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01 Oct 2014

Staff & families coping with death and dying, by The Reverend Sue Jacobi

When people reach the point of dying in aged care facilities, they have usually been living there for some time. Very few people are admitted and then die in a few days. Likewise sudden death is relatively uncommon. We expect people to die! The only place in an aged care facility where death is not generally expected is the dementia unit. Of course, some people do die in the unit but mostly they die in hospital level care. My experience is that staff members are often really quite shocked when death occurs in the dementia unit and that has been borne out by my research where people have spoken about it in my interviews. So these are people we have got to know. The staff will frequently have far more contact with them than their family members because they are the ones who have the day to day, hands on care.

Some families visit a lot and we all get to know them well – some are difficult and demeaning and we wish we didn’t know them quite as well! Others visit infrequently and seem quite hesitant about being with their family member. Some complain a lot, others ask lots of questions, some seem almost hostile and others very shy about talking with staff. It is not our role to judge. These people have known their family members for much longer than we have – they are guardians of the history, so to speak. Sometimes the dying person will have been very difficult and caused lots of problems – there may even be family divisions and some family members who don’t speak to each other. It is important that we don’t judge – we are there to offer pastoral help and support. Of course, some family members are unsure about what to do with the clergy and they hasten to explain that they are not religious but mum or dad was!

So when we enter the room where someone is dying, a whole lot of things are going on, not only for the person who is the centre of attention but for the family members – some who feel very uncomfortable about being in this situation and for the staff who have cared for the dying person and continue to care but who may feel somewhat edged out by the family. Emotions are all over the place.

The question which confronts us today is “How do we deal with this situation?” First of all, we need to recognise that we can’t fix what’s happening and has happened over the years. We may know the dying patient well but we don’t necessarily know the family history and I have come to recognise that that can be quite helpful.

So . . . we arrive and may well be confronted by a roomful of relatives – some maybe hostile others so relieved to see us that they just about fall over themselves. Be prepared for anything. Others have dealt with ministering to the person who is dying – my concern in this presentation is to speak about ministering to the family. Be sure that you identify yourself – I always wear a clerical collar and that means that I am readily identified. There will usually be 2 one person who speaks on behalf of everyone – address that person and everyone else and simply say that you are here for them as well as for their relative. You are bound to get their Church going – or non-Church going history – it’s a bit like vicars I knew when I was growing up – especially if Mum or Dad is a Christian. That can be amusing but also very helpful – it’s a good starting point for conversation. Sometimes, they will say “I’m not religious – but mum/dad is” another starting point. Or even the opposite – “We are Christians but we are unsure about mum/dad”. Now, often mum or dad has been coming to one of our 2 Church services and I have had a lot to do with them or they are always pleased to see me. Talk about the positives. Address their questions – talk them through. Be open and honest. I think it’s important that we don’t overstay our welcome. Talk things through. I will often say “I’d like to pray with your mum/dad – if that’s okay with you” usually people want that. Then I leave –telling them I will be back and they can contact me at any time and I will be there. I need to add that here I have supreme advantage over many chaplains because I live on site! Make sure that your promises are realistic and you can follow through on them. I find that usually people want me to come back. I often leave it a few hours and then pop in again. I give them my card and tell them that if they want to talk about anything I am available for them at any time. Often they do follow up and want to talk after the death of their loved one. My card has my qualifications.

When I have been with the family, I usually follow up with looking for the staff on duty. As a chaplain, I know them well and I believe that as chaplains we need to know the staff and to minister to them. Some will be really upset and feel somewhat excluded at this point. They are also very busy because deaths often seem to happen at night or in the afternoon shift. Some will be frantic but really upset. They may well feel excluded but recognise that the family members need to be there. Some need to talk, some need to cry and others simply brush it off. Most of our staff members are Pacific Islanders and Filipinos. They are religious people and to pray with them is very special worries me that palagi are so mono-cultural and yet we expect people to speak our language. I like to be able to at least have basic conversations with staff in their languages – the greetings and blessing etc. When we minister to people, we need to get out of our comfort zone! Of course, we expect people to speak English on our sites – that is a given – but when people grieve to hear their own language is like a gift from God. Please don’t overlook that! Don’t forget to pray with the staff.

My experience is that if the family members are Europeans, they leave quite promptly following the death. I am usually called at the point of death and pray – I know this topic has been covered by someone else. I assure the family of my availability. If they are Pacific Islanders or Maori, they will frequently stay and are happy for staff to come in –usually staff have already tidied up the body, I find that is an opportunity to pray with everybody and the staff appreciate it. I like to assure staff that I will always be available and they often take up the opportunity of talking with me. If they can go to the funeral they frequently will but this is not encouraged by those who own our facility.

On a significant number of occasions, I have spent time with the family who have assured me that they will stay so that they can be with the patient when he or she dies. They will go out 3 for a few minutes to have a drink or something and when they come back the person has died. They are usually very upset about that and say things like “We wouldn’t have gone if we had known death was so near”. Nowadays I am inclined to say that maybe he or she wanted to spare them some pain.

My topic has been ministering to family and staff. There are many similarities but frequently some opposition at the point of death. The staff members who have cared for the patient may feel excluded and the family members –some of whom have not had a great deal to do with the patient while in care – are in charge –so to speak. We are there to minister to both groups and to pay attention to their needs. Sometimes it van be something of a balancing act – other times it’s quite different. We need to pay attention to both groups and give them the attention they need.

Availability – our availability is the best gift we can offer people. We need to be prepared for the fact that some people are slow in speaking about what concerns them most – some are shy – some think chaplains are a rather strange breed. Give them time. We are the people who don’t need to rush.

Rev.Sue Jacobi