The Role of Social Work in Hospice and Palliative Care

By Mary Raymer, MSW, ACSW

Introduction

The social work profession helps individuals, families, groups and/or communities enhance or restore their capacity for optimal psychological, emotional, spiritual, social and physical health. Social workers are a core service on hospice and palliative care teams. Their professional values and skills are a perfect match with hospice and palliative care programs, which are designed to treat the whole person in an interdisciplinary manner to enhance quality of life during challenging times. Social workers are strong advocates for self-determination and culturally appropriate care. They are trained in evaluating the strengths of individuals and families and understand that good medical care requires that the wishes and needs of the individuals being served are respected. When cure is no longer possible, a host of psychological, physical, and spiritual stressors arise that social workers are specifically trained to assist the individual and family to cope and manage.

Social Workers assist individuals and families in the following areas:

  • Symptom Management. Physical symptom management, such as relaxation exercises to help with nausea or pain, is just one example of the services that social workers provide.

  • Psychological and Spiritual Stress. Psychological/spiritual stressors such as anxiety, guilt, or depression can be addressed and managed through counseling (including emotional support), education, or short-term psychological techniques.

  • Ethical Dilemmas. Ethical dilemmas (such as withdrawing or withholding treatment) may also arise, and social workers are adept at problem solving, advocacy and facilitating the proper resources to find solutions that are helpful for each family.

  • Financial Stress. Financial concerns are often an issue at the end of life, and this is another area where social workers are extremely knowledgeable and successful at helping people navigate resources such as health insurance coverage, medical costs, and bills, or accessing disability income.

  • Advance Care Planning. Assistance with advance care planning to ensure that all treatments meet the wishes of the people receiving care is also within the purview of social work intervention. Advance care planning entails making decisions about treatment in end of care and funeral planning, and communicating this with loved ones and in legal documentation.

  • Grief and Bereavement. Coping with loss and the ensuing grief process is another area in which social workers are well versed. Dealing with the intense emotions associated with grief can be overwhelming without the proper support and information. Social workers have information and skills that help facilitate grief and help people avoid obstacles that can lead to more complicated reactions like depression.

How Do Social Workers Evaluate with Individuals and Families?

Social workers on hospice and palliative care teams make an initial psychosocial evaluation that is essential to making medical care effective and appropriate for each unique family. In this evaluation, questions include spiritual and cultural beliefs so that social workers can help educate other team members as well as themselves about what each family wants, and even more importantly, what they might not want.

Past history is also crucial, because social work takes into account past strengths of the family, and identifies coping skills and strengths people have already utilized. These skills and strengths are drawn upon and enhanced to help people during their current challenge. If there are special difficulties, such as multiple losses or financial stresses, social workers help make plans to provide extra interventions, support, and/or resources.

Social Workers Are Part of a Hospice Team

As a part of the interdisciplinary team, social workers will represent the individual/family’s wishes at every team meeting and advocate within other systems to enhance their responsiveness and insure that each family receives care that is hand tailored to fit their needs. After death, social workers provide bereavement information, education, and support to help survivors cope with the death and the subsequent adjustment (”new normal”) to a life without their loved one.

A recent study (Reese and Raymer, “Relationships Between Social Work Involvement and Hospice Outcomes: Results of the National Hospice Social Work Survey”, Social Work, 2004) showed, among other things, that there was higher client satisfaction and fewer nights of inpatient care when there was more frequent social work intervention on hospice teams. With about 2.4 million people dying each year in America, it is helpful to know that more and more social workers in the field are receiving even more specialized training to help people live the last days of life as fully as possible and to help survivors find a meaningful “new normal.”

###
The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.

Posted in Death and Dying |

6 Responses to “The Role of Social Work in Hospice and Palliative Care”

  1. EmG Says:
    March 23rd, 2009 at 10:27 am

    As a social worker working in the hospice setting, our role in end of life care is one of utmost importance. Many times it is just the presence of the social worker that offers a sence of support to the patient and family because they know we are here to help. I often describe my role to the families as that of emotional support-to help them through this journey and address concerns be it financial, emotional and ethical that they may have. I was taught in my early years of social work that it in end of life care, it is not about saying or doing the right thing but being there for the patient and family and offering the support and validation that they so desperatly need.

  2. mili Says:
    March 3rd, 2010 at 6:36 am

    what role a msw person can play in hospital duties

  3. mili Says:
    March 3rd, 2010 at 6:37 am

    what is the role of medical social worker in hospital

  4. MLC Says:
    March 5th, 2010 at 8:22 pm

    Social work and hospice and palliative care go hand in hand. Hospice and palliative care are described as holistic forms of care, and social work is exactly that. We look at the entire patient and family, their relationships, their resources, their environment; not just the diagnosis with which they come in. And we work with the interdisciplinary team to help address any barriers to achieving comfort on all levels, physically, spiritually, and emotionally. As a staple of our profession, we are advocates for our patients, and are able to assist them in voicing their needs and empowering them when appropriate.
    More and more hospitals are beginning to create palliative care departments in which they either staff full time social workers or work with medical social workers already within the facility. As a medical social worker, the role is typically to assist in the transition of a patient throughout the appropriate levels of care (i.e., assisting with nursing home placement, setting up home health care/hospice care, etc). Medical social workers should be involved in assisting patients and families in understanding the transition and discharge process, as well as advocating for patients’ decisions when needed. We are in a way, a liaison between the medical world, and the patients and families. As a palliative care social worker in the hospital setting, our primary role is to provide support to patients and families as they process diagnoses and prognoses, make decisions regarding healthcare treatment options, advocate for them as necessary, and, again, act as a liaison between the medical world and the patient and family to ensure they understand the terminology being used by hospital staff.
    Social workers have a wide variety of roles in a wide variety of settings. But many things we have in common despite our different jobs, that keep us connected in our understanding of each others’ roles. We view the patient and family by looking at all aspects of their lives that may affect them, in every setting we work, which is why hospice and palliative care is such a perfect match for social work.

  5. Mike Says:
    April 5th, 2010 at 12:39 am

    Very good informative, Just what I was looking for.

  6. Celia Rodriguez Says:
    June 25th, 2010 at 9:59 am

    I am an RN working in the development of a hospice program. Your article helped me see the role of a social worker in hospice more clearly. What it did for me aswell is increase a passion for palliative care. Not only the article but also the comments. Thank you.

Leave a Comment