Month: May 2017

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When a Worker Is Grieving: How to Handle Everything from Condolences to Time Off

By Dana Wilkie

[W]hen someone loses a loved one, it’s not only friends and neighbors who may not know what to do or say—it can also be that person’s employer and colleagues.

From whether to send a sympathy card or flowers to whether to offer bereavement leave or ask an employee when she’ll be back at work, it can be difficult for managers to know how best to support someone who’s grieving.

One common reason people grieve is because they’ve lost a close relative or friend. But people also grieve over divorces, catastrophic illnesses or accidents, and even the passing of a beloved pet.

“Death is, by far, the biggest [cause for grieving], especially if it’s untimely or unexpected,” said Andrew Shatte, a clinical psychologist and co-founder of meQuilibrium, a Boston–based company that helps people and organizations navigate change. “Sudden, cataclysmic loss shakes the very foundation of our beliefs about control and therefore shakes our resilience. There are big individual differences in how people respond to grief and what they need. For some, they need time away from the world, while others need to reimmerse themselves in it. The manager can start the discussion with the grieving employee by asking, ‘What can we do for you?’ ”

Bereavement Leave
There is no federal law requiring that companies offer bereavement leave. Oregon requires employers in the state with at least 25 workers to offer up to two weeks of bereavement leave, while Illinois requires employers with 50 or more workers to grant up to 10 workdays off for the death of a child.

While bereavement leave is not generally covered by the Family and Medical Leave Act (FMLA), the law mandates leave to address issues that arise when an employee’s covered family member (spouse, child or parent) dies on active military duty. A bill recently introduced in Congress would, under the FMLA, allow a grieving parent up to 12 weeks of unpaid leave off from work to cope with the loss of a child.

However, many companies do offer bereavement leave. The time off varies from a few days to a few weeks, said Robin E. Shea, a partner with Constangy, Brooks, Smith & Prophete LLP in
Winston-Salem, N.C.

“Most bereavement policies provide only a few days—about enough time to make arrangements, fly out of town if necessary, attend the funeral and return home,” Shea said. “But that doesn’t mean that employees cannot be given more time. If the employer offers personal leave, or if the employee has paid time off or vacation available, the employer of course should allow the employee to take it.”

In cases involving a particularly devastating loss, Shea said, her experience is that companies give the employee time off with pay, even if there’s no specific policy addressing such a situation. “If they do this” in one instance, she advised, “they would have to do the same for other employees, to avoid discrimination claims.”

How Much Time?
Are there certain types of events that should require more bereavement leave than others? For instance, if an employee loses a child, as opposed to a sister, should an employer be more lenient about time off?

“There are differences,” Shatte said. “Typically the closeness of the relationship matters. We grieve more for siblings than for cousins. Also, the level of unexpectedness, for instance, whether [the loss] involved an accident or a long, prolonged illness. And nothing is more debilitating than the death of a spouse or child.”

Shea suggests that the time off afforded a grieving worker should depend on the size of the employer, the nature of the employee’s job and the loss the employee has suffered.

“My quick answer would be [to allow] as much [time off] as the employee needs and the employer can afford to allow,” she said. “In the case of the death of a spouse or child, or in the case of a very traumatic death, like a murder, accident or suicide, I would seriously consider giving the employee as much as a month off if he or she wanted that much time.”

Returning to Work
It can be tricky for an employer to inquire when a grieving employee plans to return to work.

One way to handle this is to check in periodically with the employee to see how he or she is doing.

“Let the employee know that he or she is missed,” Shea said. Hopefully, the employee will volunteer details about her plans to return during these conversations. Another way is to tell the employee how much paid leave he or she has available and then offer to extend that with unpaid leave, if the employee chooses. In most cases, the employee will need to return to work when the paid leave runs out, Shea said.

Shatte suggests that about a week after the employee has taken bereavement leave, a manager—after consulting with HR and company attorneys—should reach out to the employee and ask what the company can do for him or her. “At that point, they can ask how much time they think they might need, with an offer to touch base periodically to see if anything has changed,” he said.

If an employee is too devastated to return to work, he or she may benefit from counseling. An employer might steer the worker to an employee assistance program or even suggest short-term disability benefits.

