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How to Help a Loved One Through Sudden Loss

Here’s how to offer support to someone grieving after an unexpected death.

 

By Julie Halpert

Over the past several years, the husbands of three of my friends died suddenly at the age of 50. These experiences helped educate me on how to be supportive in the face of an unexpected loss. I couldn’t imagine that I would ever be on the receiving end of such support. But that happened when I lost my son, Garrett, to suicide in September 2017.

Since Garrett’s passing, I have been amazed at the generosity of my community. One friend paid to have my home’s gutters cleaned and windows washed. Our family’s veterinarian refused to let us pay for her pet care services for a year. Another friend gave us keys to her lake house to use when we needed to get away. Each spring, we find a hanging plant on our porch from parents of a friend of Garrett’s. As brutally hard as it’s been to walk this new path without my son, these actions have provided a glimmer of positivity amid my despair.

While people have stepped up to help after our loss, such generosity is not always a given in the wake of a sudden death — an outcome that many families are experiencing with the coronavirus pandemic, which has killed more than 800,000 people in the United States alone.

“Many bereaved people experience another secondary loss when friends and family run away after a loss due to their own discomfort,” said Sherry Cormier, a psychologist and certified bereavement trauma specialist. Being present with a friend’s grief in this situation can stir up anxiety about death, she said. “They think, ‘That could happen to me.’”

Unlike a death that occurs in an older person after a long illness, with a sudden loss, “your world is turned completely and totally upside down; you’re in complete chaos,” said Camille Wortman, a professor of social and health psychology at Stony Brook University and author of “Treating Traumatic Bereavement: A Practitioner’s Guide.”

Outside of the loss itself, one of the most painful experiences for grievers is that their friends and family may not be willing to help them through their grief, Dr. Cormier said. Rather than turning away, you can offer connection. Here are some ways to help a person who has recently experienced a loss.

Take on tasks.

With a sudden loss, the bereaved find themselves immediately inundated with new and mounting responsibilities. Helping ease that burden can be invaluable. Dr. Cormier suggested leading with language like: “I’d love to help. Does anything occur to you that may be useful?” If they don’t provide suggestions, you can be specific: Ask if you can bring dinner, mow the lawn or pick up groceries. You can also provide a welcome distraction, offering to go for a walk with the bereaved or take them out to dinner.

Jerri Vance, who lives in Princeton, W.Va., lost her husband, James, a 52-year-old police officer, to Covid-19 on New Year’s Day of 2021. “He went into the hospital on Dec. 7th and I never saw him again,” she said.

Immediately following her husband’s death, people in her community threw a fund-raiser for medical bills and funeral costs that raised $29,000. Friends and neighbors provided meals for a month and a half. Other friends helped her take down Christmas decorations. The principal of the school where she teaches third grade even showed up to clean her kitchen.

Ms. Vance said she appreciated all the prayers after her husband’s death, but she was most buoyed by those who offered to lighten her load.

Continue reaching out.

A study released in August by the American Psychological Association found that the loss of a loved one in a traumatic event can cause complicated reactions for those left behind, including prolonged grief. Other studies have found that people who have endured a traumatic loss are more likely to experience severe, intense and persistent psychological reactions, such as post-traumatic stress disorder, compared with those who have had an expected loss, according to Kristin Alve Glad, a clinical psychologist and the lead author of the A.P.A. study. In these situations, Dr. Wortman said, the bereaved can struggle for many years or decades.

“Time does not heal all wounds,” Ms. Vance said. “There are times when I feel forgotten. Everybody goes back to their normal lives, and, for us, there’s never going to be a normal life again.”

Dr. Wortman suggested checking in periodically and reaching out during times when those who are grieving may be particularly vulnerable, like a wedding anniversary or major holidays. She has compiled a list of helpful websites and articles that focus on offering support in these situations.

Consider adding simple “thinking of you” messages to your to-do list. Lisa Zaleski, who lives in White Lake, Mich., confronted the unimaginable, first losing her daughter, Sydney, in June 2017 at the age of 23 in a car accident, then her son Robert in December 2019 to suicide when he was 31 years old. After her daughter died, a friend she wasn’t especially close with sent her a text of acknowledgment every day for a year. “It felt like a tremendous amount of support,” she said.

Connect the bereaved with community support.

Nneka Njideka, a licensed clinical social worker in Brooklyn, N.Y., who specializes in grief, explained that those with more resources have “grief privilege.” They may be able to take an extended leave of absence from work and afford a team of professionals to cope with the loss, for example. But she said that isn’t the case for those who are low on resources — and people of color in particular — who, in addition to losing their loved one, may be faced with “living losses,” like unemployment or food insecurity.

Calandrian Simpson Kemp, who is Black and lives in Houston, was working the night shift at a homeless shelter for women in 2013 when she got the call that her only son, George Kemp Jr., had been shot dead at 20 years old. “Everything you envisioned for them has been stolen from you,” she said. It was too much to bear for her husband. When she broke the news to him, “he dropped his keys and never went back to work,” she said. The family, which includes her daughter and stepdaughter, became uninsured as a result. She couldn’t afford mental health care and at one point needed to use a food pantry.

