Grief Education for Caregivers of the Elderly

Harold G Koenig, Junietta B Mccall

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317720881
• Edition: 1
• Topic: Education
• Subtopic: Education General

Through firsthand accounts and research, Grief Education for Caregivers of the Elderly focuses on the education, training, and support of individuals who care for the elderly. This book provides caregivers with methods to cope with grief and loss and will help educators design programs that meet the needs of their consumers: the elderly and their families, friends, and service providers. From Grief Education for Caregivers of the Elderly, you'll learn how to cope with the stress and emotions of caregiving and improve the quality of services to your patients. With an emphasis on caregivers of the institutionalized elderly and the special services provided by clergy, chaplains, and pastoral counselors, Grief Education for Caregivers of the Elderly offers the caregiver or educator several model workshops focusing on grief, loss, and bereavement care. Grief Education for Caregivers of the Elderly contains proven methods and strategies that will sharpen and enhance your caregiving skills, including:

• focusing on the emotional responses and phases of dying, including denial, anger, and acceptance, to help patients deal with death
• considering physical and administrative atmosphere and your elderly population when setting goals and designing workshops to provide optimal patient/resident care
• discussing the themes of grief and loss, stress management, handling change, and promoting self-care for caregivers in workshops and through self-evaluations
• developing workshops that open with grief history surveys and attitude checklists, discuss normative development and issues of old age, and have themes based on the biological, psychosocial, and spiritual needs of the elderly person
• providing caregivers with an opportunity to practice what they have learned through case studies, simulated role play, open discussions, and care plan designing
• thinking about your own mortality and learning about your feelings and ideas of growing old

Utilized at a psychiatric nursing home facility of New Hampshire Hospital, the workshop exercises in Grief Education for Caregivers of the Elderly have allowed caregivers to express personal feelings; talk about beliefs and experiences; learn about biological, psychosocial, and spiritual processes of grief and phases of bereavement; and apply these understandings and insights into typical caregiving situations. Grief Education for the Caregivers of the Elderly gives you the framework for such a program, using vignettes, composite case material, poetry, and a holistic approach to health care to emphasize the importance of your emotional health and enhanced care of the elderly.

Chapter 1
The Challenge of Grief Education for Caregivers of the Institutionalized Elderly

I first started clinical work at New Hampshire Hospital in the summer of 1982. As I listened to patients and residents, I became aware of what it meant to them to be mentally ill and hospitalized. It seemed that much of their world was centered around an overwhelming experience of loss and grief. They would speak daily of loss of home, vocation, family and friends, church and faith, health and individuality, freedom, and hope. Frequently, I would hear about the time, precious time, of which their illness had robbed them. Often they spoke of the loss of their youth, of middle age, and even of seventy years spent in the hospital. This pervasive sense of loss and grief was confirmed by the experiences of students in our clinical pastoral education program at the hospital and by the experiences of others such as chaplains and staff. To be mentally ill is to experience not just the ordinary losses of living but the extraordinary loss of an all-consuming illness.

In August 1985, I joined the hospital staff as Protestant chaplain and then as director of the Department of Pastoral Services. Now, more deeply involved in direct pastoral care throughout the institution, I worked more frequently with the elderly unit. It was at this time, during the final moments of a patient’s life and the days following, that I observed staff doing their best to provide quality care for these elderly persons.

Just as loss and grief were prevalent among patients of all ages, so too was their toll great among caregivers. Here, in the elderly unit, caregivers were faced with the stress of working with an aging and institutionalized population, with multiple health problems, and minimum or no social supports. Some patients slept much of the day. Others were fed through tubes. Others were lost to the realms of dementia or the final stages of Alzheimer’s. These persons were not dying from the pains of mental illness but from age—from sixty-five to one hundred-plus years of living!

For example, it was during this time that a ninety-seven-year-old woman died. The last time I saw her alive was about seven o’clock one evening, when I stopped in to see how she was doing. I had never heard her speak. The week before, I had been at her bedside when her only son, approximately seventy years old, had come by to visit. The nurse on duty at that time appeared relieved to refer him to me, since the son was having great difficulty visiting his dying mother. At that time, he shared with me that he had not lived with his mother since he was a toddler. She had nearly scalded him while giving him a bath. She had been hospitalized, mostly in a psychiatric facility, since she was twenty-seven years old—some seventy years. She no longer knew him and had not for some time.

