Beyond “DEATH and Dying” – Part 2

Moving Past Denial

One of the common mistakes in grief management is not allowing feelings of DENIAL. This is often demonstrated by relatives attempting to force the individual who has suffered a loss to “face reality” and move on with their life.   Yet, Dr. Elisabeth Kubler-Ross in her renowned book “On Death and Dying” states that initial denial is an important temporary defense and serves “as a buffer after unexpected shocking news”.[1] She  goes on to suggest that this defense mechanism is necessary to allow the individual adequate time to adjust to their loss and notes that it may be combined with a tendency towards isolation – wanting to be “left alone”.  Family and other caregivers should understand that this is part of a healthy grieving process. [2]

This knowledge impacts the senior living industry because move-ins are a PROCESS more than an EVENT.  An individual in denial is unlikely to recognize the value of a move-in at this stage.  At the same time, it would be a mistake to write them off from marketing efforts:

  • They became a prospect when they demonstrated interest in the senior living community.  Although you may not know their particular “need”, BUILDING A RELATIONSHIP will move towards an ultimate move-in.
  • Most aging adults are constantly dealing with some form of loss.  A move-in will occur when the senior perceives more value in the lifestyle offered by the community than in their existing situation.  This process takes time.
  • Previously, it took 8 – 9 prospects per unit to fill an independent living community.  With today’s economy, those numbers have almost doubled to 15+ per unit.
  • By maintaining communication and social interaction, management may help the person move beyond the denial stage.  Dr. Kubler-Ross states that people may be selective in choosing which individuals to whom they communicate feelings of denial.  In practice, they may be more open to discussing future plans with the manager/marketer than with their own family members.

The first step in recognizing the denial stage is on-going conversation to learn what losses the senior has experienced (See Part 1 for examples).  This requires an investment of personal time and energy in each relationship – it won’t happen by simply inviting prospects to Special Events and/or calling every 6 months.

The marketing strategy for this stage is DON’T PUSH!  Long term success is more likely by simply “making a friend”, being positive and understanding that it’s part of the process if your overtures are initially rejected.  Be subtle when communicating the benefits of your community.  In time, these may be seen as positive alternatives to the prospect’s current situation and help in their acceptance of their loss – but it can’t be forced!

Liz’s CASE STUDY will help illustrate these points:  She is 85 years old and a widow for 5 years.  She now lives alone with her cat in her home of 20 years.

Liz is in reasonably good health but suffers from arthritis with several knee and shoulder surgeries in the past few years.  She has limited mobility, using a cane for walking any distance.  She continues to drive (around town only) and remains active with her church.

Anne, Liz’s adult daughter, recently stopped by and expressed concern about her mother’s ability to keep up with her house.  Although Liz has a cleaning lady, a lawn service and a handyman when needed, Anne is concerned that the house and yard are more than “Mom” can handle.  Liz has great friends that help out but they are getting older and have their own health issues.  Anne explained that she works and lives out-of-state.  She is finding it increasing difficult to visit and help with things around the house.

Liz has been upset because she wasn’t able to put up her Christmas tree.  Unlike past years, Anne was unable to visit and handle it this year.  So now, Anne has come to you for help – what do you do?

Obviously, the first step is to meet Liz.  Since this is apparently her daughter’s idea, you can expect some resistance.  A traditional way to become acquainted with Liz is by inviting her to a Special Event, but a more intimate approach may be to invite Anne and her mother for a personal visit, including a meal and/or participation in a planned group activity.

The objective of this first meeting should be to initiate a relationship.  During that process, you will identify various walls that Liz has erected as reasons why she can’t move in.  Some of these barriers are a result of the DENIAL of her current situation, while others are related to pre-conceived notions about senior living communities.  These apprehensions may be caused by outdated perceptions of “old-folks” homes or past experience with other levels of care such as nursing homes.

You will need to overcome these barriers, but in the initial stage, it is best to simply educate the prospective resident and her family.  Speak of your efforts to PROMOTE INDEPENDENCE, insure privacy and treat all residents with dignity and respect.  Focus on what the resident “can do” vs the “cannots”.  Utilize the information you’ve gathered to address specifics (e.g. Liz’s pet cat) before they become issues.

Make a follow-up in-home visit with Liz after Anne has departed.  Liz will probably be feeling a little lonely and welcome the visit, which should generate a wealth of information about her current situation.

Finally, here’s a word of caution.  It is very tempting to “gang-up” with Anne and coerce Liz into a premature move-in.  Yes, this might assuage Anne’s guilt feelings, but remember that the customer is Liz – not her daughter.  She won’t become a happy and satisfied resident until she moves past denial.


[1] “On Death and Dying”, Elisabeth Kubler-Ross, M.D., 1969

[2] NOTE:  An extreme or extended denial phase must be treated by professionals.

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4 CommentsLeave a comment

  1. I have read the article – very interesting. But sometimes you have to put aside the book approach..street smarts vs. book smarts. Sometimes the person you are dealing with does not deal with reason or guidelines. It with heart and emotions. Look into yourself when you are not feelig “up to par”. Yes, there are clinical venues and answers, but I really don’t think the one you are caring for cares. As stated in the article, move slowly, mindful of what the other feels. Keep in mind to yourself what it was like making a change, moving somewhere different, changing your style, job, etc.. Some may be so stubborn at relocating to a facility is out of the question. When nearing the “end” most look for their comfort zone. If you are able to even have oe consider/think of the idea, present it as an adventure, yes trial with error. Isn’t that what life is?

    • Patti,

      Thank you for your insightful comments.

  2. Part II and III are so interesting and inherently useful. Where can I find PartI?
    Gail Inglis RN/Certified Geriatric Care Manager
    Custom Care Management

    • Thank you for your comment Gail.

      Part 1 is also on the blog. Just click on the Categories box on the right side of the blog and select Beyond Death and Dying. All 3 segments will then appear in inverse order.


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