Who cares for the caregivers? Why medical social workers belong on end-of-life care teams.
Changes within the health care industry have resulted in a shift that, to a large extent, places patients in the position of managing their own health care. While self-determination is desirable, it can also lead to new challenges, as when patients who are critically ill and/or dying must rely on family members to function as primary caregivers and managers of their treatment plans. Typically, patients and their families lack the guidance and oversight of a medical professional to coordinate a multifaceted health care regimen instituted by the variety of specialists involved in patients' diagnoses and treatments. As the patients' health declines and treatment plans become more complex, so too does the level of involvement of family caregivers, who often must manage treatment plans in addition to providing bedside care. This article cites the example of a woman who was exhausted by her role as sole caregiver for her dying husband and describes her feelings of powerlessness within the hospital setting as she struggled to coordinate assistance from her husband's medical specialists during end-of-life decision making. This case illustrates the importance of the following: (a) in cases involving hospitalized patients who require complex care from multiple specialists, it should become standard practice to enlist medical social workers to provide an overall assessment of the patients' status, prognoses, and home care plans, (b) in cases involving prolonged home care culminating in end-of-life decisions, the needs of nonprofessional caregivers must be recognized, evaluated, and addressed.
Dubus
Nicole
N
School of Social Work, Wheelock College, Boston, Massachusetts, USA. nicole.dubus@gmail.com
D017028:Caregivers / Q000523:psychology*; D002908:Chronic Disease / Q000523:psychology; D003657:Decision Making; D005192:Family Health; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D010817:Physician-Patient Relations; D012648:Self Care / Q000379:methods / Q000523:psychology; D012947:Social Work / Q000379:methods; D012962:Sociology, Medical; D013727:Terminal Care / Q000379:methods / Q000523:psychology*