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The Social Worker’s Role in Hospice

The Social Worker’s role in hospice has received an increasing amount of attention from the media in recent months. This elevated awareness of the social worker mirrors society’s willingness to accept end-of-life issues and deal with them in part through hospice intervention.

Ponderings spoke with Elizabeth Montero, MSW, LSW from Compassionate Care Hospice to get a better understanding of the role of the hospice social worker helping patients and families deal with end-of-life issues. The following is an excerpt from a conversation with Ms. Montero.

PONDERINGS: Tell me about your role with the hospice patient.

MONTERO: In order to understand the role of the hospice social worker, you need to understand that hospice works as a team. In addition to social service, hospice provides nursing, nursing assistants, chaplaincy, bereavement, and volunteers. Each member of the team has a distinct role, but within the team concept I find myself doing a little bit of everything. I suppose social service lends itself to being the catch all in many instances. For example, I’m responsible for identifying community resources for families, educating regarding final arrangements, and helping families to place a patient into a facility for both respite and long-term care stays, just to name a few. I also assist in locating financial resources. To achieve this, I work closely with the Office of Aging and other various community programs. I spend time writing grants to utilize the Compassionate Care Hospice Foundation. These grants help to pay for a financially needy patient’s rent or electrical bill. I also write grants to the foundation to access monies that help to improve a patient’s quality of life. For example, I frequently write grants for massage therapy, which allows patients to receive a massage from our massage therapist as often as three to four times a month. At Compassionate Care, we also have a Life Enhancement Specialist whose job is to improve the socialization of our nursing home population through one-on-one activities and music therapy, which the social worker makes referrals for as well.
Of course, clinically, I develop the plan of care with the family and identify specific goals and objectives that we want to accomplish. Much of my time is spent providing emotional support to patients and families and helping them through a difficult time by developing grief and coping skills.

PONDERINGS: How does your role differ in the nursing home versus providing care for home patients?

MONTERO: At Compassionate Care Hospice, we view our role in nursing homes as being part of the team. I like to participate in the family care conferences whenever possible and just be an extra resource for a patient and family. When I receive a new admission, I seek out the nursing home social workers to receive input and feedback on the patient status and family dynamics. Many patients have been residents of a nursing home for years, and I find the facility social workers to be a valuable asset to me. The background they provide allows me to learn about the family without having the families reiterate everything they have already discussed with a facility. As an example, it’s helpful to know when a patient is self isolating so I can take the appropriate approach and pass this information along to the other members of the hospice team.

PONDERINGS: What are your goals and objectives when working with patients and families?

MONTERO: Really, it’s the patient and family that determines and develops the goals. Each situation is different and unique. After I meet with the patient and family, I have a better understanding of what is necessary. We hope for having a patient on service for a few months so we can develop a relationship with the patient and family. However, that’s not always the case, and a lot depends on how much time there is to work with a patient and family. By that I mean, where is the patient within their disease process? In either case, I try not to have a prepared agenda before meeting the patient and family, but rather let them dictate their own goals and assist them in achieving these objectives.

PONDERINGS: Tell me about your role with the family after a patient dies.

MONTERO: After a patient dies at Compassionate Care Hospice, our bereavement program follows the family for thirteen months. Personally, I make a phone call to the family to express my sympathy and to see how everyone is coping with the loss and grief. At that point, I transition the care of the family to our Bereavement Coordinator who is responsible for staying in touch and providing a myriad of services over the next thirteen months.

PONDERINGS: How is hospice social work different from social services in a hospital/nursing home/home health care setting?

MONTERO: I have worked in hospital, home care, and hospice settings and one of the benefits I feel the social worker has in hospice is that hospice seems to allow more leeway for visit frequencies and the amount of time spent with patients. In my experience, I am able to provide more emotional support and counseling in a hospice setting, while accessing community resources for the patient and family. This may have changed since my last work experiences in those fields; however, I am happy that hospice allows me to support the patient and family in achieving their goals through a tailored plan of care.

