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Discussion 6.1: Grief and Bereavement

15 days ago

As a society, we are so focused on prolonging life and curing illness that very little thought is given to when we experience the death of someone close to us. The grieving process can often begin while the person is still alive. Individuals who have experienced a death need time to grieve, to remember, and to heal. They also may need help to find information, resources and support.

When is the best time to introduce grief support?

How long should this support be offered after the death?

Should it be offered before the death, and if so, how?

How can this support be shaped to individual needs?



This consultation is now closed. 

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  • Ajnp1588 2 days ago
    As a school based social worker who supports both children and adolescents through the grief process my assessment is that grief support should be provided at the time that a loved one is diagnosed with a terminal illness. The support prior to the death allows any fears, concerns and uncertainties to be addressed. In addition it allows for a much different experience when the loved one dies and in the period of time that follows. The support needs to be provided in a manner that takes into account an individuals age as well as whether there are any learning disabilities or other diagnoses that may impact on a child's ability to comprehend. The support also needs to take a holistic approach, taking into account the impact the death will have on a child/adolescents life on a larger level (will the death result in a change in living arrangements, a change in schools etc). There is no "end date" when it comes to providing support. My experience is that when children experiences the death of a loved one at a young age, they frequently do not experience grief (the actual physical, emotional or mental reaction) until they are a little older and have a greater understanding of the implications this has had on their life. Grief counseling needs to be fluid, ongoing and available as needed- it is very individual.
  • fernandlily 2 days ago
    I have a lot to say about this topic. Basically grief support should be offered throughout all stages of life and for all types of losses. Right now, "Grief support" services are often run as free or not-for-profit programs by volunteers or peers - which is excellent, as they bring their "heart" and experience to the program...BUT, access to highly trained and qualified professional support comes along with a huge bill. While I appreciate there is free support to be accessed by all, and people with low incomes, I find it frustrating that there aren't formal programs developed by our healthcare teams/government etc that address the fact that EVERYONE WILL GRIEVE AT SOME POINT IN THEIR LIFE. "We" put money into many different programs (smoking cessation, obesity, diabetes, heart disease) but there is no formal "program" or funding for supporting grief....and yet EVERYONE will experience it. Strange, no? I think it stems from the fact that there are many misconceptions about grief, and no one takes responsibility for it. The healthcare and government think it's a community issue and the community is desperate for MORE SUPPORT. How can this be shaped to individual needs? I don't know...more variety of support might help because different support options appeal to different people (e.g., group versus individual, creative versus intellectual, written versus spoken etc). More funding for formal programs to reimburse trained professionals doing grief support work so that more people can access it. More directories that outline ALL the grief support options in the community not just the not-for-profit ones. Before all this though, I think grief education and grief literacy needs to change on a societal level. Maybe there needs to be funded education programs for people working in healthcare, religious organizations, mental health communities, universities etc...
  • Bora 3 days ago
    I believe that grief support should be introduced as soon as loss is experienced, which is not necessarily at the time of death. My husband was diagnosed with inoperable stage 4 pancreatic cancer in 2011. He was offered clinical trials and lived for 26 months. We were very blessed, However, loss was a huge part of our lives right from the moment of diagnosis. We lost control of our lives. We lost the ability to plan. We lost control of our choices. We found ourselves in a world of hospital visits, chemo, medications, good days, bad days, debilitating fatigue and the daily attempts to enjoy what time we had to share. Grief support in terms of life as we knew it would have been very much appreciated. In terms of support after the death, I would like to see support offered according to the individual's need. It is impossible to put a defined time on it. It has been 5 years since my husband died. I have learned a great deal about how to live with the loss, but still face challenges. Friends and family can offer some support, but in general, people are not comfortable talking about death and the challenges one faces in grieving. I would appreciate workshops, on line talks or courses that would offer discussions and suggestions. Most of the support I have heard about is limited to one year after the death.In looking back, I would have appreciated some support in facing death. It was very difficult to know when to live with hope and when and how to face death. I remember thinking that if I spoke to my husband about death, it would look as though I was giving up hope. I think that at the point that there is no hope, it is important to offer some support to face the end of life. Grief intensifies as a loved one loses the ability to walk, eat, talk and slowly shuts down. Professional help at this point in terms of what to expect, what to say and what to do are critical. Pamphlets are helpful, but reading can be exhausting. I feel personal intervention at this point is important. It could be provided by professionals and perhaps volunteers who have experienced similar losses.
  • Katherine 5 days ago
    I think that support of all types should be available to people who are experiencing a life-threatening illness themselves or of a close family member. While I think grief counselling and support groups are very helpful, I think that we all need to be supporting people in their times of difficulty and not just shunting them off to a service. After my sister died (at 51), I found that people soon seemed to tire of my grief and started asking if I'd thought of going to grief counselling. I felt that rather than just talking with me and being with my pain in a human way, they wanted to push me away because it was too frightening for them! I have seen that in other settings as well. In the hospice where I volunteer, staff and volunteers support family members and dying people through the entire process. Volunteers can be especially helpful because we have the time to talk and we are in a sense "the real deal" since most of us have had someone close to us die, and we "get" what people are going through.
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    • dorrie 3 days ago
      we need to be able to talk about our grief for as long as we need to. Community and friends begin to return to work/activities about a week after a death. Family often take weeks/months to get to a place where they get through the loss and begin to find a new normal. Death of one you love is not something you get over "It's something you get through"--Willie Nelson cd
  • Egal 4 days ago
    I've seen many good comments about providing support before and after suffering a loss, but have seen few comments on how to do this. It can be a touchy subject for some, prior to death, and as it hasn't been part of our culture to honor our feelings when losing a loved one, I feel it's essential to introduce support prior to passing in thoughtful way that doesn't come across as macabre. Pamphlets at a nursing station or in Drs waiting rooms or at a pharmacy counter would be a good way to introduce this type of support. Nurses and home care workers can also offer the information when appropriate, and could perhaps be the front lines of helping people become more aware of the challenges grief brings and offer insights for dealing with these challenges.
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    • dorrie 3 days ago
      In trying to not talk about death with family and friends we are preventing the one dying to be able to express their fears, concerns of what will the family do without me. We are not going to "jinx" or Make it happen--that's not our responsibility. We need to find ways to have those hard discussions early in life--celebratelife and stop trying to hide our feelings, fears and lack of being the most important member of "the palliative care team".
  • trust 4 days ago
    The Best time to introduce grief support is as soon as possible because grief support is helpful whenever anyone faces change whether it is change because of a terminal or chronic illness, a tragedy, or the loss of a job or relationship.The support needs to be offered for as long as the person who is grieving feels the need for support and this may be years because people's lives are changed for ever when we encounter grief.Grief support needs to be offered before a death in order to encourage grieving to occur both in the person who is dying as well as for family and friends who are experiencing anticipatory grief. Grief support may be shaped to individual needs by creating a caring, trusting, relationship with the grieving person. Grief has no time line and we have to factor in how the body's nervous system carries the pain of the loss. Trauma or the shock of the loss to the nervous system needs to be factored into the grief support in order to provide space for the grief to be processed in addition to the affect of the trauma on the grieving person.
  • AdvantAgeON 4 days ago
    The best time to introduce grief support is some time between when a patient is diagnosed with a life-threatening condition and when death is expected so that those suffering from anticipatory grieving can obtain assistance. Palliative care, including grief and bereavement supports, should serve as an undercurrent throughout the patient’s care and should begin when the patient is first diagnosed with a life-threatening condition. There should be no predetermined or expected timeline for support to conclude as the process of grieving varies on a case to case basis. Grieving after losing a loved one can happen quickly for some individuals, much later for others, and recurs in different periods for many. If the intent is to deliver client-centred care, then support should be available for as long as possible. Tools, resources, individuals, or organizations providing grief support should first and foremost recognize that grief IS an individualized experience and there is no template for addressing. Accordingly, grief support should be flexible so individuals can determine what type of resources would be most helpful to them in their recovery. It should also be available in different formats (online, in-person, digital, print) to allow for ease of accessibility.
  • Weston7050 4 days ago
    The best time to introduce grief support is some time between when a patient is diagnosed with a life-threatening condition and when death is expected so that those suffering from anticipatory grieving can obtain assistance. Palliative care, including grief and bereavement supports, should serve as an undercurrent throughout the patient’s care and should begin when the patient is first diagnosed with a life-threatening condition. There should be no predetermined or expected timeline for support to conclude as the process of grieving varies on a case to case basis. Grieving after losing a loved one can happen quickly for some individuals, much later for others, and recurs in different periods for many. If the intent is to deliver client-centred care, then support should be available for as long as possible. Tools, resources, individuals, or organizations providing grief support should first and foremost recognize that grief IS an individualized experience and there is no template for addressing. Accordingly, grief support should be flexible so individuals can determine what type of resources would be most helpful to them in their recovery. It should also be available in different formats (online, in-person, digital, print) to allow for ease of accessibility.
