Beyond Clinical Care; Addressing the Psychosocial Needs of Residents; A Response from Irish Social Workers.

Sinéad McGarry & Kerry Cuskelly (Irish Association of Social Workers)

Concerned by both the disproportionate, devastating impact of Covid-19 in Irish nursing homes and the narrow focus of the national clinical response to the needs of residents, the Irish Association of Social Workers developed a model of practice and accompanying guidance for social workers to address the broader emotional, social, practical and communication care needs of residents and families.

62% of all Covid-19 related deaths in Ireland have occurred in Irish nursing home setting to date. As the mortality rates in nursing homes rose, urgent public health measures were required to limit the spread of infection and prevent further loss of life. This resulted in the introduction of visiting bans, essentially cocooning residents from their family and friends. Social activities reduced or ceased, residents were encouraged to avoid congregating and many spent long periods confined to their rooms. Residents died without appropriate palliative or end of life care and bereaved families reported poor levels of communication and support.

Dominant national discourse focused on responding to clinical needs arising within nursing homes. Residents were described through a lens of frailty, clinical status or physical vulnerability. Irish social workers became increasingly concerned about this national narrative of older people as passive recipients of care. The failure to recognise and respond to the broader practical, emotional and social needs of residents, needs related to their quality of life, their sense of well-being and sense of connection to their loved ones and local communities was deeply concerning.

Driven by core social work beliefs which support the centrality of human relationships across the lifespan, recognise the dignity and worth of each individual and uphold principles of social justice and rights of equality for all, the Irish Association of Social Workers developed this model of practice, based on the experience of social workers who provided a liaison service in a small number of public nursing homes to positive response from residents, families and staff. The Irish Association of Social Workers advocate for access to this service for all residents in nursing home and residential care settings.

Informed by evidence, practice knowledge and collaboration across social work specialist posts, the model provides clear guidance to support a social worker within residential care settings as they respond to psychosocial needs, provide communication care to residents and families, support residents and family members around their rights and needs and provide, when required, palliative and bereavement care. New techniques, such as the ‘Beyond the Door’ visualisation and the ‘Connection Care Plan’ provide practical ways to work in partnership with residents around their sense of isolation and empower them to find new ways to feel connected to life outside their nursing home. The model demonstrates how the broader needs of residents can be identified and addressed within public health restrictions.  

While the model was developed to support the professional practice of social workers, the ethos and spirit of this resource will enable all within the health and social care professions to work holistically with residents, recognising that people aspire to much more than clinical well-being and physical health.

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