“I would never ask an employee to return before he or she felt ready to do so, but at some point, the employer may have to tell the employee that the job cannot be held open indefinitely,” Shatte said.

Expressions of Sympathy
Also tricky is knowing how to extend condolences to a grieving employee. Should the company send a card? Flowers? Provide meals? Should company colleagues attend a memorial service?

“These decisions need to be made by weighing the individual,” Shatte said. “How long have they been with the organization? How close is the manager to the employee? This is a sensitive time, and every outreach should be made only after consulting with HR.”

Shea said that if the memorial or funeral is in town, anyone personally acquainted with the grieving employee should try to find out if their attendance is desired. This includes the employee’s direct supervisor, she said, and possibly others further up the chain of command.

The HR department, she said, can coordinate expressions of sympathy on behalf of the company, including flowers or cards.

Complete Article HERE!

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If you don’t learn to deal with grief and loss, it can lead to depression or worse!

It is important to grieve the deal of a loved one or deal with loss the proper way says Dr Arun John. Find out why…

By Sandhya Raghavan  

[I]magine that you injured yourself and there is a fresh, bleeding wound on your hand. Instead of letting the injury heal, you go about with your life ignoring that it even exists. Before you know it, the wound starts to fester, causing more pain and discomfort than before. What could have been fixed with a little bit of care and attention is now a big gaping wound that will take more time to heal.

Like physical wounds, your emotional wounds get worse when you ignore it. That’s probably why you hear people telling you to “cry it out” if you are going through a rough phase in your life.

Why some people don’t grieve
• Sadly, some of us hate showing the world we are vulnerable. We hate being perceived as powerless or weak. So we put on a brave face and make it seem like we aren’t hurt.
• Society sometimes dictates what we can and cannot grieve about. I was shamed for grieving for my pet cat who died in an accident last year. “It’s an animal, after all,” they would scoff!
• Sudden loss of a loved one or failure of a relationship can leave us stunned for a while, delaying the grieving process.
• We may want to put things behind us and move on with life and speed up the grieving process.

According to the Kübler-Ross model, a person undergoes five stages of emotions in the grieving process: denial, anger, bargaining, depression and acceptance. Skipping any of these steps can lengthen the grieving process causing more harm than good. Dr Arun John, executive vice president of the Vandrevala Foundation, who has a wealth of experience in dealing with bereavement and grief issues, tells us what could go wrong if we don’t grieve properly.

Self-blame
“Self-blame is a telltale sign of an incomplete grieving process,” says Dr John. If someone doesn’t grieve properly, they may get stuck at the bargaining stage. “They get obsessed and waste a lot of their time and energy investigating what went wrong and how they are to be blamed for it,” adds Dr John. “Usually, people blame themselves for a week or two, but if the self-blame extends for more than one month, the person could need help.”

Acute depression
“If the grieving process is not complete, the person could slip into acute depression,” says Dr John. Depression sets in when the person does not deal with his or feelings of grief appropriately. It may not show initially, but if the problem is not dealt with at the earliest, it may spill into his personal life and work. Prolonged depression can also become a cause for other health and mental problems.

Anxiety
According to Dr John, prolonged depression can also precipitate anxiety. When the loss is sudden or unexpected and if the person doesn’t give enough time for grief, he can slip into a state of stress and anxiety. In the case of a loved one’s passing, the idea of having seen death at such close quarters makes the person think about his own mortality.

Lifestyle diseases
It’s a known fact that stress, anxiety and depression can have serious effects on your health in the long run. Repressed negative emotions like fear and sadness cause elevated levels of cortisol in the blood. “It can lead to weight gain, hypertension and other lifestyle diseases,” says Dr John. Some may take to binge eating or drinking to escape confronting negative feelings; this can also affect their health adversely.

Whether it is a death of a loved one or a loss of a relationship, only you know the depth of your grief. Instead of bottling up your negative emotions, you should deal with it at the earliest. “Talking to loved ones speeds up the grieving process. If you feel no one understands you, feel free to call up a helpline number and talk to a counsellor.

Complete Article HERE!

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Pathologist Carla Valentine Will Teach You How to Die Fearlessly

“The people who think about mortality tend to have the highest happiness rate.”

