Final farewell
A Guelph long-term care facility finds ritual a fitting — and welcome — way to say goodbye
The beds never stay empty for long at St. Joseph’s Health Centre. After someone dies, new clients are typically moved in within a day or less, the southwestern Ontario nursing home’s full waiting list demanding a rapid exchange between the deceased and the living.
The deaths come relentlessly, one or two a week.
St. Joseph’s has developed a unique program, however, to infuse some meaning into its clients’ inevitable demise, and help people who knew them deal with oftensuppressed grief: It routinely holds “room-blessing rituals” to commemorate the patient who has just departed, sometimes with his or her body still in place.
There are prayers and often-tearful remembrances, as grieving family members, nurses, other workers and neighbours spill out of the compact space. Then, when it’s all over, a card is left behind for the next occupant, explaining the room had been blessed to make it a “welcoming and safe home.”
As well as the positive, frequently humorous recollections shared at the rituals, staff occasionally unload their frustrations, perhaps talking about conflicts between the dead resident and the person’s relatives over care at end of life, says Simon Malonda, one of the centre’s chaplains.
A new study suggests the ritual is welcomed by nearly everyone who takes part.
“The expectation is that you continue with business as usual [after a death], you have to move on, despite what you might be feeling inside,” said Janine Maitland, a St. Joseph’s researcher who co-wrote the study. “People learn to put their feelings aside so they can go and support the other residents,” she said. “This allows them to take a brief moment in their day ... that hopefully averts them becoming desensitized.”
The Catholic-run home is about to take another unusual step, too, in dignifying its clients’ deaths. Some families have complained about bodies being left unceremoniously in the facility’s “cold room” to await pickup at a side entrance by funeral directors. St. Joseph’s has had a special canopy built to place over gurneys, so the resident’s remains can be discreetly wheeled through the busy main lobby, past the gift shop and out the front door, a sort-of funeral procession that allows them to “leave the same way they came in,” Mr. Malonda said.
The room rituals instituted a few years ago, meanwhile, seem like an excellent model that could, and probably should, be implemented throughout the healthcare system, said Dr. Mel Borins, a University of Toronto professor of medicine with research interests in both grief counselling and healthcare stress.
As it is, doctors and nurses do not really process the passing of their patients, however traumatic the end, or however close they might have been to the individual, Dr. Borins said .
“We don’t really acknowledge death in a way that is helpful to all involved,” he said. “When someone dies, we just move on to the next person ... We don’t have a way in our medical culture to really talk about it or deal with it.”
Formal bereavement is generally lacking in the long-term care field, but is “critical” to workers’
It’s nice to know that you don’t just disappear
emotional health and by extension the quality of care they provide, suggests Ms. Maitland’s paper, just published in the journal Palliative and Supportive Care. The concept could probably be applied in a variety of different homes, with more secular facilities making the ritual less spiritual if necessary, she said. Some hospices — where death is even more commonplace — do hold memorial services.
Nursing homes may be in a unique position within the healthcare system, their populations changing as authorities emphasize keeping elderly and chronically ill people in their own homes as long as possible, Ms. Maitland said. Those who come a long-term care facility, typically their final stop, are sicker and older than in the past, yet may still live there long enough for staff and others to get to know them intimately.
Statistics indicate that half of a home’s residents at any given time will have died within two years, she said. About 75 to 100 deaths occur annually at the 300-bed St. Joseph’s facility, Mr. Malonda said.
When a life ends, wheels are quickly put in motion to organize the ritual and issue invitations to staff and residents. Families sometimes opt to have the ceremony the same day, before their relative is taken away, the chaplain said. “We are talking about someone who is gone, but physically the body is still there, and the feelings of the staff and the family are raw,” he said. “The sharing and the strength of the emotion is much stronger.”
A dozen or so people frequently show up, overflowing into the hallway, as the chaplain recites non-denominational prayers and announces “let us give ourselves permission to somehow get in touch with the emotional part of our call and duty.” Then the ritual is opened up to comments from participants.
For workers, the short memorials provide a time to remember who just left, even as attention quickly refocuses on the living residents, said Sheila Walsh, a St. Joseph’s nurse and team leader. As illustration of the pressures that staff face, many initially questioned whether the 20-minute rituals could be fit into their hectic, nonstop shifts.
“A lot of what we do is quite rushed, so when you have that moment to pause, it does surface all those feelings, those memories, those experiences you had,” said Ms. Walsh, who has attended 20 or 30 rituals. “So much of it is so medical, technical, documentation, all of that. That’s when you lose touch with ‘This was a really, really human experience.’ ”
John Code, 60, who has been to about 30 of the ceremonies in the five years he has lived at St. Joseph’s, said it took him a while to get used to seeing the dead bodies of fellow residents, but feels the services are an essential part of the home’s routine, especially when the deceased is someone he knew well.
Without the ritual, “I would feel a loss,” said Mr. Code, who suffers from a rare form of Lou Gehrig’s disease. “I would feel there’s a hole there, and something missing.”
Ms. Maitland’s study, based on a survey of staff, residents and family members, found residents had a more basic reason, as well, to welcome the services: It suggests they would not be forgotten themselves when they died.
“It’s nice to know that you don’t just disappear,” said one individual, “as though you have never been.”