A Glimpse into the Life of a Social Worker

Today I shadowed one of our social workers to see a rather interesting case. The pt. is a 65 y.o. man, terminal diagnosis as COPD, who is unable to ambulate on his own and requires assistance to urinate every 10 minutes. His main caretaker is none other than his 85 y.o. mother, who recently threw out her back trying to assist him out of a reclining chair. Upon d/c from the hospital, the mother left under the impression that our hospice company would provide her with 24-hr relief care if she needs help taking care of him, or needs to take a break. (Sometimes hospitals relay information inaccurately, and sometimes family members hear what they want to hear...) Yesterday, our volunteers director was stressed, saying that she can't get any of her work done today because she has to go to a pt.'s house and hold a urinal for him for 4 hours. I now understand that it was because the mother had called our company, asking for a respite aide to come every Wednesday for a 4hr shift so she can go to lunch with her daughter and get her hair done. There are so many things wrong with this whole picture that if I was the social worker, I would've probably pulled my hair out.

The pt.'s mother was so sweet. She kept smiling at me and winking at me as she talked to the social worker (not in a creepy way.) She even took me back to her bedroom to show me her cat nestled under the covers (first cat I've seen since I've been in California! They do exist!) After an hour of talking, discussing, and talking to MediCal on the phone, the social worker was finally able to sign her up for financial assistance to help her afford an aide to come in a take care of her son for a couple hours every so often so she can have a break.

Thoughts/observations of the situation:

1. An 85 y.o. woman should never be the sole caregiver for her 65 y.o. son!
2. She didn't want to put him in a facility, so she agreed to take care of him in her own home 24/7, even though it's not in either of their best interest (can you blame her though? What mother wouldn't want to take care of her own kid, and keep him out of a facility?)
3. You can not request to have a volunteer a.) come at a specified time every week for more than 2hrs at a time because they volunteer their time! and b.) our volunteers are not medically trained and cannot replace a HHA. They are simply a companion. (sorry, I've been in "volunteer training" all week!)
4. If you don't want your mother to have to nurse you through hospice, don't smoke.
5. The nurse assigned to this pt. provided the mother with medication for her laxatives and a back brace for her sore back. She cannot provide medical care to the pt.'s mother (unfortunately.) The mother is not our pt. All she can do is offer medical advice and maybe a referral.

Other things I read today in the volunteers manual about Hospice:

• There are typically 5 stages of grief:
  1. Denial 2. Anger/resentment 3. bargaining 4. depression 5. acceptance
• Grief - physical or emotional reaction to loss
• Bereavement - period of time to grieve after a loss
• Mourning - process dealing with grief
• Anticipatory grief - grief experienced in anticipation of the loss of a loved one
• Shadow grief - feelings of grief which occur on the monthly or yearly anniversary dates of the loved one's death
• Complicated grief - grief that requires processing with licensed medical professionals
• The path of grief is not linear in its progression - it goes back and forth, up and down through each of the stages, often within the same month, week, day, or hour. Unexpected "triggers" can throw a person instantly backwards to earlier stages of grieving. Grief will often appear in some way at some time whether the person wants to deal with it or not.
• Hospice Bereavement: The hospice company follows the bereaved for the next 13 months following the loved one's death with phone calls, cards from the team, home visits, short term counseling, newsletters, etc. This is mandated by Medicare as a vital part of hospice services.
• 1. Routine Bereavement - survivors are seen as probably being able to cope normally with the loss of the pt.
• 2. High Risk Bereavement - survivors may need more immediate attention and are at greater risk for needing support during the grieving process

Facts about grief and bereavement:

• Every person's grief is unique; intensity and duration is unique to their personal experience, personality, and perception of the loss
• there is no proper way to greive
• there is no time limit - can last days, weeks, months, years...
• grief needs a witness - someone to hear the story of loss until it comes to a place within where it can be held without distracting activities of every day life.

Feelings/Emotions of the grieving process:

• sadness, loneliness, emptiness
• loss of appetite/eating too much
• disbelief
• ANGER (towards the person, God, or those around)
  
• fear i wont' survive the grief
• despair at rapid changes
• depression
• yearning/pining for the way things were
• frustration with current situation and the need to deal with things alone
• denial
• shock (at what's happened and/or subsequent events...)
• confusion - what to do next
• numbness as protection from so much pain
• helplessness in the face of overwhelming lack of energy while big decisions need to be made
• relief - see progress through path of grief
• anxiety over "doing the right thing" and caring for yourself and your loved ones

Children and Grief:

• Ages 3-5: may deny death as a final process; see mom and dad leave during the day (death) and come home at night (ta da! not dead anymore!)
• Ages 5-9: may be able to accept the idea that someone has died, but may not understand that it will happen to everyone or even themselves
• Ages 9-10: recognize death as inevitable, even for them

3 questions children may ask:

1. What is death?
2. What makes people die?
3. What happens to people when they die/where do they go?

Memo from the MT: For children’s grief, it’s important to be concrete in the terminology used to describe death. For example, some people may say “go to sleep” but that is not an accurate description of what is happening. Be open and honest in describing death to children.