“I felt that bullet was still killing my husband and I, because we lost everything that we had,” she said.

Ms. Njideka said in these types of situations, it’s important to help the bereaved network with the community and build a circle of supportive resources, perhaps to raise funds for bills and therapy. Ms. Simpson Kemp started a program, The Village of Mothers, to assist mothers who lost their children in finding the services they need.

Listen more than you talk.

It’s helpful to just sit with those who are grieving and let them cry, Dr. Cormier said. Allow them to tell you the story of their loss and don’t try to problem solve or give advice. After Ms. Simpson Kemp’s son was killed, a woman from her church offered to drive her to the cemetery and simply sat with her there.

“She would just wait in the back and allow me to be still and silent in that space with George,” Ms. Simpson Kemp said. She “showed me it was OK to slow down and put the pieces together to help make sense of what had just happened.”

Choose your words carefully.

Try to be mindful to avoid minimizing the loss or encouraging a quick recovery, said Roxane Cohen Silver, a professor of psychological science, public health and medicine at the University of California, Irvine. She has developed a list of “don’ts” in the event of a loss, based on her research with hundreds of bereaved people. Never suggest that you know how grievers feel, even if you’ve experienced a similar type of loss; you can’t possibly comprehend the depth of their grief, she said.

Other phrases to avoid, according to Dr. Wortman: “You’re so strong,” “You have so much to be thankful for” and “Everything will be OK,” along with religious platitudes like, “It’s part of God’s plan” or “He’s in a better place.”

Ms. Vance said it’s best not to make empty promises. Some of her friends promised her children pedicures and an outing to get ice cream, yet no one followed through. Her kids were hurt. “When you promise something, you’ve got to follow up with it,” she said.

In the case of a death by suicide, it may be even harder to know what to say or how to help, since stigma can be an issue. Doreen Marshall, a psychologist with the American Foundation for Suicide Prevention, said loss survivors often feel an incredible amount of guilt and may assume responsibility for what happened. Dr. Marshall, who lost her fiancé to suicide, said that means friends and loved ones may be even more reluctant to offer support.

As with any other type of sudden loss, focus on providing the type of support that the griever needs, Dr. Marshall said. Avoid asking about the circumstances of the death, she said, but say the loved one’s name, ask about the person’s life and share happy memories that you have.

“We miss our kids like crazy,” said Marny Lombard, when we spoke about her son, Sam, who died by suicide in 2013 at 22 years old. If Sam comes up in conversation, it doesn’t make her more upset. “When you say the name of my child, you bring me momentary joy,” she said.

Complete Article ↪HERE↩!

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A Guide To Your Financial & Legal Responsibilities After Loss

Loss of a loved one is a difficult time to navigate. Learn how to obtain a death certificate, when to begin reporting the death and more.

Key takeaways:

  • Grief is a natural part of losing a loved one. Having an after-death checklist can take a tremendous burden off your shoulders when it comes time to execute final wishes.
  • Besides making funeral arrangements, you will have to determine if there was a will, report the death to various entities and close financial accounts.
  • You will need certified copies of death certificates to claim the deceased person’s assets, including life insurance policies and brokerage accounts.

Everyone experiences loss at one point or another in life. It’s natural. However, many people underestimate the amount of paperwork involved to settle their loved one’s affairs. From making funeral arrangements to obtaining death certificates, the process can be stressful if you don’t know where to start.

Having a plan in place can help you better navigate this difficult time. You should also reach out to family members and consider obtaining the help of lawyers and certified public accountants (CPAs) to ensure you don’t have to handle everything on your own.

We’ve put together a checklist to help you prioritize your tasks and delegate where needed.

After-Death Checklist: A Guide To Managing Your Loved Ones Death

It can be overwhelming trying to figure out what to do when a loved one dies. Having an after-death checklist can lessen the burden.

Here are some key steps to consider when a loved one dies:

  • Acquire a pronouncement of death
  • Alert friends and family
  • Implement burial plans (based on will or last wishes)
  • Report death to Social Security and other government agencies
  • Obtain certified copies of death certificate
  • Identify all assets and liabilities
  • File insurance claims
  • Determine if there was a will
  • Close bank and brokerage accounts
  • Send copies of death certificate to major credit agencies
  • Terminate memberships and subscriptions that are not in use
  • Terminate health insurance policies
  • Settle a loved one’s outstanding financial debts
  • Notify election office of death

Remember that timing may vary depending on your circumstances. If this was an unexpected death, it may take longer to access all the required information to begin the final arrangements. This is another reason why planning early is important.

Immediately Following The Death Of A Loved One

The first task on your list will be to obtain a legal pronouncement of death. If your loved one died in a hospital, a staff member will provide you with a pronouncement of death form.

The process is different for deaths that occur in the home. You will need to call a medical professional to pronounce them deceased.

