Holistic Approach

ORIGINAL PAPER

The Meaning of ‘‘Place’’ to Older Adults

Jeanne Sokolec1

Published online: 16 July 2015

� Springer Science+Business Media New York 2015

Abstract Social workers are well-equipped to work with

older adults and their families. The life course perspective

provides a framework for seeing older adulthood as a stage

of life in the continuum of life as well as a stage with its

own characteristics and tasks. All the roles within social

work practice can be adapted to this population. In addi-

tion, social workers working with older adults and their

families must be cognizant of the specific issues that are

associated with aging and older adulthood. The issue of

loss on many levels is a frequent topic. One area of loss

that is not frequently addressed is the loss associated with

where one lives. The word place can have several mean-

ings. One meaning has to do with where one lives. The

second meaning of loss is about one’s status and role—

place-in-society. For older adults both meanings become

important issues as they and their families navigate the

decisions that have to be made. While residence is based on

the level of independence and competence of the older

adult, the issue of place-as-status is a constant frustration

for older adults. Issues of leaving one’s place and losing

status in the eyes of others evoke a myriad of feelings

depending on the particular older adult. But given that as

one ages there are naturally some physical and mental

acuity losses, every older adult is subject to feelings of

sadness, depression, hopelessness, and even anger. These

feelings are natural responses to loss. Among the roles of

social workers working with older adults is one of helping

a mourning process move to a healthy acceptance of one’s

aging and planning rather than devolving into major

depression.

Keywords Older adults � Aging � Ageing issues � Social worker role

Introduction

The literature on older adulthood consistently reports that

there is a shortage of professionals to work with the older

adult population (Hartford Foundation 2011; National

Association of State Mental Health Program Directors

2014; Eldercare Alliance Network 2015). Among these

professionals are social workers and especially those who

provide services on a direct practice basis. Social workers

are educated about the tasks and issues of the life stages

across the life course. Until more recently older adulthood

was treated as the end stage where individuals reflected on

their lives while waiting to die. Similar to other life phases,

older adults are not a homogenous group in many factors.

One of these factors is their state of health. It is unrealistic

to think that older adults will not have a variety of ailments

but the nature and severity of these ailments are dependent

on a host of factors and experiences earlier in their lives or

acquired as they age. Thanks to the few geriatric social

workers and researchers we now know that there is much

more happening during older adulthood than was thought

about previously. Recognizing the variation in functioning

of older adults, social workers are not only working with

diminished older adults but older adults who are healthier

and more active. These clients in turn may, according to

Ruffin and Kaye (2006), bring higher expectations for their

lives to the counseling relationship (p. 529).

& Jeanne Sokolec [email protected]

1 School of Social Work, Loyola University Chicago, Chicago,

IL 60611, USA

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Clin Soc Work J (2016) 44:160–169

DOI 10.1007/s10615-015-0545-2

One major concern for older adults and their families is

where they are going to live as they age. Some older adults

will not have options about their residence because of the

resources they do not have or the level of care that is

needed. However, there are an increasing number of older

adults who have both the resources and the health to make

choices about both how and where they want to live.

Housing as an issue is not a new problem that social

workers address with their clients. For older adults housing

issues are more than about addresses. Along with the

physical structure of housing are emotional issues related

to the particular address. Borrowing from other authors,

Gonyea (2006) stated this very well saying that:

…housing is about much more than a physical space or structure. Rather, a home serves multiple functions

and has a deeper meaning. A home offers individuals

a safe haven and protection from the intrusion of the

outside world. One’s home and neighborhood are a

crucial piece of one’s self-identity and evoke a sense

of belonging. For many older adults, a home is a

highly cherished symbol of their independence and

dignity (p. 559).

Geriatric social workers are cognizant of the many

issues older adults have in order to provide the best practice

for their clients. Housing is an example of a common issue

for older adults that involves social work interventions at

micro, mezzo and macro levels. At the micro, direct level,

social workers may be directly involved in locating hous-

ing options and facilitating transitions. As the direct prac-

titioners social workers have to encourage the client to

address whatever underlying feelings the older adult has

about their future. Given their knowledge about the older

adult life stage and the varying needs of older adults, social

workers can be instrumental at the mezzo level in helping

older adult facilities to have appropriate programs. Policies

and programs are behind in terms of the increasing num-

bers of older adults needing policies to provide resources

and programs to provide services. Social workers in macro

roles are a key source of knowledge to policymakers and

the departments that implement policy.

In the literature about older adulthood, and even in

public policies, the terms ‘‘aging-in-place, healthy aging

and active aging’’ (World Health Organization 2002; White

Conference on Aging 2015) have become the organizing

principles for thinking about the lives of older adults.

A Policy Brief from the 2015 White House Conference on

Aging committee has stated:

Healthy aging means more than just managing and

preventing disease and chronic conditions. It also

means continuing to live a productive, meaningful

life by having the option to stay in one’s home,

remain engaged in the community, and maintain

social well-being. Older adults may require other

services and supports, including social and commu-

nity services, and age-friendly communities, in order

to maximize their independence.

Aging-in-place is generally is meant to promote older

adults continuing to live in their own homes, or at least in

the community, as opposed to some type of care center. A

central component for aging in place is the concept of

choice, which is allowing the older adult to determine their

own living arrangements (Australian Psychological Society

Ltd 1999). Sijuwade (2009) has framed aging as:

…occurring in a societal context, ranging from the micro scale of the family to the macro scale of the

society. This context includes the attitudes, stereo-

types and age norms, which determine age appro-

priate behavior for the aged (social-image). Further,

the aged have an image of themselves (self-image)

and an image of how they feel, the ‘others’ in the

society perceive them (image of social image). The

societal attitudes shape the social behavior towards

the aged. The interactions of the aged in the social

environment result in the self-image of the aged

being reinforced by the social image (p. 1).

