America mourns, hospices respond

Bereavement experts help a nation deal with its grief

When three hijacked commercial airliners slammed into the Pentagon and the twin towers of the World Trade Center and a fourth crashed in a Pennsylvania field, killing more than 6,000 people, a nation gasped at the magnitude of the carnage. As disbelief gave way to anger and grief, few Americans were immune to a feeling of loss.

The worst act of terrorism on American soil left wives grieving for husbands, sons grieving for mothers, sisters grieving for brothers. And the mourning was not confined to New York, Washington, DC, or the hometowns of its victims. People in every state are still grieving at some level: Employees of companies based across the country weep for fallen colleagues; people cry for the heroic rescue workers who were buried trying to help those fleeing from the crumbling skyscrapers; and many mourn the loss of a nation’s sense of safety. American society, it seems, has changed, leaving those in it more suspicious and fearful.

In the midst of the pain and in anticipation of the waves of grief that will follow, hospices haven’t shrunk from the responsibility of helping those who have lost loved ones as well as those who have been affected indirectly, but significantly.

"I started getting calls as early as Tuesday [Sept. 11, the day of the attacks] from hospices as far away as Texas and Wisconsin," says Kathy McMahon, president and chief executive officer of the Hospice and Palliative Care Association of New York State in Albany. "They offered to send bereavement counselors, chaplains, and social workers."

The New York hospice trade group, the state equivalent of the Alexandria, VA-based National Hospice and Palliative Care Organization (NHPCO), has acted as a clearinghouse that New Yorkers can use to get in touch with bereavement experts. "There has been a huge amount of outreach," says McMahon. "I’m very impressed with how this community has come together."

In addition, hospices such as the Hospice of Orange and Sullivan Counties set up grief centers at its suburban New York City offices in Middletown and Newburgh. "We have gotten a number of calls from schools wondering if they are saying the right things to their students, and from hospitals seeking grief and bereavement inservice training for their employees and families of victims," says Kathi Webber, community relations director for the hospice.

Other hospice involvement included grief and bereavement care for families of New York City rescue workers and police officers who were killed or missing as a result of the massive collapse of both towers.

But with the impact of the tragedy being felt nationwide, there are many who can benefit from grief and bereavement care. Americans who sat in front of their television sets and watched terrorism unfold only to have the same images repeated over and over again are also searching for answers and pondering unfamiliar emotions.

NHPCO calls for hospices to help out

The NHPCO reacted quickly, urging its members to volunteer their services where needed. On the afternoon following the attacks, NHPCO Board Chairwoman Rafael Sciullo issued a member alert asking hospices with bereavement or other counseling staff who could assist with the situation to contact hospice organizations in states near the crash sites.

Citing "respect for the magnitude of loss following Tuesday’s national tragedy, and based on the need for hospice personnel to provide bereavement leadership and support in their own communities," the executive committee of NHPCO postponed its 16th Management and Leadership Conference, which was scheduled for Sept. 24-26 in Arlington, VA. NHPCO hopes to reschedule this event for early December.

The NHPCO’s call underscores the importance of hospices addressing the tragedy’s effects in their own communities. New York is an economic hub that attracts not only visitors, but also national and multinational corporations that have offices in the city’s financial center. With that in mind, hospices should offer their services to employers in their communities that have ties to companies that lost employees inside the World Trade Center.

To provide hospices with resources to use in their own communities, the NHPCO has posted guides to help employers understand workplace grief. Hospices working with companies should help them understand the following:

The grieving process. Feelings and symptoms of grief can take weeks, months, and even years to manifest and evolve. This underscores the importance for a sustained program, rather than one that dissipates as memory of the events fade.

Equally important is educating workers that grief and mourning occur individually and that healing cannot be expected to follow a timetable. In time, however, the emotions will ease. Workers should be told that funerals and memorial services represent only the beginning of the grieving process, not the end.

Experiencing a range of emotions

Hospices should help workers understand the range of emotions and symptoms they will experience during the grieving process: shock, denial, anger, guilt, anxiety, sleep disorders, exhaustion, overwhelming sadness, and concentration difficulties.

Most of the time a person feels several of these emotions at the same time, perhaps in different degrees. Eventually, each phase is completed and the person moves ahead. The extent, depth, and duration of the process will also depend on how close people were to the deceased, the circumstances of the death, and their own situation.

Take the time to grieve. Employers need guidance in how and what to do to allow their employees to grieve. Some suggestions include:

Creating a memorial board. A photo, card, or special item the person kept on her desk can be a way to remember.

Hold or participate in a fundraiser. Help them honor the memory of a co-worker by helping them to raise money for the family or an appropriate cause.

Conduct a workplace-only event. A luncheon or office-only memorial is a chance for co-workers to acknowledge their unique relationship with the deceased.

What employers can expect. The workplace will become a place to help work through grief. Talking about the deceased helps some people manage their grief, while others may keep to themselves. Educate employers on how to handle the varied response to the death of an employee. Guilt and anger will be evident among workers; employers should allow for these normal reactions.

Workers may also need help reacting to the deceased co-worker’s replacement. They need to be made aware that anger or disappointment at the new workers’ performance, personality, or work style may be more a by-product of grief than the new worker’s habits or skills.

Helping children cope

Other victims of this tragedy include children. The weight of the attacks hasn’t been lost on young children and teenagers. In the days following the attacks, television and newspapers recounted the events in vivid detail. Sound bites and video images all but guarantee an emotional response from children, despite their inability to completely process their feelings or to completely comprehend the disturbing events.

Hospices may have expertise in dealing with grief in instances where the death was expected and family members had some amount of time to consider the patient’s death. Traumatic grief, on the other hand, is something altogether different. The same can be said about helping children deal with traumatic events.

The New York hospice association is employing the following guidelines to help children cope with the violently disruptive events:

  • Encourage parents and caregivers to take time out to talk with their children. This is important because the child will likely hear about the events in other places, such as school.
  • Explain the tragedy in factual, but simple terms. If they want to know more, give them the opportunity to ask questions.
  • Use the correct language. That includes using words, such as "hijacking," "terrorism," and "dead."
  • Stress to parents that they must be honest about their own feelings. It’s acceptable for children to see sadness or grief in their own parents.
  • Parents should be given the freedom to let their children know they are scared. But they should also help reassure their children by explaining what they are doing and what the country is doing to keep them safe. In addition, parents should ask their children what would help make them feel safe.
  • Parents and caregivers need to be told that they should not guarantee complete safety. Instead, parents should focus on positive parts of family life, but also remind children that life is unpredictable at times.
  • Encourage children to continue with their daily routine. School provides a sense of regularity and order. This will move along the process of rebuilding their sense of safety and security.
  • Get back to a normal routine. Parents and caregivers must be encouraged to return to the activities in which they and their children participate, because routine is necessary for children to anticipate their future.
  • Allow children to struggle with their own childhood crisis, even amidst this tragedy. Their challenges and concerns should not be minimized because of national concerns.
  • Encourage parents to hug their children and say, "I love you." Providing reassurance and physical contact will help children relax and may placate their fears.

Time may have faded the images of Sept. 11, 2001, for some. Others may still be struggling with images of exploding airplanes and crumbling skyscrapers. And with the images likely to follow from retaliatory strikes and military casualties, hospices can expect traumatic grief and bereavement outreach to be a part of their programs in the immediate future.