After the Act on Decisions on Life-sustaining Treatment for Patients at the End of Life was enacted in South Korea (hereinafter, Korea) in February 2018 to address the need for hospice and palliative care, the scope of these services expanded to include various chronic diseases, such as terminal cancer, chronic obstructive pulmonary disease, and chronic liver cirrhosis [1]. Therefore, the number of inpatient hospices rose from 81 in 2017, prior to the enactment of the Act, to 94 in 2023. Additionally, the number of cancer patients newly admitted to hospice care increased from 17,317 in 2017 to 22,323 in 2023 among those who died from the disease [1]. According to projections by Statistics Korea, the annual number of people utilizing hospice and palliative care is expected to reach approximately 100,000 by 2037 [2].

In 2018, the government identified community care as a key policy agenda, incorporating hospice and palliative care as integral components of community-centered end-of-life care for older adults [3]. Community care embodies the concept of "deinstitutionalization," a topic of global discussion since the 1970s, which has now been translated into a concrete policy. For community care to be successfully implemented, the involvement of the community and the expansion of community activities are crucial [4]. Community care is significant in that it not only supports the independence of those in need but also encourages communities to ensure that individuals can live dignified lives in their familiar surroundings. In Korea, the Moon Jae-in administration championed community care in 2018, aiming to bolster social services focused on home care and community support. This initiative's main goals included enhancing medical and care systems for the elderly, individuals with disabilities, and those with severe mental illnesses, promoting deinstitutionalization, and facilitating community integration [3]. From the standpoint of community-centered end-of-life care for the elderly, the initial phase of community care prioritizes home medical services for older adults. As the policy matures, it expands to include the creation of integrative discharge plans and the development of home-based hospice care. This evolution allows elderly patients with terminal conditions, such as terminal cancer, to spend their final days in the comfort of their homes, ensuring continuity of care [3]. However, community-centered end-of-life care for older adults is challenging due to legal requirements for diagnosing specific diseases and a focus on inpatient services, making it difficult to access end-of-life care within the community [5]. Additionally, there have been insufficient efforts in planning service provision, establishing a connection system, and defining roles among professionals who bridge health and welfare services [6].

Regarding home-based hospice care, a key strategy for facilitating community care, terminal patients and their families face complex needs that extend beyond medical demands such as pain management. These include financial, nutritional, housing, familial, and religious considerations. Thus, an integrative and interdisciplinary approach that bridges health and welfare services is crucial. However, research investigating the current state of home-based hospice and palliative care services has identified a significant issue: nurses predominantly conduct home visits, while the roles of other interdisciplinary professionals, such as doctors and social workers, are not clearly defined [7]. Specifically, in home-based hospice care, social workers are not legally mandated to make home visits, and the reimbursement for these visits is minimal. As a result, many hospice organizations employ social workers on a part-time basis, which significantly reduces the frequency of home visits [8]. Therefore, to establish hospice and palliative care as effective community care initiatives, it is vital to engage in active discussions aimed at revitalizing home-based hospice care. Additionally, the current practices of social welfare related to hospice and palliative care need to be evaluated critically. It is also necessary to clearly define the roles of hospice and palliative care social workers within community care.

Therefore, this study aimed to achieve the following objectives: First, it examined the significance of the roles played by hospice and palliative care social workers in community care through a review of existing research. Second, it explored both domestic and international research trends concerning the roles of these social workers, identifying current issues. Third, analyzed data on the perceptions of social workers involved in hospice and palliative care regarding their roles in community care and aimed to identify tasks necessary for establishing their roles within this context. Not only does this study provide a foundation for addressing issues related to the treatment of hospice and palliative care social workers and challenges in hospice and palliative care practices, but it also supports the strengthening of their competencies and the solidification of their professional expertise in community care practices.

1. Importance of the role of hospice and palliative care social workers in community care

Community care specifically refers to the provision of care within the community where an individual resides, as opposed to isolating them in a quarantine facility. This approach is also referred to as "community protection" and primarily focuses on the concept of home-based welfare services [9].