The World Health Organization has defined healthy

aging as ‘‘… the process of optimizing opportunities for health, participation and security in order to enhance

quality of life as people age. It applies to both individuals

and population groups’’ (WHO 2002, p. 11). In this defi-

nition active is not merely physical moving or working but

the more holistic conceptualization of participation. The

Minnesota Department of Health (n.d.) defined healthy

aging as:

… the development and maintenance of optimal mental, social and physical well-being and function

in older adults. This is most likely to be achieved

when communities are safe, promote health and well-

being, and use health services and community pro-

grams to prevent or minimize disease (p. ii).

Taken together these concepts become the framework

for Aging Friendly Cities or the newer phrase used by the

World Health Organization: Age Friendly World (WHO

2014). In strength-based, empowerment based practices the

social worker will as much as possible honor client self-

determination and encourage the older adult to advocate for

themselves by at least stating their preferences. One fear in

promoting client self-determination is that the client will

not choose wisely. Social workers constantly deal with this

dilemma and employ strategies of full disclosure of risks

and benefits of the client’s choices, as well as help the

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client through a process of decision making process. Any

work with clients is predicated on assessment of the client,

their history as well as their current functioning. Social

workers are well-versed in biopsychosocial assessment.

Geriatrically trained social workers will understand that in

addition to a general assessment the assessment should also

inquire about issues pertinent to older adulthood such as

loss. Loss is an issue for every person; however as one ages

the number of losses one has increases with the deaths of

spouses and partners, other relatives as well as friends. A

common sentiment of those in their late nineties is that all

their friends and even children have passed away. Along

with loss then is a feeling of loneliness which if not

addressed can lead to loss of enthusiasm and even

depression in the sense of giving-up.

Spirituality is a topic that has gained importance in

social work since for many clients spirituality, however

defined, is a source of comfort and strength. On the other

hand, some older adults may feel anger at their current

predicament and diminish their previously held beliefs. In

either case, these issues should be part of any assessment.

One other area that needs to be explicitly addressed is that

of risk. NASW in its Standards for Family Caregivers

(2010) lists a variety of risks that need assessment from the

ability of caregivers to adequately understand the older

adult’s situation and provide appropriate care to risk of

abuse and neglect of the older adult. Including the category

of risk there is the recognition that older adults are not

immune from having or developing substance abuse and

alcohol problems.

Anthropologist Margaret Clark in the mid-1960’s, based

on her research, reframed aging ‘‘as a situated phe-

nomenon—an iterative, socially embedded process that

requires adaptation to specific sociocultural contexts’’

(Perkinson and Solimeo 2014, p. 102). The notion that

there is a sociocultural context to aging is not surprising to

social workers and reminds us that any approach to aging

has to be seen in the particular culture in which it is

occurring. It also supports the premise that within a mul-

ticultural setting like the United States, there may be dif-

ferent views of what older adulthood should look like from

the environment to the individual.

The Meaning of Place

The word place can have several meanings. One meaning

has to do with where one lives. Tuedio (2002) has asked,

‘‘What is the connection of home to personal identity,

growth, and development (p.1) ? The other meaning is a

‘‘state of mind’’ (Tuedio 2002, p.1) including concern

about one’s status and role—‘‘place in society.’’ For older

adults both meanings become important issues as they and

their families navigate the realm of older adulthood.

Place attachment is a term that is often found in the

environmental psychology literature. In its simplest terms,

‘‘place attachment is an emotional bond between people

and their environment’’ (Anton and Lawrence 2014,

p. 451). Studies on place attachment have found that the

positive effects of this type of attachment include physical,

emotional and social phenomena (Anton and Lawrence

2014). Within place attachment there is the dimension of

place identity. Proshansky et al. (1983) described this

identity ‘‘as a substructure of self-identity consisting of

memories, ideas, feelings, attitudes, values, preferences,

meanings, and conceptions of behavior and experience that

occur in places that satisfy an individual’s biological,

psychological, social, and cultural needs’’ (p. 59). While

this concept is not specific only to older adults, it does have

particular significance for this group given the current

emphasis on aging-in-place.

As people are continuing to age, we are learning that

they are not a homogenous group, nor is there a constant

predictable pattern. In the best of worlds there would be a

robust continuum of care with adequate resources. Real-

istically however, like children, older adults may not

always be able to make an informed choice and what they

would want, which is most often to stay in their own home,

may not be appropriate. While residence is based on the

level of independence and competence of the older adult,

the issue of place as status is a constant frustration for

older adults, especially those who remain healthy and

independent well into their 80’s and 90’s. This means that

when talking about the meaning of place that there will be

different concerns depending on individual older adult. For

example, for the older adult who has to move into a level of

care away from their home and community, place as living

space may be the main concern. Three in ten Americans 40

or older would rather not think about getting older at all,

and when prompted to think about it, a majority worry

about losing their independence (Tompson et al. 2013,

p. 2). Chen’s study (2001) interviewed older adults about

how they felt about being old. The participants related their

capability to do things as meaning they were not old. One

widow stated: ‘‘Age is just a number. I don’t like the

number because people usually view the age in a negative

way’’ (What Aging Means section, Para. 1). For the older

adult these are psychological issues that come from the

core of their identity. Undoubtedly risk and resilience

factors play an underlying role in the older adult’s attitude

and coping skills. For practitioners these are issues that

have to be discussed in order to develop an integrated care

plan.

