By Vicki Marsh Kabat
Most Americans don't want to talk about death, even if it's imminent. But Sally Neely (MSW 2009) grew up in a home where conversations about death and dying were natural.
"We had a very positive outlook on hospice and death in our family," says the Mineola, TX, native. Her father is a pastor, and two of her grandparents were enrolled in hospice before their deaths. "I was used to the concept of death, but in my practice, I have to be aware that others aren't."
They often are even less ready to make the decision about when to enroll a loved one into hospice. It's the question that drove Sally's research at her internship this spring at Providence Hospice. After reviewing the literature and finding little information on assessing a family's readiness to enroll someone in hospice, Sally got busy. She held two focus groups, consisting of physicians, nurses, social workers and family members, and conducted three individual interviews. She found 10 factors to assess readiness and from that she developed a 16-question family assessment tool of yes or no answers.
"One of the greatest lessons I've learned is that every one has value and worth at every age, and that it impacts a whole community"
"The tool's ultimate goal is for family members to gain self-awareness about their readiness for hospice and to use this to open up discussions with social workers," Sally says.
Jim Ellor, Sally's social work professor and mentor, explains that hospice social workers have not had a readiness tool, although nurses do. "Technically, her research was to form the background for the development of an instrument, but Sally has gone the extra mile to actually develop the instrument," he said.
Sally says her passion for gerontological social work began when she served as secretary in the 7th grade for her church's older adult women's Sunday school class. ‘I fell in love with these ladies, but as I got older, so did they, and I saw from their perspective the challenges they were facing: to stop driving, families moving you closer to where they live, not being able to go to church because of physical limitations."
Sally says she also went to their funerals. "I lost several of, what I called, my second and third grandmothers."
She saw a real need to help the elderly through these difficult transitions, and very few social services to do that – especially in a smaller community such as Mineola. From that moment on, she says, she never had a doubt that she'd be working with older persons.
"One of the greatest lessons I've learned is that every one has value and worth at every age, and that it impacts a whole community," she says. "So many older persons in hospice just think they no longer have any value."
For Sally, it is a challenge to be able to help facilitate the conversations the dying person and his/her family need to have. "There are things they need to say so they can die in peace."
Sally says her faith is instrumental in her ability to handle issues of terminal illness and death, and that she has also learned the importance of self-care. She has learned to leave the events of the day at work and to relax at home. "Then, I can go back the next day and be what I need to be for those families."