Self-determination is a primary goal

Posted: Wednesday, April 30, 2008

"What we're dealing with is quality of life and relationships," said social worker Sandy Harris when I interviewed her a few weeks ago. "We want clients to have a feeling of self-determination and control over decision-making."

Courtesy Of Sara Chambers
Courtesy Of Sara Chambers

Quality of life and self-determination were the main themes during my interview with Harris. She talked about her experience serving clients through Hospice and Home Care of Juneau.

"When you are experiencing severe losses, as so many of our clients do, it becomes very important to control whatever is within your control," Harris said.

That might mean being able to have some say about your medications, to choose what to have for breakfast, whether to have a pet nearby, or to go for a walk in the sunshine even if that may be difficult.

"We can foster that kind of self-determination because we visit people in their homes," Harris said, "and often we can work with family members to help make it happen."

As part of the interdisciplinary team that serves all hospice clients, Harris works closely with the hospice nurses.

"Nurses are the case managers for each patient," Harris said. "They make a referral if they think a social worker would be helpful, then I call and offer to visit patients and sometimes their families as well. We might accomplish what needs to be done in a single visit, or I might visit regularly over a period of time."

Harris sees her role as three-fold, serving first of all as a patient advocate.

"I believe people have inner resources that will help them get through a difficult situation," Harris said, "and my job is to support that process. Also, when people are sick or under stress they don't always have the energy to follow through with agencies and speak up on their own behalf, so I help them do that."

This ties in closely with Harris's second role as a link to resources.

"I help patients and their families identify what services they need, then try to link them with whatever resources are available," Harris said.

That might mean connecting a patient who is unable to cook with Meals on Wheels or meals at the senior center. It might mean helping a patient find housing. Or it could mean helping a patient take part in an activity or volunteer program he or she would enjoy.

Finally, Harris serves as a counselor.

"Hospice clients and their families usually are adjusting to huge changes in their lives," she said. "A severe medical incident or a terminal diagnosis changes everything: the roles of people in the family, the way people see themselves, their needs and abilities.

"Most people have coped successfully with whatever life has thrown at them through the years. At a time of crisis they may just need to be supported in the coping mechanisms they use and perhaps be reassured that what they are feeling is normal. They may need new information so they can put their feelings into context and understand their reactions to what they're going through.

"When they're at home people are more confident making decisions for themselves," Harris said. "You're meeting with them on their terms, and they're more likely to be honest with you about what they're interested in and what they feel is appropriate to their situation.

"Older people especially have a lifelong track record to look back on. They can look back and see how they coped with various life situations, what they learned, and how they grew into better people. We acknowledge the losses clients are experiencing, but we also try to focus on the things a person maintains. There's that inner core of personality that isn't lost. Things can be falling apart all around you, but inside you're the same person you've always been-and sometimes you're even stronger. It's during these times of medical crisis that you really appreciate how courageous and strong people are-and how resilient. It's a privilege to be a part of that, and an honor to do whatever we can to help."

Before joining hospice, Harris worked for 17 years at the Juneau Pioneers Home. For more information about the hospice's services, call the office at 463-6111 or ask to receive hospice brochures and newsletters.

It's never too early to learn about the services available to patients and families.

• Marge Osborn is a Hospice and Home Care of Juneau volunteer. Hospice and Home Care of Juneau is a program of Catholic Community Service. CCS serves all persons regardless of their faith.

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