NHPCO NewsLine Summer 2020 - 31

Other impacts can include
decreased respite opportunities
and decreased social support.
Sometimes families have to
balance risk of exposure to the
virus with a sense of guilt that
maybe they're not providing what
the patient needs, which can lead
to increased anxiety, fear, and
compounding anticipatory grief
- including the fear of their loved
one dying alone.

hospice programs do not have the
tools to offer it. But that does
not mean they're getting left out;
we're need to make an effort to
call and check in with those
people more frequently. And
there's an opportunity for more
community coordination, to
connect with our program
partners and other organizations
in our areas to quickly connect
the bereaved with resources.

Impact on Families
After Death

Family members are also
experiencing feelings of guilt,
anger, blame, sadness, and
depression; much of that is tied
to secondary losses. If a person
couldn't see their loved one who
died, or they were separated from
loved ones due to travel
restrictions, those situations can
compound these feelings. Not
being present for the death can
contribute to delayed or
ambiguous grief, a feeling of
unfinished or unresolved business.
As hospice providers, there's an
opportunity for us to visit with
that caregiver down the road and
fill in some of those gaps for
them. That could be a rich and
rewarding experience for them.
Even if we weren't the ones in the
room, we might be able to get the
details and paint a picture for the
grieving family.

A lot of programs are seeing that
family members are increasing
the kind of access they're seeking
from bereavement services after
a loved one's death. The natural
supports - friends, neighbors,
spiritual communities - and
formal supports are less
available. When we're reaching
out via phone, we're catching
people more and they're wanting
to talk longer and receive
additional follow-up calls. They're
also interested in online groups.
Perhaps families are getting more
tech savvy and comfortable with
virtual support because that's
more of the world we're living in.
While more people are open to
virtual supports than we might
have anticipated, and that has
been helpful, there are still
limitations that we need to
acknowledge. Being with a
grieving peer community in
person is different. Not everyone
finds virtual support meaningful,
or they lack the technology and
resources to access it, and some

The COVID-19 related restrictions
are also having a profound
impact on funerals and other
memorial rituals. The bereaved
may be unable to see their loved
one or spend time with the body,
and funerals or cremations are
limited or inaccessible. Some

families have found success with
virtual memorial services,
parades of cars driving by the
loved ones' home, or planting
memorial gardens. We're finding
that it really doesn't matter how
sophisticated or snazzy our
events and our support are. It's
the simple and intentional things
that people need. What we can
do now is help families and the
bereaved identify the unique,
highly personalized rituals that
they had with their loved one so
they can continue that on.

Impact on the
Interdisciplinary Team
Along with the impact that
COVID-19 has on the dying and
their loved ones, we need to
acknowledge the impact it has on
the hospice and palliative care
interdisciplinary teams. It's easy
to focus on keeping things status
quo and saying to ourselves,
"We're hospice and we deal with
death and dying all the time." But
this is different, and the changes
to our world have an impact on
us, too.
Staff might have a difficult time
expressing support without the
use of touch as a healing and
comforting piece of the
bereavement process. That is a
kind of secondary loss, both to
the staff member and the
bereaved, and it's important to
acknowledge and affirm that it's
a real part of their experience.
Many programs are also seeing
increased staff ambivalence. This

Newsline / Summer 2020

31
NHPCO NewsLine Summer 2020

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