  • PallCareSW 5 days ago
    Grief support -- psychosocial support! -- ideally should begin at the time of a life-limiting diagnosis. There are so many losses patients and families experience along the illness trajectory. We need social workers to be better funded as part of community-based home care, and we need more social workers in health care settings that can focus on psychosocial care/anticipatory grief support, instead of discharge planning. So many people living with and dying from terminal illnesses, right now in Canada, do not have access to psychosocial supports, whether in the home setting, or hospital setting. This needs to change. Currently, bereavement care/support is included under the model of palliative care delivery as per the World Health Organization definition (e.g. care that begins at time of diagnosis, through end of life, and into bereavement), but in my experience as a palliative care provider, bereavement support is a very under-funded part of palliative care service delivery. Palliative care units do not provide bereavement follow-up support programs to families. Residential hospices do provide this kind of support, though it can often be limited in scope. People who die at home with the support of palliative care often do not have access to any formal bereavement support. In the work that I do every day, I see how much people struggle in their acute grief, days, weeks and many months after a significant loss in their life. Most of the time, people feel lost, and they feel as though something is wrong with them, when really, they are having very normal/common responses to significant losses. Without formal grief support available through palliative care programs, and because private counselling is so expensive, people are left to access free community based group support. This community-based support is amazing! However, much of this group support is cancer-specific; much less free bereavement group support is available for losses related to deaths from other illnesses (e.g., dementia, ALS, heart disease, etc. etc.). The average Canadian cannot afford to access private grief counselling, even though this would often be very beneficial. And not every grieving person wants to access support in a group setting. We need more funding for bereavement care as part of palliative care (again, it IS part of palliative care, but it is massively underfunded in existing palliative care programs), and we also need more affordable/accessible grief support writ large. I agree that adding a bereavement period onto compassionate care leave would be helpful, but I think it needs to be more flexible in terms of timing; two weeks is often not enough.
  • paddlin 5 days ago
    The best time to introduce grief support is when someone has suffered any loss or impending loss. After witnessing the long suffering death due to cancer of a loved one before there were any hospices or support, there was fallout for the dying person trying so hard to be brave and for the surrounding family for so many years after. There should be no time limit as some put the feelings away for even up to 50 years. As a survivor of the homicide of a family member over 10 years ago, support is still required at times as the grief ebbs and flows. If possible support definitely should be offered before if death is anticipated and imminent. Trained professionals along with support groups are a tremendous asset to help the grieving move forward and there again should be no limit on amount of assistance to an individual as we are all so different. We need to be speaking about all this not hiding it away. We need to understand what we feel is normal.
  • Jenn 5 days ago
    If a loss is soon anticipated, I think information about available bereavement services should be made available to the family. This may be done through members of their care team. I also see benefit in the bereavement support provide following up with the family in some way 4 and 6 weeks after the death (done by letter and phone call) outline the supports available to them. Timing as to when an individual reaches out for bereavement support varies dependant on various factors in the their lives, so I see benefit in bereavement support being available as long as possible.Support should be offered before the death. Support offered to address end of life concerns and anticipatory grief often benefits clients who utilize these services. Psycho-social/ psycho-spiritual support often meets this need via a counsellor who is training to provide support for the individual who is dying and their family. To shape this support to individual needs, it is important to keep the barriers and constraints as minimal as possible (considering cost vs. no cost, home visits, referral process, how long support is available to be offered after the death, and various kinds of bereavement support (individual, volunteer based, group services).
  • JusticeinDying 5 days ago
    By attaching grief at the end of a disease trajectory we are staying attached to a medical model of care.Introducing whole person and family centred palliative approach to care at the onset of disease is progress. Anticipatory grief is something that ALL involved need to be aware of- and supported.Throughout the trajectory and after death a continuum of community- palliative approach in caring would definitely enhance our approach to death and dying in Canada.It is time to resource our teams with care providers who excel in these aspects of care.
  • PsatCaregiver 5 days ago
    Just over a decade ago, my mother was diagnosed with advanced breast cancer. My sister and I became her primary caregivers. We very much started experiencing grief before she passed away but in order to cope and hold it together to take care of our mom, we consciously opted to be in denial and anti-anxiety meds. We figured there would be time to grieve after she died. When someone is diagnosed with cancer, the whole family is affected. If the diagnosis is a terminal one, I would recommend that grief support be offered to the patient and family, after the first appointment when they get the bad news so that they have time to process the news. Maybe incorporate grief support when the patient’s care plan is developed. What I learned from my family’s experience is the grief is fundamentally misunderstood in our culture. That whole “7 steps of grief” concept is bunk. No one grieves the same way, follows the same process and grieves for the same amount of time. I know this because I now use my experience to support others through an online palliative care and grief community.In my opinion, a range of grief support options should be offered: online communities are great for those who want self-serve support or who live in rural or remote areas where group support is not available and councillors are few. More group supports could be created through cancer centres or hospitals and social workers should encourage patients and family caregivers to attend. Also offering publicly-funded access to psychologists to patients and their families would also be helpful.
  • Gramps1 5 days ago
    The best time to introduce grief support is when a person describes a significant personal loss. It is often associated with the death of a person. But it may also be with relationship loss, job loss, change in status, etc. Grief support is appropriate and helpful before the death of a person, particularly following a life limiting diagnosis or a quality of life limiting condition. Known as anticipatory grief, it may be more complicated since it may be seen as just ordinary coping mechanisms.It ought to be offered in psychosocial spiritual support settings in community services centres, family health teams and community outreach programs.Ideally, Bereavement support after death ought to be present and embedded in communities on a short term basis as well as as long as the bereaved wish to access support.It can be shaped to offering a variety of options - small group settings, one on one therapy, open and closed groups focusing in Bereavement support. Public health focus is very appropriate in educating the community on the importance of grieving and describing models of support and caring.
  • SLD 5 days ago
    I volunteered for many years in palliative care, and by becoming used to normalizing death I found that when my parents passed, I still grieved, but I understood so much more about it than let's say my siblings did, even though we were all over 50 years old. They had very little exposure, and seemed to fight the feelings that come with it. I know it's not everyone who is meant to volunteer or work in palliative care, but as a society, we definitely need to strike a better balance because we all inevitably deal with grief. That also goes for the person who is dying, because they also grieve in their own way.
  • flowingbrook 5 days ago
    1. Offer grief support immediately after death.2. Support should be offered indefinately.3. I don't think its necessary to offer grief support before death because most people in my experience can't even believe that their loved one is dying.4. By offering everything that is available and the individual can choose which avenue to take.
  • Sab 5 days ago
    I believe that we need to normalize grief and the notion of death. As soon as someone is receptive to support it should be available. Also, more than a few days off of work would also be valuable. Support should be offered for quite a while after death as it's possible that the reality of the death may not settle in for some time
  • Tia 5 days ago
    The experience of grief encompasses far more than the loss of the physical presence of a loved one, it also involves the change in plans, the death of hopes and dreams, a re framing of ones life and priorities. Grief support should be made available immediately and continually available for at least 18-24months after loss. As mentioned below, a type of EI or leave from work that is flexible within that first year would be beneficial. For example, sometimes a person 'needs to; work immediately after a loss- for their own sanity- but 6 months later, the grief hits hard and they are no longer able to receive any support. since everyone processes grief at different speeds and in different ways, flexibility and availability is imperative. Employers may find this flexibility a challenge at first, but if they address these challenges head on, they may well find themselves with a more stable and reliable employee in the long run.
  • grief18 5 days ago
    I definitely think that there needs to be more support for time off of work for the bereavement period as workers are often "lucky" if they receive 3-5 days off of work, which is nothing when we consider the grieving process to be so complex and not to have a time table associated with it. EI compassionate care should definitely include time off for bereavement, whether that is up to the 6 months max or as a separate EI. I had the young adult son of one of my patients who was going to have to quit his job as he could not function at work, and with no family doctor to support him in taking medical EI given his inability to function... I always encourage people to start EI Compassionate Leave sooner rather than take "vacation time" as they will likely need that for their grief.
  • Stdenis 5 days ago
    I have been a grief facilitator fir several years and have found that when clients are anticipating the death fir a lived one they grieve better as they come to accept their date. There is no set time to receive grieving services but one needs to confront their grief in order to move on. We offer 1:1 ( for those who lives with complex variables) and group services
  • nottheaveragejo 5 days ago
    The best time to talk about grief support is anytime and regardless of age. If we can talk about grief and normalize the need for grief support when it is not needed or required, they will know it exists when they do need it. Grief support should be offered to individuals/families as soon as a diagnosis is made or unexpected death/trauma has occurred. Printed or online resources should be provided during this conversation so they can follow up and look up information at their own pace. Grief support should be discussed and offered multiple times throughout the diagnosis and over the first year of their loved one’s death as their needs and personal support network may change over time. Grief support should be available at any time (even if years after death) a request has been made. This support needs to be offered to ALL ages and provide options to encompass culture, personality, character, cause of death, age and economic status. Listen. Listen to see what the specific needs of the individual and family are. If there is a variety of bereavement resources and opportunities available, these can then be adjusted to meet the needs of the individual. The ideal wish list would be to have a variety of programs, opportunities and formats for grief support: one on one counselling. online resources, books (to read and audio), physical groups (walks, hikes, biking, yoga), bereavement groups (general, spousal, child loss, parent loss, teen, preteen, child, cultural specific etc.), mindfulness groups, peer support, drop ins, art therapy, music therapy, grief dinners/potlucks, one day retreats, and workshops on specific topics that address cultural and personal needs (finance, cooking, practical skills etc.). The basic list should include: affordable or free bereavement counselling, online and printable resources, support group and access to quality online bereavement programs. This support needs to be affordable or free to the bereaved individual. Those on fixed incomes and in rural communities should be able to access the same supports.
  • caringkim 6 days ago
    Grief support, in the form of anticipatory grief support, should be offered as early as possible - starting at the time of diagnosis or decline in health. There are many losses experienced along the journey of an illness and the more support available the better chance that the client, caregivers and loved ones will be prepared to cope with changes. There is no timeline on grief. Support should be offered as long as required, and as many year later as required. Sometimes people are so caught up with the shock of a death, and all the "responsibilities" (funeral planning, deciding what to do with personal belongings, selling house or moving, updating banking, bills, etc) after a death that they may not have the time (or desire) to face their grief head on for many months or even years later. Support should be based on what each individual client needs - client centered care.
