Hospice Social Worker Laura Gilbow sees the joy and sadness that comes with caring for people at the end of their lives
Ten years ago, a supervisor told addiction counselor Laura Gilbow that she was meant to be a social worker. She decided to take an Introduction to Social Work course at Washburn University, just to see what she thought.
“They were my people,” she explains, “the social work core is to be able to help vulnerable people live the way they want. That’s what I wanted to do.”
Gilbow came to Midland Care in 2010 as a Social Work Intern in pursuit of a Master of Social Work (MSW) degree. After her internship, she was totally committed to hospice social work. After interviewing at a number of other organizations that didn’t feel right, she was thrilled to come to Midland Care as a Hospice Social Worker, a unique job that involves helping people in the final months of their lives. She loves her job: working with the elderly, helping empower people to take control of their health care and having a job where each day is different.
Gilbow often starts her day in an Interdisciplinary Team (IDT) meeting, which is part of what makes hospice care unique in the medical system. A group of professionals responsible for patient care, which includes doctors, nurses, social workers, home health aides, chaplains and volunteers, meet several times a week to coordinate patient care. Each member of the team brings a unique philosophy and information to the process. A social worker might help educate the IDT about how to best calm a patient with dementia, or support a patient with a history of substance abuse. In turn, a social worker might learn about a patient’s spiritual needs from a chaplain, or love of reading classic literature from a volunteer. The IDT team can then focus on treating the whole person, with knowledge from each professional contributing to a plan of care.
After IDT, Gilbow will typically set off across Northeast Kansas to visit with patients and families. She visits patients in their homes to help address their questions and concerns. The hospice social worker helps educate the patient and family about what to expect in the final months of someone’s life. They help prepare families for the physical and emotional realities of the dying process. The social worker also initiates planning care for the patient’s final days and funeral services. Much of the discussion centers on the patients goals and wishes. Anticipatory grief, meaning grief before someone dies, is a common issue, and hospice social workers are highly specialized to help both children and adults deal with loss. A hospice social worker might also help connect a patient or family to community services, like Medicaid, Meals on Wheels or other kinds of financial assistance. Gilbow ideally visits patients repeatedly over the course of their final months, helping them with a wide range of issues and questions.
Hospice providers across the United States are increasingly concerned about patients getting hospice care only in the final days or hours of their lives, rather than months, as hospice care is intended. People are hesitant to ask about hospice, fearful about what it means and assuming their doctors will tell them when it’s time to enroll. However, studies have found that patients enrolled in hospice care live, on average, a month longer than patients not in hospice care, have better control of symptoms and report higher quality of life. Gilbow reports that many patients and families wish they had asked about hospice earlier.
Unfortunately, when someone starts hospice services with very little time, patients and families are frequently not able to get education from or plan with the hospice team. This can leave family members reeling from unexpected symptoms, and guessing, sometimes disagreeing, about their loved one’s final wishes.
“It can be very stressful for families,” explains Gilbow, “people need to know that hospice is not about death or giving up, it’s about quality of living and taking back control of your care.”
Gilbow typically spends more time with patients who live alone, who do not have family members or who are estranged from family.
“For people who live alone, the hospice team really becomes their family,” shares Gilbow.
Despite perceptions, working in hospice care can be joyful, beautiful and transformative. It can also be difficult. At the end of a challenging day, Gilbow says focuses on “one thing I did that made a difference for a patient or their loved one.”