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Involved in the business of death: the social work role in postmortem care

In the United States, around 70% of deaths take place in hospital or other institutional settings (e.g., hospice). Hospitals need to handle the unique business of postmortem care: end-of-life needs, care of the decedent’s body, permission for autopsy, release of the body to the funeral home, and questions from family that may not surface for days, weeks, months, or even years after a death has occurred. One way hospitals address these concerns is through an office of decedent affairs (ODA). Models for hospital-based offices attending to decedent affairs vary in staffing and priorities. In addition to taking care of the decedent’s body from death to release to a funeral home, a hospital might want to focus on the increasing the rate of autopsies or of organ and tissue donation. Almost all hospitals use staff members trained in mortuary or other sciences who report to the hospital’s Pathology Department.

In a recent article by Susan Sefansky, published in the February 2017 issue of the journal Health & Social Work (published by NASW Press), the author discusses a different organizational structure for ODAs than the usual Pathology Department model. The University of Michigan Hospitals and Health System created a program that emphasizes patient- and family-centered care along the continuum from the immediate death and beyond. The program office reports to the Social Work Department. Sefansky examines the use of social work principles and clinical training to provide leadership to an ODA and describes the key elements of a successful comprehensive program.

Sefansky notes several social work skills that are valuable in ODA programs:

  • Being able to empathize with the individual and confront human suffering
  • Respecting ethnicity, culture, values, religion, socioeconomic status, and health-related beliefs
  • Helping clients work through crisis, including situations of acute loss
  • Understanding the importance of human relationships, family systems, the dignity of the person, and social justice
  • Being aware of ethical dilemmas of the health care setting
  • Acting as advocates in complex systems
  • Providing formal and informal education to other disciplines as well as patients and families
  • Participating in multidisciplinary care teams, bringing social work’s unique skill set, and understanding the roles of others
  • Providing leadership to improve and maintain the quality of care provided by an institution

Looking at the history UMHS system for decedent affairs, Sefansky uncovered the rationale for having the Social Work Department run the ODA. The committee that created the ODA saw that the skill set of social workers uniquely apply to the needs of a well-run ODA. In the current UMHS set up, the Office of the Medical Examiner and the Department of Forensic Pathology are important partners for the ODA. The chief of forensic pathology at the University of Michigan is now the medical examiner for the county. As a result, when medical examiner cases come to the hospital morgue, families often are told or learn that their loved one is “at the University of Michigan,” rather than “at the medical examiner’s.” Family members sometime appear at the ER door asking to see their loved one, who may never have been a hospital patient. ODA and Emergency Department social work staffs have become instrumental in assisting these families, whether offering immediate grief support or locating information about the decedent. When possible, social workers coordinate with the medical examiner investigator for a viewing to take place after an autopsy is performed. With strong advocacy, a viewing might even be possible before the autopsy takes place. Sefansky notes that providing an opportunity to view the deceased is important to the mental health of the survivors; it helps the mourner with the first task of grieving, namely, accepting the reality of death. Even if a viewing is not possible at the time, sometimes the social worker can offer a photo of the deceased loved one. When a viewing is not possible, social workers use their expertise in crisis management and bereavement.

Sefansky notes that the expanded coverage of having social work staff available at UMHS allows for a timely response to deaths and has allowed the ODA coordinator to focus on policy, practice, and protocol. This includes taking the lead in creating or collaborating on programs that enhance end-of-life, postmortem, and bereavement practices for patients and staff members across the institution. She cites examples of successful outcomes of this social work leadership:

  • A bereavement packet
  • Guidelines for transporting remains and viewing and releasing bodies
  • Staff trainings and consultations
  • The institution’s Grief Awareness Week for staff members

Additionally, the ODA at UMHS has evolved to become the central phone contact for health center staff and family questions concerning postmortem care.

Sefansky goes into further detail on the ODA at UMHS. She notes in conclusion that other hospitals would benefit from consideration of this model. She says there is as yet no formal academic investigations into the benefits of social work-managed ODAs, and recommends further research into these types of programs.

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