Personal Holiday Plan

As a greiving individual, it is helpful to approach the holidays wiht a personal plan. Here is an outline to help you get started.

I predict that the most difficult parts of the holiday season for me will be:
1.
2.

My support people (those who can hear my grief) are:
1.
2.

The most difficult people to be with might be:
1.
2.

My grief triggers might be:
1.
2.

Words that would be helpful for me to hear would be:
1.
2.

Last year (or years), prior to my loss, I celebrated the holidays by:

This year I want to include the following traditions in my holiday:

We are here wiith comfort, hope and healing in the new year.

Grieving Through the Holidays

‘Tis the season! We have come upon the annual blitz of the holiday season. For many, this acts as our internal cue to begin to “get into the holiday spirit.” For many others, this can act as a grief trigger, which can make the holiday season a very difficult time. We may be personally grieving a loss, or we may know of a friend or family member who is grieving at this time. The following are some ways in which we can be supportive to a friend or family member who is grieving through the holidays.

Separate the wants from the shoulds. Encourage the bereaved to separate how he/she would like to celebrate the holiday season from how others feel they should be celebrated.

Plan ahead. Decide how you would like to spend the holidays this year in order to reduce the anxiety of its anticipation. With whom would you like to spend the holidays? Where would you like to hold the holiday dinner?

Support systems. Surround yourself with those who are supportive and understanding of your grief. Avoid those people who will place expectations on your feelings and your grief.

Communicate. Convey your needs with family and friends. Honestly share with them how you would like to spend the holidays this year.

Lower expectations. Encourage the bereaved to lower expectations about actively participating in the holiday season, and allow him/her to feel the pain of grief.

Reduce commitments. Limit the number of social engagements to which you commit. Choose only those that you are comfortable attending, if any. Also understand that your energy level may be very low at this time. Take time to rest.

Start a new tradition. Begin a new tradition within your family. This could be something which honors the deceased, as well as allows for new traditions.

Honor the deceased. Buy a gift for the deceased; visit the cemetery; light a candle in his/her honor; share stories about the deceased; reminisce about past holiday celebrations. Include the deceased in your holiday plans, because the reality is that he/she will probably be on your mind.

Shopping and baking. Allow someone else to do the shopping and baking for you this year, or have a friend share in these activities with you. Utilize catalogs or the internet to do your shopping. This will reduce the commercial blitz often feel when shopping in stores/malls. You can certainly opt to skip the shopping and baking for this year!

Support groups. Many places of worship, hospitals and other organizations offer programs to cope with the holiday season. Think about attending such a group, and allow yourself to feel the support of others who are grieving a loss.

Overall, it is important to remember that we need to be gentle with ourselves during this time. Each one of us will handle the holidays in a different fashion, therefore listen to your inner cues and do what works best for you.

November is National Hospice Month

November is National Hospice/Palliative Care Month and in honor of this time of expanded awareness, the National Hospice and Palliative Care Organization released updated facts and figures about hospice care in the U.S.
Statistics Indicate GrowthAnnually, NHPCO reports on hospice trends and provides updated information on the field. Newly released data reflecting 2007 usage of hospice, indicates that:

• 38.8 percent of all deaths in the U.S. were under the care of hospice, up from 35 percent the previous year.
• 1.4 million people with a life-limiting illness received care from the nation’s 4,700 hospice providers.
• Average length of service increased to 67.4 days (from 59.8 days in 2006).
• 30.8 percent of those served by hospice died or were discharged in seven days or less.
• 13.1 percent of those served died or were discharged in 180 days or more.
  For more information go to http://www.nhpco.org/i4a/pages/index.cfm?pageid=5763.

The Bereavement Center is a program of Hospice of the Western Reserve - who's mission is to provide palliative end-of-life care, caregiver support, and bereavement services throughout Northern Ohio.

We are proud to be a part of Hospice of the Western Reserve and thank all employees for their signifcant contribution to so many lives.

Veteran's Day

This Veterans Day, many Northeast Ohio families will remember those soldiers who died while serving in Iraq and Afghanistan. Special circumstances affect the grieving process for the families of these brave soldiers. Often shock and anger accompany grief, making support systems vital for moving through the healing process.