Complicating the ageing-in place discussion is the

growth of retirement communities where people can move

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in as early as age 55. These communities differ in the levels

of care they provide. Some communities only may have

independent living; others may have independent living

and some assisted care options; and others may offer a full

continuum of care from independent living to nursing care

with specialty floors for those residents who have demen-

tia. At the independent living stage these communities

make themselves attractive to potential residents by

offering a range of options from dining choices, social

activities, field trips, and various classes. Anecdotally older

adults who select a retirement community like the sense of

community which perhaps was no longer available in the

previous residence as well as a sense of being cared for

even if they were living as independent persons. Ideally

these facilities have social workers on staff for both

assessment purposes and the on-going monitoring of the

residents’ mental health. A major consideration in the place

issue is cost. Many of these communities require an

entrance fee which could be up to several hundred thou-

sand dollars plus monthly assessments. The costs can make

it prohibitive for those without monetary resources who

would, if they could, select a retirement community option.

It is important to note this is an area where social work

knowledge about housing needs can be translated into

advocacy at the state and federal levels.

Ageism and Status

Unlike other cultures in the world, older adulthood in the

United States has not traditionally been a revered stage of

life as a societal norm. Milton Fisk (2002) has used the

word ‘‘superfluous’’ to describe what has happened to

certain groups of workers throughout our economic history.

Synonyms for superfluous include not required, redundant,

unnecessary, or non-essential which are terms we generally

associate with things, not people. These terms could be

equally applied to the views of older adults. The proportion

of older people who are employed is an important factor

that is related to perceptions of the social status of older

people in less modern societies (Vauclair et al. 2014).

A number of factors create this age divide. Increasingly

younger people in the United States are more mobile in

comparison to other generations so that adult children and

their parents are often living in different cities. Until 1976

working persons who were 65 years old could be made to

retire regardless of their health status and quality level of

their work. The United States is seen as having a focus on

the younger generation and it is only recently that there has

been advertising that has included older adult actors

speaking directly to older adults about a specific product.

The term ageism is now regularly included in the list of

isms in our society meaning that there are prejudicial

feelings or actions based on beliefs about the limitations of

abilities due to age. Institutional ageism manifests in the

policies that do not address the needs of older adults or

treats older adults with demeaning attitudes and disem-

powerment (Grant 2010).

Status is a societal issue in terms of how older adults are

viewed by younger generations. Ridgeway defined status as

an ‘‘… an inherently multi-level form of inequality in that it involves hierarchies of esteem and influence between

individual actors as well as hierarchies of social esteem

between groups in society’’ (2014, p. 5). This status issue is

embedded in the concept of ageism. Stereotypes about older

people suggest extremes, ranging from the incompetent fool

to the compassionate and wise elder (Carstensen and Hartel

2006, p. 22) and Nelson reminded us that until the invention

of the printing press, older adults were respected as the

‘‘sole repository of knowledge’’ (2011, p. 38). Status dif-

ferentials affect both the receiver of the status designation in

terms of their behavior as well as the one who bestows or

reduces the status of the other in terms of their attention to

the other person. Also, as Ridgeway reminded us, this

occurs at both micro and macro levels. At the micro level it

occurs when older adults are not invited to participate in

community activities and at the macro level when policy

agendas do not include concern about older adult issues.

Status as one variable can be confounded by other variables

such as gender, race, ethnicity, and/or economic resources.

Differential treatment in healthcare based on gender, race

and socio-economic status is well documented in the

healthcare disparities literature (Centers for Disease Control

and Prevention 2014). For example, older men who have

retired from businesses may receive higher status than an

older woman who has never worked. While not phrased as a

status issue by older adults, practitioners have to help their

clients deal with the hurt feelings of being discounted by

others as having nothing of value to add to society.

Bell and Menec (2015) have looked at the relationship

between independence and social exclusion. They pointed

out that individual independence is seen as a core value in

American culture that operates on at least two levels. Not

only is it a value that individuals wish to have, but inde-

pendence is also an expectation made of capable adults.

While there are reasons for individuals not being inde-

pendent persons, they can be seen as not operating within

the mainstream and can then be excluded. Given this cul-

tural norm and the consequences of not meeting the norm,

it is not surprising that older adults hold on dearly to their

independence even when it can be detrimental to their

well-being. The ‘‘fear of dependency and anxiety’’ (p. NP9)

that is created can also lessen one’s self-esteem. The fear of

dependency can also lead to older adults putting on a ‘‘false

face’’ of competence, refusing assistance and opportunities

that can be helpful to them as well as not participating in

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social activities ‘‘that are for old people’’ (p. NP12). One

finding of Bell and Menec’s study (2015) indicated that

social exclusion of older adults occurs at both the personal

level through self-exclusion as well as at the community

level through lack of policies, resources and supports

which in part reflect the effect of current perceptions of

older adults (p. NP 16). They concluded that along with

any structural changes that are made, there also needs to be

a cultural change ‘‘with a reimaging of aging and old age’’

(NP 18).

