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Success in the Bereavement Program at the Bedford, MA VAMC

In FY10, the Bedford facility in VISN 1 scored the highest on the Spiritual Support item and achieved top marks for the EMOTIONPRE, EMOTIONPOST, SURVIVAL and BURIAL benefits, LISTEN, INFORM, and ALERT items.  According to Dr. Rachel L. Movitz, the hospice and palliative care program’s psychologist, the facility takes a multifaceted approach to providing support for Veterans and their families.

First, Bedford offers a comprehensive bereavement program based on the philosophy that such support is crucial because it may impact both the grieving process and its outcomes.  Second, the program recognizes that the grieving process is comprised of multiple stages and myriad aspects, addressing grief before, during, and after the death of the patient, both psychosocial and spiritual needs, and focusing on factors such as type of death, survivor personality/coping skills, relationship to deceased, and ethnicity and culture.  Finally, the Bedford program attends to the bereavement and emotional needs of its staff, particularly the nurses who witness medical futility, the prolongation of suffering, and death and dying.  Based on a survey of nursing staff in the summer of 2009, 77% of respondents agree that having the opportunity to regularly debrief and discuss the experience of caring for patients and handling death helps to improve work with other patients.

Before the death of the patient, the Bedford bereavement program institutes “Caregiver’s Tea,” a weekly “Anticipatory Grief Support Group,” and individual and family counseling for palliative/hospice care Veterans.  The hospice/palliative care team also provides education about the dying process itself, including signs and symptoms, how to be with the dying person, and bedside support for Veteran and family.  After the Veteran’s passing, the unit team sends personally written bereavement cards and makes a series of phone calls – at one week, one month, three months, six months, and nine to twelve months.  Other forms of bereavement support are offered as well, such as bereavement counseling, counseling for the “holiday blues,” and memorial services with participation from the chaplain, social worker, psychologist, and unit team.

Bedford’s approach to bereavement support can be instructive on how to make the dying and grieving processes more comfortable and easier to bear.  The effect of Bedford’s efforts to improve its support to Veterans, families, and staff is significant: bereavement contact following vet’s death increased from 14% in Q1FY08 to 70% in Q1FY09, with an increase in family member satisfaction with the emotional support provided from 14% in Q1FY08, to 79% in Q1FY09, to 88% in Q4FY09.  The key is in the program’s comprehensive scope, attending to the various stages and elements of grieving and to all the individuals involved.