The impact of client death on health care workers

Health care workers (or aides) may suffer instrumental (e.g. loss of work or pay) and emotional consequences after a client dies. However, aides insignificant relationships with clients and insignificant losses after the death of a client may deny them forms of support typically granted to grievers. That is because health care workers grief are often referred to as disenfranchised or grief that is not openly acknowledged, socially validated, or publicly observed. This study was, therefore, developed to investigate the experiences of home care workers with client death and loss and to gather feedback on two possible interventions (emotional and financial support) to help home care workers prepare for and process client loss.

The study participants consisted of 26 females between 32 to 60 years of age. They were recruited through Home Care Industry Education Fund (the Fund) classes. Data was collected through focus groups and peer interviews. The main outcome variable was measured by the use of qualitative research methods, including inductive and narrative approaches, to explore the mechanisms that disenfranchise home care workers grief. Furthermore, the following themes were discussed in the article: the relational factors that shape experiences of client death; the outcomes and effects (emotional and physical) of client death; and the core strategies to navigate social and employer-based grieving rules.

The article found that grief and lack of support following a clients death are critical problems that likely reduce job satisfaction, increase burnout and turnover, and compromise home care workers health and the care they provide. One limitation of the study was the inability to sample the multiple forms of diversity within this workforce. The second limitation was the sample consisted of home care workers who were all union members, and, thus, had more support and better benefits than the much larger population of non-unionized home care workers. The third limitation is the inability of the study to describe the frequency with which home care workers experience client deaths due to the qualitative nature of the research.

Provider-patient relationships are largely unrecognized. One possible explanation may be that agencies and coordinators are actively discouraging these relationships. The second reason may be that, due to the one-on-one home-based nature of this work and the fact that home care workers are isolated from their peers and supervisors, the relationship is not visible to the rest of society. A third reason may be due to the social context that strongly defines who

is allowed to grieve, under what circumstances the individual is allowed to grieve, how the individual grieves, and what types of support the individual receives. As a result, home care workers grief is doubly disenfranchised through employer and societal underestimation because when clients die, aid workers are wrongly perceived to have both insufficient losses (e.g. job losses after client death) and insufficient relationships to justify their grief and merit support.

The following emotional supports could be put in place to support bereaved home care workers: a phone call or check-in by the coordinator; counselling or referrals to mental health services, either in-person or over the phone; more practical training opportunities on how to prepare for client death and how to navigate the emotional effects; and the opportunity to contact the deceased clients family as a means of closure. Also, the following financial supports could be put in place: consistent scheduling or placement in a new permanent or temporary case after a client loss, and paid time off for bereavement leave and to attend counselling.

In order to better assist aides through the coping process, I feel that agencies should leave it to the discretion of the aid workers as to whether or not they chose to remain in contact with clients families after a death. The agencies should also make the aid workers feel more comfortable with seeking support from their supervisors. Also, I believe that aides should not be denied the support they need to cope emotionally and financially. Finally, coordinators play an important role in the lives of home care workers, and I feel that they should use their position to appropriately assist home care workers with their grief after the death of a client.