The LGBTQ (Lesbian, Gay, Bi-Sexual, Transgender,

Queer) community of older adults provides many examples

of differential treatment that have historical, social and

political aspects often beginning when the individual first

made their orientation known to others. The SAGE Foun-

dation—Services, Advocacy for Gay, Lesbian, Bisexual

and Transgender Elders—has summarized the various

issues within the realm of social isolation:

The primary risk factors for social isolation affect

LGBT older adults in unique and disproportionate

ways. LGBT elders are more likely to live alone and

with thinner support networks. Additionally, the

research shows that LGBT elders face higher dis-

ability rates, struggle with economic insecurity and

higher poverty rates, and many deal with mental

health concerns that come from having survived a

lifetime of discrimination. Location-related barriers,

coupled with stigma and discrimination, can make it

difficult for LGBT older people in many parts of the

country to find the LGBT-friendly community sup-

ports they need to age successfully and avoid social

isolation (Social Isolation 2015).

The issues of economic insecurity and poverty are in

part directly related to the issue of same-sex marriage and

the rights that come with marriage. For example, marriage

allows one partner to obtain social security benefits from

the spouse at a certain age or when a spouse dies. One

important value of social security benefits has traditionally

been seen as preventing older adults from falling into

complete poverty. Also related to social isolation for the

LGBTQ community is the issue of affirming services

within the Aging Network under the Older Americans Act.

Given the variation in attitudes towards same-sex relations

across states, it could be hypothesized that since aging

services are provided by state offices and agencies, atti-

tudes among these organizations may reflect their particu-

lar state’s attitudes regardless of non-discrimination

policies.

Older immigrants are another group who in addition to

having the usual concerns of getting older may have more

difficulties because of language, cultural customs, docu-

mentation, and monetary resources. How the older

immigrant came to live in the United States is an important

question in a cultural assessment. Immigrants coming to

the United States by choice may have very different feel-

ings and expectations than older immigrants who are

refuges, forced to leave their country of origin. In addition,

the timing of when in their lifetime the older immigrant

came to the United States is important in terms of accessing

public resources. Immigrants from other countries may

have different expectations for the involvement of their

children as caregivers than their more Americanized chil-

dren feel. The social work profession in general needs to

build a workforce that is bilingual in the many languages

that are present in the U.S. today.

Issues of leaving one’s place and losing status in the

eyes of others evoke a myriad of feelings depending on the

particular older adult. But given that as one ages there are

naturally some physical and mental acuity losses, every

older adult is subject to feelings of sadness, depression,

hopelessness, and even anger. These feelings are natural

responses to loss. The role of the practitioner is one of

helping a mourning process move to a healthy acceptance

of one’s aging and planning rather than devolving into

major depression.

Place and Status as Locational Issues

While it seems natural to separate place as physical space

from place as status, there is a third conceptualization

which is to frame both physical space and status as a lo-

cational issue in which the two concepts are intertwined.

For example, older adults will reject or resent leaving their

homes because the home represents the narrative story of

the older adult’s life. At least when remaining in the family

home in the same community the older adult can maintain

a sense of integrity and status. Tueido (2002) quoted Iris

Marion Young’s view of homemaking:

Creative preservation is the practice of ‘‘renewing’’

our investment in the meaning of things. Though it

functions in support of our ‘‘longing’’ for a ‘‘settled,

safe, affirmative, and bounded identity,’’ creative

preservation also serves to inspire a dynamic culti-

vation of identity, which in turn contributes to pro-

moting an affirmative yet ‘‘fluid and shifting’’ context

for living. Activities of preservation give some

enclosing fabric to this ever-changing subject by

knitting together today and yesterday, integrating

new events and relationships into the narrative of a

life, the biography of a person, a family, and a people

(p. 4.).

Place and identity are inextricably bound to one another.

The two are co-produced as people come to identify with

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where they live, shape it, however modestly, and are in turn

shaped by their environments, creating distinctive ‘‘envi-

ronmental autobiographies’’ that are the narratives we hold

from the memories of those spaces and places that shaped

us (Gieseking and Mangold 2014).

Becoming Marginalized

In many cases older adults are put into the position of being a

marginalized group. Hohler (2010) described the usage of the

word marginalization by saying that since the 1960’s, the

word has been used as a sociological term referring to

research on people and groups of people who are driven to the

edge of a given society. Hohler went on to say that: ‘‘The

concept marginalization implicitly assumes that there are two

parts, the ‘‘marginalizer’’ and the ‘‘marginalized’’ (Hohler

2010, p. 5).’ When talking about older adults we can ask

‘‘Who istheonethat ismarginalizing?’’ Certainly individuals

can marginalize other individuals and likewise entire groups

can be marginalized by other groups. Marginalization in

general is problematic because it prevents individuals and

groups from participating fully in the society in which they

live.Marginalizationcanleadtoself-deprecation,lossofself-

efficacy and for some deep depression with poor coping

skills. In addition, the stress which can ensue is applicable to

both individual older adults as well as older adults as a group.

Meyer (2003) reported that ‘‘stress discourse has been con-

cerned with external events or conditions that are taxing to

individuals and exceed their capacity to endure, therefore

having potential to induce mental or somatic illness (p. 675.)

In the case of older adults, the external events or conditions

are related to the place of older adults in society.

On the societal level marginalization prevents members

of the marginalized group from obtaining the resources

necessary for their everyday living. More recently however

there has developed the belief that society in general loses

from marginalizing certain groups because once

marginalized, the group no longer is a resource for the

community or society. Iris Marion Young (1990) referred

to marginalization as the ‘‘…most dangerous form of oppression. A whole category of people is expelled from

the useful participation in social life and thus potentially

subjected to severe material deprivation and even exter-

mination’’ (p. 53). Marginalization raises the issue of how

an individual or a group responds to being marginalized.

Like all psychological phenomena, responses will vary by

individuals as well as by subgroups of the larger

marginalized group. For example, Sokolec and Dentato

(2014) reported that older adults who are LGBTQ are

finding that their sexual orientation status can make it

difficult to access a full range of housing options in

response to changing status in health and capacity.

