Beyond Grief and Loss

Everyone who is born in the world dies some day. It is difficult to describe what death is like, and how painful it may be. It is also difficult to know if people of different ages feel the same way about death as I do. Presumably, people will experience death differently because they have different cultures and learn about it from different perspectives. These thoughts that people may differently experience death became stronger after I observed several residents who were in the end-of-life stage. Since I took my field placement I have often seen residents’ empty beds after they died. Most of them who died due to old age or chronic illness looked just like the other residents one week ago. Indeed, one of the female residents with dementia who looked very healthy suddenly died one week later due to a stroke. My instructor told me that the stroke bursted in her brain. I was in shock, but I could not even cry. I could not say anything about her because I felt that someone hit the back of my head. A few minutes later, when I remember what she told me several days ago, I cried. I learned that older adults could die very fast regardless of gender, race, and ability/disability. I was also shocked the dying process was so fast.
I began to recognize and acknowledge how this loss made it hard to control myself, and thought about how I will never forget her. On the other hand, I had to learn to cope with this loss. I had to exit from the moment of grief and move on to other work. I found out that this kind of sudden death was the most difficult death for me because I did not say good bye to her. Probably, this was really difficult for her family too. I only saw her for several months, but her family had relationships with her for many years. When I saw her for the last time, she complained to me that nobody wanted to talk with her, and did not listen to her. She thought that others secretly talked about her, and she wanted to know what they were talking about. When I listened to her, she was happy and told me “thank you so much”. When I reflected on what she said to me, I felt comforted. I recognized she left me, and that she was no longer in the world. I think my own grief was resolved because I feel that I had a positive experience with her. However, a puzzle still remains in my mind. If a family had negative experiences with family members, how could a social worker help the family to resolve their grief?
Along with this first question, several other questions arose in my mind. In personal care home settings, if social workers know who is close to dying, how can the social workers help him or her to maximize quality of life? If a family does not have a chance to say good bye, how can social workers help this family? If a person wants alcohol or other substances that the person really had enjoyed in life, should the person be allowed to drink alcohol before death? After a person who had bad relationships with his or her family dies, the family may not want to come to collect all belongings. How can social workers handle this situation? Are there palliative care centres in Winnipeg, Manitoba? As many families experience bereavement, grief, and loss, social workers who work in personal care homes may also experience deep sadness. As a human being and a professional, how can social workers deal with this situation? It is worthwhile to understand what social workers do for families who are in bereavement.
According to Kail, Cavanaugh, and Ateah (Kail et al, 2006), “bereavement is the state or condition caused by loss through death. Grief is the sorrow, hurt, anger, guilt, confusion, and other feelings that arise after suffering a loss. Mourning concerns the ways in which we express our grief” (p. 624). To help families who lost loved ones, social workers need to understand the grief process, and how people experience grief. Worden (1991) notes, “grief is an active process in which a person must do several things” (As cited Kail et al, 2006, p. 625). What Worden emphasizes is that people must recognize the reality that their loved ones died. People must appropriately adjust to a new situation, and must find effective ways to say good bye by freeing from themselves the bonds of the dying person. Maybe, this active coping process for family means that after the loss, they arrange to come to the resident’s place, which was the resident’s physical world, to pick up belongings left behind, and interact with family and friends by sharing their experiences (Kail et al, 2006. p. 625).
Attig (1996), and Stroebe et al. (1996) assert that the grieving process is very different because individual experience differently. Therefore, social workers should remember that there may not be the best grief process. Also, during bereavement, each family has own needs to deal with issues regarding the loss, social workers should not underestimate the grief time. There is a critical point that social workers must think about an ethical decision-making at the end of life (as cited in Kail et al. p. 625). As Foster and McLellan (2002) point out, even if there is “a tendency still exists toward a paternalistic approach in ethical decision-making with an emphasis on the biological” (p. 38), social workers should consider the psychosocial perspectives and practices as well as considering bioethical perspectives. As NASW press (1994) notes, “Clinical social workers [should] focus on internal and interpersonal dynamics related to the experience of moral pain in such decisions; their interventions include clarifying advance directives, advocating for a patient’s right to choose, supportive counseling, acting as liaison to the team, and encouraging family involvement and the exploration of end of life options and resources” (As cited in Foster & McLellan, 2002, p. 40).
When social workers conduct psychosocial assessments, crisis intervention, and implication for social work practices, social workers in clinical settings should assist families as a “counselor, context interpreter, advocate, and team member” (Bern-Klug, Gessert, & Forbes, 2001, p.45). The palliative care centres below are in Winnipeg. It is helpful to know these resources may give some hopes to improve quality of life at the end of life stage.

