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 :
Chronic fatigue – exhaustion, tiredness, a sense of being physically
Anger at those making demands
Self-criticism for putting up with demands
A sense of being besieged
Exploding easily at seemingly inconsequential things
Physical symptoms, such as headaches, gastrointestinal problems, weight
loss or gain, sleeplessness or depression
Feelings of cynical detachment
Feelings of helplessness and ineffectiveness
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
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
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.
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.
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
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
I will offer just a few suggestions related to the issues I have raised
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
3- Fight isolation by getting out of your facility and by creating support
networks for yourself. Join support organizations, (like SSWANH3);
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!
1. “13 Signs of Burnout and How to Help You Avoid
It”, by Henry Neils. www.assessment.com.
Burnout in Human Services”, by L. Jenkins, MSW.
The Social Service Workers' Association for Nursing Homes is a non-profit
organization designed to provide support, education and networking
opportunities to social workers in long-term care and other aging services
in Philadelphia and the surrounding areas.
Lori Ammon, MA, LSW is
a Social Work Consultant specializing in geriatrics and long-term care. She
is the editor of SSWANH's website and newsletter.
Copyright © 2005-2007
Lori Ammon, MA, LSW.
All Rights Reserved. Reprinted by permission.
31 Jan 2005
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