Providing Grief and Bereavement Support in Aged Care
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Providing Grief and Bereavement Support in Aged Care

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Providing Grief and Bereavement Support in Aged Care 1021

Written by Dr Kristin Bindley, Postdoctoral Research Fellow at the University of Technology Sydney.

Dr Kristin Bindley is an Accredited Mental Health Social Worker (AASW) with extensive experience in bereavement counselling, and the national Bereavement Consultant Lead for Palliative Care Social Work Australia. Her work focuses on dying, caring and grieving in settings of end-of-life and aged care.

Grief and loss are universal human experiences. In aged care they are also everyday realities. Older people, their families and carers, and staff who support them are often navigating many transitions and losses. These may include changes in health, movement into residential care, end of life and death.

As workers and carers our ability to recognise and respond to grief with compassion and sensitivity is essential to quality care.

It can be helpful to clarify some common terms:

  • Grief refers to the personal and subjective range of feelings, thoughts, physical responses and behaviours that accompany any significant loss.
  • Bereavement is usually used to specifically describe the experience of loss due to a death.
  • Anticipatory grief refers to the cascading losses that may be experienced before a death, such as the loss of the ability to plan for the future, losses in function, or changes in roles and relationships.

Traditional ideas about grief led to the assumption that people move through grief in ‘stages’. We now recognise that grief is not linear, nor does it have a fixed ‘start’ and ‘end’ point. Grief often involves a process of moving back and forth between attending to the loss and attending to life, which is known as the Dual Process Model. [1]  Knowing that adaptive grief often feels chaotic and messy can help us to reassure those we support.

Another helpful way of understanding grief is the idea that we grow around grief, over time. [2] Our grief may not necessarily shrink, and sometimes it may even feel as intense as it first did, particularly around significant dates like an anniversary or in holiday seasons. We don’t simply ‘get over’ a major loss. Instead, our lives may expand or grow around it, as we find ways to carry the loss with us.

Although most people will adapt to grief without the need for professional intervention, a small number may experience additional difficulties. These may include physical health issues, new or worsening mental health issues, or Prolonged Grief Disorder. Being aware of this possibility helps to recognise when more specialised support may be required.

In practical terms, providing grief support in aged care begins with connection. Workers often worry about finding the ‘right’ words, but presence and empathic listening are a key starting point. This often requires us to sit with our own discomfort with painful feelings, and to tolerate silences. Inviting people into conversations through thoughtful questions can be helpful, if they are open to this. Where the loss is a death, this might involve gently asking about the person who died, or their memories of the person. It is also important to avoid the tendency to try to ‘fix’ the situation by problem solving or offering clichés. Allowing people to be where they are at without a sense of judgment is a powerful form of care.

Providing information can also help people make sense of what they are experiencing. Information can be shared verbally, in conversations, and through simple written resources about grief, the dying process and bereavement. Sharing information can also open further conversations and support families and carers to prepare for what lies ahead.

It is also important to help people maintain or strengthen their natural supports. Exploring who is around them, what kinds of support have been helpful or less helpful, and ways in which they may want more support can promote meaningful connection and reduce isolation.

Finally, staff should try to recognise people who may need additional help. This is likely to be people with identified risk factors, as well as signs that grief is disrupting their day-to-day life. Signs may include persistent low mood, loss of purpose, withdrawal from others or intense and painful longing after a death, which may indicate that a referral for more intensive support is needed.

Supporting grief and bereavement is core business in aged care and aligned with the new Strengthened Aged Care Quality Standards (5.7). It requires compassion, awareness and a commitment to care for ourselves, as well as those we support.

By approaching grief with understanding and humanity we can contribute to aged care environments where people feel seen and supported in times of profound loss and change.

Find the new ELDAC bereavement resources here:

References:

  1. Stroebe MS, Schut HAW. The Dual Process Model of coping with bereavement: Rationale and description. Death Studies. 1999;23(3):197-224. DOI: 10.1080/074811899201046.
     
  2. Tonkin L. Growing around grief-another way of looking at grief and recovery. Bereavement Care. 1996;15(1).
    DOI:10.1080/02682629608657376.

 

 

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Dr Kristin Bindley

 

 

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