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Irene Moore, MSSW, LISW

One of the many advantages of a career in social work, says Irene Moore, MSW, is that you can pursue social work in such a wide variety of venues - in private practice, hospitals, nursing homes, business, government, research, schools and universities, home care, or a complementary combination of these.

One of the many satisfactions of a career in geriatric social work -- which focuses on the needs of older people -- is that there's such a wide range of approaches that can improve older adults' quality of life so significantly, Moore explains.

"If you're working with an older person, there's always something you can do to help make the life he or she has be better for him or her," says Moore, who teaches at the University of Cincinnati, is a member of the American Geriatrics Society Ethnogeriatrics Committee and past member of the Board of the AGS Foundation for Health in Aging.

Demand for social workers trained to work with older adults is steep - and it's only expected to get steeper. Over the next two decades the nation's 77 million Baby Boomers will reach retirement age. By 2030, one in five Americans will be 65 or older.

"Geriatrics is a wide open field," says Moore. There's plenty of room to make your mark in geriatric social work, she notes, no matter what venue you choose.

In clinical settings, geriatric social workers assess and communicate the needs of older adults and their families; provide services, counseling and support; locate additional services in the community; coordinate the care that other professionals, hospitals and local agencies provide older adults and their loved ones; and do follow-up. Most important, they initiate proactive planning to prevent crises. In administrative roles, they oversee other social workers, or manage organizations or businesses that provide and arrange for social services. In academic settings, they teach and train healthcare professionals; oversee and conduct research; and play related management roles.

Moore herself wears many hats. As a field service professor in the University of Cincinnati's Department of Family Medicine, she teaches first-year medical students medical interviewing skills appropriate for both younger and older patients. As the administrator of the university's geriatric medicine fellowship program, she recruits fellows in geriatric medicine, coordinates their fellowship clinical rotations, and is responsible for geriatric-specific curriculum development. As assistant project director for Cincinnati's Reynolds Center, which is funded by the Donald W. Reynolds Foundation, she provides administrative leadership for key programs designed to improve geriatrics training for students, residents, fellows and community primary care practitioners. In addition, she oversees the university's Geriatric Evaluation Center, and introduces the multidisciplinary team approach to medical and pharmacy students, family medicine residents, and geriatric medicine fellows. Moore also does clinical assessment of, and referrals and follow-up for, older patients and their family members. Finally, she serves as the project coordinator for Cincinnati's Ohio Valley Appalachia Regional grant, which helps healthcare professionals update the skills they need to provide care for older patients.

Even as a child, Moore says, she knew she wanted to pursue "a helping profession." She decided on social work early on, and soon determined that she would concentrate on older adults. Several factors contributed to her decision. Though her grandparents died before she got a chance to know them, both of her parents came from families of 12 children, and she grew up with numerous older aunts and uncles -- whom she adored. In 1976, while earning her bachelor's degree in psychology from the University of North Carolina at Chapel Hill, Moore attended the American Geriatrics Society-Gerontological Society of America joint annual meeting in New York. The reception she received deepened her interest in geriatrics.

"I met all the leaders in geriatrics and went up to these famous people and said, "Oh, I read your book!" and "I saw your article!"" Moore recalls. "I was so young -- I had no inhibitions about doing this. And I was so warmly received; it was very encouraging."

Volunteer work she did the following year, after finishing her undergraduate degree, further cemented her interest in the field. Moore spent nearly a year in England, driving a bus that ferried older people to and from a senior center in Southampton. "I really loved the stories they told, especially about what it was like to live through World War II," she recalls.

That same year, Moore's mother, then only 61, was diagnosed with Alzheimer's disease. "At the time, there was nothing written about the disease. No one famous had shared that they had the disease with the public. Then Rita Hayworth's family bravely stepped forward, followed later by Ronald Reagan's family," Moore says. "But when my mother was diagnosed, there was one paragraph about it in the medical textbook I had. My mother was in the very first research protocol at Duke. She went through extensive testing and questionnaires and was followed until after her death, with a confirming autopsy. "

Moore's mother lived with the disease for 19 years. And Moore went out of her way, literally, to be there for her. Even when the two were separated by a 12-hour commute, Moore made the trek every other month. She lived what she teaches others to practice when caring for older people.

"I had this Zen approach with my mother," Moore explains. "It was: Just go with the flow. So, if my mother said, "The sky is orange," well, then, there it was. And, you know, I had so much fun with her, continuing after her diagnosis. We did a lot. We went to Hawaii together. We went camping. When I was in graduate school in Knoxvillle, and the World's Fair was there, I got my mom a job as a greeter at the fair. She gave everyone a brochure and a "Hello!" with such enthusiasm it was as if she knew them. We just had a very good relationship. I was privileged to have my mother teach me so much, even in death."

Moore earned her Master's in Social Work from the University of Tennessee in 1982. The university didn't have a gerontology track, so Moore took as many relevant courses in other departments as possible and chose internship and practicum opportunities that involved working with older adults. (Some MSW and PhD programs in social work offer practice concentrations in aging. Others offer field placements or internships in settings that serve older adults, or opportunities to work with faculty on aging research, and do practicums in aging studies or gerontology.)

Moore did her field placement at Duke University Medical Center, with Lisa Gwyther, MSW, as her mentor. And Duke offered her her first job in the field, as Clinical Coordinator of its Center for the Study of Aging and Human Development. The job involved clinical assessment, counseling, education and follow-up with patients and their family members. At Duke, Moore was also a preceptor for graduate students in the university's social work, physician assistants, family medicine resident, and geriatrics programs. She stayed at Duke until 1987, when she was recruited to the University of Cincinnati.

Given the nation's changing demographics, efforts to increase the number of social workers trained to work with older people are underway. Funded by the John A. Hartford Foundation, the Geriatric Social Work Initiative (GSWI) is a collaborative effort among social work education departments that aims to do just this. The GSWI supports the careers of faculty in gerontological education and research though initiatives that train academic leaders and doctoral students. It also creates training opportunities through a program that develops and disseminates models of social work education that prepare students to work with seniors. And through the National Center for Gerontological Social Work, the initiative also helps incorporate gerontological education and training into social work curricula.

Despite the opportunities and satisfactions it affords, geriatric social work isn't for everyone, Moore acknowledges.

"The ideal candidate for this work might be someone who enjoys networking and connecting people with real help, patient education, helping people be proactive, and helping family members be objective about what's happening with their loved ones," she says.

While social workers can help older adults and their families start thinking about what they need, and suggest services that can help and ways to plan for the future, whether older people and their loved ones recognize what they really need, take advantage of available assistance, or take additional steps, is up to them, she notes. They have to reach the necessary conclusions on their own.

You're unlikely to help matters by telling an 85-year-old that he can't drive his car any more and insisting that he needs to use the local senior mini-bus, Moore explains, offering an example. You may make headway, however, by approaching his children and asking them if they feel comfortable riding in his car, or having their children ride alone with him.

"That can begin a discussion that helps the family achieve the objectivity they need to realize that, if they would not allow their child to ride with their father, perhaps driving requires more capacity than their parent maintains," says Moore.

"Someone might say that families in these situations are in denial, but I always think the families are in bereavement, that they're experiencing loss - the loss of health, the loss of independence, or the loss of a parent's "perfect retirement dream," - and there's a lot of sadness and grief," Moore notes. "To help, you have to understand the individual and his or her family where they are. The process can't be "fast forwarded" to where the busy professional would like it to be. You try to assist, within their context. You need to remember to take that Zen approach."