Grieving people may have unusual dreams, be absent-minded, withdraw socially, or lack the desire to participate in activities that used to be enjoyable. While these feelings and behaviors are normal during grief, they generally change over time. In general, grief makes room for a lot of thoughts, behaviors, feelings, and beliefs that might be considered unusual at other times. Following significant loss, however, most of these components of grief are, in fact, quite normal.

One method of dealing with grief is to be more aware of the ways we express it. Even the exact words we use (to ourselves and to others) can make a difference. For example, when we think, “I regret that I was not in the room when he died,” we’re less likely to wallow in the feeling than if we think, “I feel guilty that I was not in the room when he died.”

*Ways to Cope with Grief and Begin Healing*
Grieving people have two choices. The first choice is to try to avoid their grief and the emotions associated with their loss and continue on, hoping to forget. This is a risky choice, because when grief is ignored, it continues to cause distress.
The other choice is to acknowledge grief and seek healing and growth. Coping with and adjusting to loss is slow, hard work. As difficult as it may sound, it is healing to embrace your grief and give it the full attention and expression it demands. While a “stiff upper lip” at times of significant loss may seem admirable, it doesn’t serve the human need to express grief. It is essential to let yourself feel all the emotions that arise, as painful as they may be, and to treat yourself with patience and kindness.

*Grief Support*
Although it is common for people to want to find their own way through grief and avoid seeking help, grief support can make a remarkable difference. Experiencing the death of a loved one can overwhelm our ability to cope; some things are simply bigger than we are and require more resources than we have available.
It is a sign of strength to reach out for help and resources in times of need. Most people feel strengthened, encouraged, and supported when they learn about grief, understand how it affects them, identify coping strategies, and learn new methods to help themselves through the grief experience.

Content developed through a collaboration between AssistGuide Information Services (AGIS) and the National Hospice and Palliative Care Organization. For more information or to learn more about related issues visit AGIS’s End of Life section at: http://www.agis.com/eldercare-basics/Support-Services/End-of-Life/

I have been a patient care volunteer since 2006 and was recently present at the death of a 35-year-old mother of five who had been under our care.

When I arrived for my evening shift, I went to the patient’s room and introduced myself to everyone surrounding her bedside. I let them know that I didn’t want to disturb their privacy and would be nearby, ready to help. Sadly the patient died soon after.

There was an immediate initial emotional outpouring. Her brother was first to exit the room, crying and unable to find comfort anywhere. He sank into a nearby chair, attempting to curl into a fetal position. Others then emerged quietly crying, walking with no apparent direction or course of action in mind. Many others simply hugged in silent understanding. Most striking was the 8-year-old daughter, who ran from the room, hugging a pillow. She was sobbing uncontrollably, repositioning herself from chair to chair in a nearby room.

During all of the commotion and emotion, the young husband seemed unaffected by what had transpired and how his future had just been so dramatically altered.

It wasn’t long before the family dynamics changed to that of support roles. Small groups of family and friends began to make plans. The group also consoled — lending compassion and strength to those needing it most, especially the daughter and her father, who were in apparent shock.

As for myself, I observed all of this not wanting to intrude on their grief. I was taken back when someone approached me, taking my hand and telling me how thankful they were for the support that our organization and its volunteers had given during such a difficult time.

It’s fascinating to note that despite knowing the probable outcome, how despondent the family was when the actual death occurred. Perhaps no one can really ever be totally prepared. I am only grateful that in some small way I was able to help support someone else in their time of need.

As for the father and children left behind, I know that his family will be there for him as will Hospice of the Chesapeake.

The two married after Larry had enlisted in the Army and Glea began her teaching career. When Larry had signed to stay in the Army for three more years, the couple lived in Japan where their oldest son was born.

After returning to the U.S., Glea taught Kindergarten for two years and preschool for 18 while Larry’s career focused on economics and banking. A bank officer and director, he was also a Professor of Business Economics and Public Policy at Indiana University and served for 17 years as President and CEO of the Conference of State Bank Supervisors in Washington, D.C.

With the couple’s 65 years of marriage came three more sons, five grandchildren and now four great-grandchildren.

As a founding Board Member, Larry helped with the initial planning and marketing of Westminster at Lake Ridge, a CCRC which opened in January of 1993. Eventually, the couple, attracted to the community’s financial position and professional care, decided to move in from their home in Arlington, Va.

“We thought it was a great place to retire to,” said Glea. “We’ve met so many friends and one of the nicest things about being here is you’re never at a loss of things to do.”

