A Theoretical Exploration of Live Discharge from Hospice for Caregivers of Adults with Dementia

Stephanie P. Wladkowski, Cara L. Wallace, Allison Gibson

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Patients with dementia may be discharged from hospice if their condition stabilizes. The loss of professional support and an already complex grief process needs careful attention. A live discharge presents a unique experience for each hospice patient, caregiver, and hospice team, which varies from traditional bereavement theories used to describe the grieving process. This article explores live discharge from hospice for caregivers of adults with dementia through a theoretical lens of Symbolic Interactionism (SI) and Attachment Theory (AT). The theories of SI and AT support and assist in understanding the experience of caregivers who lose hospice support due to ineligibility. In addition, caregivers watch the gradual deterioration and psychological loss of someone with dementia while they remain alive described as an ambiguous loss. Ambiguous loss as a subset of traditional bereavement theories provides a framework for this exploration and provides a relevant illustration of the complex needs. This article will conclude with implications for social work practice. It is important for hospice clinicians to be aware of current termination practices necessary to manage appropriate attachments, support the symbolic meaning of the hospice experience, validate the ambiguous losses, and maintain a sense of hope through a live discharge from hospice.

Original languageEnglish
Pages (from-to)133-150
Number of pages18
JournalJournal of Social Work in End-of-Life and Palliative Care
Issue number2
StatePublished - Apr 2 2020

Bibliographical note

Publisher Copyright:
© 2020, © 2020 Taylor & Francis Group, LLC.


  • Ambiguous loss
  • Live discharge
  • attachment theory
  • caregivers
  • dementia
  • grief/loss
  • hospice
  • symbolic interactionism

ASJC Scopus subject areas

  • Health(social science)
  • Life-span and Life-course Studies


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