What is Included in Hospice and Palliative Care?

Hospice and palliative care social workers provide critical support to individuals facing chronic pain, a terminal illness, or both. This is a specialized area of clinical practice for which social workers need on the job experience and education. They may gain experience through fieldwork and working in the field before licensure. To prepare for a career in palliative or hospice social work, students may also take courses focused on this sub-specialty of social work during their graduate studies and receive CEUs in hospice and palliative care after graduation. In fact, those interested in this field of practice may become credentialed as an Advanced Certified Hospice & Palliative Social Worker (ACHP-SW).

Social workers working in palliative care units in hospitals work with patients who are facing either chronic pain or pain due to a terminal illness like cancer. Palliative care aims to manage a patient’s chronic pain and may be received alongside “curative treatment”  Palliative care social workers work as part of an interdisciplinary team to provide support and counseling to patients and their families. Patients may need counseling to learn how to use psychological techniques such as focusing or meditation to block pain or deal with the psychological numbness and stress that pain causes. Social workers may also help patients find support groups and other resources to help them cope with their illness and pain. They may assist with discharge planning and navigating insurance issues.

Provide Care and Support

Social workers may also work primarily with patients who have pain and are also facing a terminal illness. Hospice provides care and support for patients who have stopped life-saving treatment and who may need palliative care to help them remain comfortable for the remainder of their lives. Social workers working in hospice will also work as part of an interdisciplinary team alongside doctors, nurses, clergy, and administrative staff.

The support of a professional, licensed social worker who specializes in hospice care can be a critical resource for a patient and their family. The social worker serves the patient and family in many capacities including helping patients and their families understand what type of care they will receive while in hospice and helping them make peace with the decision to stop treatment and enter hospice care. Hospice social workers may also work with the patient and family on advanced care planning and advanced directives. These discussions involve what type of care a patient wants to receive at different phases of their illness and when/if they would want to be resuscitated (i.e. a DNR order).

Take Care of Spiritual Needs

A very important aspect of hospice social work is tending to the spiritual needs of patients and their families. Terminally ill patients may be facing an entirely new set of existential (i.e. having to do with the meaning of life) and/or spiritual or religious questions related to their impending death. For some patients, their terminal diagnosis may have spurred them to think about their own mortality or the meaning of their life for the first time. Some patients may fear death or be in denial. Some may be more comfortable with death due to their spiritual or religious beliefs and may simply want to talk about their beliefs or about what they believe they will confront at their time of death.

Hospice social workers must be comfortable discussing all of these issues with their patients. They should take courses about the role of spirituality in social work practice with different populations. They should be educated about the sociology of death and dying in our culture and feel comfortable speaking openly with patients about their fears and concerns. They should also be willing to talk to patients about meaning and purpose.

Be Aware of Different Perspectives

Furthermore, hospice social workers should be open to different cultural perspectives on death and dying. They should also be open to hearing about patient experience that they may not understand. For example, some people who are facing death experience things that seem to come from a place that the rest of us cannot perceive. Patients may talk about seeing deceased loved ones in their room or about receiving messages from these loved ones. One of my friends’ grandmothers, for example, seemed to be talking to her husband who had passed away years earlier two weeks before she passed away. She said something to the effect of, “Vinny I’m not ready yet, you can come back in two weeks.” She said he had come to take her to heaven but she wasn’t ready, and in fact, she did pass away two weeks later.

These experiences, voices, visions, and sensations are very real for hospice patients. They are also well documented as being quite common. Hospice nurses have written several very interesting books documenting the deathbed visions and experiences of their patients. These collections of stories often provide an important message to the living: pay attention to what your dying loved ones are experiencing and relating because it’s real, and appreciate life!

Hospice social workers should be open to these experiences, even if they find these reports odd or hard to believe. They should simply listen to what their patients have to say and appreciate the stories for what they are—their patients’ unique and personal experiences of dying. Social workers working in this field may be enlightened by these stories, and in fact, these stories may help them help other patients who have concerns about death and dying.

Arrange Spiritual Care

Arranging for the appropriate spiritual or religious care is another important part of the hospice social worker’s job. They will want to conduct a brief assessment of their patients’ spiritual care needs and connect them with the appropriate services and clergy. Patients may want to see a member of their faith’s clergy regularly or just once. Hospice social workers can also be involved in arranging spiritual care for family members including after their loved one has passed.

What Do Hospice and Palliative Care Workers Do?

When deciding whether to pursue a career in palliative and hospice care social work a student should think about their own resilience and sensitivity to working with people in chronic pain and/or facing a terminal diagnosis. They should also think about their comfort with talking about and being around death. This sub-specialty is not for every social worker. It requires a great capacity for empathy, compassion, and resilience. Students who are uncomfortable with the big questions about death may not want to work in this field, as they will be experiencing death regularly. Those who have very rigid beliefs about death or dying may also not want to work in this field. Furthermore, students should carefully consider whether they could work with patients of all ages, including very young people who could need hospice care.

Hospice care social workers, in particular, will need to take good care of themselves. Self-care may include having their own spiritual path or beliefs, reading about others’ spiritual experiences, being around loved ones who make them feel supported and peaceful, and simply enjoying what they have in life and having fun. For the right type of person, this field can be immensely rewarding, enlightening, and challenging in a positive way.

Stephanie Bosco-Ruggiero

B.A. Political Science| Vassar College

M.A. Urban Affairs | University of Delaware

Social Policy | Fordham University Graduate School of Social Service Doctoral Program

August 2019

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