Last year Hospice of Humboldt began collaborating with two communities in Trinity County to implement grief support services in Willow Creek, and also in Hoopa, a nearby Indigenous Community. These communities are not only rural, but also remote, and deaths in the community, which appear to be frequent, affect the entire community. An agreement, spanning six months, was developed between the community health clinic in Willow Creek, and the Family Resource Center in Hoopa. However at some point in the implementation process, differences in cultural values and structures began to challenge the relationships between the organizations involved. From discussing the idea for the implementation of the Trinity County grief support groups with the Manager of Grief Support Services for Hospice, it sounds as though Hospice staff had several initial expectations or assumptions, which were based on their past lived experiences, and their own cultural backgrounds or professional training. Hospice staff agreed to drive to Trinity County once a month and provide volunteer grief support training. Based on their dominant white cultural values, and past lived experiences, Hospice staff assumed that when they came once a month to teach courses, the same cohort of students would be in attendance. However over the course of the Trinity County Grief Support training program, the Trinity County facilitators did not meet the expectations of the Hospice staff, and this caused frustration. As I come into the Trinity County Grief Support program, I am attempting to understand what cultural values and structures may be leading to a disconnect between the experts (the Hospice staff) and the Trinity County facilitators (which are in certain ways assuming the role of the client). The actual experience for Hospice staff is that it is difficult to coordinate the monthly meetings with the Trinity County facilitators. Each time Hospice staff make the journey to Trinity County, which they feel on some level is a special exception or gift to the Trinity County facilitators, the attendance at the trainings is inconsistent; former attendees are missing, and new attendees are showing up several sessions into the training program, and then they will disappear again. Clearly there is some level of disconnect between what Hospice of Humboldt staff are expecting from the implementation of the Trinity County program, and what the Trinity County facilitators are expecting. As I switch perspectives and try to understand the reality of how the Trinity County facilitators may be experiencing the Hospice trainings, several questions come to mind. I wonder if the Trinity County staff felt that a mutually respectful relationship was sufficiently established prior to engagement in the official training. Did the Trinity County facilitators and Hospice staff both have a clear expectation of what ‘the plan’ was going to be? It may be possible that Trinity County facilitators, particularly Indigenous staff do not do not feel that a sufficient context of familiarity and relationship, and therefore trust, has initially been established between the Hospice staff and themselves prior to beginning to work together, and particularly to discuss private topics such as family, religious ceremonies, and feelings about death. Or maybe it could be that the general Hospice curriculum did not feel culturally relevant for their community, given the additional factors of multiple losses and complicated grief that significantly impact their population. Perhaps the Trinity facilitators decided the dominant culture’s direct approaches to facilitated grief support would not be accepted in their communities; however they did not feel empowered to openly express their views to ‘experts’ i.e. Hospice staff, and therefore they demonstrated avoidance and disengagement. The staff at Hospice are reevaluating their own values and biases and identifying new ways to approach the Trinity County facilitator meetings. The grief support manager brings some training materials to the meetings, however she also is open to following the ‘flow’ of the meetings and responding to the input she can gather from the Trinity County volunteers. This is allowing room for discussions of Indigenous cultural practices, and how some are in conflict with the group facilitation practices Hospice normally utilizes. Facilitators are openly sharing what ways they will be utilizing some aspects of the Hospice training, but also looking for additional models, which may be more culturally appropriate. I feel that progress is being made toward developing mutually respectful relationships involving trust, and feeling that there is an opportunity for both parties to be the provider versus the client, or the teacher versus the student, which assists in equalizing the relationship.  

