Grieving in the Time of COVID-19

I went to a funeral last month for a 98 year-old mainstay of my synagogue who died of COVID. The immediate family, rabbi and cantor stood at graveside. I sat in my car, parked on the perimeter of the burial site, along with people in at least 25 other cars. We could not hear what was being said but we could say our own prayers and access our own memories. My husband played the Jewish memorial prayer—El Molei Rahamim—on his phone, and it set the appropriate somber tone. We reminisced about the deceased and said how pleased we were to see so many present under these very strange circumstances.

At the end of the service, we were allowed to go up to the grave, one at a time, to place shovels-full of dirt on the casket in accordance with tradition—if we wanted to do so. We were masked, standing 6 feet apart. We acknowledged each other with nods but did not speak. We hoped that the family would gain strength from our show of support. We gained strength from being together in this new, strange way because we shared our love, respect, and sense of rightness in being in the cemetery together.  Over the weekend, the synagogue held a Zoom memorial service that was attended by at least 100 people where stories were told and reminiscences shared.

This is grieving in the time of COVID.

We are already grieving the loss of a normal life. The loss of a loved one hits us even harder because the normal rituals of grieving are not available. As illustrated above, these difficult times call forth creativity and a search for new ways to come together to show respect, to grieve, and to share memories.

In these unusual and unprecedented times, I will share some of the wisdom I have gained as a chaplain leading bereavement groups for more than a decade and as a human being living with the grief of many in this time of COVID.  While my focus is on those who are grieving, I hope relatives and friends of the bereaved may also gain insight.

FEEL YOUR FEELINGS & BE KIND TO YOURSELF: Remember that there is no time limit on grief. Mourning the loss of a loved one is forever, but it also changes with time. There is no “right way” to grieve or “right timeline” for grief. Grieving does not happen in a straight line, it is experienced as waves that come and go.

In these surreal times of social isolation, it may be harder to accept the reality of the death of a loved one—that is normal. It also may not be possible to take time out for the mourning you want to do at this time, there are young children at home, or a job that demands all your energy and attention (this is particularly true for all front line responders, though everyone going out into the COVID world is living in a time of incredible stress), or you must attend to your own health or that of others.  Do what you have to do and do not be afraid that you are not grieving “properly.

HONOR THE MEMORY OF YOUR LOVED ONE: There are many ways to find the comfort that usually come from traditional funeral practices (shiva, viewings, etc.). Use Facetime, Skype and Zoom to connect with loved ones singly or in groups. Create memorials or electronic collages on Facebook or other platforms, these can continue indefinitely into the future. Plan a memorial for your loved one for the time when it will be possible to be together again. Pick up the telephone to call each other.  Send emails with pictures and stories. You don’t have to be technologically advanced to make the connections—just do whatever you can. A friend’s father died this past week of COVID. I did not know his father well but I would have attended the funeral, instead, I asked my friend if he would tell me stories about his father on the telephone.  He eagerly agreed. I plan to continue our phone conversations over the coming weeks and months.

CURRENT GRIEF BRINGS UP PAST GRIEF, REMEMBER YOUR PAST STRENGTHS: It is also normal to revisit many past losses while experiencing a fresh grief. This can be very painful, but it also can give you an opportunity to remember how you dealt with grief in the past—what helped you get through the unimaginable. One of my cousins is having flashbacks to her father’s death many years ago, she is using her COVID social isolation time to reach out to family members, share stories, and document family connections. The pain of loss is very fresh to her, but she also is finding new coping mechanisms that give her love and support.

STAY IN TOUCH: For the mourner, it may be hard to reach out and even harder to know what is wanted or needed. Friends and relatives may need to be more proactive than usual in making calls, sending cards, bringing or sending food, or offering any kind of comfort that is possible. It’s important to take action without being asked. This is another opportunity for creativity

SEEK PROFESSIONAL SUPPORT IF YOU ARE STRUGGLING: Connect one-on-one with a JFCS counselor for individualized support and tips during “Drop-In” Hours, Mondays, Wednesdays and Fridays 10AM-12PM, Tuesday and Thursday 5 PM-7 PM. Call JFCS at 609-987-8100 and dial 0.

Beverly Rubman, Chaplain & Support Group Facilitator

Sheltering in Place: How older adults can stay connected and active

The phrase “social distancing,” the action needed to reduce the risk of exposure to an illness or virus, has now become part of our vernacular. We’re advised to maintain a distance of 6 feet from others, avoid being in crowded areas (i.e., avoid shopping when stores are busy or use “senior” hours to shop), wash our hands for 20 seconds or longer both before and after an array of activities, and use online grocery service. While all this is meant to safeguard us as best as possible, we have become isolated out of necessity and safety.

One of the keys to remaining healthy during this crisis, both physically and mentally, is to find alternative outlets for socialization and stimulation. We need to follow a “normal” routine with regards to sleep/wake times, exercise, eating, etc. Limit the amount of news exposure and consider the source of where you are obtaining your news from, as some may be more sensational rather than factual. Constant exposure to the news can also increase one’s anxiety. 

