Honoring Loss, Respecting a Life: End-of-Life Rituals in Nursing Homes
Bern-Klug, Mercedes, Aging Today
The following is excerpted and adapted from Mercedes Bern-Klug's article, "Rituals in Nursing Homes," which appears in the Fall 2011 issue of Generations.
Rituals punctuate life. This truth remains even during the last chapter of life, and even when life is lived within a nursing home. The continuation of daily rituals can help a nursing home resident retain a sense of self. When staff and family members help to facilitate these rituals, they honor the dignity of each nursing home resident.
Life transition rituals mark the major milestones of life, such as birth, coming of age, life partnering, parenthood, retirement and death. A ritual helps to normalize the life transition and guide the people who are most affected by it.
Ritual is a way to help a person transition from the in-between phase to the new circumstance. But people don't always welcome new circumstances, especially if these are connected with reduced social status and increased social stigma, which is often the case when a person enters a nursing home after the progression of a chronic illness or the loss of a support system.
Most nursing home residents experience multiple losses. Advanced old age can be accompanied by the loss of vital roles and relationships. As most nursing home residents advance in years and have chronic illness, the experience of loss is common, and can include being a witness to the deaths of fellow residents. Despite the avalanche of losses-or perhaps because of them-the nursing home setting is ripe for rituals that restore a sense of meaning and connection. Rituals can help remind us that while it is normal to die in advanced old age, the death of one member of a community is a loss for all in that community.
Some nursing homes, through their activities or social services departments, have developed rituals related to residents' deaths. These rituals are im- portant to the culture of the nursing home. In some cases, a short, informal gathering is held at the bedside of the deceased with staff, family and residents who were close to that person in attendance. In other nursing homes, families are welcome to use the library or chapel for a service.
In an article that I co-authored with colleague Peggy Sharr, "Final Discharge Planning: Rituals Related to the Death of a Nursing Home Resident" (from Transforming Palliative Care in Nursing Homes: The Social Work Role; New York: Columbia University Press, 2010), we note how different nursing homes mark the deaths of their residents. Social worker Lynn Oliver works in a nursing home where a small, anonymously penned poem called "The Little Ship" is posted on a deceased resident's door and remains there until after the person's funeral. This same nursing home also plays a hymn over the intercom system upon a resident's death. Oliver says, "I post 'A Little Ship' with the resident's name by the time clock for staff. …