Guide to Counseling Careers: Aging, Gerontology, and End-of-Life

America is getting older. A 2018 report from the Administration for Community Living, which includes the Administration on Aging, found that the number of Americans aged 65 and older increased 34 percent between 2007 and 2017. Furthermore, it forecast that the 85 and older population would more than double by 2040. Part of the reason for these increases is demographic: the world’s largest generation, the Baby Boomers, is entering old age. But part of the reason is also sociological: modern medicine and modern technology have evolved significantly over the last century. 

Just as medicine and technology have evolved, so has our understanding of aging and the careers available to support it. Mental health counselors have always been available to help their older clients navigate the aging process, but they’re far from the only profession counseling on aging. Many professions are centered around aging, and some focus on counseling their clients regarding the aging process. As the Baby Boomers continue through old age, more and more professions will begin to include specializations in geriatrics and gerontology. 

Counseling is critical for older Americans. A 2016 post by the American Mental Health Counselors Association (AMHCA) found that older adults are particularly vulnerable to untreated mental disorders such as depression, which stems from isolation. Older adults are 30 percent more at-risk for suicide than the average American; tragically, as many as 75 percent of older adults who commit suicide visited a physician a month or less before doing so. It’s increasingly important that of all the medical and mental health professionals an older person comes in contact with have some form of counseling on aging training. 

Elderly people have a wide range of mental health needs. Counseling professionals need to be able to serve them. To learn more about careers specializing in counseling on aging, read on.

Become an End-of-Life Counselor

End-of-life counselors are trained in working with emotions related to death, dying, grief, and bereavement. They may work with a patient who has received a terminal diagnosis, or their family. They may also counsel patients who are struggling with a chronic condition. 

End-of-life counseling is a category that also includes palliative counseling, which seeks to treat the effects of a particular condition, rather than the cause; it also includes hospice counseling, which involves counseling patients who are terminally ill. 

End-of-life counselors may work in a hospice setting, in a palliative care center, in a hospital, in private practice, or in a consultative capacity. 

Often, end-of-life counselors are either licensed social workers (LSWs) or licensed clinical mental health counselors (LMHCs/CMHCs) by training, but multiple career pathways exist. Professional organizations for end-of-life counselors include the Social Work Hospice & Palliative Care Network (SWHPN) and the Association for Death Education and Counseling (ADEC).

Become a Geriatric Counselor

Geriatric counselors work directly with older and aging adults. While they generally work with clients aged 65 and up, they can work with clients as young as 50, providing both physical and psychological assessments and focusing their sessions on a client’s continued interaction with the aging process. 

They may work either in private practice, in an assisted living facility, in a long-term care facility, in a senior services agency, or in a consultative capacity. 

Geriatric counselors are often clinical mental health counselors (CMHCs) by training; the American Mental Health Counselors Association (AMHCA) offers an official credential for CMHCs specializing in geriatric counseling. Associated professional organizations for geriatric counselors include the American Mental Health Counselors Association (AMHCA) and the National Coalition on Mental Health and Aging (NCMHA). 

Become a Gerontological Social Worker

Gerontological social workers, also known as geriatric social workers, help to coordinate social, psychological, and medical care for an older population, typically aged 65 and older. They will perform psychosocial assessments and may provide direct forms of counseling to clients who struggle with issues like depression, or to the family of aging clients with conditions like dementia. 

Gerontological social workers can work in community health centers, assisted living facilities, long-term care facilities, hospice facilities, and senior centers. 

Gerontological social workers will almost always have an advanced degree in social work and earn the official title of Licensed Social Workers (LSWs). Professional associations of interest to gerontological social workers include the Association for Gerontology Education in Social Work (AGESW) and the National Association of Social Workers (NASW). 

Become a Gerontologist

Distinct from geriatricians (who are physicians that specialize in older patients’ health), gerontologists are experts in the study of aging. Gerontologists educate others about the effects of aging; they also help design and implement policies and services that help meet the needs of the elderly. Taking a multidisciplinary approach, they will incorporate counseling, education, advocacy, and research into their practice. 

Gerontologists can work in assisted living facilities, long-term care facilities, community health centers, senior centers, or universities. 

Gerontologists will typically have advanced degrees in an area such as psychology or neuroscience, with a particular specialization in gerontology. Associated professional organizations for gerontologists include the Gerontology Society of America (GSA) and the American Society on Aging (ASA). 

Become an Occupational Therapist

Occupational therapists help people across the lifespan do what they want and need to do, treating injured, ill, or disabled patients through the therapeutic use of everyday activities. They are particularly valuable to an elderly community that may struggle with issues of mobility, deafness, and blindness; they can also help people recover from strokes or set up environments with fewer fall hazards. 

Occupational therapists can work in hospitals, private clinics, assisted living facilities, long-term care facilities, community health centers, and senior centers.

Occupational therapists serving the elderly will need to have advanced degrees in occupational therapy and be licensed by the state in which they practice. They will also need to pass a national exam administered by the National Board for Certification in Occupational Therapy (NBCOT). The American Occupational Therapy Association (AOTA) is developing a voluntary board certification in gerontology, which is set to launch in mid-2023.

Become a Psychiatric-Mental Health NP

Psychiatric-mental health nurse practitioners (PMHNPs) are highly trained medical professionals who specialize in psychiatric care and issues of mental health. PMHNPs are qualified to diagnose, treat, and manage mental health issues across the lifespan, but their holistic, patient-centered approach makes them well-suited to treating the elderly and counseling them on issues related to aging. 

PMHNPs can work in their own independent practices (depending on the state), as well as in hospitals, community health centers, assisted living facilities, and long-term care facilities. 

PMHNPs need at least a master’s degree, though a doctor of nursing practice (DNP) degree has strong support to become the new industry standard. PMHNPs will also need to be certified and licensed to practice. Professional organizations of interest to PMHNPs include the American Association of Nurse Practitioners (AANP) and the American Psychiatric Nurses Association (APNA).

Become a Geriatric Psychologist

Geriatric psychologists are psychologists who specialize in the study of mental health issues in elderly patients, often those 65 and older. They can also counsel patients on the effects of aging. Geriatric psychologists are experts in issues such as dementia, Alzheimer’s disease, and Parkinson’s disease, and help patients with these conditions enact strategies to make life more livable. 

Geriatric psychologists can work in assisted living facilities, in long-term care facilities, in hospitals, in hospice facilities, or in senior centers. 

Geriatric psychologists will need an advanced degree, usually a PhD, in psychology (note that geriatric psychiatrists are a distinctly different category; as medical doctors, geriatric psychiatrists can prescribe medications). For geriatric psychologists, professional associations of note include the American Psychological Association (APA), the American Psychosocial Oncology Society (APOS), and Psychologists in Long Term Care (PLTC).

Become a Rehabilitation Counselor

Rehabilitation counselors work with clients who have developmental, mental, physical, or psychological disabilities, helping them to live as independently as possible. When working with the elderly, they can coach patients through coping strategies and counsel them on community resources. 

Rehabilitation counselors can work in assisted living facilities, long-term care facilities, community health centers, senior centers, hospitals, and private practices. 

While certification isn’t required in most states, many rehabilitation counselors choose to earn the industry-standard Certified Rehabilitation Counselor (CRC) credential from the Commission on Rehabilitation Counselor Certification (CRCC) to distinguish themselves professionally and demonstrate their mastery of the subject. Professional organizations of note to rehabilitation counselors include the American Rehabilitation Counseling Association (ARCA) and the National Rehabilitation Association.