Next, you want to alert friends and family of the death. Send out text messages or share on social media to spread the word. Remember to take a careful approach during this step. Use your judgment to determine the best way of informing those who need to know.

What To Do Within The First Week Of Losing A Loved One

The first week can be a whirlwind of emotions and roadblocks without a proper plan in place. Here are some steps you can take to better manage your priorities.

Make funeral arrangements
Your loved one may have recommended what they wish for their last requests. This may include burial and estate planning. Contact their funeral home, make the burial arrangements and determine if there was a prepaid burial plan in place.

If your loved one did not share their last wishes, it might be best to reach out to close family or friends for assistance. Research funeral prices and outline the expected costs. Then, determine how you will pay for the funeral. The Department of Veterans Affairs offers burial benefits for qualified individuals.

Report death to Social Security and other government agencies
The funeral home usually reports a person’s death. If you need to report it yourself, you’ll need to call the Social Security office at 1-800-772-1213 (TTY 1-800-325-0778).

Obtain certified copies of death certificate
You can contact the Vital Records office of the state where your loved one died to obtain copies of the death certificate. You’ll need the certified death certificate to file insurance claims and access bank accounts. You can request at least 5-10 copies of the death certificate. It all depends on the number of assets that your loved one held.

Identify all assets and liabilities
You typically need certified copies of the death certificate to claim assets that may be in your loved one’s name. Here are a few types of assets that you may need to inquire about:

  • Deeds and titles
  • Insurance policies
  • Safety deposit boxes
  • Brokerage accounts
  • Employer benefits
  • Retirement assets

You probably won’t be responsible for any outstanding debt that your loved one left behind. If you co-signed on any type of asset or debt that has gone unpaid, you may be responsible. Many in the family mistake debt as “inherited” when this is not always the case. Money from the estate is used to pay the debt. State laws on inheriting debt may vary, but liabilities commonly go unpaid if there isn’t enough from the estate to pay the debt.

File insurance claims
Reach out to your loved one’s life insurance provider to submit a claim. Here’s the standard process:

  • Contact the insurance company and inform them about the death.
  • The insurance provider will send a packet of forms and instructions to follow.
  • Submit the death certificate and completed forms.
  • The insurer usually pays claims within 30 to 60 days of receiving all requested information.

Determine if there was a will
A will can help you determine how assets should be allocated. It can also help you manage any other requests that your loved one may have had. This includes identifying the executor of your loved one’s estate. The executor is the person appointed to carry out the instructions of the will.

Here are some items to consider:

  • An executor files the will with the probate court. You can consult with an estate attorney for guidance. An executor typically has a limited number of dates to submit this. Check with your probate court for more information.
  • Wills become public record once they have been processed through the County Clerk’s office.
  • The executor must notify the appropriate authorities about the death.

If your loved one died without a will, your state law will determine how assets are managed.

Within The First Month Of Losing A Loved One

There are steps of action that should be taken within the first month following the loss of a loved one. These can vary, depending on how much was prepared initially and where the loved one passed. However, this is a great baseline to follow if you’re unsure.

Close bank and brokerage accounts.
Identify all financial accounts in your loved one’s name. Notify the institutions about the death and provide a certified copy of the death certificate. They will release the funds to the beneficiaries on the account.

Send copies of the death certificate to major credit agencies.
The three major credit-reporting agencies in the U.S. are Equifax, Experian and TransUnion. Report your loved one’s death to the credit agencies to prevent any fraudulent activity. You can find their contact information by visiting the Federal Trade Commission’s consumer information.

Terminate memberships and subscriptions that are not in use.
Check mail, email and bank statements to identify gym memberships or digital subscriptions that need to be canceled. Have account or member ID numbers handy to expedite the process.

Terminate health insurance policies.
If you haven’t already, now is the time to file a claim with your health insurance to ensure the policy has been closed upon the death of a loved one. Contacting the insurance agency should be the best way to get in contact with the claims department and start this process.

Settling a loved one’s outstanding financial debts.
Repaying debts falls on the deceased person’s estate. This is not the responsibility of a particular family member. However, the executor or power of attorney is responsible for paying these debts using money from the estate. This is done by selling assets or using any other funds provided by the estate.

Notify the election office of death.
Notifying the election office of a death does not fall on you directly, as a family member of the deceased. Once you’ve filed for a death certificate, this record is then used to remove deceased participants from the voter registration list.

Who Gets The $255 Social Security Death Benefit?

The Social Security Administration (SSA) provides a lump-sum payout of $255 to qualified individuals following the death of a loved one. In order to receive this benefit, you must first apply by calling the Social Security office at 800-772-1213. The following individuals may qualify if they meet criteria outlined by the SSA:

  • Surviving spouse
  • A widow
  • A surviving divorced spouse
  • An eligible child

What Happens To A Person’s Estate After They Die?