For all older adults, at one end of the continuum the

response can be an increased sense of loss of status and

hopelessness. However, at the other end of the continuum

the response may reflect resilience in the face of adversity.

Marginalized groups often develop ‘‘compensatory strate-

gies’’ (Carstensen and Hartel 2006) to cope with the neg-

ative perceptions of others outside the group.

The Nexus of Locational Space and Status

Where one is going to live in older adulthood has become

an increasingly more urgent question as people are living

longer especially through scientific and medical advances.

Older adults do not succumb to many illnesses as early as

they did in previous years when newer treatment options

were not available. So the question of locational space is

no longer a one-time decision—i.e., from one’s own home

to a nursing home—but rather a process during which an

older adult may move through levels of care from their own

home in the community to a senior-living building, to

assisted living and sheltered care, and finally to full nursing

care. At least in the early stages of this process, each move

can be perceived as a loss to the older adult that is a signal

of their decline. So the locational movement becomes not

just about changing the brick and mortar of where one lives

but rather the meaning of the locational move especially

when there are no clear signs of the necessity. This

becomes very evident when it is suggested that an older

adult couple leave their home and move into a senior living

arrangement where they will still be living independently

often in a newer space than their own home and even

within the same community as they have lived previously.

The older adult’s reaction to this suggestion, especially if

they—and their partner—are still considered to be healthy

is often one of disgust in having to live with other ‘‘old

people.’’ One area that has not been studied regarding the

attitudes of older adults towards senior living arrangements

such as assisted living is the effect of media reporting about

conditions in these facilities. PBS’s 2013 documentary

‘‘Life and Death in Assisted Living’’ could influence an

older adult, as well as their family members, on the

arrangements they decide to make. The notion that a

facility for older adults could make things worse supports

the belief that older adults do not matter.

Aging-in-place has become the mantra of both older

adults as well as those who work in the field of gerontol-

ogy. This phrase can have several meanings from older

adults staying in their own home with or without help to

remaining in a familiar community with assistance rather

than being moved to assisted living or a full nursing

facility. Those that deal of cost issues support this notion

because community care is always less expensive than

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institutional are. But for the older adults the issue is not

monetary costs but rather it is about maintaining their

integrity as a human being and someone who wants—and

can—continue to be a participating member of society.

Aging-in-place when only referring to the space, in which

the older adult will live, is not sufficient to support the

concept of place as status. A corollary to remaining in

one’s community is that the older adult has opportunities

for social engagement and is granted access to civic par-

ticipation opportunities.

The notion of needing special allowance to access civic

engagement opportunities is not surprising since one effect

of marginalization is that the voices of those marginal-

ized—individually and collectively—become weaker, if

not eventually mute. This is not voice in the sense of sound,

but rather this is voice as standing which is expressed in the

acceptance of verbal and written communication of indi-

viduals and groups, as well as in the physical sense of being

present. The loss of voice does not indicate a lack of

something to say—although without practice, voices can

become weak. Rather, the loss of voice stems from not

being asked to speak or ignored when voice is offered.

Taking the view that physical space and status are

intertwined locational concerns for older adults; dealing

with these issues can define a new strategy of healthy

aging. Ideally older adults who wish can remain in the own

homes and communities with enough support so that they

remain safe. However, for any number of reasons an older

adult may have to leave their home and community, and

sometimes it is by choice. However, wherever an older

adult lives, integrity, self-efficacy, social engagement, and

other components of self-esteem and stress reduction are

still important issues that affect physical and socio-emo-

tional health. In fact, it is these components of identity that

are of most importance to older adults and often the basis

for not wanting to leave one’s physical home. Given that

some older adults choose to move into a retirement com-

munity some important research questions are: (1) What

are the demographics of this group? (2) What influenced

their decision to make this choice and leave their previous

home, and often times, their community where they lived

their earlier lives? (3) Do they maintain their former

identity in a new place or do they form a new identity given

their new location as well as new status as someone living

in a senior community? The third question speaks directly

to the question of the meaning of place.

Perhaps then the crucial element in aging in place is not

the place aspect but rather the notion of aging aspect. The

task becomes creating places that allow aging to occur in

such a way that the older adult remains a valued member of

their community regardless of where the community is

located, what the community looks like or who resides in

the community. For example, older adults often prefer to

remain in the own homes because their neighborhood

provides opportunities to engage with several generations.

Obviously this is not true for most specifically senior living

arrangements but it does not mean that programs cannot

be structured where a variety of generations interact

together.

Practice with Older Adult Clients

A paper written for a social work journal must look at the

topical issue from the point of view of the profession which

should inform both social work clinical and policy practi-

tioners. The policy perspective is important because clini-

cal issues and subsequent treatment never occur in a

vacuum, or out of the context of happenings in the society

in which the client lives. A clear example of this is the

1967 Age Discrimination in Employment policy which

prohibited using age as a reason for dismissal from a job.

The social work framework of person in environment

strengthens the concerns for policy and programs as the

basis for healthy aging. On a broader level the International

Federation of Social Workers ‘‘encourages the considera-

tion of older adults in all policies’’ (IFSW 1999, p. 60).

