5 Things to Keep in Mind When Providing Hospice Care

Death and dying are topics that are not often discussed within our culture. It is often avoided, left-alone, and remain as lingering thoughts in our mind. According to Broderick (1988), decades ago, death was a subject less likely than sex to be found in most college curriculum but the commitment to the subject varies from discipline to discipline (Huff, Weisenfluh, Murphy, & Black, p. 220). Today thousands of colleges and universities are involved in death education. Thanks to the wonderful work of our social workers, the importance and discussion of this topic is expanding. Social workers are the only healthcare professionals that focus solely on the psychosocial aspects of death and dying, working directly with the family and client in adjusting to the life-threatening illness and providing them with the adequate resources (Huff, Weisenfluh, Murphy, & Black, p. 227).

  1. “Never tell someone you know exactly what they are going through” (Hopkins, lecture). This may devalue their experience. We may share similar experiences but not everyone has the same exact feelings & reactions to these experiences. It’s important to value and take into consideration the uniqueness of each individual and their troubles.


  1. “Invite adults into the conversation versus asking direct questions” (Hopkins, lecture). There is a difference between directly asking a client, “how do you feel about your grandmother’s death?” and “I really miss my grandmother, it was a hard process letting go. I remember going on hikes with my grandmother and exploring the parks around our town, do you recall any special or joyful moments you shared with your grandmother”? The question is less intrusive and more inviting, allowing for clients to start reflecting on their own thoughts/feelings in regards to the death of their loved ones.


  1. “You should support the person, check up on them, and be there for them down the road” (Hopkins, lecture). Consistency is key. Telling someone, “call me if you need me” is not enough. People need external support throughout their entire grieving process. As previously mentioned, grieving is a very sad and internal process that may last for multiple years. Often the 2nd second year is the most difficult, as people may start to wake up to the reality that their loved ones are no longer with them (Hopkins, lecture).


  1. When addressing self-disclosure, ask yourself “What is the purpose? Is it going to help your work? While it is important to connect with clients by fostering a sense of genuine care and empathy, you also have to consider just how much is too much. Establishing an appropriate boundary in sharing personal experiences with clients is essential to providing the best possible care to clients. As previously mentioned, you do not want to take away from the client’s individual experience. If what you are revealing is line with helping the client reach their goals, then it may be okay to self-disclose.


  1. Make sure you are properly taking care of yourself; practice positive self-care. Because death can be a very emotionally triggering and taxing experience, it’s important to formulate a proper self-care plan to deal with the emotional ramifications of a client’s death.

    For example, a member of a focus group intended to better understand the educational needs of social work students working with dying clients stated, “I found that the only way that I could deal with the stress of work was to meditate in the mornings, eat right, and get plenty of rest. Otherwise, I couldn’t deal with the death that I saw in my clients” (Huff, Weisenfluh, Murphy, & Black, p. 226).

Your self-care plan has to be suited to meet your own personal needs and may thus consist of different activities that uplift you and help to alleviate the cluster of emotions you are likely to undergo in this field.


References

Hopkins, S. (2016). Lecture on Hospice Care.

Huff, M., Weisenfluh, S., & Murphy, M. (2008). End-of-Life Care and Social Work Education.   Journal of Gerontological Social Work, 48(1-2), 219-231. doi:10.1300/J083v48n01_15

Judy MacDonald Johnston’s 5 Step Plan to Die Well

By: Mindy Barnes

Death is a difficult subject to discuss, especially when the death is our own. Many of us avoid the topic all together until it is too late.  But like it or not, death is inevitable. According to Judy MacDonald Johnston, planning for your end of life is a very important process. It will not only help you die well, it will also help you to maintain a high quality of life right up to the very end. For those of us who are finally coming to terms with our own mortality but don’t know how to begin the planning process–or those of us who still need to be dragged kicking and screaming–Judy has some tips to help. Here are Judy MacDonald Johnston’s 5 practices to help you prepare for your end of life:


#1. The Plan

Here are some questions to help you begin your end of life plan. Who do you want as your power or attorney, and your medical power of attorney? Where would you like to go if/when the time comes when you are no longer capable of performing activities of daily living? Do you want your family to follow the palliative care outlined by a hospice program? How do you feel about physician-assisted suicide? Do you or do you not want the following extension of life procedures administered: CPR, feeding tube, surgery, breathing machine, antibiotics, etc.? These are all questions that you need to answer and have a plan for.

