Archive for Social Worker

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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Hospice Strangers at Your Door

It's like a crowd headed your way . . .

It’s like a crowd headed your way . . .

In 1989’s Field of Dreams, Kevin Costner’s character famously heard, “If you build it, he will come.” If you haven’t seen the film, I won’t reveal the enigmatic “he” that eventually arrived at the baseball field built on an Iowa farm.

I usually recall the quote as “If you build it, they will come” . . . since crowds did gather at that heaven-like spot of the Midwest.

Field of Dreams was a sweet fantasy, but the reality of hospice means that many strangers will also arrive at your house. While hospice care happens away from a person’s residence, 58% (according to 2014 data) of all hospice patients remain in their homes and the “team” from hospice knocks on your front door. Part of hospice’s appeal is allowing people to continue living in the place they know best: home. For some families, that appeal is undermined by the flood of “strangers” from hospice phoning to make appointments and soon parking on your street.

If only it was one “he” that arrived at the busy “field” formally known as your lovely, quiet home!

First it may be the admitting nurse that visits. Maybe she or he actually came to the hospital, and they shared about the great things hospice will do. You heard hospice’s wonderful promise about the patient—your beloved—being able to return home. Where do you want to die? (Research I’ve read indicates 7 in 10 prefer home.) You may never see the admitting nurse again once you’ve agreed to hospice, but I hope it was a good experience. I hope she helped you understand the hospice benefits. I hope he was able to answer many of your pressing questions. Read More →

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