  • br 6 days ago
    Considering anticipatory and complicated grief......support should start at the time of diagnoses. The length of support definitely depends on the individual(s). I do not believe you can put a timeline on how long grief and bereavement support should be offered. I also think an important questioned was missed: how do we provide equal access to all? Many rural residents have no access to grief and bereavement support. It may not be possible to always have face to face professional supports in rural areas but all rural residents should have access to the very best current technology to access the same supports and resources as urban.
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    • nottheaveragejo 6 days ago
      Rural communities do not have the same resources, affordability and/or variety as cities. This does need to be addressed and improved. Access to excellent, current technology so rural individuals may access support and resources is a good suggestion.
  • Shannon Furey 6 days ago
    As someone working in a rural setting within a large geographic area, I think that offering support can happen when we initiate palliative services. I also follow up via letter 1-2 months after the death, to offer my support. I do not get a high volume of uptake on my counselling services, but those who do contact me are able to engage in meaningful services as they present with the readiness for help. Greif processes are dynamic and affected by so many factors that I think we need to be road about availability of services and the timing on when to offer them. Specifically during palliation and at any point for 1-2 years following the death would be my personal opinion.
  • hospice 7 days ago
    The CHPCA attests that caregivers who are better supported, informed and empowered are able to provide better care. Werecommend that federal/provincial and territorial governments extend their compassionate care benefit (CCB) programsto include a 2-week bereavement period, and that access to culturally sensitive and language appropriate resources isimproved, including online supports.The CHPCA also recommends a targeted education and awareness campaign about the availability of resources for caregiversand healthcare providers to generate more public pressure for caregiver needs. Finally, the CHPCA recommends that anexpectation be set at all healthcare levels for providers to assess caregiver quality of life as part of routine practice and tomake caregivers aware of tools and resources that exist to support them.
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    • Hopeful Advocate 6 days ago
      Indeed. The outcomes of each recommendation are much needed change, and would go a long way to support so many, who, at present, are often left to navigate scarce resources in silence.
    • ssadava 6 days ago
      I strongly agree. Caregivers are an immeasurable resources for health care, and must be supported
    • nottheaveragejo 6 days ago
      The 2 week bereavement period extension is a great suggestion. Often caregivers are exhausted on all levels after caring for a loved one. To go back to work right away is often too difficult and many people request a leave of absence and time off to attend meetings connected to estate issues. A greater understanding of resources available in our communities and online will be beneficial to all who provide care.
  • dream 6 days ago
    1. As early as possible, whenever people are ready and listening. Even if they did not think they need it, it can help when loss occurs.2. As long as they feel that it's needed. Consider bridging peer support with general social support, and community awareness. 3. Yes, with the opportunity to resolve things before the person passes! The same way you would during and after, perhaps with more couples/ family/ groups counselling and mediation.4. Have various formats, listen to clients, be creative about community collaborations.
  • PAILNetwork 6 days ago
    At Pregnancy and Infant Loss (PAIL) Network, we offer peer led support to families in Ontario who have experienced the loss of a pregnancy or the death of an infant up to 12 months of age, including babies who have died unexpectedly. There is no time limit on grief, and as such, there is no time limit on grief support. We have families who return for support with certain milestones, and families who experienced their loss more than 15 years ago but never had an opportunity to talk about their baby. We feel that all families who experience a loss should be aware that support is available to them and they are not alone in their grief. The uniqueness of pregnancy and infant loss often means that families don't feel they belong in a more typical bereavement support venue and many families report that their grief is pathologized when they have sought support from professionals. When families are aware that a loss is imminent, it's important to ensure that their emotional needs are prioritized to support a normal, natural, and expected grief response.
  • Kate 14 days ago
    When to offer grief support is a great question!I think awareness of support should always be available!Education regarding the effects of grief should be constant. As a Bereavement facilitator for the past 17 years ... I feel that the 3 month window after the death of a loved one for formal support is appropriate.Some are ready to walk through programs earlier ... it is not easy to identify always.How long? Hmm... we offer an 8 week program ... with an option for another week. People take it!We also offer a chance to continue to meet informally.... there is no recipe when people are ‘better’I am an advocate of supporting those before death. I think the biggest and most important thing is education! As a palliative care volunteer we have ample opportunities to connect with those before death. Increasing access and awareness to palliative care would be a great start !To support individual needs create the opportunity for access and education
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    • ssadava 6 days ago
      To all of the above: well-considered discussion which shows the complexity of the problem. While I insist that we not treat grief as a pathology that need treatment, I can also appreciate that access to appropriate supports can be a public health imperative that increases the effectiveness of caregiving, attenuated the risks of both caregiving and loss, and attenuated the risks in bereavement.
  • BGoossen 6 days ago
    Thank you so much for this discussion. Grief is that "invisible wound" that requires care and support throughout the trajectory of loss. In my area of work, as a palliative social worker, I am specifically aware of the challenges faced by children, teens and young adults. Support is required, specifically after the death, and I believe it is imperative to have the system - government, health care services, non-profits and educational bodies embrace the trauma and complexity that can present during grief stages.
  • ltwaj 6 days ago
    Reading some great comments here. I am most concerned about access and availability of professional services from a rural perspective. I work in a rural visiting hospice and I think we do a great job supporting grief and bereavement with many programs but all manned by volunteers. They do a fantastic job and meet many needs but when it comes to complex issues there is no one to refer these people to. Some people can not drive the distance to a professional councillor, some people can't afford the transportation and most can't afford the fees associated with professional service. I agree that supports for grief and bereavement needs to start much earlier ---------perhaps at time of diagnosis. This could all fall into place if we could get appropriate referrals for palliative care earlier in the trajectory of care. Education, education , education
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    • ssadava 6 days ago
      I agree that well-trained volunteers can provide xcellent care, with appropriate background and backup
  • mj 6 days ago
    Grief is such a multi-faceted experience that can come up for individuals even before a loved one is accessing palliative care. There are "invisible losses" that occur such as perinatal loss, the ambiguous loss one experiences as they support a loved one diagnosed with Alzheimer's disease, and the anticipatory grief that comes into play when a loved one has received a terminal diagnosis. Assessment and support regarding grief should be occurring before the death in these circumstances. This could help normalize their grief journey as it begins to unfold, and can act as a reminder throughout the palliative process that support is available before and after the death. I would recommend that this support should be available to those first accessing the LHIN for palliative or in-home care support. This could be complemented by offering caregiver support groups or programming for individuals to come together to discuss challenges, highlights, and their feelings of grief.Many individuals I have offered peer support to outside of my current role often state that they are unable to address their grief until a few months after the loss. They share they feel that they are "in a fog" and can focus on basic tasks to ensure they are following through on their responsibilities (i.e. funeral planning, paperwork, wills, going back to work, etc.). This support should be available for a year after the death, but should individuals wish to access support beyond this point, clinicians should be flexible. Whether this flexibility allows individuals to access support groups, individual support directly, or a referral to a local and affordable agency will depend on what services are already available within the organization.There are universal emotions grieving individuals may experience such as guilt, anger, and sadness but their own process will be incredibly unique depending on their relationship with the deceased, their cultural/religious background, and social location/intersecting identities. Creating programming to meet these diverse needs, and training for working with more vulnerable populations within the palliative care field should help clinicians and agencies offer appropriate services to meet each individual where they are at.
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    • ssadava 6 days ago
      Yes
  • Wewson 6 days ago
    The best time to introduce grief support is when the client either asks for support or appears to need support. Anticipatory grief is very common before the actual death. There is no time limit to grief and everyone grieves differently. Some people seek support right away, others find they hit a wall and seek help long after the death. As professionals, supporting someone after the death depends on the SOP's of the agency or practice. Typically it is one year, however oftentimes the second year is harder. The individual experiencing the grief is their own expert, we are their students. They will indicate through their needs what support is best suited to them.
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    • ssadava 6 days ago
      Yes, well said.
  • CanadianVirtualHospice 7 days ago
    Grief for an individual and the family often starts as soon as serious symptoms are recognized and ultimately when the individual is diagnosed with a serious illness. Family and friends grieve many losses and changes as a significant person in their life lives with a serious illness and as they anticipate the loss of that person. It is important to introduce grief supports long before the person dies. Supporting a person through their grief prior to a death begins with helping people to understand that grief is a normal process. It is important to offer space for a person to openly express their thoughts and feelings. Often, people avoid talking about the future because it takes a lot of emotional energy to deal with what is happening in the present and sometimes people need help and support to express that. For both the individual who is dying and the family members, opening up the process of communication can help them regain emotional energy to live their life as best as they can during this difficult time. Grief supports should be offered as long as there is a need. Grief is a very individual process and grief takes as long as it takes. There isn’t a specific time period for grief. There are different times in grief experiences, it’s an up and down process and people will continue to visit and revisit grief. Grief support can be shaped to individual needs by recognizing that individuals come from all different backgrounds and will require different types of supports. It is important to acknoweldge and cater to those differences and if possible, offer various types of supports such as one-on-one counselling, group sessions or online grief resources. The programs and services section on the http://VirtualHospice.ca website features grief support services available across the country, in addition to written and video content on grief and bereavement for those who prefer to seek out information on their own. We’ve also developed two free online self-directed grief resources, with the help of national and international grief experts. http://MyGrief.ca, winner of two national innovation awards, is a series of online learning tools that enable people to move through their grief from the comfort of their own home any time of the day or night. http://KidsGrief.ca is a series of bilingual learning modules that equips parents with tools to have difficult conversations with their children, support them with their grief and help them develop healthy coping strategies. We will be expanding our grief resources with new modules in the upcoming year.
