There are lines social workers have to walk in hospice. There’s the line between promoting things we know are usually good, and respecting people’s reasons for not wanting to discuss them. We walk a line between knowing that facing discomfort is healthy, and respecting that many just don’t want to. This applies to funeral home planning as much as any other topic.
People naturally don’t want to think about which funeral home will retrieve their bodies after they die. And they don’t want to think about who’ll take their loved one’s body away.
But you as a hospice social worker DO have to encourage funeral home arrangements. That can make your position a little uncomfortable.
The solution is to be a fantastic social worker. You can face discomfort, just as you know is healthy for patients to do.
Be persistent yet respectful. Courageous and sensitive. Express willingness toward everybody. Nod your head sincerely for your director who wants the funeral home box checked, and the family that wants you to leave it alone.
Specifically, here’s what I recommend:
1. No prying! Offer to help instead.
I first spend the bulk of the assessment connecting with clients so I gain enough trust to difficult topics. Towards the end, I let them know about the services I provide that I haven’t touched on yet. I pause after mentioning help with funeral home planning. They almost always interject, indicating where they are in making that decision.
If they say, “That’s ok. We have that figured out,” then we are good. I find out who they’ve chosen and move onto another topic.
If they respond by asking for help making the choice, I provide the help.
If they say they know they need to think about it, but just aren’t there yet, I meet them where they at. I might affirm that it is a good idea to plan ahead. Or ask if it will be a burial or cremation. I might ask if it is ok for me to bring the topic up in a future visit. My response depends on how the interaction feels. I’m there to support them.
2. Bring up funeral home planning only as frequently as will be comfortable enough for them.
If mentioning funeral homes brings them to the brink of anger or shutting down, don’t bring it up every time you visit. If they respond more casually, then bring it up more when convenient.
3. Document your ongoing efforts to facilitate funeral plans (even if your efforts are soft and gentle).
If a patient does not yet have a funeral home chosen, document the status and your efforts to discuss the topic in each visit note. This does not mean you need to bring up the topic every visit. If you consciously decide not to, because they are upset about other things, document that. Or if you discussed it during the previous three visits and want to give them a break, document that. Or if you call the son of a facility patient for the sake of discussing funeral homes, but leave a message, document that–even if you don’t refer to the topic in the voicemail.
This way, you have a paper trail demonstrating that your diligence with funeral home planning, without having to inappropriately hound patients or their families.
4. Suggest tentative plans.
When a family member repeatedly states she’ll work on her decision, but doesn’t, I suggest we settle on a tentative back-up plan.
“You can always change your decision, but for now, how about we list Heart of Texas Cremations as your funeral home? Then, when the time comes, we can either call them or call one you’ve looked into before then.”
Usually they respond positively. Sometimes they end up doing their research while there’s still time and choosing another. If they don’t, there’s a plan in place if they aren’t able to think about it when their loved one has passed away.
This may seem ethically dubious, but I believe it’s appropriate. We are not manipulating them into making any decision when we take this approach: the actual decision won’t made until the patient has passed away and we ask the family if it’s ok to go ahead and call the funeral home. Their acquiescence is not a decision. It is a baby step towards a decision. As long as they know they can change their minds, a tentative plan is better than no plan.
Being effective in this role with funeral home planning can take some practice, but hopefully these ideas can help. When we return next week, we’ll talk about how to make routine visits both thorough and out-of-sight!