British Association of Social Workers (BASW)

Professional practice guidance for End of Life Social Work during Covid-19 Pandemic

Purpose and background

This guidance has been developed by the British Association of Social Workers (BASW) in consultation with practitioners, managers, academics and sector leaders to help social workers and their employers undertake social work at end of life during the Covid-19 pandemic.

Social workers have told us they need consistent guidance to support professional practice. This is generic guidance for all social workers across the UK.

The guidance aims to:

  • Help social workers think through the specific considerations around practice at end of life
  • Help social workers consider the specific support they may need
  • Provide information about additional resources and support for people at end of life and in bereavement and their social workers.

Note: This guidance is on-line and will be reviewed and updated. Please use the online version to ensure you have the most recent version. It will be reviewed at least monthly during the Covid-19 emergency.

Other useful documents

All practice, ethics and policy advice is available on the BASW website coronavirus pages https://www.basw.co.uk/coronavirus-covid-19-basw-updates  

The guidance is grounded in BASW’s ethical guidance for the pandemic as set out in our Covid-19 pandemic ethical guidance https://www.basw.co.uk/covid-19-pandemic%E2%80%93-ethical-guidance-social-workers

Using the guidance

This is professional guidance based on best available evidence, latest public health guidance, practice experience and expertise. It draws on The role of social workers in palliative, end of life and bereavement care (2016) by the Association of Palliative Care Social Workers in collaboration with the former College of Social Work and Making Waves Lived Experience Network/OPEN FUTURES Research, with support from the British Association of Social Workers and Hospice UK. https://www.basw.co.uk/resources/role-social-workers-palliative-end-life-and-bereavement-care

Social work has an important role in the delivery of meaningful palliative, end of life and bereavement care. Some social workers are palliative care social workers, working in services which specialise in this area of support. All social workers will encounter people who are experiencing loss, the end of life or bereavement, particularly during this pandemic.

 

We hope this guidance will support frontline practitioners and provide a framework to influence good practice within the workplace, as well as helping social workers to manage the ethical and emotional impact of their work.

The priority is to promote wellbeing before, during and after end of life, and to promote the wellbeing of the workforce.

Please use the guidance to:

  • Guide and inform your practice
  • Request appropriate support and guidance from your employer
  • Raise professional concerns and questions about local practice or guidance with your employer, health and safety representative, trade union and BASW

This guidance does not:

  • Replace public health national (official) guidance 
  • Replace regulatory or employer guidance 
  • Advise on how to manage statutory duties – this is for statutory bodies to advise based on the law, however BASW is developing ethical guidance.

Understanding of health and safety throughout this pandemic is developing. Practitioners should continue to check and must follow public health guidance at https://www.gov.uk/coronavirus. This includes the latest information about self-isolating, shielding and what to do if you have symptoms.

Practitioners should also be aware of the latest information from their government, regulator and their employer.

 

Personal, Protective Equipment (PPE)

At the time of writing, there is no specific Public Health guidance for the use of PPE by social workers in any settings. However, there is guidance of relevance to social workers. For hospital settings please see the public health/ government table of recommended use of PPE for ‘healthcare workers by secondary clinical context’.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/879107/T1_poster_Recommended_PPE_for_healthcare_workers_by_secondary_care_clinical_context.pdf

Social workers undertaking should review this table to match to their situation

Advice for other settings is available in other tables in the series (e.g. PPE for primary, outpatient and community care settings – see below) https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/877599/T2_Recommended_PPE_for_primary_outpatient_and_community_care_by_setting_poster.pdf

Updates on guidance for health and care workers from Public Health are available here https://www.gov.uk/government/organisations/public-health-england

BASW’s position is that social workers should always risk assess any face to face activity for coronavirus risk, both symptomatic and asymptomatic; should consider all alternatives to face to face contact; should organise necessary activities to maintain physical distancing of 2m wherever possible; should always have access to relevant PPE to factor in to risk assessments; should not undertake activities where risk is not reasonably mitigated.

BASW endorses the Health and Safety guidance of the Social Workers Union https://www.basw.co.uk/swu-health-and-safety-during-covid-19-position-statement

The ongoing lack/insufficiency of PPE for social workers at time of writing is being raised with government by BASW.

 

Professional practice guidance for End of Life Social Work during Covid-19

1.  End of life social work

All social workers need to be able to help people maximise wellbeing at end of their life and ensure they and their dependents, carers, families and friends get the support they need to manage the impact of loss.

