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LeadingAge magazine May/June 2016

Vision

Are We Addressing the Emotional Needs of Residents?

by Ron Kelly
LeadingAge e-mag May-Jun16 Vision PVN Kelly 226w

Ron Kelly

When seniors and their families ask about the types of care services we provide for our residents, many want to know if we offer help with assistive tasks such as medication management, grooming and bathing, housekeeping, and meals. Others ask about health care amenities such as on-site clinicians, pharmacies, fitness centers and transportation to and from doctors’ visits and hospitals. While we seek to address these needs and concerns, we also highlight services and programs that many people haven’t considered.

Most senior living communities put a lot of emphasis on addressing residents’ physical, medical and social needs, but what about their emotional needs? What if while living at your community, a resident loses a spouse or a child? What if a resident goes to the hospital for a traumatic visit, but doesn’t have anyone to call? At Presbyterian Village North (PVN), we’ve established unique programs to ensure that there is always someone for residents to talk to and share their feelings with so they don’t feel alone. Two programs that help address the emotional well-being of our residents are the Journey Through Grief support group, and our Resident Emergency Advocacy Program.

The importance of emotional support really came to light for me last year, when we experienced some difficult deaths within our organization, including a few employees. Powerful emotions come along with that and it made me that much more aware of the importance of dealing with grief in a healthy way.

It also brought to the forefront for us as an organization that we must be prepared for unexpected things and be able to quickly respond and provide resources for people.


Support for Those Who Grieve

Helen Keller once said, “What we have once enjoyed deeply we can never lose. All that we love deeply becomes a part of us.” This is the underlying message of the grief support groups held at PVN. A person may be struck by grief at any point in time, and grieving can be an isolating experience for many, as reactions to loss may be overwhelming and frightening. The grief support groups decrease isolation and offer a safe place to fully express emotions. Most of the participants have lost a spouse or other loved ones; however, there are other causes of grief, such as loss of health or parting with something that holds sentimental value, such as a family house with 40 years of memories.

LeadingAge e-mag May-Jun16 Vision PVN group 400w
Presbyterian Village North

A Journey Through Grief support group meeting.

For many, simply having a few people listen to their story does much healing on its own. The Journey Through Grief support group is intimate in size, consisting of 5 to 8 members, and everyone makes a promise to keep the discussion confidential. Carolyn Mitchell, minister of spiritual life at PVN, collaborated with Valerie Sanchez, who serves as the director of bereavement and integrated therapies for Faith Presbyterian Hospice, to bring this program to fruition.

For most, grief starts with shock. You cannot believe the person is gone. Shock is followed by denial. You still expect the person to call or to walk in the door. Then people may get angry–angry at the person for leaving or angry at God for taking them too soon. Eventually you reach the point of acceptance, in which you can accept their death and move forward while keeping their memory in your heart. This process can take a very long time for some.

Many times, friends and family members urge a loved one experiencing grief to snap out of it, but it is not always that easy. Everyone is different. However, everyone in the support group has a deep understanding of the pain that the other members are going through, as they are going through something similar. The goal they work toward as a group is to move forward with their lives despite what has happened, and try as best as they can to live them to the fullest. In the presence of love and acceptance, a group empathizes with each other’s deep sorrow and supports one another in the hope of the joy that will come.

Our field has a long history of helping people deal with death and loss, and people who do this work bring incredible wisdom, formed by experience, to working with residents and clients who are suffering. If there is one area we might improve on, it’s the way we help our teammates with grief. That’s a next step for us: How can we do a better job for them, especially those who are frontline staff who work so closely with seniors? The emotional impact of loss is something that leads some to leave our field. The very qualities that drew them to be caregivers might also make it hard for them to stay because they can’t quite bear the burden.


Advocacy Support

Another program that caters to the emotional wellbeing of residents is the advocacy support program, which provides active support to a Presbyterian Village North or Grace Presbyterian Village resident during a health crisis at an area hospital ER, usually when family or designated care companions are not immediately available. It also provides a caring presence for the residents and their family by coordinating communication between the hospital and the senior living community. The advocate is used when the resident is an elder orphan, when family cannot be there within a reasonable amount of time or when the medical emergency is determined to be critical and extra support to family is needed. When caregivers become a part of Presbyterian Communities & Services they undergo special training to be an advocate.

