Burnout In Long-Term Care Social Work: Unique Features
by  Lori Ammon, MA, LSW

Burnout is a well-known phenomenon in the field of social work. Long-term care social workers deal with their own unique set of problems that can lead to burnout. Over the past few years, I have seen an increasing number of social workers either leave the field of long-term care for other social work positions or leave the field of social work entirely. We can’t afford to lose good social workers in this setting. As the population of older adults continues to rise in the next decades, social workers with expertise in gerontology and long-term care (LTC) will become increasingly important.

Job stress is something we all deal with from time to time. Burnout, however, is a much more debilitating and potentially destructive problem for us and for the clients we serve. Here are some warning signs ^{1, 2} of burnout :

1. Chronic fatigue – exhaustion, tiredness, a sense of being physically rundown

2. Anger at those making demands

3. Self-criticism for putting up with demands

4. A sense of being besieged

5. Exploding easily at seemingly inconsequential things

6. Physical symptoms, such as headaches, gastrointestinal problems, weight loss or gain, sleeplessness or depression

7. Feelings of cynical detachment

8. Feelings of helplessness and ineffectiveness
    

LTC Burnout
It’s easy to see why burnout can occur in social work. We enter the field as energetic optimists, committed to helping others toward positive change. What we often find are high caseloads, excessive paperwork, low pay, and clients who often do not change or appreciate our efforts. It can be hard to stay committed and enthusiastic in the face of this. In LTC social work, there are some unique challenges that can contribute to the potential for burnout.

Grief and Loss
In LTC, we deal with a lot of grief and death. We also get to develop relationships with residents and families over a long period of time and develop bonds with them that social workers in other fields don’t always get to experience. This can be a positive thing, making our jobs more meaningful and rewarding. It also makes it harder to cope with the inevitable losses. One of our roles is to help families, staff, and other residents cope with the death of a resident, so we have little time to acknowledge our own feelings of grief. We seem to be constantly trying to strike that balance between having genuine empathetic relationships and having enough emotional distance so that we don’t fall apart each time we lose someone.

Politics and Finances
The politics of long-term care can also lead to burnout. There are frequent changes in regulations and insurances, which can place more demands on our time. Staffing shortages (especially in nursing) have become an increasing problem, sometimes compromising resident care. We work in an interdisciplinary setting where each department plays an integral role in the functioning of the facility. It is also fertile ground for conflict, power struggles and feelings of being under-appreciated. Inadequate reimbursements from Medicaid and the HMO’s have increased budget pressures, which make us feel like the “bottom line” or a full census takes priority over residents’ needs. Many facilities must also answer to the “corporate office”, which can lead to added pressures. When dealing with all of these issues, it can be hard to feel that we are supported in putting residents first.

Professional Isolation
Many social workers in LTC are isolated from others in their profession. They may be the only person in their “department” or have a very small number of people compared to other departments. When isolated, it becomes easy to feel that no one else really understands or appreciates your varied roles and responsibilities. You can start to question what you’re doing and feel you have no one to share ideas or problems with.

Role Clarification
Related to the isolation factor is the difficulty in defining our roles and responsibilities. Do you ever have a hard time explaining your job when someone asks what you do? It seems we are spread in so many directions on any given day – from dealing with family complaints, to finding someone’s glasses, to picking up someone’s dry cleaning (the list is endless). Better job descriptions have helped to define our roles, but we still seem to be the department that gets dumped with the miscellaneous duties.

Excessive Paperwork
Most social workers complain about excessive paperwork. While those of us in LTC may not have the most (or maybe we do!), we seem to spend an excessive amount of time doing progress notes, MDS assessments, care plans, social histories and assessments, quality assurance reports, and more. Because of regulations and deadlines, we start to feel like we spend much more time pushing a pen than in meaningful contact with residents. This is not why we became social workers.

Coping With LTC Burnout 
Each of us has a responsibility to recognize and deal with the issues in our work that cause us the most stress, so it does not lead to burnout. There is a great deal of information available related to stress reduction on the job. I will offer just a few suggestions related to the issues I have raised here.

1- Acknowledge and deal with your own grief in the loss of residents you have become close to in whatever way is meaningful to you. I have heard hospice workers describe the opportunity to be part of a person’s dying experience as “a special privilege”. It can take a while to feel comfortable with this concept, but it’s a great goal.

2- Amid the political struggles of your facility, try to see yourself as an agent of change on a larger level. We tend to focus on our role with individual residents, but if we initiate or advocate for change in policies and procedures for the entire facility we would benefit many residents or staff members and would feel more effective and valued in our jobs.

3- Fight isolation by getting out of your facility and by creating support networks for yourself. Join support organizations, (like SSWANH); attend seminars for LTC social workers; have a list of other social workers you can call to share ideas and questions (or just to vent); get out and visit other facilities or agencies in your community that you have never been inside of; or initiate a monthly lunch group with other LTC social workers in your area.

4- Know your job description and become an advocate for yourself in explaining the value of what you do to others. And don’t underestimate your role in effectively dealing with complaints, which makes residents and families feel more secure in your facility and can improve the reputation of your facility. About those misc. duties – sometimes you need to be a team player and deal with them gracefully, but other times you need to say no. It’s very empowering.

5- Try to become a strict scheduler of priorities for your week. If you have a specific time set aside for your paperwork, it is more likely to get done then. Also, schedule specific time for 1:1 visits with residents so you don’t start to feel disconnected. Too often, other responsibilities take priority. Better yet, start a group. It encompasses more residents in a shorter time and builds an additional supportive network for them.
 

Although I would certainly like to see LTC social workers stay in the field, no job is worth your health and emotional well-being. If you have tried to cope with the stresses of the job with no success, it may be best to seek employment elsewhere. There are many facilities with different personalities and philosophies. Try to find one with a better fit or try another field for a while to see if LTC is right for you. Most importantly, know that what you do is valuable and meaningful. Take pride in it!



References
1.  “13 Signs of Burnout and How to Help You Avoid It”, by Henry Neils. www.assessment.com.

2.  “Preventing Burnout in Human Services”, by L. Jenkins, MSW.

3. www.friedsocialworker.com

Copyright © 2005 Lori Ammon, MA, LSW.
All Rights Reserved. Reprinted by permission.
31 Jan 2005

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