A Life Altering Career

Journey to End-of-Life Social Work

By Camille Evans, LMSW, ACHP-SW
Executive Director,Heart ‘n Home Hospice and Palliative Care LLC.

Heart ‘n Home Hospice and Palliative CareIf you would have told me 10 years ago that I would be working in hospice I would not have believed you.

When I began my social work education, I was working in an adolescent treatment home. I mapped out my education to provide myself with the tools and knowledge to work with the adolescent population. But, once I finished my undergraduate degree and began looking for a job, I was introduced to hospice. I held what I now know are common misconceptions about hospice. I thought hospice was only care for those who had been sent home from the hospital to die. I thought it was incredibly sad and I worried I would become depressed and overly focused on death.

I applied for a hospice position, though, and was granted two interviews. And with each conversation, my assumptions were challenged. I began to see that there was something unique and special about this work. As I discovered the beauty and challenges of this work I saw the difference I was able to make in people’s lives. I found that walking alongside those in the final chapters of their story was a perfect fit for me. I would have never thought I would feel this way.

If you are in a position of planning where your social work career will take you, I encourage you to consider end-of-life work. Here are 10 reasons why being social worker in end-of-life care is the best:

  1. You get to work with every population and walk of life.
    Hospice social workers focus their care on the patient and family system. Death and dying impact everyone regardless of culture, religion, ethnicity, economic class and so on. So, whether you are working with the patient/client or the family/social system around them, you will impact each population.
  2. You learn from those you work with.
    I have learned that it is the relationships we build throughout our lives and gift of being truly present in the moment that mean the most in the end. I have learned that we all have the human capacity to face the unspeakable and come out on the other side stronger with the ability to move forward. These are just a few of the lessons I have learned as those I have worked with have shared with me the knowledge a lifetime of joy and sorrow has taught them.
  3. You have a support team.
    Working in hospice has given me an appreciation for working within a team. The hospice philosophy is holistic care which makes it unique in the medical system. A team consisting of a nurse, doctor, chaplain, CNA, social worker and volunteer work side by side to address the whole patient. It is acknowledged that pain in not only physical. Pain can be emotional, social or spiritual in nature and therefore it requires all members of the team to fully meet the needs of the patient.
  4. People express their gratitude.
    I recognize that most of us did not become social workers expecting to be thanked for the work we do…but who does not like to be recognized for their hard work? Families express their gratitude on a regular basis; hearing the difference the work we do has made in their lives makes those difficult moments and long days worth every minute.
  5. Not everyone can do this work.
    I remember a 30-year-old female patient that was dying of breast cancer. She had a wonderful, caring husband who was doing everything he could to care for her. The cancer had spread to her bones creating intense pain whenever she moved, causing her to be bedridden.. During my visit she decided she had to sit on the side of the bed because she could not stand to lie in bed one more minute. Without success, her husband tried to convince her this was not a good idea. So together we assisted her to the upright position on the side of the bed. As expected, this caused her pain, but she wanted to just sit there for a few minutes. Seeing his dear wife in such pain was more than her husband could handle and he had to leave the room. I sat next to her on the bed and physically and emotionally supported her as she wept. Sitting with people when they are in the depth of incredible pain and just letting them move through it without trying to take it away is not something everyone can do. If you have the ability to give this gift to someone it brings great rewards and I encourage you to recognize that strength you possess.
  6. Opportunity to be an advocate and educator.
    One of the key responsibilities of the social work profession is advocacy. The aging and the terminally ill are a highly vulnerable population whose rights and autonomy are not always considered and respected. A key role of the social worker is addressing the ethical issues presented and providing education to the team, the family, the community and the care system. Social workers offer a unique ethical perspective based on the Social Work Code of Ethics.
  7. You give people the gift of speaking the truths that no one else will speak.
    We live in a society where people will do just about anything to avoid having to talk about issues related to death and dying. I cannot even count the times a patient has been referred to hospice and no one has had the courage to tell them they are dying. Even the medical community will avoid saying the difficult words, leaving the patient and family feeling lost. I believe people need to hear the words “all medical interventions have been exhausted, you are dying.” This gives the individual and the family the opportunity to shift the fight from holding onto hope for a cure to hoping for comfort, quality of life and the opportunity to have the conversations with those they love. Speaking the truths in these situations can be terrifying, but these conversations can change lives if done with compassion and respect.
  8. You will be able to find a job.
    As I write this, there is a shortage of social workers to work with the aging population and the need is only going to increase. With the aging Baby Boomer generation, advances in healthcare increasing life expectancy and current social workers working in this field retiring, the need will nearly double by 2030. Healthcare is quickly becoming one of the primary fields for social work jobs.
  9. Great opportunities for leadership.
    Working within an interdisciplinary team creates opportunity for leadership development. As these skills are developed and demonstrated, I and many others have been given the opportunity for leadership roles early in their careers.
  10. Opportunity to redefine what aging looks like.
    The Baby Boomer population is challenging what retirement and aging looks like. With these changes, the current care delivery systems and policies are being challenged and rewritten. With social workers’ focus and training on holistic care and strengths-based approach, we are the best fit to help move toward a healthier, dignified and informed aging process.

The National Association of Social Works estimates that 75 percent of social workers right now are working with the aging population in some capacity. So I feel safe in assuming I am not alone when I say I found myself working with this population having not been fully prepared to do so. Social work programs are beginning to incorporate gerontology studies into the curriculum; however, for those currently in the field less than 10 percent received training specific to working with this population. The good news? Because of the diversity of the aging population, skills learned in other areas of social work practice are easily transferable. For example, I received a certification in conflict resolution with the idea that I would work with adolescents’ families and these skills would come in handy. I have found that working with families who are struggling with difficult decisions and conflict related to the care of their loved one is not much different. These conflict resolution skills are very valuable. If you are looking for a rewarding, life changing and impactful career, I encourage you to consider hospice or any social work role working with the aging and end-of-life population.

Camille Evans LMSW, ACHP-SW has worked in for Heart ‘n Home Hospice and Palliative Care LLC. since 2007 in the role as direct care provider, Director of Medical Social Services, and currently Executive Director. Camille sits on the Gem County Board of Guardians, NASW Idaho Chapter Board of Directors, and NHPCO Social Work Steering Committee.