“I can’t help thinking about him”

“No one can ever take her place”

You might expect to hear those sentiments about the loss of a family member, but in a recent study from The Jewish Home Research Institute on Aging, those feelings of deep grief were expressed by 30% of Home Health Aides and Certified Nursing Assistants about clients they’d cared for who passed away.

In Direct Care Workers’ Experiences with Patient Death: Training and Support Needs, Kathrin Boerner, PhD, Jewish Home/Icahn School of Medicine at Mount Sinai, asked professional caregivers—80  Home Health Aides (HHAs) and 140 Certified Nurse Assistants (CNAs)– about their grief in response to the death of a patient they had cared for and compared their responses to the reaction of bereaved family caregivers from a large population-based study of family caregivers, The Resources for Enhancing Alzheimer’s Caregiver Health.(1)

In response to the results, Jewish Home is now developing targeted staff training and exploring appropriate memorial rituals.

CaregiverchartCaregiverchartCaregiverchartTCaregivercharthis chart shows symptoms of grief expressed by professional caregivers and family caregivers, demonstrating that CNA’s and HHA’s experiences reflected many core grief symptoms typically reported by family caregivers.The professional caregivers not only reported a surprising depth of grief, many also shared that despite their profession, they felt emotionally unprepared (30% of CNAs; 40% of HHAs) for their patients’ deaths.

There is also a practical reason to pay attention to caregiver grief. The mourning they experience for a client can impact others’ care, in the form of sick days and potential job burnout.

One CNA shared, “I was all day in bed thinking about him. I was so down, I couldn’t go to work. I just called and said I don’t feel well.”

Caring for the Caregivers
As a result of this research, Jewish Home is exploring the implementation of death preparedness and grieving support to augment staff training – more than 50% of the CNAs and HHAs responding reported that they were not provided adequate training to help deal with client death. Some felt the study itself was a good first step.

Said one caregiver, “this study is a good thing. Like now it makes me feel like I’m kind getting real closure with the client”

With close to 40% of the CNAs and HHAs expressing a desire for memorial opportunities, Jewish Home is working to devise appropriate rituals.

Caring about those one cares for is desirable trait in CNAs and HHAs, but, this study suggests, professional caregivers need training to help them prepare for the death of a client. Along with the 1199 Union Labor Management Project, Jewish Home is working to develop targeted staff training. Acknowledging the depth of caregiver grief and developing outlets to help workers cope will provide staff with the support they desire and mitigate the impact on management from grief-related absence.

Direct Care Workers’ Experiences with Patient Death: Training and Support Needs was supported by a grant from the National Institute on Aging and several private donors.

1.) Wisniewski SR, Belle SH, Coon DW, Marcus SM, Ory MG, Burgio LD et al: The Resources for Enhancing Alzheimer’s Caregiver Health (REACH): Project design and baseline characteristics. Psychology and Aging 2003; 18: 375–384.