    Hide replies (3)
    • Hopeful Advocate 6 days ago
      Well said Canadian Virtual Hospice. I completely agree. The diagnosis of a serious illness impacts individuals and families of all ages, often resulting in feelings of uncertainty, isolation and grief at time of diagnosis (long before death itself). Acknowledging the multitude of these losses for individuals and families that occur throughout the illness certainly warrant validation and support. As a longtime clinician and educator, I consistently refer individuals and families of all ages (as well as learners in health sciences and multidisciplinary healthcare professionals) to CVH to access the brilliant range of compassionate, accessible, FREE resources available on the CVH site. I am a big proponent of http://www.mygrief.ca/ and http://kidsgrief.ca/. I also routinely refer to http://livingmyculture.ca/culture/ as another means to explore coping with the illness and multitude of losses from diagnosis to bereavement. Am truly grateful for these brilliant CVH resources creating safe spaces for people to explore, and begin to cope with, serious illness, grief and loss.I hope that the government of Canada, each of the provinces and territories and each healthcare organization will explore these essential conversations including the multitude of losses (physical, cognitive, emotional, practical, spiritual), the unique and varied means of coping, and the essential support needed for individual and families of all ages following diagnosis, throughout the illness and into bereavement.
    • BAR 6 days ago
      100% agree with and echo this post by VH! Thank you. Grief is not a problem to be fixed, but an experience we all share by virtue of being human. Knowledge about, validation and normalizing the grief experience is vital to mental health for all folks as grief arises from losses of all kinds. There is no timeline, every loss evokes a unique grief response and how people metabolize their grief and learn to live with their losses in a healthy way is different for every person. I believe that caring for someone to the end of life and companioning someone on the grief journey can be manageable and meaningful for all involved if people are given adequate and ongoing support, information and space to explore and understand their grief in the unique ways that make sense to them.
    • ssadava 6 days ago
      Well, I agree somewhat. We must recognize grief as a natural, human reaction, not a pathology . Yes, people “move through their grief”, but not in a defined, prescribed sequence. Grief is a process but is individual to the person, the nature of the loss and the attendant circumstances. Loss of a spouse through bereavement is not loss of a spouse through marital dissolution, and both may involve grief. Loss Of a spouse is not the same as loss of a close friend or relative, loss if a child or loss of a parent. All involve grief in some form
  • pearl 6 days ago
    Grieving is a personal experience but the more information we have about what to expect, the better. Thus being aware proactively about grief support is beneficial. Grief support up to a year after death is reasonable. At a year, if the individual is not moving through the stages then counselling is likely necessary. Before death, there is a grieving for loss or change related to a diagnosis, so yes it needs to be available in the form of support services associated with the diagnosis: for example a cancer center. Coaching or counselling would start the assessment of need, and move from there to a support group, or individual counselling as assessed.
  • jkatan 6 days ago
    Grief support could be offered to caregivers before palliative care. Information/awareness and support curriculum could be developed by health Canada and national organizations could deliver the assistance/training to caregivers - or the federal government could specifically allocate money to the provinces with the caveat that education/awareness programs be developed. Materials could also be delivered by social workers who work at hospitals, etc.
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    • Lori I-B 6 days ago
      Not just social workers but nurses and physicians. They are more responsive when materials are available.
  • Sislin 6 days ago
    So many excellent comments. As a long time hospice/palliative care worker I have learned so much just by being with people who are living until they die, their caregivers and other supporters. There is no time limit for grieving. Some people are so busy after a person dies just taking care of the business end of dying. It takes so much time and energy there is not enough time to do anything except cope with tasks. Who are we to judge how others feel? Death is a natural part of living yet we are such a death denying culture. One person commented on teaching children at a young age and I agree with this. The cycle of life with birth, living and death. Many children have experienced the death of a pet, a friend, a grandparent and those around them have no idea how a child grieves or how to help them. Elderly people or those with a terminal illness may want to talk about the end of their life but how many family members or friends don't or can't hear what is being said. It is not helpful to say to them don't talk like that, you will be here for a long time. They need to be acknowledged.Use the name of the person who died, send a card or call on the anniversary date. It does not hurt them more. In fact they are so appreciative that their loved one is being remembered. I have found in my hospice work that an initial sympathy card followed by a call every few months is beneficial if the person wants it. ASK!!!Admission to hospice is coming later and later and families and friends are not feeling the benefit of the hospice support that enables them to see and be part of the dying process which can be such an amazing time of growth and healing. Hospice is not a dying place but a living place. Healing touch programs can be very beneficial to those who are grieving. Sometime the more informal visits, phone calls, doing little chores and sitting with someone with a cup of tea are more beneficial than scheduled "counselling". Not everyone is comfortable in a group of strangers even though groups can provide amazing support. Many programs have a cost and for some it is difficult to attend especially if they need transportation or child care. I envision a traveling grief support care team that would follow up with family members, again if they wish it. The community bereavement programs need to be more widely advertised and first line staff need to know these organizations exist. Doctors, nurses, social workers etc should have bereavement resources ready to hand out when there is a life limiting diagnosis. So many people say months after a death, if I had only known you were there, I could have used you, etc. We need to work together to spread the word about the importance of grief education as the need is growing.Governments provide funding for bereavement programs, include death education early on and especially in medical, nursing and social work programs. Dying is a journey that we all will take and it would be so good to know our loved ones will be supported after we are gone..
  • ClinicalPsych 6 days ago
    Grief support should be introduced as soon as the person's life is 'altered or impacted' negatively by the terminal prognosis of their person.There is no time limit on love so there should be no time limit on support for a loss. If after 6 months the person is still in the early parts of grief, then a different type or strength of intervention may be required, as is the case with complicated grief. Yes. Support that allows the person to feel heard, focused on, not alone, and one where others understand their feelings is a vital part of surviving grief.All support should be customized, that doesn't mean creating new programs for each person, but it does mean having a moderator that understands each person abilities, stage, and willingness. Grief is not a case of taking the horse to water and expecting it to drink, it is a case of understanding that even though the horse may be parched and suffering from thirst, you put the water down and let them drink when they are ready. Kindness + Patience = support.
  • lorlorntor 6 days ago
    I like the comments by "listening"; it is crucial to listen to the patient and to their loved ones, to be at their service as long as they need.
  • 32wallace 6 days ago
    I think it can be offered when any loss is strongly anticipated or experienced
  • ynal 6 days ago
    Although an individual thing I have found as a volunteer doing bereavement sessions with people they need some time from 1 to 6 months after death to be able to process. I have found that for the most part they will let you know when they feel they can carry on but some are afraid to let go of support, these can be further assisted with day programs or monthly get togethers. For some they ask for assistance when their loved one palliative during anticipatory grief and it is offered. To make it individual a thorough assessment needs to be done.
  • bjpalliative 6 days ago
    Grief support starts when the patient feels the loss of their job, independence, close friends, whatever they define as a loss, due to a diagnosis of a terminal illness. Support should be offered for the rest of the patient's life, then to the surviving family following the death, I would suggest for 6 months, if needed. People living in rural communities often take on the "self reliance" role and don't ask for help. It needs to be offered to them, as a matter of course. Grief support groups are not for everyone, so one-on-one support, even if it's just a good old cuppa tea and a "chin wag" can make a huge difference.
  • seadreamer 6 days ago
    Grief support is important for the individual and family members to have to as soon as a diagnosis is made. Not everyone wants or needs it. It is best to offer the support, and let them use as they wish. A variety of supports can be made available including reading materials, online support, one to one from a professional, one to one with a volunteer, one to one with a peer who has experienced a similar loss, group support that is structures and groups that are not structured. There is also a need for options for resources that address a variety of cultural/religious/spiritual needs
  • Arborcare 6 days ago
    1. this depends on the situation, if a person is dying family members may need grief support in anticipation of they death. If this is a sudden death families may need grief support there and then but again depends on the situation and who is offering that support.2. How long should support be offered? Depends on the needs of the person grieving and the type of death & relationship.3. Better to ask the grieving person "what do you need" "how can I support you"4. Find out what the grieving person/family need. A support person is their to listen
  • Holly 6 days ago
    Grief support can be started soon after a death by a simple acknowledgement of the death such as a sympathy card. After that people often need time to deal with there families and immediate issues when there is often lots of support available. After 2-3 months it would be appropriate to offer grief support in a more organized setting. Sometimes that date can be moved up a bit if the griever has gone through a time of anticipatory grief.
  • bg 6 days ago
    I think that all depends of the situation: how, when, causes of the death, etc. If it is expected, unexpected, etc. Every person is different and reacts in different ways to the different types of losses suffers along his/her life: the loss of somebody, a pet, a job, etc. When the death of a loved one is unexpected and abrupt grief support should be offered inmediately. If not, I think that health care providers should do a good assessment and offer it to those in need and in the moment needed. That is, before or after the death occurs depending on each indivicual person.Knowing the person (family, friends, etc.) involved in the process and also the history of his/her (their) live(s) is essential. Also understanding the relationship they maintain or maintained with the person will die or died. In this way a personalized and effective growing support can be provided that really answers to the individual needs to prepare to the future loss or to face the situation.
