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).