Estranged relationships are challenging, but this is never more true than at the end of life.
Our team of experienced social workers, including Carol, Cheryl, and Christina, have extensive experience in supporting families dealing with estranged relationships at the end of life. They have graciously shared their insights to help us understand how to best support people in these challenging situations.
Understanding the complexities of estrangement is crucial when dealing with end-of-life care. It’s not just about the patient’s physical needs, but also about their emotional and relational needs. When the hospice team enters a family’s life, they’re given a small, intimate window into years of history. The dynamics and background are unknown to the team.
“Our role as social workers is not to dictate, but to support and educate,” said Christina. “We respect the unique life of each patient and their family, and we’re here to help them navigate the end of life in a way that’s meaningful to them.”
Hospice social workers can help ease suffering and provide support for closure when people are willing to permit them.
Sometimes, a patient may be struggling to pass, subtly holding onto an unresolved relationship. Our social workers can gently explore with the family if there are unhealed relationships. However, it’s crucial to understand that closure isn’t always what we perceive it to be.
“Our perception of closure may be different from theirs,” Christina shares. We might offer the opportunity – “Do you have anything you’d like to say to that person?” – and if the answer is no, we respect that. Sometimes, patients have already made their peace, and our role is to partner alongside them in that journey.
The Four Needs of the Dying
Families often ask what a patient (and their loved ones) may need before they pass on.
“Something we share with families is the ’Four Needs of the Dying,’ which are incredibly powerful phrases that can bring immense peace to a person,” said Cheryl.
They are:
- Please forgive me.
- I love you.
- I forgive you.
- Goodbye.
These often manifest as “gifts” – the gift of love, forgiveness, gratitude, and farewell.
Carol recounts powerful moments when patients, even if unconscious and lingering, are holding on for unspoken words. In these instances, our social workers will ask families if there’s anyone the patient needs to connect with. Even a speakerphone call, with a loved one saying, “I love you, go in peace,” can bring profound peace to the patient, allowing them to transition more easily.
Carol shared a moving story of a patient, struggling for days despite pain medication, who passed within 15 minutes after receiving the last rites when the chaplain identified a spiritual need.
Finding Your Peace: For Family and Friends
Beyond the patient, our social workers recognize the profound impact estrangement has on family and friends. Carol’s powerful advice is to “do what you have to do for you to be at peace if a family member or friend were to pass when you’re not there.” This means considering what will bring you peace if a loved one were to pass, especially if you can’t be physically present.
Whether terminally ill or not, life is precious and fleeting. Carol suggests thinking about the memories you want to make and remember. She advises you to “be in the moment” and ensure you have said what you need to say. Cheryl suggests that, if possible, stating the “four needs” when a loved one is nearing the end can be powerful – for both the patient and the loved one.
In today’s world of widespread families, “family looks different.” Our social workers help bridge distances because they recognize that you can’t always be there when a person you love passes. Carol’s personal story of singing to her mom over the phone hours before her passing illustrates that goodbye doesn’t always have to be in person to offer closure.
“It’s also about forgiving different versions of a person, including the one who may have caused harm,” said Christina. And crucially, it’s about self-forgiveness – acknowledging that you did what you could.
Healing for the Living
Our social workers witness a wide range of family dynamics daily. They understand the distress and trauma that can arise from unhealed relationships. For those struggling with the inability to heal a past relationship, “parenting yourself a little” is key. This means giving your inner child the love and validation you might not have received. While bereavement coordinators don’t provide counseling, they are excellent resources who can recommend and connect individuals to appropriate counseling services, as well as offer support groups and educational materials.
Other powerful tools for healing include:
- Writing a letter to the person who passed (or is in the process of dying), saying what was left unsaid, or even writing a letter to yourself with words you wished they had said. If you want the letter read to the patient, a social worker can do this on your behalf. Cheryl also suggests burning the letter as an act of release.
- Releasing self-guilt. Holding onto guilt can be debilitating.
- Be gentle with yourself. There’s no “wrong way” to feel anger, hurt, or any other emotion. Find healthy ways to release these feelings, whether through physical activity, music, or simply allowing yourself to feel.
- Saying goodbye in your own way. This doesn’t have to be in person. It could be singing a song or another meaningful ritual.
Our social workers often help patients accept their past actions, gently guiding them toward subconscious healing. It’s about meeting people where they are, without judgment.
At Hospice of Redmond, we are constantly inspired by the beauty of community. We witness immense love – from families, neighbors, and even strangers – as they step up to care for someone during their final journey. It’s a profound privilege, as Carol aptly puts it, to “get to love people up at the end of their life – it is the greatest job ever.”