The advocate is responsible for knowing the reason a resident is going to the hospital and to which hospital they are being taken, their room number at the senior living community, whether a family member or care companion is on the way, as well as contact information for medical power of attorney and estimated time of departure from the community if the resident has not yet left. The advocate makes sure that the hospital staff is attending to the residents’ needs, such as getting a blanket if they are cold, helping them to the bathroom or providing beverages if they are thirsty. If the resident is discharged back to the community, the advocate ensures that the hospital has made transportation arrangements and communicates them to the community.

With programs like these in place, we can help our residents feel supported, safer and more composed, all while giving their families peace of mind, too. Emotional wellbeing is just as important as physical and social wellbeing in order for residents to age successfully while living the best life possible.

“Journey Through Grief”: a Structured Curriculum

The Journey Through Grief program at Presbyterian Village North offers a structured approach to help grieving residents cope with their feelings over a course covering one year.

The curriculum covers 12 topic areas, one per month, though participants will often revisit earlier topics as they go through the program.

The 12 monthly topics are:
 
1. Grief
2. My Story: What have I lost? Who died?
3. Theories
4. Reconciliation Needs
5. Living with Memories
6. Coping Strategies
7. Mourning and Spirituality
8. Journaling
9. Milestones, Birthdays, Anniversaries
10. Promises and Intentions
11. Finding Comfort, Peace and Joy
12. Honoring and Remembering

LeadingAge spoke with Carolyn Mitchell, minister of spiritual life for PVN, and Valerie Sanchez, director of bereavement and integrated therapies for Faith Presbyterian Hospice. The curriculum was created by Sanchez, a social worker with long experience in hospice.


LeadingAge: Can you describe the beginning of “Journey Through Grief”?

Carolyn Mitchell: It was a resident who came to us and said she really felt it would help the folks here. I went to Valerie Sanchez over at Faith Hospice and she shared a whole curriculum. There was a 6-week program but we’ve started here with a once-a-month program. There are 12 sessions so it takes us through a full year. People can join at any time; some come for one or two sessions but it’s too soon [for them] so they leave and come back later.


LeadingAge: What is a typical session like?

Carolyn Mitchell: We talk about what grief is, we talk about ways people [may] try to help you but why they really can’t. We go through stages of grief, and talk about the psychological, spiritual, emotional and physical pain grief can bring. We go over things that people say that are not helpful. We talk about how to take care of the pain. We do a class called “memory making” where you talk about video collages and journaling and scrapbooks and quilts.

It’s structured; each month we deal with a different topic. We also open things up for questions and sharing.

We’ve had 5-6 people per class. We started with 10, but there were a few that weren’t ready yet. And, for some people it’s just not helpful. It’s a small and intimate group, genuinely concerned for each other.

I also do a fair amount of pastoral counseling one-on-one; they’ll come to me and want to talk about their grief.


LeadingAge: Is there usually a gap of time between the death of a loved one and the point where a resident will begin with this program?

Carolyn Mitchell: It can take months before they’re ready to come here. Most of them don’t want to cry in front of anybody; it’s too painful to talk about yet. In some cases it’s been their children who have died. I usually talk to people individually, and not everyone is going to be helped by this.

A lot of times it’s their friends who come to us and say so-and-so is having a hard time and then I’ll approach the person and ask if they’re interested.


LeadingAge: What is the background of the curriculum? Is it based on a standardized model or did you create it from scratch?

Valerie Sanchez: We used models from different places. I have worked with the American Cancer Society, which had pieces I liked. There are a lot of articles out there. Many of the theories [about grief] are pretty much the same but use different wording. What I encourage people to do is create their own theories. How is this working for you? I ask people to look for ways to find comfort and joy. That might mean not much more than “I’m going to get dressed today, and get up and move around.”

You can find a lot of information by just searching for “activities for grief groups.” I created the curriculum in 2010, but it gets adjusted all the time.

The first section is “What is grief?” My purpose is to provide information and education to reframe that experience. What about those reactions, that emotion? There is anger, sadness, regret, guilt. “What is it that makes them overwhelming to me at this time?”

My goal is to offer information and education so “This experience I have may define me but it won’t be the only thing that defines me. What does this mean for me? Is there a transformation?”

For some that’s a big thing, for others not so much. It might be “I’m just going to survive this.” It might mean “My life will be very different. But my life is not over.”

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Ron Kelly is executive director of Presbyterian Village North, Dallas, TX.