Since their move, Glea has helped start the community’s drama group and participates in Capital Hospice training while playing the chimes in her free time. Larry continues to engage in the community’s financial matters. He is in his 10th year as a member of the Westminster Ingleside Investment Committee. Also serving on the Westminster Ingleside Foundation Board, Larry raises money to enable his home and two related communities to provide support for residents who need financial assistance as well as other special programs.

They enjoy their spacious cottage house and the freedom they have to continue their tradition of spending summers in Vermont without the worries of making sure their home is being taken care of.

“The staff is wonderful,” said Glea. “Every time we come back, the same people are here and that makes us feel great.”

With a helpful staff, a sense of security and numerous opportunities to stay active, the Kreiders certainly have more great memories to look forward to.

A resident of Fairhaven, a Continuing Care Retirement Community in Sykesville, Maryland, Troxell had watched her husband fight a ten-year battle with prostate cancer. “For six years he was symptom free, but his PSA [prostate specific antigen] score kept getting worse. When we lived in New York, he underwent experimental treatments at Memorial Sloan-Kettering Cancer Center, but nothing worked,” Troxell explains. “Finally, we looked at each other, and we both just knew. We had been toying with the idea of moving to Fairhaven, and we decided it was time.”

After the move, Troxell’s husband continued to undergo chemotherapy treatments at Carroll Cancer Center. “Eventually, his physician told us there was nothing more that could be done, which was very difficult for him to admit to us. Although we had access to Fairhaven’s excellent nursing facility, I preferred to keep my husband in our cottage, but I needed help. Carroll Hospice was recommended and I contacted them right away,” Troxell recalls.

Troxell and her husband relied on Carroll Hospice home care for the next six months. “They provided outstanding care to my husband, and supported me every step of the way. From mastering his medication regimen to moving him around, there was a lot for me to learn. But I knew I could call them at any time, even
10 p.m. on Saturday night, and they would help us.”

Troxell was particularly impressed with the hospice nurses and aides: “They were so gentle with my husband. They treated him with respect and even humor when appropriate. I remember the day my husband died, a nurse came to our home late on a Friday night, in a horrible rainstorm, to make a legal death pronouncement, just so I wouldn’t have to call the police to do it.”

Now, Troxell extols the benefits of hospice care””and the importance of requesting it early. “I tell people not to wait until the last minute to call hospice. It’s hard, because it means facing the fact that a loved one is dying, but it really is the best thing you can do, for yourself and your loved one. The earlier you call, the more hospice can do to help you.”

Having enlisted a provider that strives to improve quality of life for those experiencing advanced illness or bereavement, the Nalleys found many valuable resources, including hospice volunteer Ray Boileau.

“For almost five months, I saw this wonderful, gentle man weekly for about two to five hours,” said Boileau. “He was always telling stories. One caveat came once when he said, “‘When my kids were young, my daughter was always asking questions. I should have been more patient with answering her.’”

Boileau continued, “There’s a saying that in every man’s life there is a novel. I took this to heart and at the suggestion of Renee Bland in the volunteer department I learned about one of the many offered programs — Lifetime Chronicles.”

“Lifetime Chronicling usually comes under the auspices of a volunteer that sits with a patient over the course of time and records conservations,” said Bland. “As patients are nearing the end of life, they may find it helpful to reflect upon their lives. Through a written journal, audio or video interview or photo album, many find the opportunity to preserve some of their experiences and look back upon cherished memories.”

Using questions from a life review form, Boileau journaled George Nalley allowing him to determine the pace and direction of the interview. After compiling all the conversations into a single journal, Boileau then presented the album to the family. He could not have prepared himself for their reaction. The pages had brought them all the answers to so many unasked questions, from the daughter in particularly. It had become a pivotal point in all their lives.

“This was the most extraordinary experience for me,” he said.

“Ray did a wonderful job,” said Rose Marie Nalley. “I appreciate what he did in writing this journal. My daughter hadn’t really understood her father before this. It just shed him in such a different light. George was a very special person.”

With Hospice of the Chesapeake, the Nalleys had found a premier organization for not only hospice and other palliative care and bereavement support, but they found a terrific vision with its Lifetime Chronicles.

Robert, a life-long baseball fan, had never actually been to a game and wanted so much to see his Washington Nationals play at the ballpark – but that was unthinkable because of his pain. That all changed once the Charitys were introduced to Capital Palliative Care Consultants by the staff at Washington Hospital Center, where Robert was being treated.

“It is critically important that all of the needs of our patients be addressed,” said Dr. Sandra Swain, medical director of the Cancer Institute at Washington Hospital Center. “We are committed to reducing the suffering and improving the quality of care of our patients.”

