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SWHPN's statement in response to the ASWB report

The Social Work and Hospice Care Network (SWHPN) is compelled to issue this statement in response to the demographic data released by the Association of Social Work Boards (ASWB) on the racial composition of social workers passing the licensure exams.

SWHPN applauds the dissemination of this important data, and we are deeply troubled by it. We, like many social work organizations during the past few years, have proclaimed our outrage at the structures of white privilege and our commitment to racial justice in our profession and the larger society. It is in this context that we express profound alarm and dismay at learning of the low pass rates of our Black colleagues on the licensure exams. We believe that this data is the product of the implicit racial bias embedded in the ASWB exam -- a bias that is pernicious and pervasive throughout the education and practice institutions of the United States. Immeasurable injury is exacted to our profession when the ASWB exams prescribe ideas of a "knowledge" that is steeped in dominant white cultural values and ways of knowing. There are no tools of racism and colonialism more powerful than pedagogy and epistemology. SWHPN refuses to remain complicit in perpetuating such systems of racism. To that end, we commit ourselves to the following actions:

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Update on SWHPN's anti-racism work

Hello SWHPN Members! On behalf of the SWHPN Board and staff, we hope you are enjoying a relaxing and safe summer. At the 2022 Conference, we extended our commitment to enhanced communications and transparency with our members. We hope you have enjoyed the new monthly Membership newsletter which came out last week, as well as our first Advocacy and Policy newsletter.  It was developed in conjunction with several Board members, and is generously supported by Healthsperian, a Washington DC-based company that provides healthcare advocacy on behalf of non-profits across the country; they are providing this to SWHPN free of charge to help our members stay abreast of policy issues that may impact our field, and have been supporters of SWHPN conferences for a number of years.

Additionally, we are working to write more regular blog posts, to provide more opportunities to gather feedback from members, and to develop new member benefits, including leadership and professional development opportunities. We also want to make sure our members stay up-to-date on what is happening behind the scenes with the Board and staff as we take on our own development to transform the organization into an anti-racist, inclusive space. 

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SWHPN Statement on SCOTUS Dobbs v. Jackson Ruling

SWHPN Statement on SCOTUS Dobbs v. Jackson Ruling

The Social Work Hospice and Palliative Care Network (SWHPN) is outraged and profoundly disappointed at the decision released on Friday, June 24 by the Supreme Court of the United States in the Dobbs vs Jackson ruling. This decision not only becomes the first Supreme Court decision to take away recognized individual liberty by ignoring stare decisis, it also places many people’s, and in particular, women’s autonomy lives, and well-being in jeopardy.  It conflicts with the Social Work Code of Ethics by interfering with social workers’ commitment to the dignity and worth of every person, and people’s rights to self-determination, especially over their bodies. Bodily integrity and autonomy are cornerstones for liberty within our society. We anticipate that those who have been historically marginalized and excluded within our society will suffer greatly, and disproportionately, from this decision. We will remain vigilant and encourage our members to work for unfettered access to high-quality health care for every person in our country. Social workers will stand firm in our commitment to social justice, access to quality healthcare, including reproductive health, and the right of every person to self-determination and liberty. 

Honoring Lives Lost from Gun Violence

“To heal a person, one must first be a person. We are all spiritual beings. Healthcare is a spiritual discipline.”  
— Daniel Sulmalsy MD, PhD,  The Rebirth of the Clinic: An Introduction to Spirituality in Health Care (2006)


It’s hard to find the words and we are struggling with what to say. But how can we not say anything, not acknowledge the shootings, the grief, the tremendous loss, and suffering. 

In continuing our commitment to speak up against injustice, racism, and acts of violence committed against people of color, SWHPN is issuing this statement to acknowledge the grief, loss, and heaviness in the world right now. SWHPN condemns the recent racist attacks in Buffalo, NY, where 10 people were murdered by a white supremacist; the murders of Taiwanese-Americans in a church in Laguna Woods, California; the massacre of 19 schoolchildren and two teachers in Uvalde; the killings at a medical facility in Tulsa, Oklahoma. These are just the acts within communities that made national headlines in the past few weeks. Yet gun violence remains a public health crisis that disproportionately affects Black and Brown communities. As of June 7, 2022, there have been 8,415 gun deaths and 247 mass shootings this year in the United States (1). 



