1. Death and Grief: Helping in Congregations Helen Harris, LCSW, DCSW

2. 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

3. Societal Attitudes…. Medicine should have an answer for every problem…. Death is the enemy………….. Dependence on others is a burden………

4. Many Church attitudes…. Prayer lists Food in crisis Celebration and Pollyanna Out of sight, out of mind There are programs to address needs

5. Reimbursement Drives the System Fee for Service DRGs Per Diem Coverage for Medications Coverage for In Home Care Coverage for Institutional Care

6. Contexts of Practice with the Dying Hospitals Hospice Home Care Skilled Nursing Facilities Everywhere….CIS, Churches, Intergenerational nature of our work…

7. Fears of the Dying…. Fear of being abandoned Fear of intractable pain and symptoms

8. Needs of the Dying… Presence Honesty Hope Symptom Management Value Opportunity to complete unfinished business

9. Communication with the Dying Reflective Listening Listening for Feelings Listening without Judgment Reflecting Feelings Non verbal communication Active Listening Problem Solving

10. 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

11. Symptom Management Pharmacology Delivery systems…po, pr, iv, patch, sublingual Alternative pain management Psychosocial pain management TENS Touch, distraction, etc.

12. 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

13. 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………….

14. 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

15. Dying Children…..Needs Hope redefined Normalcy Family Symptom Management Help for well siblings Finances for family

16. Self Care Own Mortality Mortality of loved ones Own grief Rest Restoration Hope Spiritual Life

17. 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

18. Death and Grief Happen Among our peers at work In our families In our country In our friends In our neighborhoods In our churches

19. 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

20. 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.

21. 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.

22. “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

23. 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

24. Grief impacts us holistically…

25. Spiritually Speaking…. Spiritual Why Hope redefined Forgiveness

26. 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.

27. 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)

28. 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)

29. 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

31. 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

32. We CAN help…………

33. 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

34. 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

35. The beginning…. This is the church. This is the steeple. Open it up… And see all the people.