Something is Right With You

"I still believe, in spite of everything, that people are truly good at heart." -Anne Frank

I had a client come into my office the other day. An elderly gentleman who reported that that he has been feeling very lost since the death of he wife and constant companion of 64 years. As he described to me the tragic circumstances surrounding his wife’s passing, my heart ached for him. Before I started working in bereavement, I was under the mistaken impression that it is not such a big deal when the elderly die because they are nearing the end anyway and “have lived a good long life” (as the platitudes offered by well-meaning well-wishers often go). Tell that to the person who has spent the last 64 years with someone by his side.

As a young person, it is difficult for me to even comprehend 64 years of my own life, let alone the idea of spending that much time with a loved one. (At this point, my chances of actually being with someone for that long are really pretty slim. Unless I live to be very very old).

Loss is difficult at any age and for any person. Much of what grieving people need is an opportunity to share their story with someone. Too many times, the bereaved person’s circle of support moves on before the bereaved one is ready to. Too many times, the bereaved person feels like he or she needs to put the grief aside and “get on with life.” Our fast-paced American culture expects the healing process to occur in a small window of time (as evidenced by the fact that most companies only offer about 3 days of bereavement leave).

A vast majority of my hours with clients involves listening to their stories and allowing them to express their grief. Because we live in an impatient culture, bereaved people often feel like something is wrong with them because they are spending “too much” time focusing on the death of a loved one.

The simple truth is that this painful focus is actually a sign that something is right with them. The fact that people have not become so jaded and cynical that they still see and feel the pain that comes with losing a loved one is a sign to me of the goodness of human nature. That in a world full of constant news of tragedies, both personal and public, people still find it in their hearts to love someone else so much that a loss impacts them this badly tells me what amazing creatures we human beings are. 

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Posted in: direct practice,grief and loss,hospice

Religion and spirituality

So one of the volunteers I work with mentioned the other day that I am “just not religious enough to be a good social worker.”  Terrific.

I have two problems with this statement: A) Since when is religiosity (or even spirituality) a prerequisite for success as a social worker? And B) Since when am I not religious?

We are planning a memorial service for hospice families that have lost loved ones in the last year.  It is taking place in a local church. We were discussing the order of programs and it was mentioned that we need an opening and closing prayer. I offered to say the closing prayer. One of the volunteers looked at me and said, “Um, we are looking for someone to pray who has more, um, traditional beliefs. You know, beliefs that go along with the majority of the people in this area.” That was what he said, but what he meant, if you are not a Baptist preacher or preacher’s wife, you are not qualified to pray in public. 

Never mind the fact that this is a non-denominational memorial service meant for members of any/all/no religion. 

During the same conversation, my boss commented to me "you are so unchurched it is ridiculous." Which is actually not true, given that I am a weekly participant in church services, pray several times a day, attend scripture study weekly, and volunteer much of my time each week to my church.

As eye opening as it has been spending this time in the south, I struggle with this a great deal. I grow weary of people assuming that religiosity equals worth in a person. I have had hospice volunteers who have refused to go into the home of a patient who is not religious, and volunteers who have all but insisted that their own minister meet with a non-religious patient to make sure that patient is all right before Jesus before death.

Although intentions may be sincere, this creates challenges as a social worker to train volunteers and staff members to protect the patient’s own right to determine what he/she needs from a spiritual point of view.

Social workers are trained to work in a very inclusive fashion, and to accept the realities of other people’s lives without judgment. This applies to religious beliefs and practices as well. While I don’t personally mind being the religious minority, I do wish that there was a little bit more open mindedness about that in my area.

How do religion and spirituality and social work relate? I feel like in some lines of work, it is a very fine line that separates them. What has your experience been? If you find it to be a fine line, how do you navigate it?

By the way, this is a fascinating project that is attempting to better understand and bring together world religions. If you are interested in getting a better understanding of world religions- either for yourself or to better understand your clients- check out: Project Conversion. And follow it on Facebook here.

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Posted in: direct practice,hospice,religion,uncategorized

Educational Experiences

I’ve had some interesting educational opportunities this week. First of all, I had the privilege of hearing Larry Churchill lecture on the healing power of relationships. Mr. Churchill is a professor of Medical Ethics at Vanderbilt University. The lecture was, for all intents and purposes, absolutely fascinating. Seriously, it was. I mean really.

Mr. Churchill and some colleagues did a qualitative study on medial clinicians who have received peer reports indicating that they are very good at building rapport with patients. The intent of the study was to help us develop some understanding of common practices that are used in building relationships. Mr. Churchill and his colleagues identified some common practices. As a side note, I took copious notes on the lecture, and I was actually complimented on my note taking skills, which is a first for me. Note taking is not normally my strength).

He instructed us to take the time to be present, personalize the relationship with the patient, utilize common courtesies, and do things that remind the patient that you are human too.

