Redefining death and dying in aged care: A call for compassionate end-of-life care
An article written by Rose Plater, Community Health and Ageing Manager, Paynters
Despite over a decade of experience in aged care, conversations about death have been rarely initiated with me. While palliative care discussions have certainly increased, providing undeniable benefits, little time is spent addressing the actual moments in raw detail to make a death a good one. In aged care facilities, the passing of residents is often handled discreetly, with minimal acknowledgment or ceremony. From a built environment design perspective, death is even less discussed. Design considerations typically include only practical aspects, such as the undertaker’s entry, without addressing the personal needs surrounding death for the individual and the family.
So what could be a good death?
Allow me to share Patricia’s story. Patricia was a remarkable woman, a mother of five, a grandmother to sixteen, and a great-grandmother to eighteen. She loved birds and often sang her favourite song, "Irish Eyes." Patricia spent the last years of her life in a residential care facility, blissfully unaware of her slip into dementia. Like many before her, Patricia didn’t pass away in the facility. Her last days, like those of too many of our residents, were spent in a hospital. Despite this, in her last 24 hours, Patricia's daughters and son, supported by staff, physically cared for her dying body. They sang "Irish Eyes" and kissed her, ensuring she felt the warmth of family and love. Patricia passed away surrounded by those who cherished her, experiencing what I believe to be a good death.
Patricia was my grandmother. At this stage in my career, I was an executive in aged care, and it was embarrassingly just a happenstance that a nurse at a facility I managed talked me through the things she would suggest to family in these final hours. If it wasn’t for this wonderful, generous heart, I wouldn’t have known that it was “okay to ask” to be a part of these final moments with the care staff. It was my realisation that good deaths happened almost by accident rather than being structurally supported. Good deaths exist in every facility, but normally through the small, hidden actions of those on shift.
The need for change in aged care
A residents death whether in the hospital or at the facility is not always acknowledged meaningfully. This lack of recognition often means that the staff who cared for our loved ones may only learn of a resident’s death when tasked with preparing the room for the next occupant or seeing a new face in the old room of another. Historically, many aged care facilities would host wakes or services, with staff attending funerals and providing support. Today, the increasing turnover of residents has made such practices less viable. This has led to a “thank you, next” mentality, contributing to emotional exhaustion among staff and a devaluation of the resident’s end-of-life experience.
For other residents, the absence of a familiar face can leave a profound sense of uncertainty and sadness. When someone doesn't return from a day out or appear at breakfast it can create a silent void. Residents may quietly assume the worst, their curiosity and concern after days will be met with an unspoken understanding that another companion has passed away. This lack of closure can be deeply unsettling and dehumanizing, suggesting a lack of importance on the loss.
Recommendations for improvement
To create more compassionate and holistic “good death” experiences, I would encourage aged care facilities to consider the following steps:
- Communication: Reflect residents' passing through meaningful communication of the loss. Start open conversations among care staff to promote discussions about death and techniques that floor staff utilize to support good deaths, and make the death experience.
- Compassionate Design: Integrate design elements that honor the end-of-life process, such as memorial lights, tree planting, pebbles in water, or dedicated spaces for reflection.
- Support for Loss: Provide emotional support and training for staff to help them cope with the frequent loss of residents and prevent burnout.
- Family Involvement: Actively involve families in the end-of-life process, ensuring their loved ones experience a dignified and compassionate death. Allow residents’ family members to know how they can be involved, from final cares to music, allowing death to provoke awe.
- Start Recording: Ensure you know your residents' place of preference for death and record your ability to meet this.
By breaking the silence and embracing conversations about death, we can ensure that more of our residents and their families experience a good death. This is not just a challenge but an opportunity to redefine the experience for our elderly loved ones, honoring their journey with the respect and care they deserve not be accident but by design.
The image used in the blog was generated using AI and is a representation of the authors description of an ideal end-of-life care setting.
Author
Rose Plater
Community, Health and Ageing Manager
Paynters