Bereavement care is part of the job, no matter how difficult it is to talk about death and deal with grieving family members.
“Callous disregard.” These two little emotionally loaded words are how the plaintiff complaint summed up the following story from a grieving daughter named Sally.* In her deposition, Sally recounted how nice and welcoming everyone was at the nursing home when she toured it 3 years ago prior to moving her mom in. It seemed like a good place where the staff could provide the care her mom needed; care Sally was no longer able to provide for her at home as her mom’s physical and mental condition continued to worsen. Those feel-good sentiments were replaced by anger, sadness, and ultimately litigation after her mom died. When Sally was asked why she was suing, she replied that no one at the nursing home cared about her mother.
Lack of Caring or Not Knowing What to Say?
When pressed for specifics, Sally told the story of the week her mom died. Her mom was transferred from the nursing home to the hospital and died in the hospital after a 3-day admission. The day after her mom died, the nursing home called. It seemed to Sally that the main purpose of the call was to encourage her to come in and retrieve her mom’s personal belongings. She surmised that they needed her mom’s private room for someone else. So, she and her son arrived at the facility about 6 pm with a few empty boxes in tow.
She recalled how she walked the long corridor to her mother’s room passing many staff members she knew, but they diverted their eyes and busied themselves at the desk. She packed her mother’s belongings into the boxes and left.
Besides some bills that arrived in the mail over the next few weeks, that was Sally’s final encounter with the facility. This lack of closure festered for some time, and she began to wonder about all aspects of the care her mom received. She started to dwell on the bedsores her mom had developed in the last few months of her life. She had seen those television commercials and started thinking that maybe the sores were from a lack of care. Eventually she called an attorney, and a lawsuit was filed. Was it possible to avoid this? While we can never know for sure, it is quite possible that bereavement care might have made a difference.
Most health care providers receive very little education about delivering bad news, dealing with death, and handling grieving family members. Not knowing what to say often leads to simply saying nothing, which is likely the case in Sally’s situation. I am sure the staff that was on duty simply did not know how to approach Sally or what to say. Often nurses state that they do not say anything for fear of upsetting the family. The truth is that the family is already upset because that is a normal part of grieving.
While full-on grief counseling is not what is expected, a heartfelt expression of caring and support can go a long way. According to the New England Journal of Medicine, “A physician’s responsibility for the care of a patient does not end when the patient dies. There is one final responsibility—to help the bereaved family members. A letter of condolence can contribute to healing a bereaved family and can help achieve closure in the relationship between the physician and the patient’s family. Whether intentional or not, the failure to communicate with family members conveys a lack of concern about their loss.”1
Imagine how much better Sally would have felt if she received a sympathy card signed by several staff members. Or if she had received a phone call where she had the opportunity to discuss any concerns she had to find some closure. These simple acts could have made a difference and saved the facility the financial burden of litigation.
Implications for Wound Care Practitioners
According to the Agency for Healthcare Research and Quality, more than 17,000 pressure ulcer-related lawsuits are filed annually (second only to wrongful death lawsuits). The agency also estimates that about 60,000 patients die each year as a direct result of a pressure ulcer.2 Of course we treat more than pressure ulcers, so this number is likely much higher when you figure in all types of skin integrity problems. This means we have many opportunities to provide support.
Every family will have different needs, but the common thread is that they want to know you care. Patients with wounds die just like other patients. Often we have gotten to know them and their family members quite well after weekly or more frequent wound treatments that sometimes ensue for several months. Do not let the busyness of the day’s appointments keep you from pausing a moment to send a card, make a call, or offer a heartfelt word if you meet a family member in person. It just might make all the difference in the world. Death is difficult to discuss but I’d love to hear your comments on how you handle this situation so we can all take steps to improve this final act of caring.
- Bedell SE, Cadenhead K, Graboys TB. The doctor’s letter of condolence. N Engl J Med. 2001;344(15):1162-1164.
- Agency for Healthcare Research and Quality. Preventing pressure ulcers in hospitals: are we ready for this change? Agency for Healthcare Research and Quality website. https://www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/pu1.html Accessed February 1, 2020.
*Fictitious name used for privacy.