The Role of Social Work in Dementia Care

Accreditation Statement

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In support of improving patient care, the University of Wisconsin–Madison ICEP is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.

Credit Designation Statements

For more information about continuing education credit for this episode, visit the ICEP online learning portal at https://ce.icep.wisc.edu/dementiamatters2026/social-work

The accreditation for this course expires 3/23/2027. After this date, you will no longer be able to access the course or claim credit.

Claiming Credit

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To claim continuing education credits using the texting function:

• At the end of the podcast episode, you will receive information about texting in a code with your cell phone.

To claim continuing education credits through the ICEP online learning portal.

• Visit https://ce.icep.wisc.edu/dementiamatters2026/social-work. Go to the Register tab, click the Begin button and under the Course Progress section, click on Attendance Code -> Start and enter the text code given at the end of the podcast episode.

To complete the episode evaluation:

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Learning Objectives

As a result of participation in this educational activity, members of the healthcare team will:

1. Define social work
   Describe a social worker’s role in dementia care
   Describe key topics and questions covered in a social work assessment

References/Resources

Aging and Disability Resource Centers (ADRCs). Wisconsin Department of Health Services. February 25, 2026. Accessed March 17, 2026. https://www.dhs.wisconsin.gov/adrc/index.htm.

Transcript

Intro: I’m Dr. Nathaniel Chin, and you’re listening to Dementia Matters, a podcast about Alzheimer’s disease. Dementia Matters is a production of the Wisconsin Alzheimer's Disease Research Center. Our goal is to educate listeners on the latest news in Alzheimer’s disease research and caregiver strategies. Thanks for joining us.

Accreditation Intro: This episode is approved for continuing education credits for physicians, physician assistants, nurses, and other members of the healthcare team through the Interprofessional Continuing Education Partnership at UW–Madison. At the time of this recording, Jeni Synnes has no relevant financial relationships with ineligible companies to disclose. I, Dr. Nathaniel Chin, have the following relevant financial relationships with these ineligible companies as a contractor: Eli Lilly and Company, Eisai, and NewAmsterdam Pharma. Information on how to claim credit will be shared at the end of this episode. Additional continuing education information is provided in the show notes.

Dr. Nathaniel Chin: Welcome back to Dementia Matters. Effective dementia care depends on more than clinical expertise. It requires systems knowledge, emotional intelligence, and sustained support for patients and families alike. These are core elements of social work practice. Jeni Synnes, a social worker with UW Health, joins me today to tell us about social work's role in dementia care and what patients, family members, and health care providers should know before and after a memory assessment. Jeni, welcome to Dementia Matters.

Jeni Synnes: Thank you so much for having me.

Chin: Let's start with some basics. For listeners who haven't worked with a clinical social worker, what is your role in a memory assessment clinic and how might it be different than in primary care?

Synnes: Well, in an assessment memory clinic, both primary care and specialty care, the social workers primarily are doing assessments of some kind. But when you're talking about a memory clinic, you get a lot more specialized in what you're talking about. You are focusing on—when you're doing your assessment, you're really trying to hone in on changes that might have occurred and how they're impacted by memory in particular, or cognitive changes. It's different than primary care. I mean, there's a lot of overlap between both primary care and specialty care in terms of the social work role, but you go a little more in depth in the memory clinic and trying to get background information like family history on who in their family might have had some kind of cognitive impairment or really digging into the details of the onset of when symptoms or changes started and really getting into the particulars of that, how something's progressed and that type of thing. You also, in both settings, you do work a lot with the care partners but not always in primary care. Someone may be living independently and not need that, but in a specialty clinic—especially for memory—you typically have a care partner who's involved and so a lot of the focus might be support for that person, not just the patient who's getting tested and being seen in memory.

Chin: And so your assessment really is an investigation. Like you said, in a memory clinic, it's very focused on memory, but that itself is quite broad. You're going to cover cognition and function and mood and sleep and safety and social history, obviously, and family history, like you just mentioned but you would do that—social workers do that in primary care, just slightly different focus, maybe not as in-depth as you would do in a memory clinic.

