By Kaitlin Louie
[About Sheila Clifford, LCSW]:Sheila Clifford worked at Hospice by the Bay for six and a half years as a field social worker and a manager of a transdiciplinary team. At Hospice by the Bay, Ms. Clifford oversaw a team of nurses, social workers, home health aides and spiritual care counselors for both adult and pediatric patients. She also supervised the pediatric hospice team. This leadership experience allowed her to assist in the implementation of improvements in the electronic medical system and to launch programs to track patients who were discharged from hospice. Ms. Clifford currently works at Kaiser Hospice in the Volunteer and Bereavement departments as a Social Services Team Coordinator. She received her MSW from San Jose State University. After graduating from her MSW program, she also earned an Advanced Certification in Hospice and Palliative Care.
[OnlineMSWPrograms.com] Can you give an overview of the core responsibilities of the hospice social worker, including how they help patients and their specific role as part of a team of hospice staff? How does hospice social work relate to palliative care social work?
[Sheila Clifford, LCSW] Hospice social workers wear many hats and their role depends on the needs of each family and patient. Some patients and families need assistance with caregiving, logistics of where the patient will live during their final days or assistance with documentation. Other families/patients are in need of processing their terminal diagnosis and the process that leads to their hospice admission. They need to tell their story and each story is unique and deserves that recognition. One of the most incredible parts of this job is listening to patients tell their life story which is often referred to as “life review.” Patients recall all of the occurrences in their life…the pain, joy, love and triumph.
Hospice social workers also educate. Many families have never experienced a death and need constant education around end of life issues and what to expect as their loved one is declining. Hospice social workers will walk the family through decision-making along with the assistance of their nurse and/or MD.
Hospice social work and palliative care are closely related and often work together. The palliative care movement is growing and is able to reach patients and families prior to hospice. Many patients and families feel that hospice is “the end” but may be open to a palliative care consult or support. Palliative care does not require a patient to have a prognosis of six months or less, while hospice does. Palliative care provides support to patients and their families during treatment with the hope of alleviating symptom burden. A palliative care social worker might meet with a family during the course of treatment and offer support. The social worker can also take the psychosocial perspective of exploring how each member of the family is impacted by this disease and treatment while possibly starting some facilitation of discussion around the patient’s desire and choices in his or her treatment.
[OnlineMSWPrograms.com] During your work at Hospice by the Bay, what were your experiences working directly with hospice patients and did you work with hospice patients of all age ranges?
[Sheila Clifford, LCSW] As a field social worker I held a caseload of patients ranging in age from infants to adults. Some women who received prenatal diagnoses which were incompatible with life were referred to our program for the social worker to facilitate discussion around a birthing plan that aimed to empower the woman during the delivery of her baby as well as give hospital staff information, such as the baby’s chosen name, in order to personalize this incredibly difficult process.
I also covered all pediatric patients and their families. The challenge of losing a child is one that no parent can or should have to imagine. In each family situation we are trained to “meet the family where they are.” My approach to each family was unique. It was important to let the family lead and offer education/insight at certain moments.
The age of the patient often shapes the interventions that the family/patient needs. Some younger patients with young children needed assistance talking to the kids about their prognosis and in some instances sitting with the family when the kids were told. However the age of the patient did not always predict the plan of care. There were several elderly patients who were not ready to die or their family members were not ready to let them pass. Each family system had a history that continued to play out during the patient’s hospice stay. My role was to listen, validate and walk families through some of the most difficult days.
[OnlineMSWPrograms.com] What were the most challenging aspects of your job at Hospice by the Bay? How do you recommend students who wish to enter hospice social work prepare themselves to face these challenges and hardships?
[Sheila Clifford, LCSW] Working with children around death can be a difficult task. Some families choose to not tell the kids about their diagnosis or prognosis but so many children are perceptive and recognize a sudden shift in their treatment course. Kids often use play to act out their fears or questions. One three year old cancer patient was playing with his super hero figures and he poised the question “Do you think that superman gets scared of dying sometimes?” This was an opportunity to explore his fears through his superhero figure. There is one family who will always sit with me, as the patient was the same age as my son. Same toys in his room and the similarities were startling.
I tend to run to relieve stress. Also having incredible colleagues is so helpful and supportive. Not many people lose patients on an almost daily basis and so it is important to be able to process these losses with people who can relate to that experience. It is so important to not become cold and jaded as many do who experience compassion fatigue. These are not numbers that I can push… these are people who often remember their hospice team for years. If you stop caring it is time to move onto another job.
[OnlineMSWPrograms.com] Why did you decide to become a hospice social worker and what were the most rewarding parts of your job?
[Sheila Clifford, LCSW] The most rewarding part of social work is being able to advocate for patients and families and to listen to their stories. As a hospice social worker education plays a key role not only to the individual patients and families but also to the community. Not many people see death on a daily basis and how it affects families. This job also provides incredible gratitude and reminders to not take life for granted. It is incredibly humbling.
[OnlineMSWPrograms.com] For MSW students who are interested in becoming hospice social workers, what advice can you give them about optimally preparing for this field while pursuing their degree?
[Sheila Clifford, LCSW] I worked as a unit secretary in the Intensive Care Nursery while completing my schooling. This experience transformed my professional goals entirely. The exposure to the hospital, clinical terms and education around diagnosis strongly assisted in my ability to gain a position as a medical social worker. Some schools do offer specific classes on gerontology but not many on medical social work. It is difficult to bring to the classroom the emotion and intensity of the hospital setting where staff and families can never predict where the day may lead. I never imagined myself working in healthcare but continue to enjoy the environment.
Also look for opportunities to volunteer at a local hospice. This experience will allow you to be part of the team and may lead to an internship or even a job. Hospice volunteer programs typically have intense training programs that all will allow you to test out the opportunity. I strongly encourage students to work in their field of choice because sometimes it may appear to be your dream job when in reality it is not. One student wanted to work in criminal justice but after spending a few months working within this field during grad school she decided that it was not the career path for her.
Thank you Ms. Clifford for your time and insights into hospice social work.