Dealing with death: Finding closure

When an aged care resident dies, a dignified and open process is important for loved ones, fellow residents and staff.

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.

Paying tribute at the memorial table at Uniting Farmborough
Paying tribute at the memorial table at Uniting Farmborough

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.

Empowering staff

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.

Molly Carlile
Molly Carlile

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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Tags: bryan-lipmann, death and dying, deathtalker, education, grief, Island Care, molly carlile, program, staff training, uniting, wintringham,

7 thoughts on “Dealing with death: Finding closure

  1. Its great to see that residents, relatives and staff are all included in such an important part of life.I am a professional social worker who has worked with loss,grief,trauma and death for over 30 years.

    Over 15 years ago it was impossible to find any research into how residents,
    carers and staff acknowledged and coped with loss/grief/death when my daughter wanted to investigate the topic of death in aged care facilities for her HSC.

    I do however,have reservations about being so prescriptive in how the person is remembered and the idea of a quilt being given to a new resident. How we all deal with grief is unique and individual and I know that encouraging individuals to create their own memorials and rituals can be therapeutic.

  2. I am an ex-Nurse having worked in Aged Care for over 20+ years. Training at the age of 20yrs I was absolutely petrified every time I had to deal with a dying patient and death. It took me many, many years as there was no training or support on this. I did attend one of Molly’s forums in the later year of my Nursing and I do believe this was the start of my turn around in my fear of death and dying . When I grew up I always believed (or it was implied) that when someone died they just closed their eyes and went to sleep. I had no idea that the process of dying would not always be this simple. I also recall the many trips to sneak the resident who had passed away out the back door. Also the look of fear and horror on other residents faces….almost …..”is it my turn next”. It is great to see that residents, staff and family are all included in this important journey of life. The other 2 things that come to mind is “choice” ….. every resident having the choice as to how they would like to leave the facility on their end of life journey…be it with a rug or without a rug. Then there is training…..a good hard look at what is included in PCA and Nursing training to support students when they do encounter death and dying….this can make all the difference throughout their career and how they actually treat the family, other staff and the particular resident. It is not always disrespect…..its fear…fear of death and dying.

  3. Glad to hear things are changing since my father died. It was at a weekend and the centre director who was off duty at that time never even called my mother the next week.

  4. A brilliant post.So many facilities so need to take on this approach.So DOES the one where I work!!!.

  5. I have just read your posts – my daughter is doing PCA in an aged care facility now – she completed a pca course at beginning of year. You are quite correct – I think this topic is not covered as well as it could be in the courses they run. She is not coping with death – everything else is ok – she comes home crying . I have tried to console her, tried to suggest she talk to management but she won’t. What or who would you recommend for support in this area. She is such a compassionate person but this job I think for her is too emotionally draining. Would appreciate the feedback.

  6. It’s always tough when someone passes, but that’s how residents check-out of aged care. I hope she understood this prior to joining the care team.

    There are a range of resources on dealing with grief and loss but nobody can ‘teach’ you perspective. At the risk of sounding harsh, compassion isn’t worth much if you’re unable to operate professionally and effectively: the clients depend on you, especially in times of loss.

    If she’s unwilling to seek assistance and finds the job too emotionally draining, perhaps she needs to review her career choices? Shes not doing herself, her clients or her team any favors by persisting with a job that reduces her to tears.

  7. This article identifies the issues around death which aged care facilities don’t handle well. I work as an art therapist in a variety of facilities & the staff are scared of death & uncomfortable around it, so hence so are the residents. There has been many occasions where the residents are not informed to the passing of a resident & the person who has passed on is never spoken about again. I am trying to advocate that the facilities improve the way they don’t handle death a natural part of life for all of us

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