Transcript Death and Grief: Helping in Congregations

Death and Grief:
Helping in
Congregations
Helen Harris, LCSW, DCSW
Changes through the years…
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Average life
expectancy in the
early 1900s was 40
Most deaths 100
years ago were from
acute conditions, ie
infection and injury
Most deaths 100
years ago occurred
at home
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Average life expectancy
now is late 70s
Most deaths today occur
from long term chronic
conditions like cancer
and heart disease
Most deaths today occur
in institutions
Societal Attitudes….
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Medicine should have an answer for every
problem….
Death is the enemy…………..
Dependence on others is a burden………
Many Church attitudes….
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Prayer lists
Food in crisis
Celebration and
Pollyanna
Out of sight, out of
mind
There are programs
to address needs
Reimbursement Drives the
System
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Fee for Service
DRGs
Per Diem
Coverage for Medications
Coverage for In Home Care
Coverage for Institutional Care
Contexts of Practice with the
Dying
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Hospitals
Hospice
Home Care
Skilled Nursing Facilities
Everywhere….CIS, Churches,
Intergenerational nature of our work…
Fears of the Dying….
 Fear
of being
abandoned
 Fear of intractable
pain and symptoms
Needs of the Dying…
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Presence
Honesty
Hope
Symptom Management
Value
Opportunity to complete unfinished
business
Communication with the Dying
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Reflective Listening
Listening for Feelings
Listening without Judgment
Reflecting Feelings
Non verbal communication
Active Listening
Problem Solving
Principles of Hospice
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Patient/Family as Unit of Care
Palliative vs. Curative Care
Home vs. Institutional Care
Interdisciplinary Team Care
Symptom Management
Bereavement Services
Services regardless of ability to pay
Symptom Management
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Pharmacology
Delivery systems…po, pr, iv, patch,
sublingual
Alternative pain management
Psychosocial pain management
TENS
Touch, distraction, etc.
Legal Issues….
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End of life decisions
Hospice Election
Competence to sign informed consent
Health Care Power of Attorney
Living Will
DNR…in hospital, out of hospital
Will
Legacy
Signs and Symptoms of
Approaching Death…
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Social….withdrawal
Physical…
Blood pressure changes
Pulse and respiration changes
Urinary output changes
Cognitive changes
Spiritual changes
Moment of death………….
Ethical issues….
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Reimbursement Driven Care
When patient and family wishes conflict
When family and family wishes conflict
When worker’s values conflict
Boundaries
Dual Relationships
Confidentiality/HIPAA
Dying Children…..Needs
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Hope redefined
Normalcy
Family
Symptom Management
Help for well siblings
Finances for family
Self Care
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Own Mortality
Mortality of loved ones
Own grief
Rest
Restoration
Hope
Spiritual Life
Why do this work?
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Calling….
The blessing of being invited into people’s
lives when they are most vulnerable
The opportunity to see courage and
strength
The richness of life intersecting with
eternity
Death and Grief Happen
 Among
our peers at work
 In our families
 In our country
 In our friends
 In our neighborhoods
 In our churches
Sometimes, it happens badly
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When we judge
When we prescribe
When we
“celebrate”only
When we excuse
When we abandon
When we think we
know just how
someone feels
The Known
Death is universal; it comes to us all
 Grief is universal; we will all experience it
many times.
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While the average life expectancy in the
United States continues to grow, the
mortality rate is still the same. One out of
one will die.
We also know………….
Death and grief are unique.
 Each person’s experience is his or hers
alone.
 Each experience is unlike any other.
 So, I can never know exactly how
someone else feels.
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“Though united in that we are grieving, we
grieve differently. As each death has its own
character, so each grief over a death has its
own character, its own inscape.”
Nick Wolterstorff
Lament for a Son
Grief is Normative
Consider the age of the bereaved
 Consider the relationship with the
deceased
 Consider the circumstances of the loss
 Consider the degree of change in day to
day life experienced by the bereaved
 Consider the support available
 Consider the bereaved’s history with crisis
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Grief impacts us holistically…
Social, Physical, Cognitive, Emotional, Spiritual
These five needs overlap.
Spiritually Speaking….
Why
Spiritual
Forgiveness
Hope redefined
Grief Takes Time
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Whole first year is one loss after another
Beware of special occasions and holidays all
year
Uncomplicated mourning is normally 2-3 years
Complicated mourning may be a 5-7 year
process.
Grief continues for a lifetime through major life
milestones.
Grief is Work:
Worden’s Four Tasks
Experience the reality of the loss
 Experience the pain of the loss
 Adjust to an environment without the
deceased
 Withdraw emotional energy from the
deceased and invest it in new
relationship(s)
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(William Worden, Grieving)
Alan Wolfelt’s 6 Reconciliation
Tasks:
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Acknowledge the reality of the death.
Move toward the pain of the loss while being nurtured
physically, emotionally, and spiritually.
Convert the relationship with the person who has died
from one of presence to one of memory.
Develop a new self identity based on a life without that
person.
Relate the experience of the death to a context of
meaning.
Experience a continued supportive presence in future
years.
(Wolfelt, Healing the Bereaved Child)
Resources
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Hospice
Local for
bereavement
resources and groups
Hospice Foundation
of American for books
and yearly
teleconference
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Congregations
Schools of Social
Work
School counselors
Bookstores…shelves
of books
Funeral homes,
particularly with after
care programs
Families of Dying and Grieving
Children Need
Resources….financial, transportation,
errand, chores, helping with well siblings
 Permission to feel what they feel without
our judgment or condemnation
 Hope without fantasy
 Presence
 Care for well siblings
 Time with each other
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We CAN help…………
Tangibles
Be present
 Mark your calendar for the entire year of
difficult days
 Call and send cards
 Do concrete tasks….lawn, meals, errands
 Assess and refer when needed
 Memorialize
 Don’t be afraid of tears
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Self Care for Ministers
The Jesus Model: Get away
 The Jesus Model: Say No
 The Jesus Model: Name it
 The Jesus Model: Cry
 The Jesus Model: Spend time with friends
 The Jesus Model: Pray
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The beginning….
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This is the church.
This is the steeple.
Open it up…
And see all the
people.