  • BCBereavement 6 days ago
    The option of Grief support should be introduced at the moment of the diagnosis of a life-limiting illness, death or disaster (wildfire, hurricane, flood, etc.) that has resulted in the loss of life, home, pets, job, or relationships. Everyone deals with their grief in different ways, and the option for grief support should always be available at any point along their grief journey.Grief support should be offered at any time after a death or disaster. Some may want support right away, others may look for it a few months or years after the event. And even others may not be ready for 10+ years. Anticipatory grief is a reality for those who have a loved one, or who are supporting someone who has a life-limiting illness. Grief support and care for the caregivers is very important. Support before death can be similar to support after death: support groups, 1-1 counselling, recommended readings on coping with grief and loss, art therapy, exercise and more. Everyone deals with grief in their own unique way. They bring with them their life and family experiences in their own grief experience. Varying support options should be offered in order to meet individual needs; support groups, support groups based on a specific kind of death (homicide, suicide, substance use, spouse, child, etc.), 1-1 counseling, art therapy groups, walking groups, online chats, recommended readings. As noted in other submissions, affordability is very important. Many cannot afford the counseling or group fees that are charged. Nonprofit organizations offering free/low-cost options often have waiting lists. Rural residents have a hard time accessing options. a real challenge in today's world to offer support in so many ways, that can be affordable!
  • hopeful caregiver 6 days ago
    I am hopeful that grief will finally be recognized and acknowledged as a normal part of loss. Where there is a loss experience, there is a grief experience. Since we all experience our grief differently and there are many variables that contribute to our experience of grief, the support made available should also be varied. Caregivers and families as well as the individual with the illness will have different needs, but if we don't acknowledge this as part of their experience, then we are not offering them all that palliative care can. Communication, understanding what is influencing their grief experience, the support they have available to them in their communities of care and access to formal grief support through counselling, psychotherapy, support and psycho-educational groups etc... is what is needed. This can not be a one size fits all approach. Health care providers also need to learn more about grief and how to communicate with those experiencing losses. Educational institutions and curriculum needs to assist in developing competencies for helping professionals. Unresolved or unexpressed grief can be a precursor to health problems and therefore it is essential that it is supported through communities and professional help is made available through our healthcare teams. Proper screening and assessment of caregiver and families needs should be part of care provision.
  • One mind 6 days ago
    When is the best time to introduce grief support?Grief is a natural part of life and should be normalized in everyday conversations. Grief wording should be adjusted to the level of the audience, feelings of being sad. Grief needs to be taught to all ages in this manner, everyone understands it and can offer appropriate help. Sometimes supporting someone suffering grief is to just sit beside them an say nothing. How long should this support be offered after the death?Grief counseling should be provided, as needed and as required. people all grieve differently, some dramatically right away, some people like to be left alone and others may need six months or a year before they are ready to admit they are grieving. The Indigenous populations is handling generations of grief in their DNA and multiple episodes of grief back to back. How many people lose three of their family members in one year or in less time than that. Then you are required to care for a dying family member. The aspect of grief is very complicated, as many options as possible in as many opportunities as possible, quick flyer, inspirational quotes, memory jars, tips of managing day to day, rewards.Grief counseling should be offered before death because the patient themselves are dealing with their own personal grief, what I did not complete in life, where is my family going to go? will they remember me? The family members of the people taking care of the patient are grieving the moment they start looking after their family member. They need to be supported as they go along. My father died a couple of months ago, we looked after him for 3 years, our grief started immediately. Families need to understand together and help each other. any family member that helps cut grass, get groceries, do an errand, in their mind they are helping just as much as the person by the bedside. Even if they cannot go into the house to help, they are still helping and this needs to be recognized as help. We all have to learn. How can this support be shaped to individual needs?Listen, to what the person wants. Sometimes they just want someone to listen to them. Sometimes people have cultural traditional beliefs, sometimes they want to share their stories and sometimes not, this needs to be respected. Ask questions, one size does not fit all. If the person requesting support is outside your sex, religion, belief system, income bracket, other side of the street, other part of the country, out of the country or a combination of all of these, we need to be respectful and ask ~ how can I help, nothing more.
  • Bonnie 7 days ago
    Before death and for as long as the person who is grieving needs it. Not sure how it should be shaped to individual needs. I think we as a society need to talk about death openly and be honest about our fears. We don’t do that now. We are afraid to talk about end of life issues.
  • tig 7 days ago
    Grief support should be offered prior to death, knowing that everyone goes through the grieving process individually. Some people will be ready for support prior to, immediately after , a month later or some longer timeframe after a loss. Support can be offered prior to death as simply compassion to listen to the issues and feelings prior to death. Some people may want to talk, some may not and some don't know until they experience someone speaking with them. Some people can voice their need and some can not. I think grief support can be offered at any point along the journey. For some people they do not need support until some life experience takes them back to their loss. Grief is not linear.
  • mfrog 7 days ago
    I think there are different circumstances for each introduction of grief support. I grieved my mom who had alzheimers long before she passed away from it. I could have used some support then. I have stage IV cancer, have had it for 4+ years, I don't need it right now, nor does my family, but at some stage it will be required. But I have never been offered any support, which would be nice to know if it's there.
  • Iam14thone 7 days ago
    It should be offered Before death so that one can prepare and know how to pass the last days with our loved ones.
  • palliumcanada 7 days ago
    Grief and bereavement is a critical aspect of palliative and end-of-life care and Pallium has incorporated modules on grief in all its LEAP courses. This grief often begins at the point of diagnosis with the anticipation of loss and continues throughout the course of treatment, palliative and end-of-life care, death, and beyond. We understand that the patient themselves, as well as their family, can and will go through the grieving process and we want to equip health providers with tools and skills on how to differentiate a normal grief response from a complicated grief response and how to support those individuals. Furthermore, anyone connected to the patient will also go through the grieving process: family members, friends and even the health providers themselves. This is one way in which Pallium’s work on Compassionate Communities integrates with its LEAP courses; the community coming together to support those grieving and going through bereavement, and shifting the culture around death, dying, grief and bereavement in Canada. We want to provide supports for communities across the country so they can create safe environments for those who are grieving to open up about their feelings towards death. An example of this is the concept of Death Cafes, where individuals can meet with friends and strangers to talk openly about death with a goal of raising awareness about death and helping people become more comfortable with the subject and make the most of their life. We believe strongly that provincial, regional and local partnerships are essential to provide effective support for communities and caregivers across the country and we are committed to working with and building these partnerships as we advance our work on Compassionate Communities. Such an approach creates a diverse, connected network of support that allows the individual experiencing grief to engage with supports in a manner an location that best suits their needs.
  • hospice 7 days ago
    CHPCA recognizes that grief is a complex process and that those who are bereaved need adequate time to process and workthrough their feelings. We recommend that compassionate care benefit (CCB) programs across the country include a 2-weekbereavement period for individuals to mourn in the ways most meaningful to them without fear of reprisal of loss of incomefrom their employment. The development of tools and resources that address overall wellbeing, including mental health,can support the grieving process for caregivers and those closest to a patient who has died.A requirement for healthcare providers to routinely assess caregiver quality of life can help identify issues and emotionalneeds that are part of the grieving process, and provide more opportunities to facilitate the delivery of support services.Support for volunteers is also essential to help ease them through the grieving process, and culturally sensitive, languageappropriate supports can assist the grieving process at the community level.
  • hospice 7 days ago
    grief and Bereavement supports are often offered by residential hospice and some acute care palliative care programs but most of these costs are not covered by the health care system and they should be. Also the CCB should allow for a bereavement time of two weeks so that the benefit ends not on the death of the patient but two weeks after. These programs are important and should be expanded and offered before and after death.
  • Maryisarat 7 days ago
    Offer grief support as soon as a probable terminal prognosis is made...recognizing that the individual and the family/friends might not be ready to accept that. I'd say support should be offered for at least a year after the death - to help grieve through all those first anniversaries of the person being dead. Might need to be a lot longer if it the deceased had a lot of difficult relationships - more counselling might be needed for those still living.
  • cmakwana 7 days ago
    Grief support should be offered as soon as the patient has been diagnosed with a terminal illness.Should be offered for at least 6 months.Yes it should be offered before death so the patient feels needed and not afraid to die.It should be offered and catered to the individual's culture.
  • Blackman 7 days ago
    Grief begins when ones lifestyle changes and if one is facing the lifestyle change of a family member grief becomes a part of the process. Grief support is different for each person and should be available for 1year minimum. Not all will avail themselves of grief support because family and or their spiritual community will step up to providing support during this time.Yes if the family would benefit from the changes palliative care possess occurs and especially if they recognize they would benefit from grief understanding and support.
  • miserator 8 days ago
    Grief support should start as some as care is moving towards palliative as opposed to curative. Does not have to be huge support at the beginning but as long as patient and family know something is there for them and they can contact the support at anytime. Support should be offered anytime after death. For many of my patients, who are often exhausted and a bit stunned every thing is "over" so to speak, grief is often delayed; some for months. People need support when the need it, so it needs to be available at anytime. Provide families and friends with contact information for support and check-in with them for a few weeks. This reassures them someone is there.When you are told that you have a life limiting disease grief starts immediately. What you "thought" your life was going to be is likely now very different from your "plan". There is loss from the moment you/your family are told you are palliative and the loss can touch everyone. If your Mom hoped you would care for her in her declining years, not only is facing the loss of her child (even if your are 60 you are still your Mom's child) but the loss of the plan of her final years. A business partner may face the loss of a partner, supporter, friend. My point being that loss is HUGE, multifactorial and poorly supported more often than not. With many folks beyond our patients facing loss of our patient and that can occur at any point in the journey. Providing contact info and a quick face to face with palliative support team member at the start of the journey and then checking in with all parties from time to time and sometimes just making sure everybody understands it is ok to grieve at anytime. The truth is better palliative care with teams of trained physicians, nurses, allied health members who work with groups in all areas such as renal, dementia care, oncology, Respiratory, cardiac, etc. is how every aspect of palliative care needs and should be addressed.EVERYBODY dies, so why do we do this so badly?????
