Guidelines for a Palliative Approach in Residential Aged Care

Kellehear (2002) [419] argues that the current focus of bereavement care puts the emphasis on
personal control and the ability to adapt to loss (Level EO). A new direction in bereavement
care stresses the importance of creating a supportive environment in the communities in
which bereaved people live and encourages a renewal of meanings through transformation
instead of the previous ‘letting go’ of the attachment. In this light, skilled but unprofessional
bereavement workers can adequately manage bereavement care, if coordinated and supervised
by a professional bereavement worker. Social workers were found to be effective grief work
facilitators. [420] However, the role of the social worker in palliative care still needs to be qualified
by service receivers [323,420] (Level QE; Level QE).
Bereavement care in rural and remote areas has additional challenges to overcome such as
levels of stress due to role conflict and definition, and poor debriefing opportunities for
care providers, poor access to health services, poor quality of services for residents and their
families [350,421,422] (Level QE; Level QE; Level IV). The evidence suggests that a bereavement
service that encompasses bereavement support and follow-up for any cause of death works well
in country areas [423] (Level QE).
Focused management of bereavement support reduces risk and improves bereavement
outcomes, [413,414] whereas untargeted support may not have such an overall beneficial effect [315]
(Level EO). Similarly, the aged care team will require increased awareness and knowledge about
grief and loss issues for residents, their families, and for other staff involved with the resident who
died. This increased awareness can enhance early identification of distress and implementation of
appropriate support [415] (Level QE). Cultural differences may also affect the ways in which people
respond to death (see Chapter 11, ‘Cultural issues’, for further information).
15.4.1 Public acknowledgment of death
Death is the ultimate rite of passage and needs to be marked in a public way [424] (Level EO),
such as a memorial service [425,426] (Level EO; Level EO). There is considerable anecdotal
evidence that suggests that a chance for family members to say ‘goodbye’ is crucial, especially
if they were not present at the death [315] (Level EO). This is also true for friends of the person
who has died, other residents of the RACF, and the aged care team [427–429] (Level EO; Level EO;
Level QE). Cultural differences may also affect the ways in which individuals respond to death
[361,430]
(Level QE; Level IV) (see Chapter 11, ‘Cultural issues’).
A WorkCover NSW report (2000) [431] (Level EO) indicates that a significant source of stress
for members of aged care teams was the issue of unresolved grief. Mourning rituals facilitate
psychological recovery and are helpful to aged care team members, who do not often attend to
the task of mourning because they are busy attending to the next resident’s admission [432,433]
(Level EO; Level QE). Memorial services are effective for facilities providing a palliative
approach. The evidence suggests that these services are a valuable resource for residents, family
members, the aged care team and volunteers and that memorial services are appropriate for the
grieving process [429,433] (Level QE; Level QE). The following story provides an example of a
memorial service that included the use of a reflections book:
Guidelines for a Palliative Approach in Residential Aged Care 177