Running between the Raindrops: The Obligation Dilemma of the Social Worker in the Nursing Home

Abstract

The authors examined perspectives of social workers working in nursing homes concerning their obligation to the older adult, the family, and the facility, and identified the dilemmas and difficulties that arise from these sometimes conflicting obligations. Authors conducted semistructured in-depth interviews with 15 social workers employed in nursing homes in Israel. Inter-theme consistencies and contradictions were elucidated, and descriptive and then interpretive categories were created to represent interview data. Social workers acknowl- edged their multiple, often contradictory loyalties to the older resident, the management of the institution, the staff, and the resident's family. The obligation dilemma was particularly evident in relocation decisions and suspected cases of elder abuse. The findings highlight the importance of the obligation dilemma in the work experience of social workers. Potential, implications for the care provided to older adults in nursing homes are discussed.

Coping with the Obligation Dilemma: Prototypes of Social Workers in the Nursing Home

“…The literature relates to the possible occurrence of conflicts and obligation dilemmas in the social worker's nursing home environment ( Allen et al ., 2007 a , 2007 b ; Lev and Ayalon, 2015 ; Fogler, 2009 ; Monk and Abramson, 1982 ) and suggests models, coping strategies and resolutions of such conflicts and dilemmas ( Iecovich, 2000 ; Monk and Abramson, 1982 ; Nelson et al ., 2001 ). However, little research has been done on the ways the nursing home social worker deals with obligation dilemmas.…”

“…The obligation dilemma emerged as the central theme of a qualitative study conducted in Israeli nursing homes, in which the social worker was torn between several obligations: to the resident, to the institution and to the resident's family ( Lev and Ayalon, 2015 ). The current article focuses on the second part of the study, addressing the characteristics of social workers, their relationships with management and the multidisciplinary staff, and the ways in which they deal with the obligation dilemma.…”

“…Studies on the coping of social workers who faced an ethical dilemma, in which their obligation to their clients was challenged by institutional constraints and restrictions, have stressed the social workers' difficulties in acting in accordance with their obligation to the residents. Social workers acted in diverse ways, ranging between respecting their obligation to the organisation and respecting their obligation to their clients ( Lev and Ayalon, 2015 ; Hyde, 2012 ; Fine and Teram, 2013 ; Papadaki and Papadaki, 2008 ).…”

“…This tension highlights the dual loyalty of the social worker, who is sometimes caught between conflicting obligations to residents and management, and must favour one or the other or find a balance between the two. The conflict can surface with respect to suspected cases of elder abuse ( Lev and Ayalon, 2015 ), unnecessary admission of residents whose needs could have been met outside of the institution ( Lev and Ayalon, 2015 ) and delayed release of residents whose rehabilitation is complete ( Fogler, 2009 ).…”

“…Although the professional literature does not contain much about the social worker's dilemma of obligation to the family versus the nursing home ( Allen et al ., 2007 b ; Lev and Ayalon, 2015 ), theoretical and field studies relate extensively to the potential conflict between the resident's family and the staff of the institution and suggest ways of dealing with it. Families that have difficulty accepting the authority of staff members, or have different expectations of the treatment their relative receives, tend to clash with the staff ( Abrahamson et al ., 2009 ; Bauer, 2006 ).…”