If you read the previous post, in which I rant about how many hospice team members do not know what hospice social workers do, you may agree it’s time for a clear definition of a hospice social worker’s role.
Most social workers know what a BPSS stands for (in case you don’t, it stands for Bio-Psych-Social-Spiritual, referring to an assessment of these dimensions). Nurses in hospice monitor and treat the patient’s biological self and spiritual counselors promote the spiritual well being. The hospice social worker, like most social workers, assesses and intervenes to promote wellness in the psychological and social dimensions. Our realm is everything that is more abstract than the body, and less abstract than spirit.
How hospice social workers do the psycho and the social
Hospice social workers work in the psychological arena by assessing and intervening to support cognitive, emotional and behavioral well-being. Interventions can involve counseling, educating about dying and grief processes, and facilitating participation in programs that can improve their experience.
We work in the social arena by assessing and promoting social functioning and social justice. To promote good social functioning, we look for ways to help improve the patient’s or family member’s experiences as they interact with their environment, family, friends and the economy. This includes working with family members, facilitating improved housing or home modifications and financial resources. We promote social justice by providing education, and advocating for self-determination, fair treatment and optimal service. This includes discussing advanced directives and advocating that a patient’s end-of-life wishes be honored.
The psychosocial gestalt is confusing. There are a number of duties that should definitely belong to social worker without an obvious reason why. It takes some thinking to decide why topics such as funeral provider choice are considered a part of the psychological or social domains. Funeral homes are a psychological topic, in a way, because funeral planning is best supported by someone with tact, empathy and communication skills. It’s also kind of a social issue because funeral home involvement is an expectation of our society. And it’s a social justice issue when it comes to ensuring that a patient’s end-of-life wishes are respected even when a family member strongly objects, or when a patient has neither money for burial or cremation, nor a family member willing to coordinate arrangements.
Putting it simply: hospice social work is about emotional well-being
A simple way to describe what a hospice social worker does is everything that might be causing a patient or family emotional stress. We look at all potential risks to emotional well-being, and endeavor to resolve or improve those areas.
Fear of dying, grief, existential crises and family conflict are all obvious topics that affect emotional well-being, but so is not knowing what to do or how to get by. As any good social worker knows, optimal mental health is almost completely unacheivable when someone doesn’t know when their next meal will be. In a similar way, uncertainty can cause emotional stress when it relates to housing, receiving adequate care and what happens to one’s body after death.
Depending on the demeanor of who I’m speaking with, I sometimes explain my role as “the guy who tries to help with anything that might be stressing you out. If there’s stress about money, family conflicts, loneliness or boredom, I’d like to try to help.” More often than not, I hear a response from a family member like, “Great! Cause I have something I want to talk with you about.”
Clear role boundaries = good teamwork
Challenges can arise in hospice when team members have different understandings about the boundaries between different roles. Sometimes the best solution for this has more to do with developing relationships with your team members than educating about what your role is.
I will dedicate a good amount of discussion later on how to develop harmonious work relationships. We are still getting started. Come back Monday for a post that will describe how you can know you are succeeding in your role.
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