End-of-Life & Palliative Counselor

HomeCareersEnd-of-Life & Palliative Counselor

“People often tell me I have the most depressing job in the world and wonder how could you possibly do this line of work. I always tell them that my job is to help bring people back into life. I help people move through the experience of death and be as present as they possibly can with a person who is significant to them.”

Elizabeth Schandelmeier, LCSW, APHSW-C, Senior Bereavement Counselor, Family Hospice (UPMC)

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 with 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.

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.

Meet the expert: Elizabeth Schandelmeier, LCSW, APHSW-C

Elizabeth Schandelmeier has supported grieving families for over a decade, including as a palliative social worker at a major level 1 trauma hospital supporting families through illness, decision-making, and end of life. She is currently a senior bereavement counselor for Family Hospice, part of UPMC, where she is also responsible for training palliative MD fellows in bereavement and end-of-life communication.

Schandelmeier facilitates a support group for people with malignant brain tumors at Cancer Bridges and has a small private practice (Howling Lion Grief Support) focusing exclusively on grief, loss, death, and dying. She is also a recognized grief expert and has published podcasts on various topics through UPMC HealthBeat with Tonia Caruso. She holds a master’s of social work from the University of Pittsburg and is a licensed clinical social worker as well as an Advanced Palliative Hospice Social Worker – Certified (APHSW-C).

CounselingSchools.com: What is something you wish the public understood about palliative/end-of-life counselors?

Schandelmeier: People often tell me I have the most depressing job in the world and wonder how could you possibly do this line of work. I always tell them that my job is to help bring people back into life. I help people move through the experience of death and be as present as they possibly can with a person who is significant to them.

Then, after the death, I help people pull their life back together. There’s been all this change and adjusting that they have to do and that can feel weird. At the end of the day, this isn’t so much about death and dying; it is about living.

CounselingSchools.com: What advice would you give to aspiring palliative/end-of-life counseling students?

Schandelmeier: It’s important to understand that there is no standardized curriculum for doing this work. Students who want to work in this field need to first think about what community they want to serve.

For example, do you live in a rural farming community? Do you live in an urban environment? Engage with the medical system that is local to you because then you can truly see what families are going through. You will learn what going through cancer or a transplant looks like. You can have a better understanding of what happens when someone is sick. Being able to bring some insight into the process that potential clients have moved through is really helpful.

How to Become an 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 with a degree in a related field—is to seek out a school offering 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. 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 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 aims to achieve a bachelor’s or a master’s degree, at minimum. Fordham University 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 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 admission options: regular 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 with a bachelor of social work degree from a CSWE-accredited program and 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 state’s specific requirements. Programs accredited by the Council on Social Work Education must provide at least 400 hours of field education for bachelor’s degree programs and 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 toward 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 to complete the master’s of social work (MSW) degree. Students must 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, a board of health will handle end-of-life and palliative counselor licensing. 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 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 has recently 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 to verify their specialized knowledge, skills, and professional abilities related to end-of-life care and pain and symptom management. 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 ethics units 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 various people is important. It is crucial that the counselors 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 $45,500 and $98,500 per year with a master’s degree in social work, according to ZipRecruiter (Oct. 2024). They say that, on average, a hospice social worker with a master’s in social work can earn an annual salary of $70,656. PayScale (Oct. 2024) reports that the average social worker salary, without the end-of-life specialization, is $55,128 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

Kimmy Gustafson

Writer

At CounselingSchools.com, Kimmy Gustafson’s expertly crafted articles delve into the world of counseling and mental health, providing valuable insights and guidance to readers since 2020. In addition to feature pieces and interviews, she keeps the state licensing tables current. Kimmy has been a freelance writer for more than a decade, writing hundreds of articles on a wide variety of topics such as startups, nonprofits, healthcare, kiteboarding, the outdoors, and higher education. She is passionate about seeing the world and has traveled to over 27 countries. She holds a bachelor’s degree in journalism from the University of Oregon. When not working, she can be found outdoors, parenting, kiteboarding, or cooking.

Vanessa Salvia

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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.