Since its beginnings, hospice care has been a plan of care rather than a specific medical treatment or resolution to a distinct medical problem. Hospice care is designed to address all the issues of a terminal illness, including the needs of the family and significant friends of the patient. This includes their needs during the patient's illness and the need for support experienced by the survivors as they proceed through a grieving process called bereavement.

After the death of a loved one, it is natural to feel grief – but it may seem unnatural and sad. Many people who have experienced a loss feel afraid and out of control. They may think of grief as only an emotional experience. It is an emotional experience, but it is also a physical, intellectual, social, and spiritual experience. This is all part of what is called bereavement.

All hospice programs offer bereavement services to the family member or other primary caregiver of the patient for at least 13 months following the death of the loved one. There is no charge to the primary caregiver for this important help in healing from the loss. In addition, many hospice programs offer grief support groups for anyone who wishes to attend, often at no cost or for a small donation to the hospice.

The bereavement services offered to caregivers are based on an assessment that helps identify areas of need. Thus, through the expertise of hospice bereavement specialists, survivors are able to fully experience and express grief and learn to live a productive life without the deceased. If grieving is especially complicated or the individual is experiencing unhealthy behaviors, hospice personnel will refer them to other counselors in the community for more intensive care.

Hospices design their bereavement programs to provide at least the following:

• Information about the normal grief process.
• Support to the grieving family and friends of the deceased through opportunities to talk about their loved one and the experience of caring for that person.
• Assistance to the survivors as they learn to cope with their loss, including help with specific problems and referrals to other community resources when indicated.

The range of reactions to the death of a loved one vary from person to person, but generally any means of coping with the death is normal with the exception of behaviors that put the individual or others at immediate risk. Common responses to the death of a loved one include:

• A feeling of numbness and shock.
• A sensation of tightness in the throat or heaviness in the chest.
• Restlessness, with a tendency to wander around the house or familiar places.
• Crying easily, unexpectedly, and intensely.
• Loss of appetite and a hollow feeling.
• Denial – an inability to accept the reality of the loss.
• Low energy level and difficulty in concentrating.
• Loss of interest in social activities or work.
• A fear that one is experiencing a mental illness.
• An increased number of some minor illnesses such as colds and the flu.

The bereavement staff of hospice programs are trained to handle grieving issues. Many people join grief support groups, even if their deceased family member or friend was not treated by a hospice program. It is often important to hospice patients to know that their family and friends will be cared for in the emotional time just after death. Providing this support is always a part of the hospice plan of care – and makes hospice unique among health care providers.