A Quest for Meaning: Hospice Social Workers and Patients with End-Stage Dementia (Report)

Social work, like other health care fields, is facing a paucity of individuals interested in pursuing practice with older adults (Cummings, Adler,&DeCoster, 2005; Cummings&Galambos, 2002). Although interest in gerontological social work practice has been historically lower than interest in other practice areas, such as children and youths, it is even lower when considering practice with older adults with some form of cognitive impairment, such as Alzheimer's disease or related dementias (Kane, 1999).The number of individuals with Alzheimer's disease or a related dementia will reach 14 to 16 million by 2050 (Alzheimer's Association, 2005), ensuring that social workers, whether or not they are employed in gerontological settings, will interface with individuals with dementia and their caregivers during their professional careers. Greater consideration is needed for how to better promote dementia care as a valuable and needed form of social work practice. Therapeutic nihilism (Dunkelman&Dressel, 1994; Kane, 1999), a belief that interventions cannot benefit patients due to their cognitive health status, may affect the interest of professionals in dementia care. This becomes a bigger concern at the end stages of the disease, a period when the cognitive impairment is most progressed. Even though social workers have a firm grounding in equality and the belief that individuals, regardless of disability or health status, can benefit from therapeutic services, many of the traditional functions of social workers involve two-way communication and client involvement during the therapeutic process. This presents challenges for social workers when working with these patients given the inability of patient with end-stage dementia to engage in this type of relationship. This, unfortunately, leaves social workers questioning whether their involvement with the patient had any purpose, meaning, or value (Sanders&Swails, 2009).