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A note from the 2022 SWHPN Executive Committee

Dear Members,

We are thrilled to welcome you to the 2022 SWHPN Annual Assembly in Santa Fe, New Mexico. It’s so nice to finally meet in person and we hope you enjoy your time connecting with colleagues you haven’t seen since 2019. 

It’s been an unprecedented two years with the pandemic, murders of Ahmaud Arbery, Breonna Taylor, George Floyd and too many other Black and Brown people, social unrest, and the war in the Ukraine. In reflecting on this year’s theme, “Looking forward & back: celebrating our history and the future of hospice and palliative care social work,” we’re struck by the word “celebrate.” While there is a lot that we are proud of in this field, and proud 
of SWHPN as an organization, it’s a difficult time to “celebrate” when we are aware of our roots in white supremacy and anti-Blackness. As an organization, SWHPN is dedicated to cultivating a sustainable community rooted in belonging and justice. An important part of this is to own our past and move through a period of disruption and discomfort. To develop new ways of working to ensure we do not perpetuate harm to historically marginalized and excluded communities, including our colleagues in hospice and palliative care. 

In Alicia Elliott’s memoir, A Mind Spread Out on the Ground, Elliott, a Mohawk writer, reflects on her childhood growing up on a reservation in Ontario, Canada:

“Perhaps one day this neighborhood, this city, this country will finally hear its neglected past whispering. Look at me plainly. Look at me. Look at your patterns. Don’t make the same mistakes. Don’t hide who you were. Acknowledge it, then make something new, something beautiful, something that will make everyone proud.” (Elliott, Pg. 57)

SWHPN is in the process of reflecting on its patterns, its history – so we can acknowledge where we have colluded with oppressive structures, so we can stop making the same mistakes, and make something new.  We have committed the human and financial resources necessary to help us identify our patterns and plan for a more equitable future. As the history of systemic racism and oppression within the medical system begins to be acknowledged and addressed, we as social workers need to look at ourselves as individuals and at social work as a profession. As a profession that is rooted in “nice” whiteness, we need to question its role in proliferating power structures and imagine a new future. In 2022-2023 and beyond, my hope for SWHPN, to borrow from Elliott’s words, is that we not only “hear the neglected past whispers” but actively work to turn whispers into trumpets to address systemic racism. 

Acknowledge the neglected whispers of the past
Make something new
Something beautiful 
Something that will make everyone proud (A. Elliott)

We look forward to seeing what SWHPN will create together, in 2022 and for many more years. Jessica Strong, Executive Director, will share more about these exciting updates. 

SWHPN Executive Committee:
Anne Kelemen, LICSW, APHSW-C, Chair 
Danielle Jonas, LCSW, Vice Chair
Caitlin Scanlon, LCSW, Secretary/Treasurer 
Stacy Remke, LICSW, APHSW-C, Past Chair 

Advocacy Opportunity: Improving Access to Mental Health Act (S 870/HR 2035)

In March of 2021, the Improving Access to Mental Health Act of 2021 was introduced in the House. This bipartisan bill, co-sponsored by Senator Debbie Stabenow (D-MI), Senator John Barrasso (R-WY), and Representative Barbara Lee, MSW (D-CA), will address gaps in services that Clinical Social Workers are able to provide under current law. 

There are 42 cosponsors in the House and 5 in the Senate. Per the NASW advocacy alert, we need at least 175 cosponsors in the House and over 50 in the Senate to demonstrate broad support for this bill and elevate it to potential consideration. It is anticipated that this might be a topic of focus in the coming months due to a recent request from the Senate Finance Committeeabout concerns that every American should be able to access high-quality behavioral health care when needed. 

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Political Palliative Care: Opportunities for Advocacy to Transform Palliative Care

Finding time to keep updated on pending palliative care legislation can be a challenge for busy palliative care practitioners. However, political advocacy work is as important as direct care work, and in some instances, may have the potential to improve lives and decrease suffering on a much larger scale. There is an urgent need to improve equitable access for all people who could benefit from palliative care, especially those who have been unfairly impacted by systemic racism and other forms of oppression in health care. This type of change will require some changes in public policy and laws. The palliative care community can work together to influence these changes through increasing engagement in political palliative care practice. 

Political palliative care is not partisanPolicy advocates view frontline healthcare professionals as important potential contributors for political action and advocacy due to their unique knowledge, proximity, and insight into the lives of the patients they care for. For patients with complex long-term healthcare needs, such as those served in palliative care, this type of practitioner advocacy can help communicate the perspective of a population of patients who may not be as well-equipped to communicate their experiences barriers to care and unmet needs.