By Sarah Sloat

[A]mbitious technocrats may predict a deathless future, but as the world stands now, we’re all going to die. This leaves us humans with the same two options we’ve had since we emerged from the evolutionary mire: Fear the final shuffling of our mortal coils, or embrace the inevitability that we’ll all be one with the dirt.

Fortunately, there are people out there who can help ease your mind about the whole “one day you’ll be dead” thing. One of those people is Carla Valentine, whose job as an anatomical pathologist, technical curator at Barts Pathology Museum, and author of The Chick and the Dead, has more than prepared her to come face to face with the inevitable end. In her book, which will be released in the United States in June, she weaves together corpse science and her intimate involvement with the “death industry” with the vital lesson about dying she’s learned over the years: Everyone wants to learn more about death whether they admit it to themselves or not, and accepting that education is the best preparation for their final days.

Valentine, whose book will be released in the United States in June, recently spoke to Inverse about the CSI effect, the future of “soul midwives,” and urban legends that just won’t go to the grave.

Carla Valentine.

>Why was now the right time to write this book?
There are two reasons, really. There is definitely more of a desire at the moment for people to speak about death and learn more about it. That’s been on an upward trajectory. That just happened to coincide with when I left my career as a full-time pathology technician and I began to work at the museum, which gave me more free time to actually start to write.

What do you think has driven that increased interest in talking about death and learning about it?
When I first studied forensic science, which was 15 years ago, there were barely any courses. Those courses began to increase with what we call the “CSI effect”. That’s an actual academic term now for the interest in death and autopsies that has emerged from the increase in books and TV shows on the topic.

I think another issue is just the cost of funerals, like many things, is rising. People want to be a bit more informed and demystify the process around death so that they can plan properly and just dispel a lot of the myths before the time comes. There have always been a lot of myths around autopsies and how we conduct them. I think people just want to know the truth and it’s a good time for it.

What do you think people gain when from learning about what happens to their body after they die?
Personally, I think that when people face this idea of their mortality, the reality of it, and the reality of what may happen to their family members, for example, they tend to live a better life. They tend to understand how quickly it can be taken away. They can appreciate their own mortality and their own health. That was always what I felt and that’s been backed up by psychological studies, as well, which I reference in the book. The people who think about mortality tend to have the highest happiness rate. I think it’s because it demystifies it. People say that you’re afraid of the unknown. Sometimes it’s better to face the reality of it. Then it’s not so scary anymore.

Fracture of a mandible at the Pathology Museum.

Do you get consistently the same sort of questions from people when they learn about your job?
I get consistently the same sort of questions and I get consistently told the same myths. Those absolutely drive me insane. I took as much opportunity as I could to answer all of the questions that I always get asked in the book. A lot of these myths have been doing the rounds since I was a child. For example, I was at the hairdresser’s yesterday, and the girl in the chair next to me overheard that we were talking about my job, and she said, “It’s true, isn’t it, that the fingernails grow and the hair grows after death?” I was like, “No it’s not like that.” I’ve heard the same things for 20 years.

What else do people get wrong about death?
People also think the deceased sit upright because of their gases, which is not true at all. Some deceased people are possibly in a state of rigor mortis, where they’ve passed away in a chair and so that means for a while they’ll still be in a bent-over position. They’ll look slightly like they’re sitting up when they’re on the slab. But they don’t sit up because of the gases. There are the odd groans or burps or farts. That is true.

The most annoying urban legend is the one where someone tells me, “A friend of mine knows someone who got a rash and when she went to the doctors she found out that it can only be caught from a corpse.” Basically insinuating that the guy that she’d had sex with or whatever has had sex with a corpse. That always drives me insane because there’s nothing on a deceased individual that isn’t on a live individual. We have the flora and fauna. There is no such thing as a parasite or a fungus that you can get from the dead.

It just goes to show how fascinated people are by those subjects. I’m doing my MA on the relationship between the sexualized gaze and anatomical displays. When I blog about sex and death and people go, “Really?” I think, look, you’re all interested in sex and death, just look at this one urban legend that’s nearly outlived me. Clearly, people are far more interested in sex and death than they’d like to let on.

A broken cervical spine.