The Ministry of Health and Welfare defines community care as "an innovative social service system that helps society's members access welfare benefits and services tailored to their needs as they live in their communities, such as houses and group homes. It also enables them to achieve self-realization and engage in social activities within their communities" [3]. Additionally, community care provides a support system for individuals in need, such as the elderly and disabled, offering services that meet their specific needs and help them achieve self-realization through social interaction in their communities [10]. From the perspective of those receiving care, community care involves providing an appropriate level of intervention and support that allows individuals to manage their own lives while maintaining maximum independence within the community [11]. In summary, community care represents a community protection system that delivers integrative, customized services centered around the eup, myeon, and dong (the smallest-scale administrative divisions in Korea). This system includes health and welfare services that require social care and is facilitated through public-private collaboration, connections, networks, and adjustments, all aimed at ensuring the independence and healthy lives of community residents [12].

Community care can also be implemented through policies. For instance, the Ministry of Health and Welfare defines community care as a community-led social service policy that integrates housing, healthcare, nursing care, and support for daily living. This approach enables individuals in need of care to leave institutional settings, such as facilities or hospitals, and live within their local communities. Here, they can access tailored services and engage socially with others [3]. The concept of community care was first implemented in several developed countries. Notably, the United Kingdom, where the concept and system originated [13], passed the Community Care Act in 1991. This legislation marked a significant shift from reliance on institutional care to a community-centered care management system [14]. In the UK, these services continue to operate under the name "community care" [15]. In the 2000s, Japan undertook reforms with the Social Welfare Basic Structure Reform and the introduction of the Long-Term Care Insurance System. Following these changes, in 2009, Japan further enhanced its approach by amending the Long-Term Care Insurance System to establish the full-scale Community-Based Integrated Care System, emphasizing community-centered service policies [15,16].

Community care in Korea started when the Ministry of Health and Welfare announced the "community care policy" in 2018. This policy marked a shift from government-led social services to those provided through local governments or community entities [9]. In 2019, the Ministry introduced the "Community Care Leading Project Fostering Plan," which outlined the first phase of the community care roadmap. This phase focuses on identifying services that meet community needs, validating and refining provision models, and developing various community care models [17]. In 2020, the government released the Guidebook to Fostering Community Care Independently to assist local governments in implementing the leading project or promoting community care on their own. The community care policy specifically aims to "lay the groundwork for providing community care by 2025" and to "facilitate universal access to community care by 2026" [18]. The policy emphasizes individual human rights, local autonomy, and sustainable inclusive welfare as key directions for advancement. These measures are designed to effect meaningful changes in the lives of those needing care and to ensure the long-term viability of the policy by achieving tangible outcomes [19].

The Basic Community Care Proposal, published by the Ministry of Health and Welfare, outlines plans to provide older adults with home-visit medical services, including examinations and nursing care, and to expand home-based hospice care, enabling end-stage cancer patients to receive hospice care at home. Additionally, it aims to establish comprehensive discharge plans for older patients before their discharge, set up community connection centers in approximately 2,000 hospitals nationwide, and assign dedicated personnel, such as social workers, to facilitate community connection activities [3]. Despite the ongoing community care project announced by the government, there has been little progress in the area of home-based hospice care for end-of-life care of older patients. For these patients to receive community-based end-of-life care and to die at home, a significant promotion of home-based hospice care is essential. However, the number of home-based hospice facilities has not substantially increased even after the project's implementation. To improve home-based hospice care, improvements are necessary in accessibility, the expansion of the range of diseases covered, and the adjustment of costs to realistic levels [20]. It is particularly crucial to connect the training of personnel dedicated to caring for older adults at home or in the community with various welfare resources within the community [21]. Achieving this requires social workers to effectively coordinate different types of hospice services—such as inpatient, home-based, and consultation types—based on well-established discharge plans. Moreover, it is vital for them to integrate various community welfare resources. As the population ages, the number of older adults living alone with limited financial resources increases, and care becomes more market-driven. Therefore, the role of hospice and palliative care social workers has become increasingly important in providing community-based end-of-life care for financially vulnerable older adults [6]. From this perspective, it is necessary to examine the current practices of hospice and palliative care social workers and clearly define their role in community care.