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Attention Hospice and Palliative Care Social Workers: There is a need for your voice!

The Congressional Social Determinants of Health (SDOH) Caucus is a bipartisan effort of lawmakers started in July of 2021 to improve approaches for addressing health disparities experienced by persons disproportionately impacted by SDOH and improve well-being. In this effort, the Caucus is seeking comments and feedback from the public on challenges and opportunities related to SDOH by September 21, 2021.  

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SWHPN Strategic Engagement Committee Update: Building Connections & Advancing Social Work in HAPC

Beginning this week, SWHPN will begin posting weekly updates from our committees, to highlight the important work each is doing to help advance the organization’s mission. This series is being launched by our Strategic Engagement committee, and the following was written by Jennifer Hirsch, LMSW and PhD candidate.

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SWHPN Statement Against Anti-Asian Racism

In continuing with our work to speak up and challenge social injustice, SWHPN is issuing this statement condemning the hateful attacks against Asians, Asian-Americans, and Pacific Islanders. We have seen a rise in verbal and physical violence in cities across the United States because of anti-Asian racism following the COVID-19 pandemic (Ruiz, Horowitz, Tamir, 2020; Jeung, Yellow Horse, Popovic, Lin, 2021). In the murders of Korean-Americans on March 16th in Atlanta, we saw the twin biases of sexism and racism that Asian women, in particular, have been victims of in our societal structure of white patriarchy. Affirming our social work values, we explicitly reject all forms of racism, xenophobia, and nativism, and stand with our Asian-American victims of violence and hate. By doing so, we also acknowledge that the struggles of Asian-Americans are inextricably linked with other BIPOC communities in a common endeavor for the humanity of this country. We uphold the inherent dignity and worth of each person and challenge others to join us in working against anti-Asian violence.

We recognize that our statement must be followed with action. Understanding our positionality and respecting the vanguard role of the Asian-American community, we want to use this opportunity to highlight the work being done by our Asian American Social Workers, and advocacy groups like Asian Americans Advancing Justice and Stop AAPI Hate (@stopAAPIHate on Twitter). The Atlanta branch of the Asian Americans Advancing Justice released a very powerful statement earlier today that we encourage you to read, and amplify and donate if possible. The Chicago branch is holding a series of bystander intervention trainings during April that SWHPN staff will be participating in, and we encourage you to sign up (also available here, through ihollaback.org).

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Three Social Workers Named 2020 Cambia Health Foundation Sojourns® Scholars

SWHPN is thrilled to announce that three social workers have been announced as part of the seventh cohort of the Cambia Health Foundation’s Sojourns® Scholar Leadership Program. 

Cara L. Wallace, PhD, LMSW, APHSW-C of Saint Louis University; Rachel Rusch, LCSW, MSW, MA of Children’s Hospital Los Angeles; and SWHPN Board Member Stephanie P. Wladkowski, PhD, LMSW, APHSW-C of Eastern Michigan University were each carefully chosen through a rigorous selection process from a highly competitive pool. SWHPN is proud of their commitment to improving the experience of people facing serious illness and their caregivers. 

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SWHPN Condemns Riots at U.S. Capitol Building

Watching the events from yesterday unfold, and then reading many responses on social media and in major news and journalistic outlets, we at SWHPN feel the need to reflect and respond. As an organization, we obviously strongly condemn the insurrectionist riot that occurred at the Capitol Building in Washington, D.C. and at statehouses around the country.

While social justice and self-determination are pillars of social work, what happened yesterday was an attempt by a group of nearly all-white people to compel their desired election result over the expressed wishes of millions of Americans who voted differently. Freedom of speech and freedom of assembly are guaranteed rights, but breaking windows and doors to enter Congress for the sole purpose to cause havoc and delay a procedural process to certify the President is not.

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SWHPN Statement on Changes to Social Work Code of Conduct in Texas

On Monday, October 12, the Texas State Board of Social Work Examiners changed the section of its code of conduct that establishes when a social worker may or may not deny services, to remove previous language specifying that discrimination based on disability, sexual orientation, or gender identity constitutes a violation of the code of conduct for Social Workers in Texas. The removal of these specifications puts the Texas code of conduct in contrast with existing social work principles, ethical guidelines for practice, and federal anti-discrimination mandates by allowing for discrimination based on disability, sexual orientation, or gender identity. 

