Hospice Grief and Loss: Understanding the Stages of Grief

Table of contents

• Why do we feel grief and loss during hospice?
• Where did the five stages of grief come from?
• How to help someone through the stages of grief and loss
• How hospice can help with grief and loss

When your loved one is admitted to hospice, it can bring up a lot of emotions, both for the person in hospice and their family members.

Over the years, researchers and psychologists have developed different frameworks to help people understand and talk about their feelings surrounding the end of life. The most popular is the “stages of grief.”

Understanding these stages can help you process and talk about hospice grief and loss.

Why do we feel grief and loss during hospice?

Grief is a collective term that refers to all emotions you feel when you lose someone or something you value. Each person’s experience of grief will be unique. It can take many forms, and everyone moves through it at their own pace.

We most commonly associate grief with the death of a loved one; however, any significant life change can trigger feelings of sorrow and loss. Some other events that can include a grieving process include:

• The end of a romantic relationship or close friendship
• A medical diagnosis such as cancer or Alzheimer’s
• Loss of a job
• Loss of a beloved pet

Grief doesn’t just begin at the time of the loss. It can also precede a loss.

Anticipatory grief refers to the distress you might feel with the impending loss of someone or something you love. It can occur days, months, or even years before the actual loss and can be just as heart-wrenching as the loss itself.

It’s not unusual to experience some level of anticipatory grief when your loved one is admitted to hospice care.

The part that your loved one plays in your life is about to change as they move through their final days. It’s normal for this to bring up a range of emotions for both you and the person in hospice.

Where did the five stages of grief come from?

The five stages of grief originally began as the five stages of dying. This theory was first proposed by psychiatrist Elisabeth Kübler-Ross in her 1969 best-selling book, On Death and Dying. She based her work on interviews with terminally ill patients at the University of Chicago’s Billings Hospital.

Kübler-Ross was struck by the difference in how death was treated in her native Switzerland versus in the United States.

In Switzerland, death was treated as a natural part of life. People died comfortably at home with family whenever possible. In contrast, in the U.S., death was considered a taboo subject. This often created stress for the person who was close to death as well as for their loved ones.

Kübler-Ross developed the five stages of dying as a communication framework at the end of life. She hoped this would lead to patients and their healthcare providers speaking more openly about terminal illness and the emotions surrounding it.

Over time, healthcare professionals started to use this same framework to describe the stages of grief you might experience when you lose a loved one. In her final book, On Grief and Grieving, Kübler-Ross wrote about applying these same five stages to the grieving process.

In hospice, grief and loss are common feelings. Having an understanding of the stages of grief can help you process these emotions and communicate with others.

What are the five stages of dying and grief?

When people mention the five stages of dying or grief, they are typically referring to the five main stages put forward by Elisabeth Kübler-Ross. Over the years, mental health professionals and even Kübler-Ross herself have proposed changes to this model, but it remains popular.

It’s important to know these stages aren’t set in stone. People can experience them for different lengths of time or in different orders. They are more of a guide to the feeling of grief and loss you might experience during hospice than an exact roadmap.

Denial

This first stage of grief is a defense mechanism that protects you from feeling overwhelmed. When you’re in the denial stage, you may partially or totally refuse to admit the loss exists. You may deny having any feelings about the loss or report feeling numb.

Slowly, you’ll begin to feel and process the loss at your own pace. Denial will start to fade, and you’ll move on in the healing process.

Anger

Many people think anger is an unhelpful emotion you should avoid; however, it can actually be an essential part of healing from grief and loss during hospice.

Kübler-Ross theorized feeling anger and pain was a step towards coming to terms with your loss. Anger allows you to connect with your grief. It is the opposite of the disconnection felt with denial.

Bargaining

Bargaining is a way to acknowledge life as you know it has changed, and you want it to go back to the way it was. This often looks like “If this, then that” or “what if…” statements directed towards a higher power or healthcare providers. Thoughts of guilt sometimes accompany this.

Depression

In the depression stage of grief, you may feel intense sadness or emptiness. This is a normal part of grieving and not a sign of clinical depression. It comes from realizing you can’t alter the past through bargaining.

Feeling some depression after a loss is an appropriate response. It typically fades as healing progresses, but if symptoms are severe or persistent, you might need help from a healthcare professional.

Acceptance

Eventually, you’ll move into the acceptance stage of grieving. This doesn’t mean you’re okay with losing a loved one. It means you’ve accepted that the loss has happened, and life now looks different.

You will start to find meaning in your new reality. Some days will still be more challenging than others. Emotions from other stages might still surface from time to time. Through acceptance, you realize life will go on even with your loss.

How to help someone through the stages of grief and loss

Everyone copes with grief and loss during hospice differently. There is no right or wrong way to grieve a loss.

Some people find it helpful to maintain a connection with their loved one. Some ways to keep this connection include:

• Keeping a memento such as a piece of clothing, jewelry, or a favorite possession
• Creating a “living legacy” with a memorial donation
• Visiting the grave or memorial site
• Lighting candles or other religious observances

Others find it helpful to talk about the way they are feeling. One of the best ways to support someone dealing with grief and loss is to simply ask questions and listen. Ask them about what they remember about their loved one. Give them a chance to express what they’re feeling.

Sometimes people experiencing grief and loss aren’t ready to talk. This is also okay. You can help these people by talking about other, everyday matters to build trust. Let them know you are available to listen if they do decide they need to talk.

How hospice can help with grief and loss

Unlike other types of medical care, hospice care focuses on keeping the patient and their family comfortable and supported at the end of life. In addition to caring for physical needs, hospice provides:

• Emotional and spiritual support
• Bereavement support
• Grief counseling

Parentis Health Hospice also has an in-house Chaplain and Bereavement Counselor on-call to offer comfort in all forms. Our skilled hospice employees and volunteers provide whatever support patients and families need, wherever they need it.

If you have a loved one in hospice, grief and loss are a part of the process. Know that we’re here to help support you and your family. Reach out to us today to learn more about our hospice services.