Bereavement
Grief is a natural response to any loss, such as death, a diagnosis, a change in health.
Bereavement is the experience of grief after the death of a significant person.
Residential aged care will be the last home for most older people who enter this setting of care in Australia. [1] This means that grief and bereavement support for older people is core business in residential aged care. Support is also provided to those around older people, such as their friends, families, carers, and workers.
Older people, their family and carers:
- Will often experience increased grief during times of transition. Such as when someone enters residential care, when their needs are changing, and at the end of life. [2]
- May be at risk of Prolonged Grief Disorder [3, 4], and other mental health concerns related to their grief or bereavement. [5, 6]
Providing grief and bereavement support based on the spiritual, cultural and psychosocial needs of older people aligns with the Strengthened Aged Care Quality Standards. Information about loss and bereavement should also be offered to family and carers (Action 5.7.3). [7]
All team members in residential aged care are well-placed to provide basic support for older people, and their family and carers. Care workers and clinicians need to be aware of:
- core concepts (grief, anticipatory or pre-death grief, and bereavement), and
- factors that may increase the risk of negative outcomes related to grief and bereavement for older people, their family and carers.
These ELDAC resources provide this key information:
Care workers and clinicians can provide effective grief and bereavement support for older people, their family and carers.
Bereavement Practice Tips for Care Workers and Clinicians
ELDAC has Grief and Bereavement: Practice Tips for care workers (375kb pdf) and clinicians (441kb pdf) that provide key information on how to:
- offer support before and after a death, and for other losses
- share information about dying, grief and bereavement
- help people to connect with their own social support
- identify and respond to people with extra or complex needs.
In addition, all workers in residential aged care should think about these specific issues and tips when providing grief and bereavement support:
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Day-to-day care
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Share information
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When the older person dies
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Identify support needs
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Extra support
What can I do in my day-to-day care now, to try to ensure people cope as well as possible with grief and bereavement later?
Recognise that positive experiences of care at the end of life may reduce the risk of poor outcomes in bereavement. [8] The care you provide can have an impact upon family and carers long after an older person has died. High-quality care at the end of life includes:
- talking with family and carers about changes in an older person’s condition
- exploring and addressing any spiritual, cultural and religious needs
- inviting family and carers to be involved in care at the end of life
- ensuring an older person’s room is as ‘home-like’ as possible at the end of life.
Why is it important to share information about dying, grieving and bereavement?
Sharing basic information about dying and grieving can help people to understand and normalise their responses to grief. It may also assist older people, family and carers to prepare for a death. [9, 10] There will often be opportunities to share this sort of information in residential care settings. You might:
- Offer printed or downloadable resources to older people and their family or carers when talking with them over time about end of life or grief.
- Ensure printed copies of helpful information are available for older people, families, and other visitors at your residential aged care facility. The information can be displayed in family room or lounge areas. This should include information about available support services, such as grief and bereavement counselling.
For examples of simple resources you might offer, see Information for families and carers. Keep in mind the need to share culturally appropriate information about grief and bereavement. There are also translated resources that are freely available. For instance, Coping with Grief by Griefline is available in English, Arabic, Greek, Spanish, Vietnamese and Chinese.
How should I respond when an older person in my care dies?
It is important to respond actively to the death of an older person in residential care in meaningful ways. This includes:
- Using thoughtful words and actions to recognise a death with family and carers. For more information, view this brief clip What to say to family when a resident dies from palliAGED.
- Acknowledging the death with other older people living in the same residential care setting. For instance, arranging a Guard of Honour, using their name in conversations where culturally appropriate, and supporting ways to remember the person. Some examples may be placing their photo in a common area, creating a memorial table, and sharing stories about the person.
- Following up with families after a death, to check in and offer support.
How might I identify people at risk of poor grief and bereavement outcomes?
All workers should be aware of factors that may place an older person, family members, or carers at increased risk of difficulties in grief and bereavement. This includes mental health concerns, such as Prolonged Grief Disorder.
