Profiles in Social Work

Improving Living and Dying in Nursing Homes

Mercedes Bern-Klug, MSW, MA

Mercedes Bern-Klug, MSW, MA, has been interested in aging and the elderly since her youth. "Some of the most interesting people I ever met were over 80," she recalls. She first got a chance to explore her interest in aging as an undergraduate at the University of Iowa.

"When I found out the university had a certificate program in aging, I was thrilled," she says. "I took as many aging classes as I could because I just loved learning about older adults and the issues they faced." Bern-Klug went on to complete an MSW at the University of Iowa, followed by a master's in demography at Georgetown University seven years later. Her interest in demography was piqued after listening to a Georgetown professor testify before Congress on aging-related issues. "I was so taken by her ability to talk to members of Congress about demography and aging, to translate research for non-researchers," explains Bern-Klug. "And I just thought, I want to be able to do that, too."

Several years later, while pursuing a PhD in Social Welfare at the University of Kansas, Bern-Klug received an opportunity to combine her dual expertise in aging-related social work and demography. In 2000, Bern-Klug, a Senior Research Associate at the university's Center on Aging, was tapped to head a project called Kansas ElderCount. Devised by State Senator Sandy Praeger, ElderCount gathered a wealth of data on Kansas's older population, including their economic status, health, access to services, and nursing home use. The project's findings, organized by county, were published as a book and a popular wall chart.

During the project, Bern-Klug applied for and received a Hartford Doctoral Fellowship. She has found it to be invaluable to her career development. "The Hartford Fellowship changed my life," she says. "It connected me with ideas and people I otherwise wouldn't have met, with leaders in the field. Before I became a Hartford Doctoral Fellow, I didn't really think that much about my future career. Now I realize I have to take into consideration what the field needs."

What geriatric social work needs, Bern-Klug concluded, is good information about the un-met needs of nursing home residents and how social workers can help address them. "Instead of trying to convince people with emotion about what social workers can do, I think we need to show the data," says Bern-Klug.

Bern-Klug's Hartford-funded dissertation project, which will be completed by summer 2003, is a step toward this goal. Called "The Social Construction of Advanced Chronic Illness Among Nursing Home Residents," it explores the culture of illness and dying in nursing homes. Because many nursing home residents have chronic, serious illnesses or conditions, they are caught in limbo between being classified as sick and classified as dying. Although most are too ill or frail to have hope of recovery or rehabilitation, few are clearly sick enough to qualify for hospice-style care. This makes it unclear as to whether doctors' orders or patients' and families' wishes should dictate care. By analyzing data collected through observation of nursing home care and interviews with residents and their families, Bern-Klug hopes to define the ethnography of advanced chronic illness in the nursing home environment.

In a related project, Bern-Klug is also investigating the psychosocial status of nursing home residents. In a study sponsored by the Soros Foundation's Project Death in America, Bern-Klug is examining the emotional and social issues encountered by nursing home residents and their families as they try to cope with advanced chronic illness in an institutional setting. In particular, she is trying to identify unmet emotional and social needs and determine how residents are using their own strengths to meet some of those needs.

Bern-Klug believes her research will show that most residents' concerns are psychosocial in nature. "Once I get a better handle on the perspective and needs of nursing home residents and their families, then I want to focus on the nursing home social worker's role," Bern-Klug explains. "I think that a lot of the unmet needs of residents are a perfect match for social workers' skills. I believe we can refashion the role of the nursing home social worker to make it more fulfilling for the social workers and also provide better service to families and residents."

Click Here for a complete list of Profiles in Social Work

Updated on November 18, 2010