He had visited her infrequently over the years because he could not handle her craziness and rejection. Now it was his responsibility to make arrangements for her burial and to be with her while she was dying. He had selected a funeral home but confessed that he wasn’t up to being alone with her. It was then that I offered to be with him and to work with him to provide a funeral for her.

Later, at her graveside, twelve formerly estranged relatives (from nine to eighty years of age) and two staff persons participated in her funeral. On a beautiful fall day, under a huge maple tree, we said good-bye. She was surrounded by family, most of whom had never known her, and two staff members who had represented her surrogate family for seventy years. Back at the hospital, the staff confided that they were angry that the family was there but had not come to visit her while she was alive. I, on the other hand, had celebrated that her son had come and that, before dying, she had looked up at me with big blue eyes from under a beautiful comforter that a caring staff person had drawn around her. I thought it was wonderful to see generations gathered round to hear what she was like in her life and to come together, even at this time. Some had not spoken to one another for years!

The countryside was remote and beautiful, and having grown up on a farm, I couldn’t help but appreciate the beauty of the day, the site, and the persons. The family was appreciative and talked to one another. Meanwhile, the staff remained angry and bitter and distant. I knew that they were grieving. I also knew that their intense grief was affecting the care they were providing to this family. Their grief blocked them from being supportive of the family during this time of need. I wondered how many of these conflicted feelings would be carried back to the unit to affect their work with other residents and families. I knew something needed to be done.

Grief and Loss Support Services Needed

In the fall of 1986, the staff of the Department of Pastoral Services met with the chief executive officer of the Psychiatric Nursing Homes Services to discuss ways to support staff in their grief over the death of patients. From that meeting came the proposal that Pastoral Services provide staff workshops on “death and dying” and “grief and loss.”

The first workshop was held in the winter of 1987. It consisted of the sharing of personal experiences of loss, a presentation on normal and complicated bereavement responses, and a case example focusing on interventions related to grief and loss. Between 1987 and 1990, ten workshops were held, with 108 participants representing all caregiving fields within the elderly services unit. More workshops were held from 1990 to 1995. Today, grief education is an integrated part of the total health care program.

The Scope of the Need

What began as an identified need for support for caregivers working with elderly people who were facing death and/or grieving, soon began to take a specific shape. The identified need of “support” was found to have three components: administrative, educational, and therapeutic. These three areas provided the challenge and the parameters of our workshop focus.

Administrative Support

None of these workshops would have been possible without the explicit recognition and support of the chief executive of the unit. Through this channel, the area of need was legitimized as important and, more than that, as essential to meeting the needs of the patients. The challenge included the allotment of time, the legitimization of need, and the provision of services through the educational in-service model. We were fortunate that administration saw the need and presented the idea to us at a time when we in the department were similarly focused on grief education. From this and other experiences, we have identified that the basic requirement for administration is to have a clear concept of grief education and a means of naming and supporting training in this area. This is a fundamental challenge in all grief education efforts in institutions.

Educational Support

The second challenge, that of the provision of support through the in-service educational model, was actually the easiest of the three challenges to meet. The hospital already had a format for skill acquisition in place. Further, stress management and grief education were recognized as essential interventions, based on observed burn-out rates, high staff turnover, and management problems with individual patients. These tangible observations provided the motivation needed to develop a grief education program. Staff turnover and burn-out on the old-old age units were particularly high.

After the first workshop, our hypothesis was confirmed: staff, in general, did not have a working awareness of the grief process or of normal responses to death and dying. At this time, we were also aware that the staff needed to practice applying the fundamentals of grief process theory to specific case situations. The challenge of educating the staff about grief and loss processes and relating this to an elderly population was enormous.