2. Korean and international research on the role of hospice and palliative care social workers

When the hospice and palliative care health insurance fee pilot project was launched in Korea in July 2015, hospice and palliative care social workers were recognized as essential personnel, alongside doctors and nurses. These social workers fulfill a variety of roles, including providing psychosocial counseling and care to patients and their families, developing and connecting community resources, implementing programs related to hospice and palliative care initiatives, and supporting bereaved families [22]. Bereaved families who received systematic end-of-life care from these social workers reported relief from psychological burdens and experienced emotional stability. In contrast, families who lacked such support expressed regret about their end-of-life care experiences [23]. Thus, hospice and palliative care social workers are crucial in delivering high-quality psychosocial care within hospice and palliative care services. Their responsibilities typically include offering psychological and emotional support, counseling for terminal patients and their families, providing social and financial assistance, family counseling, managing and coordinating volunteer work and therapy programs, and caring for bereaved families. A significant body of international research on hospice and palliative care social workers has focused on delineating their roles and functions to demonstrate their professional expertise. This research covers the following topics:

1) Roles of social workers in hospice and palliative care in the 2000s as explored in international research

Qualitative research methods were predominantly employed in the early 2000s, during a period when there was scant research on hospice and palliative care social workers. This research aimed to evaluate the fundamental nature of the roles played by these social workers. Specifically, Sheldon categorized the roles of hospice and palliative care social workers into four distinct categories: focusing on the family, participating as a team member, managing the environment, and addressing anxiety [24].

In the late 2000s, a variety of research methods, including literature reviews and quantitative studies, were employed to evaluate the distinct roles and capabilities of hospice and palliative social workers, as well as to affirm their professional expertise and necessity. For example, Payne [25] contended that the roles of hospice and palliative care workers are complex and ill-defined. He suggested that these roles should not be generically defined but rather tailored and solidified within the context of their teams during practical application. Furthermore, numerous scholars have highlighted the critical role that social workers play within hospice and palliative care teams [26-28]. Lawson [26] noted that the roles of social workers might differ based on the environment of the hospice and palliative care teams they are part of, as well as the extent of care they provide. Moreover, there is a heightened emphasis on interdisciplinary communication and collaboration for social workers in hospital-based hospice and palliative care settings.

Recent research has focused on the professional training and practicum of hospice and palliative care social workers [29]. The need for training medical and hospice social workers was specifically addressed through the Social Work Leadership Development Award Initiative (1999 to 2004), which was supported by the Project on Death in America (PDIA) and involved various social work researchers [30]. Herman [31] highlighted the risk of de-specialization in hospice and palliative care social projects and advocated for research to verify the effectiveness of training and education. This, he argued, would enhance the professional expertise of social workers and reinforce the recognition of social work as a professional occupation. Additionally, Rine [32] stressed the importance for social workers to thoroughly review hospice and palliative care literature and to develop cultural competencies. Furthermore, Head et al. [33] conducted a nationwide study on the profession of social workers within the hospice and palliative care sector. They analyzed a total of 152 profession rankings and assessed the importance of these positions.

2) Roles of social workers in hospice and palliative care as outlined in Korean research

Domestic research has primarily focused on the role perception, practice, competencies, and task exploration of hospice and palliative care social workers. Lee [34] explored the qualifications and work of these professionals through a literature review, categorizing their tasks into core and expansion tasks. Core tasks encompass psychosocial evaluation, individual counseling, group counseling, information provision, and handling requests. Expansion tasks involve consultation within hospice teams, community linkage, employee training, resource publication, volunteer consultation, activities, and the role performance of hospice managers. In a survey of medical social workers providing end-of-life care for terminal cancer patients, Sohn [35] identified key tasks in counseling these patients and their families. These tasks include addressing communication challenges, providing practical services and information, and counseling bereaved families. Intervention methods for improving communication encompassed self-screening tools, role-playing, letter writing, non-verbal expressions, and building trustful relationships. Han and Lee [36] investigated how medical social workers perceived and performed their roles in hospice and palliative care. Their findings revealed that participants viewed roles in "direct intervention areas," such as psychosocial and community resource assessments, as essential. Conversely, roles in "indirect intervention areas" like volunteer management, or in "expansion task areas" such as activities or research tasks, were deemed less important.

