Providing Geriatric Cognitive Assessments as a Social Worker

Reader’s Question

I am a social worker, who also holds a degree in psychology and sociology. I have been working in the geriatric field (long term care) for 18 years. Recently I have found myself doing work in the attached hospital. I am the only professional of this kind here; I work in a small remote place where people do not have access to psychiatric specialists at all. I am often called upon to do cognitive assessments on elderly people, by our GPs. I do MMSE’s but find that while they are a good screener they do not offer enough detailed information about a person’s judgement and insight. Can you recommend other assessment tools or a good book on assessments? I worry that I may not be qualified enough to do this type of assessment, but I also know it’s my assessment or nothing for these people. It’s hard to believe in a time like this that anyone has such limited resources, but it is absoluetly true where I reside. Any thoughts/advice on this for me?

Our Clinical Psychologist’s Reply

Are you qualified to provide a cognitive assessment? No. Do remote and limited-resource locations stretch the practice responsibilities of available professionals? Yes! It’s not unusual for limited-resource communities to use Social Workers and Nurses to provide a variety of screening assessments. As a professional who has been asked to contribute to the services in your remote community, how can you help, what can you do, and can your make your situation better? Here’s some thoughts:

• Document all your work in cognitive assessment as a “screening” procedure. There are a variety of screening tools used in medical, psychology, and nursing professions for this purpose. Contact regional hospitals, psychologists, geriatric units and see what they are using, as that tells you about the “standard of care” in your region. Obtain and use what they use.
• After contacting people in your area who routinely provide such assessments, arrange to shadow them for a day as they provide assessments and consultations. This increases your credibility and experience — but not your credentials.
• To increase your credentials, contact online universities (useful in remote sites) and consider taking a class or two in psychological assessment or geriatric assessment. Successful completion of coursework can build your credentials. Your facility may be willing to pay your tuition for these classes.
• Never offer a clinical/medical diagnosis. Your job in a screening consultation is to identify those people who have normal versus abnormal results. When abnormal results are present, inform the physician that additional neurological or cognitive studies should be considered. Offering a diagnosis would violate professional ethical standards as well as state licensing laws.
• To protect yourself legally, ask a frequently-referring physician to supervise and co-sign your report of findings. Explain that you are willing to perform these services under medical supervision. This is not an unusual practice, and physicians often have office staff, with various training levels, performing a variety of interviews and screening procedures. If you are providing these screening assessments as part of your job as a facility social worker, ask for supervision from the Medical Director at the facility or other assigned staff. Physicians in small communities are often very accepting of such arrangements, as they are also dealing with the limited resources in the area.

With the above procedures, you are showing good faith in your attempt to provide this much-needed service in an area with limited professional resources. You are also protecting your clients and your career by taking steps to increase your experience, your credentials, and your supervision.