While all social workers are educated to address policy,

the majority of social workers working in gerontology will

see individuals, couples and/or family members of the

older adult. The traditional practice methods of social

workers such as respecting the individual, employing good

listening skills, acting empathically and reframing content,

all in the context of developing a working relationship, are

practices that older adults can relate to. The particular

intervention approach should vary with the needs of the

older adult. However, whatever the approach ‘‘clinical case

management should be considered a key intervention

approach in gerontological social work’’ (Naleppa 2006,

p. 521). Naleppa (2006) supported this statement using the

definition of case management from the National Associ-

ation of Social Workers as a:

…method of providing services whereby a profes- sional…assesses the needs of the client and the cli- ent’s family, when appropriate, and arranges,

coordinates, monitors, evaluates and advocates for a

package of multiple services to meet the client’s

complex needs….Case management is both micro and macro in nature; intervention occurs at both the

client and system level (p.521).

In addition to the more traditional interventional prac-

tices, social workers in the twenty first century need to

acquire the knowledge and skills that match the needs of

their ever-changing clientele. One area that has not often

talk about in regards to working with older adults is

166 Clin Soc Work J (2016) 44:160–169

123

planning for retirement. As with so many issues there are

the practical concerns of retirement such as finances but

there are also the psychological and emotional feelings that

arise when one is considering retirement. One’s identity—

and status in the community—is often intertwined with

one’s work so to lose the work can leave a person unsure of

who he or she is in their own eyes and the eyes of others

even if one is looking forward to retirement to take up other

activities. Social workers, while leaving the financial issues

to other professionals, can address with the client their

feelings about the meaning of retirement. It is not unusual

today to have elder law attorneys or elder law clinics have

social workers and other professionals such as lawyers and

financial planners working together. Since social workers

are accustomed to working within service networks with

other professional disciplines, they can take the lead in

suggesting and organizing a systems approach to many

issues within older adulthood. The mezzo and macro skills

of advancing policies, programs and professional programs

that promote older adults’ self -advocacy, lifelong learning,

civic engagement, and equal opportunity in employment

contribute to the resources that support the goals of older

adults in all settings (Social Work and Aging, n.d.).

Respect for autonomy or client self-determination, when

appropriate, is a client centered practice that has been

central to the profession. In general, autonomy is respected

when one is treated as an adult who can act in a responsible

manner and that ability is acknowledged and supported in

any context. Respect for autonomy as an ethical principle is

not necessarily an all-or-nothing principle. Autonomy must

take into consideration the capacity of the individual in

regards to critical decision making. This does not mean

ignoring autonomy when capacity is broadly diminished

but rather finding ways to include the client in the con-

versation to the extent that they can participate or at least

be informed of decisions that are being made in their

behalf. Client self-determination is neither an all-or-noth-

ing principle. Social workers continually evaluate clients’

wishes for appropriateness and safety. When clients are

able, social workers will help the client process their

wishes and help them understand the risks and benefits of

their choice. In addition, ‘‘…autonomy does not happen in a vacuum but rather in a context that not only provides

resources but ensures access for all’’ (Polivka and Moody

2001). This conceptualization has implications for public

policy.

Beneficence, a term used more in medical ethics than in

social work, can be a double-edged sword. Beneficence

implies the striving to do good but can sometimes devolve

into paternalization of the client based on assumptions that

may or may not be true. Any practice situation involves

both the client and practitioner both of who bring their

values, perceptions and experiences to the relationship. The

practitioner expects that part of the work will be around the

client’s feelings about aging and the changes aging brings

to their personal, social and economic lives. The client

expects that the social worker is capable of accepting the

client’s anxiety and that they will not be judged for how

they feel. This can be said of older adults and all the

practitioners they encounter. Social workers and other

practitioners naturally come to the treatment encounter

with their own values, perceptions and experiences.

Research has found that among the perceptions and feel-

ings of practitioners there can be a conscious and/or

unconscious ageism (Troll and Schlossberg 1971). Pater-

nalistic and ageist biases by the practitioner decrease their

ability to value and practice from a strengths perspective

‘‘which focuses on what is ‘strong’ in an older adult’s

ability to rally personal and social assets to find solutions to

the problems he or she faces in the aging process’’ (Dittrich

2014, p.7).

The strength approach as applied to all clients presup-

poses the belief that individuals can change. This approach

is in direct contrast to the assumption that all the negative

things that happen to an older adult are part of the aging

process thus not treatable. A clear example of this is in the

area of depression in older adults. A pathological model

assumes that all older adults are naturally depressed and

medication, rather than treatment, is the proscribed rem-

edy. On the other hand, not all older adults are depressed

and when depression does appear at least an evaluation

needs to be done to assess whether it is related to a pre-

existing condition or is functional due to a recent loss.

Changes in individuals are often dependent on appro-

priate resources to enhance and support the changes.

Internal resources such as self-reliance, self-efficacy, pro-

ven coping skills while generally stable over time can be

assaulted from a variety of sources. However, the assault,

while resulting in bruising, may not necessarily destroy

these resources. From a strength perspective treatment

should focus on identifying previous successes and the

reclamation of these personal factors. External resources

can mediate internal and external assaults. From a social

justice framework, Charles Taylor’s ‘‘politics of equal

dignity’’ requiring ‘‘an equal basket of rights and immu-

nities’’ would resonate with social workers at all levels of

their work (1994 p. 38).

The integrated resource model looks at resources from a

three pronged perspective: ‘‘… (a) looking at resources broadly, rather than focusing on a specific resource;

(b) viewing resource change in the face of stressful chal-

lenges as a key operating mechanism by which well-being

and health are influenced; and (c) viewing the possession of

reliable resource reservoirs as critical in promoting and

maintaining well-being and health’’ (Hobfoll 2002, p. 311).

