Archive for Social Worker

Hospice’s Two for One

two for oneBack when working as a hospice chaplain, one of the newer social worker suggested that we visit together. We shared various patients as part of their hospice “team.” I recall that two of those patients lived a long and winding drive from our office. Carpooling was a good use of resources. Additionally, the families wouldn’t be interrupted by multiple phone calls from multiple staff trying to schedule multiple visits.

Everyone loves more phones calls and visits, right?

On the way there, I said, “You know, this does defeat part of our impact.”

“What do you mean?” the social worker asked.

“We won’t get much of a chance for one-on-one encounters. A lot of what we do is based on being with the patient or family member. Having another person around changes that.”

“Oh,” was mostly what she replied. She was young. She was new. On we drove, excellent stewards of hospice resources. Read More →

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A Hospice Chaplain is Quantifiably Wrong

(*Photo by John Rothwell.)

“The nurses do things that can be quantified,” one of our hospice chaplains announced, “which is not like what us chaplains or the social workers do.”

With hospice, a patient is supported by a “team” of doctors, nurses, social workers, chaplains, home health aides, and volunteers.

Was the chaplain, a person and a professional I respect, correct?

What is quantified? It’s a word describing precision, numbers, and comparisons.

A nurse may ask a patient what her or his pain is like on a scale of 1-to-10 or (especially if a patient can no longer talk) to choose from a range of emoji faces depicting happy smiles to grim anguish. Nurses increase or decrease the precise dosages of medications based on experience, information, and established guidelines.

The medical staff in hospice—and this is one of the tough parts of patient care—needs to regularly report how a patient is declining. If a hospice patient demonstrates consistent improvement in their physical health, they certainly still have an illness (and can’t stop the aging process), but they may no longer be eligible for the hospice benefit.

  • Is the patient losing weight?
  • Does he require stronger doses of pain medication?
  • Is she eating less, or only liquids, compared to last week or month?

Yes, nurses quantify, with specifics, to discern a patient’s changes. Read More →

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Social Workers and the Value of Compassion

A compassionate heart…

I smiled.

I shouldn’t have smiled.

Quinn*, one of our social workers, was providing details on a patient’s background and current condition to the rest of the hospice team. The patient, living alone and seventy-something, had numerous health concerns along with her cancer diagnosis.

Our new patient, Quinn suggested, might have undiagnosed mental health issues. She could be easily upset. At times, unexpectedly, she may lash out. It was possible she wouldn’t answer the door and later, when you tried to leave, she might keep talking and talking, making it difficult for staff to leave. Quinn also wondered if the patient would be compliant with medication. (If patients/caregivers forget or refuse the scheduled doses, pain from the disease may spike. Inconsistent dosages make everything for the patient more difficult to manage.)

Why did I smile? Quinn was so, so, so polite when describing this new patient. Read More →

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