I spoke to Tina the day my father died, and she told me that she hoped to attend his funeral as well, to gain similar insights into his life. It was not to be. When I checked in with her a few days later, she told me that her supervisors had not allowed her to take the morning off. She was bitterly disappointed, and angry that, after all those years, she was blocked from that closure.
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I was also resentful, but I am not writing this column to bash the nursing home, which served my parents so well for so long, and with such compassion and good cheer. I'm writing because my conversation with her brought home how those who care for our parents in their final years must also have the opportunity to grieve, even though they deal with death on a regular basis.
Tina spent vastly more time with my father over the past several years than I did. I live in New York City, and while I visited regularly, she was on the floor with him five days a week. She had always been an advocate for our family's concerns and was always straight with us about his condition, especially during the final months of his life.
Should Tina's supervisors have allowed her to attend the funeral? The answer is not as straightforward as it might seem.
Many of the nation's 16,000 nursing homes are independently owned, and policies on staff grieving and funeral attendance vary widely, says Greg Crist, vice president of public affairs for the American Health Care Association. Some facilities will have a moment of silence and encourage staffers to speak about the deceased's life, but budgets and staffing are tight and few managers can afford to have staff take time off to attend a funeral when patients require around-the-clock coverage. “It’s tough," Crist says. "These operators really depend upon whomever’s on duty that day. There may be two nurses on the floor," and if one misses a half-day for a funeral, "you’ve cut your staff in half."
Crist says, however, that he expects such policies to evolve as his industry shifts away from an institutional model toward more individualized, “person-centered care," with a greater emphasis on the daily preferences of patients, increased staff empowerment, a more homelike atmosphere and an expectation that the same aides will work with the same patients each day. The movement is growing nationwide, he says, and as more aides, nurses and residents connect in a deeper way, "that will enhance the grieving process" for workers.
“The important thing," says Larry Minnix, president and chief executive of Leading Age, an international network of aging services organizations, "is that everyone recognizes the completion of the life cycle, and that people respect the fact that staff have a need to express their own personal grief and express their condolences to families."
Some nursing home and long-term care facilities host memorial services inside their buildings. "I know of at least one facility that invites families," Minnix says, "and invariably families will hear something about their own loved one that they didn’t know. It gives you a whole different perspective sometimes."
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Tina learned from the eulogy I read at my mother's funeral that the woman she had known as somewhat paranoid and dour, as vascular dementia took its toll on her personality, had been fun-loving and romantic, a mah jongg player and the president of her synagogue's sisterhood. Had Tina attended my father's funeral, she might have learned more about the connections he made while working in the uniform business, the experiences he had in World War II, and the riddles he told his young children as he tucked them in each night. And she might have learned that the man she knew, who could barely speak for the past few years because of Parkinson's disease, relished wordplay.
"It's natural human curiosity" for caregivers to want to know more about the people they provide care for, Crist says. Attending a funeral "can fill the gaps in an individual's life," he says, but family members who take the time to get to know aides and nurses can do that, too, by sharing photos, letters and news clippings.
"What all of this symbolizes," Minnix says, "is that residents and families become part of each other’s lives. Everyone has been close in a way for a long time even if they didn’t quite realize it."
After I spoke with Crist and Minnix, I printed a copy of the eulogy I read for my father and put it in the mail for Tina. There are things she doesn't know about Dad, and after all she's done, sharing them with her is the very least I can do.