The Social Work Hospice and Palliative Care Network (SWHPN) is horrified and dismayed by these changes, and condemns them in the strongest terms possible. This action explicitly violates the National Association of Social Workers’ Code of Ethics Section 4.02:

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An Election Guide for Social Workers

“The world has been abnormal for so long that we've forgotten what it's like to live in a peaceful and reasonable climate. If there is to be any peace or reason, we have to create it in our own hearts and homes.” ― Madeleine L'Engle, A Swiftly Tilting Planet

As of this writing, there are less than thirty days until the 2020 Election. This has been a year of tremendous uncertainty on so many fronts, and unlike in past years, it seems the uncertainty will continue through Election Night and possibly beyond.

As a 501(c)3 nonprofit, SWHPN is not permitted to endorse a specific candidate, nor are we allowed to oppose any candidate.

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How SWHPN Is Addressing Diversity

Last month, more than 125 SWHPN members, social work professionals, and students joined together for our virtual June Summit, “Cultural Competency in Hospice and Palliative Care.” Held on Juneteenth and during Pride month, we wanted to use the day as an opportunity to go beyond didactic presentations to showcase meaningful, actionable steps social workers could take to address racism, explicit and implicit bias, intersectionality, and more. During the post-Summit “networking happy hour,” attendees stayed online for an extra hour and a half to continue the discussion. It’s clear there is a hunger for more information about how to dismantle inequitable systems that harm Black people, Indigenous people, and people of color (BIPOC), whether they are patients, families, or social workers.

Post-Summit, what is SWHPN doing to address the changes that are needed?

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Social Justice and Palliative Care Policy

In an effort to engage in social action to address racial inequity, SWHPN’s Statement on Racism and Structural Inequities in Hospice and Palliative Social Work is suggesting the bold and necessary step of asking us to critically question how we, as hospice and palliative care social workers, are contributing to maintaining systems of inequity in the work that we do.
These are hard conversations to have, but needed to do the work necessary to correct racial and ethnic disparities inherent in end-of-life care. In the book, Anti-Racist Social Work, Lena Dominelli writes that racism is not just a matter that can be “educated away,” but rather requires the “eradication and the transformation of our socio-economic and political structures.”

To begin to be anti-racist palliative care and hospice social workers, we need to examine our own personal biases and the systems of care that pay our salaries and contribute to poorer care provision for people who are not white. Using a lens of intersectionality to examine the market based economy of health care in the United States, having a life-threatening illness and being black or Hispanic unfortunately, leads to poorer end-of-life care outcomes. As our healthcare system struggles to care for those impacted by COVID-19, we have seen that higher rates of infection and death have occurred in nonwhite communities. Palliative care research also tells us that racial and ethnic minorities experience a higher likelihood of difficulties in managing symptoms from all illnesses, including higher rates of experiences with pain, a higher likelihood of hospitalization in final stages of life, and a higher likelihood of discharge from hospice. According to the National Hospice and Palliative Care Organization (NHPCO), hospice utilization rates for blacks and Hispanics/Latinx persons are still vastly disproportionate when compared to the general population, with 82.5% Caucasian, 8.2% African-American, and 6.4% Hispanic/Latinx patients enrolled in hospice compared with the overall U.S. population percentages of 60% Caucasian, 12% African-American, and 18% Hispanic/Latinx. 
In a recent article I co-authored in The Journal of Policy, Practice and Research I attempted to examine these disparities using a social justice informed policy analysis to examine two of the primary payors for end-of-life care, the Hospice Medicare Benefit and Medicare coverage for Palliative Care. In practice, these federal policies have substantially socially unjust effects by providing disproportionate advantages for those who are white, have family caregiving support systems, and higher socioeconomic status.

We need to ask ourselves, what role do we play in maintaining this hospice and palliative care system of structural inequity that favors and maintains a norm of whiteness and socioeconomic stability?  We also need to recognize how the hospice and palliative care workforce continues to not only serve more whites than other ethnic minorities, but also maintains a majority of whites employees in professional and leadership roles, while at the same time maintaining a low paid workforce of direct care workers who are more likely to be black and brown women.  