  • HPCReady 8 days ago
    Grief is a natural part of the human experience. Grief would be appropriately introduced in elementary and secondary school education. There is never a wrong time to introduce the topic of grief, and to explore with others – whether they are children, adolescents, adults or older adults.Grief literacy should be embedded into our natural communities, wherein informal grief support is received. Through community centres, family health teams, religious communities, and schools.For the person and family through the advancement of life-limiting illness, there are many consecutive losses. Before death even occurs, grief begins as an acknowledgement and processing of loss and those losses to come. Formal grief support should be offered soon after diagnosis of a life-limiting illness, as it is in funding-limited supply through Hospice programs. Such programs could also be imbedded into the work of family health teams, leaders in religious communities, counsellors, and community programs. There is no reason that access to grief support should be time limited – rather, that people should be directed to grief support programs when they identify that bereavement has precipitated their grief experience.High-quality, evidence-based grief training is a necessity for those providing any form of grief support, and needs to be connected to formal health care support, for continuity. Support needs to be individualized to the person and/or family. System structures need to be committed to high-quality services with trained, knowledgeable providers (formal and informal), and accessibility that is informed by the grief process and accommodates the individual griever.
  • Globalschedule 11 days ago
    I'm sure that different people respond differently to grief so there maybe several good options. Options therefore may be the answer. When my husband was ill and his medical team was switched to palliative care, I could have benefitted greatly by some sort of counselling, or just someone to talk to. He was at the Ottawa General Campus and the nursing team was amazing to me. But they weren't there for me and didn't always have the time. I think, along with introducing palliative care, an option for grief counselling (by another name) is apptoptiate.
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    • TiredCarer 8 days ago
      Perhaps integrating a social worker into the Palliative Care team can be a good first step in providing bereavement support. The social worker is part of the team - available to everyone - you don't have to have a "problem" or be referred. The SW could also get to know the patient and caregivers and journey with them through the dying process and bereavement. Wouldn't be a stranger coming in.
  • Support4u 8 days ago
    I think patients and caregivers need to be aware of grief support as the prospect of death becomes imminent. In the very beginning of a terminal diagnosis it may be too overwhelming or TMI to be given information about grief support. However, after the initial shock of a terminal diagnosis sets in people need information about what resources are available to help them navigate through their own distress. Bereavement support should be offered for at least a year after a death even though it may take awhile before they are ready to accept that help.Gentle reminders to caregivers that support is available to them can be given before and after death. Everyone in a care team need to be aware of follow up services and to tell caregivers how to access support. Caregivers often have difficulty retaining all the information that is thrown their way. For that reason I suggest formation be given both verbally, in writing and repeatedly. Grief support can come in various ways: individual counselling, drop in groups or time limited (6-8 week) focus groups. Some groups are for widowed survivors, some are general, some for immigrants, some for indigenous people, etc. It must be welcoming and easy to access.
  • pcresearcher 8 days ago
    The need for bereavement support is undeniable, as many of the comments below attest. The earlier timing is also important, as the grief process often begins before the patient's death.I think it is integral that the government come up with a plan to sufficiently fund bereavement support. There are limited funds and severe gaps in services in mental health supports across the country. I would like to see a clear action plan for how bereavement support could be provided in addition to existing mental health services, and alongside palliative care supports for the patient.
  • hfbkn 8 days ago
    The best time to offer grief support is at the moment of diagnosis or when clients and families start to show grief (whichever comes first). The support after death should last at least a year; if people need longer, there should be ample resources on where else to go (e.g., community mental health, private practitioners, religious communities, etc.). Support should absolutely be given before death; the grieving process starts long before the death of a person; preparation for grief should also be offered. This support should take into account the medical, physical, psychological, and spiritual needs of the person and their families, no matter how "ridiculous" those needs may seem in a Western medicine framework.
  • Jasper 13 days ago
    I am a counsellor and believe that grief support should be provided to the dying person, and their family, as soon as they receive a terminal diagnosis. I think it should be available for the family for at least a year after death, and sometimes two years.
    Hide replies (2)
    • Sabuki03 12 days ago
      I agree. We had a counsellor when my husband was DX with glioblastoma, and throughout to death. We were ready by that time, as we could be. What we didn't see coming was a massive arrest and court case for the worker in hospice who was stealing his pain meds in the last days of hospice. A few months after his death. As ready as we were for what I saw coming, I was floored by what was done in the last three weeks of his life. The guilt has been so heavy on me, I have struggled to get beyond that part. I replay those days every day, and it's been three years....
      • Egal 8 days ago
        I can try to assuage your pain by saying no one would ever expect to have to watch a hospice worker, , and when you're losing your spouse, you are suffering significantly throughout this process. Because this is still eating away at you I hope you will consider seeing a therapist to help you put this horrible behavior of someone you should have been able to trust behind you, and allow you to let go of the guilt you're holding onto for not noticing. You've suffered enough. I'm so sorry for what you've experienced.
  • geb 12 days ago
    Grief support needs to be introduced at the time of diagnosis, for the patient and their support network.After death - the immediate family member, such as a spouse, needs that support and it should be integrated with support for the various paperwork that comes including the final tax return. Yes - before death - it needs to be part of the medical support team with the patient. However, if the patient is not open to having family ones included, there is not much one can do in that case.
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    • Egal 8 days ago
      I understand that the person with a terminal diagnosis could benefit from counselling to help them come to terms with their prognosis, but I don't understand why they should have any say about who can and can't utilize counseling for grief support. Having therapy together is another issue, however, and there can be many reasons why individual therapy might be better in some cases and couples or group therapy might be better in other cases. Support should be offered in some form as soon as the diagnosis is given, because grieving begins then, and it should end when the person feels they can move forward sucessfully without support.
  • Hermione 8 days ago
    Grief support should be introduced at the time of a terminal diagnosis in several ways, and should be introduced again and in different ways (pamphlets, personal introductions, referrals) as the illness progresses. It is important to offer it before the death, even if it is refused, so that people know that resources are there when they need them. It should be offered for 6-12 months, or longer if grief is complicated.
  • valeighgirl 8 days ago
    I believe that introducing grief support prior to a death is important. Not every individual will want this type of support, but if they aren't aware that it exists, they will be at a loss if they do need support. I think the more this type of support is normalized in our society, the more likely people will be to accept it. Helping soon-to-be-bereaved recognize that they may be at risk for complicated grief prior to the death can be eye-opening and help them to realize the normalcy of the rollercoaster of emotions they are dealing with, even prior to the death occurring.
  • Vinigan 9 days ago
    I am a retired health care worker and have walked with several friends and family members to the gates of death. Human Beings have three inseparable components that are built into our DNA: Body, Mind and Spirit. The most positive deaths were those whom had access to Hospice Care either in their homes or in a home like facility. The most memorable being a gentleman who asked to be taken to his church community to say goodbye... he died peacefully the next day, to the singing voices of family and community members joined in a hymn around his bed as his wife and children held his hands. Another time was being with my aunt who was in congestive heart failure, being cared for in the Palliative ward of a hospital. We talked and prayed together until she fell into sleep after being given a pain killer. Hours later she breathed her last peacefully. When a person is dying, thoughts of past, and future surface, it is in our genetic make up to have questions about life's meaning and 'eternity' . Palliative care offers the opportunity for deep life question to be openly discussed and healing of families to often take place. Death should not be a frightening process, but a peaceful one and Hope is a key component of every life and it is as important in death as in life. Too many times I have seen great healing take place in the days or hours before a person dies. I don't believe we have the right to take this away from a person. We now have the medical ability to alleviate suffering and pain so there is no reason to end a life prematurely and deny the spiritual and mental healing.
  • Wolfie 9 days ago
    Grief support should start as soon as death is the prognosis, and continue as long as an individual needs it.
  • Sherry Moran 11 days ago
    It should be available to families as soon as they are dealing with a diagnosis of a terminal illness. It should continue to be available for up to a year following the death of the family member. The family should also be able to access grief counselling together (non-terminal spouse and children) or individually.
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    • musictherapist 9 days ago
      Agree with the offering of psychological support at diagnosis and throughout, as there are so many losses, large and small, to negotiate. The one-year mark, however, is artificial. I've found that many grievers (and those around them) expect things to magically get better after they've made it through the first year, but they continue to struggle, and there is often less support from close ones.
  • Brocko 10 days ago
    when a person enters the stage we determine as palliativeduration of time: six months
  • Trish 12 days ago
    Include psychological support under OHIP and let the individual decide when to go or not go.
    Hide reply (1)
    • monkeymom 10 days ago
      Although including psychological support under OHIP is not a bad idea there are other people who can offer grief support. It is better to offer a plan rather than burden the grieving individual with another decision.
  • Caffy 13 days ago
    Support should be offered before death to the palliative client and to close family members/supporters. This support can be as simple as a check-in to assess their well-being to more in-depth counselling., peer support etc all based on an individual’s needs.Grieving is a process and just how much time is needed to go through this process is very individual. But no matter how long the process takes, individuals should be offered support if it is needed.
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    • monkeymom 10 days ago
      "How are YOU doing?" is a very helpful question to ask family and friends. It invites them to express their feelings and validates these feelings.