Elizabeth Montero, MSW, LSW is a licensed social worker for Compassionate Care Hospice. For questions on hospice social work, please call Elizabeth Montero, MSW, LSW at 215.245.3525. Ms. Montero was interviewed by Gregory Field, also from Compassionate Care Hospice and a Board Member of SSWANH.

PONDERINGS:	Tell me about your role with the hospice patient.
MONTERO:	In order to understand the role of the hospice social worker, you need to understand that hospice works as a team. In addition to social service, hospice provides nursing, nursing assistants, chaplaincy, bereavement, and volunteers. Each member of the team has a distinct role, but within the team concept I find myself doing a little bit of everything. I suppose social service lends itself to being the catch all in many instances. For example, I’m responsible for identifying community resources for families, educating regarding final arrangements, and helping families to place a patient into a facility for both respite and long-term care stays, just to name a few. I also assist in locating financial resources. To achieve this, I work closely with the Office of Aging and other various community programs. I spend time writing grants to utilize the Compassionate Care Hospice Foundation. These grants help to pay for a financially needy patient’s rent or electrical bill. I also write grants to the foundation to access monies that help to improve a patient’s quality of life. For example, I frequently write grants for massage therapy, which allows patients to receive a massage from our massage therapist as often as three to four times a month. At Compassionate Care, we also have a Life Enhancement Specialist whose job is to improve the socialization of our nursing home population through one-on-one activities and music therapy, which the social worker makes referrals for as well. Of course, clinically, I develop the plan of care with the family and identify specific goals and objectives that we want to accomplish. Much of my time is spent providing emotional support to patients and families and helping them through a difficult time by developing grief and coping skills.
PONDERINGS:	How does your role differ in the nursing home versus providing care for home patients?
MONTERO:	At Compassionate Care Hospice, we view our role in nursing homes as being part of the team. I like to participate in the family care conferences whenever possible and just be an extra resource for a patient and family. When I receive a new admission, I seek out the nursing home social workers to receive input and feedback on the patient status and family dynamics. Many patients have been residents of a nursing home for years, and I find the facility social workers to be a valuable asset to me. The background they provide allows me to learn about the family without having the families reiterate everything they have already discussed with a facility. As an example, it’s helpful to know when a patient is self isolating so I can take the appropriate approach and pass this information along to the other members of the hospice team.
PONDERINGS:	What are your goals and objectives when working with patients and families?
MONTERO:	Really, it’s the patient and family that determines and develops the goals. Each situation is different and unique. After I meet with the patient and family, I have a better understanding of what is necessary. We hope for having a patient on service for a few months so we can develop a relationship with the patient and family. However, that’s not always the case, and a lot depends on how much time there is to work with a patient and family. By that I mean, where is the patient within their disease process? In either case, I try not to have a prepared agenda before meeting the patient and family, but rather let them dictate their own goals and assist them in achieving these objectives.
PONDERINGS:	Tell me about your role with the family after a patient dies.
MONTERO:	After a patient dies at Compassionate Care Hospice, our bereavement program follows the family for thirteen months. Personally, I make a phone call to the family to express my sympathy and to see how everyone is coping with the loss and grief. At that point, I transition the care of the family to our Bereavement Coordinator who is responsible for staying in touch and providing a myriad of services over the next thirteen months.
PONDERINGS:	How is hospice social work different from social services in a hospital/nursing home/home health care setting?
MONTERO:	I have worked in hospital, home care, and hospice settings and one of the benefits I feel the social worker has in hospice is that hospice seems to allow more leeway for visit frequencies and the amount of time spent with patients. In my experience, I am able to provide more emotional support and counseling in a hospice setting, while accessing community resources for the patient and family. This may have changed since my last work experiences in those fields; however, I am happy that hospice allows me to support the patient and family in achieving their goals through a tailored plan of care.