Departing with dignity.

It is an all-too-common contradiction in nursing homes: When residents enter a facility for the first time, they are welcomed through the front doors with open arms and made to feel as if they are an important part of the community. Staff treat them with respect and do their best to maintain the residents' dignity. Yet, when a resident dies in a nursing home, typically the hallways are cleared and in an almost secretive way, the body is taken out the back doors to a waiting hearse, as if it were something to be ashamed of.

Mike Roth, CEO of Alexian Brothers Sherbrooke Village (ABSV)--a campus featuring 120 skilled nursing and 44 assisted living units in St. Louis--decided to do something about it. Roth and his management team founded the "Highway to Heaven" program, a simple yet dignified method of honoring residents at the time of death. "The program grew out of a need and it really fits," explains Roth. "We generally don't treat death right in this country, especially in nursing homes. Part of this I speak of from personal experience: (A) I don't deal with death very well, as most people don't, and (B) in any nursing home that I've been in throughout my career, as well as most hospitals, you walk in through the front door, but you leave by the back door. Traditionally in nursing homes, the hallways are cleared and it is sort of hush-hush when someone expires. The resident is wheeled out the back door, sometimes right next to the dumpster where all the deliveries are coming in. So when we're talking about the dignity of an individual, what are we really saying?"

The Highway to Heaven program allows the entire community--residents, staff, and family members--to show respect for a resident who passes away. "When a resident passes, he or she always has friends in the facility among the residents and staff," explains Roth. "Everybody feels a loss, and we wanted to find a way to share that. I've had people say that we should put a white board up and write the names of the people who have expired on it, but we decided that was tacky. With the Highway to Heaven program, we accomplish this tribute in a dignified way."

When a resident expires at ABSV, the funeral director arrives at the facility to remove the body and an announcement is made over the PA system: "Highway to Heaven," followed by the hall or division where the resident lived. The funeral director then prepares the individual in his/her usual manner. The body is then covered with a special pall--a simple white cloth covering with a gold cross sewn on it, which is kept folded in the ABSV chapel. All staff have been trained as to its location and function, so that if a resident passes in the middle of the night, the staff on duty can carry on the ritual at that time.

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Once the participating staff, residents, and visitors have lined the hallway, the processional begins. The processional can be led by any number of people: perhaps one of the Alexian Brothers, if one is available, or other staff as appropriate. "For example, one weekend I was working and a resident passed with whom one of my CNAs was particularly close, so I let the CNA handle the whole processional," says Roth. The deceased is brought out with the leader first; if there are any family members, they come next, followed by any participating staff or residents. The procession then walks out the front door to the waiting hearse. The processional pauses, prayers are said, and then the funeral pall is removed, folded, and returned to the chapel.

Since its inception, Highway to Heaven has greatly enhanced the relationships among residents, family members, and staff--and that extends to other members of the ABSV family, as well. "We have a facility dog that was particularly close to one of the residents that we lost," Roth remembers. "The dog, without any coaching or prompting, followed the procession from the resident's room all the way to the front door. Once she got to the front door, however, she stopped because she knows she can't go outside. So she just sat there as we took the resident out. I said to myself, 'Even our canine companions have bought into the process.'"

Responses to the Highway to Heaven program have been overwhelmingly positive outside of the ABSV community. In addition to praise from other nursing homes and even from local funeral directors, the Missouri Department of Health and Senior Services, Section for Senior Services and Regulation, has awarded ABSV the "Best Practice in Resident Dignity Award" for the Highway to Heaven program. The award was especially apt because dignity is one of the five core values of the Alexian Brothers (a small, 13th century Catholic order that operates hospitals in Chicago, CCRCs in Milwaukee and Chattanooga, PACE programs in Chattanooga and St. Louis, and two nursing homes in St. Louis). The other core values are compassion, care of the poor, holism, and partnership.

For more information, call [phone] or visit www.alexian healthsystems.org. To comment on this article, e-mail [e-mail].

RELATED ARTICLE: "Highway to Heaven" Prayers

(Leader)

Let us pray:

Loving and merciful God, we entrust our brother/sister (name) to your mercy.

You loved (name) greatly in this life: now that he/she is freed from all its cares, give him/her happiness and peace forever.

Let us now say together the Lord's Prayer:

(All)

Our Father who art in Heaven, hallowed be Thy name, Thy kingdom come, Thy will be done, on earth as it is in Heaven. Give us this day our daily bread and forgive us our trespasses as we forgive those who trespass against us, and lead us not into temptation, but deliver us from evil. For Thine is the kingdom, the power, and the glory, forever and ever, amen.

(Leader)

And now let us all raise our right hands over (name) in a gesture of farewell and blessing.

The old order has passed away: welcome (name) now into paradise where there will be no more sorrow, but only peace and joy with Jesus, your Son, and the Holy Spirit, forever and ever, amen.

BY TODD HUTLOCK, ASSISTANT EDITOR

A collaboration of the American Association of Homes and Services for the Aging and Nursing Homes/Long Term Care Management Not-for-Profit Report, appearing in every issue of Nursing Homes magazine, addresses issues of particular interest to long-term care's not-for-profit sector. It provides nonprofit aging service providers with an additional information resource. Topics have been identified in collaboration with the American Association of Homes and Services for the Aging. Nursing Homes welcomes comments and suggestions for future coverage.