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PracticePerspectives
Challenges and Opportunities forSocial Workers in Hospice and Palliative Care
FallI S S U E
N O V E M B E R2 0 1 2
IntroductionSocial work in hospice and palliativecare requires a high level of professionalknowledge and skill. NASW has longadvocated for professional social workqualifications in hospice and palliativecare. In recent years, however, thefederal government has downgraded thequalifications needed to practice socialwork in hospice settings. This change ispart of a deprofessionalization trendaffecting social workers and clients in avariety of practice settings. Social workpractitioners can promote the professionby enhancing their palliative andhospice expertise, educating consumersand their colleagues about the socialwork role within interdisciplinarypalliative and hospice teams, conductingand promoting research to demonstratethe value of social work education andtraining within hospice and palliativecare, and advocating on organizationaland state levels.
Hospice and Palliative SocialWork Knowledge and Skills Hospice and palliative social work requirespecialized knowledge and skills, as describedin the NASW Standards for Palliative & Endof Life Care (2004). Practitioners must beattuned to and able to intervene in situationsinvolving complex ethical concerns, such asend-of-life decision making. Personal andprofessional self-awareness is needed to ensurecompassionate, person-centered responses toindividuals and families participating inhospice and palliative care. Moreover, socialworkers must recognize that individual andfamily perceptions of and responses to illness,disability, dying, death, grief, and bereavementvary greatly and, consequently, strive to serve each client system in a culturally andlinguistically appropriate manner.
Hospice and palliative social workersfrequently deal with nuanced situations and,therefore, must possess strong skills in clientengagement and biopsychosocial assessment.Practitioners may implement a wide variety ofinterventions used to support individuals andfamilies. Clear, concise, timely documentationof social work assessments and interventions is
Chris Herman, MSW, L ICSW
Senior Prac t i ce Assoc ia te
Occupational Profiles: Available athttp://workforce.socialworkers.org/studies/other.asp• Social Work Salaries by Gender• Social Work Salaries by Race/Ethnicity• Social Workers in Colleges and Universities• Social Workers in Government Agencies• Social Workers in Health Clinics & Outpatient Health
Care Settings• Social Workers in Hospice and Palliative Care• Social Workers in Hospitals and Medical Centers• Social Workers in Mental Health Clinics & Outpatient Facilities• Social Workers in Private Practice• Social Workers in Psychiatric Hospitals• Social Workers in Schools• Social Workers in Social Service Agencies
Social Work Practice Perspectives: Available atwww.socialworkers.org/practice/default.asp• 2011 Medicare Changes for Clinical Social Workers• Accountable Care Organizations (ACOs): Opportunities for
the Social Work Profession• Adolescent Depression and Suicide Risk: How Social
Workers Can Make a Difference• Advocating for Clinical Social Workers: Highlights of 2010• Creativity and Aging• Dangerous Rites of Passage: Trends in College Alcohol
Consumption• Domestic Violence and Human Trafficking: Double Jeopardy
for Immigrant Women in the United States• Domestic Violence and Women of Color: Complex Dynamics• Engaging Young People in Their Transition Planning• Healthy People 2020: Social Work Values in a Public
Health Roadmap
• Opting Out of Medicare as a Clinical Social Worker• Results of 2010 Psychotherapy Survey• Support for Family Caregivers: The National Landscape
and the Social Work Role• Supporting the Child Welfare Workforce to Reduce
Child Maltreatment• The Medical Home Model: What Is It and How Do
Social Workers Fit In?
Leadership Ladders: Steps to a Great Career in Social WorkAvailable at http://careers.socialworkers.org/professionaldev/default.asp• From the Front Line to the Corner Office• Letting Your Voice be Heard• Managing Stress• Navigating Large Service Systems• Opening a New Private Practice• Outside the Lines: Maximizing the Flexibility of a
Social Work Degree• Presenting Your Work to Others• Publishing as a Practitioner• Risk Management in Clinical Practice• Strengthening Your Writing Skills: An Essential Task for
Every Social Worker• The Tech-Savvy Social Worker: Prepared for the
Challenges of 21st Century Practice• The Value of Dual Degrees
New Practice StandardsFor a complete list of practice standards, visitwww.socialworkers.org/practice/default.asp• NASW Standards for Social Work Practice with Family
Caregivers of Older Adults (2010)
750 First Street NE, Suite 700Washington, DC 20002-4241SocialWorkers.org
The NationalAssociation ofSocial Workers
750 First Street NE
Suite 700
Washington, DC 20002-4241
SocialWorkers.org
©2012 National Association ofSocial Workers. All Rights Reserved.
