By Mary Raymer, MSW, ACSW
 

	Introduction
	How Do Social Workers Evaluate with Individuals and Families?
	Social Workers Are Part of a Hospice Team

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.”

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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.