Layers of Challenge: Rural Hospice Social Workers' Lived Experiences, Secondary Trauma, and Anticipatory Grief Through and Beyond the COVID-19 Pandemic.

This study investigated the lived experiences of hospice social workers who supported dying persons, their families, and caregivers in rural settings during the COVID-19 pandemic and beyond. The study included focus groups with 17 social workers from rural hospice organizations in Indiana. Of particular focus of the examination were the layers of identity and oppression that affected the work of social workers. Key themes identified include feelings of disconnection, grief over the loss of normalcy, diminished hero status, a false sense of security, closer peer relationships but increased distance from organizational leadership, and systemic barriers. Additionally, the study measured anticipatory grief and secondary trauma levels using the Anticipatory Grief Scale (AGS) and Secondary Traumatic Stress Scale (STSS). Findings indicated that participants experienced moderate to high levels of secondary traumatic stress, while anticipatory grief remained comparatively low. The findings underscored the distinct challenges these professionals encounter, including exposure to trauma and significant disparities in patient health and available resources. This research underscores the importance of recognizing and addressing the multifaceted challenges faced by hospice social workers and caregivers, particularly in rural settings and during times of crisis.