  • monkeymom 11 days ago
    Grief support should be introduced as soon as it is known that a person's illness is likely to be or will be terminal. Individuals may not be ready to accept this support but they need to know that it is there whenever they are ready. I agree the grieving process may begin as soon as we know that a person is dying. Support is needed from that time forward but the length of time will vary for each individual and should not be dictated. Support can be shaped to individual needs by listening, being flexible and adjusting
  • Buffy70 11 days ago
    Grief Support should be introduced upon diagnosis of terminal illness. Support should continue after death. In some cases the person who passes is the one that does everything for the other person and they are totally lost without them. More help is needed with counselling particularly if they are totally alone. Access to programs for assistance with household duties meals on wheels, nursing assistance , etc are sometimes required. Sometimes it takes a loss to realize and appreciate how much the person who passed on was doing, We all have a tendency to take so much for granted.
  • bookworm 11 days ago
    Grief support can be introduced immediately and should last as long as needed as there is no time line for grieving.
  • Mom 11 days ago
    Put focus on practical steps to self help
    Hide replies (2)
    • psimmons 11 days ago
      Yes I agree
    • Globalschedule 11 days ago
      Practical steps to self help may come later in the process but at first, I could have used some hand holding, then certainly a focus on self help when I was ready.
  • Globalschedule 11 days ago
    How can grief support be shaped for individual needs? I don't know what options are out there, but I think both private and group sessions should be made available. People will feel different needs.
  • Globalschedule 11 days ago
    With regard to how long should grief support be offered, my response is- for as long as someone needs/wants it. I was a basket case for at least 2 years after my husband died, stayed in bed all day, couldn't make decisions, couldn't talk about it without crying. Sometimes, even now, 8 years later, I wish I had a drop in group centre to talk.
  • psimmons 11 days ago
    I think it can be offered and then if they need it hopefully they will get the support. If it’s not wanted I guess that’s another fact you have to respect their wishes.
  • psimmons 11 days ago
    It could be offered at the time of the Palliative care diagnosis.
  • psimmons 11 days ago
    I think the support should be offered for a year after the death.
  • psimmons 11 days ago
    I think the support should be offered as soon as the person passes away.
  • LT41 12 days ago
    In our society, we tend to narrow the use of the word "grief" to mean the loss we feel when we are mourning a death. And, we tend to think of palliative care as what happens when the end of life is near. In so doing, we overlook many of the needs of people who have been diagnosed with a life limiting illness and their caregivers. In my experience, that is a downstream approach that can leave families in crisis as illness progresses, not knowing what to expect or how to cope or make meaning of what is happening. Perhaps there is a fear on the part of both professionals and families that talking about death will extinguish hope. Perhaps we simply lack the resources and the manpower to adequately support people in the time between a life-limiting diagnosis and their demise. By not talking about death and loss, we miss opportunities to help the person who is dying and their caregivers adequately prepare for death, and to cope with anticipatory grief. In terms of timing, people grieve in different ways, and have individual needs for practical, emotional and spiritual support. Not everyone wants to talk to a counsellor or attend a support group. There is not a magic cut-off of a year after a death, but needs for information and support around grieving do change over time, and depending on the circumstances of the death. I agree with previous comments that 3 days of bereavement leave is inadequate for many losses.
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    • pat'shelper 11 days ago
      It is not enough to just hit the green "agree" icon on this cogent and perceptive commentary: it is so "bang on"!
  • wellkabwell 11 days ago
    We all should be aware of grief and be able to offer help, even if it is just to get the conversation started. Perhaps professional counsellors will not be required. As people live longer with life-altering illnesses, or while caring for someone with life-altering illness, grief will often begin before death occurs. If people talk about grief, what it looks like and how to offer help, we will all become better at being grief counsellors. There aren't enough professional grief counsellors around to cover all instances of loss and often people just need to have someone acknowledge their loss and offer empathy. If a person has a community for support there is no need for professional help unless the person or their friends become concerned that they can no longer support the person appropriately. People sharing their experiences with loss and death help the person experiencing it now to understand how much we all share and to be confident in sharing their current feelings of grief and loss. Grief is a subject that varies a lot depending upon one's culture. I would expect that the supports that work in one culture won't work in another. So much depends on our expectations. Also, each culture changes over time. For example, viewing the body of the deceased accompanied by lengthy periods of paying respect to the family of the deceased used to be commonplace in Canadian society. These practices started in the home and later moved to funeral homes. Now, it is not uncommon for families to skip the viewing, skip the visitation, skip the funeral at the graveside, and to have a celebration of the person's life at a time convenient to the family. The celebration of life does not have to be in a church but might be in a chapel in the funeral home and might be in a hotel or restaurant or other public gathering place. Also, people no longer are expected to travel long distances to say their goodbyes. We all change and we should not assume that our cultural values are set in stone. This would apply to long-established Canadians and to new immigrants as well.
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    • pat'shelper 11 days ago
      Although a very large measure of what is written here is, in my opinion and from my experience, valid and insightful. If I have a significant difference of thought it is with the statement "If a person has a community for support there is no need for professional help unless the PERSON or their friends become concerned that they can no longer support the person appropriately". I have seen too many cases where the grieving person denies the need for support even while clearly exhibiting signs of such need.
  • Marrob5 12 days ago
    If a patient has been diagnosed with a terminal illness, in my opinion, grief support should be provided immediately. Both the patient and the caregiver(s)/family need assistance on this journey. In today's world, it is not uncommon for family members to be scattered around the world and survivors to be without family support.
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    • Annabelle 11 days ago
      I agree wholeheartedly. I have recently become a hospice volunteer and this is offered to people experiencing loss. The problem is that when an individual is given the diagnoses it is mind numbing. You are in a fog which is of course part of grief. The disbelief causes the individual to go down the pathway of hope which is great but it seems that if they were to say " oh I have just been told I have cancer and will die soon, I better get on the list for grief support", probably will not go there because they are on the hopeful road and going down the grief road is too sad. So they don't and then die without the support. Each person is different of course and we need to ensure that people understand hospice, and that they are not al
  • roygbv00 12 days ago
    One week following death, length of time 3-4 months.
  • Elder 12 days ago
    Grief support needs to be introduced right after the sudden death of a loved one or could start before death in the case of a terminal illness. The support should last as long as it is needed. Every case is different.
  • Bereavement Supporter 12 days ago
    Grief support is best introduced about 3 months after the death in most cases. By then, many of their support network have often backed away and the numbness after the death begins to thaw. However, those who don’t have a support system around them may need to be included earlier and should be given that opportunity.Grief is different for each individual. Some need very little support as they have church support and friends and family who are there for them. Some people run away from the pain of their grief and it catches up to them. They may find they have to deal with it a year or two later as they feel they are crashing. Some progress quickly and adapt to their changed life quickly. Others need support groups for much longer. It is often complicated by the death of two or three others close to the grieving individu. It is important to look at the individual’s situation and help them determine what their needs for continued grief support are.I think the most important support before the death is from trained hospice workers, nurses and doctors who will provide the person with an opportunity to talk about their concerns about the dying person’s situation and are open with information about what is happening, what and when to expect in thefinal days. Often the caregiver is more focused on the patient than on themselves and feels very uncertain about what to do for them. If the caregiver has concerns about the future, they need to feel free to express them and are already comfortable with these support people if the are the right people to be providing palliative care.Various types of support need to be available and an assessment made between the person and a qualified bereavement support person as to what is best for them. Many who are in traumatic bereavement (sudden unexpected deaths medical, through accidents or by suicide) need bereavement counselling. Some people need one-on-one support and are not comfortable ina group setting. Others benefit more from group support as they find inspiration from other group members’ progress.
  • HPCnurse 12 days ago
    It is important that our entire society learns about grief, about grief support, how to care for one another. People differ in what type of support they find to be supportive, and some people will not start to realize the need for support for months or years following a death. In an ideal world, supports would be available when needed and when wanted.Yes, support should be offered prior to death.Support will be shaped to individual needs, when the health care team understands grief, and when a counsellor/therapist is part of every team.
  • Wowie 12 days ago
    Grief support when needed.....maybe immediate, may be later.Grief support length.....no longer than one year. More than a year requires psychological support.Offered before death if the death is imminent.....but often difficult with sudden deaths!Support shaped for individual needs by asking them preferences and supply if possible.
  • qualicumgirl 12 days ago
    Grief support should start when the person has a terminal diagnosis. Before the death it should consist of offering information about what to expect during the process of death (eg. what does active dying look like? what does cessation of food and fluid mean?) so that the reality does not come as a shock. By having the person with a terminal diagnosis be referred to a palliative care physician who has nurse practitioner support, information can be provided as needed...ie. when the student is ready, the teacher will come. Grief is experienced by the person who will die, as they look at their life. Family experiences it too. Children have to be handled with sensitivity but that does not mean not saying anything (since kids know more than they say or think they know). It is a good thing to support the culture moving towards being "death positive". Such citizen led activities as "death cafe" are a good sign that we are coming out of denial that life ends and we can't control that. But how it ends? We can have much more control here.
  • Anonymous1941 12 days ago
    Yes open access to grief support should be offered to all residents thru access programs like Distress lines, and workshops taught to people experiencing varieties of major loss.
  • jalofa 12 days ago
    As a psychotherapist focusing on grief, death and dying, as a former hospice volunteer, as someone who has seen friends and family members die of cancer and as a caregiver for 7 years to my mother with Alzheimer's, I have a lot of frustration about the misunderstandings about palliative care, especially in the medical community ie doctors. Grief begins long before death and though not everyone will accept the support, I believe it should be available to all and at no or nominal cost. I have been frustrated to have friends and clients denied palliative care because they were receiving palliative chemo which is not curative. This is such a critical part of health care in our country, especially as the population ages. Grief is also much misunderstood (move on, get over it, etc) which I work constantly to rectify - it really is quite simple: it's about learning to have a NEW relationship with the person who has died, not forgetting about them. In our death-phobic and grief-ignorant culture, we have a lot of work to do but I am encouraged by this initiative.
