During the COVID-19 era, many individuals have found themselves struggling with the loss of a loved one. Now, in these changing times, their grief loss has been accentuated by several different things. With a second pandemic looming in our future, complicated grief may very well become part of the picture.
According to Dr. Kenneth Doka, PhD, Senior Bereavement Consultant to the Hospice Foundation of America, while you may not have heard of the term “complicated grief” before, in the coming months you certainly will. Due to social changes in response to COVID-19 – in particular disruptions to bedside visits and funeral rituals – the normal process of grieving has been disrupted, and Dr. Doka expects to see an uptick in the number of complicated grief cases, which normally account for about 20-33% of all cases.1 In turn, this also leads to implications for us as hospice professionals.
What is Complicated Grief?
Complicated grief is considered a generic term that encompasses a type of distortion in the normal process of mourning. More specifically, it includes significant deviation from either time or intensity of grief, or impairment in social, occupation or other areas of functioning.
The main components of this grief loss can include:1
- Chronic grief (continues without stopping)
- Exaggerated grief (one symptom becomes magnified)
- The grief is “masked,” or in other words, another issue (like alcoholism) can present as the main problem when the underlying issue is grief
- Delay in experiencing grief (no appearance of at first, then an intense experience)
Additionally, an individual may experience other complications related to their grief loss, such as:1
- Separation Anxiety
- Adjustment Disorder
- Major Depressive Disorder
- Post-Traumatic Stress Disorder (PTSD)
- Suicidal tendencies and ideations
The lack of physical presence with family members and bedside visits, as well as great limitations to funeral rituals, can often lead to complicated grief. “Funeral rituals are historically a critical way we deal with grief,” said Dr. Doka. “They allow us to feel like we can do something during a disorganized time, and spiritually it gives social support and sharing of memories. Now with minimum rituals, you lose all that.”
Unexpected Grief Loss in Unpredictable Times
As hospice professionals, we understand that the normal grieving process has been completely upended during COVID-19. Grief loss can occur relatively suddenly and unexpectedly and be further complicated when only minimal visits with patients have taken place.
These unpredictable times can also see individuals with other conditions treated as somehow less significant.
Dr. Doka recalled a story of a cherished aunt who passed away the day after 9/11 occurred. “My aunt passed on September 12, just the day after 9/11,” he said. “When I talked about going to her funeral, there was almost this air of excitement, as people would say, ‘Oh, did she pass on 9/11?’ When I told them she passed as a result of issues older people get later in life, they almost lost interest. Even the priest at the funeral began the sermon with the words, ‘This was not one of those tragic deaths.’ But for my family at the graveside I reminded everyone that, for us, it was a tragic death. Sometimes other causes can be looked at as, well, not as important as COVID-19.”
Caring for Ourselves During the Pandemic
How are we, as hospice professionals, affected by all these changes? In many ways, we are all already grieving cumulative COVID-19 losses due to disruptions to our lives. For example, we may be experiencing loss of employment, income, freedom, social movement, collective gatherings such as sports events, graduations, proms, and more. “Most of us have lost our sense of routine and our sense of connection,” said Dr. Doka.
For many hospice professionals, social workers and chaplains, along with those involved in direct medical care and home health care, Dr. Doka explained that it can be frustrating to work remotely when many “would like to do more than they are able to.”
Dr. Doka provided the following recommendations for these challenging times:
- Step 1: Acknowledge your feelings
- Step 2: Practice self-care
- Step 3: Take time to put work aside
- Step 4: Turn to a spiritual practice and/or philosophy
Dr. Doka believes that maintaining a spiritual practice or philosophy “allows you to cope with the unfairness of life.” He also referred to experiencing a sense of “cosmic anger,” whereby you start to wonder why did this happen at this time? But, as a source of encouragement, he summarized famed American psychiatrist, educator and author Avery Weisman’s advice to “take pleasure in all you can do; you can make their life a little more comfortable.”
How Hospice Managers Can Help Staff
For hospice managers, Dr. Doka recommends revisiting resources on the Hospice Foundation of America website, as well as assisting staff in numerous ways. He noted that you can provide “help for them to ritualize losses, as well as validation, making sure they are recognized and supported in what they are experiencing.”
Dr. Doka also pointed to Danai Papadatou, PhD, Professor of Clinical Psychology at the University of Athens, Greece and her Dual Process of Caregiver Grief as a way of understanding the grief process. A process which includes “oscillating between experiencing the grief and detaching from it.” If you experience too much grief, it becomes easy to burn out; and if you try to contain it, you may feel detached.
Complicated grief can be a tricky subject to navigate, but it’s important that hospice professionals take care of their staff as well as themselves as we experience COVID-19 and its aftermath on the front lines. To work through some of these challenges and keep your everyday hospice operations running smoothly, learn more about Optima Hospice.
1Hospice Foundation of America, “Complicated Grief in the COVID-19 Era,” June 25, 2020.