Synnes: Yeah, when someone comes to primary care, they honestly might be coming in and we're just establishing care with them. We're getting their social history and we're learning a little bit about them and we get, you know, a brief kind of glimpse of their function, trying to identify if there's any place for an intervention such as, oh, maybe they've been falling and maybe they could use a Life Alert or something like that. We do also, actually, a cognitive screening on everybody who establishes care in our primary care clinic, but that's brief and it's just a screener and it's not diagnosing anything. Then when they come back for follow-up care with the provider, as we get to know them over time, certain issues will pop up and we'll address those issues as they come but it could be years before they need anything from a social worker.

Chin: People sometimes confuse social workers with case managers or case workers. What's the overlap and what's the difference?

Synnes: Well, they both are doing a lot of assessing. When I think of—I spent a lot of my career as a case manager. I'm also a social worker. So, you know, case managers could have a variety of different backgrounds. They could be social workers. They could be nurses. They could be criminal justice. You know, they could have any type of background. But usually I think of them as long-term, getting involved. Like me as a social worker in the clinics, I'm not a case manager in the sense that I'm kind of addressing those issues as they arise but then I might not be involved again for another year or two or my colleague might get involved instead of me. But I would bring in a case manager for someone who doesn't have a family member or a friend or some kind of care partner, or their kids live in another state and they're having more and more needs that are going unmet. Then that case manager can come in and sort of work towards all the goals that are needing to be addressed and issues that are coming up.

Chin: That’s a helpful distinction because you're right, there is an overlap in that you're both providing resources and support but how it's applied is different. And we work together, Jeni, so I can ask this question more bluntly or at least say it. Some of our patients will say I don't want to meet with the social worker—or they'll say case worker—like we're doing just fine and we don't need anyone evaluating us from the state. How do you differentiate that case worker from what you're talking about, what you do in clinic?

Synnes: Yeah, and maybe what they're trying to say, too, is just there's a stigma sometimes around social work. What is just social work or anyone in that field sort of getting into your business? It feels like maybe a little invasive on some level. One of the skills that they teach us in social work training is really building rapport with families, or being empathetic, or you're working with family systems. That's a lot of our training, what we learn in school and what we do in our job. So maybe the most reassuring thing is to have us be in the room and be able to form that relationship but, you know, if you're just meeting with someone and trying to convince them that social work is there to assist—I think, for our clinic, it's really just being part of this multidisciplinary team where everyone's sort of bringing their knowledge to the table and then we're stronger as a group, right, as we bring all our pieces together.

Chin: Well and you hinted to it, or you mentioned it, earlier about the communication and some social workers are licensed therapists or they provide counseling, whereas other social workers might have an expertise in resources and being able to connect people. Can you explain the different options of training, or at least outcomes, in social work school?

Synnes: Yeah. In social work, you can have your bachelor's degree or you could have your master's degree, so I'm going to kind of focus on master's degree right now. When you get your master's degree, part of the training—you have field placements and you pick a specialty. So, those field placements, which last a year, you specialize in something. I went into geriatrics early on. Health care could be another field, that type of thing. When you're a bachelor's, you might have a year of that. When you're a master's, you have two years of that. Anyone who gets their bachelor's or their master's, in order to practice—and I'm gonna speak to the state of Wisconsin where I am—you have to take your boards, effectively, and you have to be certified. That's the first—once you get your master's, you don't need hours of service. You need your master's degree, and then you can go on and get your boards and be certified. So that's advanced practice, social work, certified advanced practice. You might see the credentials C-A-P-S-W. That means someone's got their master's. They've taken their tests. They stay current in their certification every two years—they’ve got to get recertified by doing continuing education credits every two years. For licensed clinical social worker—and there's a couple different varieties—you have to go on and get 3000 hours of supervised hours where you're doing clinical work. That's an LCSW. You have to also take exams once you've earned your hours. I think it's got to be at least two years that you take to earn those hours and then you take your exams, and if you pass that exam—if you're licensed, you can become a therapist. You're a counselor. If you're certified, we still—people who are APSW are still doing counseling but I would call it supportive counseling as opposed to clinical. Using the word clinical gets a little sticky. That's sort of a nuance between the two.

