As the nation's 76 million Baby Boomers begin to age, that generation -- born between 1946 and 1964 -- stands to drive up the need for end-of-life and palliative care, an approach that improves quality of life for patients and their families facing life-threatening and life-ending illnesses.

Anticipating this impending need, the National Association of Social Workers (NASW) has issued standards for social work practice in palliative and end-of-life care. The guidelines will cover practical issues, such as potential ethical dilemmas, cultural competency and care-assessment needs for aging Boomers and others facing these stressful situations.

"Many social workers did not have formal end-of-life care training during school," says NASW executive director Betsy Clark. "These guidelines help social workers understand their role in palliative and end-of-life care and also set standards of care for practitioners."

Day-to-Day Duty

Dealing with palliative and end-of-life care is typically part of the social worker's daily duties, regardless of the practice setting. Clark says social workers help people of varying cultures, ages, socioeconomic statuses and family dynamics cope with trauma, suicide and death across the life span.

"Social workers are a valuable part of an interdisciplinary team of healthcare professionals, because they understand cultural competency," says Karyn Walsh, a spokeswoman for the NASW's Practice and Policy Department. "Different cultures have different ways of living and different ways of dying. We have to respect those cultural preferences."

As patient advocates, social workers are often part of a team that helps physicians, nurses and other healthcare professionals understand the unique needs of a patient and his family. For that reason, the social worker can serve as a communication bridge between busy healthcare administrators and the patients and family members who are suffering.

"Death and disease [are] devastating, and there are psychological reactions, social reactions and financial implications in addition to the physical needs," Walsh says. "None of those pieces can be ignored."

A Look at the Guidelines

The new guidelines set forth 11 basic standards:

• "Ethics and Values" offers advice on dealing with conflicts related to religion, spirituality and the meaning of life.
  
• "Knowledge" outlines the essential areas of knowledge about the medical and social systems that social workers must possess to provide effective care.
  
• "Assessment" discusses the areas that social workers must consider when conducting a comprehensive patient assessment.
  
• "Intervention and Treatment Planning" deals with the skills social workers need to provide effective palliative and end-of-life care and the types of interventions social workers must be prepared to perform.
  
• "Attitude/Self-Awareness" promotes the importance of compassion and empathy.
  
• "Empowerment and Advocacy" describes the social worker's responsibilities and role in ensuring equal access to quality healthcare.
  
• "Documentation" addresses the need for social workers to record all social work service performed with regard to a patient's care.
  
• "Interdisciplinary Teamwork" discusses guidelines for collaborative relationships with other healthcare workers.
  
• "Cultural Competence" reinforces the need for social workers to respect the ways of individual cultures with respect to palliative and end-of-life care issues.
  
• "Continuing Education" makes clear the social worker's responsibility to continue professional development in palliative and end-of-life care.
  
• "Supervision, Leadership and Training" calls on social workers with expertise in this speciality to lead educational, supervisory, administrative and research efforts.

Another aspect of working in palliative and end-of-life care is professional grief management. Social workers admit that witnessing pain and suffering can be difficult. Clark says social workers can cope with these feelings by focusing on the value they offer to patients during healthcare crises.

"The patient may be dying, but if you can help them end their life with dignity, then that can be a tremendous gift," Clark says. "The social worker's role is to place dying on the continuum of life. A lot of people don't know what to expect when they are dying. That's something we can talk about and help them and their families prepare for."