When an aged care resident dies, a dignified and open process is important for loved ones, fellow residents and staff.
Always through the front; the same way they come in. This “dignified farewell” is usual practice at the Uniting Farmborough aged care facility in Unanderra, NSW. After a resident dies, they go from their room and leave their home for the last time in clear sight.
As part of the facility’s farewell, the resident then makes their departure through a guard of honour and a remembrance table is set up to provide a place for residents and staff to gather to honour or pay tribute to their friend.
The Better Practice Award-winning approach, known as the Dignified Farewell and Memorial Project, aims to help residents and staff deal more openly with death, says Jill Harvey, Farmborough’s service manager.
It also aims to challenge the conventional approach to death in aged care of removing the deceased person’s body quickly with little or no communication to other residents, she says.
“Everyone at Farmborough is close. Our farewell gives residents, staff and family members the time to pay their respects and gain closure,” Harvey says.
It is important that each person is acknowledged with a dignified farewell, she says.
“When a resident dies we invite residents to say their goodbyes – they form a guard of honour with staff and family members as the deceased person is taken out the front door. Background music is played, a ceremonial quilt is placed on the body and a photographic memorial is set up in honour of their life.”
While Uniting Farmborough is dealing with death in an empowering and positive way, it isn’t the case at all aged care facilities, says consultant Molly Carlile, who is also known as the Deathtalker.
Carlile, who is a regular keynote speaker at aged care conferences, has a clinical background in specialist palliative care nursing, and is an advocate for a more open approach to talking about and dealing with death, dying and grief in a variety of settings, including residential aged care.
“There is an enormous fear in aged care about confronting death. Even though every single resident knows when they walk in the front door for the first time they will be going out in a box, nobody talks about it,” Carlile tells AAA.
Often when someone dies in aged care, the facility calls a funeral director, who comes to the back door and takes them out the back and into the van, she says.
“The person just disappears. It is like they have been kidnapped by aliens. All of a sudden there is someone new in that room. No one says anything to other residents. Nobody tells them that Mary is going, or asks if they would you like to say goodbye to her.”
Giving people an opportunity to have a morning tea or something to say how they feel, what they miss about the person who has just died, or share memories is important, but pretty rare in her experience, she says.
Carlile believes the key reason things are not done well is because staff often do not know how to have conversations about death and dying with people in the facility, or even to talk about their own feelings around death.
“How can you expect staff to facilitate conversations with people when they can’t even talk about it themselves,” she asks.
Dealing with death is not covered adequately in nurse or personal care worker education, says Carlile, who encourages organisations to invest in skilling their staff.
Jason Binder, CEO of Island Care in Tasmania, called on Carlile to help his organisation improve how death is dealt with at its three aged care facilities.
In addition to training from Carlile, Island Care’s $100,000 investment included compulsory workshops for all 350 staff, new policies and procedures, and ongoing employee projects tasked with finding ways to improve processes around the death of resident.
The training, which was completed at the end of 2015, focused on a good death for a resident, which includes a multi-faceted approach that also aims to help employees, who can become desensitised to death, a resident’s loved ones, who are going through a very sensitive time, and other residents, he says.
“A key part to that is providing timely, and clear and honest information as it is unfolds… People don’t want to say the words that someone is dying; or someone has died but it is really important to be clear about those things,” Binder tells AAA.
Their process also include opportunities for staff to debrief, he says.
The employee projects are being led by champions and aim to come up with ways of showing that the organisation cares as well help families through the process, Binder says. An idea from a staff member and volunteer already to emerge is to give new residents a quilt when they arrive.
“They will use that quilt all through their time at the facility. Then when that person passes away, we give that quilt as a gift to the family who can then keep the quilt as a reminder of their loved one,” he says.
In terms of meeting the needs of other residents, Binder says they have a get together after a resident has died, but one of the employee projects is exploring further ways residents can say goodbye.
The extended version of this feature appears in the current issue of AAA magazine (March-April)
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