Black Seniors at the End of Life
by Noni-Ife Taylor, BSW
In my senior year of my BSW, I had the opportunity to intern at a hospice agency in Chadds Ford, PA. My experience there confirmed one of my desired fields of practice. Engaging with seniors and their caregivers provided me with great insight into loss across the life span. Their stories, told through life reviews, were filled with knowledge and wisdom. At hospice, I realized older adults are living longer and the aging population will need social workers.
There is an issue that is often not discussed: Black seniors, lack of end-of-life planning (EOL), and low enrollment in hospice among African Americans. As a Black woman, I was appalled to learn that African Americans are less likely to utilize the hospice benefit compared to their White counterparts. The barriers that contribute to low enrollment include mistrust in the healthcare system, lack of information about the hospice benefit, lack of diversity among the interdisciplinary team, and spiritual beliefs conflicting with hospice's philosophy. Infamous studies like the Tuskegee experiment, and other past and present racial health disparities, make it easy to understand the concerns among Black seniors and caregivers at the end of life.
As social workers, we put cultural sensitivity into practice when we acknowledge and are honest about the trials and tribulations that African Americans had to endure. If I could express anything, I would want hospice social workers to think about the future of hospice and how to increase the enrollment rate among African Americans, especially Black seniors. There should be collaboration efforts with clergy members. Their feedback matters to Black seniors, sometimes more than that of medical providers. Collaborating with them can create a healthy dialogue about death, dying, and EOL planning. Black Seniors need to be reassured that when planning and/or utilizing the hospice benefit, their spiritual beliefs will be honored. Another call to action is creating culturally attuned practices for Black seniors who do not have a religious affiliation.
Hospice is both hard work and heart work. It is not for everyone, but for some it is a calling. After graduation with my MSW, my goal is to become a hospice social worker. My call to action is to converse more about the inevitable - death and dying. I want to create more discussions about EOL planning to prevent crisis decision-making in the African American community. Verbalizing wishes and plans at the end of life is a human right and should be encouraged before a terminal illness is diagnosed. More work will be required as the aging population grows.
Noni-Ife Taylor is a clinical MSW student specializing in aging and health at Rutgers University. In 2017, she created an online community called The Social Work Student Connect (SWSC). SWSC's mission is to inspire, empower, and connect with social work students and practitioners while changing infamous narratives about the profession. Her interests include social work students, older adults, and end-of-life planning and care (hospice).