This section sets out some practical ways that social workers can support end of life and bereavement care. As with all social work, consideration should be given to

  • A personalised approach
  • first/preferred language,
  • specific communication and sensory needs,
  • family and social network
  • culture, religion and spirituality
  • optimising choice and control and mental capacity

Throughout work at end of life, use legislation, including Human Rights Act and Mental Capacity legislation, to protect the rights of people including people who may not be offered treatment. Seek legal advice if this is needed. (See support section for further information).

Ensure any decisions about Do Not Attempt Cardio-pulmonary Resuscitation (DNACPR or just ‘DNR’) designation have been made legally in accordance with good practice guidance and principles of personalised advanced care planning. BASW guidance on this is available her https://www.basw.co.uk/media/news/2020/apr/high-quality-and-person-centred-advance-care-planning-acp-vital-means-promoting

Managing ‘physical distancing’ and use of PPE

During Covid-19 pandemic, it may be more likely that you will need to keep physical distance of at least 2 metres and/or use face and/or body covering PPE when working with people at end of life.  Ensure you talk/communicate with the person and those close to them why you are taking these precautions and seek to overcome the physical barrier e.g. through clear explanation, showing a photograph of yourself,  enlisting the support of other staff or carers, family or friends.

Discussions about end of life

  • You may be the first person to talk about the possibility of death or you may be following up on others. The questions, what do you understand about the seriousness of your illness/condition? (If approaching death) what sort of care at the end of your life would you want?  What does a good death mean to you in these circumstances? may be helpful.
  • Help people to express what is important to them and to share this information with their network including other professionals.
  • Signpost people to areas of planning ahead, such as making a will, planning a memorial, advanced care planning, including advance statements, advance decisions to refuse treatment, emergency health care plans, lasting powers of attorney and organ donation so that their wishes are respected. (See support section for further information)
  • Ask professionals, ideally a palliative care social worker, at your local hospice for information that you can provide to people. (See support section for further information)
  • Recognise the need for support for individuals and their loved ones who have been involved in making (best interest) decisions e.g. not to offer treatment.

Assessment, care planning and review

  • Support your organisation to prioritise people whose human rights and dignity are at risk during the pandemic.
  • In risk assessments, use evidence and health information to identify people who may need monitoring and contingency planning.
  • Be aware and open about the risk of death and bereavement during the pandemic, and openly include contingencies in your planning with people, including for dependents, families and carers.
  • Take a strengths-based approach to talking to people about how they feel, help them deal with their worries, and draw on and develop their coping strategies.
  • Respect that people may not feel able to talk about this to you or plan ahead. Ask to them/find out who they might talk to now or in the near future.
  • Continue to make sure that people’s cultural, linguistic and spiritual needs are considered and responded to as the person wishes.
  • Be aware of the financial implications of dying and death, and signpost for advice. (See support section for further information)

Co-ordination of care

  • Ensure people are at the centre of their care and have information in forms/languages they can understand about who is doing what in their care team.
  • Strive to have one point of contact for updates on care and support for the person and those who care about them.
  • Seek to access emotional and spiritual support in a way that works for those involved. (See support section for further information)
  • People dying from Covid-19 have been frequently physically separated from those close to them in their final days. Strive to ensure connection through virtual means for dependents, carers, families and friends who are not able to visit.  Communicate your role and any information you have to them.  If you are able to safely be with a person at end of life from Covid-19, you may help by speaking the words of loved ones to them, reporting back that you have been able to do this.
  • If you are involved in bad news being given or heard, help this to be clear and make sure there is space and time for questions during and after.
  • Help people to identify how they can say goodbye. If possible find a way to do this before social contact may be ended. Otherwise strive to do this virtually. If not, this may be through a letter or an object that is shared at end of life or after death.

