Bereavement in Later Life: an emerging policy issue for the 21st Century by Jodie Croxall
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Bereavement in Later Life: an emerging policy issue for the 21st Century Jodie Croxall, Swansea University A presentation at the BSA Death, Dying and Bereavement Symposium, November 2011
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Bereavement in Later Life: an emerging policy issue for the 21st Century by Jodie Croxall
- 1. Bereavement in Later Life: An emerging policy issue for the 21 st Century Jodie Croxall Lecturer in Social Policy Centre for Innovative Ageing, College of Health & Human Sciences, Swansea University [email_address] 01792 606726
- 3. Bereavement in later life sssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss Neglected area of academic enquiry Bereavement an increasingly common experience in later life Neglected area of Social policy Bereavement plus complexities associated with ageing Age specific needs for support
- 5. Interpretive Framework sssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss The ‘Pathologising’ of bereavement … an individual problem to be cured… The ‘individualisation’ of bereavement … .experiences of death & bereavement no longer shared by community Bereavement is ‘discounted’ in old age … they can handle it…. Ageist assumptions Bereavement in Later Life NOT constructed as a ‘social problem’ WHY?
- 7. Findings: Sources of support for older people... sssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss Voluntary Services Private organisations Public Services Neighbours Friends Family Supportive?
- 10. Findings: informal support... sssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss Divorce Female employment Social mobility ‘ Grandparenthood’ Community decline Socio-cultural transformations have reduced the potential availability of informal sources of support
Hinweis der Redaktion
- Bereavement in Later Life: An emerging policy issue for the 21 st Century’
- This presentation offers some initial findings from an ongoing PhD study which focuses on whether older peoples needs for support are being met during times of bereavement.
- My PhD is concerned with the issues surrounding the needs of older people during times of bereavement. Just a bit about why I became interested in this subject. Before coming into academia I worked for a number of years with social services and voluntary organisations as a community support worker for older people. My interest in bereavement was triggered by personal experience, a close family member died and this was my first experience of loss- I was struck at the lack of support offered to my family during this time, and coming from a social policy background and its emphasis on Cradle to the Grave support- I realised how at this time in life very little support is offered. And so this began my research journey into bereavement and older people. Although we will all experience bereavement at sometime in our lives; the social and medical advancements over the past century have meant that the majority of deaths now occur in later life, and older people are more likely than any other age group to experience bereavement. Bereavement at any age is considered to be one of the most traumatic and stressful experiences in a persons life and the cause of much emotional, psychological and social upheaval. However, for older people in particular, this traumatic and stressful time is often compounded by additional factors that are accompanied with ageing. Health - Older people more likely to have existing health problems- bereavement can make these condition worse or can lead to new health problems, such as depression and anxiety. Environment & Lifestyle – Bereavement also impacts on environment & lifestyle, for example the loss of income or loss of carer may necessitate a move into residential care Multiple- losses- Older people more likely to suffer from multiple losses – more than one family member or friend may die in a short period of time Therefore, older people have additional needs for support during bereavement . Bereavement = need for social support derived from social networks Bereavement = a ‘Social Network Crisis’- diminished informal support, especially for older people Benefits of formal support during bereavement, especially when deficits in informal support Bereavement dominated by voluntary & private providers - little state intervention ……. a ‘private’ not ‘state’ matter Recent policy discussions point to inadequacies of formal support provisions for older bereaved: bereavement services not offered to older people (Age Concern 2008) existing services uncoordinated and need improving (Varney 2006) services fragmented, confined to those who accessed hospital, hospice or palliative care services while deceased was alive (NICE 2004; DoH 2005) However, despite significant research evidence highlighting its determining effect on well-being, the needs of older people during times of bereavement has remained largely at the periphery of the welfare agenda. There are no coherent policy framework to meet the needs of older bereaved people in Wales, or indeed the UK. Bereavement in later life is also largely neglected area of academic enquiry, literature is dominated by