Death at work: supporting the navigation of grief for employees

At the dinner-party table, there are a few topics that go off without a hitch. From Sunday’s nights footy game to “this weather we’ve been having!”, there are areas of conversation that most of us enter into without a second thought. The same goes for the hallways at work, Monday morning conversations had over steaming cups of coffee, blearily blinking away sleep while bemoaning the slowness of the RBA’s rate cutting.

While many industries can stay within the guardrails of these ‘safe’ topics, those of us in aged care, by the nature of our work, who we interact with and the situations that are key components of the routine, limiting conversation to the trifecta of sports, weather and the latest twist in Federal monetary policy may not only be hollow but unhealthy.

Death is a reality that all must contend with in aged care, from chief executives to the newest casual hire. As leaders in the field, executives and managers have a great opportunity and impetus to facilitate the space to process death.

Julia Samuel MBE, is a leading British psychotherapist. Over her 30 plus years of professional work she has seen that there are two dominant trends; grief is inevitable and most of us don’t want to look at it. In an industry where death is an ever present reality, this leads to the end point that those in leadership, those with the opportunity to make systemic changes, have a great opportunity and responsibility to implement opportunities to discuss death, to process grief and to work through loss in the professional setting.

The overwhelming time of COVID-19 in residential aged care highlighted many stress points within the industry. One of which was the extremely harmful consequences of isolation and loneliness, for both residents and employees. With the sharp and protracted increase of death in aged care during these years, some centres experienced never before seen rates of mortality. The impact of this is still being understood but one of the areas that came out strongly in anecdotal evidence was that of the emotional and physical burnout of workers. With the seemingly relentless rates of mortality, employees maintained working while having no time to process the loss of many close relationships with residents. 

Samuel and her contemporaries highlight why the burnout of COVID-19 for employees was so severe, we as a human species cannot bear the pain of grief alone. This is the most important caveat of grieving. The unfolding feelings from death and grieving loss, cannot be shouldered alone. With residents being alone, families being isolated from loved ones, employees themselves isolated from close partnership with colleagues, it was an profoundly isolating time which compounded the ability to collectively grieve. 

Samuel states in her work that connection with others is what enables us to survive when someone we care about dies. By connecting with other humans in support, connection and solidarity, energy is derived to move in and out of the pain. This is true with the death of a loved one, as well as that of a resident an employee has formed a bond with. Samuel explains that in moving through grief, humans need to be able to turn into it (feeling the pain) and turn away from it (having a break from it and in the professional sense, to keep working) both movements must be supported in the work setting. It’s called the dual process, oscillating between loss orientation and restoration orientation. Understanding that employees will need the opportunity to keep working as normal, and be able to discuss their grief, is the balancing line managers are encouraged to investigate and support. 

It is also helpful for managers to comprehend the ease at which connection is formed. Dr Frates of Harvard’s Medical School and a team of colleagues investigated the core need and drive for human beings to connect, and how this leads to increase physical and mental health. Connection being formed between employees and residents is not only natural but has proven to benefit aged care centres as a whole, with increased resident and professional cohesion. 

For residents and employees, where the daily morning chat has been a constant for years, where conversation about family, career, laughter, even gripes about food and comfort, has flowed, connection has been shared, and constants formed. Samuel explains these constants are neurological truths that we set in place for people we care about. The mind creates maps and pathways of consistency. 

Here is an example: Let’s say there is Margaret in room 103, and you know that on Wednesday’s when it’s rice pudding day, she’ll be delighted because it’s her favourite. Jenny has worked with Margaret for 2 years and not only knows it’s her favourite but anticipates the joy on her face when she opens the door with the rice pudding on a tray. There is layers of understanding, anticipation and emotional exchange. Margaret suddenly she passes away one day. Samuel would highlight it is a distinctly human trait for Jenny to have a stab of pain when serving out rice pudding to other residents after Margaret has passed. The mind is fighting the reality that Margaret is no longer in room 103 and won’t be having rice pudding that day. Cumulatively over the weeks, months and years, this is a significant weight for an employee to bear. Herein we can start to see the benefits of having established systemic measures to provide employees with not only the ability to speak about their grief but the awareness that within their area of the centre, with their manager, there is the space to do so. A place to discuss and reminisce about how much Margaret loved rice pudding, it may be small but it’s a healthy outlet of pain. 

Psychologists who have studied grief have found it to be powerfully alienating in and of itself. Studies have shown it can draw a person inward to intensely deal with the pain alone. It is important that prior to waves of grief working in employees there has been a discussion about the opportunity to grieve with each other, to talk about it openly in a safe and set space. It is helpful for management to understand the pull of the pain inward, and to set in place measures that prevent any irrevocable alienation of employees from their colleagues and direct reports. 

There is an opportunity for managers to normalise the opportunity to discuss death, loss and grief through leading by example. Whether that’s in smaller meetings with staff members, personally written newsletters and open office hours. All these measures have been used at times to highlight an openness to be vulnerable in a process that has no set model of healing. 

