Hospice & Palliative Care Social Work: A Guide for 2020

In this article:

What is a Hospice Social Worker?

According to the National Hospice and Palliative Care Organization, 1.49 million Medicare beneficiaries were enrolled in hospice care (PDF, 1.3 MB) for one day or more in 2017. As the population continues to age, the number of social workers needed for hospice and palliative care will likely continue to increase.

Palliative care can begin at diagnosis, and at the same time as treatment, according to MedlinePlus.gov. Hospice care begins after treatment of the disease is stopped and when it is clear that the person is not going to survive the illness.

Hospice programs provide medical care; psychological, emotional, social and spiritual support; and pain management treatments and services to patients suffering from debilitating conditions or terminal diagnoses. Patients who need hospice care and their families experience a number of hardships, including anger and anxiety; depression; financial strain; intense physical pain or discomfort; social isolation; and family conflict.

Hospice services are delivered not only at hospice centers but also through in-home care services. For instance, hospice social workers might provide services to visitors of hospice centers and follow up with terminally ill clients who need intensive medical care during hospital visits.

What is a palliative care social worker?

Palliative care focuses on relieving physical suffering and continuing life-prolonging medications. Such services are delivered at hospice centers, through in-home care services and palliative care departments of hospitals.

Palliative care social workers address a client’s physical, mental, social and spiritual well-being in all disease stages, and accompany the client from diagnosis to cure. Palliative care social workers might conduct home visits to help clients and their families establish effective palliative care at home. They also may act as an advocate with medical providers.

Role and duties of hospice social workers

Hospice social workers help clients and their families navigate planning for end-of-life care; understand their treatment plan and be vocal about their needs; manage the stresses of debilitating physical illnesses, including emotional, familial and financial; overcome crisis situations; and connect to other support services. Hospice workers are advocates for patients and their families, and know what their clients need and what resources are available within and outside of hospice settings to help them.

Hospice and palliative care social work is challenging work, as it involves helping people through difficult and stressful times of their lives. However, the rewards may include making strong connections with people, learning and celebrating their life stories, and having a positive impact on clients and their families.

Education requirements

Master of Social Work (MSW) programs prepare students to train to become licensed social workers. They help students with foundational social work courses while focusing on the skills needed to provide social work services and treatment to individuals and small groups.

Students may learn advanced assessment techniques, how to promote, develop, and restore mental health and social functioning and how to diagnose and treat psychosocial problems. Students may also be taught how to evaluate their practice and intervention techniques. Palliative care and hospice social worker candidates may have a special emphasis on elder care.

Learn more about online MSW programs with a clinical concentration.

Salary

The median pay for social workers is $50,470 per year, according to the Bureau of Labor Statistics (BLS). The median wage for health care social workers, which includes hospice and palliative care social workers, is $59,300.

The BLS projects there will be 11% more jobs for social workers from 2018 to 2028, a growth rate much greater than the average for all occupations. Increased demand for health care and social services will drive employment growth, but the prospects of each specialization, such as hospice and palliative care social workers, will vary.

The Difference Between Hospice and Palliative Care

While related, hospice and palliative care are distinct from each other in several key ways. Hospice care involves caring for patients who are suffering from an acute terminal illness that has progressed to the point that they have fewer than six months to live. Palliative care is medical treatment that does not seek to cure disease, but helps patients manage the symptoms of their condition. Hospice care includes palliative care, but palliative care also applies to patients who are not suffering from terminal illnesses and who require non-curative remedies for painful or debilitating symptoms.

The simultaneous distinction and overlap between hospice and palliative care means that social workers who work in hospice care by necessity work in palliative care, while palliative care social workers may not work in hospice settings.

How to Become a Hospice or Palliative Care Social Worker

Below are six common steps to become a hospice or palliative care social work.

  1. Complete a bachelor’s degree in social work or a related field.
  2. Pursue an MSW with relevant coursework.
  3. Seek an internship in a medical, hospice or palliative care setting and complete required fieldwork.
  4. Take the licensing exam.
  5. Earn relevant certifications.
  6. Apply for state social work licensure.

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Hospice and palliative care social work takes academic, professional and emotional preparation. Due to the complex nature of the medical conditions of hospice and palliative care patients, and the need to provide intensive care coordination and therapeutic services, social workers in hospice and palliative care settings require a bachelor’s degree in social work (BSW) accredited by the Council for Social Work Education (CSWE) or an MSW.