Counseling services available through the Elisabeth Severance Prentiss Bereavement Center at Hospice of the Western Reserve can help families cope with the death of their loved one. In addition to seeking guidance from professionals and support groups, it is important for families to remember a few things as they grieve a soldier killed in combat.

· Give yourself permission to feel the pain and share these feelings with others.
· Don't feel the need to fight reoccurring thoughts, dreams or flashbacks; they are normal and will decrease overtime and become less painful.
· Maintain as normal a schedule as possible (as impossible as it seems); structure your time.
· Follow the basics for good health (even when you don’t feel like it) – rest, eat well, exercise.
· Reduce other stressors as much as possible - make to do lists, be patient with yourself when you can’t find your keys, limit distractions that might interfere with concentration.
· Be aware of numbing the pain with overuse of drugs or alcohol; go easy on caffeine.

Military Grief Support Information

Dougy Center for Grieving Children and families
Grief support
www.dougy.org

Fallen Patriot Fund
Provides grants to families of those killed or injured in Iraq
www.fallenpatriotfund.org

Gold Star Wives of America
Military widows organization
www.goldstarwives.org

Intrepid Fallen Heroes Fund
Provides grants to families of slain U.S. soldiers
www.fallenheroesfund.org

Readjustment Counseling Service Vet Center
Offers bereavement counseling
www.va.gov/rcs

Tragedy Assistance Program for Survivors (TAPS)
Provides services to those who have lost a loved one while serving in the US military
www.taps.org

Coping with the Trauma of Sudden Death

The inconceivable happens - a special person dies in an unexpected and traumatic way. This may be a family member, a co-worker, a friend, or the neighbor down the street…The cause can be murder, suicide, car accident, natural or man made disasters or combat.

Things that Help
The signs and symptoms of a stress reaction may last a few days, a few weeks, a few months, or longer, depending on the severity of the traumatic death. The understanding and support of family and friends can help the stress reactions pass more quickly. There are a number of things that can help during this very difficult time.

· Maintain as normal a schedule as possible (as impossible as it seems); structure your time
· Follow the basics for good health (even when you don’t feel like it) – rest, eat well, exercise
· Reduce other stressors as much as possible - make to do lists, be patient with yourself when you can’t find your keys, limit distractions that might interfere with concentration
· Be aware of numbing the pain with overuse of drugs or alcohol; go easy on caffeine
· Talk to people – reach out, spend time with others
· Do things that feel good to you – take a walk, listen to music, keep a feelings journal, etc.
· Give yourself permission to feel the pain and share these feelings with others
· Don't feel the need to fight reoccurring thoughts, dreams or flashbacks; they are normal and will decrease overtime and become less painful

S.T.A.R.S...grief support for children and adolescents

Now that we have completed NEOEA day training for schools, we are instilling new energy in our S.T.A.R.S support groups for children. S.T.A.R.S (Supporting Tears, Anger, Remembrance and Sadness) if offered both in the schools and the in community. For our six-week community S.T.A.R.S, while the children are meeting, there is an adult support group to assist family members in dealing with their own grief. In the schools, we tailor and modify the curriculum so that it is developmentally appropriate for pre-school through high school. There is no parent component and the groups usually last 8 weeks.



The goals of S.T.A.R.S include:

Coping with Feelings

Support for Remembering Loved Ones

Peer Support

One of the comments I remember the most is when a nine year said to me, "I am so relieved. I thought I was going crazy. Now I know there are others just like me."

Busy, busy, busy...

The autumn has been extremely busy in the bereavement center. We have been planning and completing numerous presentations for the Greater Cleveland community. Our Walking Through Grief: a bereavement certificate program has proven to be highly successful. We will offer Level II in the winter. Particpants have been singing praises of the courses and the expertise of the instructors. This Friday, we will presenting to teachers throughout the five-county area on Facing Death: Grief and Loss at School. In addition, I'll be presenting When a cancer related death touches a school to another group. During the midst of all this prep work and presentations, we have had numerous crisis response in the schools. The stories touch our hearts and range from suicide and homicide to previous medical conditions to sudden death. The schools have responded swiftly and responsibly and have utilized our resources appropriately. We are grateful that we are able to provide these services.

Pet Grief

The love relationship between a child and pet has many qualities. Children and teens enjoy their pets: they take charge of them, hold, feed, clean up after, and claim their pet as their own. A dog becomes a tireless playmate eager to chase and wrestle. A usually grouchy teen can find comfort in a purring/petting session with the usually aloof family cat.

