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Role of the Hospice and Palliative Care Social Worker #390

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FAST FACTS AND CONCEPTS #390
ROLE OF THE HOSPICE AND PALLIATIVE CARE SOCIAL WORKER
Alyssa Middleton, MSW1; Barbara Head, PhD, RN, CHPN, FPCN, ACSW1; Stacy Remke, MSW,
LICSW, APHSW-C2
Background Social workers provide unique knowledge and psychosocial skills for seriously ill patients
and their family (1). Clinicians often collaborate with social workers when caring for seriously ill patients.
In fact, the Medicare Hospice Benefit and the National Consensus Project for Quality Palliative Care state
that social workers are a core member of a hospice or palliative care (PC) interdisciplinary team (IDT) (2).
This Fast Fact will discuss the role of the hospice and palliative social worker.
Training and Certification Although social work practice requires a Bachelor of Social Work (BSW)
degree at minimum, most hospice and palliative social workers have a Master of Social Work (MSW) or
Master of Science in Social Work (MSSW) degree, awarded upon completion of a 2-year post-graduate
program accredited by the Council on Social Work Education in the United States that includes
supervised practicum experience. Licensure, certification, or registration is available in all states, and
regulations vary (3). Currently, many palliative programs prefer clinical licensure at the Licensed
Independent Clinical Social Worker (LICSW) / Licensed Clinical Social Worker (LCSW) level or similar,
which reflects 2 years post master’s degree supervised work experience and denotes qualifications for
mental health diagnosis and treatment as well as individual and/or family therapy. Advanced certification
in hospice and palliative social work is available and requires experience, licensure, commitment to
ethical practice, and passing of an evidence-based exam (3). Most social workers report learning their
specialty through interprofessional practice and post graduate continuing education (4).
Scope of Practice Major social work roles for the seriously ill include providing evidence-based
interventions that empower the patient in the context of their health care and family situation and
facilitating a dignified death as defined by the patient. According to the NCP Guidelines, “social workers
attend to family dynamics, assess and support coping mechanisms and social determinants of health,
identify and facilitate access to resources, and mediate conflicts” (2). A national job analysis further
delineated the social work role (6). From this work, a range of direct and indirect patient care services
driven by individualized assessments and care planning needs have been described (2,5-10):
Direct Patient Care Services Indirect Patient Care Services
Utilizing a biopsychosocial assessment of the
patient and family as the basis for care planning
Facilitating or co-facilitating family meetings
Facilitating effective communication between
patient/family and the IDT
Advocating for effective team dynamics, including
conflict management, wellness and self-care
Assisting patients with advanced care directives Debriefing difficult cases or deaths within the IDT
Patient/family psychoeducation regarding coping
with illness, normalization of stress, and palliative
care options such as hospice services
Identifying and reporting abuse and neglect as
mandated by law
Resource identification and referrals; practical
assistance; insurance coverage; system
navigation; funeral planning.
Documenting assessments, progress, and
response to treatment as required by
organizational and professional standards.
Financial counseling related to the cost of care Improving care delivery for persons with life-
threatening illness
Individual and family counseling specific to the
disease process, coping, and planning
Educating IDTs about mental health issues, family
dynamics, or psychosocial factors impacting care
Assessing and addressing caregiving resources
and needs
Advising IDT members of the maintenance of
appropriate and therapeutic boundaries
Crisis intervention including suicide assessment
and prevention
Facilitating and participating in research and
quality improvement activities
Collaborating on discharge planning Cultivating community relationships and
developing community resources
Legacy work including dignity therapy and
Acceptance and Commitment Therapy (ACT)
Influencing and improving social policy and ethical
practice related to hospice and palliative care
Bereavement care and grief counseling, including
anticipatory responses to and processing of grief
Awareness of state laws and regulations
regarding end of life care
Like other members of the PC IDT, social workers develop expertise relative to the patient situation. PC
social workers are often engaged with adjustment to illness, decision making, and family coping along the
illness trajectory. Hospice social workers are focused more specifically on end of life, though the job
descriptions and tasks carried out are much the same as those in PC social work. Typically, there are two
main models for utilizing social workers to address palliative care needs: 1) utilizing the unit or clinic
generalist social worker or 2) utilizing the IDT social worker with specialized training and experience. A
specialized palliative social worker is preferred and offers greater expertise relative to the serious illness
context of the IDT, patient and family.
