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Addressing the Social Work Needs of Older Immigrants and Refugees
By Christina Reardon, MSW, LSW

Growing numbers of older immigrants and refugees are living in the United States. The number of foreign-born people living in the United States rose from about 31 million in 2000 to about 38 million in 2009, according to the U.S. Census Bureau, and roughly 11% of the foreign-born population is aged 65 or older.

All older adults struggle at times with the challenges that accompany aging, such as health problems, cognitive decline, loss of independence, and social isolation. But what if you are confronting these issues when English is not your first language and you don’t understand it well enough to navigate American culture or social services systems?

As the social work profession prepares to better serve the coming wave of aging baby boomers, it must not overlook the needs of aging immigrants and refugees. Empowering these elders involves a delicate mix of cultural competence, an understanding of the unique dynamics of immigrants’ and refugees’ lives, and a willingness to advocate on their behalf.

Identifying and Overcoming Barriers
Setting up a new life in an unfamiliar country can be difficult for anyone, and the stress of settling into a new culture while coping with language and cultural barriers puts older immigrants and refugees at risk for anxiety, depression, and other mental health concerns. These problems can be exacerbated when immigrant and refugee elders must also overcome challenges related to everyday living, such as illness, poverty, and geographic isolation. Elders who have limited English proficiency and low levels of acculturation are most at risk because they cannot easily understand or access social services.

Older immigrants and refugees may find their situations to be overwhelming, says Eric Kamba, MSW, MPH, executive director of the Congolese Development Center, a Massachusetts-based nonprofit organization that provides services to African immigrants and refugees. “In addition to the trauma of war or persecution, separation from family and homeland, losses of loved ones, and a familiar life, [immigrants and refugees] may also have to deal with poverty and a lack of control over their lives, living between moments of crisis and boredom, anticipation, and hopelessness,” says Kamba, who is administrator of the refugee health assessment program at Massachusetts General Hospital in Boston.

The role of social workers serving older immigrants and refugees is to help clients identify their challenges and assist them in finding ways to overcome these barriers. There are many steps social workers can take to ensure that their interactions with such clients are successful. According to Kamba and other social workers who have extensive experience with these populations, the most important things social workers should keep in mind include the following:

• The need for culturally competent practice. Social workers must educate themselves about an older client’s culture and how that culture views such issues as aging, mental health, and the role of elders. At the same time, social workers must always remember that each client is an individual with unique experiences that will shape his or her interactions with the social services system. “One thing to avoid is the assumption that there is a single approach to treating older immigrants,” says Amelia Missieledies, LICSW, a geriatric care manager and private practitioner in Washington, DC, and Maryland. “Assuming that they interact the same way or function the same way is not the thing to do.”

• The circumstances of the client’s arrival in the United States. Older immigrants and refugees who recently arrived in the United States often face more challenges than those who have been in this country for many years, says Patricia L. Moore, ACSW, LCSW, assistant vice president of business development for Comprehensive Care Management, a New York-based long-term care organization. Newly arrived immigrants are more likely to face language and cultural barriers that limit their ability to access services. Undocumented immigrants need special attention because, fearing deportation, they can be especially frightened to access services, Moore says. In addition, clients who came to the United States after being displaced by war, political turmoil, or natural disaster may have experienced trauma that will affect their functioning, says Susan Winston, LCSW, who practices in Queens, NY.

• The client’s medical concerns. Like any older client, immigrant and refugee elders may be facing medical issues that affect their mental health and overall well-being, Winston says. Coordinating care with medical professionals is essential, she adds.

• Family dynamics. A social worker serving an older immigrant or refugee often must interact with a multitude of family members, so understanding the dynamics among family members provides key clues as to how to best help the client, Moore says. “You need to know the family culture and structure,” she says. “For example, if you spend all of your time with the female family members and it’s the men who call the shots, you’re not going to get very far.”

• Creating social connections. Because isolation is often a concern of older immigrants and refugees, it’s important for a social worker to assess clients’ social connectedness and link them with community organizations, churches, and other support networks, says Josh Hinson, MSW, LCSW, LCAS, a clinical instructor at the School of Social Work at the University of North Carolina at Chapel Hill. One way elders can make these connections is by becoming cultural resources for their extended families and communities, Hinson says.

• The need for patience and respect. Patience and respect are necessary in any social work interaction, but they are especially important when working with immigrant and refugee elders because these clients may be particularly reluctant to access services. A trusting relationship with such clients may take time to build, and one comment or action a client perceives as disrespectful could cause irreparable harm, Missieledies says. “Creating that therapeutic alliance where they’re at is of utmost importance,” she says. “If you make them feel needy or talked down to, they’ll shut down.”

A Population in Desperate Need
With the U.S. Census Bureau’s estimate that the number of Americans aged 65 or older will double to almost 89 million by 2050, the demand for social work services targeting older immigrants and refugees is poised to increase significantly. Services will be needed not only by immigrant and refugee elders, but also by their caregivers. “It is absolutely a growing issue,” says Hinson. “We’re seeing a lot of children of immigrant parents, and they’re caring for aging parents. It’s going to be an area of huge need for social work.”

Especially vital are social workers who can work with older adults who live outside traditional immigrant and refugee enclaves, says Sarah Won, LCSW, APN, BC, a private practitioner in South Plainfield, NJ. That’s because geographically isolated clients face additional barriers—such as a lack of transportation—when they try to access specialized services.

Many social work schools are trying to better prepare students to work with older immigrants through specialized programming in geriatrics and culturally competent practice. For example, the University of North Carolina at Chapel Hill plans to offer a graduate certificate in social work with immigrants and refugees in 2012. Still, Moore says, social work educators and professionals need to do a better job of demonstrating to young social workers how working with older immigrants and refugees can be a rewarding career choice.

“From my own experience of the young social workers I see, there isn’t anyone chomping at the bit to be a community organizer and advocate for the immigrant population,” Moore says. “Everyone wants to do therapy, but there is a whole other world out there where you can use your clinical experience to help a population that is being ignored. This is a population in desperate need.”

— Christina Reardon, MSW, LSW, is a freelance writer based in Harrisburg, PA, and a contributing editor at Social Work Today.