In nursing homes, deaths are shrouded in secrecy and silence

In many nursing homes run by the Department of Veterans Affairs, friends and acquaintances gather to honor residents after they have died, lining the halls as a body moves past, sometimes shrouded by an American flag.

In other nursing homes and assisted-living facilities, bodies are often secreted out back passageways; friends who ask staff about missing residents are frequently told that information is private.

“They’ll typically camouflage death,” said Jill Harrison, a consultant and researcher who studies health care among the elderly.

Residents are left to intuit what happened to friends or roommates and mourn in private, except for quarterly gatherings where residents acknowledge multiple deaths. Harrison says residents tell her that those gatherings are nice, but in the days between the death and the memorial, they’re crying alone.

“It’s heartbreaking to hear,” she said. “In the real world, we don’t go to funerals quarterly for our friends. The day you die is the day you die.”

Residents of nursing homes and assisted-living facilities have far more rights than they once did. In 1987, the federal government enacted the Nursing Home Reform Act, which, for the first time, stipulated that they were protected from basic abuses such as physical harassment, involuntary seclusion, and any physical or chemical restraints.

But many facilities still fail to protect their residents from all sorts of emotional trauma.

The movement toward more compassionate care in nursing homes and assisted-living facilities is being nudged forward by people like Harrison, who works for Planetree, a nonprofit healthcare advisory service. But finding solutions can be complicated, as with the issue of resident deaths.

Staff members might be perfectly willing to coordinate immediate memorial services for friends, or provide even brief counseling sessions. But insurance generally doesn’t reimburse social workers for such sessions, and few staff members could find spare time to organize and conduct memorial services every time a resident dies.

Harrison said one solution is to encourage institutions to openly acknowledge when someone has died, and to help friends to start processing the loss together. Staff can offer to frame a photo of the deceased in their memory.

“And have staff talk to them about what they remember about that person, and how they’re feeling,” she said.

This approach is similar to that of the VA Medical Center in Manchester, N.H., where an inpatient skilled-nursing facility serves 41 veterans.

When a resident dies, the gurney is draped with an American flag quilt, and a chaplain leads the bereaved in a bedside prayer or meditation while staff members inform friends and acquaintances of the death. The body is then moved to the hallway just outside the room, where others from the facility join for another prayer or meditation.

A procession of sorts then moves with the gurney to one end of the hallway, where a “Remembrance Table” is decorated with a framed photo of the veteran and a memory box, which friends and family members can fill with written tributes.

Over the following days, social workers and staff check in on the bereaved, and arrange informal bereavement gatherings if staff members sense the need. A more formal memorial service is held quarterly.

“As an institution, we get a lot out of it,” said Gary Rolph, chief of chaplain services at the Manchester VA. “It allows us all to see that death is simply another chapter of life.”

Rolph said other residents are also reassured by the idea that their own deaths won’t be hidden, and that their friends will be well cared for, emotionally, when the time comes.

Indeed, in Harrison’s experience with other nursing homes, residents carry that fear heavily, she said. But beyond the question of whether surviving friends might be consoled in their grief is a bigger mystery: whether those friends will even hear the news.

“They’re wondering, ‘Is anybody going to know what happens to me?’”