Practice Perspectives Fall November 2012
Center for Workforce Studies & Social Work Practice Recent Publications
critical to ensure continuous, coordinated care.Furthermore, because self-determination is integralto both the social work profession and thehospice and palliative philosophy, social workersneed to advocate for the rights, decisions, andneeds of individuals and families.
Hospice and palliative social workers must becomfortable working autonomously and able toexercise strong individual judgment, often in crisissituations. At the same time, they work closelywith other members of the interdisciplinary team,communicating during and between teammeetings and sometimes conducting joint visits orfacilitating family meetings with their colleagues.Such collaboration necessitates not only a strongsocial work knowledge base, but also anunderstanding of how to support the work ofother disciplines while maintaining a social workscope of practice. Thus, palliative and hospicesocial workers need to engage in ongoingprofessional development to ensure their practicereflects ongoing advances in the field.
Personnel Requirements for Hospiceand Palliative Social WorkThe Centers for Medicare & Medicaid Services(CMS) sets Conditions of Participation (CoP) forhospices that participate in the Medicare and
Medicaid programs. These requirements, firstimplemented in 1983, were revised to somedegree in 1990 and underwent major revisionbetween 2005 and 2008. The latest CoP,which took effect on December 2, 2008,include significant changes to the personnelrequirements for hospice social work:
• Whereas the previous CoP required abachelor’s or master’s degree in social work(BSW or MSW) to perform hospice socialwork, the current CoP require an MSW,BSW, or “a baccalaureate degree inpsychology, sociology, or other field relatedto social work” (Medicare and MedicaidPrograms, 2008, pp. 228–229).
• Whereas the previous CoP did not requireMSW supervision of BSWs, the new CoPrequire all baccalaureate-level staffperforming medical social services withinhospice programs to be supervised by anMSW. This requirement applies to bothBSWs and individuals with baccalaureatedegrees in other disciplines. CMS exemptsonly one subgroup from the supervisionrequirement: BSWs who work for the samehospice organization that employed thembefore the CoP took effect (Medicare andMedicaid Programs, 2008).
In addition to the educational and supervisionrequirements specified above, the 2008 CoPrequire “one year of social work experience in ahealth care setting” (Medicare and MedicaidPrograms, 2008, p. 229). This requirementmatches that of previous CoP for hospiceprograms participating in Medicare and Medicaid.
Though states and employers may implementmore stringent personnel qualifications than thoseset by CMS, changes in the federal requirementshave garnered concern among hospice socialworkers of all educational levels. MSWs mayfind their direct practice opportunities limitedbecause some hospice programs now employbaccalaureate-level staff for jobs previously heldby MSWs. On the other hand, the newsupervision requirement may limit employmentopportunities and mobility for BSWs.
Of greatest concern to NASW and many socialworkers is that both MSWs and BSWs must nowcompete for hospice social work jobs withindividuals who lack social work education andtraining. This change parallels both thedeprofessionalization affecting multiple socialwork practice settings (NASW, 2012) and thedowngrading of CMS personnel requirements forcertain other health care settings, such as nursingand skilled nursing facilities (Requirements forLong-Term Care Facilities, 1992). In bothinstances, social workers have raised concernthat lack of social work education and trainingmay compromise the quality of services providedto individuals and families (Bern-Klug et al., 2009;Social Work Policy Institute, 2010a, 2010b).
The revised CMS personnel requirements forhospice social work have implications far beyondhospices participating in Medicare and Medicaid.The Joint Commission’s accreditation standards forhospice defer to CMS’s personnel qualifications(The Joint Commission, 2012, StandardHR.01.02.01, EP3). Similarly, the JointCommission’s advanced certification for palliativecare programs defines social worker as “anindividual who either has met the requirements ofa graduate curriculum (leading to a master’sdegree) in a school of social work accredited bythe Council on Social Work Education, or whohas the documented equivalent in education,
training, or experience [emphasis added]” (C. Mooney, personal communication, May 10,2012).i These broad requirements for hospiceand palliative social work in Joint Commission–accredited and certified programs are but oneexample of the ripple effect triggered by the2008 Hospice Conditions of Participation forMedicare and Medicaid Programs.
