Bereavement care should be a public health priority, rather than afterthought for health care institutions according to a recent article in The Lancet Public Health. Care of those in grief is often overlooked, for many reasons. But the ramifications of grief extend beyond one’s personal loss to society as whole.
The article addresses bereavement care as an extension of palliative or end-of-life care for terminal patients. It focuses on the fact that although many institutions do focus on family-centered care, that care abruptly stops with the death of the patient. Meanwhile, the family is left feeling abandoned, with no support resources to cope with their grief. If one is unable to recover from grief, they suffer mental and physical health issues. This hinders their ability to take care of their families and work, becoming a public health issue.
This is not a failing of physicians, nurses or other caregivers, it is systemic and structural. The care system does not support hospital staff to continue to provide care to those left behind. It is not built for this. Bereavement care is care for those who lost someone important to them. Each individual’s need are different. There are resources available but when deeply grieving, one may not be able to seek that care.
Public health models of bereavement include guidance about what different people may need, education about the grieving process, compassion and understanding. This support can be received from family, friends, workplace, religious institutions, schools and more. These resources are thought to be sufficient for 60% of those grieving. Approximately 30% require more, such as support groups and consultation with a mental health provider. About 10% of the population struggle more and need mental health providers who specialize in grief.
After a loved one dies, many feel guilt, regret, anger. They feel they should have done more or done something differently. If bereavement support begins prior to the death by including family, offering reassurances and decision-making support, it will help after the death. We need system-level care for health care institutions to have time, resources, training and tool kits for bereavement care.
More funding for bereavement research would be valuable, as scientific research is crucial for evidence-based care. Funding for educating health care workers is also necessary. Tool kits for bereavement after-care, along with access to evaluation of a griever’s needs and available resources, are needed.
A major aspect of bereavement care includes bereavement leave provided by employers. The Fair Labor Standards Act does not require payment for time not worked for funerals, however, most employers provide leave. A few states have laws regarding leave. The U.S. Bureau of Labor Statistics defines bereavement leave as time off to attend a funeral. Average grief leave given by companies ranges from 1 to 5 days, some paid and some not paid. This is hardly enough time to plan services and take care of the many obligations. When does one grieve?
Different companies have different definitions of family. Historically, it was extended only for immediate family members. In today’s society, many companies recognize bereavement policies should extend to the loss of any loved one. There is plenty of literature that supports a movement toward providing thorough, empathetic and generous bereavement leave to aid employees with coping with their grief, ultimately returning to their job and capable of functioning well.
Death and loss affects all, leaving a hole in one’s heart. Grief is complex and can be paralyzing. It is difficult to navigate alone and as family. Difficulty coping with grief while returning to work and everyday life can become a public health issue. A call for action for more research and funding addressing the many layers of bereavement care is warranted, as well as laws providing comprehensive bereavement leave policies.
Take care of yourself and someone else.
Juanita Carnes is a Westfield resident and a nurse practitioner with 38 years of experience in a hospital emergency department and urgent care facilities. She served 30 years on the Westfield Board of Health.
