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Career Story: Social Worker At A Hospice

Social Worker At A Hospice

Job Title: Social Worker

Education: Master of Social Work (MSW), Boston University

Previous Experience: I have been a college psychology teacher for 20 years but without a degree which allowed for counseling licensure. I decided to get a second Masters so I could be licensed and eventually have the option to do private practice counseling.

Job Tasks: I am a social worker for a local hospice organization. A hospice provides services to people who are terminally ill and choose to no longer seek medical interventions for their illnesses. My position as social worker provides case management, counseling and general support to terminally ill patients and their families.

As a case manager, I help the family and patient access support services like volunteers, homemakers, chaplain services, companions and other community services that help a patient to remain in their home until their death if that is what they prefer. Sometimes patients and families will need longterm placement support for a patient to move into a nursing home or hospice house for end of life care.

As a counselor, I support dying patients in resolving life issues and relationship issues that have not been addressed. I also support patients in creating their own funeral/memorial services if they desire to do so. It can be hard to deal with the reality of one's own impending death and counseling can allow for people to freely speak of their fears, hopes, and beliefs around death and dying. Family members of dying patients often begin grieving well before the patient actually dies. Social workers offer bereavement support to family and friends and help them to find positive ways of coping with the impending loss of a loved one.

A typical day consists of listening to the phone messages from hospice staff that update the clinicians on patient status changes. This phone system keeps us all on the same page as nurses, social workers, chaplain, volunteers and home health aides go to their patient visits. Patient deaths are also reported through the phone system so we all know that it's time for bereavement support for the family and caregivers.

After checking in, I usually scan my appointments for the day and confirm them by phone with the patients I have scheduled visits with. Sometimes, people who are dying do not feel well, or do not feel like talking about death and dying. Sometimes they cancel visits and we support their right to do so. Dying at home offers patients the ability to be in control of who comes into their home and which services they accept or decline. It allows people to die as they want to die without medical interventions or directions of external 'authorities'.

I see an average of three patients per day in their homes and the average visit is about one hour. After the visit, I am required to do medical charting. Charting entails logging into a medical database that houses patient assessments, problems and goals, and space for clinical notes. It is important that this documentation be completed in a timely manner so that other clinicians can follow along with what each team member is doing with any given patient.

Beyond visits and charting, I attend counseling team meetings and interdisciplinary team meetings in which staff share experiences, ideas, case studies, patient status, and other pertinent issues in an effort to provide integrated support to the patient and family. The hospice team that I work with are amazingly dedicated professionals who offer comfort, care and compassion to patients and families.

Hospice social work is just one way that a Masters in Social Work can be used. As a licensed social worker, one might get a job in a hospital, nursing home, outpatient mental health clinic, school, private practice mental health clinic, business, government and social services. It is a degree that offers a very wide range of uses both as a clinical counselor and as social service program planner and developer.

In Massachusetts there are two levels of licensure. The first licensing exam happens after graduation from an MSW program (LCSW). Then, after two years of practice with supervision, a social worker can sit for the second level of licensure (LICSW). At this level of licensure, one could open a private counseling practice and bill insurance for mental health services.

As someone who has studied both psychology and social work as advance degrees, I would recommend social work as a practical and versatile choice in the counseling industry.

Best and Worst Parts of the Job: I love most aspects of my job; home visits, charting, meetings, the team process. Some days the quota of visits adds unnecessary pressure to my day. Some days the weather is terrible and I still have to get out there and see people in their homes. Some days are sad as family express their grief at losing a loved one. Overall, I love this work and feel privileged to be allowed into people's process of dying, a most intimate and personal time of their lives.

Job Tips:
1. Go full time for 2 years in a program that requires internships so you can get practice as you take courses. This is invaluable.

2. Try out social work in a few different venues. For example, shadow a hospital social worker, a school social worker, and others to see which population matches your preferences and personality.

3. As a hospice social worker, one needs to be clear about their ideas about living and dying. This work can take a toll on people who are easily overcome with empathic emotion as we often witness people in pain.

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