The life span of most pets is relatively short and children face the loss of a pet at some point. When a pet dies, parents usually expect a child or teen to be upset about the death, but not the intensity of the grief reactions. Sometimes the death of a relative may seem distant to the child. However, the death of a pet is of the child’s world, and children feel and show that their heart is breaking.

A helpful family member can prepare a child by teaching death awareness throughout the child’s life. When an animal declines with age or illness or must be euthanized, death can be anticipated and talked about. It is important to talk directly to children about euthanasia and not use terms like “put to sleep” that might confuse children or cause anxiety. This talking together can bring comfort when the pet finally dies and the feelings are intense. An accidental death is always hard. It is crisis that often requires action and decisions on many levels and in turn colors the grief responses.

Create a family atmosphere that losses can be felt and talked about. Help children resist an impulse to replace the pet too quickly. Children need to know that grief takes time and the dead pet has a special place in their lives that will live on. Sometimes not all family members agree with this, but hopefully a compromise can be reached.

A modest memorial for your pet can take on the unique features of your pet and your family. It is especially helpful when the memorial activity is geared to the developmental age of the children, represents what was “special” about the pet, and reflects family traditions and history. With pets as with people, poems, pictures, music, hugs, laughter, memories and tears help your special relationship with your pet live on.

Web Memorials

We recieve many calls asking about web memorials. Here is some information that we share with our bereaved clients.

Web memorials are personalized websites that allow the bereaved to create individual memorials to their deceased love ones, to visit the site and demonstrate affection.

To create a web memorial search, do an internet search and review a number of sites. Each is unique. Consider these factors when choosing a site: price, permanence, options for individualized memorials, and the community in which the memorial is housed.

Benefits of web memorials:
Emotional Expression
Personalization
Demonstration of continuing bonds
Shared grieving
Community support

A bit of caution:
Limited research – There has been limited research on the benefits of web memorials.
Permanence – Some websites become obsolete and vanish. Some websites will maintain your memorial for limited periods of time.
Strangers – Many times, strangers will post letters of condolence. They may have hidden agendas and negative intentions.
Unintended memorials – There is a difference from posting condolences on MySpace versus web memorials. The web memorial is controlled by the bereaved.

Hope this helps.

Education and Training

The fall has been a very busy time for education and training. Walking Through Grief: A bereavement certificate program is off to a good start. Tomorrow is the second of eight sessions. Dr. Bob Ballantine will be the instructor on Anticipatory Grief. The greater Cleveland community has made numerous requests. Last week, I presented to 60 older adults on grief and loss. The Hospice Institute featured a day long conference on Geriatrics: The Next Chapter to over 200 professionals. This week I well be presenting on the Impact of Grief in the Workplace in Lakewood. Next month we will be presenting multiple presentations throughout the community on Children and Adolescent Grief and Traumatic Grief. Attached are links to two presentations open to the community. If you are interested in having a presentation for your organization or workplace, please contact us.
http://www.hospicewr.org/uploads/pdf/programs/Registration%20Educational%20Certificate%20Program.pdf
http://www.hospicewr.org/uploads/pdf/programs/NEOEA%20DAY%20AGENDA%202008.pdf

TEEN GRIEF

During grief, teens experience all kinds of emotions. They may be overwhelming, frightening, and intense: they may feel out of control.

The variety of grief reactions is endless and includes physical, behavioral, emotional/social, intellectual/cognitive and spiritual reactions.

Here are some tips for teens coping with grief:

Shock, disbelief: Talk, talk, talk. Grief needs to become real before you can go on with the mourning process. Avoiding the pain is not possible.
Denial: Understand that you cannot escape from grief. So talk about your pain.
Anger: You have every right to be angry. But you don’t have a right to take out that anger on others - or on yourself. If you feeling angry, try shooting hoops, walking, listening to music, journaling.
Guilt and regrets: If only I hadn’t said… I wish I had… Give yourself a break. When someone dies we often second-guess ourselves, but the truth is that awful things happen and there is little we can do about that.
Fears, worries: It’s difficult not to worry that something will happen to someone else you love or to you. Try to identify what your worries are. Then, talk to someone about those worries. Is anything in your control? If so, take a responsible action. If not, try some relaxation.
Inability to sleep: Rest, rest, rest. Grief is draining.
Inability to eat: Watch yourself. Grief can sometimes make you “forget” to eat or have not cares about what you are eating. Try to sit down at mealtime and eat.
Inability to remember: You forgot about the paper that’s due? You locked your keys in the car? Write things down. Organize for the next day the night before. Have friends call with reminders about assignments.
Inability to concentrate: How can you focus when your mind is wandering? Allow more time to do homework. Talk to your teachers. Be extra careful when doing any task that requires your complete attention, ESPECIALLY driving

