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Bereavement Care for Veterans and Their Families

Sometimes, military culture can complicate the grieving process for the families of veterans who have died. This article by Pat McGuire explores those challenges.

Caregiving , End-of-Life Care, Hospice , Forgiveness, Guilt, Shame , Grief, loss, Transitions , Healing , Rituals, Myths, Ceremonies , Soul Injury, Moral Injury , Veterans, First Responders

Bereavement Care for Veterans and Their Families

by Patricia McGuire
Veterans and their families need the same things non-veterans and their families need when a loss is experienced: comfort, sympathy, emotional support of friends and family, knowledge, coping skills, time, and healing. The military culture, however, can create special grief needs as well. Complicating bereavement matters further, Soul Injuries tend to surface at the end of life for the entire family.
Stoicism, while a needed quality for an operative military, can be a hindrance in grief. Stoicism may cause grief to be hidden behind a silent or angry facade, cavalier humor, an attitude of bravado, or an “I’m fine” wall of denial. Stoicism not only affects veterans, it can affect whole family systems. One woman spoke of her friend who was married to a career Marine. She described the woman’s stoicism: “She is as much a Marine as he is. When her mother died, she was expected to grieve quickly and return to normal functioning in short order. She did.” Twenty years later, however, her mother’s death was reactivated when her husband died. This time, I gave her permission and encouragement to grieve and to take the time she needed to grieve both of these losses.
In addition to stoicism, “career-military” family systems may present special considerations. The family may have lived in numerous places for short periods of time, and this impacts family in several different ways. For example, at one veteran’s deathbed, his adult daughter identified for the first time where her bitterness for her father had begun: “It was the five different first grades I went to.” Because staff had been trained in veteran-specific issues, his daughter made this discovery as part of her anticipatory grief. She had the opportunity to work through this issue and the wall it had created before her father died. I acknowledged the patriotism and sacrifice that her entire family had made, which allowed the daughter to change her relationship to her past. This change helped her let go of some of her anger and open up to her father in a new way. Her grief after his death was facilitated by acknowledging the ways that this early loss affected her life and her perception of her father, which helped her deal with those losses prior to her father’s death.
Another issue which may arise with career-military families is that when there is a death or major loss, the family may find themselves far away from their family and support system. Because military families have not established roots, there may not be a network of support that facilitates effective grieving. On the other hand, because of these frequent moves, families of veterans may readily reach out for support because they have learned how to ask for help and form new bonds quickly. A Greek war bride from World War II cried at her husband’s death bed: “I have no family, what am I going to do?” I anticipated the possibility of complicated grief due to lack of support. An hour later, however, I found her in the hospice kitchen, with five lifelong friends from the Officers’ Wives Club. It was every bit a supportive family, just a different kind. Conversely, a young Vietnamese wife who barely spoke English said: “We did everything together. We are each other’s world.” This veteran’s isolation excluded everyone except his wife, leaving her unprepared for his death. She was at high risk for complications of grief and required extensive support to find her way materially and emotionally after his death.
Consider a third young American bride living in Germany while her husband served in Afghanistan. He was due to return in time for the birth of their first child. Unfortunately, the young woman went into labor early and their child was delivered stillborn. She was far from home, family, and anything familiar as she struggled with her overwhelming grief. Her husband returned to her as soon as possible, which in this case was a week later. He was grieving the loss of their child, feeling like he deserted his platoon, and struggling with symptoms of Posttraumatic Stress Disorder (PTSD). She was grieving the loss of their baby, the loss of innocence that she saw in her husband, and changes within her own body. This couple required intensive support as they faced their changed world. Their return to home was delayed due to legal issues related to transporting their child’s remains from one country to another. Plans had to shift to assist her parents to travel to Germany. This whole family system needed extensive support due to the complexity of the situation.
In her book, Peace at Last: Stories of Hope and Healing for Veterans and Their Families, Deborah Grassman explores the impact of military service on veterans at the end of life. She offers insight into some of the possible effects of combat on veterans and their families. Providing the book for family members to read helps them better understand the military influence on their loved one, their family, and themselves. This enhanced understanding can facilitate peaceful life closure and more effective grief recovery.
Veterans may gain a deeper appreciation of life by surviving combat and recognizing each day as a gift. Others may superficially integrate their experiences and carry on with their pre-war lives after returning from war. A third group may be changed by their combat experience and be unable to effectively cope. These latter two groups’ coping styles may adversely affect the family. Veterans in the last category may have struggled for years with bouts of depression, anger, nightmares, or from being overly protective or controlling. The veteran may have coped by using drugs and alcohol, or might have isolated himself in order to feel safe. Families living in this environment may have been abandoned, abused, or developed dysfunctional coping mechanisms to deal with these behaviors. This kind of lifestyle might precipitate divorce, creating multiple families by the time the veteran comes to the end of life. A common saying among Vietnam vets that overly simplifies this issue is, “Most veterans with PTSD have been married three times.” There may be three different sets of children at a veteran’s death bed. Perhaps their first family was abandoned when the veteran first returned home from war and he was unable to reconnect with them. These children may be angry. When the veteran remarried and started a second family, these children may have lived with abuse, drugs and alcohol, and developed dysfunctional coping mechanisms. After a second divorce, the veteran may have gotten into an addiction recovery program, as well as received help for his PTSD. A third marriage is often to someone who already has children. These children may reap the benefit of the veteran’s recovery and think their stepfather is very special. Imagine this veteran’s death bed with all of these family members present! Providing support for all of these family members with a wide range of forgiveness, estrangement, and anger issues creates a highly-charged environment for needed therapeutic work in order to facilitate some resolution. I strive to keep my heart open to all of these different family members and recognize each of the particular losses and relationships with this veteran. The past cannot be changed, but new understanding can help to change their relationships to the past.
When there are multiple families, judgments about one another are often passed. Guilt, shame, and blame are often the fuel that has been used to avoid the pain of the underlying loss of healthy relationships. This can negatively impact decisions that need to be made as the veteran is approaching the end of life. For example, the person who is legally able to make the decisions for the veteran may be someone from whom the veteran has been estranged. The current significant others of the veteran may find themselves disenfranchised at the time of the death, funeral, and burial. Another common contention after the death of a veteran with this kind of multiple-family constellation is: “Who gets the flag?” There is one flag provided for each veteran, yet there may be more than one person who feels that they deserve it. In these situations, it can be helpful to work with the VA’s office of Decedent Affairs, also known as the Details Clerk, to arrange for the provision of more than one flag.