What Social Workers Can DoCountering the deprofessionalization of palliativeand hospice social work requires a multiprongedapproach. NASW consistently strives to promotethe professional social work role in hospice andpalliative care on a national level. Social workpractitioners can further this goal by taking actionin their individual practice and within theirorganizations, communities, and states:
• STRIVING FOR INDIVIDUAL EXCELLENCE.Reading professional literature andparticipating in continuing education specificto palliative and hospice care helps socialworkers keep up with the latestdevelopments in practice and research.
• CONSIDERING CERTIFICATION.The NASW-NHPCO credentials for hospiceand palliative social work allow socialworkers to demonstrate their commitment topalliative and hospice care.
• EDUCATING COLLEAGUES.Social workers can help their interdisciplinarycolleagues understand both the psychosocialchallenges associated with serious orlife-threatening illness and the social workrole in palliative and hospice care.
• RAISING CONSUMER AWARENESS.Effective social work intervention not onlyenhances client coping but also conveys apositive impression of the social workprofession.
• CONDUCTING RESEARCH.Research linking social work education withbeneficial client and program outcomes isneeded to make the case for hiring BSWsand MSWs in palliative and hospice care.
The revised
CMS personnel
requirements for
hospice social work
have garnered
concern among both
BSWs and MSWs.
Hospice and
palliative social
work require
specialized
knowledge and
skills, as described
in NASW’s
Standards for
Palliative & End of
Life Care (2004).
critical to ensure continuous, coordinated care.Furthermore, because self-determination is integralto both the social work profession and thehospice and palliative philosophy, social workersneed to advocate for the rights, decisions, andneeds of individuals and families.
Hospice and palliative social workers must becomfortable working autonomously and able toexercise strong individual judgment, often in crisissituations. At the same time, they work closelywith other members of the interdisciplinary team,communicating during and between teammeetings and sometimes conducting joint visits orfacilitating family meetings with their colleagues.Such collaboration necessitates not only a strongsocial work knowledge base, but also anunderstanding of how to support the work ofother disciplines while maintaining a social workscope of practice. Thus, palliative and hospicesocial workers need to engage in ongoingprofessional development to ensure their practicereflects ongoing advances in the field.
Personnel Requirements for Hospiceand Palliative Social WorkThe Centers for Medicare & Medicaid Services(CMS) sets Conditions of Participation (CoP) forhospices that participate in the Medicare and
Medicaid programs. These requirements, firstimplemented in 1983, were revised to somedegree in 1990 and underwent major revisionbetween 2005 and 2008. The latest CoP,which took effect on December 2, 2008,include significant changes to the personnelrequirements for hospice social work:
• Whereas the previous CoP required abachelor’s or master’s degree in social work(BSW or MSW) to perform hospice socialwork, the current CoP require an MSW,BSW, or “a baccalaureate degree inpsychology, sociology, or other field relatedto social work” (Medicare and MedicaidPrograms, 2008, pp. 228–229).
• Whereas the previous CoP did not requireMSW supervision of BSWs, the new CoPrequire all baccalaureate-level staffperforming medical social services withinhospice programs to be supervised by anMSW. This requirement applies to bothBSWs and individuals with baccalaureatedegrees in other disciplines. CMS exemptsonly one subgroup from the supervisionrequirement: BSWs who work for the samehospice organization that employed thembefore the CoP took effect (Medicare andMedicaid Programs, 2008).
In addition to the educational and supervisionrequirements specified above, the 2008 CoPrequire “one year of social work experience in ahealth care setting” (Medicare and MedicaidPrograms, 2008, p. 229). This requirementmatches that of previous CoP for hospiceprograms participating in Medicare and Medicaid.
Though states and employers may implementmore stringent personnel qualifications than thoseset by CMS, changes in the federal requirementshave garnered concern among hospice socialworkers of all educational levels. MSWs mayfind their direct practice opportunities limitedbecause some hospice programs now employbaccalaureate-level staff for jobs previously heldby MSWs. On the other hand, the newsupervision requirement may limit employmentopportunities and mobility for BSWs.