He also reminded us to be present and listen. When seeking to engage clients, there should be NO MULTI-TASKING (I am the worst at this. I feel like being present is one of my biggest weaknesses as a social worker). Patients and their families deserve our undivided attention when they are with us.

Ultimately, Dr Churchill told us that clinicians need to live out humility. We should be “worthy to serve the suffering.” This means that we live good lives, we carry ourselves in such a way that suffering people will feel safe with us.

I think one of the most interesting ideas that Dr. Churchill shared with us is that healing is not something that flows from the clinician to the client, but it is a feature of the interaction.

I was also privileged to attend a Q&A session with Elie Wiesel, distinguished professor, Nobel Laureate, holocaust survivor, and political activist. It was a very intimate conversation; only me and a handful of other students. The students asked Dr. Wiesel how he felt about various issues the world is facing, including the wars in Iraq and Afghanistan, the conflicts in Israel and Palestine, the recent suicides of homosexuals, and many other things. He shared with us his mantra: Whatever we do in life, we need to think higher and feel deeper. He encouraged those of us who want to be lifelong servants and humanitarians to remember to enjoy our own lives, but consistently be thinking about those who are unable to enjoy it.

Dr. Wiesel also made a comment about God that resonated with me. A student asked him if he felt that God was indifferent to the suffering in the world. Dr. Wiesel pointed out that the world’s definition of injustice may be different from God’s definition of injustice, due to the fact that God may have a different perspective than those of us on earth. It’s an idea that has been rolling around in my head for a few months now, but he managed to put it into words that make sense other people as well as me.

I’m so grateful for the educational opportunities I have received. I love being able to learn from great people. Great clinicians, great activists, just plain and simple great people. My goodness, I love Social Work!

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Posted in: direct practice,graduate school,hospice,Social Work

Nursing Home Placements

Since I started working in hospice, my opinion about nursing homes has evolved a bit. I used to think of nursing homes as sad, lonely, pathetic places where people go when no one else wants them. Sort of like an orphanage for the elderly. Surely the only people who were placed in nursing homes were those with no other family. When I started working for hospice, I realized that that is not always the case. Sometimes, nursing homes are wonderful places.

Our hospice is very small and does not have any contracts with nursing homes, so when a patient or family chooses nursing home care, they also choose to revoke hospice (some of our competitors have contracts with the nursing homes our patients typically choose, so they are not without hospice care completely). For our hospice this is unfortunate from a business perspective, but it is obviously better for the patient to be able to get around the clock care needed.

We have had several patients who have not identified a primary care-giver, either because there is none available or because they do not feel they need one. In those situations, when the time comes that the patient is no longer able to care for him/herself at home, part of my responsibility is to help the patient identify an acceptable nursing home placement. I’ve found this to be a difficult task; very few patients admit that they are no longer able to care for themselves, and the notion of having to leave one’s home for the final days or weeks of life is understandably unpleasant. These are the situations I’ve struggled with. What is the best way to help a patient see the writing on the wall? If the patient cannot safely be in their home, how can I explain this to the patient, who came into hospice knowing that the mission of hospice is to help patients remain at home?

A couple of months ago, we had a lovely patient Mrs. G. Mrs. G. is a very sweet lady who somehow managed to capture the heart of everyone who came into her small apartment. She was mostly bed bound, did not have any family in the state, and relied on hospice care and four hours a day personal care from her Medicaid benefits. One day, after her personal care aid left, Mrs. G. decided to make herself some stew. She took her oxygen off, turned her crock-pot on dumped the stew in the pot, turned around to answer the phone, and fell over. Since she had chosen not to wear her lifeline, she had no way of reaching anyone. From 1:00pm until 8:00 the next morning, Mrs. G lay on the floor, a hot crock-pot on the counter 6 feet away from her.

When her personal care aide arrived the next morning, she found Mrs. G on the floor, helped her get up, cleaned, and back into bed, then promptly notified hospice. Mrs. G was adamant that she would not go to a nursing home, but gradually relented when the nurse, the chaplain, and I spoke to her and gently encouraged her to reconsider. Luckily, Adult Protective Services did not have to become involved, and Mrs. G headed off to the nursing home, only a little bit sad. Two days later, I stopped by the nursing home to say hello. Mrs. G was a different woman. Although she was of course still terminally ill, her eyes and her face were so much brighter. She reported more energy, and more happiness, which she attributed to finally receiving the care that she needed. She had lots of positive social interaction with the other people in the nursing home, and she could not remember why she had been so adamant about staying in her apartment.

Experiences like this have helped my opinion on nursing homes to evolve. I know that nursing homes are not without problems, but I love the care they’ve been able to give our former patients. Responsible adults who do not wish or are not able to be the main caregiver to their elderly parents do them a large disservice by keeping them at home without providing the highest quality of care. If being the caregiver is not in the cards, the most responsible choice for the family to make is to work to locate the best possible long-term care facility. And visit regularly, of course.

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Posted in: direct practice,hospice