Grief and bereavement support for staff in long-term care homes: A scoping review

Background: Admissions of older adults to long-term care (LTC) homes are occurring at more advanced ages with complex care needs, resulting in shorter lengths of stay before death and increased demand for palliative approaches to LTC. However, frontline LTC staff often lack access to sustainable educational, organizational, and peer supports and must learn on the job to support dying residents and their kin while facing personal reactions to death in the workplace. This unique staff experience and knowledge contributing to resident end-of-life (EOL) care has yet to be reviewed. Methods: To address this gap, a scoping review of global literature on grief and bereavement support for LTC staff was conducted. Following PRISMA-Scoping Review guidelines and six-step framework by Levac and colleagues, social sciences databases were searched and data were analyzed through narrative synthesis and the creation of infographics. Results: Fifty-eight studies met inclusion criteria. Strategies, interventions, and rituals were organized into five domains mirroring a Bioecological model. 1) Cultural Attitudes Toward Death and Support-seeking; 2) Organizational Policy and Practice; 3) Workplace-based Peer-support; 4) Informal Peer-support; and 5) Individual Beliefs and Self-Care Practices are influenced by 6) Time. Grief rituals were documented from a sub-set of included studies. Discussion: Identifying barriers and facilitators of grief support, as well as hospice and palliative care specialists' practices offers more holistic approaches to LTC staff wellness combatting burnout and staff turnover. Conclusion: Future research is necessary to implement cultural, policy, and practice changes to collaboratively build LTC staff capacity for person-centred EOL care.