Services provided by Personal Care Homes:
▪Bethania Mennonite Personal Care Home (204)-667-0795
They offer a program that is very similar to palliative care. They call it comfort care within their facilities. It consists of a trained end of care team that has been educated through Palliative Care and Hospice Care Manitoba.

▪Deer Lodge Personal Care Home (204)-837-1301
They offer a program called No One Dies Alone (NODA), which stands for no one dies alone. This program was created for residents that may not have family members to help them through end of life care. It is provided by on-call volunteers. These volunteers have been trained through the center and accompany residents during this time.

▪Park Manor Personal Care Home (204)-222-3251
They offer a service through a course called “A friend in hand”, which was introduced by the Palliative Care and Hospice Manitoba organization. The course focuses on teaching staff, volunteers, and people of the public the importance of palliative care. After completion of the course the person taking the course can request to be put on an on-call palliative care list. This list indicates their availability and their hobbies.

▪River East Personal Care Home (204)-688-7460
They offer a palliative care course through Hospice and Palliative Care Manitoba. Staff, residents, and volunteers can take this course to become better educated about this new service.

Services provided by Hospitals:
▪Deer Lodge Hospital (204)-837-1301

▪Grace Hospital (204)-837-0111
They have 12 beds reserved for palliative care.

▪Riverview Hospital (204)-478-6203
They have 30 beds reserved for palliative care patients.

▪Seven Oaks (204)-632-7133
They are just beginning to develop the NODA program in their facility.

▪St. Boniface (204)-233-8563
They have 15 beds reserved for palliative care patients. This facility has access to labs and research tools to better assist the patients.

Services provided by Community:
▪Hospice and Palliative Care Manitoba (204)-889-8525
This is a non-profitable organization that is not affiliated with Winnipeg Regional Health Authorities. Their focus is to provide a provision of care to people facing life limiting illness. They provide community hospice, volunteer program, volunteer visitors, volunteer education, telephone support, bereavement support, fundraising, and sponsorship.

▪Harmony Home Hospice (204)-982-2953 It is a residential community based service. It is based upon physician referral. It provides a wide range of service like respite care, medication, psychological assessment, and family bereavement.
References

Kail, R., Cavanaugh, J. C., & Ateah, C.A. (2006). Human development: A life-span view. Canada: Thomson Nelson
Foster, L. W., & McLellan, L. J. (2002, December). Translating psychosocial insight into ethical discussions: Supportive of families in end-of-life decision-making. Social Work in Health Care, 35(3), 37-51. Retrieved December 5, 2010, from EBSCOhost, AgeLine database (91374).
Bern-Klug, M., Gessert, C., & Forbes, S. (2001, February). The need to revise assumptions about the end of life: Implications for social work practice. Health & Social Work, 26 (1), 38-47. Retrieved December 5, 2010, from EBSCOhost, Academic Search Premier database (4119501).

People with Dementia and Social Workers’ Roles

The personal care home where I am doing my field placement is a place where diverse groups of people gather and work. Those groups consist of residents, families, staff, volunteers, visitors, and so on. The majority of people are old older adults with dementia who are in closer to the end of life. As I see these people, I feel that I am lucky because I am healthier and younger than them and can help them. Now and then, questions arise in my mind about dementia: what is it, what are the risk factors, what issues make residents or families hard to deal with, and how do staff cope, especially social workers in my field placement. Although I have learned about this disease in a few classes, I do not think I really considered this disease from a client-centered perspective because I thought I already knew about dementia well before I took a few courses. However, I found out that I overlooked very sensitive parts, which can be issues among people when I talked with people that I have known for many years. I feel, at the moment, that all my knowledge pieces about dementia are disorganized in my head. I, therefore, will try to make sense of this issue by utilizing my classnotes, textbook and brochures that guest speakers brought. I will look back on myself and think about this disease again. I hope this time can help me to clearly understand some issues arising with the definition of dementia.