What is it about that intersection that people keep on coming back to?
They’ve had similar periods in time where they’ve been sort of considered taboos. But the simple fact is sex is what begins our lives and death is what ends it. They’re two sides of the same coin. They’ve always been connected to each other psychoanalytically because everything you do, according to Freud, you do with either the death drive, the morbido, or a life drive, which is libido.

Inside Barts Pathology Museum.

Are there any new modern trends you’ve noticed, when it comes to what people want immediately before and after they die?
There are definitely newer trends towards much more environmentally friendly funerals. A lot of people are moving away from the traditional funeral, and opting for a green burial. That means that they wouldn’t be embalmed. Embalming was never as big over in the United Kingdom as it is in the U.S. anyway, but it’s still definitely dwindling. Natural burials where people are placed into wicker, cardboard coffins, or linen and buried into an actual burial ground. There’s definitely an increase in people who want that, while we never really would hear of that request a few years ago.

And then there’s death doulas and end of life doulas. They’re just like midwives, but for death. I met one the other night and he actually called himself a “soul midwife.” Death doulas are usually brought in when the person is in hospice. It can also be as soon as a person discovers that they’re terminally ill. In the same way that a midwife is there for the mother as she’s becoming dilated and then she delivers the baby, the doula helps the person through the process of death. It’s a similar process, I suppose, just the other way around.

Complete Article HERE!

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Do-Not-Hospitalize Orders Reduce Resident Transfers, Says New Study

By Patrick Connole

[A] fresh look at how Do-Not-Hospitalize (DNH) orders affect the movement of skilled nursing care residents shows those residents with such directives experienced significantly fewer transfers to hospitals or emergency departments (EDs). Report authors said long term and post-acute care providers may see the information as evidence that considering DNH orders in end-of-life care plans could benefit residents and the nursing center in which they live.

“Residents with DNH orders had significantly fewer transfers. This suggests that residents’ end-of-life care decisions were respected and honored,” the authors said. “Efforts should be made to encourage nursing home residents to complete DNH orders to promote integration of the resident’s values and goals in guiding care provision toward the end of life.”

Results of the new study are in the May issue of The Journal of Post-Acute and Long-Term Care Medicine (JAMDA) in an article titled, “Are Hospital/ED Transfers Less Likely Among Nursing Home Residents with Do-Not-Hospitalize Orders?” JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine.

The design of the study saw researchers examine Minimum Data Set 2.0 information from more than 43,000 New York state skilled nursing care residents. Of that number, 61 percent of residents had do-not-resuscitate orders, 12 percent had feeding restrictions, and 6 percent had DNH orders.

“Residents with DNH orders had significantly fewer hospital stays (3.0 percent vs 6.8 percent) and ED visits (2.8 percent vs 3.6 percent) in their last 90 days than those without DNH orders,” the report said. “Dementia residents with DNH orders had significantly fewer hospital stays (2.7 percent vs 6.3 percent) but not ED visits (2.8 percent vs 3.5 percent) than those without DNH orders.”

After adjusting for statistical variables, researchers said the results show that for residents without DNH orders, the odds of being transferred to a hospital was significantly higher than those with DNH orders.

One of the report’s authors, Taeko Nakashima, PhD, visiting assistant professor, State University of New York (SUNY) at Albany and adjunct assistant professor at Rutgers University, stresses that preparing DNH orders requires collaborative efforts and thorough discussion among the residents, health care proxy, and the attending physician about the goals of the resident and the resident’s prognosis and treatment options.

“Ethical end-of-life care in nursing homes must respect the resident’s autonomy and advance directive,” she says.

Complete Article HERE!

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New nationwide study indicates patients are often prescribed potentially futile drugs in their final days

Nearly half of older adults in Sweden take 10 or more medications in their last months of life, according to a new study reported in The American Journal of Medicine

Older adults often receive drugs of questionable benefit during their last months of life, according to the first study conducted on the burden of end-of-life medications across an entire population. The authors advocate for clinical guidelines to support physicians when they face the decision to continue or discontinue medications near the end of life. Their findings are published in The American Journal of Medicine.

The simultaneous use of multiple medications has become commonplace among older adults. In high-income countries, it has previously been estimated that 25% to 40% of people aged 65 years or older are prescribed at least five medications. This practice is known as “polypharmacy,” and can lead to drug-drug interactions and serious adverse effects.