Chin: I'm glad you mentioned all social workers provide counseling of some kind because certainly in our clinic that's exactly what you guys do. And so when you meet with families in a memory clinic, who are you looking to have in that room with you—a spouse, children, friends, caregivers? What's that environment look like?

Synnes: Yeah, I mean, in the memory clinic if you're doing this initial meeting where we're gathering a lot of information, it's a 45-minute to an hour assessment. You want the person in the room that knows the patient the best. By that, I mean, they observe their day-to-day function, either they see them once a month and they stay at their house overnight or they live there or they're visiting and live down the road. I think it's harder for someone who might live across the country who is never observing them take their pills or what their calendar looks like or how their driving might be. We kind of want someone who really is aware of the day-to-day function. Now, I would also say having more than two people in the room can get overwhelming just from an interview standpoint, especially if they don't agree or they feel like—a lot of examples, sometimes one example is enough to kind of get the point across and keep moving. And so it’d just be nice to have people that agree on the situation or have similar views on the situation.

Chin: And in some of your work though, Jeni, you will meet with the family or friend or whoever the person is separate from the patient. Why is that helpful to you?

Synnes: Yeah it's, like I said, a very long interview, this initial assessment. There are a couple different reasons. One, the way our clinic is structured, the patient is getting tested while I'm doing the social work interview. But we do this triage call that happens prior to this visit and that is a phone call, so sometimes the patient will want to be on that call while the social worker is trying to gather this information. Sometimes it goes just fine but other times there's a couple of things that happen. The collateral contact or the family member is not able to be forthright about the information because it's upsetting the patient. Patients don't always have insight into what is happening or the changes, so they might argue or disagree. Also, I think so many questions at one time where we're asking someone to say, tell me this about them, tell me this about them—it's overwhelming. Sometimes it's overwhelming for the person answering the questions. Like, I feel disloyal. I feel like I'm not—like I'm somehow betraying the confidence or disrespecting my family member. We have to provide some reassurance even to family members sometimes, so I can't imagine being the patient hearing all this one after the other after the other if there's a lot going on.

Chin: It is incredible that this effort to preserve dignity, though, can sometimes limit the honesty and information that you receive. And sometimes family, though, in communicating with you, maybe they don't always use the most helpful of terms. When families say memory problems, what follow-up questions will you ask to better understand what exactly they're referring to and sort of the timeline?

Synnes: Yeah, so I usually start with the timeline, like just let me know how long ago you might have noticed any kind of changes and then I have them define what the changes they might have noticed then. It could be, “They can't remember what I tell them and then they ask me to repeat something.” If they say that, I already know there's probably some forgetting. They've talked about repeating. And then I'll just add on to that—it could be language. You know, are they able to come up with words? Are they struggling at all with language? I'll prompt different areas—problem-solving or other things like that. And then I want to know if—did the problem start and level out or are they progressing? Are they progressing slowly or quickly? And so that's really the focus on the memory piece, but I probe for additional information. Sometimes there really isn't any. Sometimes it's like, “Oh yeah, they just can't remember names.” And later in the assessment, I get to function and I get to mood and those things might bring out other examples that they might not have identified as cognitive, thinking, memory, but I will add it at that point.

Chin: But it is because of your experience and knowledge in this space that you know to go deeper than just, “I forget,” and to try to understand other parts of the brain that might be affected or really get at that nuance of what real forgetfulness might feel like or look like to the family. You did just mention something that was my next question, which is about function, because you do focus a lot on the day-to-day functional ability. Why is that so important in your history, before I start asking about specific questions?

Synnes: The change in function is an indicator of having a cognitive issue. It can be. And so the nice thing about talking to someone who knows the person well is to be able to say, “How are they doing with their—,” I like to kind of go in saying, “Tell me what their system is for,” let's just say, “medication setup. Like what's their routine? What's their system?” And then, I start going into detail about, has it changed? Are they relying on you more? Have they forgotten their meds? Well, I also forget my meds sometimes, you know, so I also am forgiving and say like, “What percentage of the time are you having—you know, is this a change?” And so if my husband gets interviewed, he'll say she forgets them maybe two times a week in the morning (laughs) but that's normal. That's what I've always done. So I want to be able to compare it to, is this a change? Or what has changed if it's different?

