This is a summary of Social Work Assessment Tool (SWAT): Guidelines for Use and Completion
Author/Developers: The SWAT was developed by the Social Work Outcomes Task Force of the Social Work Section, National Council of Hospice and Palliative Professionals, National Hospice and Palliative Care Organization. Task force members included Mary Raymer, ACSW; Ruth Huber, Ph.D., MSW; Dona Reese, Ph.D., MSW; Stacy Orloff, LCSW; and Susan Gerbino, Ph.D., MSW. Charlotte Butler, Ph.D., wrote the guidelines booklet.
Publisher: National Council of Hospice and Palliative Professionals, National Hospice and Palliative Care Organization, Alexandria, VA.
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This booklet explains the purpose, content, and use of the Social Work Assessment Tool, a scale designed to help hospice and palliative care social workers document their effectiveness with patients and caregivers.
The introduction lays out why the tool exists. Research links increased social work involvement to lower hospice and pain costs, fewer hospitalizations, fewer on-call visits, better team functioning, lower staff turnover, higher job satisfaction among physicians and nurses, and higher client satisfaction and quality of life.
Despite this evidence, social workers had no standard way to document the specific psychosocial and spiritual work they do, which made it hard to demonstrate their value in routine quality assurance. The SWAT was built to close that gap.
Psychosocial and spiritual issues
The tool covers eleven psychosocial and spiritual issues chosen from research and practice experience. These are: end-of-life decisions consistent with religious and cultural norms, thoughts of suicide or hastening death, anxiety about death, environmental preferences (pets, bed location, treasured objects), social support, financial resources, safety issues, comfort issues, complicated anticipatory grief, awareness of prognosis, and spirituality.
Each issue includes a description and the related tasks a social worker performs, such as advocating for patient self-determination, addressing denial without stripping it away too fast, assessing financial gaps, or helping a patient find meaning and connection near the end of life. Spirituality is treated as distinct from religion, applying to anyone regardless of belief system, and the booklet notes it was the most frequently addressed issue in one hospice study of home visits.
Score the tool
The instructions section explains how to score the tool. Social workers complete a SWAT after in-person visits, not phone calls, rating the patient and separately the primary caregiver on each of the eleven issues. Ratings run from 1 (having far more difficulty than usual) to 5 (extremely well, no concerns), with 3 marking a neutral midpoint. Workers base ratings on clinical judgment rather than asking clients direct questions, since some clients aren’t ready to face these issues openly. Item scores get summed into a total patient score and a total caregiver score. Comparing scores from a first visit to a last visit shows whether progress occurred over the course of care.
Case example
A full case example illustrates the process. Mary, a 70-year-old widow with end-stage COPD, lives with her son David and is cared for primarily by her daughter Dorothy. The case details Mary’s medical situation, her mixed feelings about dying at home versus calling 911, her strained relationships with her children stemming from past alcoholism, her financial worries, and her non-religious but spiritually reflective outlook.
The booklet walks through how a social worker would rate each of the eleven issues for both Mary and Dorothy, explaining the reasoning behind each score. For instance, Mary received a 2 on end-of-life decisions because she was still working through unresolved anxiety, while Dorothy received a 3 for having made a plan without fully involving her mother in it. A completed sample SWAT form follows, along with blank total-score fields.
The story of Frances
A second case, the story of Frances, a 50-year-old woman with breast cancer cared for by her son David, is offered as a practice exercise. It introduces additional complexity: religious tension between mother and son over faith and acceptance of death, and Frances’s mistrust of the healthcare system rooted in fears about racial mistreatment. A blank SWAT form is provided for readers to complete themselves as a training exercise.
The booklet closes with a list of supporting resources: a related journal (Journal of Social Work in End-of-Life and Palliative Care), a bibliography of research on death anxiety, anticipatory grief, spirituality in social work, and hospice access among African American patients, plus a list of relevant professional websites, including the National Association of Social Workers, the National Hospice and Palliative Care Organization, and several culturally focused social work associations.
Overall, the document functions as both a conceptual guide and a practical training manual, giving hospice social workers a structured, repeatable way to assess and document the psychosocial and spiritual dimensions of end-of-life care.