Charis Stiles, MSW, a Friendship Line manager at the Institute on Aging (IoA) in San Francisco, advises social work students interested in working with hospice and geriatric patients to take as many relevant classes as possible during their MSW program. “I highly recommend taking whatever gerontology-focused classes your program offers. A basic course in death and dying is a wonderful asset, even just for you personally,” she said.

Social work students who are interested in becoming hospice social workers should also seek field internships in medical, hospice or palliative care settings during their undergraduate and graduate work. Otherwise, they should find professional opportunities that provide experience working in health care settings.

The mission of hospice and palliative care social workers is to help clients and their families manage difficult situations with dignity and peace of mind. Through academic and professional training, a network of friends and family, and a sound self-care plan, social workers in hospice and palliative care settings may achieve this mission while building a fulfilling career.

What Does a Hospice or Palliative Care Social Worker Do?

Whether they work at hospice centers, hospitals or in-home care services, hospice and palliative care social workers provide personalized support to clients and their families to help them manage the mental, emotional and social challenges of terminal illness.

The main responsibilities of hospice social workers include conducting psychosocial assessments, coordinating care, providing counseling and psychotherapy, intervening in client crisis situations, and educating clients and families about their treatment plan and the resources and support systems available to them.

Psychosocial assessments

Hospice and palliative care social workers conduct assessments of clients and their families to determine their psychological, social, emotional and spiritual needs. This information is important for the larger hospice and/or palliative care team to develop an effective and compassionate care plan.

Care coordination

Hospice social workers coordinate the care of patients with a team of medical and human service professionals. Care coordination is defined as the delivery of effective medical, psychological and/or social care through the organization of primary and secondary care providers. With their knowledge of systems of care and support within medical settings and the larger community, hospice and palliative care social workers are often the point of contact between different care providers, as well as the liaison between clients and their treatment team.

Hospice and palliative care social workers also play an important role in patient intakes and discharges. During the intake process, they gather data from patients upon their enrollment in a care program (through the psychosocial assessment), orient patients and their families to the hospice or palliative care environment and communicate with the treatment team regarding patients’ ongoing needs.

Counseling and psychotherapy

Hospice and palliative care social workers also provide emotional support, counseling and psychotherapy to clients and their families who are experiencing psychological and emotional difficulties in the face of terminal, debilitating illness or both. Social workers may employ a combination of clinical social work modalities to help their clients evaluate and manage their thoughts and emotions and overcome various behavioral challenges.

In their work with clients, social workers may use mindfulness-based stress reduction, cognitive behavioral therapy, dialectical behavioral therapy, supportive psychotherapy, expressive arts therapy and storytelling therapy. For more information on the therapeutic modalities that hospice and palliative care social workers may use in their work with clients and their families, see our Guide to Clinical Social Work or visit the NASW website.

Stiles explained the therapeutic methods she used with geriatric patients and others in hospice settings at Odyssey Healthcare and the Institute on Aging.

“Counseling and case management are the primary forms of intervention. Life review, grief support and bibliotherapy may also be helpful,” she said. “Life review is essentially actively listening to individuals tell the stories of their lives. Many older clients do not get to share the wisdom and lessons they’ve learned over the decades. Many clients, like clients of any age, need to tell the stories of their experiences in order to integrate and explore themes, come to new insights and better understand the path they have taken.”

Crisis intervention

Social workers in hospice and palliative care settings may also intervene and provide emergency psychological support when clients or their loved ones are experiencing mental, emotional, social or familial crises. Crises are generally defined as events that cause a degree of distress that exceeds an individual’s capacity to cope in the short term.

Qualifying events vary from client to client but may include the unexpected advancement of a particular condition; traumatic family conflicts; neglect, physical violence or verbal abuse that result in trauma; or the development of suicidal desires in a client.

In these situations, hospice and palliative care social workers provide immediate psychological support and counseling, while also coordinating care services by informing the rest of a client’s treatment team so they may collaborate to effectively address the patient’s distress.

Patient education and resource navigation services

Hospice and palliative care social workers help clients and their families understand their treatment plan and the processes involved in hospice and palliative care.

Hospice and palliative care social workers also help clients and their families navigate relevant resources and assistance available to them. Social workers help their clients connect with local resources, such as cancer or terminal illness support groups, pro bono counseling services and religious communities. Social workers’ resource services are typically part of patients’ discharge plans, as they help ensure that clients and their families receive the support they need even after leaving palliative care.