Chin: And so in our clinic, of course, you're providing a lot of this functional history. Our neuropsychologist provides that cognitive testing. And as we talk about—both are really important, but a cognitive test is one slice in time whereas you're actually getting information about how a person is consistently living. I think it's really important that you not only look at baseline, but you're really getting at change or what's different or how is it different? Do you get any red flags—or do certain things or certain phrases sort of jump out at you? Like you just mentioned management of medications. If someone says, “Oh I was hospitalized,” or, “The loved one was hospitalized because their blood pressure was really low,” are those things that you're looking for like, oh, this is truly reflective of an impairment?

Synnes: Yeah, I mean, that might be an indicator to say they haven't taken that pill or they're double dosing on a pill—yeah, it's probably double if it's too low or whatever—but so, yeah, you're paying attention to all those details. You have to really be ready to dig deeper because someone might say, “Well, I've always done that for him.” Well, why? Okay, that's just the way they've always done it or he's just not ever been good at numbers or he couldn't—you know what I mean? So you've got to understand who this person was. I think we individualize for every single person that comes in our clinic and I think that's really important. I really feel like the details of how they've lived their life and what they're doing, there's a lot to be found in there that can help with the assessment and care.

Chin: What are the daily activities that you routinely ask about, the instrumental, the basic? And how do those answers impact you and what you're thinking?

Synnes: Well, it's appointments, it's medications, it's driving. If I didn't say finances already. But we also go into meal preparation and, you know, can they run the washing machine? The chores in their home—can you run the dishwasher? Are they able to run errands and go shopping? Technology—that's a tricky one, too, for the generation that we're talking to because I'm not going to knock someone down for not understanding how to set up a Zoom if they really never touched a computer. Again, it's a comparison to what they've always done. So yeah, no, they're not great at technology, but they never were. Then with the other function, more the activities of daily living, you're talking about bathing and dressing and hygiene and talking about ambulation, eating.

Chin: When you learn of changes in one versus the other, or in both I should say, versus just the IADLs (Instrumental Activities of Daily Living), how does that impact what you're thinking about as you're assessing not only—I mean, you're assessing the patient by talking to the family?

Synnes: Yeah. Well, that's what's really driving the interventions that I might bring up or the resources or recommendations. When I hear that somebody's, you know—the other day I think it was like, they don't ever use their stove but they use their flat glass top stove as a countertop and all their papers are on it. And so I just asked, “Is it unplugged or are the knobs off?” I don't know. You can bump it or whatever, but like when I hear things, then it leads me to—they don't eat or all they eat is Doritos and Pepsi. Then I'm probably going to give them some resources for either meal delivery or how to get better nutrition or is it a senior center where they maybe could go get lunch. It's going to drive my recommendations.

Chin: And that speaks to the other really important or one of the important aspects of your interview, which is really assessing safety. And so what domains do you screen for? What are the things that you look for when you think of safety in a memory evaluation?

Synnes: Yeah, in the memory evaluation, wandering and actually firearms or gun safety is definitely always there. Suicide ideation or suicidal thoughts. Those are sort of the big ones. Falls. I mean, we do ask about falls and… everything sort of touches on safety, right? So like the stove. The medications—if your blood pressure is way up—so everything. The big ones that are sort of categorized on their own are like wandering and firearms.

Chin: Weapons in the home can be a very sensitive topic, and so how do you bring that up in a practical, nonjudgmental way? What are you really looking for as far as information if they do have a weapon in the home?

Synnes: Yeah, first of all, I normalize it. So “I ask this of every single person and, because it's a memory clinic, this is why I'm asking.” And, you know, I make it very clear that the safest gun user who follows all the NRA rules for storage and safety—if your mind isn't working the same way, sort of all of that, all bets are off in terms of how well someone might manage their weapons or even recognize it to be what it is at some point. You hear once in a while in the news, an accident that happens, so I just am real straightforward about that. We're in Wisconsin. A lot of people are hunters. I mean, I talked to someone today. She's like, “He was a gun collector. He's got an entire—like a very large safe full of weapons.” And so it's not then to me just about are they in the safe and are they separate from the ammunition? Those are things I ask about. But I've taken it to the next step of saying, “Who's got the access to the safe?” So if there's a key or a combination, it's really thinking ahead and saying, maybe not now, maybe not even in the next year, but keep it on your radar that, potentially, there's going to be a point where you have possession of the key and there's just one more step to get to the weapons if there's more confusion or disorientation.