Robert arrived at the palliative care clinic in excruciating pain. “It was the worst day of my life,” he recalls. He thought he would never return home. He certainly didn’t expect that the physician, Dr. Hunter Groninger, would provide him with such effective and immediate relief that he “literally felt the pain leave my body,” he says. “Almost instantaneously, I felt like a new person.”

In addition to cancer, Robert’s debilitating arthritis made it hard for him to get around. Relieved of that pain, Robert has made trips to Chinatown, visited the National Zoo and went to see his niece in Sterling, Virginia.

Being active, in turn, lifted his spirits. He’s currently making plans to attend a family reunion.

When the cancer inevitably advanced, Dr. Groninger described to the Charitys a number of local hospice programs. “We didn’t hesitate for a minute,” says Silvia Charity. “We chose Capital Hospice because of the continuity of care and because we like Dr. Groninger who has continued to take care of my husband, along with a team of staff and volunteers who come to our home.”

“For someone like Mr. Charity who was diagnosed with a serious, progressive illness and was experiencing pain and other symptoms, palliative care is a major step because the immediate goal is to manage those symptoms. Once the pain is under control, they can focus on living,” says Robert’s Capital Hospice Social Worker, Carlene Costello. “When someone sees and experiences the benefits of a palliative care program, it is easier for them to accept hospice when the time comes.”

Suddenly, near his 70th birthday, the parts and pieces of machines and electronic devices became unfamiliar to him. He began to struggle with turning on the television, couldn’t operate a computer and started getting lost on trips to the nearby grocery store.

Thus began a 17 year-long tribulation that was the darkest and most painful the Brooks family had ever undergone. John, their beloved husband and father, was diagnosed with Alzheimer’s disease.

Though his mental health deteriorated rapidly, his physical condition was in prime condition for almost two decades. The prolonged pain of watching the once brilliant engineer fade from the disease was more than the family could bear at times.

“He was in perfect health, he would still eat, and was just very physically healthy,” said Irene, his wife. “My daughter and I took care of him, but he didn’t have the slightest clue as to who we were.”

It eventually got so bad that Irene could no longer take him to the bathroom or pick him up off the floor when he fell. She placed him in an assisted living facility, and when he deteriorated more, the nearby hospital.

Wracked with bedsores, ulcers and arthritis, John’s body began to shut down. The hospital staff was unable to medicate him or treat his wounds, so he became eligible for a bed at Montgomery Hospice’s Casey House , a hospice center in Montgomery County.

“He was not conscious of much that was going on around him other than the pain,” Irene said.

Not wanting to leave John alone in his final days, Irene was glad to find there was no limit on visiting hours in the hospice center. However, she realized she was able to go home and take a shower or grab a snack without worrying that he was being given adequate care-something she had not been able to do at the hospital.

“He relaxed so much; you could just see it on his face,” said Irene. “He couldn’t talk about how he felt, but were very gentle and they kept him so clean and comfortable.”

John died free of pain, and full of peace. His family members were grateful for the hospice staff’s efforts, but were also confused as to why they were not provided with more information about it.

“I just wish there was more talk about it,” Irene said. “A friend had said that I wasn’t supposed to talk about hospice, because it wasn’t publicized very much.”

The mother of three, who was born in the U.K., said her characteristically English, stoic nature helped her through the tough times, but life would have been much simpler with the help of Montgomery Hospice.

“When I was at home, it was practically impossible to get anything done. If I left his side, I would be very nervous,” said Irene. “Sometimes I would sit and wonder how I was going to get through this. I just wish I would have known earlier about hospice.”

When it came to his retirement, he used the same research and quality control skills to ensure that he received the finest of care at home.

John was 71 when he was diagnosed with chronic obstructed pulmonary disease, which left him with about 10 percent of his normal lung volume. He used an oxygen machine, was unable to stand or walk without assistance and needed medical care that was outside the expertise of his family.

After getting out of the intensive care unit of a local hospital, John couldn’t do much of anything.

“I just laid in bed, watched TV and slept,” he recalled. “I had lost weight, too.”

His illness left him completely weakened, but his daughter-in-law, Rosemary, worked with him every day to build up his strength. She walked him up and down the steps, helped him out of bed and made sure he was gaining back the weight he had lost in the hospital.

“She was my angel,” said John of his daughter-in-law. “Without her, I wouldn’t be where I am today, but I realized she couldn’t do everything.”

Knowing that his family couldn’t perform complex medical procedures alone, John sought help from Odyssey Health Care, which provides hospice services in the comfort of the home. He heard about the company from his hospital social worker, made the call and let them take care of the rest.

