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Hospice Social Work: Meeting the Patient’s Needs Where They Are


Social workers comprise one of only four disciplines required to oversee a hospice patient’s plan of care, and with March being National Social Work Month, it’s the perfect opportunity to highlight these core members of the interdisciplinary group (IDG).

What Is a Hospice Social Worker Responsible For?

In general practice, a social worker’s priority is to improve the mental well-being of a patient and help meet their needs.

In hospice care, the Centers for Medicare and Medicaid Services (CMS) Hospice Conditions of Participation (CoPs) require that hospice organizations provide medical social services that are delivered by a qualified social worker under the direction of a physician.

The hospice social worker is responsible for providing services based on both the patient’s psychosocial and comprehensive assessment.

The Psychosocial Assessment

As one of the keys to holistic hospice care, the psychosocial assessment includes an assessment of the patient’s family members and any other caregivers. The data collected as part of the psychosocial assessment impacts the hospice organization’s quality scores as identified by CMS’ Hospice Quality Reporting Program (HQRP) in the Hospice Item Set (HIS).

Some HIS questions regarding the patient’s treatment preferences and beliefs/values addressed are often answered by or with the input of the social worker.

In addition to the HIS assessment questions, the hospice social worker assesses the patient’s and family’s support systems, living situation, quality of family communication, family dynamics, concerns, worries and responses to the patient’s illness and prognosis.

The Benefit of the Social Work Assessment Tool

The psychosocial assessment in Axxess Hospice includes the Social Work Assessment Tool (SWAT) for the patient and caregiver.

This additional level of assessment enables social workers to further assess the needs of the patient and caregiver to ensure that the patient’s plan of care includes comprehensive psychosocial problems, interventions and goals.

The Comprehensive Assessment

A comprehensive assessment examines the patient’s physical, psychosocial, emotional and spiritual needs and must be completed by a member of the IDG team within five days of the patient electing hospice. The psychosocial assessment is part of the information included to generate a comprehensive assessment for the patient.

The hospice social worker is responsible for the ongoing assessment of the patient and updates made to the patient’s comprehensive assessment and plan of care. These updates are required of the IDG team no less than every 15 days.

Understanding the profound role that social workers play in providing holistic care to hospice patients highlights the importance of mental health to a person’s overall health and well-being.

Hospice social workers are always busy. Their work goes beyond continuous assessments and typically impacts other members of the IDG team and hospice staff. These selfless hospice professionals help the world around them, ensuring change for the better.

Axxess Hospice is an intuitive hospice software that allows for documentation at the point of care, resulting in timely and accurate assessments. Its HIPAA-compliant IDG Center streamlines communication and automatically generates documents for IDG meetings.

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