The Impact of Prison Hospice

Abstract

This study reports on a qualitative national telephone survey with coordinators of 14 prison hospice programs in 11 states. The rationale behind the survey was to learn about interdisciplinary collaboration between social work and criminal justice, using prison hospice as an exemplar of this collaboration. In addition to learning that all prison hospices in the study operate using an interdisciplinary team model and that most report high quality collaboration on the hospice team, the following additional five themes emerged: administrators and wardens are very supportive while correctional staff provides mixed support to team and program; greater collaboration with those outside prison hospice is critical; collaboration through prison hospice has a positive impact on dying prisoners; collaboration through prison hospice has a positive impact on prisoner volunteers; and, collaboration through prison hospice has a positive impact on the entire culture of the prison.     

The impact of prison hospice: collaboration among social workers and other professionals in a criminal justice setting that promotes care for the dying

This study reports on a qualitative national telephone survey with coordinators of 14 prison hospice programs in 11 states. The rationale behind the survey was to learn about interdisciplinary collaboration between social work and criminal justice, using prison hospice as an exemplar of this collaboration. In addition to learning that all prison hospices in the study operate using an interdisciplinary team model and that most report high quality collaboration on the hospice team, the following additional five themes emerged: administrators and wardens are very supportive while correctional staff provides mixed support to team and program; greater collaboration with those outside prison hospice is critical; collaboration through prison hospice has a positive impact on dying prisoners; collaboration through prison hospice has a positive impact on prisoner volunteers; and, collaboration through prison hospice has a positive impact on the entire culture of the prison.     

Detained and Dying: Ethical Issues Surrounding End-of-Life Care in Prison

Prisons are increasingly being called upon to provide end-of-life (EOL) care within the restrictive correctional environment. Several relatively recent phenomena have brought medical ethics to the forefront of prison EOL care—including aging behind bars, a paradigm shift in prison culture, the increasing rate of in-prison deaths, and the corresponding prison hospice movement. This article examines prominent ethical issues that emerge for prison personnel who are tasked with providing care to terminally ill offenders by presenting three offender composite characters that exemplify dying offenders and emergent ethical issues surrounding their care. Identification and critical analysis of these ethical issues demonstrate the need for strong commitment to ethical practice and highlights specific issues for prisons to examine in their own EOL care practice.     

Live Discharge from Hospice and the Grief Experience of Dementia Caregivers

When an individual has dementia, family members are involved in many care transitions in their roles as caregivers. One such transition is the ‘live’ discharge from hospice services. This occurs when an individual no longer meets eligibility criteria. This can be difficult for caregivers who have been anticipating an end to understand in the context of their grief process. This qualitative study (N = 24) explored the experience of caregivers of adults with dementia, including Alzheimer’s disease, who experienced a ‘live’ discharge from hospice. Specifically, the experience of grief is examined. Results from this study highlight the complexity of caring for someone with a terminal disease and the grief experience in end-of-life care as caregivers struggle to understand the individual’s terminal prognosis as temporary. This is further complicated for caregivers who must resume caregiving responsibilities or assume a new caregiving role after experiencing a loss of hospice services. Finally, hospice social workers are well positioned to offer emotional and other concrete support to caregivers who experience a ‘live’ discharge.     

Unmet Needs at the End of Life

Abstract

Among persons at the end of life, it is important to understand whether the needs of patients are being adequately addressed. In particular, in hospice settings where the emphasis is on comfort care and quality of life, we know little about the presence of unmet needs. The purpose of this study was to examine the experiences of hospice social workers in working with hospice patients who had unmet needs at the end of life. Surveys were mailed to hospice social workers (N = 212) in two Southeastern states with a response rate of 36%. Results revealed that hospice social workers perceived patients to experience a wide variety of unmet needs-more commonly at the time of admission than during subsequent patient interactions. The most common unmet need reported at both times was a decreased ability to participate in activities that make life enjoyable. In situations where unmet needs exist, social workers reported that the most common perceived reasons were patient-related psychosocial issues and family conflict/issues. Additionally, a variety of interventions were used to address unmet needs, but a large number of barriers appear to impact outcomes in the cases. Results suggest that hospice patients experience a number of unmet needs, many of which are potentially treatable problems and concerns. Hospice professionals must continue to seek ways to assess and intervene effectively with patients who have unmet needs.     

Unmet needs at the end of life: perceptions of hospice social workers

Among persons at the end of life, it is important to understand whether the needs of patients are being adequately addressed. In particular, in hospice settings where the emphasis is on comfort care and quality of life, we know little about the presence of unmet needs. The purpose of this study was to examine the experiences of hospice social workers in working with hospice patients who had unmet needs at the end of life. Surveys were mailed to hospice social workers (N = 212) in two Southeastern states with a response rate of 36%. Results revealed that hospice social workers perceived patients to experience a wide variety of unmet needs-more commonly at the time of admission than during subsequent patient interactions. The most common unmet need reported at both times was a decreased ability to participate in activities that make life enjoyable. In situations where unmet needs exist, social workers reported that the most common perceived reasons were patient- related psychosocial issues and family conflict/issues. Additionally, a variety of interventions were used to address unmet needs, but a large number of barriers appear to impact outcomes in the cases. Results suggest that hospice patients experience a number of unmet needs, many of which are potentially treatable problems and concerns. Hospice professionals must continue to seek ways to assess and intervene effectively with patients who have unmet needs.     

