Managing Anticipatory Grief in a Pandemic

Each of us feels what we feel. Here are some tips for coping. (Read complete article HERE.)


A profound sadness has settled over our planet. Whether it’s the loss of visits with loved ones, the loss of steady work and income, the loss of our usual routines or the full-stop loss of a person in our life whose own life has been extinguished by COVID-19, grief is now a part of our daily landscape.

So, let’s not deny it. And, please, let’s try to avoid constructing mental lists of who-has-it-worst, then arguing with ourselves about whether it’s appropriate for us to be upset about whatever is rocking our own universe.

Example: A neighbor of mine is quarantined at home with her two children, mourning the recent death of her husband from coronavirus. Given this family’s pain and isolation — neither friends nor family can drop by to offer comfort and support — am I entitled to the sadness I feel because I can’t see and hug my adult daughter? Answer: Yes, I am.

Instead, let’s acknowledge that, at a minimum, coronavirus is infecting all of our lives with anticipatory grief.

For some, it’s a sense of impending loss as we gird for the very real prospect that someone we know and care about may be felled by COVID-19: a family member, a colleague, a friend, a neighbor, a caregiver.

As the list of items stoking our fears and grief grow by the day, it helps to remember that while loss is universal, grief is personal.

For others, it’s anticipation, or the bald reality, of financial turmoil: loss of a job; loss of income; loss of a stock portfolio intended to see our grandchildren through college or ourselves through retirement.

No less real, anticipatory grief now darkens even what were once the simplest transactions in our lives. When we go out to shop for food, what might we bring home that wasn’t on our list (COVID-19) or what might we fail to procure (toilet paper)?

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When we phone a child for a weekly chat, what unanticipated news bulletin might explode in our ears? When we extract an envelope from the mailbox, what might it be carrying along with a greeting or a bill?

Grief Is Personal

As the list of items stoking our fears and grief grow by the day, it helps to remember that while loss is universal, grief is personal.

This means that we should honor whatever best enables us to process and handle the myriad disruptions and blows upending our lives, but should neither expect nor assume that our own coping strategies are appropriate for our partners, our children or any of the other people in our orbit.

At a stressful time like this, we need to steer wide of judgment (of ourselves and of others) and widen the space for compassion (for ourselves and for others).

We need to agree that there is no hierarchy to the sadness each and every one of us feels. We need to recognize that there is no one-size-fits-all rule or remedy for handling all these feelings.

Then, we need to get practical and find ways to deal with our own grief.

Coping Strategies in the Face of Grief

Toward that end, here are some coping strategies that draw on my work as a grief coach; my personal experience with pre-COVID-19 family losses and my three-year meditation practice. Take what works for you. Toss the rest.

Just, please, don’t deny, dismiss or denigrate the grief you’re feeling. It’s real. You’re entitled to it.

Try techniques to quiet dark thoughts. When you find your thoughts spiraling into a black hole of what-ifs, try replacing them with a one-word mantra or phrase. Shifting your focus from a sprawling mental narrative to a simple word or phrase can help pull you back into the present moment.

One particularly timely phrase: “Don’t go there ’til you get there.” Quiet repetition of these words reminds both that you are in the here and now and that there’s no gain in trying to predict events hours, days or months from now.

Another approach favored by meditators is to focus on the in and out of the breath. Alternately, you can experiment with your five senses to see which best helps you achieve focus. Maybe it’s the warmth of clasped hands. (Touch) Aromas emanating from your kitchen. (Smell) The sound of birds or windchimes. (Hearing) A single flower petal. (Sight) The sensation of an ice cube dissolving in your mouth. (Taste)

Feel your emotions. When we are rocked by a wave of grief, we typically respond with thoughts that strain to parse, argue with or deny what we’re feeling. An alternate approach is to let go of those thoughts and instead focus on the physical sensations.

To do this, sit or lie comfortably. Next, train your attention on where the emotion is showing up in your body. Are you feeling a stiffening in your shoulders? A quickening of your heartbeat? An unease in your gut? A pounding in your temples?

Whatever the sensation, explore it with interest, not judgment. Say to yourself, “So, this is what grief feels like.” By focusing on physical sensations, rather than thoughts, a strong wave of emotion often quiets and passes within minutes.