Over the past few weeks, I have been reading about grief and loss, and the dying process as part of my internship experience. This has been useful as far as gaining empathy for families who are in these situations, and building a depth of knowledge regarding different experiences individuals may have with grief. While I am reading about death and grief, I keep encountering themes around the importance of love, life, family, and acceptance. If someone has not had the experience of being with a loved one at the end of life, this may seem contradictory. However, being with someone at the end of life, may end up finally teaching us the lessons we need to fully appreciate our lives going forward. This has certainly been the case in my personal life, and I continue to find more appreciation in life as I progress through my internship at Hospice. Which led me to explore a topic around how humans appreciate life and what makes human beings “happy”? How do we know the choices we are making will be worth it? How do we go about making significant choices? In this search, I came across a book called, Stumbling on Happiness, by Daniel Gilbert. The book sounded a bit simplistic, yet Dr. Gilbert is a Harvard psychologist and spoke at the APA convention in 2010 regarding his research on happiness. One of the main themes is how humans spend a significant portion of their life living in the future. We are constantly planning ahead, hoping our hard work pays off, hoping retirement is relaxing, even though we are stressed out at our current jobs…. whatever the situation is in our particular lives. Ultimately however our brains are not able to predict who our future selves will be, and if we will appreciate the choices that our past selves made, or resent those choices, in a similar way to how children may grow up and resent the parents who tried their best, but ultimately did not provide what the child decided was important as an adult. Through various research scenarios Dr. Gilbert explores how and why our brains are not accurate historians, and how comparing to the past causes problems when we use our past experience to make inferences regarding what our future wants, desires, and needs will be. Therefore the bottom line of his suggestion is if we want to know and understand what it is feel like to have a different job, live in a different place, raise a child, whatever the experience is, our best source and most honest source of information is to ask someone who is currently having this experience, and not to rely on our past memory, or other people’s historical memory, when making decisions about our futures. This is a TED Net Talk featuring Dr. Gilbert- http://www.ted.com/talks/dan_gilbert_researches_happiness.html

I am continuing to shadow providers at my internship, and I am learning how varied and the environment and challenges are that each of the client settings presents. I shadowed a social worker that works with patients in nursing homes or assisted living facilities last week. She likes working with these patients, because she feels the care is more consistent and there are less complications around caregiving than when patients are in their home. The visits that we did were to patients in a special unit for dementia diagnoses. From my observations it appeared the patients’ diagnoses could make it challenging to determine causes of pain or decline, as they may not be able to communicate clearly, logically, or remember their symptoms from one visit to the next. One of the patients we visited appeared to be presenting markedly different behavior from prior visits, and the social worker investigated possible causes for this patient’s change in behavior. Due to her particular attention and patience, the social worker was able to spend additional time with one client, and I believe make a possible medical diagnosis, or at least suggestion, which may not have happened otherwise. The patient was awake and sitting up, however she had difficult focusing her eyes, and finding words. The social worker said this was unusual. Normally the patient was either completely asleep or quite interactive and able to go for walks and hold a conversation. However for this visit staff was reporting the patient had almost stopped eating and drinking, and was not getting out of bed or talking for the last week. On one hand, these could perhaps be signs of expected decline at the end of life. However the social worker was not confident of this, and investigated of other possibilities, such as medication changes, however this was not the case. The social worker continued sitting with the patient to see if additional clues could be gathered, even though the patient’s interactions were limited. As the patient dozed, the social worker quietly completed documentation, while still being present for this patient. I sat close to the patient and also tried to observe her and hold her hand. The patient would periodically start a sentence, and then not finish. Several times she said, that she was “confused” or “couldn’t find any of her things.” The fact that we spent a significant amount of time with a patient that was not very responsive, yet were able to still communicate with her a small amount, may have been what assisted the social worker in hypothesizing a possible cause for the patient’s change in behavior. The social worker mentioned that it is common for older people to exhibit signs of confusion if they have a urinary tract infection (UTI), and that UTIs are common in elderly people and frequently go undetected. Therefore after the social worker’s communications with facility staff, the patient, and in combination with her professional judgment, she determined there was a significant possibility the patient had a UTI. This one case study was an excellent example for me to see the challenges associated with working with this population of Hospice patients. On one hand the patient that I visited were in an exclusive facility for high level of care patients. Yet it is difficult for rotating staff, as well as even Hospice team members to have a true sense of the intimate day to day changes that occur with a patient, particularly when the patient themselves is not capable of accurately communicating with staff. Given these challenges, a social worker must be able to access and investigate multiple sources of knowledge, and communicate well with a variety of individuals in order to complete assessments and provide any appropriate interventions.