Groupwork in a Hospice Setting

Hospice has developed rapidly to become a major health care orovider for those with a life threatening illness and their families. As part of their services, hospices offer several types of groups for their clients, volunteers and staff as well as social support groups for their own team members. This paper examines the functions of groupwork in hospice, focusing particularly on the use of hospice staff support groups. Research on the use of a group perspective and group methods in a hospice setting is presented.     

Grief support groups used by few--are bereavement needs being met?

Few adult bereaved attend closed grief support groups, yet many of those who do attend say they are extremely helpful. This research explores factors influencing support group attendance, and the extent to which bereavement support needs are being met. Focus group discussions reveal that a broad scope of sources of support is available to the bereaved. Results show what is seen as unhelpful to them, and what might be more helpful to them. The study indicates many adult bereaved suffer from an overall lack of support and would benefit from more caring overtures from those around them. Findings from this small frontline hospice bereavement study point toward ideas for adjustments in support groups and innovative bereavement education and programming.     

Hospice care for the child with AIDS

Hospice care was established to provide palliative (i.e., noncurative) services for the dying and their families. The advent of the AIDS epidemic has posed a challenge to hospice care, particularly for the child dying of the disease, and has adapted to modified palliative services. Parents, with a child dying of AIDS, must deal with many issues of disclosing the disease status to the child, coping with the emotions of losing a child, and when and where to incorporate hospice services into the dying process. Optimizing home based hospice care involves; (1) Nutritional management, (2) Prevention of opportunistic infections, (3) Pain management, and (4) Protection of Non-HIV positive members of hospice care. For the dying, hospice strives to achieve a peaceful death and provide supportive intervention for the survivors.     

Suicide in Gaol: The Construction and Measurement of a Phenomenon

The Royal Commission into Aboriginal Deaths in Custody has brought the issue of inmate death, especially suicide, to public attention. This paper examines theoretical accounts and existing research on suicide during imprisonment. Current international findings on the characteristics of inmate suicide are discussed and compared with the findings from the first Australian study of death in prison. It is argued that the extant research on suicide presents a fragmented and incomplete account of the phenomenon. Further, the theoretical construction of suicide within international and local research and the methodological approach to its measurement contribute to the obfuscation of specific aspects of the phenomenon. In particular, attention is deflected from the policies and procedures within the institution. Suggested remedies for reducing the incidence of inmate suicide are thus constrained by the initial construction of the issue. The paper concludes with a discussion of the challenges posed for the Royal Commission into Aboriginal Deaths in Custody. This is contrasted with the need for comprehensive accounts of death in custody which apply to all inmates.     

Grief Support Groups Used by Few—

Abstract

Few adult bereaved attend closed grief support groups, yet many of those who do attend say they are extremely helpful. This research explores factors influencing support group attendance, and the extent to which bereavement support needs are being met. Focus group discussions reveal that a broad scope of sources of support is available to the bereaved. Results show what is seen as unhelpful to them, and what might be more helpful to them. The study indicates many adult bereaved suffer from an overall lack of support and would benefit from more caring overtures from those around them. Findings from this small frontline hospice bereavement study point toward ideas for adjustments in support groups and innovative bereavement education and programming.     

Results of a nationwide hospice and palliative care social work job analysis

The role of the hospice and palliative social worker is often ambiguous and misunderstood by colleagues and fellow team members. One reason for this is the lack of identified, clearly delineated roles, skills, and tasks employed by these specialty social workers in their daily work. This article summarizes the first nationwide job analysis of hospice and palliative social workers. A contextual, cross-sectional survey design was used to identify current and relevant job tasks from practicing hospice and palliative social workers. A sample of 482 social workers representing 46 states responded to a survey that included demographic questions and ranking of 152 tasks and importance to the position. Tasks were categorized into four broad categories: assessment and reevaluation; planning and intervention; death, grief, and bereavement; and professionalism; which includes subcategories consisting of multiple tasks and skills. Respondents identified performing a psychosocial assessment from a patient/family centered care perspective, assessment of the patient’s current and desired quality of life and of coping skills as the tasks most important to their role. This outline of the role of the hospice and palliative social worker was then used in the development of an evidence-based certification exam that may be required of those who want to receive specialty certification in the field.     