Crisis Response

The school year has been off to a busy start with crisis response. There was a teen death last week in Ashtabula county and two teen deaths over the weekend in a Cuyahoga county school. Our team is able to mobilize quickly and get out to the school to help disseminate information in a systematic way as well as provide support and comfort to the staff and students. The day usually starts out with strategic planning with school personnel which is followed by large and small group interventions. We provide literature, art materials and most importantly, grief counselors who have had numerous experiences with crises and can remain the calm in the storm. We then follow up with school and provide on-going support and interventions as needed. Last year, we provided over 40 crisis response. Although these experiences are exhausting for staff and students, it is always so rewarding to learn from the students. They work hard and are truly amazing.

School Services Program

We are very excited to introduce Megan Davis, LISW-S, as our new school liaison. Prior to coming on board , Megan worked as a Social Worker on one of our hospice home care teams. Prior to that she had worked as a school Social Worker. Megan joined us as a counselor at camp and is getting her feet wet learning all the intricacies of the position. Today we sent out Partners in Grief, our school E-Newsletter. http://208.206.15.235/uploads/pdf/PartnersInGrief_Fall08_7%2030%2008.pdf
Please feel free to contact Megan with any grief related concerns. Here is a description of our school program.
http://208.206.15.235/uploads/pdf/SchoolGrief_Flyer_8%2031%2007.pdf

Greetings!

It's been a few weeks since the last blog. Our 3 day grief camp was a great success and afterwards, I took some time off. During that time and since the creation of this blog, I have had several conversations on how to improve the blog, reach more readers and meet the needs of our readers. It is my intention to post twice a week and I invite you to respond.

There have been many events happening in the bereavement center. Last week, we had our first advisory council. The advisory council is made of up community members who may or may not have utilized our services. There are mental health professionals, funeral directors, estate planners, bereaved, volunteers, fire and safety personnel, school professionals, etc. The purpose is for the council to make suggestions on ways to improve the bereavement center and reach the community. It is the responsibility of the bereavement center to act on these ideas. In the first meeting, we provided a general overview of the center and it's services. Council members made multiple concrete suggestions on ways to collaborate with others and reach out to underserved areas. An action plan will follow. One idea was to send our About Grief newsletter that we send to our hospice bereaved families to our school data base and to everyone we know on-line. I am posting here for you to look at. http://208.206.15.235/uploads/pdf/AboutGrief_Fall08.pdf

Look forward to more frequent postings and updates on the advisory council.

Bereavement Camp

The third and final day of the tenth Together We Can camp finished yesterday as 36 campers hiked down to the lake to the heartbeat of a buffalo drum. The campers wrote a message to their loved one on rice paper which was then tied with hemp to a carnation (all biodegradable). Most campers were able to toss their carnations into the lake as they honored their special person who died. A few just threw in the stem or the flower, or just the message. It was touching as repeat campers who were unable to throw their flower last year were able to do so this year. The three days were filled with profound moments as the campers learned to express their grief, identify coping strategies and supports and find ways to honor and celebrate their loved one. Counselors and staff, both paid and unpaid, were moved. Many thanks go to the Red Oak Staff in helping facilitate our recreational activities of swimming, canoeing and rockclimbing. In the next few weeks, I will post pictures of our grief camp.

Camp training

Yesterday, Together We Can camp training was held at Red Oak Camp for 25 dedicated counselors. These camp counselors are both paid and unpaid staff. Many took time out of their busy day to attend the training. Training is mandatory every year for counselors. In addition to reviewing grief and loss issues for children, active listening tips and professional behavior, the counselors practiced the camp song and learned how to facilitate the therapeutic activities. Each group of campers is led by an experienced grief counselor, but all the camp counselors play an important role in building a safe and fun environment. After a muggy and buggy tour of the campgrounds, we enjoyed a delightful meal prepared by Kandi, the camp cook. We are so excited and ready to meet our 41 registered campers!

