live longer than 6 months, some actually live for years, but as long as doctor approves and certain criteria are met, a person may remain on hospice longer than 6 months. The point is dementia alone is NOT going to be sufficient to get on hospice (if that were true, my mother would have been on hospice for about 7 years!)
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Some have suggested that we can ONLY get a Social Worker therapist through doctors, and that is likely the easiest way to get a recommend, but they do have their own offices in many case, just like a psychologist. They are listed as LCSW, clinical social worker, and would be available to find locations and numbers for in your local phone books or search engines on computer. They work with family therapy, life transitions therapy, and etc.
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In Texas, you can call 211 (for help with any need.) The operator will forward you to appropriate agencies. Have you tried your local Alzheimer’s agency? How about your church? Finally, your father most likely qualifies for hospice assistance. Hospice doesn’t necessarily mean he is about to die. Instead, it pretty much means he will not be getting better. Hospice people will be a great resource for you. Best wishes to you, your father, and your entire family in this time of life.
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If you're in the US try your local Area Agency on Aging. They have really variable services from state to state, but all of them should have some sort of services for the older adult and the family caregivers. That might be a social worker, case management, benefits coordinator, elder care clinician, or caregiver support specialist of some kind. Like someone else mentioned above they may be more or less overworked and overwhelmed, but you can always ask them to refer you to an outside source of help as well (private therapist, gerontologist, etc...). Type your Dad's zip code into the Administration for Community Living's finder: eldercare dot acl dot gov
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IMHO: You need a referral for Geriatric Psychiatrist or Psychologist for your father. A social worker might be able to make a referral. However, your doctor is the first place you should start because some doctors will not accept new patients without a professional referral like from your PCP.
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Care facilities usually have a social worker on staff. Hospitals usually have a department of social workers. All doctors should be able to point you in the direction of a social worker. Many larger towns and counties/provinces also have social service departments. Check your local department on aging for a social worker as well.

If you need help dealing with your emotions as a family, a counsellor would be a better option. Ask your doctor or community of faith for recommendations.
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In most facilities, if your loved one is under the care of a doctor or nurse; they can give you information; and help you find a "social worker". If your loved one is in hospice care, there is "always" a social worker available through the company that the hospice care team is from. I just found this out. I hope this helps Chooch!
((((((((((hugs)))))))))) :)
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I would start with a hospital. Every hospital has a social worker. He or she can give you lots of information and recommend other entities to contact.
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The social worker I relied on most was through Catholic Charities Senior Services. They weren't religious, and they were connected to the local government branches of APS/Senior Services. I'm not sure they have locations in Idaho, I don't think so, but if you contacted your local Senior Services, I believe they could point you to someone, if not have social workers on staff available to the public.
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Social workers are not part of the physician's staff. They are part of the hospital or care facility staff. They are not available to help you or your family deal with the emotional distress moving your father into a care facility. That you will have to pursue outside help with a therapist for.
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drooney Jul 2021
Look for your local AOA (area agency on aging) . Your senior center should have contact information.
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A geriatric specialist probably has a SW on staff, or at least has info on how to find one.

My daughter's BF is a SW, working with kidney transplant patients. That's her speciality--but if I ever need a SW to help with mother, I'd call this friend first. She would have names of other SWs and they could help.

At the hospital, recently, with DH, they kept offering him SW help and he kept refusing it. I don't know why, as he did need help navigating post hospital care.

Perhaps even calling the Agency on Aging in your area would set you on the right path.

My FIL's oncologist helped us a LOT in gaining access to the care we needed for dad. The nursing service they sent were beyond abysmal--but at least they did something.
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Chooch, is your father a Veteran, and if so, has he been enrolled for VA assistance?   Back in 2017 or so, the VA assigned a social worker to each of the teams.    Ours was highly qualified, proactive, and provided me a lot of good information. and suggestions.  

The only other experience I had with social workers were those working as discharge planners, or in rehab centers or home care teams.   One was very good; two were so pushy and obnoxious that I had to tell the agencies I wouldn't work with them, and if insistence was made to do so, I'd find another agency.
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You can locate a geriatric care manager by clicking on elder care locator.
A geriatric care manager, usually a licensed nurse or social worker who specializes in geriatrics, is a sort of "professional relative" who can help you and your family to identify needs and find ways to meet your needs. Or call the Aging Life Care Association at 1-520-881-8008, or visit its website at www.aginglifecare.org.
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disgustedtoo Jul 2021
Add note to this:

"Geriatric care managers charge by the hour. Most insurance plans don't cover these costs, and Medicare does not pay for this service. You will probably have to pay for this service."

and

"Geriatric Care Managers charge clients in a variety of ways, but typically their hourly rates are between $50-$200 / hr. Medicare, Medicaid and health insurance very rarely pay for these costs. Long term care insurance might, but most often this is an out-of-pocket cost."

It also appears they are more oriented to providing for the person, not the family per se:

"Geriatric Care Managers (or GCMs) help families with an immediate care need to create and implement long term care plans. This includes an in-person needs assessment, the development and review of a care plan and arranging and monitoring care services. Some also do financial planning. Though most are not professionally certified and their planning services might be better described as "resource assessments." GCMs do not usually provide hands-on care."

Half, more or less, of OP's concern seems to be how the family deals with this impending issue, not so much the logistics (although that was touched on.) Family counseling? Mediator?
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Social workers are part of the hospitals staff. Normally the doctor will send a referral to the social work department of the hospital he/she is affiliated with. ask your dad's physician or neurologist to refer a social worker. The social worker will follow through with you.
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If your dad has a PCP that you like/trust, call the office and ask if they have a care manager on staff. If so, speak with him/her and go from there. They can usually at least steer you in the direction of the resources/people you might need.

My mom's PCP had a care manager who reached out to me when she got really ill - I had no idea there was one on staff- and she was a big help in giving me names and phone numbers of resources.

If your dad's doctor doesn't have a CM on staff, the next people I would reach out to would be the Area's County on Aging for some names.

Good luck.
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In general, best advice is to contact your own MD and say that you need therapeutic help working through these problems and would like to see a therapist, preferably a Social Worker therapist specially trained in life transitions.
Many of the insurance companies that cover therapy (including my own Kaiser) often now decide, based upon what therapy help you need, whether you should see a Social Worker therapist or an actual psychologist. Both can work with a psychiatrist if medications such as mild anti-depressants, anti-anxiety med are required. You can otherwise just look up therapist online. It will say if it is LCSW (Licensed Clinical Social Worker). Some have their own practice; many work within the medical system.
So start at your own MD and good luck.
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The social workers I've dealt with were on staff at a hospital or on staff at a care facility. Their abilities and experience vary widely. The range of things they can and will do also varies widely. I was very hopeful when my LO was assigned to one social worker (through a care home) who proclaimed to be "here for the whole family" but unfortunately..... that was not my experience working with her. She was always overworked/overwhelmed and didn't have time to discuss someone's emotions. I never really found anyone in the process who truly "helped" with the stress and brokenness of placing someone in a care home. I hope your experience is smoother than mine. Others will have different answers for you which I hope will be more encouraging. I know some social workers are experienced and dedicated. I think turnover was very high at the facility I am referring to, so I'm sure that only made my situation worse in terms of finding someone who could truly help/advise.
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Melora Jul 2021
I am very sorry you’ve had such a bad experience.
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