Home Funeral Assistance

According to the National Hospice and Palliative Care Organization, an end-of-life doula (sometimes called a death doula or death midwife) is a non-medical care partner who companions a dying person and their family through serious illness and death. Often working in tandem with hospice, they offer education, support and comfort to the dying and other people involved in their care. Although their role sometimes overlaps with those of a home funeral guide, the end-of-life doula typically provides care during the dying process, while a home funeral guide steps in after death occurs. 

End-of-life doulas tailor their services to the individual needs of the clients they serve. However, they are most often called upon to help the family in the following areas:

• Preparing important documents, such as an Advance Directive and Durable Power of Attorney for Health Care
• Planning and participating in a bedside vigil
• Memory making 
• Completing a life review
• Providing respite care 
• Hands-on comfort care
• Helping the family cope with anticipatory grief

Many end-of-life doulas maintain relationships with others in the death care community who offer various kinds of bedside services and support. They may, for example, partner with a celebrant, who will come to the home and help the family plan a memorial service or celebration of life. Or they may work with a local chapter of the Threshold Choir, an organization that will send two to four singers to the bedside of the dying person to perform. 

Like home funeral guides, death doulas are not licensed professionals. They may practice without formal training, although many who enter the profession choose to take a certification course, such as that offered by the International End of Life Doula Association. These trainings usually include coursework on active listening, journaling, meaning-making, creating personalized rituals and vigils, and various aspects of providing comfort to the dying and helping their families cope with their loss. 

Sources

International End of Life Doula Association. https://inelda.org/

According to the founder of Final Passages, Jerrigrace Lyons, a home funeral guide is a trained professional whose role is to “educate and empower families to exercise the innate right of caring for their own dead.” A home funeral guide is a non-medical provider who lends an additional layer of support for families who wish to care for their loved ones after they die. Lyons emphasizes that a home funeral guide does not care for the body of a person who has died, but rather supports and educates the family so they can do so themselves. They are knowledgeable about natural death care, as well as state and local laws and ordinances that impact a family’s right to care for a loved one who has died. They also act as liaisons between funeral service providers, vital records departments, coroner’s offices, and the like. 

Unlike end-of-life doulas, who work with families (or chosen families) throughout the dying process, a home funeral guide helps families plan for and manage the tasks involved in caring for their loved one after death occurs. They serve as an important resource in helping families navigate the practical aspects of caring for a body, such as gathering necessary supplies, assembling a team of people to help, and slowing decomposition so that a home vigil can occur. In states where a funeral director must be involved in after-death care, they will also work with those providers to streamline the process of obtaining and filing a death certificate and a burial transit permit, and transporting the body to its final resting place.

Like all service providers, home funeral guides typically charge a fee. However, because they are not (as a rule) licensed funeral directors, they are not covered by the FTC Funeral Rule and are not required to provide consumers with a written price list or estimate for their services in advance. For this reason, it’s always a good idea to enter into a written contract with the funeral guide that details what services they will and will not provide. 

If you need a home funeral guide, you can search for one by name, location, or area of expertise in the NHFA directory linked below.

Sources

“The role of a home funeral guide.” Final Passages. https://finalpassages.org/the-role-of-a-home-funeral-guide/ 

International End of Life Doula Association. https://inelda.org/ 

“Home Funeral Laws”. NOLO. https://www.nolo.com/legal-encyclopedia/home-funeral-laws 

“NHFA Directory”. National Home Funeral Alliance. https://www.homefuneralalliance.org/directories.html#!directory 

If the person who died was on hospice, contact your hospice provider. They will contact the on-call hospice nurse, who will certify the death. An RN is allowed to sign the medical portion of a death certificate in some jurisdictions, but not all. If the attending physician must sign it, the hospice nurse will typically contact the doctor and arrange for it to be done within 72 hours of the death. 

If the person who died wasn’t on hospice but their death was expected, contact their attending physician. Ideally, the doctor should be present at the time of death. But if your loved one was under the doctor’s care for an ongoing condition, and the cause of death is known, they will typically sign the death certificate and certify the date, time and cause of death. If you’re not using a funeral home, the doctor can sign the death certificate in your home. 

If you can’t contact the person’s doctor within a reasonable amount of time, you may need to call 9-1-1. Before doing so, locate the person’s POLST or out-of-hospital DNR. This will mitigate any chance that first responders will initiate CPR. You may also keep your loved one’s body in your home for some time before calling if you wish. 

(Note: In most jurisdictions, a paramedic may certify that a person has died at the scene if the person has obviously been dead for some time or if resuscitation is deemed impossible. If an EMT responds to the call, they can usually call the ER to have a doctor certify death over the phone.) Depending on the circumstances surrounding the death, first responders may be legally required to take the body to the Emergency Room. In that case, the family may claim the body after appropriate determinations have been made. If transport is not required by law, you may keep your loved one’s body at home. You will need to contact their attending physician to sign the death certificate. 

In the event that your loved one died unexpectedly or there is any suspicion of foul play, the coroner or medical examiner’s office may need to be involved. This rarely happens when the doctor certifies that the death is due to natural causes. However, if there is any doubt, the coroner or medical examiner will investigate. In that case, the authorities will determine if an autopsy is required. If it is, the body will not be released to you until the autopsy is complete. (Note: State laws differ on when an autopsy is required. If the family objects for religious or cultural reasons, it can sometimes be waived.)

SOURCES
“Table 2: Selected Characteristics of Deaths Requiring Autopsy by State”. Centers for Disease Control and Prevention. https://www.cdc.gov/phlp/media/pdfs/table2-autopsy.pdf?CDC_AAref_Val=https://www.cdc.gov/phlp/docs/coroner/table2-autopsy.pdf