Over at the PHI Blog, an article about grief experiences with CNA’s is highlighted.

The problem is one cannot access the original article without coughing up some cash. Instead of going by whatever it indicates, I’m going to write here about how CNA’s are often forced to deal with the deaths of their residents.

CNA’s who work in nursing homes and assisted living facilities have long term relationships with residents; it’s part of what we do. We care for them, in many ways. Over time, aides become attached to the residents and even though it’s discouraged from management, friendships develop between the aide and resident. We’re all human and not robots. Feelings and fondness are natural.

When a resident declines, the CNA is the first to take note of it. In facilities where consistent assignments happen, the CNA’s work with the same group of residents over a long period. Sometimes though, without consistent assignments, CNA’s can see problems and decline as well. It’s difficult to watch this decline occur: The weight loss, the loss of function and ability. CNA’s grieve the loss of mental ability and physical health.

End of Life Policies

Far too many nursing homes go with a traditional mindset that death happens…get over it! It’s the expected outcome for most residents…and CNA’s should be tough enough to handle it.

I say: Not so fast. CNA’s are tough. But we’re also human. We don’t become immune to death simply because it occurs often. Anyone who IS immune to the feelings and emotions that are normal after a death, shouldn’t be working in nursing. When we lose that, we’ve lost a lot.

When death is imminent, CNA’s usually know it before anyone else. There are tell tale signs. A good facility will assign one aide per shift to work with a dying resident- be that the primary CNA or not. A dying person needs consistent staff more than any other. This isn’t the only resident the aide should be assigned to, but the group should be smaller in number so the aide can manage to spend more time with the resident.

CNA’s should be given the option of working with this very special resident: Some are just not comfortable with the dying process and this will make for a very sour experience for all involved. The attitude should not be one of, “It’s part of YOUR job!” Death and dying and the process of doing so isn’t just another task to be done. A human being’s life is about to end. We should strive to be as respectful as possible. Dignity for everyone is important. Including the CNA. Much of the caring at this time could go to family, who may be at the bedside. Who wants a CNA there who is nervous, scared, or otherwise not able to provide care and comfort?

When CNA’s are included in the process and planning of an impending death, they feel more empowered. They will be able to mentally prepare for events; they will be able to manage their time and afford the resident the best care. Often, the resident won’t need a lot of actual care. Limited movement and fuss is the norm; really good oral and skin care is important. And just being there is probably the most valuable form of care at this time.

When a resident has passed away, the CNA should ALWAYS be given the choice about providing post mortem care. Nine times out of ten the aide will not have an issue with doing this; but there are times when they won’t feel good about doing it. This should be honored. The charge nurse should be able to anticipate this and plan accordingly.

Mrs. Smith Died Last Night
When we come to work, we need shift report. When the news of a residents’ passing is shared, it can be a shock to some CNA’s. As well all know, many residents simply “die” with no prior “warning”. This is what concerns me. The shock factor is real and hard to manage for many. The CNA’s, nurses, and probably everyone else, will experience the five stages of dying:

Denial, anger, bargaining, depression and acceptance.

The first three stages are apt to be felt within minutes of learning of the passing. And this is where many facilities let the ball drop. Death is so common in nursing homes. It becomes another event- sometimes anticipated and other times not. Regardless, CNA’s are expected to go about their normal routines without any concern for their very human feelings. CNA’s do experience depression when a favorite resident passes away suddenly. They miss the resident. Perhaps the resident was on their assignment for a long time. There were no opportunities for a goodbye.

A relationship has ended. Abruptly. Think about how you would feel, and react.

Time should be allowed for grieving. A moment of prayer; a quick break; a hug- and a shoulder to shed some tears on, are all appropriate measures that should be acceptable at these times. The hours immediately following the death of a resident will be difficult for CNA’s. Reminders of the resident are everywhere: their room, their laundry, their place at the dining room table…maybe family trailing in and out. It’s a time to reflect and it’s okay to be SAD. In many cases, it’s a blessing as well and CNA’s will be sad AND grateful at the same time. Grateful the suffering has ended.

A range of emotions are to be expected. CNA’s will “get over” this, but they shouldn’t be rushed. Death is a part of life, but it’s a sad part. If a CNA is really overwhelmed with strong emotions that she cannot control, it is entirely appropriate to allow her to go home unpaid, I recommend. The pay issue is a stickler for me: Paying staff to stay home due to normal human reactions isn’t good policy. The lack of being paid is a factor many will consider; this is in an effort to really weed out those who can be SAD and professional at the same time, from those who might be newer to the work and inexperienced in these things.

Management should be supportive during these rough hours and days. Some facilities make religious counseling readily available to staff; others allow personal time off to attend wakes and funerals. Small memorials are set up- usually a table with flowers and a Guest Book in the lobby. The family gets the book when it’s been signed by staff and others.

The Involved Family: Mourning The Loss of Them
One more thing that isn’t often discussed: When a resident dies, not only do we miss the person, we miss their family in most cases. These families become a part of the unit; they visited often and we got to know them pretty well. These were the people who brought in Christmas gifts for all the staff; these are the people who thanked us each and every day for our very hard work; these are the people who looked to us as heroes. They made us feel good about the work we do. CNA’s especially will feel this loss.

A little planning and after-action briefings could go a long way towards helping validate the feelings and emotions of ALL staff after the passing of a resident. A facility that respects these very human traits will be a better place to work at. CNA’s are not robots, as much as we feel like so many times.