Presentation of the flag in a respectful manner is of the utmost importance. Because many families today choose cremation, there may or may not be a funeral or memorial. In these cases there is not a formal presentation of the tri-corner flag to the next of kin. One VA nurse saw a family leaving the details office after their loved one’s death with a flag in a small rectangular box. He was upset by this “indignity” and called the team together to find a way to correct it. The solution was found when the Korean War Veterans Service Organization (VSO) agreed to use this need as an opportunity. The VSO provided education to a local Boy Scout troop about proper flag etiquette and flag folding. The Boy Scouts now meet bi-monthly with the VSO to fold flags. Together, they have maintained a supply of folded flags for that VA facility. The flag is now formally presented in a dignified way to the family at the time of death.
Other family members might have anger or bitterness about their veteran not getting a medal, service-connected disability, or pension. These feelings can interfere with effective grieving: “Dad was wounded in combat and he never received his Purple Heart. They lost his records.” This veteran and his entire family had chafed over this injustice for many years. After his father’s death, one son doggedly pursued his father’s records until the Purple Heart was awarded posthumously. This act helped the family begin to move through their grief. In a similar situation in which the Purple Heart could not be obtained, Deborah Grassman, their nurse practitioner, made a “purple heart,” ceremonially pinning it on the veteran while citing the heroic deeds that he had done. The bereaved family survey subsequently identified this act as extremely meaningful.
If PTSD is identified for the first time as a veteran is dying, the impact on family needs to be factored into their bereavement needs. Some family members feel relief: “I’m so glad to know it has a name. I knew something was wrong but I didn’t know what. Now this makes sense.” Other family members might feel guilty: “I wish I would’ve realized this sooner, I would have_________ (listened more carefully, gotten him help, been more patient and understanding, etc.)”
If the veteran had PTSD, physical or mental disability, or long-term illness prior to the death, the family member may be exhausted from providing care; they may not have the energy to grieve. In her book Chronic Sorrow: A Living Loss, Susan Roos (2002) writes about “significant losses with no foreseeable end” in the context of children with disabilities. Veterans and their families may share a similar experience. This may lead to frequent periods of sadness with no stable periods to allow time for grief and adjustment.
The family may have financial concerns near the end of life. For example, if the family has been supported by the veteran’s disability check, they may want extensive futile care because they do not know how they will survive without the veteran’s check. They may have provided care for the veteran for years and thus been unable to maintain work outside the home. It is important to acknowledge the reality of this practical consideration and recognize that the family’s questions about money may not indicate a lack of love, but instead may be a first step in providing the practical groundwork for their future welfare and their ability to grieve. Providing social work services can help the family with financial strategies and resources. The veteran may also be concerned about the financial plight of their family after he or she dies. This concern might cause the veteran to fight death so the disability check continues. One veteran lived for 40 years as a quadriplegic in a VA nursing home. He said, “My job is to stay alive as long as I can so my wife will have the money to raise our kids.” When he died, his family spoke of “growing up at the VA,” and there were as many staff mourners as family at the memorial service. Many such families have provided care and support for their loved one for years with little or no recognition. Acknowledgment of their patriotism and a word of gratitude for the sacrifices they have made may bring tears to their eyes. Those tears often represent the internal healing that is taking place. We developed a ritual that recognizes the family members who have been caring for veterans by pinning them with a small patriotic angel dressed in red, white, and blue. The family is thanked for their sacrifices and service to America by providing care and support to their veteran. A small card is given to them so they will remember the meaning behind the pinning. The card reads: “Caregivers are important too! Because we know you have also paid a price for our freedom, we honor you with this pin. It’s our way of acknowledging the many ways you’ve been impacted by the military and also the many ways you have provided care to our veteran. We are grateful.” (Go to “resources” tab for information about how to obtain pins).
Caregivers are 93% female. Most caregivers are spouses (72%) and parents (12%) (National Alliance for Caregiving, 2012). Today, there are more services for family caregivers than ever before. All VA medical centers now have Caregiver Support Coordinators (Johnson, 2012). They are experts on caregiver issues and are knowledgeable about VA and non-VA resources. They manage a menu of options to support veterans including in-home care service, respite care, needed equipment, home and automobile modification, peer support, and caregiver support groups. The VA also runs an interactive website for caregivers ( The Primary Family Caregiver Benefits include a stipend (post-9/11) paid directly to the caregiver, which is centrally funded and managed. The caregiver may be eligible for health insurance through CHAMPVA (a health benefits program through VA), travel, lodging, and mental health services through VA or by contract. This kind of support allows veterans and their families to have more time and energy for their bereavement and emotional needs.
In addition to needing support when a veteran is facing illness and death, family members may also need help in understanding a veteran’s response to loss. A veteran’s inability to grieve someone’s death might be due to their fear of unresolved grief from comrades who died in combat, and this fear can sometimes cause the veteran to detach from grief. This was true for a veteran and father of four whose youngest son was killed in a hit-and-run motor vehicle accident. The veteran went through the formalities of identifying the body, arranging the funeral, and receiving the outpouring of support from his community; yet he remained impassive throughout the process. His wife and family were appalled at his lack of emotion. When the veteran came in for counseling, he reported being on a convoy in Vietnam 40 years earlier. One of the trucks hit a young Vietnamese boy. It was a dangerous area and they were under orders not to stop. This veteran was devastated by seeing this innocent boy left presumably dead and unattended. When his own son died in a similar manner, he could not allow himself to feel the grief for his own son until he had acknowledged the loss and grief of the parents of the Vietnamese boy. The latter was the focus of the bereavement intervention.
Another young soldier serving in Iraq was notified of his grandfather’s death; the Red Cross was prepared to bring him home for the funeral. The soldier declined to leave his troop, and the family was very upset with his decision. As bereavement counselor, I discussed with the family their son’s need for stoicism so he could face war every day. If he came home for the funeral, he may have felt that he had deserted his troop. He could also be opening himself up to an emotional bungee jump, bouncing from his feelings of his grandfather’s loss which could also trigger grief over deaths he was seeing in war, only to have to go right back into war two weeks later. Thus, the bereavement intervention did not focus on trying to convince the grandson of the need to return home, but rather on helping the family choose to validate the young soldier’s choice. Intervention also focused on planning a family gathering when the young soldier was home again and emotionally able to participate in working through his grief for both his grandfather and his fallen comrades.