In the context of end-of-life care, polypharmacy also raises important ethical questions about the potential futility of treatments close to death.

“People with life-limiting illness often receive medications whose benefit is unlikely to be achieved within their remaining lifespan,” writes lead author Lucas Morin, of the Aging Research Center at Karolinska Institutet in Stockholm, Sweden. “However, previous studies have been conducted in selected samples of individuals. Future research and clinical guidelines need to be informed by findings that are generalizable beyond a specific illness or care setting.”

The authors identified over half a million adults over 65 years of age who died in Sweden between 2007 and 2013, and reconstructed their drug prescription history for each of the last 12 months of life through the Swedish Prescribed Drug Register. The characteristics of study participants at time of death were assessed through record linkage with the National Patient Register, the Social Services Register, and the Swedish Education Register. Of note, over-the-counter drugs were not taken into account in this investigation.

The study resulted in two main findings:

First, the burden of medications increases as death approaches. The proportion of older adults exposed to at least ten different prescription drugs rose from 30% to 47% over the course of the last year before death. Older adults who died from cancer had the largest increase in the number of drugs. Individuals living in institutions were found to receive a greater number of medications than those living in the community, but the number of drugs increased more slowly for those living in an institution.

Second, the researchers found that polypharmacy near the end of life is fueled not only by drugs prescribed for the purpose of symptom management (e.g. analgesics), but also by the frequent continuation of long-term preventive treatments and disease-targeted drugs. For instance, during their last month of life, a large proportion of older adults used platelet antiaggregants (45%), beta-blockers (41%), ACE inhibitors (21%), vasodilators (17%), statins (16%), calcium channel blockers (15%), or potassium-sparing agents (12%).

“The clinical benefit of drugs aiming at preventing cardiovascular diseases during the final month of life is at the very least questionable. Physicians should consider discontinuing drugs that may be effective and otherwise appropriate, but whose potential harms outweigh the benefits that patients can reasonably expect before death occurs.” However, the authors noted that “the process of de-prescribing requires timely dialogue between the patient, family, and physician, and close monitoring of symptoms. It is also essential that patients and their relatives receive clear information about their options in terms of palliative care in order to counter the feeling of abandonment that they may experience when treatments are withdrawn.”

The authors call for the development of clinical guidelines to support physicians in their effort to reduce potentially futile drug treatments near the end of life.

Complete Article HERE!

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Plan for your death; be wise like Wally was

Linda Norlander is one of six reader columnists for The News Tribune.

By Linda Norlander

We sat at the kitchen table with coffee and the forms. My father-in-law, Wally, had summoned me to help him fill out one of those “living will things.” We talked about what was important to him, now that he was in his 80s.

He was clear. “I’ve had a good life. I’ve never buried a child or a grandchild. When it’s time for me to go, I don’t want one of those young doctors trying to save me.” His main wish for health care at the end of his life was to be pain-free.

However, Wally’s gift to his family was not just the paper we filled out that day. His larger gift was the conversation he had many times with the family about his wishes.

When the time came that he was unable to speak for himself, and the doctors wanted to place a feeding tube to prolong his life, we were all on the same page. As my mother-in-law said, “Wally wouldn’t want that.”

With the support of hospice, he was able to say good-bye to his children and grandchildren and dispense a few words of wisdom. I remember that he advised our son with a chuckle, “You go to college. That’s good. But someday you need to get a job.” He died peacefully with all of us at the bedside.

When I meet people and tell them that I’ve worked in hospice and end-of-life care for many years, they often open up with their own stories. Unfortunately, too many of them do not end with, “I was able to carry out Mom’s wishes.” Instead, they are descriptions of having to make harrowing decisions for a loved one in the moment of crisis. I think about the son whose mother had a major stroke and was in a coma. He was told by the neurosurgeon that they would have to do surgery or she would die. What child wants to say, “No, let Mom die.”

They did the surgery and she died six weeks later, among the tubes and medical apparatus of an intensive care unit. To this day, he second-guesses whether he made the right decision. “Her last weeks of life were horrific.” When I’d asked him if he had ever talked with her about what she might want, he’d shrugged and said, “It never came up.”