  • mwtaylorcan1 12 days ago
    As soon as possible following the death.
  • Shtudney 12 days ago
    I have little experience with this so have nothing to offer.
  • silverwolf 12 days ago
    The grief process is very individual therefore a definitive time frame is unrealistic. Process should be open and available as needed by the family. It should be offered and/or available to both the family and the patient once a life altering disease or condition is given by the medical profession. It should include ways to cope with the disease and the affects it has on the patient and loved ones. Once the loved one has passed, there is so much to do immediate grieving is sometimes not possible and you never know how a person will fall into the grieve process. Providing literature, etc on the process would be helpful as then a person can make their own decision as to when they would like to use the support available. Sometimes a reminder of the support available should be given to the grieving family members possibly 3-6 months after the death of the loved one. Sometimes a short phone call with give the grieving person the little push they need to get the support as in today's society many to not like to ask for help but will accept it when offered.
  • Poli 12 days ago
    Grief support should be offered at the time a person requests it or a care worker feels the person needs it. It should continue until the person no longer feels the need. Grief support must be offered before death. The person is already dealing with many losses, a partner that is no longer to share the life experiences they once did, etc. The palliative worker can shape the support based on their knowledge of the individual requiring assistance. Talk therapy, praying with the person, just listening, music etc.
  • Nurseval 12 days ago
    Introduce grief support at the diagnosis of a life altering illness & have it continue for a year after death.Ask the individuals affected if they would like access to resources to help them cope with the life changing and limiting illness. Have online resources available as well as counselling if requested.To meet individual needs ask what support is wanted and what it would look like if they were to feel they had all the support they needed.
  • alliedhealthworker 12 days ago
    This might be a non-answer answer, but I would say that grief support should be introduced whenever someone needs it. What I mean by this is including grief that may come before death (e.g., anticipatory grief, ambiguous grief), as people start to grieve the future loss of their loved ones, loss of relationships, loss of abilities, etc.Similarly, individuals will require different length and intensity of bereavement support after death.I think the challenge in providing grief interventions tailored to individual patient/family needs is in healthcare providers being able to identify signs of grief (including anticipatory grief and ambiguous grief), the resources to be able to refer to extra support where needed (e.g,. social work, psychology, spiritual care, etc.), and the ability to communicate in the moment when someone is expressing grief (i.e., ANYONE should be able to provide in-the-moment support on their own way).Recently watched a great webinar on grief in chronic/life-altering diseases. Resources and recording below. (Thanks to Brainxchange!)- https://vimeo.com/277294574- http://brainxchange.ca/Public/Resource-Centre-Topics-A-to-Z/Grief-and-bereavement.aspx
  • gunits 13 days ago
    The best time to introduce grief support is when a diagnosis is given, with no further prolonging life. Continued support should be given for at least a month afterwards. Doctors and nurses who specialise with the end of life will understand the need to be honest and open and that false hope, even though it is part of the grieving process, has to be dealt with in an honest way. Dr.'s and nurses who are in this part of the process should take the time to understand the needs of those individuals.
  • Sheridan1 13 days ago
    There are different types of grief that people experience before and after death. Sometimes dying people need help to manage their grief as well. I work in a hospice and there is definitely a need to support families and patients during the dying process. Sometimes this can be done by staff and other people supporting the family, but sometimes trained therapists or spiritual support is required. After death, some level of grief support might be required for months to years depending on the situation.
  • Caffy 13 days ago
    Grief is a varied experience. It is important I feel to introduce and to offer support based on the needs of an individual. Needs assessments may be effective in determining this.
  • daisey 13 days ago
    I think the best time to introduce grief support is after our loved one dies, and it should be offered about one or two months after the person dies. Also there should be an easy way to find information about counseling for a long time afterwards
  • betacells 13 days ago
    Families with someone approaching death may be somewhat prepared for their loved one to die. However, they will not start grieving until after the death. There are so many tasks accompanying death that true grieving doesn't come until later,. Everyone has different time lines. Yes, we definitly need more grief support groups. In an urban center in SK, there are only a few resources, if you look for them. Family members experiencing death of a loved one need to be offered attendance not to have to search out. Services need to be available for working people, not just during the day when some people are not working. Support should last 6 - 12 months, depending on the nature of the relationship to the deceased..
  • @truedignity 13 days ago
    Employers do not give employees enough time to grieve. You are given 3 to 4 days if you're lucky and other time must be taken from vacation or unpaid leave. Your work is expected to be performed to the same level even though you may have been exhausted from years of care-giving to elderly parents. If you're part of the "sandwich" generation, you also have young children to take care of like my sister inlaw who has a 5 and 8 year old, and my brother who has a 1 year old. Our parents - have cancer, Alzheimer's, post-stroke and onset complete blindness and deafness. How can you sustain an active career and meet workplace performance expectations while dealing with ill and aging parents, and have a family? And also be supported in grieving the loss of a loved one - someone so close to you that you burst out in tears at work, in public, during a meeting you're trying to hold it together, and there is little to no counselling as your EAP at work is oversubscribed or you don't even have the time in your day to get external counselling. It's exhausting and you have insomnia, and new health problems. And also having a mentally ill parent who is grieving is an additional significant challenge that free bereavement counselling doesn't adequately address.
  • Charla 13 days ago
    Grief support should start as soon as the patient is deemed palliative. This is where the palliative care social workers and music therapist can play a vital role. It should continue after the patients death for as long as necessary. Each loss should be looked at individually. Losing a child is very different from losing a grandparent. Group sessions are beneficial but then the group should be divided into small groups who have had a similar loss.
  • Jo jo T 13 days ago
    With in days of the death information on grief and possible outlets for support should be given and a follow up about 1 month later.
    Hide reply (1)
    • Bevy53 13 days ago
      If not a monthly definitely by 3 months as life goes on for others and calls, visits dwindle. You definitely realize how alone you are.
  • Dignity 13 days ago
    Grief Support should be offered before, during and after. Peer Support groups work well. The facilitator should be trained to recognize signs of complicated grief to which professional therapy should be made available.
  • Listening 14 days ago
    It seems to me that this is where faith communities come in. Death used to be the realm of the religious - a sacred duty of the priest, to provide guidance, comfort, assurances that all would be well. Unfortunately, in an age that has to a large extent repudiated 'organized religion' this is now being left to the state. Whereas, people once had strong communities and ways of dealing with death and the dying, many in our culture are isolated, and we must rely on either institutions or volunteers to address this issue. In either case, they are not fully prepared to do so. Yes, support should be given before, during and after death to the grieving, and to the patient. How long would be determined by the sufferers, and in many instances it should consider their faith, beliefs about life and death, and respect the natural inclination in the human being for the transcendent, whether that is through prayer, formal religious practice or some kind of discussion/mediation about what really is at the heart of our humanity - the desire for that which transcends the material world.
  • cch314 14 days ago
    Palliative care with its component of grief counselling for individual AND family should be offered soon after diagnosis - it may be declined initially but discussion of its availability should be ongoing at each interaction with a healthcare professional. After the death, there ought to be an opportunity up to a year for family to receive counselling - some may require this long to register the need, others in a shoreter time span.
  • windsong 14 days ago
    Grief support is not something that we thought about at the onset of a palliative or end of life diagnosis. To be honest, we were more concerned about what the loved one was going through and trying to make things be the best for them. Care for the caregiver can take many forms and all of those forms would come together to be a framework for grief support. Mental, emotional, physical well-being, resources for both the patient and the family are wonderful but sometimes both the caregiver and the patient are in denial of some sort and reluctant to ask for help, or to share what are considered to be private details. There is an expectation that family members step up to care for a palliative patient but no consideration is given to the toll that takes on everyone involved. In general until it affects someone in your family circle, most of us are pretty naive as to what it looks or feels like. I would love to see more education given on care for caregivers and families so that people are more aware and receptive to grief support prior to a death occurring and certainly during the first few months thereafter.
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    • cch314 14 days ago
      Grief support is an important component of palliative care and the family is included as well as the individual. Counsellors can help through the denial phase
  • Snowflake 14 days ago
    I believe grief support should begin at the point of diagnosis and continued throughout the illness. Anticipatory grief can be excruciating not only for the patient but for the family as well. It is important to have counseling available as soon as possible. I also believe that bereavement support should be continued for at least one year after death if necessary. Some people are quicker to move forward than others and may not require bereavement support and some may require it for more than a year if it is a complicated grief. I think it is important for the option to be there at all times whether it be a one-on-one counseling or group therapy.
  • Ette 14 days ago
    I would like to believe that grief councilling begins when your loved one is first diagnosed with a palliative or end of life diagnosis. But, from personal experience, I dont think we would have been receptive to that councelling. At least not at the beginning. The reason being is losing control of our lives and having others "helping" or having to share our lives with a stranger.On reflection, we both could have used help when the initial gut reaction was over. We grieved lots and it would have been helpful to have someone help us wade through the health system, financial, and just help with the over whelming grief. I don't even know what our children went through personally, because we were so focused on us and mostly on my palliative , my soon to be end of life partner.Grief support should be offered before death , to all the family. And continue for at least a year after. Support groups would be beneficial. The Cancer Agency assigned a social worker which helped with financial support and service information. But someone who is more holistic and included the family could be a added support system.As far as shaping to individual needs, best to ask and offer services. Before and after death. And varieties of help , whether financial, grief support etc