Here are 12 activities that might be of interest, while remaining in the safety of your home:

Chair Yoga

“Visit” a Museum

De-stress by listening to a 20 minutes relaxation exercise  

Sign up for a free online class…one option is Covia: Well Connected

Here is one option: https://covia.org/wp-content/uploads/2019/12/Well-Connected-Winter2020-FINAL.pdf   

Join a chat room such as Bridge Club Live or Mah Jongg

“View” historic sites or take a walking tour of NYC

Learn a new skill or craft

Use this time to declutter your home (pick a room) or switch over your wardrobe for the spring season.

Try a new recipe that uses the ingredients and spices already in your home

Socialize with friends and family through Skype, Google Duo,of Facebook Messenger

Set up a regular time for a call with family or a friend daily

Beth Hammer, LCSW (Geriatric Care Manager)

Handling the Holidays in Time of Crisis When You Are Grieving

We are all dealing with grief now—loss of normalcy; loss of connection; fear of economic toll, nervous anticipation of the future. For those in our community who are mourning the loss of a loved one, the grief is intense and even more isolating because we do not have the traditional community supports to provide some sense of stability. As holiday times approach, the Empty Chair has become the Empty Table and the Empty Room. What are some tools that can give you the support you need?

A VERY IMPORTANT REMINDER:  Everyone experiences grief in his/her own way. There is no right or wrong. Give yourself permission to do whatever feels right, and please be gentle with yourself.

Suggestions for Handling the Holidays:

  • Nothing is normal for anyone this year. Think about what has helped you since the loss of your loved one; don’t do what you think you should but what feels right to you.
  •  Connect, connect, connect—to your friends, your family, your community (of faith or otherwise).  Take advantage of technology old and new:  telephone calls, email, text, Facetime, Skype or Zoom.  JFCS will provide resources for virtual Passover seders, as well as other services and celebrations, in a future post.
  • Tell your family and friends what you need, whether or not they ask. Don’t be shy—this is not a time for false reticence, you ARE strong but you still need others for support and help.
  • Think of rituals that have meaning for you and turn to them as often as necessary—these can relate to the holiday or not. There won’t be a big family meal this year (that would have raised other issues for you as you grieve), but you can make dishes that you love or that bring back happy memories. You can share recipes, perhaps using technology as you go about your preparations, or sing songs together or tell stories of holidays past. Or you can do none of the above.
  • Turn to prayers or readings from the holiday that have special meaning for you. Repeat them as often as needed for consolation.
  • Sing special songs relating to the holiday as you wash your hands (for 20 seconds). In fact, listen to or make music as much as you can. Music leads to activity in multiple parts of the brain where we process emotion, memory, awareness, and attention. It can help short-circuit sadness by using these brain areas to bring up happy emotions and joyful memories as we tune our attention to the song. We also know that music can bring strong emotions and heartfelt tears to the surface, which can help us process the complex emotions we are experiencing at this time.

NOTE:  Memories, with their sweetness and their pain, are important tools for healing. You know that your loved one will never be forgotten. Relationships don’t end with death but, with time, they will become transformed. And there is nothing wrong with crying.

  • Breathe.  Focus on all five of your senses, perhaps with particular reference to the upcoming holiday.  The sweet smell of a favorite food, the texture of special clothing, tablecloths or a reclining pillow, the sight or feeling of one small item related to the holiday that warms your heart, the clink of glasses of wine. Memories of holidays past will, of course, be painful without your loved one.   Try to access the positive ones.
  • This is the time for spring holidays, with their connection to nature. Go outside as much as possible, if you can. Savor the sights of flowering trees or plants. Smell the smell of fresh green grass. Move your weary muscles. Remember that we are all part of the cycle of life.

Beverly Rubman, Chaplain

Daily Webinar Alert: Impact of COVID-19 on Medical Decision Making

JFCS continues to gather important resources for dealing with the impact of COVID-19. We are sharing the below information for an outside resource:

Daily 30-minute Webinar available at 1 PM EST Monday-Friday (through April 24)

“Impact of COVID-19 on Medical Decision Making: POLST and Other Important Considerations for High-Risk People” Hosted by Dr. David Barile, Palliative and Geriatric Physician, Founder & Chief Medical Officer Goals of Care Coalition of New Jersey

The purpose of the webinar is to help educate people and address their questions regarding POLST (Physician Orders for Life-Sustaining Treatment) and advance directives for the populations at high-risk for complications of COVID-19 (e.g., nursing home residents, frail elders, people with compromised immune systems and underlying medical concerns) and their surrogate decision makers or healthcare proxies.  Dr. David Barile will explain what a POLST is, why it is an important document, how to complete the form, and under what circumstances someone should have one.  Each session is followed by a Q & A period. Once registered, you can submit your questions.

 To register, go to goalsofcare.org 

The Truth About Long Distance Caregiving

About 1 in 8 family caregivers live more than an hour’s drive from the recipient of the care. Whether you are in a different city, a different state, across the country, or across the globe, as caregiver you want to be there without always being there.

According to AARP, these are five steps to staying informed and effective as a long-distance caregiver.