If your loved one has an estate plan, it can save you or a loved one from financial loss or litigation on settling an estate. The estate plan helps families determine what happens after a loved one dies. It typically includes the following items:

  • Will
  • Executor
  • Healthcare directives
  • Beneficiary designations

If there is no estate plan, you’ll need to consult state law for details on who receives assets. Generally, it passes to parents, spouse, children or other relatives.

The Bottom Line

Saying goodbye to a loved one is difficult enough without the stress of sorting through paperwork. The best course of action is to identify the most important steps in the process and move forward from there. Take time to review wills, estate plans and life insurance policies. Don’t forget to seek out help and use the resources available to you. Consult family members and experts to avoid managing the process on your own.

References

Centers for Disease Control and Prevention. (2021). Where to Write for Vital Records.

Federal Trade Commission consumer information. (2021). Free credit reports.

National Conference of State Legislatures. (2021). Voter registration list maintenance

Social Security Administration. (2021). If you are the survivor.

USA.gov. (2021). Find my state or local election office website.

Complete Article ↪HERE↩!

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End-of-life conversations can be hard, but your loved ones will thank you

You can start these conversations simply, like saying, “I need to think about the future. Can you help me?”

By

Death – along with taxes – is one of life’s few certainties. Despite this inevitability, most people dread thinking and talking about when, how or under what conditions they might die.

They don’t want to broach the topic with family, either, for fear of upsetting them. Ironically, though, talking about death “early and often” can be the greatest gift to bestow on loved ones.

As a sociologist who has studied end-of-life issues for more than two decades, I’ve learned that people know they should talk about death honestly and openly, but surprisingly few do. In fact, one recent study showed that while 90% of adults say that talking to their loved ones about their end-of-life wishes is important, only 27% have actually had these conversations.

It’s frightening to think about our own suffering, or our loved ones’ distress. But everyone should talk about and prepare for death precisely because we want to minimize our own suffering at the end of life, and soften the anguish of loved ones left behind.

No time to plan

These conversations are more urgent now than ever, as the COVID-19 pandemic has changed how Americans die.

For the past several decades, most adults have died from chronic illnesses like heart disease, cancer and lung disease. The time between diagnosis and death for people with these conditions can be months or even years. That gives patients and their families ample time to share their feelings, resolve unfinished business, and make practical preparations for death – including estate planning, advance care planning and even planning a celebration of life that bears the dying patient’s creative imprint.

But when the pandemic struck in 2020, COVD deaths began to occur quickly and unexpectedly, with many patients dying just days after they felt their first symptoms. Their families were robbed of final moments together and often had no documents in place to guide the patient’s health care or the distribution of their possessions. This suddenness, isolation and lack of preparedness all are hallmarks of a “bad death” for both the patient and their family.

What to cover

Advance care planning, which typically involves a living will and a health care proxy, allows people to articulate which medical treatments they want or don’t want at the end of life.

A living will formally articulates preferences for care, such as whether to use comfort measures like hospice and palliative care, or more invasive measures like feeding tubes and ventilators. Documenting these preferences when the patient is still able to make those decisions helps to ensure they die on their own terms – a cornerstone of the “good death.”

Appointing a health care proxy when still relatively young and healthy gives people an opportunity to decide who will be tasked with their end-of-life decision-making. It also clarifies loved ones’ responsibilities and can fend off arguments that could arise around the deathbed. Having these discussions early also prevents panicked choices when someone’s health takes a dramatic turn for the worse.

A woman and her older mother sit on a porch, drinking coffee.
End-of-life conversations can ease suffering for families, not just patients.

End-of-life discussions also help you to construct your own legacy. In “Death and Identity,” a classic book in death studies, sociologist Robert Fulton observed that “preserving rather than losing … personal identity” is a critical aspect of the dying process. Being treated like a “whole person” is a core component of a good death, and honest discussions are a key to maintaining your unique identity, even at the end of life.

Conversations also help us share how we’d like to be celebrated after we’re gone. This might be as simple as dictating the music, food, and photo or video displays for a memorial service; where to spread ashes; or charities for mourners to support. Some people take more ambitious steps at leaving behind a legacy, such as penning an autobiography or leaving behind videos for relatives. Creating a “post-self” that lingers years after the body has died can be a cherished gift to families.

Getting started

Broaching these conversations can be awkward or unnerving, but it doesn’t have to be. Death is a natural and inevitable part of life and should be approached as such. I have argued that the end of life is a stage, just as childhood, adolescence and old age are.

Each stage teaches lessons for the others that lie ahead.

Children learn skills in school that they’ll need to enter the workforce. Teens learn how to navigate romantic relationships as preparation for the future. Adults of all ages can learn about hospice and end-of-life medical care, make preparations for passing on their inheritance and discuss how they’d like to be honored in death. These steps can help attain an end of life marked by peace and self-directedness, rather than strife and the loss of autonomy.

An older Black woman writes as she sits at a dining room table in front of a china cabinet.
Recording memories and ideas for a memorial service can help you craft your own legacy.