To understand better, it is necessary to describe what dementia is. According to the Alzheimer Society of Manitoba (2010), dementia is defined as a disease of brain cells, which causes memory loss, and cognitive impairment. A currently irreversible and slowly progressive disease, dementia is related to a diversity of dementias, such as Alzheimer’s disease (AD) that Vascular Dementia, Frontotemporal Dementia, Creutzfeldt-Jakob Disease, Lewy body Dementia, Parkinson’s disease and Huntington’s disease. All these dementias are different from one another. I do not describe all about these disease here, but further research is needed in order to understand in detail. Dementia is also well-known as a main problem in geriatric care. Of course, as Saxon, Etten, and Perkins (Saxon et al., 2010) note, “…diagnosis of dementia occur[s] in the vast majority of people at the oldest ages…” (p. 189). Often dementia causes disability and morbidity in older people. Degenerative Alzheimer disease, Vascular dementia, B12 deficiency, autoimmune disorders, Parkinsonism, infections, such as HIV/ AIDS, other extra-pyramidal disorders, such as Huntington’s disease, and Trauma can cause dementia (Mackenzie, 2010).

Unfortunately, today’s medical technology cannot help. There is currently no cure for Alzheimer’s disease generates. In terms of caregiving issues, mostly women, especially spouses take responsibility care for their partners of dementia. Sawatzky and Fowler-Kerry (2003) note that “the burden of care often falls disproportionately on mothers, wives and/or daughters, who are unpaid for services. Physical effort, combined with lack of support, medical knowledge and sleep, can often place the health of caregivers at risk” (p. 277). Have you ever thought why women take responsibilities for caregiving more often than men? How should caregivers’ needs be met regarding this issue? In order to meet caregivers’ needs, what policies should be changed? Are there any options to care for people with dementia in the home? Do caregivers in the home should be paid? If caregivers want to care in their home, how can home care social workers assist them? How can social workers help them reduce the sense of burdens?

Making the decision to institutionalize is also an issue in terms of people with dementia. Lundh, Sandberg and Nolan (2000), Nolan and Dellasega (2000) emphasize that “making the decision to institutionalize a loved one is among their most difficult experiences, a time of crisis for the family” (as cited in Caron, Ducharme, and Griffitha, 2006, p. 195). If caregivers choose institutionalization, regardless of the opinion of the cognitively impaired older adults, how should social workers intervene? From caregivers’ perspectives, should social workers respect the caregivers’ decision even if the cognitively impaired older adults do not want to go to an institution? If social workers met family members who were psychologically distressed due to memory loss that caused a bad relationship, how could social workers help them? On the other hand, from clients’ perspectives, if cognitively impaired older family members refuse to go to institutions, should they be at home?

As the Alzheimer society emphasizes, early diagnosis from family is really important to address earlier treatments and to improve the life of people with dementia. Family should look for signs, such as the loss of sense of smell and loss of weight, confusion, decrease of ability to make a decision. Education about Alzheimer’s disease provides behavioural therapeutic strategies, such as activities and music. Such therapeutic techniques can help improve life for both people with dementia and their families. Social workers should think about how they encourage families to be aware of these signs, and how they encourage families to more participate in these therapeutic strategies. If families resisted against participating in these strategies, how could social workers handle this case? Are there any alternative strategies instead of these therapeutic strategies?

According to Saxon et al (2010), “The Alzheimer’s Association reports a prevalence of 5.1 million Americans with Alzheimer’s disease (AD) in 2009 , with a projected increase to 7.7 million in 2030” ( p. 167). The more AD population increases, the more ethical issues maybe increase. Presumably, social workers’ roles are more important than before.

-Eunkyeong

References

Alzheimer Society of Manitoba. (2010). Research: Related dementia-Vascular dementia. Winnipeg, Manitoba: Alzheimer Society of Manitoba.

Caron, C. D., Ducharme, F., & Griffitha, J. (2006). Deciding on institutionalization for a relative with dementia: The most difficult decision for caregivers. Canadian Journal on Aging, 25(2), 193-205.

Mackenzie, C. (2010, October 5). Dementia. Presented at a KIN 2610 lecture at the University of Manitoba, Winnipeg, MB.

Sawatzky, J. E. & Fowler-Kerry, S. (2003). Impact of caregiving: Listening to the voice of informal caregivers. Journal of Psychiatric and Mental Health Nursing, 10, 277-286.

Saxon, S.V., Etten, M. J., & Perkins, E. A. (2010). Physical change and aging (5^th. Ed.). New York: Springer Publishing Company

Inequality Affects Women’s Mental Health in Later Life

Written by Eunkyeong.....