  1. Establish Access

Caregiving often involves having the legal authority to make financial and healthcare related decisions. Having good information channels to accessing this information is crucial to a long distance caregiver. Try to arrange as much as possible during an in-person visit, when you can work with your loved one to locate, organize and fill out necessary paperwork such as a will, power of attorney and medical care plan.

  1. Create a Team

In the digital age, you can handle many important tasks remotely, such as paying bills and ordering prescriptions; however, you will need others to be your eyes, ears and sometimes hands on the ground. It is natural for long distance caregivers to feel guilty about delegating certain jobs to others, but do not try and do it all. Delegating regular check-ins and more hands-on care to nearby family, friends or professionals can be in the best interest of your loved one, especially in cased of serious or complicated health issues.

  1. Find a Local Coordinator

A local care manager can supply local knowledge and help with caregiving logistics. One option is to hire a reputable caregiving professional, also known as geriatric care manager, aging life care manager or eldercare navigator or coordinator. These professionals are often licensed nurses or social workers and can be valuable mediators or sounding boards when family members disagree on care decisions. A care manager can help make tough choices easier on the caregiver and care recipient – such as knowing when it is no longer safe for a loved one to live at home – by presenting an array of options from a knowledgeable, outside perspective.

  1. Stay in the Loop

Establish ways to communicate regularly with your local team and loved one, whether through organization apps, group emails or social tools like FaceTime and Skype.

  1. Make the Most of Visits

Nothing replaces an in-person visit. When you can manage one, come with a list of things you need to know or discuss.

How can JFCS help you to navigate these challenges?

If your loved one resides in Princeton, NJ or the surrounding Mercer County area, consider a membership in the award-winning Secure@Home program offerings through JFCS. Our Secure@Home team of highly skilled Senior Care Consultants provides a comprehensive umbrella of care management services to help older adults age comfortably, independently and safely in their own homes.

Membership includes a complete home assessment, care plan, 24-hour emergency telephone availability, “Chore Corps” volunteers and regular check-ins, preferred provider list and wellness lectures.

If you are concerned about your loved one, please call JFCS at 609-987-8100 and ask to speak to a Secure@Home representative.

How do I Talk to a Family Member about Senior Care Options?

The holidays are a wonderful time for families to gather and share in memories and traditions. However, meals around the table can also spur on questions about the health of our aging family members.

“Did Dad almost trip coming up his own front step?”

“Did Nanna look this frail last year?”

“Does Uncle Stu seem more forgetful?”

Family gatherings can shine a light on deteriorating health in our loved ones and be an opportunity to discuss senior care options from in-home care to assisted living.

What are signs your loved one needs help?

Some of the most common signs of concern include*:

  • Changes in mood or extreme mood swings
  • Cluttered, dirty and/or disorganized house
  • Disheveled clothing / poor personal hygiene
  • Expired/spoiled groceries
  • Confusion and uncertainty when performing once-familiar tasks
  • Forgetfulness
  • Loss of interest in activities
  • Trouble getting up from seated position
  • Unexplained bruises

How to start the conversation?

As with many difficult topics, beginning the discussion is often the hardest part. Open-ended questions are the best way to encourage them to talk. Sit back and really listen to their answers.

These conversation starters may help:

  • How is it living at home alone? Do you still feel safe? (OR give specific examples i.e. Are you concerned about the stairs? Do you have trouble getting into the bath?)
  • Do you feel lonely sometimes? Would you like to spend more time with people your own age?
  • How do you feel about driving? Would you be interested in other options for transportation, so you don’t have to worry about getting where you need to go, car maintenance costs, traffic, parking, etc.?
  • Is it ever hard to manage your finances and keep up with paying your bills?
  • Ever wonder about getting a helping hand with housekeeping and laundry?
  • Would you feel less stress if you didn’t have to worry about the house?

Speaking to your aging loved ones about care options can be difficult, starting the conversation is the first step. Multiple conversations may be needed to understand your loved one’s needs and wishes AND balance those with the best options for a safe, comfortable and fulfilling lifestyle. Remember these tips to have a helpful conversation each time:

  • Talk in person. This isn’t a conversation to have by telephone if you can avoid it. Instead, pick a day when you and your parent are well-rested and relaxed. Block out a time and a location where you can talk without interruption.
  • Empathy, not sympathy. No older adult wants their child to feel sorry for them. But empathy is another matter. Your kind, calm voice and demeanor will show you care – and that you’re trying to understand the fears and frustrations they may feel. The idea of accepting in-home care or moving to a senior living community is tough. You begin to help as soon as you really begin to listen.
  • Don’t rush. Once you’re armed with knowledge, you may feel ready to make a decision. But your parent may need more time. Allow them the time they need to find the words to express how they’re feeling. Coming to an unpressured mutual agreement now will continue to pay dividends as you move forward together.
  • Plan to talk again. And again. As much as you might want to wrap things up in one conversation, the reality is this will likely be a series of talks. Unless your aging family member is in eminent danger, that’s okay. It’s a process, not a once-and-done discussion.

*Signs Loved One May Need Help sourced by A Place For Mom. (link https://www.aplaceformom.com/planning-and-advice)