psychoanalytical and medical perspectives- little research on the social support needs of older people. My research is theoretically underpinned by Social Constructionism. Basically I argue that because bereavement needs of older people have traditioanlly been met through informal networks of family and community, it has not been constructed as a social problem worthy of attention- this offers a critical explanation for the lack of policy and service provisions for older bereaved people. The principle aims of this study are to: Identify older people’s perceptions & experiences of social support (formal & informal) following bereavement In doing so, identify whether there are unmet needs for support for the older bereaved And contribute to knowledge base & social policy developments in this field
- My PhD is concerned with the issues surrounding the needs of older people during times of bereavement. Just a bit about why I became interested in this subject. Before coming into academia I worked for a number of years with social services and voluntary organisations as a community support worker for older people. My interest in bereavement was triggered by personal experience, a close family member died and this was my first experience of loss- I was struck at the lack of support offered to my family during this time, and coming from a social policy background and its emphasis on Cradle to the Grave support- I realised how at this time in life very little support is offered. And so this began my research journey into bereavement and older people. Although we will all experience bereavement at sometime in our lives; the social and medical advancements over the past century have meant that the majority of deaths now occur in later life, and older people are more likely than any other age group to experience bereavement. Bereavement at any age is considered to be one of the most traumatic and stressful experiences in a persons life and the cause of much emotional, psychological and social upheaval. However, for older people in particular, this traumatic and stressful time is often compounded by additional factors that are accompanied with ageing. Health - Older people more likely to have existing health problems- bereavement can make these condition worse or can lead to new health problems, such as depression and anxiety. Environment & Lifestyle – Bereavement also impacts on environment & lifestyle, for example the loss of income or loss of carer may necessitate a move into residential care Multiple- losses- Older people more likely to suffer from multiple losses – more than one family member or friend may die in a short period of time Therefore, older people have additional needs for support during bereavement . However, despite significant research evidence highlighting its determining effect on well-being, the needs of older people during times of bereavement has remained largely at the periphery of the welfare agenda. There are no coherent policy framework to meet the needs of older bereaved people in Wales, or indeed the UK. Bereavement in later life is also largely neglected area of academic enquiry, literature is dominated by psychoanalytical and medical perspectives- little research on the social support needs of older people. My research is theoretically underpinned by Social Constructionism. Basically I argue that because bereavement needs of older people have traditioanlly been met through informal networks of family and community, it has not been constructed as a social problem worthy of attention- this offers a critical explanation for the lack of policy and service provisions for older bereaved people. The principle aims of this study are to: Identify older people’s perceptions & experiences of social support (formal & informal) following bereavement In doing so, identify whether there are unmet needs for support for the older bereaved And contribute to knowledge base & social policy developments in this field
- In order to gain older person’s experiences of support following bereavement and also to determine whether there are unmet needs, I have adopted a qualitative approach. Semi-structured interviews were held with two study populations, Older bereaved individuals and Service Providers, both utilized snowball sampling techniques. The older bereaved people interviewed: ranged from 65-92 (Not working age) Mixed socio-economic backgrounds Lived alone (Mixed tenure) Different types of loss (Mother, Son, wife, husband, sister) – I wanted different types of loss because as I mentioned earlier, existing literature is dominated by spousal loss, little is known about other types of loss that are becoming increasingly common during later life (for example it is not so unusual for a person in their late 70’s to be facing the loss of a parent) The service providers interviewed included a range of public, private and voluntary organizations who regularly come into contact with older bereaved individuals Funeral director Vicar Age Concern Cruse Bereavement Care Cancer Information Support The interviews aimed to determine: What do older people think is supportive following bereavement? Their experiences of support following bereavement – what support is available and who provides it? Whether there are unmet needs for support?
