Grief is a complex issue. It doesn’t follow a straight trajectory or timeline, and people don’t all grieve in the same way or for the same losses. The key is to understand the big picture of grief, determine how to create an organizational culture that honors and supports those who are grieving, and plan how to help people as individuals through their grief.
Start by understanding that there are many misperceptions about grief. For instance, Trish Childress, LCSW-S, ACHP-SW, a long term care social worker and director of supportive services, says, “People sometimes think that if they talk about someone’s loss, it will only make them sadder. I hear this a lot.” However, she says, “In reality, they are already sad. We need to give them an opportunity to talk about their loss if they want to.”
Another myth is that grief is the same for everyone—that there is a set timeline for grieving or that people go through predetermined stages of grief and then are “done grieving.”
Paige Hector, LMSW, national speaker and clinical educator, says, “People tend to think that grief is something we should experience briefly and move on.” This “just get over it” mentality, she says, is common in health care.
“We don’t allow people the time to reflect and experience all of their emotions,” she says. “As a result, they get bottled up inside, and [it affects their] entire being.”
People often think that grief is only an emotional experience. However, Hector notes, “Grief is a whole-body issue. We experience grief in all sorts of ways, and our bodies aren’t hardwired to get over it quickly. It’s about building capacity around grief and mourning, instead of getting around it.”
COVID Grief Looks Different
“The landscape of grief looks different in the COVID world,” Childress observes. For one thing, people are grieving many losses beyond deaths. They are suffering from the loss of social norms, activities, interactions with families and friends, traditions, and more. People may not even realize they are grieving these losses until something triggers a reaction.
For instance, says Childress, “A colleague told me how, in the middle of the pandemic, she broke a dog food dish she had bought for her first dog 20-some years ago. She said she sobbed for an hour and thought something was wrong with her. In fact, the dish actually represented all of the losses she had experienced—lost work, lost connections with friends and family, lost holidays—and she was grieving for all of those things.”
Once the colleague understood this, she was able to acknowledge her grief and begin to deal with it.
Many healing traditions, such as viewings or memorial services, have had to be skipped or postponed during the pandemic. People even had to forgo simple gestures such as bringing someone a meal or a gift. “These are important rituals and gestures for many people, and not being able to participate in them has delayed the grief process for some,” Childress says.
The pandemic took everyone off guard, and “none of us was completely prepared to deal with the amount of loss and level of grief we’ve experienced,” says James Wright, MD, CMD, a multifacility medical director in Virginia. “I think we’re actually still gritting our teeth. We’re imagining the light is at the end of the tunnel and figuring we’ll grieve when we get there.”
In the meantime, he suggests, everyone is still putting one foot in front of the other to make it through. However, it still is important to take the time to stop and grieve, he says.
Daunted by Discomfort
Even when they have the best of intentions, some people don’t know how to help someone who is grieving or even how to address their own grief. “In general, we have a dislike or fear around vulnerability,” Hector says. “We have this idea that vulnerability isn’t acceptable or worry that we’ll get stuck if we let ourselves be vulnerable.”
People may hesitate to reach out when they are grieving because they don’t want to bother others, she suggests. “We need to help people understand that part of being human is to grieve and mourn when you experience a loss.”
When people don’t know how to help others who are grieving, they may just avoid them. “People in my [grief support] groups say that it’s so lonely, that others are avoiding them ‘like the plague,’” Childress observes. Those feelings of isolation are one reason such support groups are so important.
“I think grief groups are the best thing anyone ever came up with,” says Judi Crick, a family caregiver who has lost three close relatives in the past year. “You come together with others who are grieving, and you start to share your feelings. Before long, you realize you’re not alone, that you’re okay,” she says. Someone will tell a funny story about a loved one and “you find yourself laughing and that it’s okay.”
In truth, just reaching out and expressing a willingness to be there for the person can be helpful. Childress suggests offering something specific, such as bringing the person dinner, taking their dog for a walk or their kids to a movie.
Take Time for Tears
“When someone is in grief, create a safe place for them to express their feelings,” says Hector. This means, for example, letting people cry, instead of saying, “Please don’t cry. Don’t be sad. Everything is going to be okay.” Shedding tears is a perfectly normal human reaction and can provide much-needed release.
“Take your cues from the person,” Hector says. “Don’t jump in, offer advice, reassurance, or consolation. Instead, offer an empathic presence, which may include warm silence as the individual experiences their emotions.”
An empathic presence conveys a message of caring, listening, and spaciousness, not problem-solving, she says. “If you sense an urge to say something, keep it simple and focused on the other person: ‘This really hurts,’ or ‘I hear you and will stay with you as long as you’d like.’”
When people cry, she adds, “It’s often a knee-jerk reaction to give them a tissue. But this can look like you’re encouraging them to stop crying.” Instead, wait for them to look around for a tissue or ask for one.
Some Steps Toward Healing
There is no panacea for grief, but there is much facility leaders can do to help residents, families, and staff who are grieving.
For instance, Childress says, “We do a 12-minute virtual memorial online every month, and we encourage people to take the time to feel and acknowledge their emotions. They can take a minute to think about people they’ve lost, reflect, and smile at a happy memory.”
Wright stresses the importance of openness. “We need to recognize loss, not cover it up or ignore it. At one of my facilities, we had a memorial service at the end of the January 2020 outbreak that was attended by family and staff. It brought us together respectfully,” he says.
“There was a recognition that we were going through something that was unprecedented. Our chaplain was very involved, and we offered grief counseling and opportunities to vent and be there for each other.”
A Long Road to Healing
Addressing grief isn’t one and done. Childress suggests, “Make sure your Human Resources department is putting out tips and tools all year long to help people deal with grief. For instance, have teaching sheets to put out in monthly newsletters or promote local bereavement groups they can participate in.”
It’s not just enough to say that the company supports efforts to grieve and mourn. “Even when facilities say it’s okay to grieve, staff may not feel that it’s safe to express their feelings if there are no formal processes or structure for them,” Hector says. “Everyone needs to know where they can turn if they want counseling or other help.”
Judi Crick and her husband Rob suggest a few ways staff can help families with grief. Judi says, “When my mother was dying, I didn’t know what to expect. The facility staff were so good about telling me what was happening with her physically; they walked me through the dying process. This helped me to have feelings of peace when she passed away.”
Rob recommends that staff keep the rooms of residents who are in the dying process as neat and free of clutter as is possible. “Creating a comfortable environment to spend time with a loved one really helps, and it demonstrates for family members how much respect the facility has for the resident and those who love them.”
It’s important to remember that grief is unpredictable and can pop up unexpectedly long after the loss. When this happens, Childress offers, “Think about the basics. Is the person safe? If not, how can I get them to a safe space? What was the trigger?” She adds, “It’s best to just sit with them and encourage them to talk if they want to. You don’t have to know what to say or ask a lot of questions,” she says. “The best gift is to be present.”
Joanne Kaldy is a freelance writer and communications consultant based in Harrisburg, Pa.