Celebrated each March, National Professional Social Work Month is an opportunity for us to turn the spotlight on the profession and highlight the important contributions they make to hospice patients and society in general.
Although many of us know what social workers do, there is one small niche of social work that often gets overlooked: the field of hospice. In honor of Social Work Month’s theme this year, “Social Workers Stand Up!”, you’ll get a taste of the duties and responsibilities of social workers in the hospice profession.
In an effort to help the cause of raising awareness about hospice social work, Unity Hospice of Chicagoland Social Worker Judy Mintz, MSW, LCSW, was invited to be a plenary speaker at the 5th annual Social Work Hospice and Palliative Care Network’s conference in Scottsdale, Arizona. Her speech, Providing Quality Hospice Care to an Inner-City, Disadvantaged Population: The Challenges and the Joys, described how Unity Hospice of Chicagoland—an inner-city Chicago hospice—delivers an innovative model of care to disadvantaged and marginalized families in the area. In addition to describing the challenges of working with an inner-city population, as well as strategies that she’s used to meet their needs, she also talked about opportunities to provide profoundly meaningful, positive end-of-life experiences to patients; such as the following stories.
Unity Hospice of Greater St. Louis Bereavement Coordinator Anne Chida, LCSW, tells the story of her experience with her very first hospice patient. It was the early 1980s, and Chida had just started working as a hospice social worker. Admittedly, she was “a little nervous” as she walked up the steps to visit her very first patient.
“When I got there, the house was filled with friends and family who all loved this man. I thought to myself, what can I possibly offer him that he’s not already getting?”
While there, the patient asked Chida if she could bring him a plastic bag on the floor. It was full with tulip bulbs. “He said, ‘I want you to go outside and plant those tulip bulbs all alongside the edge of the sidewalk, so that next spring, when I’m not here, my wife will remember that I love her.’” Dutifully, Chida went outside with a little shovel and planted each one of those bulbs. The next spring, she drove by his house. “Sure enough, the entire sidewalk of the house was filled with beautiful tulip blossoms, which—I’m sure—brought a tremendous amount of comfort and peace to his wife.”
Planting flowers? It’s not the first thing you think about when you hear “social work.” But a hospice social worker often finds that they do a little bit of everything to help their patients.
Hospice as an entity is very collaborative work, dependent on a whole team of individuals—including a chaplain, medical staff, nurses, volunteers, and more—to provide comprehensive care to individuals (and their families and caregivers) at the end stages of their lives.
Social worker Stephanie Lubin, LSCW, from Unity Hospice of Chicagoland says that social workers often have the best perspective on a hospice team because they are the ones who initially meet the patient in order to take a full psychosocial assessment.
“We learn about the family, the patient, their work experience, their life passions, their spouses. We get an idea about how they’re coping with their illness, and with the existential aspects of death and dying. We figure out what the family dynamics are. We get an idea of the level of support needed for the patient to remain in their home, and where we can be most effective in helping the patient and family. We assess where the family stands financially.” The initial visit produces a gestalt perspective. After that, social workers help determine a plan of care outlining how to support the family.
Sometimes this means finding a caregiver when family members work full time, or figuring out how to get food in the fridge on a regular basis. Sometimes it’s helping a patient apply for Medicaid or health insurance; other times it’s determining if the patient would be better in another facility. Sometimes it’s trying to expedite visas for family members from foreign countries who want to see their relative during their last days.
“We describe ourselves as overall troubleshooters—anything that needs solving, after medical, comes to us,” says Lubin. Case in point: At the moment she’s helping a patient receive a disability plaque for his rearview mirror so he can park in easily accessible spots. Hospice social workers can also help families organize burial arrangements, plan funerals, or send a loved one’s body to the home country after the passing.
Besides for taking care of odds and ends, hospice social workers counsel the patients and their caregivers during what is a very emotional and vulnerable time for them. They listen to the questions, the comments, and the silences. They facilitate what would otherwise be awkward family meetings and sessions so patients can communicate their wishes and requests to their family members properly. For example, Lubin is currently administering psychosocial therapy with a patient’s daughter who “feels like she can’t really move on with her own life because she’s very preoccupied with caring for her mother. I’m helping guide her towards the choices she wants to make, moving forward, while helping her process the fact that she does not need to be concerned with her mother’s needs 24/7 at the expense of herself and her own family.”
“Sometimes the questions will relate to accepting the fact that they have a terminal illness…like, how do I tell my family that I don’t want to do any treatments anymore that I’m ok with dying and living life to the fullest? How do I explain advance directives like DNR? How do I even tell my family that I want to be on hospice?” Erin Sanders, LCSW, Unity Hospice of Western Illinois Social Worker, explains.
This issue is, surprisingly, very common. The word hospice, explains Sanders, is misunderstood in Western culture. “People assume that when a patient says they’re going on hospice, that means death. What people don’t understand, though, is that hospice is not death, it’s supportive services at the end of a person’s life. So we come in and clarify this concept.”
Social workers in hospice can also be part of the collaborative effort to organize “last wishes:” requests from patients on their deathbeds who have only several weeks, or days, to live. Lubin, for example, once helped to organize a veteran-honoring ceremony for a declining patient who had served in World War II. “We weren’t sure if he’d ultimately be able to be there at the ceremony, because his health was rapidly deteriorating. But we promised to do it anyway at the funeral, in any case.
Ultimately, Unity Hospice made it happen. The patient ended up dying the very next day.
Hospice social workers often stumble into their field unexpectedly. Lubin, who received her Master’s in education and mental health, worked for fifteen years as a social worker in Chicago middle schools. But as her kids grew up, she grew tired of working with preteens all day and switched to hospice. “The great thing about an MSW is that it’s really versatile, and you can apply the same training to different settings,” she says. “After temping for a hospice social worker who was on leave for a few months, I fell in love.”
The most valuable part, adds Sanders, is being able to help people in a way that others are often not afforded entry. “The dying process is a very private matter,” she explains. “When hospice enters the picture, we are afforded the opportunity to come into this very intimate era in a person’s life. And we don’t take that opportunity lightly, or for granted.
“Within this time, within this space, every moment and word counts.”
About Unity Hospice
Founded in 1992, Unity Hospice is a family owned and operated hospice and palliative care company committed to providing comprehensive care, support and education to people facing a life-limiting illness, those who care for them and the community. Unity Hospice offers care of the highest quality by licensed and competent staff in accordance with laws & regulations and accepted standards of practice. With the dedication to make their patients’ days comfortable, Unity Hospice provides an interdisciplinary approach to each individual and family, in which they go above and beyond everyday to meet their needs.