Choe [37] assembled a panel of 30 social workers from specialized hospice and palliative care institutions across the country and conducted a two-round Delphi survey to identify the roles and competencies of hospice and palliative care workers. The researcher identified a total of 131 competencies across 11 areas necessary for hospice and palliative care social workers to fulfill their professional roles. These areas include values and ethics, assessment, planning and intervention, linkage to and development of community resources, bereavement care, interdisciplinary team activities, self-reflective practice and spirituality, evaluation, research and training, advocacy and empowerment, policy development and administration, and qualifications and career development. Based on these findings, the researcher recommended developing a fundamental solution to address the issues of overlapping roles and task ambiguity among social workers and other interdisciplinary team members, such as nurses. Meanwhile, Kim [38] analyzed domestic research trends related to hospice and palliative care social welfare through a literature review. Kim noted that research on social welfare within the context of hospice care was not being conducted systematically and that the roles of social workers were still limited in interdisciplinary approaches.

Although the National Hospice Center of Korea annually introduces hospice projects to propose the roles of various professions based on the type of hospice and palliative care, previous studies have highlighted the need for more specific definitions of the roles of hospice and palliative care social workers [37-39]. The roles of these social workers have remained largely unchanged following the enactment of the Act on Decisions on Life-sustaining Treatment for Patients at the End of Life. Furthermore, in settings such as inpatient, consultation-based, and home-based hospice care, the roles do not specifically address the development of discharge plans, which are essential for integrated community care. Previous research also shows that hospice and palliative care social workers are often uncertain about their responsibilities in relation to discharge planning [39,40] and underscores the importance of maintaining continuous connections with community practices [41,42].

Previous domestic studies on the roles of hospice and palliative care social workers have several limitations. First, quantitative studies did not include social workers from all specialized hospice and palliative care institutions in their participant pool. Second, most research on hospice and palliative care social workers was conducted before the implementation of the community care policy and focused only on their general roles, failing to explore their roles within community care at a time when home-based hospice is anticipated to expand due to the systematization of this policy. Most importantly, no study has investigated how the roles of hospice and palliative care social workers have evolved following the initiation of the community care policy and the subsequent pilot project. Therefore, this study aimed to address these gaps by examining the perceptions of hospice and palliative care social workers regarding their roles in community care within domestic hospice and palliative care institutions.

3. Examination of social workers’ perceptions of their roles in community care

Research on community care-related hospice and palliative care social welfare in Korea remains limited. Therefore, this study analyzed the results of Kim's 2019 investigation, which surveyed 135 hospice and palliative care social workers across the nation to define their roles in community care [8]. The survey, conducted in 2019, saw a completion rate of 80%, with 108 out of 135 social workers responding. To ensure the validity of the survey items, a structured questionnaire was developed by a panel of 10 experts, including hospice practitioners and doctors specializing in social welfare. The reliability of the questionnaire was measured at 0.901. The data from the investigation were analyzed using SPSS 21.0, employing descriptive statistics and an independent sample t-test [8]. Building on this, the study aims to categorize the roles of hospice and palliative care social workers in community care into three distinct categories: 1) needs, 2) role perceptions, and 3) the necessary environment.

1) Needs for community care services

Although hospice and palliative care social workers generally demonstrated a high perception of the need for community care services (M=3.93, SD=0.75), their knowledge of community resources (M=3.17, SD=0.86) and their ability to connect patients with these resources at discharge (M=3.20, SD=0.90) were relatively low. Notably, among hospice and palliative care social workers, those with low job satisfaction (P=0.02) and a weak sense of team belonging (P=0.01) perceived a greater need for community-integrated care. Therefore, to improve job satisfaction and team cohesion among these workers, it is essential to strengthen their roles and improve access to community care services.