Social work practice includes both review of a client’s

Clin Soc Work J (2016) 44:160–169 167

123

resources and when necessary, facilitating the client in

finding new resources. In fact, it could be argued that

having access to social work intervention is a resource in

itself. Additionally, from a macro perspective social

workers advocate for policies and resources that facilitate

clients’ well-being.

For many reasons older adults remain in their own

homes or live with close relatives. Caregiving to older

adults is not a new phenomenon but given the increased

longevity of older adults, there are more family members

caring for older adult members of their families than pre-

viously. Whether the caregiving is by choice or out of

necessity, there is greater appreciation for the burden of

caregiving and recognition that the caregivers may need

care for themselves. Often times the older adult and their

family members have different conceptions of what is

appropriate for the older adult. There can be differences in

opinion between the family members themselves. Social

workers as mediators can be a helpful intervention in the

family so they can come to a consensus. The strengths-

based and ecological models acknowledge others in the

client’s life as important. For older adults this creates a

‘‘dual caregiving network’’ (Crewe and Chipungu 2006,

p. 542).

Recognizing that unconscious and unaddressed biases

can affect the treatment relationship and eventual out-

comes, increasingly social workers and other helping pro-

fessionals are counseled early in their training to be aware

of their own stereotypes and biases that can affect the

treatment process. This educational tenet recognizes that

helping professionals can absorb the same stereotypes

about individuals and groups that are present in the larger

culture.

Another principle highlighted in social work education

is cultural competence in its broadest sense. Older adults

as a cultural cohort are best served with practice meth-

ods that take into account their special needs. In addi-

tion, given the multicultural nature of the United States,

this competency is equally important in working with

older adults and their families. This can be a potentially

conflictual area if the cultural aspect(s) of the client does

not fit the current societal context in which the person

lives.

As more social work students are selecting the older

adult population as their specialization they are entering the

field with more knowledge and skills to work with older

adults. Ideally they are being educated on the close rela-

tionship between clinical work and policies affecting older

adults. Terms like aging-in-place and civic engagement are

becoming the language of the specialization with a rapid

increase in textbooks about the older adult population both

for clinical and policy practices.

Conclusion

Social workers are well-suited to work with older adults

around issues of locational space and space as status

through the many roles that social workers take in behalf of

their clients. These roles span practitioner, community

organizer and advocate, mediator, educator in helping

others to learn to advocate for themselves, and, most

importantly, intersecting roles to create an integrated

framework. Concern for place in both of its meanings can

become an organizing principle for work with older adults

since in discussing the concept of space, a myriad of

themes can emerge from grieving losses to finding an inner

resilience in spite of existing stereotypes. Finally, it should

not only be academic researchers who conduct research

around the issues raised in this paper. Social work practi-

tioners hold a great deal of information from their clients’

stories which can be turned into research questions.

Equally important as conducting the research, results from

any studies need to be communicated to those working in

the various aspects of ageing so that places and programs

can become affirming for their older adult constituents.

Compliance with Ethical Standards

Conflict of Interest The author declares she has no conflict of interest.

Human and Animal Rights This article does not contain any studies with human participants or animals performed by the

author.

Informed Consent This article does not contain any studies with human participants.

References

Anton, C. E., & Lawrence, C. (2014). Home is where the heart is: The

effect of place of residence on place attachment and community

participation. Journal of Environmental Psychology, 40, 451–461.

Australian Psychological Society Ltd. (1999). Psychology and ageing.

Melbourne: The Australian Psychological Society. Retrieved

from http://www.psychology.org.au/Assets/Files/Position-Paper-

Ageing.pdf.

Bell, S., & Menec, V. (2015). ‘‘You don’t want to ask for help’’ the

imperative of independence: Is it related to social exclusion?.

Journal of Applied Gerontology, 34(3), NP1–NP21.

Carstensen, L.L., & Hartel, C. R. (Eds.). (2006). When I’m 64: A

social psychological perspective on the stigmatization of older

adults. Washington, D.C.: National Academies Press. Retrieved

from http://www.nap.edu/catalog/11474.html.

Centers for Disease Control and Prevention. (2014). CDC Health

Disparities & Inequalities Report (CHDIR). Atlanta, GA.: CDC.

Chen, N. (2001). The meaning of aging. Journal of Extension, 39(6).

Retrieved from http://www.joe.org/joe/2001december/iw2.php.

Crewe, S. E., & Chipungu, S. S. (2006). Services to support

caregivers of older adults. In B. Berkman & S. D’Ambruoso

168 Clin Soc Work J (2016) 44:160–169

123

(Eds.), Handbook of social work in health and aging (pp.

539–549). New York: Oxford University Press.

Elder Alliance Network. (2015). Education and training: Meeting the

needs of older adults. Retrieved from http://www.eldercarework

force.org/research/issue-briefs/research:education-and-training/.

Fisk, M. (2002). Rethinking community: Poverty, jobs, and solidarity.

Paper presented at ‘‘Poverty and the University’’ Conference,

Loyola University of Chicago.

Gieseking, J. J., & Mangold, W. (Eds.). (2014). The people, place,

and space reader. Retrieved from http://peopleplacespace.org/

toc/section-3/.

Gonyea, J. G. (2006). Housing, health, and quality of life. In B.

Berkman & S. D’Ambruoso (Eds.), Handbook of social work in

health and aging (pp. 559–567). New York: Oxford University

Press.

Grant, J. M. (2010). Outing age 2010. National Gay and Lesbian Task

Force Policy Institute.

Hobfoll, S. E. (2002). Social and psychological resources and

adaptation. Review of General Psychology, 6(4), 307–324.

