Social Workers in Hospice Explained

During the course of the calendar year, most months are intimately tied to health observances. The month of March is no exception. There’s colon cancer awareness. There’s a week devoted to educating the public about patient safety, and at the end of the month, there’s national Doctor’s Day. But did you know that every March, there’s another profession that’s honored? During the third month of the year, social workers are recognized across the country, and the important contributions they make to society are highlighted.

According to the National Association of Social Workers, approximately 650,000 social workers in the United States make the lives for the people they come in contact with better. To grasp how this mission is accomplished, it is important to start by understanding the role of social work. As defined by the Merriam-Webster dictionary, social workers provide social services, specifically for the investigation, treatment and material aid of the economically, physically, mentally or socially disadvantaged. Now taking the definition once step further, how does the role of social workers change or adapt for hospice?

Social Workers in Hospice

To understand the importance of social workers in hospice, you need to be aware of the complexities of emotions that occur during end-of-life care. When faced with advanced illness or a terminal diagnosis, people tend to rely heavily on their family and friends, along with an interdisciplinary team from hospice assisting with care. Physicians, nurses, aides, chaplains and social workers come together as a unit to combat end-of-life challenges often faced by patients and their loved ones.

Social workers, as key members of the hospice team, find ways and strategies to assist families and or caregivers enhance the well-being of the loved ones who face the harsh realities at the end of life. Hospice social workers are trained to look at situations in order to bring people together to discover tactics to address pressing issues. They find solutions in order to allow hospice patients to make the most of life at the end of life.

social workersThe following are some functions that social workers can assist patients and families with:

  • Aid patients in filling out advance directives
  • Provide counseling
  • Help families determine funeral arrangements
  • Offer education about caregiving, coping skills, non-pharmacological symptom management strategies
  • Connect with additional community resources

Addressing Anticipatory Grief

At the end of life, emotions run high and can span a wide range. Grief is expected after a patient dies. However, when a patient is under hospice care, anticipatory grief can take place. This form of grief is the reaction to the expected or anticipated loss.

For someone who is in the throes of anticipatory grief, symptoms can be divided into a number of categories: physical, emotional, cognitive and spiritual. Physical symptoms are changes in sleep and/or appetite and headaches. Emotional symptoms are feelings of sadness, anger, self-reproach, anxiety, loneliness, helplessness and numbness. Examples of cognitive symptoms are disorganization, forgetfulness and confusion. And lastly, spiritual symptoms are questioning the meaning of life and faith along with anger at God.

Not only do they grieve their diagnoses, hospice patients also experience anticipatory grief for other reasons such as their families’ future loss and decreased independence. Additionally, they might grieve the lack of time left to reach future goals and dreams.

As each person is unique, the same holds true for the manner in which hospice workers assist patients and families to deal with anticipatory grief. At the University of Massachusetts, Hultman and his group identified the importance of allowing patients and their families to grieve in their own way. From this foundational belief, social workers can help patients and families find the methods that will allow them to cope — it isn’t a cookie-cutter approach.

At Chapters Health System and its affiliates—Good Shepherd Hospice, HPH Hospice and LifePath Hospice, every day is devoted to educating our patients and keeping them in the place they call home. We are dedicated to ensuring that patients, young and old alike, and their families are able to make educated decisions about important healthcare matters. For more information, please call our helpful Chapters Health team at 1.866.204.8611 or send an email to info@chaptershealth.org.

About Phoebe Ochman

Phoebe Ochman, Director of Corporate Communications for Chapters Health System, manages all content and communications for the not-for-profit organization.

Learning to Say the Right Thing: Principles of Ring Theory

Do you have a family member, friend or co-worker who has a terminal diagnosis? Are you struggling with the appropriate words to say any time you call or drop in for a visit? Do you also worry about saying the wrong thing? You are not alone.

Based on her own personal experience, Clinical Psychologist Susan Silk developed a simple program to make sure people learn how to say the right thing and no longer worry about putting their foot in their mouth. She named it the Ring Theory.

How Ring Theory Works

Draw a circle that is known as the center ring. Whomever you know currently in crisis write his or her name within that circle. Next draw another circle around the first one, and put the name of the person next closest to the crisis within that ring. Keep drawing larger and larger circles until you are done. According to Silk, this ring of circles is the person in crisis’ kvetching order.

The following is an example on how ring theory is put into practice. Fifty-year-old Deborah was recently diagnosed with stage IV colon cancer. She is married to Daniel, and they have four children who are aged 20 to 26.

Here are the rules. Deborah is in the center ring and she can say anything she wants — anytime, anywhere to anyone. She can complain, whine and kvetch as much as she wants to or feels compelled to utter. She says, “Why me?” and “This is horrible!”

Any person can voice similar feelings but only to those housed in larger rings. For instance, Daniel can say to the children, “Why us?” and “This is so difficult for your mother.” The couple’s eldest child, Aaron, shares with his best friend the following, “I worry that mom will not be at my wedding.” On the flip side, utilizing the ring theory, Aaron would not say to his mother, “Mom, I don’t think that I can handle your cancer.”

Any person talking to another individual in a ring smaller than he or she is in —  closer to the crisis — has a goal and that is to help. Don’t give advice, and refrain from whining. Before you say anything, ask yourself whether what you are about to say is comforting or supportive. Words that are supportive would be: “Can I bring you a casserole?” or “I’m sorry” or “The diagnosis must really be difficult for you.”

In a nutshell, you just need to remember: Comfort IN, dump OUT. You can say whatever you’d like to say just avoid complaining inward.