End-of-Life & Palliative Counselor

Both end-of-life and palliative counseling are services provided by counselors who work with the terminally ill. End-of-life counseling is an important service to provide, as many people struggle with facing the notion of the death of themselves or a close loved one. It’s also a field that is typically misunderstood and under-represented. End-of-life counseling, as its name might suggest, is a service provided by a counselor who is trained in working with emotions related to death, dying, grief, and bereavement. An end-of-life counselor may work not only with the families of patients who are facing an end-of-life diagnosis, but also those who are in pain due to a chronic or terminal illness. 

A palliative counselor is one who typically works to help a patient find relief from their situation—whether that is through pain management, medication, or mental health therapy. As someone approaches the end of their life, that could be viewed as a transition. As such, it can bring about many of the same feelings of stress, anxiety, or depression that can be seen during other life transitions, such as marriage, moving, changing careers, or becoming a parent. 

End-of-life or palliative counseling can help a patient and their families come to terms with the idea of facing their own death. It can be a very uncomfortable topic, which is one reason why being able to offer this service as a counselor can be rewarding and important. 

The Bureau of Labor Statistics (2021) predicts positive growth in the demand for end-of-life and palliative care counselors. Note that the BLS includes hospice workers, end-of-life counselors, and palliative counselors as part of the healthcare and social assistance sector, although this data isn’t disaggregated from similar occupations. Jobs in home healthcare and personal care fields are expected to grow at a rate of 33 percent between 2020 and 2030, which is a rate much faster than average.

According to the U. S. Census Bureau, by 2030, one in five Americans will be aged 65 or over. As our country’s population ages, the demand for counselors who are skilled at aging issues will only continue to rise, making end-of-life care a growing and in-demand field.

How to Become a End-of-Life & Palliative Counselor

Some states may have their own state-specific certifications. 

In some cases, the student should aim to achieve a master of social work (MSW) degree from a school of social work accredited by the Council on Social Work Education. Thirty-five of the Council’s programs offer an emphasis on aging and gerontology. Those 35 are all master’s degree programs. 

Another option—especially for those who already have a degree in a related field—is to seek out a school that offers a palliative care or end-of-life counseling program as a graduate certificate. The University of Maryland Graduate School offers an online PhD, master of science, or graduate certificates in palliative care. The graduate certificate requires 12 credits, whereas the PhD requires 36 and the master’s requires 30. In order to enter any of these programs, the student must have at least a bachelor’s degree already.

Those with a bachelor’s degree can enter the field, but the more education they have, the more opportunities open up. Those with a master’s degree may be able to access higher-paying jobs or jobs with more responsibilities, such as managing a team of providers or working in a higher volume setting. Those who decide on a master’s degree program may have opportunities to pursue a specialization. These more specialized career paths may include working with people with terminal illnesses or severe chronic illnesses. It may involve working specifically with the aging population, or even with terminally ill children. 

Education of an End-of-Life & Palliative Counselor

The educational path of an end-of-life or palliative counselor depends on whether the student has a goal of achieving a bachelor’s degree or a master’s degree, at a minimum. Fordham University, an online university based in New York, offers both a bachelor’s and a master’s in social work. The bachelor’s program requires the completion of 33 credits along with a 570-hour practicum in an agency setting. The master’s program requires the completion of 66 credits and a series of two-year field instruction courses consisting of 18 credits. 

Those who specifically wish to work as an end-of-life or palliative counselor should seek out a school with a program of study specifically geared toward aging or gerontology. For instance, Bowling Green State University in Bowling Green, Ohio, offers a master of social work as a two-year degree with full- and part-time options. The first year is the “Generalist” year and the curriculum focuses on establishing a strong foundation of knowledge, values, and skills. The second year is the “Specialization” year, which focuses on gerontology. 

At Bowling Green, as is the case with many schools, there are two options for admission: regular standing and advanced standing. The regular standing track is a two-year program requiring the completion of 56 credits. A bachelor’s degree in social work is not required for admission, although degrees in human service fields are preferred. 

The advanced standing track is a one-year program requiring the completion of 33 credits. This track is for students who already have a bachelor of social work degree from a CSWE-accredited program who are also already Licensed Social Workers (LSWs) with a minimum of three years of experience in the field. 

Overall, the education of an end-of-life or palliative counselor focuses on a student being able to work with individuals, families, groups, organizations, and communities. They will understand the human rights, ethical, and social issues related to aging, death, and dying, as well as the science and theory of social work. 

Supervised Hour Requirements for End-of-Life & Palliative Counselors 

The supervised hour requirements for end-of-life and palliative counselors will depend on the program of study and the specific requirements of the state. Programs that are accredited by the Council on Social Work Education must provide at least a minimum of 400 hours of field education for bachelor’s degree programs and a minimum of 900 hours for master’s programs. 

Each school may be slightly different. At Bowling Green State University in Ohio, the curriculum includes a 920-hour practicum in which the students work with a social service agency over three semesters. Upon graduation, students are eligible to apply for licensure as Licensed Social Workers and begin supervision towards obtaining their independent license.

At Fordham University, the process of supervised hours is slightly different. At Fordham’s Graduate School of Social Service, fieldwork courses account for almost one-third of the required credits necessary for the completion of the master of social work (MSW) degree. Students have to complete two field practicums, one at the generalist level (first year of study) and the second at the specialist level (second field of study). To complete the MSW degree, students are required to complete 1,200 hours of fieldwork, with 600 hours being required at each level. 