We live in an era of incredible medical advances. We can replace kidneys, hearts, knees and hips. We have pacemakers, effective heart medications and all sorts of treatments for failing systems. What we usually don’t have are honest conversations about the treatments and what they might mean for the quality of life. To the son whose mother died in the intensive care unit, no one said, “If your mother survives she will likely be bedridden and comatose for the rest of her life.”

I am a proponent of doing four things regarding end-of-life care. First, sit down at the kitchen table with your family and have an honest conversation about what quality would mean for you if you weren’t able to speak for yourself. Second, name your health care power of attorney — the person who would speak for you — and give them your blessing that you will trust their decisions. Third, fill out an advance directive (the living will.) And fourth, do this now rather than waiting for a health care crisis.

I know, from years of working in the medical system, that in the moment when difficult decisions have to be made, very few doctors will seek out the health care directive document and say, “This is what your loved one wanted.” More likely, they will look at the family members and ask, “What do you want to do?”

In fact, when it came time to make decisions for Wally, we couldn’t find the health care directive. But the family knew what he wanted and we provided a united front regarding his wishes. Two weeks after he died, we finally found the form — in my mother-in-law’s underwear drawer. By then, though, Wally had already given us his gift.

Complete Article HERE!

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Why Your Fear Of Dying Alone Means You’re Not Really Living

By Kendra Syrdal

[E]verywhere around me even in modern day 2017, it seems like as a single person I’m confronted with the same message

“Here’s how to find the real love of your life!” Some old guy in a tuxedo exclaims at me from an eHarmony commercial.

“You’re totally like Carrie Bradshaw,” my friends say over drinks when I talk about my job and how I’ve gone out on dates with a few different guys this month. “Now you just need your Big.”

We just don’t want to be alone the countless submissions I read every day proclaim in their honest, heartsick words and in their desperate and painfully lonely headlines.

I’m afraid of a lot of things. I hate driving and am always convinced a semi-truck will run me off of the interstate and send me plummeting to my death. I love paddle boarding but have a weird anxiety about going too far out where the water is a certain level of deep because realistically – who knows what’s down there. The idea of my dog dying when I’m not home makes my eyes start watering just typing it out.

I’m afraid of a lot of things, but dying alone isn’t one of them.

One of my best friends told me a story about how her dad always used to tell her that no matter what, she had to like herself because she was the only person who ever really would ALWAYS be there. And that’s the truth. Some people would say that’s cynical and glass-half-empty, but I say it’s simply honest.

Think about it. Even if you do fall in love, madly in love, the kind of love that people write sonnets about and songs about and paint all over a building as a mural – eventually you’re going to die. And even if that person has been there day in and day out, holding your hand and kissing you despite your morning breath, the only person who you’ll have in those final moments is yourself. All you really have, is you.

So you’d better like you.

I think what we’re really not saying when we say we’re afraid of dying alone is that we’re really not afraid of the alone part, we’re afraid of only having ourselves to hold onto. We’re afraid that somehow, we won’t measure up. We won’t be enough. That somehow, we’re an incomplete puzzle without some else’s edge pieces.

When we say we’re afraid of dying alone we’re really saying we’re afraid that we’ll never be happy with just ourselves, and that we need someone else to dictate that level of completeness to our lives.

But you know what? The little secret that no one wants you to figure out – that the man in the suit hopes you never realize, and anyone writing a “Here Is How You Find The Love Of Your Life And Never Eat Alone Again” book hopes you don’t come to terms with?

A fear of dying alone is really just a fear of not living a life you love. A life you’re excited about. A life that makes you feel enough.

And they never want you to know that crushing that fear is simple. All you have to do is refuse to let it in.

So when you’re worried about eating alone, grab a book that swallows you with its characters and its story and go treat yourself to some Alfredo and wine and give it no second thoughts. If you’re scared of your life being empty, make friends with people who never cease to make you smile and challenge you in the ways you need. Fill your days with a job you love, with travels that blow your mind, and create a life that bears no need for another person other than yourself.

That way, if someone comes alone, they’re just and enhancement, not a requirement.

Your fear of dying alone isn’t sign of being an incomplete or unlovable person — it’s simply a sign that you just need to love yourself enough to stop being so afraid.

Complete Article HERE!