Chin: Families can sometimes cover for a loved one without realizing it. And you mentioned it earlier in one of your answers of like, “Well, I've always done this. I've always helped them.” What are common workarounds that can hide the impairment? And how do you address that, those workarounds, with families when they may not even be aware that they're doing it?

Synnes: It's tricky. Some people will come into the clinic and really not even know why they have to be there. They don't honestly agree that this referral came from the doctor and they are not seeing anything. For me, I'm in a difficult position where, I mean, maybe there is nothing going on and so all I can do is dig and peel away at the layers to the questions. If something surfaces, then I can potentially grab onto something that—but again, they haven't gone through testing yet. I don't know why this may be, if this is even indicative of something. Often I think starting in the conversation too with, “Why are you here? What are you hoping to accomplish today?” That is going to be telling to me, right, of where they might be at in the whole process.

Chin: Now, you're not a part of just the assessment clinic. You will see patients and families after a diagnosis and during care when those issues come up. Sometimes the patient and the family have very different perspectives on what's happening, what's going on. How do you navigate that, especially given that you are asking about sensitive topics like weapons or safety or functional decline? How can families who might be listening raise concerns while preserving that trust and dignity if their loved one is in the room with them?

Synnes: I think remembering to keep the patient at the center of the conversation—what's important to the patient—and that can guide you on a whole host of topics. If driving, a super sensitive issue, is on the table, potentially what's most important to the patient? And that could be anywhere from, “You sold insurance and you know what the ramifications of this might be,” or it could be, “You have grandchildren and think about if your grandchildren were walking down the street and somebody maybe, you know, isn't safe driving,” or something like that. I feel like the conversations in a room when you have a disagreement between the family and the patient or—I think it's really all about that assessment of are we all talking about the same thing, so getting on the same page of what we're trying to address. That's where the disagreement might be, right, like this doesn't need to be addressed or there's no problem or it's fine. What's fine for one person might be an issue for the other, and so it's taking the time to get to know the people, the situation. I have more of a luxury of time in a clinic room, honestly. If I'm sitting there with a husband and a brother and a son and a patient and we're having a pretty intense conversation, I sit and I take the time and I listen to all sides. Again, I'm just doing an assessment. I think oftentimes people don't even know—they don't know how to define the issue. They know there's a problem and they know something's not working right. I use the opportunity. I watch body language. I listen to verbal language. Sometimes I'll be observing that maybe the way something is said is triggering upset in the patient and we might kind of talk about that and talk about, “I saw that there was some upset. Does that often happen when you have that conversation?” Maybe role model some other ways to express that or maybe not express that. Like “You've told me that 10 times.” If the person's not remembering, it's maybe not the most valuable feedback to say, “You've told me that 10 times.” So problem-solving how—not knocking anyone for what they're doing because we're all human and you've got these patterns in a long-term relationship or you've always said it this way but now it's just not working for you anymore. I'm sort of there as a guide to say, “There's other ways to do this. Let's try some. Maybe it'll work better, maybe it won't. Here's my card so we can keep this conversation going.” I do a lot of my work over the phone as well, so that's an opportunity to continue that problem-solving. Once we've identified what the issue is, we can keep problem-solving.

Chin: So I think that's important for our listeners to know, though, that working with a social worker is both about an assessment—understanding, identifying—but then also providing interventions and solutions and problem-solving, or at least generating ideas. I'm thinking now about the listener who might say, OK, it takes a year to get in to see a memory specialist in some areas. How can I best prepare for my visit with a social worker? What should I be bringing? What should I be doing to optimize this opportunity to talk to someone with your skills about my loved one?