Licensure and Certification of End-of-Life & Palliative Counselors

Each state will offer its own licensure procedure and requirements. In many states, end-of-life and palliative counselor licensing will be handled by a board of health. In Oregon, for example, licensing for this career is handled by the Oregon State Board of Licensed Social Workers. Out-of-state licenses do not transfer. The Board only licenses those who hold either a bachelor’s of social work or a master’s of social work. 

In all states, a person may not practice clinical social work unless the person is licensed or certified by the state board.

Many states, such as Oregon, offer different levels of licensure. A Clinical Social Work Associate (CSWA) license is often the first step in obtaining a clinical license. This is for a student who is newly graduated with their MSW or is an MSW-degree holder currently under supervision in another state. Students can qualify to become Licensed Clinical Social Workers (LCSWs) if they have a certain number of post-degree experience hours and have passed clinical exams. Licensing of a Licensed Clinical Social Worker (LCSW) Candidate is available to applicants who meet LCSW requirements except that they have not passed the ASWB Clinical exam. 

There are likewise many avenues for certification. The National Association of Social Workers (NASW) and the National Hospice and Palliative Care Organization (NHPCO) offer certification to social workers at both the bachelor’s level (CHP-SW) and master’s level (ACHP-SW). Master’s degree holders can seek out this certification as a verification of their specialized knowledge, skills, and professional abilities related to end-of-life care and pain and symptom management. And as of 2019, a new certification examination for experienced BSW and MSW social workers was made available through the Advanced Palliative Hospice Social Worker Certification (APHSW-C).

End-of-Life & Palliative Licensure Renewal Requirements

The National Hospice & Palliative Care Organization offers continuing education and resources. Depending on the specialization achieved, if any, different options for licensing renewal may be available or may be required. 

For instance, a licensee with an oncology specialization may be able to find continuing education resources through the Association for Oncology Social Workers. Just as each state’s licensing requirements will differ, each state’s license renewal requirements will differ. In Oregon, LCSW license renewal requirements renew every two years. Forty CEUs (continuing education units) must be related to social work, with at least six units of ethics due at each renewal period. LMSW renewal requirements, in Oregon, are 30 CEUs with at least six units of ethics every time.

What Do End-of-Life & Palliative Counselors Do?

People often choose this type of job because they want to help people at a time in their lives when they are possibly the most vulnerable or scared. Bringing peace to someone facing a terminal diagnosis is a very rewarding thing to do, although it has its challenges as well. 

The duties of an end-of-life or palliative counselor may vary slightly depending on what their work environment is. When an end-of-life counselor works in a hospice setting, the general work requirements are focused on helping terminally ill patients and their families enjoy a quality of life. 

A hospice is a place where people can choose to go that provides medical care in a more home-like environment when they have received a medical prognosis of six months or less to live due to a terminal illness. An end-of-life counselor will work with the patient’s team of caregivers to prepare the patient for death and minimize their anxiety and discomfort. A palliative counselor will do some similar things, but their focus may instead be on minimizing pain and discomfort, rather than a focus on mental health. 

Counselors with this specialization can also work in clinics or hospitals, or in private practice. End-of-life counselors may also lead seminars, support groups, and workshops. Some workers may need to track progress, file reports, and give presentations. These clinics and other care facilities have opportunities for program managers, where someone with expertise in social work could oversee policy, procedure, or programs. 

Social workers with this specialization should be compassionate and ethical. Compassionate communication is a critical skill. Being able to talk and explain medical terminology and medication to a wide variety of people is important. It is crucial that the counselor themselves be able to set boundaries for themselves as well as remain open to the people they serve—death and dying is a frightening and scary topic, but a skilled end-of-life and palliative counselor can make it easier.

How Much Do End-of-Life & Palliative Counselors Make?

End-of-life and palliative counselors can make between $65,000 and $75,000 per year with a master’s degree in social work, according to ZipRecruiter (Dec. 2021). They say that, on average, a hospice social worker with a master’s in social work can earn an annual salary of $68,377. Their top 10 states with the highest annual income for this career are:

  • New York – $74,601
  • Massachusetts – $74,259
  • Maryland – $70,692
  • California – $69,647
  • Nebraska – $68,868
  • Vermont – $68,612
  • Alaska – $68,377
  • Nevada – $68,377
  • Montana – $68,377
  • North Dakota – $68,377

PayScale (Dec. 2021) reports that the average social worker salary, without the end-of-life specialization, is $45,068 per year.

End-of-Life & Palliative Counselor Professional Associations & Resources

  • Hospice and Palliative Nurses Association
  • National Hospice and Palliative Care Organization
  • Hospice and Palliative Credentialing Center 
  • Center to Advance Palliative Care 
  • National Association of Social Workers
  • Association for Death Education and Counseling
  • National Board of Certified Counselors
  • American Geriatric Society
  • Psychologists in Long Term Care
  • American-International Psychosocial Oncology Society
  • American Psychosocial Oncology Society
  • Education in Palliative and End-of-life Care: EPEC Project
  • Open Society Institute & Soros Foundations Network
  • Association of Professional Chaplains
  • Compassion in Dying
  • American Academy of Hospice & Palliative Medicine
  • American Society of Clinical Oncology
  • Gerontological Society of America
  • Hospice Foundation of America
  • The Hastings Center
  • Social Work in Hospice & Palliative Care Foundation
  • The National Association for Home Care and Hospice
Vanessa Salvia

Vanessa Salvia

Writer

Vanessa Salvia is an Oregon-based freelance writer and editor with a bachelor’s degree in chemistry. As fun as rigorous studies in math and science were, Vanessa took an independent path and developed a prolific career covering lifestyle and healthcare topics for magazines and newspapers, important industries such as concrete construction and building waterproofing, and even hard science. You can get in touch at Sage Media and Marketing.