Of greatest concern to NASW and many socialworkers is that both MSWs and BSWs must nowcompete for hospice social work jobs withindividuals who lack social work education andtraining. This change parallels both thedeprofessionalization affecting multiple socialwork practice settings (NASW, 2012) and thedowngrading of CMS personnel requirements forcertain other health care settings, such as nursingand skilled nursing facilities (Requirements forLong-Term Care Facilities, 1992). In bothinstances, social workers have raised concernthat lack of social work education and trainingmay compromise the quality of services providedto individuals and families (Bern-Klug et al., 2009;Social Work Policy Institute, 2010a, 2010b).
The revised CMS personnel requirements forhospice social work have implications far beyondhospices participating in Medicare and Medicaid.The Joint Commission’s accreditation standards forhospice defer to CMS’s personnel qualifications(The Joint Commission, 2012, StandardHR.01.02.01, EP3). Similarly, the JointCommission’s advanced certification for palliativecare programs defines social worker as “anindividual who either has met the requirements ofa graduate curriculum (leading to a master’sdegree) in a school of social work accredited bythe Council on Social Work Education, or whohas the documented equivalent in education,
training, or experience [emphasis added]” (C. Mooney, personal communication, May 10,2012).i These broad requirements for hospiceand palliative social work in Joint Commission–accredited and certified programs are but oneexample of the ripple effect triggered by the2008 Hospice Conditions of Participation forMedicare and Medicaid Programs.
What Social Workers Can DoCountering the deprofessionalization of palliativeand hospice social work requires a multiprongedapproach. NASW consistently strives to promotethe professional social work role in hospice andpalliative care on a national level. Social workpractitioners can further this goal by taking actionin their individual practice and within theirorganizations, communities, and states:
• STRIVING FOR INDIVIDUAL EXCELLENCE.Reading professional literature andparticipating in continuing education specificto palliative and hospice care helps socialworkers keep up with the latestdevelopments in practice and research.
• CONSIDERING CERTIFICATION.The NASW-NHPCO credentials for hospiceand palliative social work allow socialworkers to demonstrate their commitment topalliative and hospice care.
• EDUCATING COLLEAGUES.Social workers can help their interdisciplinarycolleagues understand both the psychosocialchallenges associated with serious orlife-threatening illness and the social workrole in palliative and hospice care.
• RAISING CONSUMER AWARENESS.Effective social work intervention not onlyenhances client coping but also conveys apositive impression of the social workprofession.
• CONDUCTING RESEARCH.Research linking social work education withbeneficial client and program outcomes isneeded to make the case for hiring BSWsand MSWs in palliative and hospice care.
The revised
CMS personnel
requirements for
hospice social work
have garnered
concern among both
BSWs and MSWs.
Hospice and
palliative social
work require
specialized
knowledge and
skills, as described
in NASW’s
Standards for
Palliative & End of
Life Care (2004).
Social work
practitioners can
promote the profession
by enhancing their
palliative and hospice
expertise, educating
consumers and their
colleagues about the
social work role within
interdisciplinary
palliative and hospice
teams, conducting and
promoting research
to demonstrate the
value of social work
education and training
within hospice and
palliative care, and
advocating on
organizational
and state levels.
• PUBLISHING.Articles published in the professionalliterature and popular media enhance theprofession’s knowledge base and promotepublic understanding regarding the socialwork role in hospice and palliative care.
• ADVOCATING.States and organizations have the option toexceed personnel requirements set by boththe federal government and accreditationbodies for hospice and palliative social work.
ConclusionThe downgrading of the social work personnelrequirements within CMS’s Hospice Conditions of Participation has a wide-ranging impact on hospice and palliative social work. This change presents concerns and challenges for many social workers. Multifaceted interventionis required to uphold and promote theprofessional social work role within palliative and hospice care. Action on the part ofpractitioners can complement work being done on a national level.
ReferencesBern-Klug, M., Kramer, K.W.O., Chang, G.,Kane, R., Dorfman, L. T., & Sanders, J. B.(2009). Characteristics of nursing home socialservices directors: How common is a degree insocial work? Journal of the American Medical Directors Association 10, 36–44.
The Joint Commission. (2012). The JointCommission comprehensive accreditation and certification manual (E-dition Release 4.2).Retrieved from https://e-dition.jcrinc.com
Medicare and Medicaid Programs: Hospice Conditions of Participation Rule, 42 C.F.R. § 418 (2008).
National Association of Social Workers. (2004). NASW standards for palliative & end of life care. Retrieved fromwww.socialworkers.org/practice/bereavement/standards/standards0504New.pdf
National Association of Social Workers. (2012).Deprofessionalization and reclassification. Social work speaks: National Association ofSocial Workers policy statements, 2012–2014(9th ed., pp. 77–81).