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#2. Advocates

Your advocates are there to communicate with others (medical teams, family members, etc.) what your wishes are in regard to your end of life care when you are no longer able to do so yourself. You want to make sure that you choose the right person(s) to ensure that you get the end that you want. Advocates should have the time and the ability to handle this important, yet at times stressful and emotional, task. A good advocate may have the following attributes: adapts well to change, keeps calm under pressure, has good people skills, is not afraid to ask questions. Before choosing an advocate(s), make sure to have an open conversation with them and be sure that they agree to be your advocate.

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#3. Hospital Readiness

Prepare a Medical Emergency Packet. This packet should include a summary of your medical information, and copies of important documents such as your ID, insurance cards, Durable Power of Attorney for Medical Decisions, and Do Not Resuscitate Order. Give a copy of this packet to your advocates and keep yours in an easy to access place This will make admission to the hospital quick and less stressful, and will reduce risks of treatment errors.

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#4. Caregiving Guidelines

Do you want to live in an assisted-living community, or would you prefer to stay at home and hire a professional caregiver? Determine what is a best fit for your personality, but also what you can afford. Do not settle either. You should not rush your decision. Take the time to find your perfect match.

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#5. Last Words

During your last days/hours, you may not be able to speak. So, it is important that you decide now what you would like to hear from others. You may want to be reassured that everything will be fine, so let others know what you may be worried about. Also, write a list of who you will want to see during your last days. And if you follow all of these practices, you will hopefully be able to die with peace of mind.

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Sources:

http://www.goodendoflife.com/worksheets/

5 Facts About End of Life Care-Carly Danowitz

  1. Frail elderly is a term used to identify a group of the elderly population with severe limitations in activities including walking speed, chronic exhaustion, weak grip strength, and declining activity levels. Many of the clients gerontological social workers work with are considered frail elderly. (DiNitto & McNeece, 2008, p. 262)

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  1. People of color have shown low utilization rate of mainstream healthcare and social services. It is very important for social workers to make sure that the elder care and other services they are referring their clients to are culturally relevant. In doing so, social workers should develop relationships with various religious organizations and ethnic social groups who can help coordinate services to elder people of color. (DiNitto & McNeece, 2008, p. 269)

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  1. Illnesses and disabilities in elderly people causes declines in functioning and can also limit a person’s ability to perform basic activities such as bathing and toileting, as well as independent activities in daily life including housework, money management, and meal preparation. About 1/3 of elderly Americans have a severe disability, and as age increases, the risks from these disabilities increase as well. (DiNitto & McNeece, 2008, p. 272)

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  1. According to the National Alliance for Caregiving and the American Association of Retired Persons, its estimated that 34 million caregivers in the United States provide unpaid caregiving to people over the age 50. These caregivers are commonly the elderly person’s spouse, children, or children-in-law. (DiNitto & McNeece, 2008, p. 279)

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  1. State adult protective services are extremely important, especially because some older adults are emotionally or physically abused or financially exploited by caretakers, their family, and others. When the elderly person cannot care for him or herself and are unwilling to receive assistance from others is considered self-neglect. The adult protective services employs social workers to investigate these cases, and when warranted, take actions to secure services needed by these people. (DiNitto & McNeece, 2008, p. 281)

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References:

DiNitto, D., & McNeece, C. (2008). Social work: Issues and opportunities in a challenging profession (3rd ed.). Chicago, IL: Lyceum Books.