My first field placement occurred at a private, not-for-profit organization for older adults. The organization provides comprehensive social work services that encourage self-respect and independence. Moreover, the organization provides a variety of programs and services including health and wellness education, referrals and linkages to additional resources, caregiver resources, and much more to adults age sixty and older, and their families. My role as a care coordinator provided me with the opportunity to conduct assessments with older adults in their homes, hospitals, or rehabilitation facilities.
One of the greatest challenges I found in this placement was grieving the loss of a client. It is possible to experience the death of a client in a variety of settings; however, there are certain environments where the chances are increased. Social work services involving older adults can have an increased likelihood of experiencing the death of a client. I met Mr. X at a local skilled nursing facility at which he was receiving rehabilitation services. I conducted an assessment with this client to determine his level of functioning related to activities of daily living, and assessed this client’s need for in-home services from the Illinois Department of Aging (IDOA) post-discharge from the rehabilitation facility. This client was discharged with homemaker services set in place. As I assessed this client, I began building a rapport with him. Some days were better than others, as there were times when the client would be defiant and disrespectful. As I provided on-going care management and responded to his questions or concerns regarding the assistance he was receiving, he and I developed a positive rapport.
Mr. X continued to be at risk for falling. He had been re-admitted to the hospital after a fall, then moved to a rehabilitation facility where I re-assessed him for in-home services, and finally discharged to home with services like household help and physical therapy. One day, Mr. X experienced a fall that led to his death. It was believed that he had suffered a heart attack or a stroke prior to falling. My field instructor informed me of my client’s death the next day that I arrived at the internship. I remember feeling shocked and saddened by the news. I knew there was a chance that I could experience the loss of a client; however, I also believed it would not happen to me. There were care coordinators who had worked with older adults for several years and had never experienced the loss of a client. On some levels, I believed that I was alone in the grief and loss process since I was this client’s primary worker. I was attempting to practice self-care and cope with the loss, but at times it was difficult to continue with my daily responsibilities.
Although I worried that my experience of grief might be a sign of weakness, I reached out for support. I cried in front of the staff. I took the initiative to approach my field instructor in order to process the loss of the client and acknowledge the grief I was experiencing. My field instructor allowed me to process my feelings of grief and loss and offered validation and empathy.
Distress is a normal and natural state that should be addressed appropriately within the field placement. In coping with stressful situations, interns are responsible for appropriate self-care and consultation with colleagues; their internship needs to have a culture of openness and sharing. To support them in processing incidents that cause intense emotions, interns should be able to turn to the field instructor, peer support or group supervision, or even professional associations. Since students may see their feelings as a sign of weakness, it is particularly important for field instructors to initiate the conversation with students regarding the loss of the client. I recommend that field instructors receive training in providing support and supervision to students in the event of the death of a client. In addition, I recommend that field instructors and social work faculty regularly review healthy self-care techniques with students. If field instructors can encourage good self-care and reach out to students to process their feelings, students may be able to better cope with loss of a client.
For more information:
Barnett, J.E., Elman, N.S., Baker, E.K., & Schoener, G.R. (2007). In pursuit of wellness: The self-care imperative. Professional Psychology: Research and Practice, 38(6), 603-612. doi: 10.1037/0735-7028.38.6.603
Moore, S.E., Bledsoe, L.K., Perry, A.R., & Robinson, M.A. (2011). Social work students and self-care: A model assignment for teaching. Journal of Social Work Education, 47(3), 545-553. doi: 10.5175/JSWE.2011.201000004
O’Brien, J.M. (2011). Wounded healer: Psychotherapist grief over a client’s death. Professional Psychology: Research and Practice, 42(3), 236-243. doi: 10.1037/a0023788