Social work and end-of-life care for older people: a historical perspective.

End-of-life issues became increasingly complicated during the 20th century as profound shifts occurred in who died, how they died, and when they died. This article reviews societal changes related to death in the United States and chronicles the developments in social work practice with and for dying people and their families in the 20th century, leading up to the 1993 policy statement of the National Association of Social Workers on end-of-life decision making, which reinforced that client self-determination, a fundamental principle of social work, should apply to people planning for their deaths or undergoing a dying process. After identifying limitations in policies and practices, suggestions are offered to promote competent social work practice and enhance end-of-life care, particularly with reference to the dying process of older people.