Summary Hospice and palliative social workers have unique education, skills, and training essential to
the interdisciplinary provision of holistic patient-centered care. Their psychosocial expertise and attention
to the social determinants of health enables IDTs to better appreciate the complexity of issues patients
and families face and thereby develop more effective, feasible, and patient-directed interventions.
References
1. National Association of Social Workers. NASW Standards for Social Work Practice in Palliative
and End of Life Care. Washington, DC: Author; 2004.
2. National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative
Care, 4th edition. Richmond, VA: National Coalition for Hospice and Palliative Care; 2018.
3. Chai E, Meier D, Morris J, Goldhirsch S (Eds). Geriatric Palliative Care: A Practical Guide for
Clinicians. New York: Oxford University Press; 2014.
4. Social Work Hospice and Palliative Network. APHSW-C Certification. https://www.swhpn.org/aphsw-
certification. Accessed January 4, 2019.
5. Sumner B, Remke S, Leimena, M, Altilio T, Otis-Green S. The serendipitous survey: A look at the
primary and specialist palliative social work practice, preparation and competence. Journal of Palliative
Medicine. 2015;18(10): 881-883.
6. Head B, Peters B, Middleton AA, Friedman C, Guman N. Results of a nationwide hospice and
palliative care social work job analysis. Journal of Social Work in End-of-Life & Palliative Care, 2019;
15(1):16-33.
7. Gwyther LP, Altilio T, Blacker S, Christ G, Csikai EL, Hooyman, N, …Howe, J. Social work
competencies in palliative and end-of-life care. Journal of Social Work in End-of-Life & Palliative Care.
2005;1(1):87-120. doi: 10.1300/J457v01n01_06
8. Altilio T, Otis-Green S, Dahlin CM. Applying the national quality forum preferred practices for palliative
and hospice care: A social work perspective. Journal of Social Work in End-of-Life & Palliative Care.
2008;4(1):3 – 16.
9. Weisenfluh SM, Csikai EL. Professional and educational needs of hospice and palliative care social
workers. Journal of Social Work in End-of-Life & Palliative Care. 2013;9(1): 58-73.
10. Friedman C, Guman, N. A job analysis study of the advanced hospice and palliative care social
worker. Kansas City: PSI; 2017.
Conflicts of Interest: None to report.
Authors’ Affiliations: 1University of Louisville, Louisville, KY; 2University of Minnesota, Minneapolis, MN
Version History: originally edited by Sean Marks MD; first electronically published December 2019.
Fast Facts and Concepts are edited by Sean Marks MD (Medical College of Wisconsin) and associate
editor Drew A Rosielle MD (University of Minnesota Medical School), with the generous support of a
volunteer peer-review editorial board, and are made available online by the Palliative Care Network of
Wisconsin (PCNOW); the authors of each individual Fast Fact are solely responsible for that Fast Fact’s
content. The full set of Fast Facts are available at Palliative Care Network of Wisconsin with contact
information, and how to reference Fast Facts.
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... Despite the burden of mental health comorbidity in palliative care, palliative care clinicians often lack the time, training, or systematic support to provide mental health services (Patterson et al., 2014). Few palliative care teams have dedicated mental health clinicians; palliative care social workers are frequently assigned as designated mental health clinicians on palliative care teams but often have compound roles with competing tasks (Middleton et al., 2020). The lack of integrated mental health clinicians on palliative care teams is particularly noteworthy given the diagnostic challenges of detecting and managing psychopathology in the setting of serious medical illness (Ng et al., 2015). ...
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