Supporting Veteran Grief
As part of a focus on comprehensive care, unresolved bereavement needs of veterans need to be assessed when they are being treated for physical and mental health issues, homelessness, substance abuse, and PTSD. These needs can best be addressed by a clinician who has been sensitized to the special needs of veterans. In 2003, Wounded Warriors: Their Last Battle, a presentation developed by Deborah Grassman, was produced by the National Hospice and Palliative Care Organization (NHPCO) and distributed widely throughout both the hospice and VA communities. Her presentation sensitizes clinicians, veterans, and their families to issues that may otherwise be overlooked or misunderstood. (Click on “resources” on this website to view the updated version). The same stoicism that allows veterans to be the helpers of the world may prevent them from reaching out for help or support. Messages of “big boys and girls don’t cry” were learned as children and reinforced in the military. This message needs to be reframed by clinicians. When a veteran is talking about the pain of loss and attempting to hold back the tears, they can be reminded of the courage it takes to allow their feelings to show. It may be helpful to sit beside rather than in front of the veteran to allow emotional privacy. Alternatively, the clinician might bow their head and sit quietly when tears escape from behind a stoic wall. I let veterans know that tears are a normal reaction to pain and are welcome. I have a picture in the bereavement office of a face with a beautiful tear running down it. I ask veterans who struggle to externalize tears to study it and tell me what it elicits for them. The picture acts as a reminder of the beauty of grief expressed. I also use a prescription pad and “prescribe” crying in the shower, in the car, or wherever the veteran feels safe. Some veterans are more comfortable with humor and respond well to being told that I get a bonus if they cry. Everyone grieves in their own way, so there are not always tears. The gender differences between men and women have been studied for years and many men are more likely to express their grief by doing something active: planting a tree, building a memorial, or organizing a fundraiser for a needy veteran family. Tears may or may not be part of their grief journey (Doka and Martin, 2010; Golden, 2010).
In caring for veterans with PTSD, it is important to know that they may not trust easily. My initial efforts need to focus on gaining their trust. This can make something as simple as scheduling an appointment difficult. For example, when a veteran is identified for bereavement counseling, a telephone call is used to make contact. Not unusually, there is no answer and a message is left encouraging a call back. When this is unsuccessful, a second call is made and again a message is left. If the call is not returned, a condolence note is mailed to the home. Persistence often pays off at this point and the veteran may reconnoiter and peek into the bereavement office a few times. If I pass muster and seem trustworthy, the veteran will schedule an appointment to address his or her grief issues. A basic premise of passing muster is the understanding that “we serve those who first served us.” Veterans need to know that I am aware that veterans are trained warriors; they need to know that I value their service and recognize that freedom is not free.
These issues may also be apparent when a veteran is diagnosed with a terminal disease. The veteran may not want anyone “to see me weak.” They may go so far as to say, “When I can’t take care of myself, I’ll just go off into the woods to die.” I met one such veteran during his several admissions to the hospital through his illness. My interventions focused on encouraging him to be a gracious receiver. I educated him about Dame Cicely Saunders, founder of the modern hospice movement around the world, and what she said at a conference a few years before her death. Using a wheelchair for ambulation, she stated, “I used to think that being a giver was the most important thing. Now that I need help myself, I realize that being a gracious receiver is the most important thing.” He was encouraged to see how helpful his gracious receiving could be for him and for his comrades. As his illness progressed, he was able to make healthier decisions about his care. The veteran allowed his friends in the “Vietnam Brotherhood” to participate in his care and ultimately his death. Many of these men had only witnessed violent or mutilating deaths in the past. In combat there was no time to mourn the deaths of comrades. This veteran made a courageous choice to allow the brotherhood to come together as a group to grieve while they provided care and support to their dying comrade. They were dressed in their Vietnam Brotherhood jackets; many had long hair, ponytails, and tattoos. Although their tough exteriors were intimidating, they provided tender physical comfort by repositioning the veteran, giving him drinks of water and food, and even participating in circles of prayer. By relying on their camaraderie and overcoming their fear of vulnerability, they created a dignified death for their comrade and a new concept about death for themselves.
The Commander of a local chapter of the Korean War Veterans Service Organization (VSO) was asked about the impact of combat on the members. His eyes clouded over: “We all have PTSD to some degree. It’s just a matter of what we do with it.” He spoke of some members who self-medicated with alcohol, but of many others who channeled their pain into contributing to the community. Honor guards are one of the services this chapter provides. They are frequently at the local VA cemetery to honor their newly fallen comrades by providing military honors, an interment ceremony, and the presentation of the flag to the next of kin. He acknowledged that when he participates in these events, he is attending to his own bereavement needs by honoring the buddies he lost in service so long ago.
As many as 30,000 veterans live in State Veteran Homes and there are many other long-term care facilities caring for veterans. These settings can provide an opportunity to address unresolved grief from fallen comrades decades earlier.
One State Veterans Home in Ohio provides such a service. This was developed when Deborah and I were providing clinical consultation services to the staff so they would better understand how to care for the unique needs of veterans as they die. Deborah asked a Vietnam Veteran, “Is there anything from the war that might still be troubling you now?” The veteran, hardly able to talk due to severe COPD, nodded his head. Then he said, “My brother and I both went to Vietnam, but I was the only one who came back.” Tears slowly ebbed down his cheeks while Deborah and I waited in calm silence. Then, he added: “I didn’t even get to go to his funeral.”
We explained that we could design a ceremony to honor his brother and create space for his grief. We explained the value of unmasking unresolved grief. The veteran’s face visibly lightened and he eagerly participated in the designing of the service. Deborah and I then realized the gaping wound in many of the veterans at the State Veterans Home, so we invited all of them to the service to mourn their comrades fallen during battle. About 25 showed up! We also addressed the guilt that some of them felt — survivor’s guilt, guilt of killing other people, guilt of things done or not done. This launched a program called the Fallen Comrades Ceremony that has been done throughout the country for veterans of all ages and eras.

