Guidelines for a Palliative Approach in Residential Aged Care

Vignette 18: Reflections
When provided with a small reflections booklet after each resident’s death, staff welcomed
the opportunity to make a personal comment. Examples included, “Anna was a kind and
affectionate soul who despite her pain was grateful for the comfort we could provide.”
“I remember Anthony was a trial at times, though I understood his frustration. I enjoyed
him very much on his good days and I’ll miss him and Leila.” “I will always remember Noel
for his huge smile and his beautiful, kind manner.”
However, formalised grief and bereavement services in RACFs are limited. One study found
that 55% of RACFs sent sympathy cards, and 64% attended the funeral if the resident
died while in the facility [434] (Level QE). Most RACFs surveyed did not offer any follow-up
bereavement support, either in the form of information, referrals or phone calls [415] (Level QE).
Although families find bereavement support a positive experience [433,435] (Level QE; Level QE),
it has been suggested that if the focus is on ensuring the best care possible, families are more
likely to cope well with the death of their family member [413] (Level QE).
15.4.2 Bereavement support for other residents
The evidence suggests that the support needs of residents is often centred on practical and
emotional support [429] (Level QE). It is interesting to note that, in addition to the expected
negative consequences, there can be benefits for other individuals who witness a death. For
example, hospice patients who witnessed a fellow patient’s death found this awareness of dying
to be both comforting and distressing [436] (Level III-3). The authors found that those that had
witnessed a death were significantly less depressed than those patients who had not had this
experience. This finding is relevant for RACFs where concern has been expressed regarding the
impact of a resident’s death on those sharing the same room.
15.4.3 Bereavement support for the aged care team
The aged care team will likely experience loss following the death of residents with whom they
have established meaningful relationships [314,409] (Level QE; Level QE). Therefore the team
should be provided with opportunities to formally acknowledge the loss, and have access to
adequate bereavement support [429,437] (Level QE; Level QE). One study reported that members
of an aged care team who had experienced many deaths of residents reported being significantly
more comfortable when thinking and talking about death to residents who were dying [438]
(Level IV). However, these same people still had high levels of death anxiety when measured,
which led the authors to conclude that these members of the aged care team were more able to
separate their own anxiety from their willingness to discuss death and dying with residents. This
would appear to indicate that even members of the aged care team who have experienced many
deaths might still require access to support services in order to discuss their own anxieties [438]
(Level IV).
Emotional support for the aged care team could include bereavement support services, stress
management training, and debriefing sessions [22] (Level IV). Volicer (1997) [439] (Level EO)
argues for the inclusion of bereavement support in the aged care setting, as is the practice in
many palliative services (e.g. memorial services, debriefing meetings for the aged care team,
178 Guidelines for a Palliative Approach in Residential Aged Care