Welcome back to this “very special series” of articles about hospice social work, inspired by my own anticipatory grief and the emerging psychosocial issues that relate to my grandfather’s health. As I write this at the dining room table in his home in Florida, he’s falling asleep on a couch, with the news on TV. My daughter is sleeping in the guest room. He’s wanting all conversation to be about us, and not about himself, and especially not about his illness.
He’s well. Kinda.
My grandfather would have benefited from a social worker’s support in ameliorating the issues caused by his family members’ interference. Affirming my grandfather’s ability and right to make his own decisions; providing emotional support in processing the stress his kids were causing; supporting him in establishing boundaries; and facilitating communication with his kids are all ways a social worker could help.
Lesson #2: Social workers need to stop, look and listen if social worker support is declined by a family member.
One of his kids called his home health agency and told them not to send the social worker. The question, “was this the MPOA?” does not apply yet, because the patient is still competent to make his own decision. But the daughter who called to cancel social services was not the MPOA.
The home health agency followed this daughter’s instructions, and were entirely wrong in doing so. It was not her decision to make.
When family members express this wish, we need to evaluate whether or not we can accommodate them. We need to consider, without being suspicious or judgmental, the possibility that the reason the family member canceled is that there is behavior they do not want a social worker to scrutinize.
Don’t barge in–but don’t give up easily either.
If we determine that the family member who canceled social services did not have the authority to do so, move forward carefully. Seeking an invitation from someone who does have the authority. Attempt to reach the patient by phone, if the patient is still making her own decisions. Otherwise, contact the legal proxy. An invitation from someone with authority clearly overrules the prohibition of someone who doesn’t. And the hospice social worker’s job is to be available to serve whichever family members need support, even if the patient or proxy decline support for themselves.
This idea may not be popular with your colleagues. I’ve experienced this on the job and even intelligent and well-meaning hospice directors may prefer the path of least resistance.
The reason we can’t give up is that some patients truly need the support a social worker can provide. We have a responsibility to serve them, even if there’s a relative preferring they not see a social worker.
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