Death and Dying in Long-Term Care: When Euphemisms Replace Training

This is what I got when I asked AI for a picture to represent this story. I didn’t know AI had a sense of humor.

I was teaching a nurse aide class about death and dying in long-term care when a student raised her hand.

“At my facility,” she said, “when a resident dies, we’re told to say they’ve gone to Montana.”

“Someone actually told you to say that?” I asked.

“Yes.”

“That doesn’t make sense,” I said. Facilities may have HIPAA policies, but once families are notified, roommates and other residents should be informed. Sometimes obituaries are even posted on the bulletin board. I corrected her and moved on, assuming it was a misunderstanding.

A month later, I taught the same class to a new group of aides. Another student raised her hand.

“When residents die,” she said, “we say they’ve gone to Montana.”

Again.

I corrected it again and thought I should probably call the director of nursing at that facility.

I didn’t.

The third time, the student was upset.

She told me she had been caring for a resident who shared a room with her sister. When the sister died, the aide told the surviving sister that her sister had “gone to Montana.”

I asked, “What did the resident say?”

“She said, ‘She didn’t go to Montana. She’s dead, you moron.”

Fair enough.

The next morning, I called the director of nursing.

I said, “Your aides are telling residents that people who die have gone to Montana.”

She laughed.

I said, “No. I’m serious.”

There was a pause.

Then she said, “Oh dear.”

She explained that during the change-of-shift report, instead of saying a resident had died, nurses sometimes said the resident had “gone to Montana.” She wasn’t sure how it started. A euphemism. Gallows humor.

At some point, an aide overheard it. There may have been language or comprehension issues. And because no one had ever sat down with aides and clearly taught them what to say when someone dies, the phrase spread—from one aide to another—until it became standard practice.

CNAs were orienting each other to misinformation while leadership was completely unaware.

No policy.

No guidance.

Just a culture quietly filling in the blanks.

And somehow, everyone who died ended up in Montana.