Caring takes its toll - working with the dying

14 July 2014
Opinion piece by the Rev. Helen Dick, Director of Mission at UnitingCare Health (published in Medical Journal of Australia, July 14, 2014)

WHEN a health worker says they work in palliative care in a hospital or a hospice unit people rightly respond with respect and admiration.

Those working in palliative care are seen as caring, compassionate people, looking after the terminally ill, the dying and their families. “I don’t know you how you can do that”, is the typical reaction.

However, research shows that many people working in palliative care derive a great deal of satisfaction from their roles. Whether they are nurses, doctors, allied health professionals, cooks, cleaners or receptionists, they know they can make a significant difference to people as they journey through their last months, days and hours.

Palliative care is essentially about increasing the quality of life for people, “palliating” symptoms to make life more comfortable, and allowing patients to make the most of the time they have left. There is fulfilment for workers, whatever their environment, when they know their contribution to the physical, emotional and spiritual comfort of patients makes a difference.

It is sacred work.

Yet we should never forget that it is also work that comes at a cost. Although society is often death denying, these professionals can’t escape the reality of death. Every day they are reminded that, for all of us, life will one day come to an end.

Their jobs call on them to build relationships with people who will die soon. They are asked to show genuine personal care for patients and their families and yet hold their emotions in check when that person receives bad news, suffers or dies.

Professor Kenneth Doka, an expert in grief who first described “disenfranchised grief”, has asserted that health care staff are among those whose grief goes unacknowledged and thus is often not addressed.

We know from research that working with the dying takes its toll. It has been associated with physical and emotional health problems like stress and depression. In the workplace, conflict, absenteeism and “compassion fatigue” are also common problems.

There are even greater challenges for staff working in aged care, particularly in residential facilities.

Aged care in the public discourse is sometimes associated with neglect and even abuse. Yet aged care workers do a remarkable job and perform similar work to others in palliative care as they tend to the frail, the dying and their families. Their work is rarely recognised as palliative care and yet so often it is.

As the elderly are encouraged and supported to remain at home for as long as possible, those entering residential aged care facilities tend to be more frail and more likely to be approaching the end of life.

As a chaplain working in aged care for 5 years, I saw first-hand the wonderful care given by aged care health workers as they cared for the dying and the grieving. Under the current funding model, aged care workers are often doing their jobs with significantly less training, support and resources than those in other palliative care environments.

Often, the cost for staff in hospices and palliative units is recognised and they will be offered appropriate support in the way of pastoral care, debriefing, ritual and reflection. For example, staff at The Wesley Hospital’s Palliative Care Service are offered a range of support services. Many other hospitals offer similar support.

However, staff in aged care are more likely to be left to go it alone. Employers are usually keen to support their workers and offer what help they can, but tight funding makes this difficult.
“Caring for the carers” is a popular catch phrase these days as our society recognises the importance of caring for the family and friends of those with disabilities or chronic illnesses.

However, as health care funding is tightened yet again, we should not forget to care for those who “care” in a more formal context — wherever that may be.

As staff in hospitals, hospices, aged care and the community face increasing challenges of change, compliance and “casualisation” through industrial reforms in the workplace, they will need the support and resources that allow them the satisfaction of doing their work well and to have someone to turn to when they need some support themselves.

After all, one day they will be looking after us, or someone we love, and we will want them to be whole and well.

The Reverend Helen Dick is the Director of Mission at UnitingCare Health.


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