Veterans Need to Mourn the Deaths of Their Comrades
The source of the gaping hole in our society caused by the aftermath of war is unmourned loss and unforgiven guilt/shame from the deaths of comrades killed in war. The hole this leaves in surviving comrades’ hearts continues to exert its influence throughout their lives until the deaths are acknowledged, honored, mourned, and redeemed. We believe that our civilian society has a responsibility to help heal the Soul Injuries of our nation after war. Soul Injury ceremonies can help restore wholeness to our broken nation; we struggle together to heal the wounds of war.
Opus Peace has developed a Fallen Comrades Ceremony. The resultant service can be a model for other organizations to provide so that our nation can be healed of this gaping wound. If you would like to help heal our nation of the aftermath of war, please consider sponsoring a community event that invites combat veterans to come mourn their fallen brethren. Contact us and we will come help you. Don’t miss this opportunity to heal the aftermath of war in your community. Throughout the United States, there are Fallen Comrades ceremonies taking place. These can be healing to both veterans and their families.
Most VA Medical Centers offer memorial services honoring the veterans who died in their facility annually. These services should be formatted in a ritualized ceremony that acknowledge and promote effective grieving and the ceremony should have a military context. Many VAs provide bereavement ceremonies or events to provide support for the veterans and their families for Memorial Day, Veterans Day, Fourth of July, and other holidays. Community hospices and other long-term care facilities should be encouraged to participate in these events or to hold their own veteran-centric programs.

Active-duty Deaths
The military culture influences both veterans and their families. They may face issues that do not impact the general population. This is also true of veterans and families of loved ones dying on active duty; however, hospice services are not provided to families prior to an active military death. Bereavement care to the surviving family members should follow the above guidelines coupled with standard bereavement guidelines that focus on sudden and violent death.
There are two organizations that are uniquely equipped to provide bereavement counseling and support to active duty personnel, their families, and extended families: Vet Centers and Tragedy Assistance Program for Survivors (TAPS). Vet Centers provide individual, group, and family counseling to all veterans who served in any combat zone. Services are also available for their family members. TAPS is a national non-profit organization that offers extensive peer-to-peer support and education about traumatic death and the active duty military’s specific grief needs. Some hospices partner with these agencies to provide services. Other hospices partner with the Red Cross to offer bereavement services for active military deaths. It is important that Hospice staff receive specialized training in order to perform this task.

You can receive free pamphlets from your closest Dignity Memorial funeral home. Use them to educate Veterans’ families. You can also download the pamphlets below by clicking on them.

