Upon arrival, the Medical Social Worker (MSW) was welcomed by Lisa, the client's spouse and primary caregiver. The residence was clean and orderly, with no notable safety concerns aside from the presence of two older large dogs. The client, diagnosed with non-Hodgkin’s lymphoma eight years ago, has recently experienced a significant decline leading to hospitalization prior to entering hospice care. He was seated on the couch with his feet elevated, leaning slightly back, demonstrating alertness and orientation to time, person, and place, despite appearing fatigued. The client reported a persistent pain level of 9 out of 10 in the area affected by cancer. This discomfort was relayed to the nurse case manager. The client is also managing Parkinson’s disease, which complicates his activities of daily living (ADLs); he is able to feed himself but requires assistance in other areas. Due to pain while speaking, the spouse primarily served as the historian.

The spouse informed the MSW that they have completed an advanced directive and power of attorney, designating her as the acting agent. An Out-of-Hospital Do Not Resuscitate (OOH-DNR) order was also mentioned, although it had not yet been submitted to the hospice administration. The MSW advised Lisa to provide a copy of the OOH-DNR for the hospice records and suggested placing a copy near the client’s bedside or refrigerator for prompt access by emergency services if needed. Furthermore, Lisa indicated that funeral arrangements had already been organized with Porter Loring North. The client expressed a decreased appetite and reported no feelings of hunger that morning, noting that eating takes him a considerable amount of time.

as a hospice medical social worker, type a 2 paragraph narrative note with the following information for a visit with a client: upon arrival, MSW was greeted by client’s spouse and primary caregiver, Lisa. House was clean and orderly and no apparent safety concerns were observed other than client have two older large dogs. Client was diagnosed with non-hodgekins lymphoma 8 years ago and he recently experienced an a decline that brought him to the hospital before coming onto hospice services. Client was sitting on the couch with his feet elevated. He was laying slightly back with his eyes almost closed. He was alert and oriented to time, person, and place. Client reported he knows what his diagnosis and prognosis is and that he has come to terms with it. Client reported a 9 out of 10 pain in the area where his cancer is located, even with medication. client reported the medication doesn’t work that well for him. nurse case manager was notified of client’s discomfort. client was also diagnosed with Parkinson’s disease which combined with his cancer affects his ADL’s. Client is only able to feed himself and needs help with his other activities. Client’s wife acted as his historian due to having pain while talking. Spouse reported that his appetite has decreased and he did not feel hungry this morning. Client reported that it takes him a long time to eat.

spouse reported that client has an advanced directive and power of attorney already completed and she is the assigned at his acting agent. Client also has a OOH-DNR completed but was not handed to hospice admin. MSW advised spouse to provide a copy and to put a copy by his bedside or refrigerator in case EMS responds to the house for him. Spouse reported funeral arrangements have already been completed with Porter Loring North.

Spouse reports they are financially doing ok and do not need assistance at this time. Spouse feels overwhelmed with caring for husband due to also working from home and not being able to take time off due to only receiving a paycheck from commission. Client has support of his family with his wife and daughter living with him and two other children in the area who are able to help. Spouse reported their family is southern baptist but haven’t gone to church in a while. Spouse reports she has no time for self care and stated, “I was already burned out before he got like this.” MSW suggested to client’s spouse to find an activity she can easily do that brings joy at least once this week. MSW provided education on respite and inquired if spouse would be interested in it due to already feeling burned out but she declined.

Subject: Communication Note - Caregiver Update for Mr. Ramos

Today, MSW placed a call to the caregiver of Mr. Ramos to schedule a visit for support. During the conversation, the caregiver indicated that she was currently at the hospital with Mr. Ramos and would return the call later. Her tone conveyed a sense of urgency. Subsequently, MSW contacted the Director of Nursing (DON) to confirm Mr. Ramos’s admission status and to relay the details of the conversation with the caregiver to ensure proper coordination of care.