Ample resources are available to guide these conversations. Organizations like The Conversation Project – not related to The Conversation – have created guides for productive end-of-life discussions. Advance care planning documents ranging from living wills to the “Five Wishes” program, which helps clarify people’s values about how they’d like to spend their final days, can be a good starting point.

A simple introduction like “I need to think about the future. Will you help me?” is a good icebreaker. And the first conversation eases the path to future chats, because changes in physical health, family relations and mental sharpness may necessitate revisions in end-of-life plans.

By discussing these issues during calm times, such as after a holiday get-together or birthday dinner, we can feel prepared and empowered as we and our families approach the inevitable.

Complete Article ↪HERE↩!

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9 Myths About the Stages of Grief

By Elizabeth Beasley

Ever since Dr. Elisabeth Kübler-Ross’s book “On Death and Dying” hit the shelves in 1969, it’s been a key source of information about the grief process. Dr. Kübler-Ross outlines five stages of grief that many people go through: denial and isolation, anger, bargaining, depression, and acceptance. But her theory was geared towards people who were in an end-of-life situation and facing imminent death. Also, she never intended the stages to be a linear timeline. Though her model is helpful for understanding grief, it has created myths about the stages of grief that don’t ring true for everyone.

Myth 1: There’s a clear timeline for grieving. 

“On Death and Dying” lists five stages of grieving, but there’s no real timeline for the process. Grief is a very personal experience and most people go through it in whatever way helps them the most. You may stay in one phase longer than others, bounce back and forth between phases, skip a phase, or have phases that are uniquely your own.

The grief experience is complex and, while the five phases are a guideline, it is perfectly normal to grieve in a completely different pattern. That’s why many researchers and clinicians quit using the term “stages” when talking about grief.

Myth 2: Mourning and grief are the same thing.

This might surprise you, but they’re actually different. The definition of grief refers to the emotional state you experience when you’ve lost someone or something. Those emotions include a wide range of feelings from numbness to pain. Mourning is defined as the way you express your grief and the actions you take as you go through the grieving process. A good example of mourning is wearing black, bringing flowers to a gravesite, or following specific traditions of bereavement. Most people experience both grieving and mourning.

Myth 3: The grief process is the same for everyone.

When it comes to grieving, and even mourning, there are a lot of societal and cultural expectations about how to do it correctly. But every person is as unique as their grief process and will think, feel and act differently. Know that there is no correct way to cope with a loss. If you can find a way to grieve while feeling supported, rested, healthy, and authentic, then you are doing a great job. It won’t always be easy, but it’ll be the way you need it to be.

Myth 4: Ignoring your grief helps it go away faster.

When you’re experiencing a loss, it can be tempting to stay busy and distracted. This can lead to a pattern of avoidance that keeps you from feeling your emotions and healing. Grief is emotional trauma and, like physical trauma, it’s important to acknowledge the pain and treat it.

In some cases, ignoring grief may lead people to numb their pain with substance abuse, which can cause more pain. Of course, there will be times you’ll want to take your mind off your experience. Try to find support that lets you balance some breaks with fully experiencing your grief.

Myth 5: Crying is necessary for grieving.

We grow up learning that crying is a normal response to sadness, but it’s not the only way to show you’re sad. People who don’t cry over a loss can be experiencing just as much grief as those who do. Keep in mind that feeling numb or being in a state of shock is also a common grief response. This may prevent people from expressing their emotions with tears. Crying can help you process the pain of grief, but you can still work through it without shedding a tear.

Myth 6: The first year is the toughest.

This myth is common, because it is somewhat true. The most intense emotions related to the grief process often happen in the first year. However, every year and anniversary after that may still be difficult. Remember, there is no timeline for grieving. If you are grieving or know someone who is, be open to unexpected emotions at unexpected times and don’t expect the grief process to suddenly be over. Also, remember that support groups are always available and you can get counseling services at any time, even years after your loss.

Myth 7: Grief will eventually go away.

Time does not heal all wounds, especially the wounds of grief and loss. The intensity of your grief may decrease with time, but you may never forget it or feel truly healed. Grief ebbs and flows and can continue for a lifetime. When you prepare for it to last, you may be more at ease expressing your feelings in your own way as they come and go, rather than trying to suppress or stop them. It’s also helpful to know what makes you feel better when grief shows up, so you can get the support you need.

Myth 8: The goal of grieving is closure.

Our society is built around achievement. Common milestones include graduating from school, getting married, and retiring from a career. We like to check things off the list, but closure isn’t the goal of grief. Finishing grieving is not the endgame and there is no finish line. Some say the main objective of the grieving process is to experience your feelings of loss, sadness, anger, and guilt, while taking care of yourself and continuing to live and move ahead. Keeping an open mind about grief will serve you better than looking for closure.

Myth 9: Grief affects females more intensely.

The process of grieving has taken on a lot of expectations from society, including stereotypical views of how females and males grieve. Society expects females to be more emotional, to openly grieve through crying and expressing their feelings. “Boys don’t cry” is a stereotype that keeps males from showing their sadness through tears and emotions. The truth is that every person is unique and should freely cry or not cry or show grief in their own way. No one grieves more than anyone else. We are all individual beings with individual grieving styles.

