Rehabilitation counseling has evolved from its inception in federal legislation in the early 1900s to its current recognition as a specialization of the counseling profession. An initial focus on case management served a constructive purpose during the early years, given the historic link of rehabilitation counseling to the state-federal vocational rehabilitation (VR) system. A psychiatric disability is when an individual with a serious mental illness is unable to perform major life activities in particular life contexts, such as community participation, and independent living. Credentialing has defined and regulated the professional practice of rehabilitation counseling in recent years. The professional identity of a rehabilitation counselor (RC) as a counselor has had wide formal endorsement by the major professional organizations and leaders in the field. Counselor licensure laws emerged because of regulations by Medicare and Medicaid as well as private health insurance that required licensure for the reimbursement of mental health services.

The population of older adults in the United States has grown exponentially over the past few decades. This chapter looks at the unique challenges of meeting the comprehensive healthcare needs of this population. It examines the implications for social policy and gerontological practice and highlights the current models of entitlements and support services for older adults. The chapter also illustrates knowledge and skills required by social workers in this field, and discusses the recommendations for holistic competence. It focuses on four federal social policies that have guided the development of healthcare in the United States. These policies have had a substantial impact on who is eligible for services, the type of services one is entitled to, the quality of services provided, and ultimately the lives of individuals affected by them. The four major social policies are Medicare, Medicaid, the Older Americans Act (OAA), and the Supplemental Nutritional Assistance Program (SNAP).