The role is one of the least understood in end-of-life care. Most families can describe what the hospice nurse does. The social worker is harder to explain.
Most families cannot describe what a hospice social worker does. They can describe the nurse. They can describe the physician who signed the hospice order. The social worker is harder to place, and the gap between how the role is understood and what it actually involves is significant.
Kayla Bonkowski is studying hospice and palliative care social work in Sterling Heights, Michigan. She holds a Bachelor of Science in Psychology from Rochester College, earned Cum Laude, and is completing her MSW. The question she gets most is: what does the social worker actually do?
The Formal Answer
The formal answer starts with the psychosocial assessment. In a Medicare-certified hospice, the social worker must complete one within a set number of days of admission. It covers the patient’s and family’s coping capacity, their support network, their financial situation, and their preferences around death and dying. That assessment drives the care plan and gets updated throughout the admission as things change, which they always do.
That is one afternoon’s work. The rest of the job looks different every day.
What the Rest of the Job Actually Looks Like
Hospice social workers help families understand the hospice benefit — what it covers, what it does not, and what to do when a family member does not understand why a specific medication is not included. They coordinate community resources. Meal programs, transportation, respite care, volunteer visitors. They provide grief support to family members before the death, not just after. They are often the person facilitating the conversation between adult siblings who have not agreed on anything in years and now have to make a critical medical decision together.
And some days, they sit with a patient who has nobody else in the room.
What a Psychology Background Adds
Kayla Bonkowski’s psychology background gives her a specific preparation for the clinical side of this work. She understands how grief functions as a process, how family systems behave under terminal stress, and how fear and exhaustion alter a person’s ability to hear and act on information. That is not a standard part of every MSW student’s entering preparation. It changes the quality of what she observes when she walks into a room.
She is also a mother. She trains in CrossFit in Sterling Heights and has lost more than 70 pounds through consistent effort. She fosters and rescues dogs. Those facts are relevant because they describe someone who shows up for things that are hard and do not resolve quickly. That capacity — to stay present with difficulty that has no fast resolution — is the exact thing the hospice social worker role requires.
The Continuity Function
There is also the question of what happens between visits. Hospice care is not inpatient care for most patients. It is care that happens in someone’s home, delivered by a team that rotates in and out. The social worker is not there every day. What she provides is the continuity — the consistent relationship with the family, the thread that runs through the episodic visits of the nurse and the chaplain and the aide. That continuity is its own clinical function. Families in crisis need someone who knows their situation completely, not someone explaining themselves every time a new professional walks in. The hospice social worker is that person.
What the Social Worker Is Not There to Do
The other misunderstanding worth naming is what the social worker is not. She is not there to make the family feel better. That is not the goal and it is not possible. She is there to make the situation more navigable — to reduce the degree to which the family’s attention and energy are consumed by confusion, logistics, and avoidable distress. That freed attention is what allows them to be present for the person who is dying. It is indirect, in that sense. But the indirection is the point.
What most families discover only after they are inside the hospice experience is that the social worker was the person they needed most and called last. By then, the opportunities to have helped earlier have passed.
Kayla Bonkowski is studying this work because she wants to be in the room earlier. Not because the role is easy to explain, but because what happens in those rooms matters more than most people understand before they need it.
More from Kayla Bonkowski: The Grief Nobody Prepares a Family For and What Happens to a Family When Someone Is Dying. Full background at About Kayla Bonkowski.