Hohler, U. (2010). Marginalization: Exploring the edge of consensus

reality. SGAP, Zuerich Lecture held at the IAAPCongress in

Montreal ‘‘Facing Multiplicity’’.

International Federation of Social Workers. (1999). IFSW Interna-

tional policy on older adults. Australian Social Work, 52(1),

59–60.

McInnis-Dittrich, K. (2014). Social work with older adults (4th ed.).

Boston: Pearson Education.

Meyer, I. H. (2003). Prejudice, social stress, and mental health in

lesbian, gay, and bisexual populations: Conceptual issues and

research evidence. Psychological Bulletin, 129(5), 674–697.

Minnesota Department of Health. Definition of healthy aging.

Retrieved from www.health.state.mn.us/divs/orhpc/pubs/healthy

aging/hareportnofs.pdf.

Naleppa, M. J. (2006). Case management services. In B. Berkman &

S. D. Ambruoso (Eds.), Handbook of social work in health and

aging (pp. 521–527). New York: Oxford University Press.

National Association of Social Workers. (2010). NASW standards for

family caregivers of older adults. Washington, D.C.: NASW.

National Association of State Mental Health Program Directors.

(2014). The impact of the older adult mental health workforce

shortage on the public mental health system. Retrieved from

www.nasmhpd.or. September 14, 2014.

Nelson, R. D. (2011). Ageism: The strange case against the older you.

In R. L. Wiener & S. L. Willborn (Eds.), Disability and age

discrimination (pp. 37–47). New York: Springer.

Perkinson, M. A., & Solimeo, S. L. (2014). Aging in cultural context

and as narrative process: Conceptual foundations of the anthro-

pology of aging as reflected in the works of Margaret Clark and

Sharon Kaufman. The Gerontologist, 54(1), 101–107.

Polivka, L., & Moody, H. (2001). A debate on the ethics of aging:

Does the concept of autonomy provide a sufficient framework

for aging policy? Journal of Aging and Identity, 6(4), 223–237.

Proshansky, H. M., Fabian, A. K., & Kaminoff, R. (1983). Place-

identity: Physical world socialization of the self. Journal of

Environmental Psychology, 3(1), 57–83.

Ridgeway, C. L. (2014). What status means for inequality. American

Sociological Review, 79(1), 1–16.

Ruffin, L., & Kaye, L. W. (2006). Counseling services and support

groups. In B. Berkman & S. D’Ambruoso (Eds.), Handbook of

social work in health and aging (pp. 529–538). New York:

Oxford University Press.

Sijuwade, P. O. (2009). Attitudes towards old age: A study of the self-

image of aged. Studies on Home and Community Science, 3(1),

1–5.

Social Isolation. (2015). New York: SAGE. Retrieved from http://

www.sageusa.org/issues/isolation.cfm.

Social Work and Aging. (n.d.). Washington, D.C.: National Associ-

ation of Social Workers. Retrieved from http://www.socialwor

kers.org/advocacy/briefing/AgingBriefingPaper.pdf.

Sokolec, J., & Dentato, M. P. (2014). The effect of marginalization on

the healthy aging of LGBTQ older adults. In H. Pereira & P.

Costa (Eds.), Coming out for LGBT psychology in the current

international scenario (pp. 521–527). New York: Oxford

University Press.

Taylor, Charles. (1994). The politics of recognition pp. In Amy.

Gutmann (Ed.), Multiculturalism: Examining the Politics of

Recognition (pp. 25–74). Princeton, N.J.: Princeton University

Press.

The John A. Hartford Foundation. (2011). Annual report: Mental

health and the older adult. Retrieved from http://www.

jhartfound.org/images/uploads/reports/JAHF_2011AR.pdf.

Tompson, T., Benz, J., Agiesta, J., Junius, D., Nguyen, K., & Lowel, K.

(2013). Long-term care: Perceptions, experiences and attitudes

among Americans 40 and older. The Associated Press-NORC:

Center for Public Affairs Research, 2. Retrieved from http://www.

apnorc.org/PDFs/Long%20Term%20Care/AP_NORC_Long%20

Term%20Care%20Perception_FINAL%20REPORT.pdf.

Troll, L., & Schlossberg, N. (1971). How age-biased are college

counselors? Industrial Gerontology, 10, 14–20.

Tuedio, J. (2002). Thinking about home: An opening for discovery in

philosophical practice. In H. Henning, A. Holt, & H. Svare

(Eds.), Philosophy in Society (pp. 201–215). Unipub Forlag:

Oslo.

Vauclair, C. M., Marques, S., Lima, M. L., Bratt, C., Swift, H. J., &

Abrams, D. (2014). Subjective social status of older people

across countries: The role of modernization and employment.

Journals of Gerontology. Series B, Psychological Sciences and

Social Sciences. doi:10.1093/geronb/gbu074.

White House Conference on Aging. (2015). Healthy aging policy

brief. Retrieved from http://www.whitehouseconferenceonaging.

gov/blog/policy/post/healthy-aging-policy-brief.

World Health Organization. (2002). Active ageing: A policy frame-

work. Geneva, Switzerland: WHO.

World Health Organization. (2014). Age friendly world. Retrieved

from http://agefriendlyworld.org/en/.

Young, I. M. (1990). Justice and the politics of difference. Princeton,

N.J.: Princeton University Press.

Jeanne Sokolec is an Associate Clinical Professor and the Director of the BSW Program in the School of Social Work at Loyola University

Chicago. She teaches about policies for older adults as well as making

presentations on issues concerning LGBTQ seniors.

Clin Soc Work J (2016) 44:160–169 169

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