Interview: Donalyn Gross, Death and Dying Expert
Posted by Patti on June 23rd, 2008 / Print This Post
Recently we highlighted a program offered by death and dying expert Donalyn Gross: She is a thanatologist and has had lots of experience working in nursing homes and hospitals. Her program, “Good Endings” is an excellent resource for all who provide end-of-life care.
I asked Donalyn for an interview here, to get her thoughts and opinions on this issue. Presented here, is the interview which was conducted via email.
1) How long have you been a Thanatologist and what prompted you to get into this profession? What are your perceptions of the death process in institutions such as nursing homes? At your site you offer workshops for staff. I strongly believe this education is needed. How many workshops have you done? Who attends the program? Are CNAs a part of them?
DG: I’ve been a Thanatologist for 30 years now. My dad was a physician, my mother is a nurse, so I was raised in a medical household. I was a Candy Striper at a local hospital in high school, and all the jobs I’ve had since then were in hospitals or nursing homes. I’ve been a medical secretary, transcriptionist, dr’s assistant, nurses aide, Activity director, and a social worker.
In the 1960’s when Elisabeth Kubler-Ross came out with her work with the dying, I decided that’s what I wanted to do. All of my schooling (colleges) was based around medical counseling, etc.
Working in the nursing homes, when someone died, it was like “bag “em and tag “em”. The dead were hidden behind curtains, the roommate was brought into another room if possible, the funeral home was called and the body removed. Many nursing homes put the residents into their rooms, or closed them off when the morticians wheeled the body out. Out of sight, out of mind.
Some more liberal homes now allow residents in to see the person who is dying, or the deceased person. Sort of closure. That’s the way it SHOULD be. Why hide the dying/dead? I also am a Certified Music Practitioner, and play therapeutic bedside harp for the dying. I am on call at local nursing homes and a hospital.
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2) What has been your experiences in nursing homes/long term care facilities with regard to residents’ end of life care? What is the ideal environment for a dignified death within the boundaries of the average nursing facility?
DG: You know how busy nursing homes are= who has time to sit and visit with residents, never mind sit with someone who is dying. That’s why I created the Good Endings Program, with the Vigil Team= we recruited volunteer staff to sit with the dying, around the clock. It is a great program, and many nursing homes around the world are following the program and creating their own programs.
When a resident is “actively” dying, there should be some kind of protocol= the staff should make time to go in and visit/say goodbyes to that person. CNA’s are the ones who work closest to the residents. They’re kind of like extended family. They should be allowed to be with that person if they want.
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3) Is staffing an important factor in EOL care? Many residents do not have family that can be with them during their last hours; some facilities will ask an aide to sit with the dying resident and provide optimal care, while others will not. What are your thoughts on this?
DG: I think every facility should have a specially trained group of volunteer staff, who when a person is dying, should be the ones to provide the last care of that person.
Some residents have family who want to be there all the time, and only need some respite care- example- meals brought in, someone to stay if they need to take a break. For those who have no families/friends, that is a definite focus for someone to be there for them. Some people can’t deal with death and dying, and that’s ok. They can assist in other ways. There’s no shame in it, and a person shouldn’t feel guilty because they don’t want to be there.
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4) Hospice vs Nursing Home Staff: The differences you see
DG: Many nursing homes have outside hospice people coming in to see hospice patients. Nursing home staff are always there, and see the patients constantly. Hospice personnel come in for specific times and visits. They’re not always around. Hospice is a good program- they have volunteers who are a big part of hospice work, but they have their time constraints.
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5) CNA’s: What should their roles be in EOL care?
DG: CNA’s should be allowed to be a part of end of life care, to work along with the nurses, if that’s allowed. Every facility is different. Everyone is so busy and overworked. Our vigil team members will often go in during their breaks, and many will come in before or stay after a shift to sit with people.
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6) Many CNA’s know little to nothing about the religious beliefs of residents; we get basic rundowns on cultures and the like. Should CNA’s have better understanding of religious values in the context of death?
DG: In my Good Endings publications, there is a Teacher Resource packet= it’s 29 pages of everything you wanted to know about death, dying and bereavement, and information on religions/culture. Very important. NEVER push your own religious beliefs on anyone, and ALWAYS know something about a patient’s culture! Lot’s of things to be aware of.
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7) CNA classes don’t do a good job preparing the students for death and dying and all the emotions that come with it. We’re taught signs of impending death and about post-mortem care, but in clinical terms mostly. How could this be improved?
DG: I created the Good Endings program specifically for nursing home staff to provide them with the basics of death education. They should be given information on the physical aspects of dying, as well as the emotional ones.
My Good Endings Guide, a 12 page booklet, is used for this purpose. Facilities should have in service workshops once or twice/year for ALL staff members on death and dying. We’re all going to face it in our lives. It should be mandatory for ALL STAFF. I provide training workshops for healthcare personnel in nursing homes, hospice programs, hospitals, healthcare agencies= anywhere where requested. I speak at conferences for all types of groups (social workers, activity professionals, etc.) I also teach Death, Dying and Bereavement at a local college. We’re ALL going to die and we should know how to deal with it.
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8) CNA’s are often close to their residents. When they pass away, we’re expected to “carry on” and perform our duties with as little interruption as possible. The emotional aspect of losing a favorite resident is hard on the aides. How can management support the aides and nurses, and other staff who are grieving?
DG:When a resident dies, at some of the homes I work with, a sympathy card is passed around for staff to sign and write memories, and then given to the family. Some light a battery lit candle and put a rose up on the nurses station to symbolize there was a loss.
We have memorial services, quarterly at one facility, where we invite the family, staff, other residents to share loving memories of those who died each quarter. (Hospice usually has a big one once/year). It depends on the size of the facility.
Most death occur between September and March due to the cold, winter, and flu seasons. We’ve offered bereavement to the families and staff, but many of the families don’t want to come back to the home, and it’s really hard to get staff members to get together after work hours.
They do know that they can always call me at any time if they want to talk. And talking does help- even if it’s while you’re working, during a break….it’s good to get your feelings out. Working in a nursing home, there’s always going to be another death coming up. Administration should be welcoming of any kind of emotional assistance for their staff. You’re lucky if you get a concerned, involved Administrator/DON.
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Donalyn’s web site is HERE. Make sure you visit it and check out her program. She also offers in house trainings for facilities located in the north east US.