Earth Anqels on Call.

A group of volunteers dedicated to help the dying reach their final goal

Editor's Note: Recently the Public Broadcasting System (PBS) ran a four-part series by Bill Moyers entitled "On Our Own Terms: Moyers on Dying in America." Besides providing a viewing experience, the series was intended to stimulate national discussion on the management of death and dying in American healthcare facilities and homes. The following article is offered as a contribution to the discussion.

Although other cultures perceive death as a normal transition and promote it as a time of rest, peace and celebration, our American culture fears the process and avoids facing it whenever possible. No one should die alone. That is the mission of the Good Endings[R] program.

As a thanatologist (death and dying counselor) for more than 23 years, I noticed the lack of end-of-life education in healthcare facilities, especially in nursing homes that deal with death daily. I am presently a social worker at SunBridge Care & Rehabilitation in East Longmeadow, Mass., part of the Sun Healthcare Group of Albuquerque, New Mexico. I approached the director of social services and the facility administrator with the idea of presenting an in-house workshop for staff education that includes such topics as the stages of dying, the psychosocial and physical aspects of the process, how to assist the dying resident and addressing bereavement issues for the caregiver.

Armed with information about the dying process, 13 volunteers were recruited to participate in the Good Endings program. These volunteers came from many areas of the facility, and not all of them were involved in resident care. The only qualifications required are a caring and compassionate nature, a heart full of love and a willingness to sit vigil. The team has expanded to 16 volunteers, including a family member whose loved one had benefited from vigil, a head of a home healthcare agency and a psychiatric nurse who read about the program.

The biggest concern in setting up a vigil program is finding someone to run it. There is a lot of work involved--scheduling, preparing support meeting topics and designing a remembrance service--in addition to sitting vigil.

Before sitting their first vigil, team members are given a notebook containing death-, dying-and bereavement-related articles. They are encouraged to keep a journal of their experiences, feelings and reactions. Because this is a continuing education program, support group meetings are held every other month, for which the journal entries provide a springboard for spontaneous discussion. Along with journal discussion, videos and guest speakers provide information on death and dying and other related issues.

SunBridge lets families know that the vigil program is available to them at no charge if it becomes necessary. Occasionally a family will choose not to avail themselves of the program but later see its value and often request intervention further along in the dying process. Often the family feels that they can handle vigil for the final days but then realize that sometimes it is impossible to be constantly at the bedside--children still need attention, shopping must be done, etc. A vigil might last a day or stretch over weeks, and life's daily responsibilities cannot always be ignored.

Volunteers must fill in a monthly calendar of times and days they are available to sit vigil, committing to at least two hours when sitting vigil with a resident. From the calendar, each sitter must contact her relief to maintain vigil continuity. On those occasions when coverage is temporarily unavailable, staff members are asked to check the vigil room or, since most volunteers are SunBridge employees, on-duty personnel might be able to sit with the resident on their breaks until a volunteer arrives.

When a person begins actively dying, the Good Endings supervisor is contacted to initiate the vigil rotation. It is important to have the family acquaint you with the resident. His or her preferences will guide the vigil volunteer in selecting readings or meaningful music. Sometimes simply holding a hand or stroking a brow provides the human connection and relaxation that fulfills the purpose of providing comfort care for the dying and his or her family.

When vigil begins, the resident has progressed in the dying process to unconsciousness. Although he might seem unaware of his surroundings, it is important to be aware of the tone of conversation in the room. Hearing is the last sense to leave, and what is being said in his presence could have an effect. I firmly believe that people choose when they're ready to die. Sometimes they need permission that it's okay for them to go. The first person I ever sat with was an elderly woman. I held her hand and told her that her husband and son loved her. Although they would miss her, it was all right to die. A few minutes later, she was gone.

Vigil sitters do not provide care; our function is to keep residents comfortable. When family or nursing personnel are present, the vigil sitter will excuse herself or stay if asked.

The Good Endings program also sees to it that family needs are met. We are there to help them. We have a collection of pamphlets on various diseases and information on methods of body disposal, funeral planning and advance directives, such as living wills and DNR (Do Not Resuscitate) orders. As the director and founder of SunBridge's Good Endings program, I have compiled a one-page glossary of end-of-life definitions available for the family.

After a resident expires, many volunteers try to attend the wake or funeral. Along with their support group meetings, it gives them a sense of closure because for a week or two, they have been a part of that person's extended family. I went to the wake of a gentle-man I helped vigil and was warmly greeted by the family. There were photographs of him in his youth, on his wedding day and with his children. It helped me to know him and made me feel good about having been there for him.

After the vigil and funeral are over, we often receive cards, letters and gifts from the families. One family donated a birdbath inscribed with their mother's name. Another family donated a bench. Their gratitude is the best reward that vigil volunteers can receive.

Quarterly, we invite family members of the deceased to a remembrance service in their honor. Staff and other residents also attend because they, too, knew the deceased and need to grieve. Some residents have lived at the facility for a long time and have formed friendships here. The ceremony begins with our administrator welcoming the attendees. Then a prayer is offered followed by songs and personal reminiscences. Refreshments are served and the family is given a small gift, such as a candle.

The Good Endings program is approaching its first anniversary. In that year, we have sat vigil with 75 residents. "Earth Angels: A Year of Vigil" is currently being prepared as a commemorative booklet celebrating those for whom we have sat vigil.

A Good Endings program costs almost nothing to establish, yet having it or a similar program in place benefits the facility, too. Families like to know that this no-charge service is available for them when the need arises. SunBridge has received inquiries and gained admissions because of the program's reputation. There have also been requests from other facilities for death and dying workshops. Although an end-of-life program is challenging, it is a rewarding experience for every-one involved.

Donalyn Gross, LCSW, PhD, is a social worker at SunBridge Care & Rehabilitation, East Longmeadow, Mass. She designed the Good Endings program and has prepared a 42-page training manual and support material.