Social workers are trained to be integrated practitioners, meaning that we can, and should, be considering multiple levels of practice when working with client systems. However, often, social workers tend to focus primarily on roles that are more reflective of micro level of practice. A recent job analysis of 482 hospice and palliative care social workers published in the Journal of Social Work in End-of-Life and Palliative Care showed that social workers consider macro practice or “engaging in social policy and community development” to be of lower importance in job tasks when compared with other more traditional micro practice roles. This moment in history should be recognized as a call to action for social workers to engage in policy analysis and examine policy outcomes to better develop skills in policy action and political organization.

Interested in learning more concrete ways to influence and address macro level changes that are needed?
  • See SWHPN's List of Resources for Health & Race Equity
  • Participate in SWHPN's next TweetChat, which are announced on the SWHPN Events Calendar
  • Send us your resources or suggestions for what we can share with the field or how we can improve as an organization of social workers

How Will SWHPN Change in Response to the Killings of Breonna Taylor, George Floyd, Riah Milton, Dominique Fells, and Innumerable Others?

As social workers in this pivotal moment, there are key lessons from the field of social work, and particularly the field of palliative and hospice social work, that we at SWHPN can apply to help some of us become better both in our work and our day-to-day lives.

1: listen more than you speak. 
It is very easy for those of us who have any privilege to think that we can speak on an issue, but this is often where we misstep. The opportunity for people in positions of privilege to speak and write with words that contain microaggressions is frequent, especially if those of us who have privilege do not acknowledge that privilege. Acknowledging out own biases can be difficult, but doing so without a defensive response is one way to help in this moment.

2: do not expect those who would be hurt by your questions to respond to them.
Just as you would not ask extremely vulnerable patients such as those who are in extreme pain, those experiencing extreme existential suffering, or those who are vulnerable in other ways to participate in a research study, do not expect black, indigenous, and people of color to teach you about diversity, equity, and inclusion if you are a white person. As one person put it: “That is the oppressed teaching the oppressor." While there may be opportunities to learn in webinars and other formal settings, for white social workers, it’s important to remember that some of our friends and acquaintances may be emotionally exhausted right now, beyond what you are feeling, and you will need to respect that when reaching out to them.

3 (this one’s a challenge from our Vice Chair, Karen Bullock): think outside the box.
During the last SWHPN Summit we had an open networking session where Karen made an excellent point about language and how she does not like to be put in a box. She didn’t suggest that anyone else follow her lead particularly, she just suggested that we all think critically about the language that we use for ourselves and for others. As we know in this field, language can be fraught. A “difficult family” can be code for many things, particularly when race or ethnicity are applied. When we’re talking about language such as "cultural competency", "white fragility", "anti-racist", it is important for us to explore what these terms mean to us, as well as to unpack what they may mean to others and to examine why we may want to use them, if at all. Before the last SWHPN Summit, a SWHPN member reached out to ask if “Cultural Competence” was the name we wanted to use for the Summit right now and my honest answer was, “I don’t know." Being open to discussion without defensiveness and without taking things personally but recognizing that there are deeply emotional issues around these issues is an important part of how we face up to making changes in our organization.

4: keep your ethics in check
I have seen several posts now on NASW discussion boards, Twitter, and various listservs where social workers have harkened back to our professional ethics and values. Recently, social workers Lauren Schmidt, MSW, LICSW, APHSW-C, Daphne Lindsey, LICSW, Elizabeth Julian, LICSW from Seattle Children's reached out to express their disappointment that SWHPN had not posted any resources exploring the intersection of racial inequity and COVID-19. This was after their colleague Arika Patneaude, MSW, LICSW, APHSW-C, EMMHS had reached out to express a similar disappointment a few weeks back. All of this is to say that we should be doing better, and they are right: this is in our bones as social workers. Here are just two of our core values that we should be turning to right now (and really, always) as we engage in conversations about inequities across all intersections:
  • Value: Social Justice
  • Ethical Principle: Social workers challenge social injustice.
  • Social workers pursue social change, particularly with and on behalf of vulnerable and oppressed individuals and groups of people. Social workers' social change efforts are focused primarily on issues of poverty, unemployment, discrimination, and other forms of social injustice. 
  • Value: Dignity and Worth of the Person
  • Ethical Principle: Social workers respect the inherent dignity and worth of the person.
  • Social workers treat each person in a caring and respectful fashion, mindful of individual differences and cultural and ethnic diversity (National Association of Social Workers [NASW], 2008).
SWHPN is ethically obligated to educate about social justice and to speak on the dignity and worth of each and every one of our members, as well as each and every one of the patients and families that we serve, as well as those who we do not yet serve but who are eligible for our service. In truth, we recognize the dignity and worth of all persons, and we would like to work together with our members to highlight the work we are doing to improve our work in showing that we do care about these ethics, as well as in highlighting the incredible resources that are out in the world.

