Don’t Forget About Us!

The Importance of Immediate

Follow Up After a Loss

Adrienne Daniels, LMSW

Manager of Bereavement

Services

Tina Sullivan, LMSW, ACHP-SW

Assistant Director of Community

Support Services

About Our Hospice

• Average daily census: 325

• Serve Monroe, Wayne and Seneca counties

• Provide services in the home, hospitals, comfort care homes,

11 bed hospice inpatient unit, nursing homes, assisted living

facilities, group homes

• Interdisciplinary team includes physicians, nurse

practitioners, nursing, social work, pastoral care, hospice

volunteers, music therapy, bereavement services

About Our Bereavement Program

Bereavement Team

Manager-LMSW

2 Coordinators

Community Specialist

22 Support Group Facilitators

14 Volunteers

2,391 deaths in 2016

10,084 contacts in 2016

(includes phone visits, support group attendance,

face-to-face visits, and event attendance)

Why Bereavement Is So Important

• Provides closure to the hospice experience

• Reduces a sense of abandonment

• High quality, accessible and immediate care leads to

improved post-loss adjustment2

• Affects a family’s overall impression and satisfaction with

ALL of hospice services

• Higher satisfaction with hospice and positive perception of

support leads to increased coping after a loss6

Comfort for the Brokenhearted

• Medical advancement7

• Less familial connectedness

• Less knowledge about dying

and grieving

• Cultural fears

• Hospice can provide:

• Human connectedness/validation

• Education

• Safe haven to explore and express grief

President Coolidge in mourning

This is what it looks and feels like when

a patient is on hospice…

This is what it looks and feels like for family

members after their loved one dies…

Immediate Needs after a Loss

• Financial storm

• Family tension

• Going back to the basics

• Emotional needs

• Process patient’s illness,

death and memorial

• Functioning through the fog

• Retelling the story helps the fog lift

• Accepting help offered

• Mental or physical health issues before a loss may be

exacerbated after a loss6

The Griever’s Hierarchy of Needs

Hospice can help by:

• Community resource

referrals

• Trust and dependability

(not dependency)

• Education

• Self-reflection

• Activities that facilitate

mourning

• Volunteer opportunities

Goals of Bereavement Follow Up

• Short-term goal of hospice staff

• Call very quickly after the death

• Assess status of family members

• Process hospice experience

• Resource linkage

• Create a bridge to bereavement services

• Transition from hospice to bereavement

• Initial goals of the bereavement team

• Plant seeds and awareness of services

• Make a connection with the bereavement

• Build rapport

“The stages of grief have evolved

since their introduction, and they

have been very misunderstood

over the past three decades…

They are responses to loss that

many people have, but there is

not a typical response to loss,

as there is no typical loss. Our grief is as individual as our

lives. The five stages…are tools to help us frame and identify

what we may be feeling. But they are not stops on some linear

timeline in grief. Not everyone goes through all of them or

goes in prescribed order.”

~Dr. Elisabeth Kubler-Ross

Beyond Kubler-Ross4

The Six Needs of Mourning

and “The Slow Grief Movement”8

1. Acknowledge the reality of the death

2. Feel the pain of the loss

3. Remember the person who died

4. Develop a new self-identity

5. Search for meaning

6. Receive ongoing support from others

***This takes a lot of time and commitment***

Our Bereavement Timeline

• Bereavement calls by hospice staff made within 2 weeks

• Condolence card signed by everyone in IDG

• Bereavement calls made by bereavement care team typically

within 3-5 weeks

• Newsletter mailed 3 times per year

• Invitations to Ceremonies of Remembrance/special events

• Anniversary card one year after patient’s death

Where Should We Talk?