Samuel speaks of her own personal struggle with processing grief, and those of her clients. She advocates that as grief is felt, as people allow themselves to feel the pain of loss, it slowly diminishes, that by feeling it, acknowledging it, the pain can become bearable. By having the opportunity to bring up grief in the work setting, the connection with a past resident can continue in a healthy way. To smile when rice pudding is on the menu and to have a moment of quiet memory, without the sting of death. This means remembering Margaret can bring a smile, and energy, to keep working, creating opportunities for more connection with employees and residents in aged care.

Samuel and other experts don’t sugarcoat the future. Grief can be lifelong but she explains that we don’t need to be afraid of that, by acknowledging pain, with the support of others in the aged care setting, with colleagues and management supporting the collective processing of grief, honouring connection lost and working through pain can help with the whole ecosystem of the centre. 

Samuel explains that when we have grieved as human beings, what we thought would we could not make through, where we have survived, particularly through collective support, our gratitude for life deepens, and our capacity to give and receive connection and care can deepen too. This is a critical insight into how supporting grief management in the aged care sector can have benefits for residents, employees and whole centres alike. 

It doesn’t take a leading medical experts to highlight that if someone we know and have interacted with dies, there will be grief accompanied by some level of pain. It is in blocking that pain that counsellors and psychologists say that we do the most harm to ourselves. As humans we are hard-wired to form attachments to the people we care about and are in proximity to. In an industry where connections are forged daily, and death is a constant, the potential for pain is consistent. Setting up strong systemic opportunities to feel pain and loss, with the support of colleagues and management is paramount for safeguarding against burnout and high turnover. 

Samuel explains that in her 30 years of grief and pain management, it is in re-charting the map of what truths we can rely on. The truth of a person being alive and being able to joke with about rice pudding, and that no longer being the case, that takes energy and help to walk through. The brain has to learn to adapt to that loss. Whether in our personal lives or at work, the human brain remains the same. We learn by going through one painful moment after another. There is no way around it, only through it. 

Studies show that while we grieve individually, energy and solace can be gained by grieving collectively. This is shown by moments of a public person’s death, like Queen Elizabeth, where a country was seen to mourn together, where the outpouring of grief was public and powerful. There can be significant healthiness and strength in working through pain and loss together. There is solidarity and the awareness that we are not alone. Studies continue to show the depth of how much strength, perseverance and healing can come from sharing common experiences of loss and carrying that pain together. Humans at the core are collective beings, we have our packs, our herd and the sharing of the good, as well as the bad is written into our DNA. This remains powerfully the case in aged care centres between teams of employees who know, care for and interact with the same residents. 

Isolation and loneliness has been proven to be harmful, as we saw potently during COVID-19. The ramifications of loneliness in life, are also carried through in processing difficult feelings alone. While an outpouring of grief in the professional setting would be unsettling for residents and other colleagues alike, it is the opportunity to help manage grief before it gets to this breaking point that managers can provide great support with. 

To establish weekly moments to remember treasured residents, to provide employees with resources to process their feelings through writing letters, creating art in visual or written form, to share a coffee and tea with other colleagues who are feeling the loss of a resident, all these measures are providing safe and professional outlets to collectively process grief. 

Silence on the topic doesn’t work, Samuel experienced this in her own upbringing, and the pain she highlights, tends to only shift and mutate, sometimes moving into anger and exhaustion. Working through grief and pain is deeply human. For management to seriously formulate policy whereby they can provide the opportunity to do so collectively, for leadership and employee alike, is to remove the taboo of grieving at work, to have safe, consistent and expected places to discuss loss. Importantly, if these measures are rolled out publicly and understood to be constant, there is a ease for employees to opt into the opportunities, and to decline if they wish.

Measures to normalise feeling and processing grief safely is powerful when it comes from those that are seen as leaders. The tone and navigation of tricky topics, whether overtly acknowledged or not, comes from those perceived to be in charge. Employees will consistently look to their leaders to gauge appropriateness of responses. Samuel highlights this, explaining we learn how to emote from our parents, by extension employees learn what is permitted by looking to leadership and systemic markers. 

Whether weekly, fortnightly or monthly, having an optional time to collectively discuss the loss of a cherished resident is a clear way to indicate that death can be discussed and processed together. Sharing experiences as management can also open up vulnerability in a safe way. Providing resources, whether having a counsellor come in a set time per week (instead of just online) is a tangible opportunity and reminder of support for employees in an industry where death and loss are constant. Studies have shown that in-person supports carry significant weight when processing difficult feelings. Having open hours as a manager, could spark an employee to sit down and just have a chat about grieving a recently passed resident. 

Human experience, supported by monumental evidence, greatly suggests that when executives and managers put into place systemic measures by which employees can process death, grief and loss in community with each other, strength can be found for an entire centre, reducing burnout, turnover and supporting quality of care.

To have the opportunity to be open about the impact and pain of death is already a big step forward. No policy will be perfect from the get-go, and not everyone need step into that space. However, having safe and consistent opportunity to discuss and process grief together as colleagues, is where this complex and uncertain topic and reality of death can be tackled just a little bit less alone. This is good for residents, this is good for employees and this is good for business.