A healthy life is crucial for all people. Human beings have to be able to live in a healthy and safe environment with an access to health care system, which provides mentally, emotionally, spiritually and physically supports. As liberal feminists articulate, I believe that all human beings should have freedom of choice, and their own status in society. This means that all human beings should live free from inequalities. As people age, they are likely to experience more health problems. In particular, many older people suffer from mental health problems with aging. Indeed, the majority of sufferers of mental illness in later life are older women. This means that, as some of the main findings point out in the literature, older women suffer more often from depression and dementia than men in their old age. Milne and Williams (2000) note that because women are more vulnerable to discrimination and socio-economic disadvantages based on age, gender, and class in their early years, their later lives are harder. It is obvious that older women are discriminated against under the patriarchal system, so that older women live in an unequal society.

Indeed, our society has some concerns about older women. First, older women's groups which include visible minority populations are more vulnerable. Another problem is that older women's issues, such as poverty, housing, and older women-centered-care needs are still largely ignored by health policy makers and psychiatric professionals. There is few services to respond to their care needs. In addition, according to the authors, the previous literature does not have much information about the effects of inequalities on older people who have mental illness problems.

Minle and Williams (2000) identified that mental health problems as older women face today stems from inequalities: poverty, housing and living situation, marriage and home life, trauma and abuse, and health and disability. As might be expected, poverty is the biggest considerable risk factor for mental health problems. The authors prove that older women who lived in low-income in their earlier lives experience the highest levels of poverty in their later years. Low-income women may be disadvantaged in terms of fundamental necessities for a living (p. 703). As socialist feminists argue, such disadvantages for women are based on the capitalist society, which does not recognize women's domestic work as a valuable component of productivity. Domestic house work is not paid, and does not include pension. The biggest problem is poor women often experience lifelong poverty. Moreover, social isolation, loneliness, and living alone are great risk factors for developing depression or anxiety.

Secondly, according to the authors, marriage and home life factors make older women more vulnerable to mental illness. Older women, who had married and worked at home, compared to women who had worked outside of the home are more likely to experience depressive illness (p. 704). Presumably, women had low self-esteem due to their very little earnings with no benefits. In this case, they saw themselves helpless.

Further, trauma in terms of sexual experience in childhood or younger adulthood may also lead to depression. This means that a high prevalence of trauma affects older women suffer from mental illness than men. The cause of this trauma originates from an ideology constructed by men (p. 705). Radical feminists argue that in patriarchy, women's bodies are viewed as sexual objects. This means that male power in patriarchy controls society's members to look at women as sexual slaves. As some radical feminists argue, patriarchal society tolerates male violence against women as acceptable behaviour. This tolerance may have to develop that men control of women's bodies and to the use of women's bodies for pornography and prostitution.

All these risk factors based on low-income, low-self-esteem, and victimization affects many women's later lives, so that women have more mental illness problems. These accumulated inequalities may continue in the future because our society still treats women unequally although many women's group argue poverty for a long time. For example, women still work in low-waged workplaces, which have no benefit. Domestic house work is still not calculated as productive work in the Canadian tax system. In addition, our society's members often see only one type of woman who is skinny and sexy, which is constructed by patriarchy.

In order to change such a fixed moral standard of society's members, firstly, the previous failed policies should be shifted. In terms of older women with mental health problems, the society should consider whether women's income is adequate, and if they live suitably. In doing so, the society's members should accept the idea that social inequalities considerably affect the mental health of older women, and should take older women's issues by listening to older women without ageism. Although eliminating ageism is really challenging, a step towards hearing older women's voices is necessary. This is possible when health providers and professionals are trained, and ; policy is focused on older women with mental health problems. For example, professionals should help students recognize older women's issues. Particularly, it is important to encourage older women who have trauma to attend a woman's group so that they can share their experiences (http://web.ebscohost.com.proxy2.lib.umanitoba.ca/ehost/detail?vid=5&hid=110&sid=60bb803d-cb3f-4085-a227-cdb0e13de60a%40sessionmgr110).

Today, older women especially women of visible minority and Aboriginal women are still poor. Unfortunately, many of them who have mental health problems had hard time for a living in their early years. They were poor, and suffered from low-income and hardship of life. For these reasons, older women are sufferer from mental health problems than men in their later years. Canada nationally faces these issues as big concerns today.