Editor's Note: Social Worker Gwen Rifici (LSW, CHP-SW) has 25 years of experience as a social worker, including specialized training in geriatrics and working with HIV patients. Currently, she is Clinical Team Leader for the Medina Home Care and Alternative Home Care Teams.

As a hospice social worker, commitment to a patient's goals of care entails being a good listener, honoring each person's need to follow his or her own path without judgment and collaborating closely with other members of the transdisciplinary team to achieve the best possible outcome. 

When a loved one is dying, the swirl of intense emotions frequently creates complex dynamics that can lead to family discourse and disagreement. I have witnessed family rifts that have deeply affected a patient's peace and well-being. While social workers certainly cannot change family history, they can provide options for creating a peaceful and harmonious journey.   

A hospice social worker's many skills include knowing how to read and defuse a stressful and potentially volatile situation. 

A 37-year old man dying of prostate cancer was newly married. His ex-wife and children from his first marriage were also involved in his goals of care, as were his parents. Conflicts, jealousy and tension arose between these parties, causing the patient spiritual distress and suffering.

I spoke privately with this patient, allowing him to express feelings for his ex-wife, his new wife and his parents. He expressed his desire for peace, but acknowledged several family members were unlikely to get along or feel comfortable in each other's presence. He provided me with permission to speak with each of them individually to present options on how they could assist him. The private conversations the patient and I had with each individual allowed him to express his desires and feelings with each of them.

After the meetings, we devised a care plan that included each of them. A calendar was created denoting each person's role and coordinating visits to minimize friction. I provided one-on-one weekly support to the patient's new bride, identifying her unique role as the patient's wife, and assisted her in coping with the family's involvement.

The outcome was a peaceful patient, and family members who were able to show their individual love for him who felt part of his journey. The patient died as he had wished, with his wife and children at his side. The family members attended the funeral without discourse or malice toward each other. They thanked the whole hospice team for giving each of them purpose, and for validating their love for the patient.

My career as a hospice social worker is deeply rewarding, and one that I cherish. I believe each person deserves dignity and validation at the end of life. As a member of the transdisciplinary hospice care team, I am truly honored to be a part of that.