“They Don’t Just Disappear”: Acknowledging Death in the Long-Term Care Setting

1. “They Don’t Just Disappear”: Acknowledging Death in the Long-Term Care Setting “That’s really important to people at the end of life to know that on some level people are going to remember them.” [staff] Our study St. Joseph’s Health System Research Network (SJHSRN) conducted a qualitative study to (a) document the value or impact of the Room Blessing Ritual from the perspective of residents, family members of deceased residents, and staff, (b) extend current practice and research about bereavement rituals to support those living and working in long term care settings, and (c) inform quality improvement initiatives to enhance the ritual experience for future Room Blessing participants Interviews were conducted with eight residents, seven family members, and nine staff who had each attended one or more Room Blessings. The transcribed interviews were thematically analyzed. • OVERVIEW • In the Long-Term Care setting, death is experienced frequently by residents and staff. The extended length of stay (average >2 years) and the intimate nature of care provided intensify the grief that is felt by residents and staff though this grief is often not recognized or well addressed. • In the broader community, funerals, memorial services, and other bereavement rituals provide opportunities to express grief, share the sense of loss, and support bereaved individuals. However, in the long-term care setting, logistical considerations inhibit the ability of residents and staff to attend these rituals which are most often conducted off-site. • An additional concern relates to the short time frame in which the deceased is replaced with a new resident complicating the grief felt by residents and staff. • There is very little literature examining the long-term care setting in terms of the impact of dealing with frequent deaths and of current practices for supporting residents and staff to cope with grief and bereavement. J. Maitland1,2, B. James- Abra2, K. Brazil1,3,4, Sr. M. Graf2, S. Malonda2 1) St. Joseph’s Health System Research Network 2) St. Joseph’s Health Centre, Guelph 3)Department of Clinical Epidemiology and Biostatistics, McMaster University 4) Div. of Palliative Care, Dept. of Family Medicine, McMaster University A UNIQUE RITUAL A Room Blessing Ritual is practiced at St. Joseph’s Health Centre in Guelph to acknowledge and support residents, staff, and family members when a resident dies. The ritual is led by pastoral care staff and held in the deceased resident’s room. Prayers are said and memories are shared in honour of the deceased. The ritual concludes with prayers for the incoming resident as well as a note and token left to welcome the new resident . “...we always laugh, we do more laughing than crying at those, so I think for family and for all of us it’s a good thing” [staff] FINDINGS Room Blessings fulfill a number of needs across the three groups. Specifically, Room Blessings provide opportunities to: • Take time to acknowledge death and grief and to say good-bye • Come together as a community recognizing and including all members of the care team (staff, families and residents) • Reflect on and celebrate the life lived through sharing of stories • Connect with and express condolences to family members • Welcome the incoming resident through prayer and leaving of a token note and pin • Contribute to the overall impression of St. Joseph’s as an organization that lives its mission and values by providing compassionate care [three most valued elements ] Some challenges were identified: • Conducting in-room Blessings with larger groups • Short notice can limit ability to attend • Staff often feel guilty when unable to attend • Timing can be burdensome for family members Suggestions for Improvement Most staff, residents and family members indicated they would not change anything about the Room Blessing ritual. A few suggested: • Changing time /place to accommodate different group sizes • Getting rid of religious elements • Conducting Room Blessings with deceased present in room • Inclusion of biographical synopsis of deceased “The staff and the residents don’t usually have a chance to attend the visitation or the funeral.” [family] “...it was very good to come back to the room where he died and with people who had been involved in his care. It was very reassuring that we were all in the same boat. ” [family] “It’s nice to think that you don’t just disappear as though you have never been.” [resident] “I think there is some intimacy about the room itself that is, so much happened in the room ” [staff] “it leaves one with a sense of calm and a sense of completion.” [staff] IMPLICATIONS Bereavement rituals like the Room Blessing Ritual at St. Joseph’s Health Centre in Guelph do not require a large investment of time or resources and can easily be incorporated into daily practice routines in long-term care organizations. The ancillary benefits of supporting bereavement needs is the increased capacity of staff to provide compassionate high quality care, the assurance for residents that the deceased and by extension themselves are valued by the organization, and the fostering of a stronger sense of sharing and community within the organization. RESEARCH SUPPORT ST. JOSEPH’S HEALTH SYSTEM RESEARCH NETWORK ST. JOSEPH’S HEALTH CENTRE GUELPH