Caregiver stress is predictable when someone is dealing with medical illness. The American Association of Retired Persons (AARP) estimates that 43.5 million adults in the US provided uncompensated care to an adult or a child in the past year, at an average rate of 24.4 hours per week. This raises the question: Who is helping the caregivers? Are we identifying them when their loved one enters the hospital system? When they are out-patients or at their primary-care appointment? Among the many providers in the medical world, clinical social workers are ideally positioned and professionally trained to help those who are helping others.
As the embedded Clinical Social Worker on a Palliative Care (PC) in-patient consult team at Duke Hospital, I have the skill-set both to assess for caregiver stress and to apply expertise in family systems for the benefit of caregivers. I am fortunate to have the PC Team supporting my clinical work—not everyone does. Many hospital systems devalue the role of clinical social workers or even fail to offer their services to patients and families. According to the American Hospital Association in North Carolina, only one hospital in our state has a separate Social Work Department. Other hospitals may offer social services within a case management or discharge planning department, but that translates as fewer clinical social workers available for caregivers and patients.
Ample data confirms the importance of assisting caregivers, as in the cases of end-of-life discussions, increasing bereavement adjustment[i], and the provision of emotional support leading to the family’s higher overall satisfaction.[ii] We know that families often experience PTSD, depression, and complicated grief when a loved one is in intensive care[iii]. Providing clinical interventions at this care-point can greatly improve the caregiver’s ability to manage and overcome the typical feelings of confusion and anxiety when a loved one is close to death.[iv] These are salient examples of where and how the expertise of clinical social workers can have a direct and powerful impact on the lives of patients and their caregivers.
Whether on a Palliative Care team or a general acute-care medical team, we clinical social workers need to explain what we accomplish and why we are indispensable. Our clinical colleagues need to be respectful and aware of our skills, and we must continue to make a case for the necessity of this work. We are committed to providing the best care possible. Sometimes that means reminding management: If we can do a better job helping caregivers, we will impact the important “bottom line” of effective hospital care for patients.
More of this discussion may be found at http://www.pallimed.org/2016/10/palliative-care-for-caregiver-distress.html
Vickie Leff, LCSW, BCD, ACHP-SW, is a Palliative Care Clinical Social Worker at Duke University Hospital and a member of the board of directors of the Center for Clinical Social Work/ACSWA.
[i] Wright, A. et.al. Associations between End of Life Discussions, Patient Mental health, Medical Care Near Death, and Caregiver Bereavement Adjustment. JAMA 2008;300(14)
[ii] Roza, K., Lee, E., Meier, D. A Survey of Bereaved Family Members to Assess Quality of Care on a Palliative Care Unit. Journal of Palliative medicine. 2015/ Vol. 18. No. 4
[iii] Aslakson, R., Curtis, R., Nelson, J. The Changing Role of Palliative Care in the ICU. Critical Care Medicine. 2014 Vol. 42, No. 11.
[iv] McLIvennan, C., et.al. Bereaved caregiver Perspectives on the End-Of-Life Experience of patients with a Left Ventricular Assist Device. JAMA Intern. Med. March 21, 2016