A Day in the Life of a Hospice Social Worker
By Lisa Pahl, LCSW, APHSW-C
In honor of Social Work Month (March), I wanted to share a little bit about what a typical day looks like in my role as a hospice social worker.
8:00 Interdisciplinary team meeting. Every other week, a patient’s plan of care is discussed in an IDT (or IDG). This usually means that half of the patients are discussed one week, half the next. As a social worker, I share information that is helpful for other disciplines to be aware of including social factors impacting care, anticipatory grief symptoms, coping strategies, bereavement risks, and any other psychosocial issues that may be present within the patient/family system.
9:30 Confirm my schedule for the day. My new patient, who has a very large family, has had a change in condition. I am expecting that there will be a lot of questions and need for support. I will now try to see this patient first. Coordinate with the nurse for a joint visit.
10:15 Arrive at home. The nurse and I walk in. The nurse begins assessing the patient. One son who is the primary person providing care remains at the bedside. There are several other family members sitting at the kitchen table. I re-introduce myself.
A daughter says, “I just don’t understand what happened.” I provide space for family members to share new symptoms and sequence of events. I don’t rush them. I validate how difficult it is to witness their family member beginning to transition. I ask if they have seen the booklet “Gone From My Sight” by Barbara Karnes. I pass out copies to the family members and then ask them to identify what they are seeing. They then identify that it seems likely that their family member now has a prognosis of hours to days.
We talk about the caregiving plan in place and I confirm that the patient has someone able to provide care and needed medications. I inquire about mortuary arrangements, as the patient had not made any arrangements when I asked at admission. The family designates one person to follow up on cremation arrangements. I provide education on how and when to call hospice and what to do when the patient dies. I answer all questions. The nurse then joins the conversation, providing a brief summary of her assessment and the plan for a nurse to visit daily, with the reminder to call if a visit is needed sooner.
11:15 I stay in the home after the nurse left. I find a space to sit with the primary caregiver, the son who has been taking care of his dad for several years. I provide an opportunity for the son to share his caregiving experience over the years before going over the information I shared with the rest of the family. I explore his support system and coping mechanisms (in an effort to determine bereavement risk). I make sure to answer any questions he has about the dying process and what to do when patient dies.
12:00 I sit in my car and eat my lunch while listening to music.
12:30 I drive to my next patient.
12:45 I arrive at the home of a patient who has a diagnosis of end-stage dementia and has a live-in caregiver. The patient is sleeping. I check in with the caregiver who has been providing care to the patient living for over ten years. I explore how she copes with the challenges of long term caregiving. She shares a few recent “bad days” that patient had and the strain that comes from worrying about her. She then shares pictures of her grandkids and talks about her new hobby of knitting. She is upbeat and in good spirits and thanks me for the visit.
13:30 I call the daughter of this patient. She lives out of the state and so comes monthly to visit. I provide a short summary of today’s visit and inquire into how she’s coping with being a long-distance caregiver. The daughter shares that she feels guilty that she doesn’t visit more often. I normalize the wide range of feelings that often arise in caregivers. We talk about the book club she belongs to and how through that she’s met other daughters whose parents are living with dementia. The daughter shares that knowing her mom is getting good care from the caregiver and hospice team helps her greatly.
14:15 I see my last patient of the day, a 60-something year old woman with metastatic cancer. I've been seeing her weekly for one-on-one supportive counseling sessions. Today, she begins talking about how nervous she is about her decline and how she's losing more and more independence. I give her space and support as she processes what this loss of independence means to her. I ask if she wants to try to talk more about her dying experience, in an effort to increase her control at end-of-life.
She agrees and I had select a few questions from The E•O•L Deck focusing on the senses; what she wants to hear, see and smell when she is in her final days. The feeling is very tender as we sit with the reality of what is ahead for her.
I ask if I can bring her spouse in to talk about what we've discussed related to her preferences. She agrees. He is tearful during the conversation but is attentive and holding her hand. He commits to doing his best to honor her preferences.
15:30 I sit in my car a moment before driving off. I am feeling a bit emotional watching the love between my patient and spouse. I know that my patient will begin transitioning soon and I reflect on how much I will miss our conversations.
16:00 I arrive home. I chart a bit, but know that I will need to finish in the morning. I begin planning my day tomorrow, expecting that it may change depending on how my patients are doing.
16:30 I clock out. I journal for 15 minutes about the day. I take a deep breath and go for a walk while listening to a comedy podcast. I do my best to release the energy and pain that I have absorbed throughout the day through laughter and movement.
*These are examples of a typical day- all identifying information and interactions have been changed. This is my experience at the hospice that I work for. My patients are overall in a very small geographical area, making my travel time low. Some hospices require a minimum number of patient visits a day that is higher than depicted here. When looking for a hospice provider, look for a provider that has lower productivity requirements, as it usually means visits are longer, allowing time for meaningful discussions and education.