I recently re-watched one of my favorite movies, Fried Green Tomatoes, about a soul searching, empty nester Evelyn (played by Kathy Bates) and the feisty Mrs. Threadgoode (played by Jessica Tandy) who resided at a nearby nursing center. The two met by chance in the “day room” at the facility where Evelyn’s husband was visiting his cantankerous aunt. Their friendship blossomed as Evelyn made frequent visits to see Mrs. Threadgoode who reminisced in recanting days gone by.
On her final visit, Evelyn walked into Mrs. Threadgoode’s room at the care center bearing goodies for her dear friend. The bed is “stripped” and a staff member is removing decorations Mrs. Threadgoode had placed on the wall. Evelyn is very upset and outraged, demanding the staff member stop removing the decorations from the wall while frantically asking about Mrs. Threadgoode. The staff member replied that she was only told the “patient” had died and to get the room ready for another “patient”. Overwhelmed by sudden grief of not having been notified only to find out this way, Evelyn emotionally shouts how they mishandled the situation and that she didn’t even get to say goodbye. Eventually, Evelyn learns that it wasn’t Mrs. Threadgoode that died, but her roommate Mrs. Otis.
I will stop here with the Fried Green Tomatoes story line so I don’t spoil it for those of you who haven’t seen it. This is a perfect, yet “Hollywood” example of the impact of poorly managed death notification. Although Evelyn wasn’t a CNA, her response to walking into the empty resident room is very similar to how CNAs feel when they are not notified of resident deaths prior to their shift starting.
A 2016 study on the impact of death notification on CNAs’ work experiences and feelings has been released. According to the published findings nursing homes should evaluate how certified nursing assistants learn about the death of residents in order to improve their on-the-job experience.
A “substantial minority” of CNAs reported negative experiences around how they were notified of resident deaths and how bodies were removed from the facility, the investigators found. They interviewed 140 nursing home CNAs.
“Study findings suggest that more mindful approaches to the transitions related to resident deaths would be valued by CNAs and could improve their work experience,” the authors wrote.
The workers indicated that the “most positive” way to learn about a resident death was to be contacted prior to arriving for a shift. The “most negative” experience was walking into a room to find it empty or with a new resident in the bed. The CNAs also expressed negative feelings related to how quickly facilities filled beds that became available after a death, the study authors noted.
The investigators were affiliated with the Jewish Home Lifecare Institute on Aging, the University of Massachusetts, Boston, and the University of Osnabrück in Germany. Full findings are available online and are forthcoming in Geriatric Nursing.
It didn’t take me long working in LTC to understand the strong bond that forms between nursing assistants and the residents they serve. It is a unique and mutual relationship that contributes to quality of care and quality of life for the residents. They become “family”.
So when a CNA is starting her shift, she strides into the room of a resident she has provided life sustaining and compassionate care to and the room is stripped of all personalitems and empty, or even has a “new resident”, it is quite understandable the grief that the CNA feels.
This emotional roller coaster can negatively impact CNAs, their work and their work environment. I personally know of an outstanding young nursing assistant who was fairly new to the work. He had become very close to a particular resident. This resident died during the day and no one notified Patrick, the CNA, before his shift started that evening. Starting his shift, Patrick hurried into this resident’s room to find it completely devoid of any sign of her—along with a paper towel on the freshly made bed that said “Clean”. He was devastated, no time to say good-bye, no time to process his feelings. Patrick now calls that “the paper towel that changed his life” and it made him that much more determined to do things differently, out of respect for the residents and their caregivers. That was 15 years ago, today Patrick is a registered nurse and a great nursing director.
None of us would want to learn of the death of a family member in such an abrupt and seemingly uncaring way. There are many programs to do it differently. I know of care centers that have a “calling tree” for each unit for those staff members who want to know about resident deaths before coming into work. Many homes give the staff and residents an opportunity to grieve, placing a red rose on the empty bed along with a sympathy card to be signed by all who wish, and then given to the family. At many veteran’s homes, the staff and residents line the hallway for a final salute to the resident as the mortuary departs.
There are many ways to do it, find one that works in your home. It will support both staff and residents.