Requirements for States and Long Term CareFacilities Rule, 42 C.F.R. § 483.15 (1992).
Social Work Policy Institute. (2010a). Hospice social work: Linking policy, practice,and research. A report from the March 25,2010 symposium.www.socialworkpolicy.org/wp-content/uploads/2010/09/SWPIHospice-Report-FINAL.pdf
Social Work Policy Institute. (2010b). Social work services in nursing homes: Towardquality psychosocial care. Retrieved fromwww.socialworkpolicy.org/research/social-work-services-in-nursing-homes-toward-quality-psychosocial-care.html#ref
Resources NASW RESOURCESAdvanced practice specialty credentials inhospice and palliative social workwww.socialworkers.org/credentials
Bereavement/end-of-life care practice pagewww.socialworkers.org/practice/bereavement
Continuing educationwww.socialworkers.org/cePolicy on hospice care (published in Social Work Speaks: National Association of SocialWorkers Policy Statements, 2012–2014):www.naswpress.org/publications/practice/speaks.htm
Social Work Policy Institute hospice symposium reportwww.socialworkpolicy.org/wp-content/uploads/2010/09/SWPIHospice-Report-FINAL.pdf
Standards for Palliative & End of Life Care (2004)www.socialworkers.org/practice/bereavement/standards/standards0504New.pdf
OTHER RESOURCESCenter to Advance Palliative Careonline discussion forum for social workers in palliative carewww.capc.org/forums/
Journal of Social Work in Palliative &End-of-Life Carewww.tandfonline.com/toc/wswe20/current
National Council of Hospice & PalliativeProfessionals social work sectionwww.nhpco.org/i4a/pages/Index.cfm?pageid=3628
Oxford Textbook of Palliative Social Work(Oxford University Press, 2011)
Social Work Hospice and Palliative Care Networkwww.swhpn.org
Social Work Network in Palliative andEnd-of-Life Care Listserv (Beth Israel Medical Center)www.stoppain.org/for_professionals/content/information/listserv.asp
i NASW does not have access to the advancedcertification manual for palliative care programs. The author obtained information by email from the Joint Commission’s Standards Interpretation Group,www.jointcommission.org/standards_information/online_question_form.aspx
Medicare andMedicaid Programs:Hospice Conditionsof Participation Rule
§ 418.114 Conditions of
participation: Personnel
qualifications.
(b) Personnel qualifications
for certain disciplines.
The following qualifications
must be met:
(3) Social worker. A person who—
» (i)(A) Has a Master of Social
Work (MSW) degree from
a school of social work
accredited by the Council
on Social Work Education; or
» (B) Has a baccalaureate
degree in social work from
an institution accredited by
the Council on Social Work
Education; or a
baccalaureate degree in
psychology, sociology, or
other field related to social
work and is supervised by
an MSW as described in
paragraph (b)(3)(i)(A) of
this section; and
» (ii) Has 1 year of social
work experience in a
healthcare setting; or
» (iii) Has a baccalaureate
degree from a school of
social work accredited by
the Council on Social
Work Education, is
employed by the hospice
before December 2, 2008,
and is not required to be
supervised by an MSW.
(Medicaid and Medicaid
Programs, 2008, pp.
228–229)
Social work
practitioners can
promote the profession
by enhancing their
palliative and hospice
expertise, educating
consumers and their
colleagues about the
social work role within
interdisciplinary
palliative and hospice
teams, conducting and
promoting research
to demonstrate the
value of social work
education and training
within hospice and
palliative care, and
advocating on
organizational
and state levels.
• PUBLISHING.Articles published in the professionalliterature and popular media enhance theprofession’s knowledge base and promotepublic understanding regarding the socialwork role in hospice and palliative care.
• ADVOCATING.States and organizations have the option toexceed personnel requirements set by boththe federal government and accreditationbodies for hospice and palliative social work.
ConclusionThe downgrading of the social work personnelrequirements within CMS’s Hospice Conditions of Participation has a wide-ranging impact on hospice and palliative social work. This change presents concerns and challenges for many social workers. Multifaceted interventionis required to uphold and promote theprofessional social work role within palliative and hospice care. Action on the part ofpractitioners can complement work being done on a national level.