Care for dependents, carers, families and friends after death

  • Help people to talk about how they feel and to come to terms with this.
  • Help people get advice to deal with legalities and arrangements after death. (See support section for further information)
  • There are likely to be restrictions on usual customs of mourning and memorial throughout the Covid-19 crisis. Help people understand these and identify how they can show respect and remember people. This may be through a memory box, through a virtual memorial or through planning for something in the future. (See support section for further information)
  • Provide support for people who are left at risk as a result of losing someone, for example children or cared for people.
  • Listen to people’s story of grief. Recognise grief as normal, while at the same time helping people recognise need for and seek support if grief is particularly prolonged and complex and/or if distress is extreme and/or if the person/s seem unsafe. (See support section for further information)

 

2.  Organisational support for social workers

Being alongside people at end of life and in bereavement inevitably has an impact on social workers. This may include their own loss, worry and grief. During Covid-19, a social worker may be dealing with their own experience of people they are close to being infected and at risk. Organisations need to be open about the emotional impact of the work.

  • Enable social workers to talk about their experiences of end of life and bereavement, and the impact on them. Offer opportunities to debrief, ensure social workers have supervision and identify ways of developing peer support.
  • Recognise that different people will have different levels of personal and professional resilience, require different support and adapt in different ways. Work in a person-centred way with social workers rather than expecting the same of everyone.
  • Be clear about whether social workers are able to continue with their work and offer support, including professional support, if this is required.
  • Provide information to social workers that they can use and can signpost people to.
  • Connect with your local hospice and palliative care social workers for expert information and advice.
  • At an organisational level, build relationships with the third sector, including spiritual organisations such as faith groups, to identify how they can support the community. Gather and share information about community support. Ensure social workers can access and use this.
  • Use group reflection to enable staff to discuss the emotional impact of their work. In a small group where people know and trust each other, each person takes it in turns to talk for 5 minutes about an encounter with someone experiencing loss in the course of their work. They share how they felt about this and the impact on them. As a group, then discuss the experience of sharing these stories. Do not try to solve problems. Focus on the impact of talking about these personal moments. Recognise the emotions that are present and acknowledge these. Give people time to process this before going back to work. Let people know where they can get additional support.
  • Consider/propose facilitated groups to enable staff to discuss the emotional impact of their work. There are a number of models for this and skilled facilitation is important to ensure all participants are supported and experience emotional safety.  See additional resources section.
  • Find ways to share learning about good practice at end of life.

 

3.  Additional support and resources

For people who are dying or bereaved

Dying Matters resources to support conversations about dying and bereavement

https://www.dyingmatters.org/page/updated-resources

Dying Matters information for planning ahead

https://www.dyingmatters.org/page/planning-ahead

Citizens Advice contact (you can change the country depending on where you live)

https://www.citizensadvice.org.uk/about-us/contact-us/contact-us/contact-us/

Law Society register to find a solicitor to help for example with wills

https://solicitors.lawsociety.org.uk/

Information about benefits

https://www.gov.uk/browse/benefits/bereavement

Information about what to do after a death (this may be subject to change due to the pandemic)

https://www.gov.uk/after-a-death

Public Health England information about funerals during Covid-19

https://www.gov.uk/government/news/new-advice-for-safe-funerals-after-discussions-with-faith-leaders

Hospice UK contact for local hospices

https://www.hospiceuk.org/about-hospice-care/find-a-hospice

Cruse bereavement support national helpline and local services

https://www.cruse.org.uk/get-help/local-services

NHS guidance on ‘planning ahead’

https://www.nhs.uk/conditions/end-of-life-care/why-plan-ahead/

Children and young people

 https://www.winstonswish.org/coronavirus-funerals-alternative-goodbyes/ 

https://www.childbereavementuk.org/coronavirus-supporting-children

 

People with learning disabilities: 

 https://www.pcpld.org/links-and-resources/

For social workers

The role of social workers in palliative, end of life and bereavement care (2016) https://www.basw.co.uk/system/files/resources/basw_33710-4_0.pdf

The Association of Palliative Care Social Workers

www.apcsw.org.uk

Information on reflective team support

https://www.pointofcarefoundation.org.uk/

Coronavirus guidance

https://www.gov.uk/coronavirus

BASW information and guidance around Covid-19

https://www.basw.co.uk/coronaviruscovid-19-basw-updates   

You can direct questions or concerns to BASW by contacting us

https://www.basw.co.uk/contact   

BASW Survey for feedback on practice during Covid-19 https://www.basw.co.uk/media/news/2020/mar/social-work-during-coronavirus-covid-19ongoing-survey   

BASW virtual activities to provide peer support and learning can be found here https://www.basw.co.uk/events   

BASW Professional practice guidance for End of Life Social Work during Covid-19 Pandemic

BASW Published 20th April 2020