- In my interview schedule, I asked who had provided help and support to them during bereavement: Family Many of the sample didn’t have any family surviving, and those who did didn’t want to bother them as ‘they have their own lives to lead’ I haven’t got any family now, I’ve got a second cousin, one first cousin….it isn’t that we had any quarrels or anything but they got married and gone to other places, we are social enough if we happen to see them (Mary 92) I haven’t got family. The only family I had at the time was him. I haven’t got any family, at all (Sarah 71) Friends Friends were very important to those who had them, but some who were less able couldn’t get out to meet them... Restricted to phone calls friends often old themselves- immobile Neighbours For many, neighbours played a pivotal role, pointing to sources of support and information Well the only help I think I had, it was help really, lovely neighbours across the road they saw how distraught I was, how upset I was. You know, I was ill and I had two asthma attacks, I lost my voice, so I couldn’t talk to anyone, I just went downhill (Sarah 71) Public Services None mentioned any help by public services, GPs, Health Visitors, Social Services whould refer on to voluntary orgs... Private Organisations Funeral directors pivotal role pointing to information and also vicars Voluntary Organisations Social service referrals, Age Concern, Cruse befriending pointing in the direction… Not all offered support!
- The interviews have yielded a number of key themes regarding older people's perceptions of the bereavement experience: Loneliness: All of the interviewed older people spoke of feelings of loneliness. ‘I think you are much more lonely when you are an older person; I mean if you have a family they have grown up and have got their own lives to live…I do think perhaps that it hurts you more then… (Gwen, 85) ‘ Here, clear gender differences have emerged- the women tended to have more friends than the men, this can be linked to the tradition of the man going out to work- social life revolved around work- his work mates were his friends, men more reliant on their partners for companionship in later life. Social Isolation: For many of the older people, bereavement lead to social isolation- not being able to do activities such as socialising i.e. dancing, swimming, walking etc (no partner, no transport) Rekindled grief: Another interesting thing emerging from the interviews was how when I went to speak about the loss which had occurred within the year, the older person would compare it to previous losses in their lives. When interviewing a man about the death of his mother, I used a whole tape of my dictaphone with his remembering the death of his wife… and again, I interviewed a woman about the death of her husband, and immediately she spoke of the death of her son some 40 years previous… It seems that bereavement in later life does rekindle feelings of grief for earlier losses…difficult to get over then. Practical concerns: Practical concerns, primarily concerning finances and personal affairs also dominated the interviews… the lack of support during funeral arrangements and payments especially. Lack of information: Also, there seems to be an absence of information of what needs to be done to put affairs in order, some people relied on family, others on vicars, others on funeral directors, some had no one but the voluntary services to ask
- I asked the olde rpeople what they felt they needed after a loss what would have helped them? Companionship: I think there’s been a lot of years with a partner and some of them probably entirely with their partner. You know, not a lot of social friends. So I come across them and they say “What do I do now, I haven’t got any friends”, so they need support in that area you know (Clive 65) , I mean for me it’s strange, after 40 years, I’m having to things on my own. Yes, absolutely everything, we discussed everything. I don’t think we bought anything without we talked to each other about it. Every decision, alright we discussed the paint the wallpaper you know, I’d got my input then, but go with what she says (Clive 65) Emotional support/empathy Someone to talk top about their feelings- men outside doidnt want to bother family Functional support Actual help with shopping etc transport Practical support Information & advice
- It seems that socio-cultural transformations have effectively reduced the potential availability of informal supports: Divorce: His father who he hadn’t seen for about ten years took over and I just sat there and just went along with it….. and I couldn’t open my mouth…. I didn’t have anyone with me to push me and say stop that.... … It is such a difficult time to be logical and reasonable’ (Joan 68) Female employment: No I’d have to rely on daughter, she works part-time, and of course my eldest boy and the young daughter, I mean he’s hopeless her partner (Daisy 77). But my daughter she helps us in a way, she’s quite knowledgeable and eldest daughter because she works. She’s 53. And my daughter in law; she also works (Daisy 77) Childcare: She’s got umpteen grandchildren, she’s got a lot on