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.