Home Visit

• Most requested form of contact5

• Comfort level increases

• May not be able to drive due to grief

• Homebound for physical reasons

• Better assessment of the individual

• Visual cues to stimulate conversation

• Considerations: distractions,

interruptions, becoming too casual,

blurred boundaries

Office Visit

• Offsets anhedonia

• Practice being in a social situation

• Professional setting is a safe,

sacred place

• Professional boundaries

are maintained

• Counseling may be more effective

• There should be a dedicated private and soothing space for

bereavement and caregiver counseling

• Consideration: distance for bereaved to travel

Redefining the Bereavement Team

• Grief begins long before a person signs on to hospice

• It takes a village to support a family

• Each team member has a role in the grief narrative

• Each can be a source of comfort and review

• According to FEBS comments, people do NOT differentiate

between hospice and bereavement services.

Training Staff

• Assume that many staff

members are not comfortable

with grief

• Identify areas of discomfort

• Provide suggestions for questions

• Validation

• Can’t fix the problem

• Answers are not necessary

• Listening is sometimes all a person needs

• Strong assessment skills are necessary

• At-risk family members are 5x more likely

to access services than low-risk family members4

“Empathy is full

presence to what’s

alive in a person at

this moment.”

-John Cunningham

Caring for the Caregivers

• Bereavement department is available to provide support to

prevent compassion fatigue for staff and hospice partners

• Find creative ways to support staff members

• Rituals

• Support groups

• Activities

• Mindfulness

• Strong supervision

includes emotional support

Benefits to the Hospice Program

• Future referral source

• Fundraising opportunities

• Visibility in the community

• Cultural paradigm shifts in both end of life care and

bereavement

Oh, the Places We’ll Go!

• Emphasis on bereavement care and

education lead to a stronger hospice program

• Creatively crafted variety of services tailor

made to bereaved individuals3

• There is currently a lot of variability in

scope, skill and intensity of services

• Need for clearer guidance

• Support research to establish empirically supported best practices2

• Reimbursement and payment solutions to

support bereavement staff2,1

1. Allen, J. Y., Haley, W. E., Small, B. J., Schonwetter, R. S. , & McMillan, S. (2013). Bereavement among Hospice Caregivers of Cancer Patients One Year following Loss: Predictors of Grief, Complicated Grief and Symptoms of Depression. Journal of Palliative Medicine, 16(7), 745-751.

2. Barry, C. L., Carlson, M. D., Thompson, J. W., Schlesinger, M., McCorkle, R., Kasl, S. V., & Bradley, E. H. (2012, July). Caring for Grieving Family Members: Results From a National Hospice Survey. Medical Care, 50(7), 578-584.

3. Bereavement Services Should Cater to Families. (2009, April). Hospice Management Advisor

14(4), 47-48. Retrieved from https://search.proquest.com/docview/758873111?accountid=13567.

4. Doka, K.J, & Tucci, A.S. (2011). Beyond Kubler-Ross: New Perspectives on Death, Dying and

Grief. Washington DC: Hospice Foundation of America.

5. Ghesquiere, A., Thomas, J., & Bruce, M. L. (2016). Utilization of Hospice Bereavement Support by At-Risk Family Members. American Journal of Hospice & Palliative Medicine, 33(2), 124-129.

6. Jones, B. W. (2010). Hospice Disease Types Which Indicate Greater Need for Bereavement Counseling. American Journal of Hospice & Palliative Medicine, 27(3), 187-190.

7. Lawrence, J.C. (2001). Bereavement Outcome Following Hospice Bereavement Services: A Utilization of a revision of the Grief Experience Inventory. (Doctoral dissertation, University of

Buffalo) Proquest Dissertation and Theses Global. Retrieved from https://search.proquest.com/docview/252251068?accountid=13567.

8. Williams-Murphy, M. & Murphy, K. (2011). It’s OK to Die. USA: The Authors and MKN, LLC.

9. Wolfelt, A.D. (2016). Counseling Skills for Companioning the Mourner: The Fundamentals of

Effective Grief Counseling. Fort Collins, CO: Companion Press.

References