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Emotional Preparedness for Death

By Shannon Romano, MSW, RSW, Co-founder Motivation Medics Inc.



Staff turnover amongst health care assistants in long-term care occurs predominantly within the first few months of tenure. For this reason, staff retention strategies are best implemented prior to their first shift, during the onboarding process.


The onboarding experience is typically loaded with new information, required training, and quick introductions. However, typically no time or only small amounts of time are spent exploring the new hire’s understanding of the emotional demand of the health care assistant role. This includes examining how they might prepare for the inordinate amount of death and dying they will witness while on the job. When more time is afforded to understanding and meeting the emotional demand of the health care assistant role, the key to improved staff retention will begin to turn.


Resident death and grief are a constant occurrence in the long-term care industry, but little attention has been focused on how prepared or ill-prepared health care assistants are for this experience. Furthermore, team members will have varied responses to a resident’s death depending on their previous experience with death and dying, their cultural and spiritual beliefs, as well as how emotionally prepared they are.


Studies indicate that low emotional preparedness regarding resident death is associated with intense feelings of grief and other psychological difficulties such as anxiety, sleep problems, emotional numbness, substance use, empathy fatigue, and burnout. These natural consequences related to low emotional preparedness often translate to high rates of absenteeism, disability claims, and costly staff turnover.


In short, increasing the health care assistant’s emotional resilience can successfully minimize these adverse impacts on the individual health care assistant and the employer.


High emotional preparedness has the potential to improve not only the experience of the health care assistant but the quality of care for the resident, with the ultimate goal of increased staff retention and quality improvement.


In a 2015 study titled Preparedness for Resident Death in Long-Term Care: The Experience of Front-Line Staff, the authors differentiate between informationally prepared and emotionally prepared health care assistants. The study involved 140 health care assistants from 3 separate nursing homes in New York.


One of the main objectives of the study was to determine differential patterns for emotional versus informational preparedness for death. In this study, preparedness for death was assessed with 2 questions:


1. To what extent were you prepared for the patient’s death mentally or emotionally? 2. To what extent were you prepared for the patient’s death in terms of the information you had about his/her state/your understanding of the situation?


In the end, the study concluded that education efforts targeting both information and emotional preparedness with peer support and mentorship appeared to be particularly worthwhile and enhanced health care assistants’ capacity to provide quality end-of-life care while increasing their mental/emotional preparedness for resident death.


In long-term care, health care assistants provide 80-90% of residents’ direct care and often develop familial-type relationships with residents and their families. When residents die, staff grieve the loss on a deep and personal level which has been described as equivalent to losing a family member every month.


By preparing health care assistants in long-term care to manage the emotional demand of witnessing a high prevalence of grief, death, and dying in long-term care, you are supporting them to remain healthy in their role.


In sum, the best staff retention strategy for long-term care is understanding the psychological and emotional needs of health care assistants and meeting those needs with evidence-based interventions provided in-house, upon onboarding.





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