Front Line Staff Experiences of Grief and Loss Working in Long-Term Care Homes

By J. Marcella and M.L. Kelley, Lakehead University

The Social Sciences and Humanities Research Council funded a five year research program entitled “Improving the Quality of life of people dying in long term care”.  In partnership with St. Joseph’s Care Group in Thunder Bay, ON and the Municipality of Halton, ON., our focus is developing palliative care programs in long term care (LTC)homes by engaging staff, residents, families and community organizations. For primary care workers inLTC homes, death, dying and grief are familiar experiences. 

Our environmental scan conducted in 2009 with four LTC homes indicated that staff developed close relationships with residents and experienced a tremendous sense of loss and grief when a resident died. However, at an organizational level there was minimal recognition and acknowledgement of staff feelings. Tobetter understand the experience of grief and loss, graduate students in the School of Social Work at Lakehead University conductedindividual interviewswith nine front line staff –6 PSWs, 2 RPNs, and 1 RN .

The study findings are presented below using fouroverarching themes that emerged from the data:

The LTC context influences grief and loss. There is no training for staff to prepare them for the grief and losses they will experience. A cultureof silence about death existswhich impactsend-of-life care practices and staffresponses to residents’ deaths. Although death is part of the job, it is hidden from residents and other staff.

The burden of grief. Grief is central to  the work in LTC. Despite their grief after a resident’s death, staff must emotionally detach andquickly attach to theirnew resident. There is no control over death and staff cope individually with feelings of loss.

The emotional impact of grief. There is no relief from grief and loss as it is embedded in the nature of the work of LTC. There are few opportunities for closure when residents die and staff experience the multiple loss of both the resident and their relationship with the family. The kind of death, the nature of the relationship with the resident and the personal characteristic of the staff member influences how loss is managed.

Suggestions for support strategies. Participants offered a number of strategies that would support them in their grief and loss. Many of these strategies require little time or added resources. Participants emphasized the importance of recognizing grief and acknowledging death, as well as the impact that death has on the staff. The following four suggestions came from the participants; grief education for staff during orientation, establishing a ritual to acknowledge a death, implementing peer guided support/debriefing following a death, prompt notification of deaths to all staff.

The experience of grief and loss in LTC is complex. Primary care workers are in the best position to identify their grief and bereavement needs. A formal process for supporting grief and loss in the work environment is needed as a component of a holistic and inclusive palliative care program in LTC. The findings of this study will inform development of such a process.