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Aging: A Soul → to Sole → to Soul Journey

As we age, we complete the tasks of individuation; we start letting go of our sole self and gradually start opening up to our soul self.

Aging, Chronic Illness, Stress , End-of-Life Care, Hospice , Soul Injury, Moral Injury

Aging: A Soul → to Sole → to Soul Journey

by Deborah Grassman
“It takes a lot of courage to grow old,” my 90-year-old mother said the last few decades of her life. “Aging is not for sissies,” I’ve heard others say. Indeed, it is so. Rather than cultivating courage, however, we often resist aging – even deny its personal existence.
Could it be possible that aging might have something that we need? What are we missing by not valuing aging? Are we too arrogant or too controlling to think that aging might have something to teach us? Why would we want to be anything other than who we are (which includes the age that we are)?
Conceptually, I describe aging as a Soul → to Sole → to Soul journey. Our soul is born into this world to embark upon what psychologists call an “individuation process,” which manifests as the unique individual that we are. As we age, we complete the tasks of individuation; we start letting go of our sole self and gradually start opening up to our soul self.
The Soul-Sole-Soul process is described much more scientifically in healthcare literature, most notably by Erik Erikson (1,2). Most healthcare professionals have studied Erikson’s developmental tasks for aging. He says that there are maturational crises or critical decision points that require attention and mastery in order for successful aging to occur. They are:
· 0-18 months:Trust vs. Mistrust
· 18 months-3 years: Autonomy vs. Shame
· 3-5 years of age: Initiative vs. Guilt
· 6-12 years old: Industry vs. Inferiority
· 12-18 years old: Identity vs. Role confusion
· 18-35 years old: Intimacy/solidarity vs. Isolation
· Middle age: 35-55: Generativity vs. Self absorption or Stagnation
· Older age:55+: Ego Integrity vs. Despair
It is the last two categories (middle and older ages) that are surrounded with fear and ignorance. Healthcare providers working in pediatrics are well versed in the first five categories. Programs designed for toddlers are vastly different than those designed for school-age children. But something happens after adulthood is reached. The developmental tasks seem to fade from healthcare providers’ practices. At best, the general principles of Erikson are known by clinicians, but most geriatric programs evidently don’t take the principles seriously because the concepts are often ignored. For example, Erikson writes about the value of helping elderly people face the fear of death so that they can gain “ego integrity.” Contemplating death and “the meaning of life” can bring fuel for the soul, expanding consciousness as elderly people face numerous challenges in their lives. Yet, geriatric centers and healthcare facilities seldom have classes on aging and dying; instead, classes focus on fitness, clubs, games, and interests from the past. These are important activities, but the topic of aging and death is also important. Yet, it is seldom broached, much less discussed and contemplated. Personally, I think we miss a lot when this “let’s don’t talk about dying” approach is taken, and in some ways, it’s even more than that. To not have programs that integrate death contemplation and exit strategies could be considered a form of abandonment since research and developmental models (like Erikson’s) demonstrate the value.
I cite my mother’s experience living in an Adult Living Facility (ALF). The ALF staff took good care of Mom. She was bathed twice a week, had numerous activities to choose from, and ate good food in a beautiful dining room. She seldom complained about the many ills she had but rather focused on the gratitude she felt for her many blessings. Over the last six months of her life, I noted that she was sleeping more, losing interest in participating in activities, eating poorly, incontinent, and losing weight. She was treated for depression with no change; I surmised that she probably had a cancer, which later turned out to be the case. The ALF staff had a different idea. They called her doctor and got an order for physical therapy.
“I don’t want to go,” Mom told me.
“It’s your life Mom. If you don’t want to go, tell them ‘no’.” Mom worried about staff getting mad at her if she didn’t go and so she went.
One day, I entered Mom’s room unbeknownst to her or the Physical Therapist. I stood at the doorway witnessing their conversation.
“I’m too tired to go,” Mom complained to him.
“You’re not going to get stronger if you don’t get out of that bed,” the therapist said nicely.
“But I don’t care if I get stronger. I just want to sleep,” Mom argued.
“You can sleep after you do your exercises,” he countered.
I intervened to protect my mother’s interests. “It’s okay,” I told the therapist. “Mom is nearing the end of her life. She doesn’t need therapy. If she wants to sleep, let her sleep. We’re in a mode now of just respecting what she wants.” Then I turned to Mom, “Mom, you don’t have to do anything that you don’t want to do.”
“I keep telling them that, but they don’t listen,” she said.
Her therapy didn’t stop until I called Medicare myself and told them not to pay for it.
I don’t want to imply that the staff were insensitive or incompetent. Their intentions were good. They typify the current geriatric culture with its exclusive focus on rehab and activities. It seems odd that helping people confront death and reckon with its unseemly ramifications is commonly excluded within geriatric communities. Rather than having programs that help people reckon with their approaching death, the focus is on distracting them from death, pretending that death isn’t happening. For example, I always enjoyed sitting on the front porch in the rocking chairs with the residents at my mother’s ALF.
Mom and I are on rocking on the porch swing. “You remember Florence?” Mom asked me.
Yes, I had spoken with her many times in the hallways and dining room.
“She went to the hospital and never came back. I asked what happened to her and the nurse said they’re not allowed to talk to us about other patients. We didn’t find out that she died until we saw her obituary in the paper.”
I could only sigh with my mother at the disrespect that she felt — not only for Florence, but for her own needs to know, honor, and grieve.
Another resident sitting nearby chimed in: “When you die, there’s no public acknowledgment,” he said mater-of-factly. “We’ve been living together and helping each other for years, and one of us dies, and everything goes on as if nothing happened.”
Even the deterioration of aging is squelched. One resident told me how anytime they try to talk about how bad they feel or how hard it is to get through the day, that the staff try to cheer them up and talk them out of their difficulties. “They don’t want to hear us complain.”
I’m thankful that Mom and I had many talks about her death on that porch. She told me about a few things she wanted to do before she died, and we were able to accomplish those. We planned her funeral and I reassured her that her body would be flown back to Indiana and buried with my father. However, even these meaningful conversations were discouraged. Overhearing us, a nurse said, “Don’t be talking like that. You’re going to live another 10 years.”
“Oh, I hope not!” Mom laughed. “Ninety years is long enough!”
Opus Peace focuses on aging and transitions – not by fearing or denying it. We also don’t take the other extreme: ie., looking at aging and dying by only focusing on the positive virtues of aging. Rather, Opus Peace seeks to cultivate honesty, courage, and humility to navigate the later years because these years can be difficult! Let’s look at middle age first.
