Question: I wanted to know more about your thoughts in regards to the role of Social Work in Hospice care including bereavement services.
An interesting question since over the years I have seen hospice care become more and more involved with physical issues (the disease processes) and less about nurturing and emotional support. I’m sure a lot of hospices are going to be offended by that statement, so let me explain.
Early in American hospice history the average length of stay ranged in the high 40 to 60 days. Now we feel lucky if a patient is on service for a few weeks; too many are just with us for days.
When hospice gets a referral and the patient is in “labor” with just days of living left, time becomes the enemy. The family is in crisis mode since most have either not been told their love one is actively dying or have just been told. The patient is so removed from this world in their labor to leave the attention is solely physical: enter the nurses and home health aides.
When am I going to get to the Social worker’s role? Now. It is vital that the social worker see the family ASAP when a late referral is made. This is when they do their best work of nurturing, educating, guiding and supporting the family during this very challenging time.
Unfortunately, it is generally an admissions nurse that does the initial assessment, gets the papers signed, begins instructions, fills out the required paperwork, goes back to the office, has team meetings and sets up time for the social worker’s visit. Too late for immediate family support.
Having a social worker and an admissions nurse do the initial assessment is ideal but many agencies do not feel that it is cost effective so they use only an admissions nurse who then reports to the office and a team is assigned. Too late!
I think social workers are underutilized. We tend to think of them as problem solving for social and domestic issues when that is just a small part of their role in the hospice team. Social workers bring nurturing, emotional support and guidance to patients and families. They can bring that same support to their hospice team members. They can lead support groups for families (pre-death and bereavement), facilitate a team support group and give community and hospital in-services. I’m not implying that others (nurses and home health aides) aren't nurturing, guiding, and supporting because those qualities are a requirement for anyone who works in hospice. I am simply saying that social workers often are not “front line” when those qualities are most needed.