“Cindy, my nurse, would come once or twice a week and check out my blood pressure, listen to my lungs, administer pills and order more medicine,” said John. “My family didn’t have the skills to perform certain medical procedures at home, so Odyssey supplemented their care in a knowledgeable and compassionate way.”

Though most days at home go by without incident, John still needs his health monitored constantly. Just recently, his blood pressure became dangerously high, making his pulse very stressed and rapid. John immediately called Cindy, who called the doctor and ultimately drove him to the hospital. The nurse stayed with him until he was settled in and made sure he was comfortable.

“My favorite part of this care is just knowing that you have somebody who is concerned about you all the time,” John said. “If you need them, all you have to do is pick up the phone and they’ll be right here.”

Marsha’s husband, Jere, was in the hospital undergoing treatment for a variety of respiratory problems when the doctor recommended that he be put on a respirator. At the time, the doctor indicated that he may never come off the respirator again. Jere and his family decided against going forward with the treatment, and, at the recommendation of the hospital, began looking into hospice care. “Jere wanted to come home. He wanted to be with his family,” says Marsha.

The Gaegers contacted Season’s Hospice, to get in-home, end-of-life care for Jere. “They knew what he would need to live at home comfortably and made sure that he had everything,” Marsha said. After helping Jere and his family settle into a routine, Season’s Hospice caregivers provided constant care for the next eight months. Their priority was always making sure that Jere remained comfortable.

Marsha notes that the “kindness, thoughtfulness, and caring” of the staff members was unparalleled. “I felt like there were angels at our door every time they rang the bell,” she says. She believes that the ability to live at home surrounded by family and friends allowed Jere to exceed the doctor’s prognosis by two months-giving the family more time to make memories.

One of the most poignant times was this past holiday season. Marsha remembers, “Jere read The Night Before Christmas to our grandchildren every Christmas. He would do a Santa Claus impression while he was reading. It was really sweet.” She continues, “He got to do that for the last time this year, and then he asked one of our sons to take over for him. That was really special.”

The help of experts, who knew exactly how to provide care and comfort, gave Marsha and her children much needed peace of mind during a difficult time. “The children really took to the Season’s staff. They knew that we were fine as long as they were around, and that if I needed anything, all I had to do was pick up the phone,” she says. For the Gaegers, hospice care relieved the burden of caregiving and gave them more of the most precious of gifts: time together.

In 1969, Mr. Montiel and his wife and eight children moved to the D.C. area. Several members of the large family have remained in the area, including Mr. Montiel himself, who still lives in McLean. After retiring, he remained active and independent for many years. Just a year ago, his children began noticing that their father was suffering from increasing memory loss.

One of his daughters, Maria Koropecky, recalls, “When my father developed severe memory problems, it became dangerous for him to live alone.” The family knew they needed help. They began looking for a safe environment for Mr. Montiel to live while they made important care decisions.

When Mr. Montiel’s family learned that the nearby Sunrise of McLean offered short-term, respite stays, they decided that their father would move there temporarily. Their plan changed quickly. “Initially, we intended for my father to live at the Sunrise for a few months while we made other arrangements, but it became obvious that he was getting the care he needed there,” says Maria.

One of the primary reasons for their decision was the highly-qualified staff members who worked in the Reminiscence Program, the Sunrise program dedicated entirely to the care of patients with Alzheimer’s and other memory disorders. Then-coordinator of Reminiscence Services, Kate Caldwell, was instrumental in helping Mr. Montiel settle into his new community.

When Kate made a career change and founded ElderTree, LLC, a geriatric care management firm specializing in Alzheimer’s and memory impairment, Maria knew that she wanted her to remain a part of her father’s caregiving team. ElderTree offers consultations, placement, assessments, written care plans, and long-term care management for seniors and their families. For the Montiel family, Kate’s expert advice continues to be integral to caregiving decisions.

Maria explains, “I visit my father often and I know him well, but I will never know someone with dementia as well as Kate does.” She continues, “Kate helps me put everything into perspective. She helps me see what to focus on in terms of my father’s needs.” Tapping in to her years of experience in elder care, Kate is able to offer recommendations, advice, and support to Maria and her family.

Caregiving for a relative with memory loss can be stressful, confusing, and difficult. Maria states simply, “You can’t begin to even imagine what this is like until you experience it.” However, assembling a team of qualified professionals to help can make all the difference. “Kate has been working in the eldercare field for so long, so I know she understands, and I know that I want to tap into all that expertise,” Maria concludes.