Complete Article ↪HERE↩!

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How I helped my mother to have a good death from afar

Due to the COVID-19 pandemic, Melbourne man V Srikanth had to support his mother in India from afar as she neared the end of her life. This is what he learned.

By V Srikanth

And so when I got the call from my brother-in-law at 4 o’clock on a Thursday afternoon to let us know she had suffered a serious stroke, my brain snapped into clinical gear fairly quickly.

I was in Australia and she was near Bengaluru, and so began the very strange experience of helping my mother through her illness and to have a good death from afar in the middle of a global pandemic.

I was in Australia and she was near Bengaluru, and so began the very strange experience of helping my mother through her illness and to have a good death from afar.

I come from a medical family. I trained to be a physician and a geriatrician and I think I can make very clear decisions. My father, my sister, my brother and my brother-in-law are all doctors too. However, even for us there were many difficult decisions to be made. There were points where we were second-guessing ourselves and questioned whether we were doing the right thing.

In my job I have seen dozens of advanced-care plans. They are a good thing. But even the best advanced-care plans come unstuck. People’s wishes may not always be communicated well, and many families struggle with letting their loved ones go. Some want everything to be done until the very end, but what ‘everything’ is, might be viewed differently by different people. You can’t apply the same advanced-care plan to every scenario. 

Early on my mother briefly regained some consciousness, but shortly thereafter she slipped back into an unconscious state.

I had seen the brain scans, I knew the odds. Neurosurgery was an option, but the likelihood of her surviving it and recovering to live an active life with good quality was extremely low. And Amma was in a large hospital in the middle of the Covid crisis.

My siblings and I decided it would be best to get our mother out of that hospital environment. We were fortunate in that we knew of a small primary care facility where she could have access to nurses and a physician.

What many people don’t know is that a formal system of palliative care is rare in India and is not routinely incorporated into healthcare. In fact, the medications that we use in Australia for palliative care like sedatives and opiates are very tightly regulated in India and not readily available for good palliative care.

I was lucky enough to be able to speak with my colleagues here about the best practices we might use, even if those best practices were not known in India, and provide my siblings with advice. However, we still all had to be on the same page and that is always the tricky part.

When would we stop providing food through a tube? When would we stop giving intravenous fluids? What is the right amount of care to keep someone comfortable but also allow them to die?

If you don’t know about palliative care and have not talked about death, these decisions can be challenging. And they are made harder when you don’t know the patient’s wishes or have a desire to ‘fix’ everything with every option of treatment available, however futile they may be.

With my family it was different. We were in agreement on most things and for the most part we knew what our mother would have wanted us to do. She had held separate conversations with all of us about what she would have expected for herself. And my father, tough as it was for him, also accepted the reality of how Amma was – and trusted us to help him make the right decisions.

And this is what I would say to anyone going through a similar situation. Ask yourself, to the best of your knowledge, how would your relative have wanted to live on the other side of a significant medical intervention when faced with a seriously disabling or terminal illness? Ask the doctors what are all the options and what are the specific likely outcomes of each?

When the time came for my mother it was extremely peaceful, with my family by her side, and no discomfort. She would have been 80 this year, a wonderful person and she was really clear in her mind, always keeping people connected. In many ways, as she always did, she made it easier for us at the end.

Complete Article ↪HERE↩!

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When a friend dies by suicide

— Preventing suicide contagion

A friend or classmate’s suicide can increase risk for whose who are emotionally vulnerable or see suicide as a way to solve problems.

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Suicide can shake an entire community. For some kids, a friend or classmate’s suicide increases the risk that they may resort to the same behavior. This risk, known as suicide contagion, can affect people who lived down the street from the person who died, went to school with them, or simply saw them around town.

“After suicide, the person’s closest friends aren’t necessarily the ones at greatest risk,” says Kimberly O’Brien, clinical social worker in the Department of Psychiatry and Behavioral Sciences at Boston Children’s Hospital. “The kids at greatest risk are the ones who are already emotionally vulnerable and those who believe their classmate solved their problems through suicide.” O’Brien is also co-author of Emotionally Naked: A Teacher’s Guide to Preventing Suicide and Recognizing Students at Risk with Anne Moss Rogers.

Here, O’Brien and Boston Children’s psychologist Erica Lee talk about how a classmate’s suicide can affect children and teens and ways parents can help their kids process their feelings.

Risk of contagion in the aftermath of suicide

Any death, particularly a death by suicide, brings up a wide range of feelings: shock, sorrow, anger, and guilt, to name a few. While there’s no right or wrong way to feel, some kids are more vulnerable to suicide contagion than others. “If a kid is already struggling with depression, anxiety, or suicidal thoughts, a classmate’s suicide can exacerbate those thoughts and feelings,” says Lee.