Middle Age invites us to summon the courage to stop clinging to who we were and open up to who we are. Then, we no longer cling to fame or fortune or the appearance of youth. We are transformed by relinquishing the old ego attachments and affirming our deepening descent into the mystery of the soul. We move from sole to soul and gain our freedom. This is not an easy process. It is normal to feel distress as we age with the undoing of all we have labored to secure. That’s why aging is not for SISSIES!
There is a saying in Hospice: “Those who grieve well, heal well.” This is a paradoxical truth that initially seems counterintuitive. But, grief is the normal, natural emotion that accompanies loss and change. Grief allows us to let go so we can move forward rather than “stagnate” as Erikson called it. So grief is not a destructive process as many think. In fact, it’s just the opposite: it’s a creative process that allows us to be re-formed and opened to something new that will better fit the changing circumstances. So, healthy aging during the middle years usually involves getting honest with the losses we are experiencing and allowing ourselves to humbly grieve the changes so we can open up to who we are becoming rather than clinging to who we used to be.
Older age (55+ according to Erikson) means that the horizon is no longer obscure. Bodily reminders start creeping in to remind us of our destiny. Ultimately, INTEGRITY means getting honest about the reality of approaching death. No matter how much we medically advance technologically, death is still a mystery and good travelers are able to open up to the uncertainty of it with a growing wisdom that the world is broad and doesn’t revolve around us. We start accepting death as the completion of life. Despair, on the other hand, is more narrowly focused around fear of the past (“Was the trip here on Earth worth it?” or “I wish I would have done ______ {regret}) or the future (“What is going to happen to my loved ones after I go” or “I don’t want to let go of what I know to go into the uncertainty of the “great beyond.”) Narrow focus can also be disguised as rather arrogantly denying existing fears or covering them over by pretending that there’s no uncertainty in death. Running or hiding from our fear of death can lead to despair. I have seen it many times in the 10,000 people that I’ve been with as they’ve faced death. At the same time, I will tell you that most of these people were able to reckon with their fears by allowing death to humble them. As one patient told me: “Now, while I’m dying, is no time to be lying to myself.” I applauded his wisdom. And in the space of just a few short days, he mounted the courage to open up to the peace that awaited him beyond his fears.
Carl Jung said that the pain of aging is with those who “content themselves with inadequate or wrong answers to the questions of life.” Aging wisely means asking ourselves tough questions that require non-superficial answers. If we’re honest with ourselves, we discover that much of our thinking and frustration centers on clinging to who we used to be. The questions we ask ourselves are:
· Which facelift surgeon should I use?
· How many pounds can I bench press?
· How can I maintain power and authority?
· What love-object do I need to find?
· How can I stay fixated on what I used to be?
Jung would want us to ask questions that can only be answered beyond our ego-self:
· What HONESTLY empowers me (job, status, muscles, boobs, trophy wife, etc.)?
· What happens when erotic success or social status no longer count?
· Why am I ashamed of the age I am, realizing that it is part of who I am?
· Why have I let commercials brainwash and control how I feel about myself?
· Am I willing to regain my NOW life (which includes the age I am NOW)?
The truth is we have allowed modern advertising to dictate who we are rather than allowing our own imprinted destiny to unfold with grace and dignity. Viktor Frankl puts it this way: “Today’s society is characterized by achievement orientation, and consequently it adores people who are successful and happy and, in particular, it adores the young.” (3)
We allow money and temporary materialism to take us away from the eternal. This leads to ignoring our soul. We cover it up so we can “Buy our product so you don’t have to be you.” This is an archetypal form of prostitution: we sell our current-aged self and buy a younger version of ourselves, losing ourselves in the process. When we stop being unfaithful to ourselves, then we can allow the natural urge to age unfold. This produces luminosity and liberation.
If aging is so fearful that we have to deny it, then it has a lot of power over us. Paradoxically, we then miss the very gift that aging brings; we are robbed of our own Self. In our western culture, the premise is that materialism, narcissism, hedonism will make us happy, yet, it leads to emotional/spiritual bankruptcy. In a society that is afraid of loss, aging and death will appear as the enemy to be conquered. Aging is viewed as a poison that we’re forced to drink. The question then becomes: Is it possible that if aging is a poison, that it might be a healing poison?
In my Aging workshops, I often have participants meet their Interior Elder. I even have their Elder write them a letter. Here’s the letter my Elder wrote me:
Dear Deborah,
I first met you 61 years ago. I was so far away that you could barely see me, yet I was in every beat of that tiny little heart that so bravely decided to come into this world to meet me.
You are no longer so far away. As I have called your name with the lub-dub of each heart beat, you have drawn closer. You sit at my knees now. I long to gaze fully into your eyes, but sometimes you turn your gaze away from my loving arms that await your return to my bosom – a buxom bosom that yearns to hold you and suckle you with breasts filled with the milk of life.
Each day, you are looking more and more like me. You don’t like that do you? You are ashamed of me. You didn’t think I knew that did you? Well, I do, and it hurts each time you hide me or curse me when you look in the mirror or groan with the ache in your bones. Deborah, I am the destiny you were born to fulfill. Do not be afraid of me. Do not be ashamed of me. Every time you say you are “lucky” that you don’t have gray hair, you are turning me away. Whether you know it or not, you need me, and when I come to the hairs of your very head, I hope you won’t cover me up or color me away, but that you will REJOICE and wear me proudly. If you will do that, I can hold you even more tenderly than I already am. Yes, you do have wrinkles. This should be no surprise to you. Yet, you act surprised to see them each and every day. When you pull the loose skin up from the sides of your face to erase the grooves I’ve so lovingly placed there, you make me feel very sad. Not for me, but for you. You see, Deborah, you lose your power when you do that. Yes. You are running away from the very thing that gives you strength and wisdom.
Deborah, it was I who carried you through treacherous days. It was I who suckled you at my breast during the night and gave you dreams to guide your way back home. Deborah, it was I who stood strong by your heart to assure that it would not become crusted over with bitterness.
You are about to launch Opus Peace to help bring peace to the Soul of this broken world. Deborah, I have a secret to tell you about that. You are not going to be its CEO… I AM! So, call on me when you are scared, weary, or feint of heart.
Welcome home! It’s about time that you finally acknowledged me as your roommate.
With love,
Your Soul’s Crone
1. Erikson, E. H. (1959). Identity and the life cycle: Selected papers. Psychological Issues
2. Erikson, E. H., & Erikson, J. M. (1998). The life cycle completed (extended version). WW Norton & Company.
3. Frankl, V. (1988). The Will to Meaning. NY: Penguin Books.

