Roles of social worker on spirituality in palliative and end-of-life care in long-term care

By Karen Lok Yi Wong

Spirituality plays a significant part of holistic well-being of clients in palliative and end-of-life care. As a social worker practicing in long-term care, there were many opportunities which I was involved in the spiritual part of palliative and end-of-life care. The following will share my experience.  

Discussion of spirituality in counselling  

Clients could experience challenging times when they are in palliative and end-of-life conditions. They could suffer physically, emotionally and socially as well as face their dying and death. Some may find spirituality a source of support, comfort and strength. Some may question and challenge their long-term spiritual beliefs. For example, a client of mine questioned, “I long believe in the God but why the God let me suffer?” Social workers often provide palliative and end-of-life counselling in long-term care. They may need to be prepared for discussions on spirituality because clients can bring this up. It is a good idea for social workers to build up some basic competences on how to respond when clients open up the discussions on spirituality. These competences could be active listening and respect to diverse beliefs of spirituality of clients.  

Collaboration with other professionals  

Social workers could play a role collaborating with other professionals meeting clients’ spiritual needs in palliative and end-of-life care.  

• Social worker can connect clients who expressed that they would like to receive pastoral support with pastoral care.  
• With client’s consent, social worker can provide basic information of clients who pastoral care is going to see (e.g. if client has any spiritual belief or religious background).  
• Social worker can provide clients and pastoral care more tangible support (e.g. arranging a quiet space for clients and pastoral care)  
• Some clients may have special diet requests in end-of-life stage related to beliefs and religions. Social worker can liaise with dietitian. For example, previously, I had a client who expressed that she would not eat any meat because she was dying and wanted to prepare herself back to the nature.  

Ethics  

Social workers often handle ethical cases in long-term care. There are ethical cases in palliative and end-of-life care related to spirituality. As a social worker, if I identify as of these cases, I usually bring them up to the interdisciplinary team for further discussions. The following are some examples of ethical cases:  

• Religious groups have regular talks on life, death and dying in the common area of the care home. They respect diversity of spirituality and beliefs and will only invite and bring clients who consent to participate. However, due to limited spaces of the care home, some clients who have different beliefs are in the common area during the talks. They may overhear the talk and feel uncomfortable.  
• The health authority has a policy that after the client has passed away, their body has to be picked up by the funeral service within 5 hours in consideration of health and safety of other residents. A client would like his body to be picked up after one day. This is related to his spiritual belief that there should be enough time for his body to stay in the same place where he left the human world so that his spirit has enough time to leave the body and have a smooth transition to the afterlife world.  

About the Author  

Karen Lok Yi Wong was trained in social policy for BA and MA at University of York, the United Kingdom and social work at UBC, Canada. She conducted research and analyzed policies on palliative and end-of-life care and long-term care and published and presented widely academically and professionally. She is a registered social worker in British Columbia and has been practicing in diverse settings including different long-term care facilities. She was the ethics lead in long-term care. She is also a registered therapeutic counsellor and certified in thanatology: death, dying and bereavement.