The way people talk about suicide can also increase other students’ risk. For instance, the more details about how the person took their life are made public, the greater the risk that other students may engage in similar behavior.

To reduce such risk, parents and school officials can take a cue from the news media’s suicide reporting guidelines. The voluntary guidelines aim to reduce the chance of suicide contagion by:

  • not focusing on the method or location of suicide
  • not speculating what event or person may have triggered the suicide
  • not suggesting suicide is an understandable response to difficult feelings

This is not to say that parents should try to gloss over a classmate’s death. “Parents should not try to keep the suicide a secret from their kids,” says O’Brien. “You don’t want to focus on the method of death, but don’t take away from the loss of this person by not doing or saying anything.”

Self-care for parents in the wake of suicide

It’s only natural for parents to have a strong reaction when a child dies by suicide. Ignoring such emotions in an effort to appear strong can backfire. “Kids often monitor their parents for signs of distress,” says Lee. “If they think their parent is upset, they might hide their thoughts and feelings rather than upset their parent more.”

Taking time to process their emotions also gives parents a chance to think about what they want to say and how they want to say it, adds Lee. “The conversation may be hard to have, but approaching it in a calm, open frame of mind can reassure your child you will work through this together.”

Open communication to reduce kids’ risk of suicide

O’Brien suggests that parents check in frequently with their child after a classmate’s death by suicide. “A kid might feel fine one day, then it may hit them the next day.” Conversations should leave room for children to explore their feelings about the person who died, suicide, and their own experiences.

Open communication also includes asking kids if they have suicidal thoughts. “Many parents worry that asking a child if they think about harming themself may ‘plant’ the idea in their mind,” says Lee. It doesn’t. By asking the question, parents let children know it’s OK to talk about scary feelings.

Tips for talking with tweens and teens about the death of a classmate by suicide

  • Use clear, straightforward language and leave plenty of room for your child to express their thoughts and feelings.
  • Open the conversation with questions. For instance, ‘What have you heard about what happened?’ and ‘How are you feeling about what happened?’
  • Focus on the fact that the person who died had a psychiatric illness that made it hard for them to think clearly.
  • Avoid judging the person who died or the people close to them. No single event causes suicide.
  • Be ready to hear what your child is thinking and feeling. Remember, everyone responds differently to suicide.
  • Offer reassurance. Most people with suicidal thoughts get support that helps them find other ways to cope with emotional pain.

If your child tells you they think about harming themself, feel hopeless, or is in overwhelming emotional pain, seek help from a mental health professional. If you believe your child is in immediate danger, call 911 or bring your child to the closest emergency room.

Honoring the person who died

Grieving after suicide can be complicated. “It’s important that kids have a way to honor their friend or classmate without reinforcing the idea that dying is a way to gain attention or love,” says Lee.

“To reduce other students’ risk, the emphasis should be on suicide prevention,” adds O’Brien. She suggests working with an organization like the American Foundation for Suicide Prevention to help raise awareness about suicide. Kids can also participate in a fundraiser like an Out of the Darkness Walk or volunteer for a crisis hotline. Any of these activities can help kids acknowledge a classmate’s death while learning about suicide prevention.

If you or your child is in crisis, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or contact the Crisis Text Line by texting HOME to 741741.

Complete Article ↪HERE↩!

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Is It Time to Rethink End-of-Life Decisions and Care?

By Judith Graham
For decades, Americans have been urged to fill out documents specifying their end-of-life wishes before becoming terminally ill — living wills, do-not-resuscitate orders, and other written materials expressing treatment preferences.

Now, a group of prominent experts is saying those efforts should stop because they haven’t improved end-of-life care.

“Decades of research demonstrate advance care planning doesn’t work. We need a new paradigm,” said Dr. R. Sean Morrison, chair of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York and a co-author of a recent opinion piece advancing this argument in JAMA.

“A great deal of time, effort, money, blood, sweat and tears have gone into increasing the prevalence of advance care planning, but the evidence is clear: It doesn’t achieve the results that we hoped it would,” said Dr. Diane Meier, founder of the Center to Advance Palliative Care, a professor at Mount Sinai and co-author of the opinion piece. Notably, advance care planning has not been shown to ensure that people receive care consistent with their stated preferences — a major objective.

“We’re saying stop trying to anticipate the care you might want in hypothetical future scenarios,” said Dr. James Tulsky, who is chair of the department of psychosocial oncology and palliative care at the Dana-Farber Cancer Institute in Boston and collaborated on the article. “Many highly educated people think documents prepared years in advance will protect them if they become incapacitated. They won’t.”

The reasons are varied and documented in dozens of research studies: People’s preferences change as their health status shifts; forms offer vague and sometimes conflicting goals for end-of-life care; families, surrogates and clinicians often disagree with a patient’s stated preferences; documents aren’t readily available when decisions need to be made; and services that could support a patient’s wishes — such as receiving treatment at home — simply aren’t available.

But this critique of advance care planning is highly controversial and has received considerable pushback.