2) Roles of hospice social workers for community care

Key responsibilities of medical social workers in medical institutions include preparing discharge plans [43]. This role entails counseling inpatients who are awaiting discharge and their families, assisting them in transitioning to other environments such as their homes, nearby hospitals, or care facilities, and assessing their living conditions. Essentially, the primary responsibility of medical social workers is to facilitate community care, which involves planning for patients to receive integrative care in their usual living environments. This is also the central role of community care. Therefore, preparing discharge plans in community care is crucial. However, the perception of hospice and palliative care social workers regarding their roles in community care was ranked as follows: (1) supporting families (M=4.56, SD=0.59), (2) identifying social resources and linking to them (M=4.35, SD=0.66), (3) providing end-of-life care for patients and preparing for their funerals (M=4.22, SD=0.78), (4) counseling patients and their families to help them understand and accept their diseases (M=4.20, SD=0.75), and (5) adjusting community resources (M=4.01, SD=0.76). In contrast, these participants had relatively low perceptions of their roles in preparing discharge plans for community care (M=3.92, SD=0.85) and visiting older adults’ families to assess their living environments (M=3.55, SD=0.99).

3) Environment for practicing community care

Hospice and palliative care social workers identified the establishment of a linkage system between various community services as the most critical aspect of providing community care, with 42.6% emphasizing its importance for hospice patients and their families. They noted that to facilitate the return of hospice patients and their families to their living environments and ensure they receive ongoing care services, it is essential to offer home-based hospice care and establish connections with various public service systems, including housing, caregiving, and meal provision, that are accessible to patients and their families. Additionally, they highlighted the importance of developing a task manual specifically for hospice and palliative care social workers involved in community care (20.4%), setting up a community information system (17.6%), and offering professional training related to the system (15.7%) as crucial steps for implementing community care.

4. Projects for defining the roles of hospice and palliative care social workers for community care

1) System improvement

First, the roles and functions of social workers should be established institutionally in the context of home-based hospice care. Currently, legislation requires that social workers in this field also fulfill additional social welfare responsibilities, which hampers their active involvement. This requirement significantly diminishes the frequency of their home visits in hospice and palliative care settings. Moreover, the low insurance reimbursement rates for these visits further hinder the effectiveness of social workers in home-based hospice care. To address these issues, a legal framework should be created that enables social workers to dedicate themselves exclusively to home-based hospice care, thereby enhancing their roles and functions. Additionally, steps should be taken to increase the reimbursement rates for social workers' home visits.

2) Training enhancement

Training for hospice and palliative care social workers in establishing discharge plans should be enhanced. Discharge planning is a fundamental role of social workers, serving as a bridge between hospitals and community care. However, these professionals often have a limited understanding of their roles and functions in discharge planning. Therefore, it is crucial to strengthen their training to better integrate their roles within community care. Additionally, it is essential to focus on training for these social workers, who are at a higher risk of burnout. Factors such as low job satisfaction and a weak sense of team belonging contribute to burnout [44]. By emphasizing and clearly defining the roles of social workers in discharge planning through targeted training, it can help alleviate role ambiguity and increase job satisfaction.

3) System activation

Community linkage systems need to be established, and networks should be activated through the enhancement of regional hospice centers. Currently, in Korea, these centers conduct various training programs, enhance perceptions, and facilitate communication among experts. To ensure effective linkage between the diverse services available to hospice patients and their families, it is crucial to strengthen the functions of existing regional hospice centers. Additionally, resources for practicing community care should be shared and interconnected. Furthermore, an information system that allows for convenient access to information should be established.

Community care is an evidence-based policy and practice aimed at supporting health-vulnerable populations including older adults, children, and individuals with mental illnesses. For effective implementation of community care in hospice settings, it is crucial for policymakers to comprehend the needs of hospice patients, their families, and care practice experts, and to integrate these insights into community care policies actively. Despite the critical role of social workers in the successful deployment of community care, those in hospice care appear underprepared. To clearly define the roles of hospice and palliative care social workers within community care, several steps should be taken: First, the roles of social workers in home-based care need to be strengthened through institutional improvements. Second, there should be professional training focused on discharge planning. Lastly, the regional hospice center system should be developed further to improve linkages and the flow of information pertinent to community care.

Supplementary materials can be found via https://doi.org/10.14475/jhpc.2025.28.1.1.

No potential conflict of interest relevant to this article was reported.

Conception or design of the work: WK. Data collection: WK. Data analysis and interpretation: WK. Drafting the article: WK, SL, JJ. Critical revision of the article: WK, SL. Final approval of the version to be published: WK, SL, JJ.