Other concepts about aging like this one are in Deborah Grassman’s book, The Hero Within: Redeeming the Destiny We Were Born to Fulfill.

A View from the Window

A few years ago, she might have thought the scene from this window unremarkable. Not so now. She was different now…and so was everything else.

End-of-Life Care, Hospice , Grief, loss, Transitions

A View from the Window

She gazed out onto the stillness of a landscape broken only by the strong breeze blowing off the lake through the towering pines. Opening the wooden window with difficulty, she shimmied it up from one side to the other, splintered paint curls stabbing her finger pads. The fresh air was a welcome replacement for the stale cardboard perfume that permeated the room. The echoing sound of a distant woodpecker gave her resolve to embark on the task before her. It would start with ripping the window shade from its anchorment – except its brittleness caused it to disintegrate in her hands.

It would be a long day – probably an even longer summer. Yet, she knew it had to be done. She had put it off too long already. Working would take her mind off all that had happened in the past three years. Here, she could escape from the penetrating loneliness that only separation by the death of her beloved mother could bring. Here, she would remodel the home where she, herself, had been raised.

She was determined to chisel away at her list of repairs, yet her furiously-paced work was tempered with long pauses… expanded moments of contracted hours… gazing out this window. Not that she planned these reprieves…in fact, mostly she felt them an intrusion – robbing her time and her mind from needed tasks…and often leaving her feeling guilty for the work that could have been accomplished. It was the kind of guilt that made her reluctant to acknowledge the welcome emptiness these moments enjoined.

A few years ago, she might have thought the scene from this window unremarkable. Not so now. She was different now…and so was everything else. Four years ago, she would have inwardly felt smooth and easy peering at this view. Now, she felt rough and jittery…like an old cob with its corn popping to all the ends of the earth.

The road winding from the street, around the house, and back toward the lake caught her attention. It wasn’t exactly a road…more like two paths joining everywhere to nowhere…paralleling ruts connecting perpendiculars. Connecting everything beyond nothing… The tractor that carved out those parallels had not bounced along this dusty trail for years, yet the grass and the weeds failed to grow in its vacant spaces. She recalled those tractor wheels with a bemusing smile. Giant tires, larger than she was tall – even with her arms outstretched over her head. The criss-crossed treads stood out so far they could be used as handles to climb to the top – that is if it wasn’t too hot. Black rubber sizzles summer hide no matter how fast she could scamper up its massive rounded height.