Synnes: Yeah, I think be thinking about—a lot of people come with a list of some kind, whether it's in their head or on their phone or on a piece of paper. Often on the phone when I'm having the initial assessment conversation at the end, I always say, “Is there anything that I didn't ask about?” And they're like, “Let me look at my list. OK, we covered it all.” I would say the conversation—the assessments are very thorough so we will be giving prompts and those prompts will help you to think of things, so not to stress yourself out and spend too much time sitting there thinking you have to think of everything because that would be impossible. If little things happen, you could jot it down and then you sort of have some cues of things so you don't forget to bring something up that you might've wanted to bring up. I think also if you are going to bring multiple people to the visit, just sort of have a spokesperson. Or this person will do most of the talking and then if there's a major point that gets left out then the other person certainly can jump in or that person's there to support them, which is fine as well.

Chin: Well, to end today, Jeni, I want to touch on how your role is a little different after a diagnosis, during what we would call a follow-up visit where they're not doing testing, they're not searching for the diagnosis, but there certainly are needs, their care needs, their resource needs. And so what are the most common things that you see six months, a year after a diagnosis? What are families asking you or what kind of referrals are you recommending?

Synnes: We spend, definitely, a fair amount of time talking about—I guess, people seem to put off interventions as long as they can that could be even in-home. Companion care is probably a really big thing in the memory clinic because we're looking at folks who eventually just really can't be home alone and their spouse can't get to the grocery store or they can't get out to have any kind of break and that companion care—so talking about what's the next step? It could be companion care. It could be adult day centers. It could be facility care. It's just helping people navigate sort of where they are in the process. We also do a lot with the Aging and Disability Resource Centers. In Wisconsin, every county has something called an ADRC. That's the acronym that's used. Basically, it's a place you can call and you can get a lot of information but they also have a dementia care specialist on staff if you need a little more care for navigating the dementia process. I always tell people there's books to read, there's websites to go to, there's podcasts to listen to—like yours in particular that I do recommend a lot, because you kind of touch on all the topics. If people are like, “I really am struggling with this,” there's YouTube videos from people that we recommend. It's a whole variety of things. But as you're further down the process—I mean, today it was really a crisis call that I took and someone was really needing to know, in that moment, how to manage aggression from their spouse and what to do. It could be all sorts of things that come up.

Chin: Well, with that, Jeni, I'd like to thank you for being on Dementia Matters today and sharing your experience and certainly the background of why social work is so critical to this field. I’m certainly hoping to have you or one of your colleagues from our clinic come back and talk more about what you see in the management of those with thinking changes.

Synnes: Thank you. We're very fortunate for all the support we get from our providers in our clinics so thank you for valuing social work. I really appreciate that.

Accreditation Outro: As a reminder, continuing education credit is available for this episode through the Interprofessional Continuing Education Partnership at University of Wisconsin-Madison. To claim credit, you can text this code: G-U-H-Y-U-Q at this number 608-260-7097. Again the number is 608-260-7097 and text this code: G-U-H-Y-U-Q.  Your feedback is important to us. To complete an evaluation form for this episode, see the show notes.

Outro: Thank you for listening to Dementia Matters. Follow us on Apple Podcasts, Spotify or wherever you listen. Or tell your smart speaker to play the Dementia Matters podcast. Please rate us on your favorite podcast app. It helps other people find our show and lets us know how we're doing. If you enjoy our show and want to support our work, consider making a gift to the Dementia Matters Fund through the UW Initiative to End Alzheimer's. All donations go toward outreach and production. Donate at the link in the description. Dementia Matters is brought to you by the Wisconsin Alzheimer's Disease Research Center at the University of Wisconsin–Madison. It receives funding from private, university, state and national sources, including a grant from the National Institutes on Aging for Alzheimer's Disease Research. This episode of Dementia Matters was produced by Caoilfhinn Rauwerdink and edited by Alexia Spevacek. Our musical jingle is “Cases to Rest” by Blue Dot Sessions. To learn more about the Wisconsin Alzheimer's Disease Research Center, check out our website at adrc.wisc.edu. That's adrc.wisc.edu and follow us on Facebook and Twitter. If you have any questions or comments, email us at dementiamatters@medicine.wisc.edu. Thanks for listening.