ReferencesBern-Klug, M., Kramer, K.W.O., Chang, G.,Kane, R., Dorfman, L. T., & Sanders, J. B.(2009). Characteristics of nursing home socialservices directors: How common is a degree insocial work? Journal of the American Medical Directors Association 10, 36–44.
The Joint Commission. (2012). The JointCommission comprehensive accreditation and certification manual (E-dition Release 4.2).Retrieved from https://e-dition.jcrinc.com
Medicare and Medicaid Programs: Hospice Conditions of Participation Rule, 42 C.F.R. § 418 (2008).
National Association of Social Workers. (2004). NASW standards for palliative & end of life care. Retrieved fromwww.socialworkers.org/practice/bereavement/standards/standards0504New.pdf
National Association of Social Workers. (2012).Deprofessionalization and reclassification. Social work speaks: National Association ofSocial Workers policy statements, 2012–2014(9th ed., pp. 77–81).
Requirements for States and Long Term CareFacilities Rule, 42 C.F.R. § 483.15 (1992).
Social Work Policy Institute. (2010a). Hospice social work: Linking policy, practice,and research. A report from the March 25,2010 symposium.www.socialworkpolicy.org/wp-content/uploads/2010/09/SWPIHospice-Report-FINAL.pdf
Social Work Policy Institute. (2010b). Social work services in nursing homes: Towardquality psychosocial care. Retrieved fromwww.socialworkpolicy.org/research/social-work-services-in-nursing-homes-toward-quality-psychosocial-care.html#ref
Resources NASW RESOURCESAdvanced practice specialty credentials inhospice and palliative social workwww.socialworkers.org/credentials
Bereavement/end-of-life care practice pagewww.socialworkers.org/practice/bereavement
Continuing educationwww.socialworkers.org/cePolicy on hospice care (published in Social Work Speaks: National Association of SocialWorkers Policy Statements, 2012–2014):www.naswpress.org/publications/practice/speaks.htm
Social Work Policy Institute hospice symposium reportwww.socialworkpolicy.org/wp-content/uploads/2010/09/SWPIHospice-Report-FINAL.pdf
Standards for Palliative & End of Life Care (2004)www.socialworkers.org/practice/bereavement/standards/standards0504New.pdf
OTHER RESOURCESCenter to Advance Palliative Careonline discussion forum for social workers in palliative carewww.capc.org/forums/
Journal of Social Work in Palliative &End-of-Life Carewww.tandfonline.com/toc/wswe20/current
National Council of Hospice & PalliativeProfessionals social work sectionwww.nhpco.org/i4a/pages/Index.cfm?pageid=3628
Oxford Textbook of Palliative Social Work(Oxford University Press, 2011)
Social Work Hospice and Palliative Care Networkwww.swhpn.org
Social Work Network in Palliative andEnd-of-Life Care Listserv (Beth Israel Medical Center)www.stoppain.org/for_professionals/content/information/listserv.asp
i NASW does not have access to the advancedcertification manual for palliative care programs. The author obtained information by email from the Joint Commission’s Standards Interpretation Group,www.jointcommission.org/standards_information/online_question_form.aspx
Medicare andMedicaid Programs:Hospice Conditionsof Participation Rule
§ 418.114 Conditions of
participation: Personnel
qualifications.
(b) Personnel qualifications
for certain disciplines.
The following qualifications
must be met:
(3) Social worker. A person who—
» (i)(A) Has a Master of Social
Work (MSW) degree from
a school of social work
accredited by the Council
on Social Work Education; or
» (B) Has a baccalaureate
degree in social work from
an institution accredited by
the Council on Social Work
Education; or a
baccalaureate degree in
psychology, sociology, or
other field related to social
work and is supervised by
an MSW as described in
paragraph (b)(3)(i)(A) of
this section; and
» (ii) Has 1 year of social
work experience in a
healthcare setting; or
» (iii) Has a baccalaureate
degree from a school of
social work accredited by
the Council on Social
Work Education, is
employed by the hospice
before December 2, 2008,
and is not required to be
supervised by an MSW.
(Medicaid and Medicaid
Programs, 2008, pp.