Two parallel ruts in the grass…that’s all that was left. If she strained hard enough, she could squintingly see the hard ridges of the tractor wheels still etched in the hard, yellow clay. Weather had worn down the high points of the ridges made by the tread. Ridges that she used to love feel dry and crumble beneath her feet…sometimes crumble even without the aid of her feet. Ridge tops that would harden and dry even while the deep pockets made from the tread stayed soft and mushy, cool, moist and muddy. She had always thought these pockets surprisingly crisp and distinctive…always thought they would have made perfect plaster molds of castings for who knows what…maybe for the cast she might need when she turned her ankle because her foot didn’t quite conform to the angles and holes left by tractor treads.
“I’ll walk that road before I go back home,” she thought with determination. But that would have to wait until tomorrow…and she’d stay on the soft level mound of grass between the ruts. No twisted ankles for her. For now, there was work to be done – but maybe not as much as she originally planned.

You can read stories like this one in Deborah Grassman’s book, The Hero Within: Redeeming the Destiny We Were Born to Fulfill.

After a Veteran Dies – Florida Residents

Things to consider after a Veteran Dies.

End-of-Life Care, Hospice , Grief, loss, Transitions , Veterans, First Responders

After a Veteran Dies – Florida Residents

THE FUNERAL – Your first decision may be the most difficult: burial or cremation. Local funeral homes offer both services. Choose your own funeral home or cremation company. They will help you with all the details, such as viewing, religious service, obituary, funeral notice, pallbearers, flowers, music, and shipping, if desired.

NATIONAL CEMETERIES IN FLORIDA – Go to to locate the closest national cemetery to you.

VA BURIAL BENEFITS – Contact VA Regional Office at (800) 827-1000. Note: Additional death benefits may be available for survivors. Questions about eligibility should be made through the VA Regional Office or a County Veteran’s Service Officer.

Reimbursement of Burial Expenses
Death in a VA facility (NSC) VA will pay up to $300 for burial allowance.
VA will pay up to $300 for plot allowance.
Community Deaths Must file a claim with Veterans Benefit Administration to determine eligibility within 2 years.
Service Connected Deaths VA will pay up to $2000 for burial allowance.
Service Connected Veterans VA will pay transportation cost to the nearest National Cemetery VA will pay up to $300 for plot allowance VA will pay up to $300 for burial allowance

CERTIFIED COPIES OF DEATH CERTIFICATES – Copies of the death certificates are usually available within a week to ten days following a death. Your funeral director will advise you on how many to order and will obtain them for you. You may also obtain them from the Health Dept. of Vital Statistics, 4175 East Bay Drive, Largo, FL 33764, (727) 507-4330 ext. 1200. You will need a death certificate for cars, residences, mobile homes (double-wide requires two), stocks and bonds, etc., private pensions, VA insurance (2), and bank accounts (some will accept a certified copy).

SOCIAL SECURITY ADMINISTRATION – Your funeral director should notify Social Security of the death. Death benefits from Social Security are payable to the surviving spouse or dependent children ONLY.


Benefit eligibility for survivors of Veterans is evaluated on a case-by-case basis. However, family members who usually are eligible for benefits include spouses, children, and in some cases, parents. A surviving spouse remains eligible for most monetary survivor benefits as long as they remain unmarried, or remarry after the age of 57. Children may be eligible for monetary benefits until age 18, or 23 if they are attending an approved school. Also, disabled surviving children may be eligible for long-term benefits. Call 800-827-1000 or go to

WILLS, POWER OF ATTORNEY, GUARDIANS, PERSONAL REPRESENTATIVE – Power of Attorney and Guardianship cease at the time of death. If there is a will, the personal representative will be in charge of funeral arrangements. Contact your attorney for advice.

INSURANCE – You can now call toll-free if you have any questions or need any service performed on your VA insurance policy. Call 800-669-8477. All insurance companies require a certified copy of the Death Certificate.

SAFE DEPOSIT BOX – Safe Deposit Boxes may be examined by anyone whose name and signature appear on the signature card. You may remove any or all items from the box. If you are not on the authorized signature card, you will need a Court Order to open the box.

VA-ISSUED PROSTHETIC EQUIPMENT – Prosthetic devices such as hearing aids, wheelchairs and hospital beds are issued to our Veterans. To arrange for pickup of equipment, call the hospital’s Prosthetic Department.

Information specific to FLORIDA RESIDENTS:

DONATION OF REMAINS TO SCIENCE– In Florida, remains may be donated to the State Anatomical Board for medical/dental research purposes. VA Burial Benefits may be applied to the cost of required arterial embalming and transportation of the remains to either the Univ. of Florida, Gainesville, or the University of Miami in Coral Gables, FL.

Florida National Cemeteries:

Barrancas National Cemetery
80 Hovey Road
Pensacola, Florida 32508
(850) 453-4108

4083 Lannie Road
Jacksonville, FL 32218
(904) 358-3510

Bay Pines
10000 Bay Pines Boulevard
Bay Pines, Florida 33744
(727) 398-9426

S. Florida Nat’l Cemetery
6501 South State Road 7
Lake Worth, FL 33449
(561) 649-6489

6502 Southwest 102nd Avenue
Bushnell, Florida 33513
(352) 793-7740

St Augustine Nat Cemetery
104 Marine Street
St. Augustine, FL 32084
(352) 793-7740

Sarasota National Cemetery
9810 State Road 72
Sarasota, FL 34241
(941) 922-7200 or (877) 861-9840

You can receive free pamphlets from your closest Dignity Memorial funeral home. Use them to educate Veterans’ families. You can also download the pamphlets below by clicking on them.

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