With that in mind, below are the steps we have taken so far to change the organization and the steps we plan to make in the coming months:

  1. At the July board meeting, we are discussing our strategic Equity, Diversity, and Inclusion (EDI) plan. This will include embedding EDI strategic plans within each committee (rather than creating a new committee specifically for EDI). 
  2. We will be asking all educational presenters to include EDI materials in their presentations. 
  3. We will start an Equity, Diversity, and Inclusion Special Interest Group (SIG) within the next few months, while also asking all SIGs to embed EDI within their goals and action planning.
  4. We will share new crowdsourced resources every Friday about 3 topics: Grief and Bereavement, COVID-19, and EDI. If you have read a great article, listened to a thought-provoking podcast, or watched an illuminating webinar on one of these topics, we want to hear about it! You can submit these on this form until 5:00 p.m. EST to include it in that week’s SWHPN Shares post.
Here are a few recent resources we're drawing some learning from; we know there are many more and hope you'll submit those here.

  • Code Switch: Why Now White People: in this episode, hosts Gene Demby and Shereen Marisol Meraji discuss theories for why the country, and specifically white people, appear to have responded to George Floyd’s killing when so many others have gone unanswered.
  • Income emerges as major indicator of coronavirus infection, along with race: this Washington Post article describes who is getting sick in the pandemic. This won't be surprising information to medical social workers, as poverty is a social determinant of health and a lever of power, but it will be important to note, especially for our patients who live in places of intersectionality.
  • Suggested by social workers Lauren Schmidt, MSW, LICSW, APHSW-C, Daphne Lindsey, LICSW, and Elizabeth Julian, LICSW at Seattle Children's:

To our members, we ask that you make a commitment to equity, diversity, and inclusion both with your colleagues and with your patients. If you’re white, commit to listening to colleagues and patients who are hurting. Tell us when we make a misstep (and when it doesn’t take too much energy). This is going to be a difficult period of change and I can’t promise we will be perfect; but I can promise we will try as hard as we can, and that we will try to apply the above principles.

Allie Shukraft, MSW, MAT, APHSW-C | SWHPN Board Chair

A Way to Respond: Learn and Share Your Voice

We know there is a lot going on. In just the past twelve weeks, we’ve seen the COVID-19 pandemic blaze through our communities, resulting in more than 100,000 deaths. We’re seeing the related economic downturn affect workers, businesses, housing, food security, and more interrelated systems. We’re sharing the righteous anger from thousands of people across the country as they protest the impunity with which racial, ethnic, and xenophobic hatred and violence has been allowed to flourish. We echo the statement cried out on the streets and emblazoned across social media that Black Lives Matter.

Through it all, hospice and palliative care social workers have faced changing norms and practices head-on. We’ve grappled with determining who is considered an “essential” worker eligible for PPE. We’ve learned how to conduct family meetings in our living rooms and parking garages via videoconferencing and new apps. We’ve figured out how to show a smile behind a mask, how to show concern without being able to hug, and how to record memories and share presence for loved ones who couldn’t be physically present. 

AND we’ve done all of that while also grappling with the social justice issues that, due to hundreds of years building up layers upon layers of structural racism and inequities, are suddenly split open for all to see. Of the COVID deaths, we see the disproportionate impact it has had on Black people, Native Americans, Latinos, LGBTQ+ people, incarcerated people, and other marginalized communities, due directly to historical factors including redlining, unequal access to  to jobs, healthcare, and insurance, and stigma from healthcare providers. In the economic downturn, we see the same factors at play again, affecting those already struggling; and again in the police and judicial systems that overwhelmingly harm communities of color. It has been a lot to take in and process, even more for our social workers who are living it as a reality.

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SWHPN Guidance for Talking About Masks

As some social workers who have been working remotely are now returning to work and going into people’s homes wearing masks, we are hearing reports that some are getting pushback from both patients and coworkers about wearing masks. Some have shared that patients have expressed a worry that this is an indication that they may be sick with COVID-19, while coworkers have expressed that they do not feel they need to wear masks for various reasons. Below we offer some suggestions for responses that you could give to both of these groups. These responses were provided to us from various social workers we have spoken with, while others come from a variety of resources you can click on to learn more.

