The Goodbye Guide: Why and how to terminate tenderly in LTC

Eleanor Feldman Barbera, Ph.D.
Eleanor Feldman Barbera, Ph.D.

An experienced colleague was recently let go from her job to which she'd been dedicated for 10 years. “We want to take things in a different direction,” she was told by the administrator. “Pack up your office and go.”

An hour later, she was in the parking lot holding a box containing a photo of her kids and mementoes of a decade as head of the social service department. Her replacement started two days later.

There are, of course, occasions when people who are fired or otherwise are terminating employment and need to be escorted from the building. But many workers are career professionals who wouldn't consider burning bridges with bad behavior. Despite this, I've witnessed hasty dismissals and hushed resignations on multiple occasions throughout my career. 

Sometimes, departing coworkers will tell me they didn't want to let anyone know they were leaving because they didn't want to deal with the residents' being upset.

In my training to become a psychologist, we spent a great deal of time discussing endings and termination of treatment. While work in long-term care isn't necessarily a psychotherapeutic relationship, I believe leave-takings in LTC are more important than in other settings and that the style of departure should be given more consideration.

Here are some aspects to consider:

• Due to the nature of the work, staff members form deep relationships over time with the residents and their families. When we depart, it matters to them.

• Because we work with elders and those who are ill, people are constantly leaving — through death, discharges, and hospital transfers — often suddenly and without the chance to say goodbye. This can create small traumas. In compassionately addressing our departures, we have the opportunity to reduce the amount of trauma in the lives of our residents rather than contribute to it.

• The experience of loss is cumulative. One loss triggers other past losses. If we stay long enough to say goodbye, we can help our residents heal past grief. This contributes to an emotionally healing environment.

• Residents are often hurt when workers leave without speaking to them about it. It leads them to feel as if they weren't important enough to warrant an acknowledgement of the relationship. Logically, they might know the person was fired and wasn't given time to tell them, but their hearts still feel the pain.

• Firing someone abruptly, or someone resigning without bidding farewell, makes the organization feel unsafe. Residents are likely to think, “If my favorite aide is fired or leaves the job without telling me, which beloved staff member is next?”

• Organizations are missing out on the teachable moment — the opportunity for modeling good leave-taking behavior. Ideally, residents can learn from the experience of saying goodbye to a staff member to help them handle their own end-of-life partings.

Tips for successful departures:

• Give terminated employees an afternoon or more to digest the information and to come to terms with how to handle it without acting out by “leaking” negative feelings. By telling them on a Friday afternoon, for example, departing employees can adjust over the weekend and be prepared to spend the next few weeks completing tasks, saying farewells, and looking for a new position.

• Share with them expectations about how to handle their leave-taking, including the fact that their departure will be hastened if they act out by behaviors such as disparaging the organization. Discuss the points from this article and offer a senior staff member, such as someone from human resources, to act as a “goodbye guru” to assist them.

• Leave enough time to discuss the loss with the residents. Two to four weeks would be a good amount of time.

• Tell everyone — staff, residents, and families — as close to the same time as possible. Rumors spread swiftly in the small-town life of LTC and residents will overhear staff members talking.

• Talk to as many people as possible because, despite the rumor mill, there will be those who didn't hear the news and want to know about it from the departing individual.

• Express the meaning of relationships, such as telling residents something positive that will be remembered about them. Provide reassurance to residents and family members about continuity of care.

• Allow residents to have emotional reactions without shutting them down. Let them have a good cry if they need to. Chances are it's about more than just the departure of a particular staff member.

• Refer unusually upset residents to the consulting psychologist.

• Discuss with coworkers how workflow will be managed upon departure.

In addition to the effect of leave-takings on residents, staff members also cope with turnover and sudden changes in personnel. They have their own reactions and perceptions of it, such as feeling the organization is unsafe or that they're seen as interchangeable cogs in the wheel. Addressing departures in a compassionate manner sends the message that everyone who works there is important and that their presence — and absence — matters. Compassionate departures benefit the organization as a whole.

Eleanor Feldman Barbera, PhD, author of The Savvy Resident's Guide, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.

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