Therapeutic Support

The third identified need was for therapeutic support. A portion of what was identified, by the administration and the Department of Pastoral Services, was the underlying goal of support through knowledge and acquisition of skills. An equally important dimension was encouraging caregivers to talk about what happened during their day, about patients who were critically ill and facing death, and about how they felt and how they, too, grieved. It seemed that if staff were supported, quality care would occur as a result. However, here, too, we faced a challenge not uncommon to caregivers and to grieving, that of avoiding focusing on oneself by keeping the focus and the feeling on the patient. An equal part of the challenge was the difficulty caregivers had in identifying either too closely or not at all with the aging and institutionalized person. We found that aging persons, their grief, and their death can be very threatening to their caregivers.

In summary, the challenge of grief education for caregivers of elderly persons consists of providing support through administrative, educational, and therapeutic foci. There must be time to talk about death and dying, grief and loss. Caregivers need to hear from one another, to affirm, support, and challenge one another in practical ways. Training should be available for caregivers in grief work, focusing on skill attainment, practice, and maintenance of skills. Caregivers must identify and enhance their role as supportive persons. Further, there is the need to identify and affirm the individuality, personality, and level of experience each person brings to the job and to the educational effort.

A Mandate for Grief Education

The obligation to provide grief education for caregivers of the elderly comes from the needs of the elderly, who face the grief of aging and loss (including the anticipation of their own deaths). The mandate also stems from the obligation of a healthcare facility to provide the best care possible for the aging client. This means that the caregiver must receive the following training components:

• A working theory of aging, death and dying, and grief and loss
• General information about the needs of the grieving elderly person, with attention to specific living contexts (homes, assisted care, and long-term care facilities)
• A focus on appropriate caregiving interventions
• A means for support of elderly persons through an understanding of personal and professional responses to aging, dying, and grieving patients

Why Grief Education?

If the obligation to provide grief education arises from the expressed needs of persons working in the caregiving field, then the rationale for attempting to meet those needs comes from a broader understanding of the reasons for attempting this kind of education. The growing field of gerontology, the study of aging, the study of grief, death and dying, and bereavement, and the growth of trained mental health professionals were previously identified as major trends affecting the field of grief and loss education for caregivers of the elderly. More specific reasons for meeting the needs of caregivers and elderly persons and furthering the challenge and obligation for grief education arise from experience and observation in the field. Eight such reasons make grief education essential.

Knowledge about grief is helpful. The intellectual “knowing” of the universal stages and responses of grief tends to affirm and normalize the process of grieving, which leads, in many cases, to recovery with fewer complications. A review of research in grief and loss education indicates that the amount of education an individual has, in general, can be a factor in the potential for complicated grief (Glaser and Strauss, 1968).

Social changes tend to make death threatening to individuals. In our industrialized and medically advanced society, there exists a sense of continuous change. Viewed in this light, death can become one more experience of loneliness rather than a natural process, with continuity of connections and completion of social and individual growth.

The needs of seriously ill persons and the elderly in particular are great in today’s society. Complex factors make it ever more challenging to meet the needs of seriously ill and elderly people. The sheer number of elderly persons and length of their life span is increasing at a faster pace than our knowledge of their health concerns and unique needs. We have relied on hospitals and nursing homes to provide for our elderly population and, in so doing, have lost some of our ability to value, care for, and live with these persons in our midst.

Early learning about death and loss often causes complications for the dying and the bereaved. Our first experiences concerning death and dying often come early in life and involve the media, pets, or our fears and fantasies of separation. If the death of a close family member occurs when we are young, this event is often considered something to hide from and may become a basis for further fears in later years. Grief education can help participants sort out these early losses and assist with grief recovery. This enables individuals to face grief in the here and now, with integrity of self and profession.

Education is a resource. As we grow and develop as individuals, we often learn from other people’s experiences as well as our own. Much of this learning becomes a way of modeling that can be of great value. By providing structured experiences for learning, and by mixing beginning, intermediate, and advanced learners, the range of modeling opportunities expands greatly. This ability to observe and reflect upon what is modeled leads to professional and personal advancement. Therefore, persons in the field of grief education, in which growth and recovery are complementary goals, can use education as a professional and a self-help dimension.

Connectedness is essential to psychological, social, and spiritual health. It has been claimed that education is a great socializing factor, a bearer of social and spiritual standards in particular. Grief education provides the connections people need to recover from personal and professional losses for the sake of a greater standard—the ethic of helping one live and die with meaning.

Mental health and...