228–229)
PracticePerspectives
Challenges and Opportunities forSocial Workers in Hospice and Palliative Care
FallI S S U E
N O V E M B E R2 0 1 2
IntroductionSocial work in hospice and palliativecare requires a high level of professionalknowledge and skill. NASW has longadvocated for professional social workqualifications in hospice and palliativecare. In recent years, however, thefederal government has downgraded thequalifications needed to practice socialwork in hospice settings. This change ispart of a deprofessionalization trendaffecting social workers and clients in avariety of practice settings. Social workpractitioners can promote the professionby enhancing their palliative andhospice expertise, educating consumersand their colleagues about the socialwork role within interdisciplinarypalliative and hospice teams, conductingand promoting research to demonstratethe value of social work education andtraining within hospice and palliativecare, and advocating on organizationaland state levels.
Hospice and Palliative SocialWork Knowledge and Skills Hospice and palliative social work requirespecialized knowledge and skills, as describedin the NASW Standards for Palliative & Endof Life Care (2004). Practitioners must beattuned to and able to intervene in situationsinvolving complex ethical concerns, such asend-of-life decision making. Personal andprofessional self-awareness is needed to ensurecompassionate, person-centered responses toindividuals and families participating inhospice and palliative care. Moreover, socialworkers must recognize that individual andfamily perceptions of and responses to illness,disability, dying, death, grief, and bereavementvary greatly and, consequently, strive to serve each client system in a culturally andlinguistically appropriate manner.
Hospice and palliative social workersfrequently deal with nuanced situations and,therefore, must possess strong skills in clientengagement and biopsychosocial assessment.Practitioners may implement a wide variety ofinterventions used to support individuals andfamilies. Clear, concise, timely documentationof social work assessments and interventions is
Chris Herman, MSW, L ICSW
Senior Prac t i ce Assoc ia te
Occupational Profiles: Available athttp://workforce.socialworkers.org/studies/other.asp• Social Work Salaries by Gender• Social Work Salaries by Race/Ethnicity• Social Workers in Colleges and Universities• Social Workers in Government Agencies• Social Workers in Health Clinics & Outpatient Health
Care Settings• Social Workers in Hospice and Palliative Care• Social Workers in Hospitals and Medical Centers• Social Workers in Mental Health Clinics & Outpatient Facilities• Social Workers in Private Practice• Social Workers in Psychiatric Hospitals• Social Workers in Schools• Social Workers in Social Service Agencies
Social Work Practice Perspectives: Available atwww.socialworkers.org/practice/default.asp• 2011 Medicare Changes for Clinical Social Workers• Accountable Care Organizations (ACOs): Opportunities for
the Social Work Profession• Adolescent Depression and Suicide Risk: How Social
Workers Can Make a Difference• Advocating for Clinical Social Workers: Highlights of 2010• Creativity and Aging• Dangerous Rites of Passage: Trends in College Alcohol
Consumption• Domestic Violence and Human Trafficking: Double Jeopardy
for Immigrant Women in the United States• Domestic Violence and Women of Color: Complex Dynamics• Engaging Young People in Their Transition Planning• Healthy People 2020: Social Work Values in a Public
Health Roadmap
• Opting Out of Medicare as a Clinical Social Worker• Results of 2010 Psychotherapy Survey• Support for Family Caregivers: The National Landscape
and the Social Work Role• Supporting the Child Welfare Workforce to Reduce
Child Maltreatment• The Medical Home Model: What Is It and How Do
Social Workers Fit In?
Leadership Ladders: Steps to a Great Career in Social WorkAvailable at http://careers.socialworkers.org/professionaldev/default.asp• From the Front Line to the Corner Office• Letting Your Voice be Heard• Managing Stress• Navigating Large Service Systems• Opening a New Private Practice• Outside the Lines: Maximizing the Flexibility of a
Social Work Degree• Presenting Your Work to Others• Publishing as a Practitioner• Risk Management in Clinical Practice• Strengthening Your Writing Skills: An Essential Task for
Every Social Worker• The Tech-Savvy Social Worker: Prepared for the
Challenges of 21st Century Practice• The Value of Dual Degrees
New Practice StandardsFor a complete list of practice standards, visitwww.socialworkers.org/practice/default.asp• NASW Standards for Social Work Practice with Family
Caregivers of Older Adults (2010)
750 First Street NE, Suite 700Washington, DC 20002-4241SocialWorkers.org
The NationalAssociation ofSocial Workers
750 First Street NE
Suite 700
Washington, DC 20002-4241
SocialWorkers.org
©2012 National Association ofSocial Workers. All Rights Reserved.
Practice Perspectives Fall November 2012
Center for Workforce Studies & Social Work Practice Recent Publications