her plate but she did try to do her best to help me’ (‘David 82 years old) Social mobility Community decline One of the breakdowns in society today is the breakdown in community; and people don’t join, if you look at it in all organisations: male voice choirs, drinking clubs, membership clubs, everything that requires membership or joining is going down and that part of society today we don’t know our neighbours we don’t talk over the fence we don’t go into each others houses. There are documented cases where people have passed away in their flats for three or four months and no-one has found or pointed out the fact that they haven’t see this person. This is the society that we live in now. There are better communities than others, there are closer knit communities but on the whole community is gone (Vicar) Social club decline Loneliness, Social Isolation Family Change: Social Mobility, Female employment, Divorce Community: Long-term neighbours Rekindled grief
- Evidence seems to indicate that social support from outside the bereaved person’s immediate network of family and friend is extremely helpful to those who have the opportunity and need to utilize such support, especially when there are deficits in the support systems which leave the bereaved person with an insufficient range of possibilities to make necessary adjustments to their situation However, interviews with older people and service providers point to point to inadequacies of formal support provisions for older bereaved Individuals: Public services- GP’s tended to be the first port of call- medicalised support councelling not everyone wants councelling stigma. Services fragmented, confined to those who accessed hospital, hospice or palliative care services while deceased was alive (NICE 2004; DoH 2005) Privite agents – here i include funeral directors and vicars- often act as key information providers- here again good ones and bad ones... Voluntary organisations Cruse- under funded cant attract funding Bereavement not seen as a ‘worthy cause’ Not on the policy agenda so difficult to get funding Age concern can meet demands Many small services doing part but not all pooled together... What I would like to add to this is our problem of funding that we continually have and that is that we don't actually get core funding from anywhere and we've actually, virtually been on the brink of closure twice. Because of that we can’t really make any projections, we just have to live day by day and the volunteers have to live day by day and when you've got 14 hour volunteers doing such sterling work, it’s very difficult to keep up their morale, when they’re not necessarily sure if they will be here next week or not. This is our continuing problem; it’s not being recognised as something that is, as you say, something that is important. Exactly, I think another thing is, it doesn't matter where you go, and at what level of meeting you are in, if the person holding that meeting has a fear of death, of his own mortality and there are people out there who do have that. They don’t bring it on the agenda because they don't want to talk about it because it’s awful and this is our biggest problem. ‘ I think the important thing, as well as our financial well-being, that we get a recognition of bereavement support in society; not just for the elderly but right across the board, but certainly for the elderly...’ (Volunteer, Cruse Bereavement Care, Swansea) JODIE: Do you put in bids for big lottery grants and things like that? SUE: Because we are big organisation and it’s filtered down, we can’t actually go for it. The big lottery is one of them that we can’t go for. We can go for little dribs and drabs here and there but we can’t actually go for big amounts. JOHN: The difficulty with the big lottery is, is that it needs a lot of resources actually get the bid in. JODIE: I’m just thinking because they're always on my back in University to put bids in but I would need an organisation. We can’t them in on your own. As an academic, we would need an actual organisation. SUE: Right, so for argument's sake if we were going to perhaps branch out into befriending, and we wanted to do say a befriending, that is something we could do together. JODIE: Could do an intervention study. Well the academic side of it would be how to set up the intervention, you know, and evaluating it then, like a before and after study really so we could get the people before they were befriended, you know, their details and how they were coping and then follow them up so that’s it. There is always WORD, have you heard of the Welsh Office for Research and Development? They always put bids out as well, with the Welsh Assembly that is. SUE: Oh right, I see. Well if ever you here of something or have idea. JODIE: I'll leave my details, because I’ve never put a bid in myself but they’ve been telling me to do it and I’d have people to help, you know. But it’d have to be a joint thing. JOHN: But it is, I mean bids have been put in by branches to the lottery in England and in Wales and to date, Cruse National did get one at one time, but no branch has succeeded in the lottery bid in England and