Practice self-compassion. Rather than argue with or dismiss your grief with harsh judgment and criticism, meet your pain with gentle understanding. Offer yourself words of comfort. Give yourself a hug. Treat yourself, as Kristin Neff suggests in Self-Compassion: The Proven Power of Being Kind to Yourself, “with the same kindness, caring, and compassion [you] would show to a good friend, or even a stranger.”

Another important aspect of self-compassion, Neff notes, is to acknowledge that we are not alone in our pain. By remembering that grief is a part of the human experience, one that we all share, we allow our pain to connect us to our common humanity rather than isolate us.

Allow yourself to cry. For months after my husband died in 2009, I found that each day around dusk, I’d feel a gut-punch of sorrow and a tidal wave of tears pressing against my eyelids. Rather than try to ignore or blink them away, I’d grab a box of Kleenex, close myself alone in a room and let ’em rip. I’d sob. Keen. Pound the floor with my fists. After 15, 20 minutes, the tears would dry up and I’d feel my grief subsiding.

Sharing a wave and a smile while out walking, or accessing the myriad online efforts to comfort and reassure can help to soften your grief.

During the first week of the current lockdown in New Jersey, I went for a walk. As I took in the shining sun, the blue sky, the picture-perfect clouds, the budding trees, I suddenly felt a familiar gut-punch of sorrow. “Our planet is so sick,” I thought.

With that acknowledgment, I began to weep. I didn’t care if the people across the street or the people 10 feet in front of me noticed. I just let my grief have its say. And you know what? After five, 10 minutes, I felt better.

Give it a try. Maybe you will, too.

Tap into gratitude. Within 14 months of losing my husband, I lost my sister and mother, too. During this protracted period of bereavement, I discovered that my feelings of extreme pain were attended by feelings of extreme gratitude. Appreciation for other people’s kindness. Appreciation for what remained good in my life.

These days, people are trying so hard to lift one another. Sharing a wave and a smile while out walking, or accessing the myriad online efforts to comfort and reassure can help to soften your grief.

This virtual orchestra project by a bunch of college kids opened the floodgates for me. It reminded that tears of gratitude can be as restorative as tears of sorrow.

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Medicare & Coronavirus

Your health, safety, and welfare in the face of the 2019 Novel Coronavirus (COVID-19) is our highest priority. According to the Centers for Disease Control and Prevention (CDC), older adults and people who have severe chronic medical conditions like heart, lung, or kidney disease seem to be at higher risk for more serious COVID-19 illness. Older people may be twice as likely to have serious COVID-19 illness. This means that most people with Medicare are at higher risk.

For the latest information on the coronavirus, including travel advisories, visit the CDC’s website.

Precautions to take now

  • Avoid close contact with people who are sick.
  • Clean your hands often.
  • Wash your hands often with soap and water for at least 20 seconds, especially after being out in public, blowing your nose, coughing, or sneezing.
  • If soap and water aren’t available, use a hand sanitizer that contains at least 60% alcohol.
  • To the extent possible, avoid touching high-touch surfaces in public places, like elevator buttons, door handles, handrails, and handshaking with people. Use a tissue or your sleeve to cover your hand or finger if you must touch something.
  • Avoid touching your face, nose, and eyes.
  • Clean and disinfect your home to remove germs: Practice routine cleaning of frequently touched surfaces—tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks and cell phones.

Extra caution with crowds and travel

  • Avoid crowds, especially in poorly ventilated spaces. Your risk of exposure to respiratory viruses like COVID-19 may increase in crowded, closed-in settings with little air circulation if there are people in the crowd who are sick. 
  • The CDC recommends that you defer all cruise ship travel worldwide, particularly if you also have underlying health issues.
  • Older adults and travelers with underlying health issues should avoid situations that put you at increased risk for more severe disease. In addition to avoiding crowded places, you should avoid non-essential travel such as long plane trips, and especially avoiding embarking on cruise ships.

