Social Workers: Meeting Families Where They Are

One of the principal challenges of being a social worker is “meeting patients and families where they are.” It’s a very popular catchphrase in the healthcare field.  

If you’re unfamiliar with the meaning of this saying, it pertains to respecting the choices and circumstances related to a patient’s lifestyle and working with them according to their physical/mental capabilities and limitations. The families we work with come in all shapes and sizes. They come from all around the world toting various cultural traditions, habits, family dynamics, personalities, communication practices and lifestyle preferences. As social workers, we welcome the idea of individual freedom and accept family dynamics of all types without hesitation.

However, when it comes to letting our patients make personal choices we foresee as being dubious, we turn into superheroes set on saving them from peril. Of course! We became social workers to help people, right? The correct answer is yes…and no.

The Role of Social Workers in Hospice Care

The Social Work Code of Ethics Preamble states, “The primary mission of the social work profession is to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed and living in poverty…. with attention to the environmental forces that create, contribute to and address problems in living.”

In a nutshell, the role of a social worker is to provide or recommend the best services that meet their patients’ and clients’ needs and preferences.

As medical social workers serving hospice patients, it is our duty to protect our patient’s right to self-determination regarding end-of-life choices. Sometimes this means not only accepting, but actually providing assistance facilitating, something potentially risky.

A perfect example is helping with the residential relocation of a patient from a clean, socially-inclusive nursing home to a family member’s home, which may be substandard. If the patient is alert and oriented, we must respect their choices and maintain the personal boundaries that help differentiate what we want for our patients and their reported desires/needs.

Of course, we may and should look out for our patient’s best interest by educating them on the potential harmful consequences their decisions may create. However, our primary roles are to empower and provide valuable services. As social workers, we must empower patients/families to make choices even if we don’t agree with them.

How to Meet Families Where They Are: Guidelines for Social Workers

What I would like to offer social workers trying desperately to best serve sometimes seemingly self-destructive patients while respecting their right to self-determination are some general guidelines in conjunction with the following disclaimer: There is an invisible, yet impenetrable, line between you and the patients/families you serve. You are not responsible for their wellbeing. You role is to be useful and provide aid. Your mode of service is “social” and has a unique set of guidelines regarding expectations and limitations:

1. Set the tone: Be available to your patient, return calls and address needs during regular business hours to establish limits and set the standard for appropriate communication/contact.
2. Patients will tell you what they want/need: When you are visiting a family or patient, give them your full attention. Really listen to what they have to say and communicate that you understand.
3. Complete the cycle: Follow through with providing information or any other services you have made an agreement to provide. Inform them of your progress and effort toward resolving an identified issue.
4. Be mindful of community context: Be knowledgeable of the population you are serving.
5. Offer simple/direct information: Provide accurate and appropriate education/information so patients have the necessary knowledge needed to make informed decisions regarding end-of-life choices.
6. Know the limitations of your role: Ensure that you, your patients and their families fully understand your role and the boundaries associated with your effort to provide social services.
7. Meet patients where they are…not where you want them to be: How wonderful it is to be heard, seen and appreciated for the individuals we are? The people we serve feel most respected and cared for when we see them as they truly are and when we limit our function to service rather than transformation.
8. At the very least, do no harm: Know that there will be times you will feel ill-equipped or ineffective when attempting to provide services for patients and families. If you are unable to be beneficial to those you serve, then do your best to refrain from causing harm.
9.  Intention counts: If you end your day feeling like you did not accomplish your goals, take time to appreciate your intention.We do not control the outcome of our effort to serve others and improve people’s lives. More often than not, it seems like goals are not accomplished and you may not feel a sense of accomplishment. Please take time to appreciate your intentions of being helpful.
10. Gratitude: At the end of the day, take time to feel a sense of gratitude for yourself and appreciate the people with whom you come into contact. The patients and families you work with will indeed impact your life. Take time to acknowledge the life experiences we share.

“We are our choices.” ― Jean-Paul Sartre

Angela Arnold
Crossroads Hospice
Support Services Director

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