Reflection Room: Exploring pandemic-related grief in long-term care homes

Categories: Care, Education, Must Read, Opinion, People & Places, and Research.

Celina Carter, University of Toronto; Barry Stephenson, Memorial University of Newfoundland; Elizabeth Kalles, University of Waterloo; Justine Giosa, University of Waterloo, and Paul Holyoke, University of Toronto

The COVID-19 pandemic created a tremendous amount of collective loss and grieving that requires care and support. This was as true in residential long-term care (LTC) homes, which continue to experience pandemic-related challenges, as in hospitals and among the general public.

Through the Reflection Room project, our interdisciplinary team of researchers is partnering with LTC homes in Ontario to create physical spaces to pause, reflect, connect and process grief.

Many LTC home communities were seriously affected by COVID-19. On top of the stress from COVID-19 infections and deaths, staff have experienced burnout and low morale, and some homes with outbreaks must continue to restrict residents’ movements, isolate residents in their rooms and limit activities such as social functions to reduce risk of spread.

Many people within these communities have reflected on the trauma the pandemic has caused. Ontario’s Long-Term Care COVID-19 Commission Final Report has recommended reforms and counselling services. However, with the immense levels of grief, and feelings of helplessness, regret and sadness, there is also a need for innovative and timely support for LTC communities.

Reflection Rooms

Reflection Rooms are evidence-based, participatory art installations created in 2016 by the SE Research Centre, led by Paul Holyoke from the Centre and Barry Stephenson from Memorial University of Newfoundland. The goal of the project is to support people in community and health-care settings to talk about dying and death by providing an immersive space for visitors to read stories written by others and write and share their own stories.

A forthcoming research study evaluated the impact of 62 Reflection Room installations across Canada from 2016-20. We found the installations created space for expressing emotions such as love and regret, and making sense of experiences related to dying and death.

This included making meaning of the mystery of mortality, dying and death, and feeling that connections with memories or with what participants called the spirit can continue after physical death.

Adaptation during the pandemic

During the pandemic, the Reflection Room project was adapted to address experiences of loss and grief in LTC homes in Ontario. In this evolution of the project, LTC homes are provided with an easy-to-set-up kit incorporating instructions and materials at no cost. These materials include elements such as reflection cards, a red curtain to display the cards, and candles. The kit ensures each LTC home can adapt the Reflection Room to the space available, creating opportunities for quiet and reflection. Reflection Rooms have been installed in 27 LTC homes across Ontario.

Based on 68 surveys completed by Reflection Room visitors — including LTC staff, residents and caregivers — we believe these installations offer an opportunity to work through grief in the context of COVID-19.

Reflection Rooms provide a setting where people can look inward in a helpful way, experience calm and peace, and develop a sense of connection and compassion for others. These elements – finding a calm place, reflecting, writing and allowing emotions to arise — are all part of grief work, according to Canadian Virtual Hospice, which provides support and information about palliative and end-of-life care, loss and grieving.

Most people who completed surveys recommend that other LTC homes have a Reflection Room. Many said the project can support those who are grieving and that it is important because it provides a place of respite and self-reflection, and has the potential to support holistic well-being for individuals and communities.

Some visitors to LTC Reflection Rooms commented:

“It is a coping mechanism, a place to share grief and see how others are feeling, maybe get a tip on how to cope and move on.” – Caregiver

“Some people can’t ‘talk’ about what’s really on their mind, but find it easier to write about it.” – Resident

“It became a heartwarming and meaningful space.” – LTC home staff

Experiences of grief can include a range of emotions that come and go unpredictably, including anger, joy, numbness and anguish. Acknowledging and naming grief can be an important step in processing loss in a healthy and transformative way.

In grief and bereavement research, studies have found that storytelling has an affirming, healing effect on the storyteller and on those who hear the stories. The Reflection Room project does this by providing an opportunity to acknowledge grief, feel less alone and externalize grief through storytelling.

The Reflection Room has evolved to respond to societal and personal needs surrounding loss and grief. One constant throughout the project is that Reflection Rooms offer visitors an opportunity to slow down, work on processing their grief and feel a sense of connection and solidarity with others.


This article was co-authored by Neeliya Paripooranam, Reflection Room project manager.The Conversation

Celina Carter, Instructor, University of Toronto; Barry Stephenson, Associate Professor, Religious Studies, Memorial University of Newfoundland; Elizabeth Kalles, PhD student, School of Public Health Sciences, University of Waterloo; Justine Giosa, Adjunct Assistant Professor, School of Public Health Sciences, University of Waterloo, and Paul Holyoke, Sessional Lecturer, Health Studies program, University College, University of Toronto

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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