Wales. Some really, really good bids have gone in, but not one Cruse branch has been successful with the lottery. They don’t want to know. SUE: It’s not a hope, if you've got someone like Macmillan or Marie Curie, you've got hope at the end and in facts we’ve just had, it’s our 50 th year, it’s Cruse's 50th year this year and they’ve actually put their strap-line is restoring hope. Now whether they hope that’s going to make a difference or not I don’t know but when you come to bereavement people don’t see it as a hope, it’s the end of the line. JOHN: And it’s not something you sort of want to; you don’t get much publicity from bereavement do you. SUE: No and eople don't want to talk about it. JOHN: No they don’t. SUE: If you go to a dinner party and bring up the subject of bereavement, it’s like [bang] that isn’t it? If you bring up cancer or something like that it’s an acceptable dinner topic. But we actually had one of our volunteers was going to go round giving talks to like the Lions to raise fund for us and they just didn't want to know, they didn’t want to know. She said “You know, I'll come and talk to you about other things, because she’s quite a well-known lady, I’ll come and talk to you about other things but the money is going towards bereavement and they just didn’t want to know and she couldn’t believe the response that she got. JODIE: It’s fear like you say isn’t it? SUE: Yes it’s fear. JODIE: Everyone has got some experience of bereavement haven’t they? SUE: That’s the only thing I could put it down to; people's fear and its sad, because there are a lot of people out there who want seeing who we don’t have, you know we try and support everybody that comes through our doors but we always say that it is the people that we are not seeing and we don’t do any development work because we couldn’t cope with an increase. Last year we had something like a quarter, a 25% increase in referrals and we’re already seeing an increase on that this year. JODIE: It doesn’t make any sense though does it? You don't get funding then if statutory bodies are referring to you but yet… SUE: I know, we even get letters from GP's. “Would you please see this lady?”, you know or “Would you please see this person?” and we do it all and it is very difficult, very difficult. JOHN: But as we said initially, society has changed quite considerably in the past because you had communities and you had the support available within families, within extended families and these days, long gone. SUE: That's interesting what you were saying about the daughters would come round and perhaps cook you dinner. JODIE: I interviewed a younger, well 68ish, so younger from my people and the lady was divorced and that’s going to cause lots of problems in the future because her husband, her son had died, and her husband had taken over the funeral arrangements, she felt she didn’t have any control. You know, she had brought the son up and she wasn’t in a fit state to fight him really so that’s going to be more of a problem. JOHN: Issues like that are going to be… JODIE: And stepchildren SUE: And where you get the two families converging. People come here with bereavement issues but what you are presented with on the day is the bereavement issue but then comes this niggle that, “Well I’m not going to let her on the headstone because she said she'd pay for it” and it’s all these other issues that come in and when you often say to the clients “Do you think you could talk about it with your wife?”, “Oh no, no. I can talk about it here but I can’t talk about it at home”. You realise then that the need, the need for this service, that people out there wouldn’t be saying what they need to say. JOHN: And I think as well, the difference between voluntary sector and statutory sector, there’s this sort of authority thing out there whereas people are quite relaxed when they talk to us and everything is confidential within our service. But it is a different approach isn’t it? I'm not knocking the statutory sector, I’m not saying they’re not doing a good job but it’s not always easy to be seen by them. I think you mentioned earlier, O.K. they make their will but going to see the council, I mean it is for this age group, it is. SUE: It's like there is an illness, there’s something medically wrong or is there something going on in my head. “I don't need to see a psychiatrist, I'm grieving”. But there isn’t the help out there and what’s happening I think is that the GP is becoming more of a social worker because as soon as there is a bereavement people are going to see the GP. JOHN: And I think with GP's, some are absolutely brilliant. They’re so sensitive and helpful towards the client. I have a few of my clients, their GP's are absolutely brilliant. But others who are not comfortable, know very little about bereavement. It’s like a lottery isn’t it? JODIE: It’s only recently that the hospital staff have had any training; since 2005. So nurses didn't even have to have it, it’s shocking really. SUE: But even that, their training I think is a minimum. JODIE: Yeah, and it’s still not across all hospitals. JOHN: No, it’s very patchy SUE: No, very patchy END.