Some suggested prompts:
I wear a mask in every patient’s home and in all public spaces while I am working.
One of the first responses you might choose to give to patients can be to normalize that this is standard procedure, something that has been recommended by the Centers for Disease Control for all people to wear a cloth covering their nose and mouth in public spaces or in situations when they cannot be physically distanced (6 feet apart). The primary reason for healthcare workers to mask is to protect patients. In this way, we keep any germs that we may have from transmitting from ourselves to them and we are following recommended practices that are based on scientific evidence. While we do not suspect that we have the virus at this time (if we did, we would be at home and not at work), research has shown that people can be infected with COVID-19 and not showing any symptoms for up to 2 weeks before they begin to feel ill.

Wearing a mask is not a political or cultural statement for me.
While I understand some people believe that by wearing a mask, they are stating that they have a certain belief, my personal beliefs have nothing to do with the choices I make at work. Rather, I make choices based on the policies of my employer and what is recommended as in the best interest of the patients and families that I work with.

Frequently Asked Questions:
What if a patient or family refuses to allow you in the home if you are wearing a mask but your agency has asked you to wear one or you feel it is what is recommended for patient care?
SWHPN recommends that you do not visit patients and families in person without wearing a mask until general masking recommendations have been lifted by the CDC, and especially if masking is recommended by your employer. If a patient or family member feels that a mask is an obstacle to a visit, we recommend that you do not remove the mask for a visit, but change this particular patient’s care plan to be one that is virtual when possible, unless the family member that objects to masking is not present or changes their objection.

What if a co-worker refuses to wear a mask?
We have heard reports from some hospice social workers that some coworkers do not want to wear masks for various reasons (I live alone, I know I am not sick, etc.). Because we as social workers know that we cannot control another person’s behavior, and masks are intended to keep other people healthy, rather than the wearer, we know that this can potentially impact your health. If a co-worker refuses to wear a mask, you have 3 options: talk to them and provide education, speak to your leader about the issue, or stay at least 6 feet away from this co-worker, something you can control.

Another talking point you can try is sending them articles about masks, like the one above from the CDC, or one of these from NPR: https://www.npr.org/sections/health-shots/2020/06/21/880832213/yes-wearing-masks-helps-heres-whyhttps://www.npr.org/2020/06/17/879682816/a-growing-body-of-research-highlights-the-importance-of-wearing-face-masks, and https://www.npr.org/2020/06/11/875311079/how-the-widespread-mask-use-could-slow-the-coronavirus-pandemic.

Of course, there are many different people in the world and they may have their own reasons for not wanting to wear masks. As one author writes about here in The New York Times, many black men are afraid to wear masks for fear of racial profiling. In the Atlantic, another author posits that a public health approach for people who feel asking them to mask is infringing on their rights, taking an empathetic approach, as outlined here, will be more successful than badgering, shaming, or pushing. 

One final thing to consider when providing patient education: utilize tools that are culturally competent and meet the health literacy needs of the patient and family. There are a number of healthcare inequities which are being highlighted during this pandemic and as a social worker, it's important to address and discuss these issues with your clients so that you can assess and hopefully address what barriers may exist within their medical services. Providing linguistically and culturally appropriate education is a start. Talking openly about racial and ethnic inequalities with your patients and families is a step. We will be posting more about racial and ethnic disparity and the COVID-19 pandemic on this site, but here are some tools you can use when educating about masks and COVID health literacy:

It Starts With Us: SWHPN Statement on Racism and Structural Inequities in Hospice and Palliative Social Work

The Social Work Hospice and Palliative Care Network (SWHPN) wholeheartedly rejects the killings of black and brown people by police. As social workers helping ease suffering at end-of-life, we cannot let racism and disparities in care go unchecked. We are here to support a more just, equitable system for all.

Our organization is comprised of nearly 1,000 hospice and palliative care social workers throughout the country. Our core work focuses on providing professional development, amplifying evidence-informed best practices, and advocating for improved policies and increased funding, so that all patients and families experiencing serious illness receive expert psychosocial care which alleviates their suffering, improves their quality of life, and facilitates their dying in accordance with their wishes.

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