ELDAC Grief and Bereavement: Core Concepts for Care Workers (450kb pdf) and Clinicians (721kb pdf) includes a simple summary of some of risk factors to keep in mind, such as:
- low social support
- high levels of pre-loss grief
- existing mental health concerns
- carer burden
- feeling unprepared for a death
- bereavement overload (many losses close together).
Clinicians working in residential aged care can also use the conversational prompts listed in ELDAC’s Grief and Bereavement: Core Concepts for Clinicians (721kb pdf) to support assessment of grief and bereavement-related risk and protective factors for older people, and their family and carers. Consideration of these factors should begin before a death, and factors should be revisited, and reviewed over time in residential aged care.
What should I do when someone needs extra support in their grief or bereavement?
Pay attention if someone is experiencing risk factors, such as:
- low mood
- loss of purpose
- intense and painful longing for someone who has died
- difficulty engaging in day-to-day tasks
- withdrawal from others.
You may notice some of these factors over time, as you work with an older person, and their family and carers in the residential aged care setting. This means you may be able to proactively support people in need of extra care to connect with services providing anticipatory grief and bereavement support.
It is important to offer extra support when someone has several risk factors that seem to impact their ongoing coping in negative ways. Suggest counselling or other support services.
ELDAC’s Grief and Bereavement: Practice Tips for Care Workers (375kb pdf) and Clinicians (441kb pdf) provide simple guidance about identifying complex needs, and assisting people to access additional grief and bereavement support where needed.
- Gain a better understanding about care in the bereavement phase by listening to the ELDAC podcast on this topic.
- Use the ELDAC Bereavement Residential Aged Care Case Study about Ben and John for individual or collective reflection and learning in your residential care setting.
- Download the ELDAC Bereavement resources for personal learning or to use within in-services or education in your setting:
- For care workers
- For clinicians
- Create a simple bereavement pack that team members can offer to families shortly after the death of an older person in your residential care setting. A bereavement pack is typically a small package given to family members or carers that includes printed information on grief, practical tips, and support services. Some organisations also create their own booklet about what do to after a death, with practical information about who to contact, and how to seek support. For guidance about how to create a bereavement pack and what you might include, see these suggestions.
- Develop opportunities for collective remembrance following the death of an older person. These opportunities create space for older people, as well as team members, to honour someone who has died, and to support one another. For example:
- A guard of honour when an older person’s body is leaving the care setting.
- Placing the photo of an older person on an honour board, creating a memorial table, or lighting a candle in a shared area.
- Holding memorial services or remembrance morning teas.
- Feature other resources for discussion in education sessions or in-services. For example, palliAGED has Practice Tips on ‘Grief and Loss among Older People, Families and Residents’ for Careworkers (311kb pdf) and Nurses (231kb pdf).
- Attend to your own self-care. Know that caring for people who are dying and grieving can raise thoughts and feelings about your own experiences of loss. Be aware of your own wellbeing and needs, especially around the time of or after a death, and when an older person has been known to you in a residential care setting for a long time. Draw on a range of strategies to reflect on your own grief and loss, including:
- Individual strategies to help you manage your emotional, social and physical wellbeing. For examples and resources, see the ELDAC Self-Care Room, or Palliative Care Australia’s Self-Care Matters.
- Collective strategies to help you reflect on losses within your residential care setting. Such as opportunities to informally debrief with your colleagues after a death, and engaging in rituals to remember an older person. Examples of these are remembrance morning teas, memorial table, and memorial services.
- Professional strategies, such as Employee Assistance Programs and other supports that may be provided by your organisation.
Grief and Loss
CarerHelp
This page offers a list of relevant resources and support services focused on grief and loss, with a particular focus on the needs of carers.
Understanding Grief
Palliative Care Australia
This brochure provides information about responses to grief, ways you can help yourself and others, and support services.
Griefline
The Griefline website offers a range of grief and loss resources and information about connecting with online forums and counselling. The Griefline Helpline (Ph: 1300 845 745) is also available 8am-8pm, 7 days a week.