Together We Can camp

The Bereavement Center staff has been busy getting ready for this year's camp. Forty campers have already registered. We have exciting new projects for the campers and will allow time for swimming, hiking, canoeing, rock climbing and archery. Hopefully the weather will cooperate!

These pictures show last years masks and

one of our human knots. Our therapeutic

interventions are designed to

facilitate the expression of feelings

and problem solving.

The camp provides a great forum for children to be with other children who are grieving and to know they are not alone. In addition to learning how to manage the big feelings of grief, the campers find ways to honor their deceased loved one.

Walking Through Grief: A Bereavement Specialty Program

http://www.hospicewr.org/uploads/pdf/programs/Educational%20Certificate%20Program.pdf

For the past several years, The Bereavement Center has received numerous calls requesting training in grief and loss. We are very happy to announce our new certificate program beginning in September 2008.

This certificate program is to educate and train professionals and paraprofessionals to work with those who are grieving. The focus will be on grief that accompanies a death; however the physical, psychological, spiritual and emotional responses are often the same for any loss experience.

This program begins with an understanding of normal grief reactions and interventions. It enables the participants to gain knowledge, skill and confidence to support bereaved individuals and groups in various situations, as well as to provide the appropriate services and referrals.

The goal of the program is to support the bereavement process and supplement the education of professionals with specific knowledge in the field of grief and loss.

Classes will be held Tuesdays - 5:45 to 9:00 p.m. in our Villaview location. CEs are provided.

For more information and the complete course desription, please visit our website at hospicewr.org.

Drumming By The Lake

Relieve stress and express yourself through rhythm using various drums and other rhythm instruments. No musical experience is needed. Registration is required.

Tuesday, October 14th, 7:00-8:00 p.m.

Hospice of the Western Reserve

300 East 185th Street

Cleveland, Ohio

S. Maxwell 216.383.3780

Drum Circle at Hospice House

Last month, The Bereavement Center had it's first drum circle for grieving adults at our Hospice House location. Originally it was scheduled to be lake side, but weather conditions led the group indoors. Sarah Maxwell, Board Certified Music Therapist expertly led a group of adults who were grieving the death of a loved one through a series of drumming experiences culminating in a invigorating and stress relieving drum circle. Drum circles are a wonderful way to bring people together in the spirit of community and support. We are looking forward to planning our next circle Please consider joining us. No musical experience is needed!

Grief and the Older Adult

Older adults experience grief much the same as younger and middle-aged adults. However, due to their age and life experience, many factors impact their grief reaction.

Older adults often experience several losses within a short period of time. They may have a dwindling roster of family and friends and may be grieving any number of losses at the same time. In addition, older adults who experience spousal death may also lose their financial security, their best friend, other social contacts and supports.

The natural process of aging involves many losses. These include, but are not limited to, loss of physical strength and endurance, independence, mobility, youth and beauty, the home, and purpose. If the older adult has a debilitating disease, there are losses associated with the disease progression. Older adults are more likely to become physically ill after a loved one dies. It is important that the bereaved older adult maintain contact with their healthcare providers.

Older adults often lack the support systems they had in their younger years. After the funeral, family members return to their own lives, leaving the bereaved older adult feeling very alone.

Many older adults suffer from untreated depression. Depression can occur with other medical illnesses. Healthcare professionals often mistakenly conclude that depression is a normal result of these illnesses as do the elderly. Additionally, some people believe that depression is a normal part of aging. Depression is not normal for people of any age. A comprehensive assessment can aid in determining if the older adult is becoming depressed and recommend treatment.

How can you support an older adult who is grieving?

Older adults may need more time to become aware of and express their feelings. Giving an older adult extra time shows empathy, compassion and respect.

Older adults may need more time to become aware of and express their feelings. Giving an older adult extra time shows empathy, compassion and respect.

You may need to point out signs of changes in behavior and sadness. This will help the older adult become more aware of their feelings and will help them more readily talk about them.

Older adults who are isolated can benefit from the company of others. Spend time with them.

Give the gift of presence.

