Case Study - Bereavement - Residential Aged Care
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Bereavement Case Study

Ben entered residential aged care 5 months ago after being in hospital. Ben was diagnosed with prostate cancer about 18 months before then, and his prognosis is limited. Ben also has Parkinson’s Disease. Nico is Ben’s partner of 10 years. Nico has been providing more care over time for Ben at home since his diagnosis. Before Ben was unwell, Nico and Ben volunteered, went to a local gardening group and enjoyed short driving trips. Ben has a son and daughter from a past relationship, who visit him often. Ben also had a son who died in an accident 15 years ago. Ben shared this with you a few months ago when you asked about a photo of his children in his room.

Ben’s mood seems to have changed in the last month. He seems flat and withdrawn. He has stopped doing the daily crossword, which used to be a usual topic of conversation.

Nico appears to have a good relationship with Ben’s son. However, he and Ben’s daughter have argued several times while visiting Ben. You are aware that Nico is not connected with his own family. Nico also told you last month that a close friend of theirs just died of motor neurone disease (MND). You notice that Nico is often teary when you are working with Ben. Nico seems generally flustered and stressed a lot of the time. He is often checking if what he is doing for Ben is 'right'. He appears to be very anxious about issues that seem minor to other staff and to Ben (e.g. when some items of Ben’s clothing were misplaced). Yesterday, a co-worker told you that Nico said that he feels like he is 'losing everything'. Nico told her that there will be 'nothing to live for' after Ben dies. Nico also mentioned that he is concerned that Bens’ children will contest Ben’s will after his death.

  • You know that having a life-limiting illness means that older people and their families and carers can begin to grieve in different ways over time (anticipatory or pre-death grief). You are aware that Ben might revisit past losses (e.g. his son’s death) as his health worsens. You talk with your team members over time, to ensure Ben is offered more support if needed, such as pastoral care or counselling.
Clinicians: You consider if a more in-depth psychosocial assessment might be needed at any time.
  • You are aware Ben and Nico might want to talk about their feelings and thoughts at times. You take opportunities to proactively check in with them about their coping. For instance, when Ben seems teary as you help him into his chair, you begin a conversation by gently saying: 'You seem to be feeling low today, Ben – have I got this right? I think it’s really understandable you might be feeling like this…' You allow time for Ben to engage, without pressuring him.
  • When Ben is nearing the end of his life, you and other staff invite Nico and Ben’s adult children to be with Ben as they feel comfortable. You give them some ideas, such as gently massaging Ben’s hands, or playing some of the music he loves.
  • After Ben’s death, you let Nico and Ben’s family know that they can take time to sit with Ben’s body. You let them know that there is a private family room nearby where they can be together.

You choose simple resources to share with Ben and Nico (e.g. Palliative Care Australia’s Understanding Grief booklet (812kb pdf)). You let Ben and Nico know that they can always talk to you or other team members about how they are coping.

Clinicians: When providing information, you take the time to explain that grief can involve many different responses. However, these are usually normal reactions to loss and change.

You recognise that coping with the caring role may be very challenging for Nico. When talking with him, you acknowledge that carers can be dealing with many losses. You tell him that carers often feel alone, or that others don’t understand their grief and what they are going through. You let him know about support and information that is available through Carer Gateway.

Clinicians: Knowing that low levels of social support can place someone at a higher risk of negative outcomes in bereavement, you try to get better understanding of Nico’s support over time. You use the conversational prompts from the ELDAC Grief and Bereavement: Core Concepts for Clinicians (721kb pdf), such as 'What kinds of support have others offered? What has been helpful for you?' You suggest connecting with other services and supports where this may be helpful for Nico.

  • Thinking about some of the factors that may place people at risk of extra difficulties related to grief and bereavement (e.g. Prolonged Grief Disorder, and other mental health issues), you notice a few factors seem relevant for Nico in particular:

  • Low level of support

  • Recent bereavement

  • Pre-death distress

  • Unclear financial situation

Nico may have a low level of support, and seems to be distanced from his family. You wonder whether this might also be due to discrimination that people in same-sex relationships can face. You are aware Nico might be experiencing disenfranchised grief (grief that may not be well-supported and recognised by others).

Nico and Ben have had a recent bereavement (the death of their friend).

Nico seems to have a high level of pre-death distress. You are concerned about his wellbeing and how he will manage after Ben’s death.

Nico’s financial situation is unclear and he seems anxious about Ben’s will.

Care Workers: You review the information about risk factors in the ELDAC Grief and Bereavement: Core Concepts for Care Workers (440kb pdf). You discuss your concerns about Nico with your manager.
Clinicians: You use the conversational prompts from the ELDAC Grief and Bereavement: Core Concepts for Clinicians (721kb pdf) to further explore risk factors over time. For instance, Nico’s experience of caring (e.g. What is it like for you to care for Ben? or How has caring impacted your daily life?), and any history of mental health issues. Given Nico seems to be dealing with several factors that are impacting his coping, you encourage him to consider extra support, such as counselling (e.g. Carer Gateway Counselling Service - Ph: 1800 422 737).
  • You are concerned about Nico’s comment that he will have “nothing to live for” after Ben’s death. You talk with the co-worker who shared this comment with you.
Care Workers: You decide to raise this issue with your manager straight away. Your manager makes sure that a registered nurse who has a good relationship with Nico has a conversation with him about this comment and his coping.
Clinicians: As you have a good relationship with Nico, you agree to talk to him about this comment as soon as possible. You tell Nico that sometimes people have very difficult thoughts (e.g. about self-harm or suicide) when dealing with stress and grief, and so you felt it was important to check in with him. You say something like 'Sometimes people in situations like this feel really overwhelmed, even to the point of thinking about harming themselves or ending their life. I wanted to check if you were having any thoughts like this, Nico?' Nico says he felt very stressed and exhausted, but did not intend or plan to harm himself earlier, or now.
You recognise that intense feelings and thoughts can often arise for people while caring at the end of life. You talk to Nico about the available 24 hour supports and how to connect with these if needed (e.g. Lifeline Ph: 13 11 14). You also provide information about other counselling services (e.g. Grief Australia Phone Support List). You revisit this information with Nico after Ben’s death. Nico says he is glad you raised his comment and he feels relieved to be able to talk with you about how he is coping. You also encourage him to seek legal advice regarding his concerns about Ben’s will and estate.
  • With your team members, you continue to review Nico and Ben's coping over time and discuss any concerns.

Key Messages

  • You are well-placed to offer basic grief and bereavement support for older people and their families and carers. Be open to spaces where you can listen and give support.
  • Share information about dying, grief, bereavement, and relevant support services.
  • Follow up any concerns related to safety and wellbeing immediately, as appropriate for your role.
  • Over time, recognise and review risk or protective factors that might shape the coping and bereavement of an older person and their family or carers. Continue to discuss needs and support with your team members.
  • Where more support is needed, be proactive about encouraging linkage to psychological and emotional support (e.g. counselling) or practical support (e.g. financial and legal services).
  • This case demonstrates the application of the ELDAC Grief Practice Tips for Care Workers (375kb pdf) or Clinicians (441kb pdf). Use these practice tips to guide your own work.