Current Inmate Expected Post-Release Needs and Perceived Barriers to Future Voluntary After-Care Program Attendance

When attendance in after-care programs that may help ex-offenders successfully reenter society is not a mandated condition of prison release, getting individuals to voluntarily attend these programs is challenging. In order to help social service agencies better encourage ex-offenders to participate in these programs, it is important to understand ex-offenders’ anticipated needs (thereby increasing possible motivation for attendance) and perceived barriers to program attendance prior to their actual release. Consequently, 256 individuals incarcerated in a county prison in northeastern Pennsylvania were surveyed to address these issues. Findings suggest that women, Hispanics, and parents of children under age 18 anticipate the greatest number of needs upon their future prison release. The most commonly anticipated post-release needs were obtaining food, clothing, education, and child care, although there are group differences. Regarding anticipated programing issues, all inmates foresee transportation barriers to post-release program attendance, and bus passes were the most preferred form of assistance. Scheduling and child care issues were also anticipated programing obstacles and were most pronounced for parents of young children, who report the greatest amount of anticipated needs but also the most barriers to voluntary post-release program attendance. Other group variations and programing implications for voluntary after care are discussed.     

Facilitating forgiveness and peaceful closure: the therapeutic value of psychosocial intervention in end-of-life care

The importance of addressing psychosocial concerns with dying patients is pivotal to facilitating peaceful closure in end of- life care. The social worker's role in recognizing and providing skilled, psychosocial intervention with patients and families in hospice programs is significant. In this article, the literature in this area is examined and a case example of a hospice patient's need for closure and the responsive social work intervention for the patient in his moment of death is provided. The case offers social work knowledge and skills and demonstrates the therapeutic benefit of addressing psychosocial needs in end-of-life care. The importance of targeted training and continued skill development for social workers in end-of-life treatment settings is emphasized.     

Hospice and Latinos: a review of the literature

Research on hospice use by Latinos, although increasing since the late 1990s, remains sparse. This article presents a review of the recent available literature on this topic within the past 15 years. The main aspects discussed are access to hospice care and various factors that researchers suggest affect Latino utilization of hospice care. These factors include beliefs about health care, death and end-of-life care, lack of insurance, lower referral rates by health care professionals and the hospice caregiver requirement. Overall, Latinos underutilize hospice but the reasons remain unclear. No evidence exists to indicate that Latinos are dissatisfied with services once they receive them. Also, no evidence exists to indicate they want services but cannot obtain them. Implications for social work practice and research are discussed.     

Reception to Prison

Summary The paper is concerned with the admission process to prison.The paper begins by outlining some of the current views on theeffects of imprisonment and the adjustment of the inmate toprison life. Gofiman in particular has identified the importantpart played by admission procedures in depriving the individualof his personal identity and immersing him in the institutionalsystem.The authors studied the admission procedures at two penalestablishments to see how far these showed the characteristicsdescribed by Gofrman as being 'fairly standard in total institutions'.The paper describes how the study was conducted, and gives anaccount of the admission procedure at the institutions. In theirfindings the authors try to assess the impact of this systemon the inmate, and its significance within the total socialsystem of the institution. The study casts doubt on the generalapplicability of Goffman's hypothesis, but at the same timeshows that the admission procedure has a potential for introducingthe inmate to his new environment in a constructive way, whichis not being realized within the present system     

A different kind of holding environment: a case study of group work with pediatric staff

This paper reports a nearly two-year intervention with staff at a major urban pediatric facility. The authors worked as trainers and consultants for two groups-the Emergency Department (ED) and Chronic Care units (CC). Following two days of training about grief and loss, highlighting skill building for work with traumatized and grieving children and parents, the consultants worked to develop teams which could provide a Winnicottian holding environment for staff. The efficacy of this staff training is analyzed and support needs of staff members are identified. Findings include varied willingness to make use of group support. Chronic care participants are more likely to express willingness to engage in on-going support for one another, while ED staff members seem to prefer structured, educational training and episodic support. The holding environment of the processing groups must be adapted to fit the needs of the medical sub-culture.     

Hospice and Latinos

Abstract

Research on hospice use by Latinos, although increasing since the late 1990s, remains sparse. This article presents a review of the recent available literature on this topic within the past 15 years. The main aspects discussed are access to hospice care and various factors that researchers suggest affect Latino utilization of hospice care. These factors include beliefs about health care, death and end-of-life care, lack of insurance, lower referral rates by health care professionals and the hospice caregiver requirement. Overall, Latinos underutilize hospice but the reasons remain unclear. No evidence exists to indicate that Latinos are dissatisfied with services once they receive them. Also, no evidence exists to indicate they want services but cannot obtain them. Implications for social work practice and research are discussed.     

Facilitating Forgiveness and Peaceful Closure

Abstract

The importance of addressing psychosocial concerns with dying patients is pivotal to facilitating peaceful closure in end-of-life care. The social worker's role in recognizing and providing skilled, psychosocial intervention with patients and families in hospice programs is significant. In this article, the literature in this area is examined and a case example of a hospice patient's need for closure and the responsive social work intervention for the patient in his moment of death is provided. The case offers social work knowledge and skills and demonstrates the therapeutic benefit of addressing psychosocial needs in end-of-life care. The importance of targeted training and continued skill development for social workers in end-of-life treatment settings is emphasized.