Issues around grief and loss are common in Residential Aged Care (RAC). CareSearch has a range of resources to assist with bereavement, grief and loss.
The key points relating to current knowledge about grief and loss include:
- grief is a normal response to bereavement and loss
- the way individuals' express grief varies widely
- no one can tell another how they should grieve
- it is common for people in grief to alternate between confronting and denying the death
- complicated grief requiring medical intervention is relatively rare
- having social support networks may relieve bereavement distress.
Grief in residential aged care
Families of residents
More than 60% of residents in aged care have dementia, and providing support to their families may be especially challenging for staff in RAC.
Death from advanced dementia is a slow process. Progressive cognitive decline often means that a resident's identity and individual character dramatically alters. Researchers are beginning to describe the effects of dementia on family caregivers and to identify factors that may influence their responses. The family of a person with dementia may experience triple grief as they:
- experience feelings of sadness and grief as the person with dementia declines physically and cognitively
- may also experience feelings of loss and guilt (and sometimes relief) when they place a relative in care
- face a sense of loss when the person with dementia dies.
There is some evidence that the standard of care a resident with dementia receives and the quality of communication between the RAC and the family, can affect the grieving process of the family. The more satisfied the family is with the standard of care of their relative, the lower the level of grief before and after the death of the resident.  A compassionate approach at all times can positively affect the bereavement process. 
Support for the family is integral to the provision of quality palliative care. Staff may show support by:
- including the family in care planning and use of case conferences
- sensitively informing family of changes in the resident’s status and when death may be near
- provision for family to remain with the resident when death is near
- provision of support materials relating to death and dying
- referral to support services
- acknowledging their grief and sadness.
If you provide resources for grieving relatives, ensure information is regularly reviewed, that it reflects current knowledge, and contact details are correct.
Residents of aged care facilities
Residents living in aged care may experience grief and loss due to the death of relatives or the death of fellow residents. The evidence as to how the very old respond to bereavement is contradictory. Some evidence suggests that they have greater capacity to deal with grief, while other evidence that it is a cause of depression. 
Residential aged care staff
Staff working in RAC care for many people who die. As a result they may experience repeated grief. Most of the studies of staff grief and distress have been conducted in acute hospital settings or have involved oncology and palliative care staff. There are limited studies of staff in RAC settings, however they are small and as yet the evidence for strategies to support staff is not strong.
While grief over the death of residents may contribute to burnout and overwhelming stress, it can also contribute to emotional and professional growth.
It has been suggested that careworkers are more vulnerable to negative grief responses as their work involves close personal contact with residents. They may develop close bonds with residents and families and the education of careworkers may not adequately prepare them to deal with death and dying. 
There is some evidence that education in grief loss and bereavement may help staff to manage their own grief and burnout. Workplace practices that encourage healthy grieving may be beneficial. These may include memorial rituals for resident’s who have died, the opportunity for staff to sign condolence cards to families or annual memorial services.
Reducing burnout among staff can improve morale and leads to better resident care.