Talk about the deceased. Encourage the older adult to share memories. Telling the stories is part of the healing process.

Since many older adults have experienced multiple losses, encourage them to talk about each loss separately. This helps the person feel less overwhelmed and better able to cope with the strong feelings of grief.

Be aware of the signs of complicated grief and depression. If you have concerns, encourage the older adult to consult a healthcare provider.

Crisis Response Activities

http://208.206.15.235/uploads/pdf/SchoolGrief_Flyer_8%2031%2007.pdf

In the 2007-2008 school year, The Bereavement Center made forty death related-crisis response calls, the majority of which occured in schools. With our large staff of trained grief counselors, hospice bereavement specialists and expressive therapists, we are able to respond to crisis quickly. We have crisis response kits at all of our offices so that staff can quickly access needed materials and move into the schools. Our crisis responders often work in collaboration with the other mental health agencies present. The difference in our service is that we continue to provide intervention to the schools in the days and weeks following the crisis. While it is important to return to school routines, that can be difficult. There are times when a grief reaction or a trauma reaction is triggered that requires attention. We are able to return to the school and offer interventions to the class or to the deceased's inner circle of friends. Our eight week support group S.T.A.R.S (Supporting Tears, Anger, Remembrance and Sadness) is also available. In addition, we work with the teachers and school staff as their grief is often overlooked. Crises in the school cause an upheaval of emotions and routine. We are able to respond with comfort and support.

Peaceful and Proud - personalized care for veterans

Hospice of the Western Reserve's Peaceful and Proud initiative is about honoring patients who are veterans. The Peaceful and Proud committee recently brought in Deborah Grassman, ARNP, MSN, Hospice Program Coordinator at the Bay Pines VA in St. Peterburg, Florida and Dr. James Banks, Professor Emeritus at Cuyahoga Community College and founder/director of the Crile Archives for a free educational program. Ms. Grassman spoke on Wounded Warriors: Their Last Battle and described the emotional, social, spiritual and moral injuries sustained by veterans on how these impact end-of-life care. Dr. Banks talked about the unique historical dimensions of WWII, the Korean Conflict and the Vietnam War. This education is helping staff meet the diverse needs of veterans—whether that be post-traumatic stress disorder, anxiety, remorse/regret, or the need to tell their war stories. I found both lectures extremely helpful. I am now very cognizant of thanking veterans for serving our country, welcoming them home and apologizing as appropriate.

Healing Arts Workshop - Clay Vessels

Healing Arts Workshops provide grieving people with a creative outlet for their grief and are open to all grieving people. No art experience is necessary.

Clay is a wonderful material for expression: it can be pounded, flattened, rolled, opened and formed. We will use drape mold techniques to form simple bowls and vessels to hold our emotions and feelings.

The Elisabeth Severance Prentiss Bereavement Center
Two Thursday evenings, June 19 & 26, 2008, 6:30-8:30 p.m.
Call Carol Dikovitsky at (216)486-6702.

Grief and The Military Experience

The death of a loved one is a difficult experience for anyone. While grief is a normal, natural and necessary response to a loss, veterans who have witnessed death up close may keep grief inside. The military “big boys don’t cry” attitude, coupled with the survival mode of war, can hamper the grieving process.

Family members mourning a deceased veteran often comment on their stoicism, saying it interfered with relationships. Some veterans never spoke of their military experiences. Whether you are a veteran mourning the death of a loved one or the loved one of a deceased veteran, here are some grief reminders.

Remember that grief is as individual as a fingerprint.
Remind yourself that grief is a process.
Find a friend or fellow veteran who can really listen.
Attend a support group.
Expect to have setbacks.
Don’t measure your progress against the calendar – create your own calendar of grief.
Call a counselor if you have any concerns/questions about your feelings.
Hold on to hope as you transition through your grief.

The Bereavement Center of Hospice offers a variety of services to assist in the grief process, and is open to veterans and family members of veterans.

Together We Can Photos

Together We Can

Together We Can is a day camp for children 6-12 who have experienced the death of a loved one. Children meet other children who have experienced a death , share memories, and find new ways to express feelings through art, music, games and stories. There is also hiking, swimming, canoeing and doing other great activities. Camp will be held at the Red Oak Campground in Kirtland. Please contact The Bereavement Center to register.