Preparing for healthcare needs

  • Be sure you have over-the-counter medicines and medical supplies (like tissues) to treat fever and other symptoms. Most people will be able to recover from COVID-19 at home.
  • Have enough household items and groceries on hand so that you’ll be prepared to stay at home for a period of time.

Medicare covers related needs

  • Medicare covers the lab tests for COVID-19. You pay no out-of-pocket costs .
  • Medicare covers all medically necessary hospitalizations. This includes if you’re diagnosed with COVID-19 and might otherwise have been discharged from the hospital after an inpatient stay, but instead you need to stay in the hospital under quarantine.
  • At this time, there’s no vaccine for COVID-19. However, if one becomes available, it will be covered by all Medicare Prescription Drug Plans (Part D).
  • If you have a Medicare Advantage Plan, you have access to these same benefits. Medicare allows these plans to waive cost-sharing for COVID-19 lab tests. Many plans offer additional telehealth benefits beyond the ones described below. Check with your plan about your coverage and costs.

Telehealth & related services

Medicare covers “virtual check-ins” so you can connect with your doctor by phone or video, or even an online patient portal, to see whether you need to come in for a visit. If you’re concerned about illness and are potentially contagious, this offers you an easy way to remain at home and avoid exposure to others.

  • You may be able to communicate with your doctors or certain other practitioners without necessarily going to the doctor’s office in person for a full visit. Medicare pays for “virtual check-ins”—brief, virtual services with your established physician or certain practitioners where the communication isn’t related to a medical visit within the previous 7 days and doesn’t lead to a medical visit within the next 24 hours (or soonest appointment available).
  • You need to consent verbally to using virtual check-ins and your doctor must document that consent in your medical record before you use this service. You pay your usual Medicare coinsurance and deductible for these services.
  • Medicare also pays for you to communicate with your doctors using online patient portals without going to the doctor’s office. Like the virtual check-ins, you must initiate these individual communications.
  • If you live in a rural area, you may use communication technology to have full visits with your doctors. The law requires that these visits take place at specified sites of service, known as telehealth originating sites, and get services using a real-time audio and video communication system at the site to communicate with a remotely located doctor or certain other types of practitioners. Medicare pays for many medical visits through this telehealth benefit.

Other ways Medicare is helping

Every day, Medicare is responsible for developing and enforcing the essential health and safety requirements that health care providers must meet. When you go to a healthcare provider, you expect a certain standard of care, and we work to make sure you get it. That includes taking additional steps in response to coronavirus:

  • Establishing new codes to allow providers to correctly bill for services related to diagnosis and treatment of the illness.
  • Instructing our national network of State Survey Agencies and Accrediting Organizations to focus all their efforts on infection prevention and other cases of abuse and neglect in nursing homes and hospitals.
  • Instructing nursing homes and hospitals to review their infection control procedures, which they’re required to maintain at all times.
  • Issuing important guidance answering questions that nursing homes may have with respect to addressing cases of COVID-19.
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Senate Unanimously Approves Older Americans Act Reauthorization!

March 3, 2020

Senators today capped off a year-long advocacy effort to reauthorize the federal Older Americans Act (OAA) by unanimously approving the bipartisan, bicameral bill, the Supporting Older Americans Act of 2020, H.R. 4334, to authorize funding for and operation of vital OAA programs through 2024!
“n4a is thrilled that the Senate has passed the Supporting Older Americans Act of 2020,” said n4a CEO Sandy Markwood in a statement“This bill is the result of months of negotiations among Senate and House leadership, as well as aging policy advocates and n4a members here in Washington and around the country.”
Because the House and Senate must pass identical pieces of legislation, H.R. 4334 now heads back across Capitol Hill where we are hopeful that Representatives will take up the measure swiftly.
While a modest piece of legislation—as most bipartisan bills are—the Supporting Older Americans Act of 2020 contains many of n4a’s OAA reauthorization priorities. n4a also endorsed the measure last month and led an effort securing support for the bill from 120 other national organizations!
What’s in H.R. 4334?
For full details on what is in the bill and the implications for n4a members, see n4a’s member-only resource, Analysis of Key Provisions

Need something shorter? Here is our short list of key provisions promoted by n4a and included in the Supporting Older Americans Act of 2020:

  • Reauthorizing the OAA for five years through FY 2024
  • Increasing authorized funding levels: a seven percent increase is recommended for the first year, with six percent increases in each subsequent year through FY 2024, totaling a 35 percent increase over five years
  • Language clarifying that AAAs can, outside of the OAA, engage in private pay, integrated care and other arrangements to expand services
  • Removing the Title III E funding cap on grandfamilies and older relative caregivers
  • Authorizing an HCBS grant demonstration program for Title VI Native American aging programs to enhance the capacity of Title VI programs to support wrap-around supportive services to Native American elders in tribal country. The bill also authorizes $500k in additional annual funding for Title VI programs
  • Establishing a research, demonstration and evaluation center for the Aging Network to improve assessment and promote advancement of the relationship between OAA programs and services and health outcomes
  • Encouraging states to work with AAAs to address potential administrative barriers to transferring funds between nutrition programs to best meet local needs

Next Steps
While we don’t anticipate major hurdles to House approval, it’s important for aging advocates to connect with lawmakers from their communities about the importance of supporting Older Americans Act reauthorization. It’s also a fantastic way to engage your local grassroots—they drive positive calls and emails to the House and then can join us in celebrating its passage!
Use n4a’s Advocacy Alert for ideas to engage your grassroots and community stakeholders and we encourage you to use the tools and templates provided in n4a’s OAA Reauthorization Toolkit to assist your efforts!
OAA reauthorization is almost to the finish line, but it will take all voices weighing in to get it done soon!
And, it’s not too late to register for the upcoming n4a Aging Policy Briefing & Capitol Hill Day, March 17-18 in Washington, DC, to stay fully up-to-date on the latest news on OAA reauthorization, implementation, funding and many other critical aging and health care policy updates!

This Legislative Update is an n4a membership benefit. For more information about these and other federal aging policy issues, please contact n4a’s policy team: Amy Gotwals and Autumn Campbell at, 202.872.0888.

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Avoid Census Scams this Spring

February 24, 2020

As the Census comes upon us in the coming months we want to help protect you from any potentials scams that fraudsters could use during this time period.

One of the scams that fraudsters are using is sending out a fake questionnaire to Medicare beneficiaries asking for their Medicare number and other personal information. Medicare will never call you unsolicited or send you any mail unsolicited.

To verify that mail received from the Census Bureau is legitimate look for these key details:

  • Look for either the U.S. Department of Commerce or the U.S. Census Bureau in the return address.
  • Check that the return address is located in Jeffersonville, IN.
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Illinois Aging Network Alert: January 14, 2020 A report of the impact Area Agencies on Aging have on Illinois seniors.

The 2020 Census is Critically Important to Older Adults.

 As you know, the Area Agency on Aging in your district is funded by the Federal Older Americans Act (OAA) as well as Illinois GRF and private funds. The thirteen Area Agencies on Aging collectively serve over 500,000 older adults in Illinois each year. Fifty-seven percent (57%) of the public funds used to provide such services to older Illinoisans comes from the Federal Older Americans Act. 

Funds flow to the Illinois Department on Aging based on census data. It is critical that we have an accurate count of older adults. Each Area Agency on Aging and their program partners are conducting CENSUS 2020 outreach activities to the people they serve and local communities. Examples range from making public presentations to putting placemats on the tables at Senior Centers. 

YOUR HELP IS NEEDED! If you are speaking to your constituents in a group setting, we would value the opportunity to join you in making a short presentation on CENSUS 2020 and its importance. 

The services provided by Area Agencies on Aging helped divert an estimated 183,903 adults from long-term care facilities in 2018, resulting in cost savings to those individuals and tax payers. Our programs, such as Home-Delivered Meals, are cost effective and help keep older adults healthier and remain independent. In 2018 it was estimated the Area Agencies on Aging served 21% of the older population in Illinois and saved over $16.4 billion in healthcare costs. 

Thank you for helping us share the message about the importance of completing the census. 

Author – Joy Paeth, Chief Executive Officer, AgeSmart Community Resources 

For more information, contact Susan C. Real, Legislative Chair (309-829-2065 ext. 218) or Marla Fronczak, I4A President (630-293-5990). 

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