Where Do Hospice and Palliative Care Social Workers Work?

Hospice and palliative care social workers typically work in hospice centers, but also conduct home visits and sometimes work with patients in hospital settings. Depending on their work setting, hospice and palliative care social workers may specialize in serving a particular age group, such as pediatric patients or older adults, or they may serve patients across the age spectrum.

Hospice centers

Hospices are the primary settings in which hospice social workers work. Hospices provide medical care with an emphasis on pain management, emotional and spiritual support for patients and their families (including individual and group therapy and bereavement counseling), and resource navigation services.

Social workers at hospices help to coordinate the care of hospice patients by communicating with all parties involved in a patient’s care, including physicians, nurses, hospice chaplains and the patient’s family.

Palliative care departments of hospitals

Palliative care departments in hospitals are another setting in which social workers provide care coordination, emotional support and resource navigation guidance to patients and their families. According to the Center to Advance Palliative Care, palliative care departments are becoming increasingly available at hospitals and have been proven to improve patient outcomes. Social workers in these settings typically work with a team of care providers, such as physicians, nurses, medical assistants and hospital chaplains.

In-home care services

Some hospice and palliative care social workers work for companies that exclusively provide home care to patients with terminal or incurable and debilitating diseases. Social workers in these settings help patients and their families set up the proper structures for effective home care and ensure that clients get the medical, psychological and social care they need outside a medical setting in their own homes.

For example, they may help communicate clients’ concerns to their medical care providers, and vice versa.

The Challenges and Rewards of Hospice and Palliative Care Social Work

Hospice and palliative care social work is a challenging field, as the daily work involves helping clients and their families cope with severe illness and death. The close and regular interactions hospice and palliative care social workers have with clients and their families may be both rewarding and challenging, especially during the moments when clients must face and prepare for their own mortality.

Despite its challenges, hospice and palliative care social work may also be rewarding for the opportunity it provides to form meaningful connections with people in need and to have a concrete impact on their well-being as they face some of the most difficult moments of their lives. Hearing and participating in the life stories of clients and their families may also be meaningful.

“I have had so many rewarding experiences with clients – so many frail, dying individuals I’ve had the honor of working with and being present for, so many people I’ve been privileged to advocate for when they were not able to speak for themselves, so many grieving families I’ve been able to comfort and counsel,” Stiles said. “It’s been really incredible how many clients have really touched me.”

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FAQs

What does palliative care mean?

According to the World Health Organization, palliative care can improve the lives of patients facing serious illness and their families. Palliative care is centered on preventing and relieving suffering by identifying, assessing and treating pain and other problems—physical, psychosocial and spiritual.

What is the role of a social worker in palliative care?

Palliative care social workers support individuals and families coping with serious illness, facing mortality, the dying process and bereavement. Palliative care social workers have a unique opportunity to help people identify, try to answer and live with core existential questions. Social care workers often receive positive feedback from many individuals, families and other service providers.

How do you become a certified hospice social worker?

The Certified Hospice & Palliative Social Worker (CHP-SW) certification is offered to hospice social workers by the Association of Social Work Boards.

The basic eligibility criteria, according to the National Association of Social Workers (NASW), are:

  • A bachelor’s degree in social work from a graduate program accredited by the Council on Social Work Education.
  • Twenty or more continuing education units related to hospice and palliative care .
  • At least three years of supervised and documented social work experience in hospice and palliative care.
  • Current state license to practice as a professional social worker.
  • Adherence to the NASW Code of Ethics and NASW Standards for End of Life Care.

Do hospice social workers need to be licensed?

Students in most BSW programs will complete fieldwork under the supervision of a licensed social worker. After completion of a bachelor’s degree, candidates can take the Association of Social Work Board’s (ASWB) Bachelor's Exam and become a Licensed Bachelor of Social Work (LBSW or LSW).

In some instances, degrees not in social work will be accepted for bachelor’s licenses, according to ASWB. Some jurisdictions regulate only one of these practice categories, while most regulate two or more categories of social work practice.

How much does it cost to join NASW?

The National Association of Social Workers (NASW) is the world’s largest membership organization of professional social workers, with more than 120,000 members. It works for the growth and development of members, creates and maintains professional standards, and advocates for social policies.

NASW offers a range of membership types, including those for social work students, associate students, transitional, associated, retired and full membership.

Annual dues are $60 for BSW and MSW students and $179 for doctoral students.

Last updated: July 2020