Hospice and Palliative Care: Where Are We?

November is National Hospice and Palliative Care month and palliative care is still in its infancy. We are still learning and growing, and in many ways, fine tuning who we are and what we do. As social workers and as leaders, we have work to do. It is critical that we continue to hold true to our core values: service, social justice, dignity and worth of the person, importance of human relationships, integrity and competence, especially as we look at these numbers provided by the Administration on Aging (AoA):

  • PopulationThe older population (65+) numbered 41.4 million in 2011, an increase of 6.3 million or 18% since 2000

  • Older women outnumber older men at 23.4 million older women to 17.9 million older men

  • In 2011, 21.0% of persons 65+ were members of racial or ethnic minority populations

  • About 28% (11.8 million) of non-institutionalized older persons live alone (8.4 million women, 3.5 million men)

  • Almost half of older women (46%) age 75+ live alone

The statistics go on and on and we know that members of our older population will be requiring care of all kinds in ever increasing numbers. Enter…the critical role of the social worker. But, I hate to ask, is the role of the social worker really critical? Let’s take a look: Palliative care is defined in part by the following:

  • Holistic care, utilizing the biopsychosocial/spiritual model

  • Addresses the needs of the patient and her/his family system

  • Assists people to design and achieve their best possible experience

  • Guides, supports and empowers people through the process of understanding what is important to them in their lives

  • Utilizes highly skilled and well-coordinated interdisciplinary teams

  • Assures teams are guided by the patient/family centered plan with the goals they have given to us, and…

  • Aggressively addresses both pain AND suffering

Eric Cassell describes suffering as distress brought about by the actual or perceived impending threat to the integrity or continued existence of the whole person. He states that suffering can include physical pain but is by no means limited to it.¹

But it is not just “pain and suffering” on people’s minds as they live in the light of serious illness. In addition, people struggle with thoughts of letting go of life and as they look for ways to find meaning in their experience. Hospice and palliative care can never have a predominant focus on pain and symptom management with the rest of the team serving in a “by-the-way” capacity. That is not who we are and it is not what we promise. All members of the team are necessary for a person to have a true palliative care experience – and all need to be working in concert around a person-centered plan.

It is now critical for social workers to step up as leaders in palliative care, whether it is raising the bar for more efficient teamwork or at the mezzo level, influencing care nationally and internationally. The goal is to help assure a more consistent approach to care that includes our clinical skill development and best practice approaches.

With this in mind it is exciting to discover that educational opportunities for palliative care and hospice social workers abound. Everything from live intensives to all online programs are available to accommodate diverse learning preferences.  Online programs offer social workers the flexibility to obtain certificates without ever leaving home and completing modules/assignments while working part or full-time.

So here is my challenge for hospice and palliative care social workers this month:

  • Service – work on raising the bar for true inter/transdisciplinary practice

  • Social justice – make a special effort to identify the underserved individuals and populations in your community and reach out

  • Dignity and worth of the person – never forget that “the person” not “the patient” is who we seek to serve

  • Importance of human relationships – “problem focused care plans” are not who we are…nor is our approach “diagnose and treat”. This about assisting people to have THEIR best possible experience which includes “opportunities” they might not have identified on their own

  • Integrity – Our job is to do the best job we can, in every situation, with every person

  • Competence – it is our responsibility to never stop looking for better ways to serve – to never stop seeking ways to improve/complement our skills

In the book “Phantom”, author Ted Bell describes a conversation between a young naval cadet and his boxing instructor. The instructor said:

The ideal fighter has heart, skill, movement, intelligence, but also creativity. You can have everything, but if you can’t make it up while you are in the ring, you can’t be great. A lot of chaps have the mechanics and no heart; lots of guys have heart and no mechanics; the thing that puts it all together, it’s mysterious, it’s like making a work of art, you bring everything to it and you make it up while you are doing it.²

This sounds like social workers. We pack our bags full of skill (mechanics) and life experience (heart) and then…we make it up while we are doing it. During this special month, let’s remember to recognize the importance of all social workers in every area of practice. Stepping up as leaders is truly in our blood and at the heart of who we all are.

For more information on palliative care courses for social workers, visit www.csupalliativecare.org.


¹Cassell, Eric J. 2004. The Nature of Suffering, Oxford University Press, New York, N.Y.

²Bell, Ted (2012). Phantom. Harper Collins, New York, N.Y.

Published by

Gary Gardia

Gary has more than 25 years of experience as a hospice and palliative care social work leader and consultant. He served in leadership positions with National Hospice and Palliative Care Organization (NHPCO) including as the national section leader for Social Work and was instrumental in the creation of their Manager Development Program. View all posts by Gary Gardia

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