Advance care planning has evolved significantly in the past decade and the focus today is on conversations between patients and clinicians about patients’ goals and values, not about completing documents, said Dr. Rebecca Sudore, a professor of geriatrics and director of the Innovation and Implementation Center in Aging and Palliative Care at the University of California-San Francisco. This progress shouldn’t be discounted, she said.

Also, anticipating what people want at the end of their lives is no longer the primary objective. Instead, helping people make complicated decisions when they become seriously ill has become an increasingly important priority.

When people with serious illnesses have conversations of this kind, “our research shows they experience less anxiety, more control over their care, are better prepared for the future, and are better able to communicate with their families and clinicians,” said Dr. Jo Paladino, associate director of research and implementation for the Serious Illness Care Program at Ariadne Labs, a research partnership between Harvard and Brigham and Women’s Hospital in Boston.

Advance care planning “may not be helpful for making specific treatment decisions or guiding future care for most of us, but it can bring us peace of mind and help prepare us for making those decisions when the time comes,” said Dr. J. Randall Curtis, 61, director of the Cambia Palliative Care Center of Excellence at the University of Washington.

Curtis and I communicated by email because he can no longer speak easily after being diagnosed with amyotrophic lateral sclerosis, an incurable neurologic condition, early in 2021. Since his diagnosis, Curtis has had numerous conversations about his goals, values and wishes for the future with his wife and palliative care specialists.

“I have not made very many specific decisions yet, but I feel like these discussions bring me comfort and prepare me for making decisions later,” he told me. Assessments of advance care planning’s effectiveness should take into account these deeply meaningful “unmeasurable benefits,” Curtis wrote recently in JAMA in a piece about his experiences.

The emphasis on documenting end-of-life wishes dates to a seminal legal case, Cruzan v. Director, Missouri Department of Health, decided by the Supreme Court in June 1990. Nancy Cruzan was 25 when her car skidded off a highway and she sustained a severe brain injury that left her permanently unconscious. After several years, her parents petitioned to have her feeding tube removed. The hospital refused. In a 5-4 decision, the Supreme Court upheld the hospital’s right to do so, citing the need for “clear and convincing evidence” of an incapacitated person’s wishes.

Later that year, Congress passed the Patient Self-Determination Act, which requires hospitals, nursing homes, home health agencies, health maintenance organizations and hospices to ask whether a person has a written “advance directive” and, if so, to follow those directives to the extent possible. These documents are meant to go into effect when someone is terminally ill and has lost the capacity to make decisions.

But too often this became a “check-box” exercise, unaccompanied by in-depth discussions about a patient’s prognosis, the ways that future medical decisions might affect a patient’s quality of life, and without a realistic plan for implementing a patient’s wishes, said Meier, of Mount Sinai.

She noted that only 37% of adults have completed written advance directives — in her view, a sign of uncertainty about their value.

Other problems can compromise the usefulness of these documents. A patient’s preferences may be inconsistent or difficult to apply in real-life situations, leaving medical providers without clear guidance, said Dr. Scott Halpern, a professor at the University of Pennsylvania Perelman School of Medicine who studies end-of-life and palliative care.

For instance, an older woman may indicate she wants to live as long as possible and yet also avoid pain and suffering. Or an older man may state a clear preference for refusing mechanical ventilation but leave open the question of whether other types of breathing support are acceptable.

“Rather than asking patients to make decisions about hypothetical scenarios in the future, we should be focused on helping them make difficult decisions in the moment,” when actual medical circumstances require attention, said Morrison, of Mount Sinai.

Also, determining when the end of life is at hand and when treatment might postpone that eventuality can be difficult.

Morrison spoke of his alarm early in the pandemic when older adults with covid-19 would go to emergency rooms and medical providers would implement their advance directives (for instance, no CPR or mechanical ventilation) because of an assumption that the virus was “universally fatal” to seniors. He said he and his colleagues witnessed this happen repeatedly.

“What didn’t happen was an informed conversation about the likely outcome of developing covid and the possibilities of recovery,” even though most older adults ended up surviving, he said.

For all the controversy over written directives, there is strong support among experts for another component of advance care planning — naming a health care surrogate or proxy to make decisions on your behalf should you become incapacitated. Typically, this involves filling out a health care power-of-attorney form.

“This won’t always be your spouse or your child or another family member: It should be someone you trust to do the right thing for you in difficult circumstances,” said Tulsky, who co-chairs a roundtable on care for people with serious illnesses for the National Academies of Sciences, Engineering and Medicine.

“Talk to your surrogate about what matters most to you,” he urged, and update that person whenever your circumstances or preferences change.

Most people want their surrogates to be able to respond to unforeseen circumstances and have leeway in decision-making while respecting their core goals and values, Sudore said.

Among tools that can help patients and families are Sudore’s Prepare for Your Care program; materials from the Conversation Project, Respecting Choices and Caring Conversations; and videos about health care decisions at ACP Decisions.

The Centers for Disease Control and Prevention also has a comprehensive list of resources.

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