Death and Grief: Helping in Congregations Helen Harris, LCSW, DCSW.
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Transcript of Death and Grief: Helping in Congregations Helen Harris, LCSW, DCSW.
Death and Grief: Helping in Congregations
Helen Harris, LCSW, DCSW
Changes through the years…
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
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….
Medicine should have an answer for every problem….
Death is the enemy………….. Dependence on others is a burden………
Many Church attitudes….
Prayer lists Food in crisis Celebration and
Pollyanna Out of sight, out of
mind There are programs
to address needs
Reimbursement Drives the System Fee for Service DRGs Per Diem Coverage for Medications Coverage for In Home Care Coverage for Institutional Care
Contexts of Practice with the Dying 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…
Presence Honesty Hope Symptom Management Value Opportunity to complete unfinished
business
Communication with the Dying
Reflective Listening Listening for Feelings Listening without Judgment Reflecting Feelings Non verbal communication Active Listening Problem Solving
Principles of Hospice
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
Pharmacology Delivery systems…po, pr, iv, patch,
sublingual Alternative pain management Psychosocial pain management TENS Touch, distraction, etc.
Legal Issues….
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… Social….withdrawal Physical… Blood pressure changes Pulse and respiration changes Urinary output changes Cognitive changes Spiritual changes Moment of death………….
Ethical issues….
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
Hope redefined Normalcy Family Symptom Management Help for well siblings Finances for family
Self Care
Own Mortality Mortality of loved ones Own grief Rest Restoration Hope Spiritual Life
Why do this work?
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
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.
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.
“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 WolterstorffLament 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
Grief impacts us holistically…
These five needs overlap.Social, Physical, Cognitive, Emotional, Spiritual
Spiritually Speaking….
Forgiveness Hope redefined
Why
Spiritual
Grief Takes Time
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) (William Worden, Grieving)
Alan Wolfelt’s 6 Reconciliation Tasks: 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
Hospice Local for
bereavement resources and groups
Hospice Foundation of American for books and yearly teleconference
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
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
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
The beginning….
This is the church. This is the steeple. Open it up… And see all the
people.