elegant repose

1.    Partnering with the client, and/or family caregiver to help clarify current medical issues, identify any unmet needs, and facilitate access to appropriate resources.  
 

2.    Supporting the client and/or family caregiver to navigate a complex healthcare system and be better prepared to ask the right person, the right question at the right time.

3.    Offering education, as needed, to support informed decision-making and to increase confidence in the ability of the client and/or family caregiver to cope and manage with a progressive illness. 

4.    Explaining the role and services of palliative care and hospice, as well as when and how to access, should that be requested or beneficial.  An End of Life Doula can offer services alongside hospice and work collaboratively with their team.  On the other hand, should a client be eligible to enroll in hospice, but chooses not to, the End of Life Doula can be an ongoing source of support.

5.    Providing a safe place to share thoughts, feelings, and stories.  This can help to process emotions, reflect on changes that are happening, and feel more connected.

Short-term Respite care designed to give caretakers a break for a limited period. Someone else provides care so the caretaker can go on holiday, attend to everyday activities or just relax, and practice self-care. It can take place a few hours a week to a few weeks a month. This includes home management and care planning, medical advocacy, personal assistance, and companionship. 

Here is a list of more services this could include:

⦁    Assist clients with personal care, including dressing, mobility, administering medication, personal hygiene, assisting with meals and nutrition, eating and transport or running errands. As well as help with mobility for those who are at risk of falling.

⦁    Home maintenance and basic housekeeping.

⦁    Monitor patient medications and help with prescription management.

⦁    Maintain open communication between families and healthcare professionals regarding client’s medical and emotional condition.

⦁    Document and report any changes in client’s health status.

⦁    Ensure highest client safety and well-being.

Advance care planning (ACP)documents can indicate who would make medical decisions (the health care proxy) for someone, if and when they were too sick to make decisions on their own.  These documents can also share the individual’s values, goals, and preferences for future medical care. Advance care planning is a process and goals may change along the way and documents can be amended.  Knowing the wishes of a loved one, can lessen the burden on the family of making difficult medical decisions, especially during a crisis. 

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ACP can be completed with the client individually, with family or a health care proxy present, or with a health care proxy alone if the client is no longer able to speak for himself/herself.  This process could include the following:   

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1.    Promoting discussions around the goals of care (what really matters to someone), ideally, prior to a healthcare crisis if the client, or family caregiver agree.

2.    Providing education regarding options for care at the end of life.

3.    Assisting in understanding the relevant state documents for ACP.

4.    Discussing if the MOLST (Medical Orders for Life Sustaining Treatment) would be appropriate and should be reviewed with and signed by a physician, nurse practitioner or physician assistant. 

5.    Reviewing how to share any ACP documents that are completed. 
 

Sharing and discussing plans for how to care for the body after death, and what type of ceremony is preferred, can relieve family members from last minute decisions during a stressful time and could potentially limit the options.  These plans can be as simple or as detailed as needed based on personal preferences, along with cultural and spiritual affiliations.  Some people may want to participate, and others may not feel ready or able to do this.     

An EOL Doula can help to facilitate this planning process when requested.  

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⦁    Decisions regarding care of the body might include: important rituals/prayers, who should be present at the bedside and who might want to wash and prepare the body after death.  Is the preference for cremation, embalming or neither?  What are the burial requests, including “green burial” with no embalming and a biodegradable casket.  Has a cemetery plot or mausoleum been chosen? Are there wishes regarding how to handle any cremains? 

⦁    Ceremonies could include: a funeral (traditional or home), special requests for music, readings, flowers, suggested donations, and eulogies.  A memorial celebration or life celebration following the burial are additional options.  Writing the obituary can also be  discussed in advance and some people even write their own. This could also include "Living Funerals"

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A living funeral is a celebration of life that is held prior to a person's death. Sometimes it is referred to as a "pre-funeral." The person is usually involved in making plans and it has a more festive feel than somber, although this can vary depending on the honoree's wishes and desires. It generally includes a mix of elements similar to a funeral, memorial, or celebration of life.

These include:

• Eulogies of the honoree

• Music, whether religious, secular, live or recorded

• Religious readings, poems, or passages from books

• Funeral program for the service/event

• Reception with food and drink

In addition to the basic elements, the person being honored and remembered often offers a speech to family and friends as well, and there may be other special things planned, too. The living funeral is usually held when someone is approaching death, perhaps from a terminal illness or age. The events can be formal or informal, more reverent or with a more party-like atmosphere; just be sure to let guests know what to expect in the invitation. Some religions may prohibit or frown upon a living funeral so make sure to check in with religious leaders before making plans if it is important to the guest of honor.

This issue can be important, as someone is thinking about approaching the end of a life.  Discussing creative and personal ways to be remembered can lead to a collaborative project.  Examples include: a collage, a shared playlist, scrapbook, letters, a collection of recipes, videos, audiotapes or an ethical will (sharing your values and life lessons).  Some may want to participate in funeral planning as a final remembrance.

The active dying phase can be an emotional and exhausting experience for family caregivers.  At the same time, it offers opportunities for continued growth, connection and beauty with loved ones. I offer support and guidance from sitting by the bedside, to helping prepare the body for home funerals or natural burials.

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Currently, due to the COVID-19 pandemic, the End of Life Doula will follow CDC and state guidelines and respect the comfort level of the family for the safest approach to being at the bedside when someone is close to death. Practical guidance and education for physical, emotional, or spiritual needs at the end of life can and will still be offered.  Emotions may be raw and physical energy may be low, so having additional support during this transitional phase can be reassuring.  This can be done in person with masks, outside with masks and social distancing, or via phone calls, texts, face time, emails, or scheduled on-line conferencing.
 

A sense of loss for the client and family caregiver can begin as soon as a diagnosis of a life-threatening illness and grief work may start long before someone dies.  Bearing witness to these difficult emotions and helping to find appropriate resources, can be an important contribution for an End of Life Doula.  A complementary follow-up call or visit to the family caregiver would be incorporated into the Doula’s services following the death of a client, as well as ongoing bereavement support if needed.  Referral to  formal grief therapy would be discussed for more complicated situations.

Those that wish they could spend more time with their dying loved one may find it difficult to find to do so if they have small children or infants to care for. Or perhaps the parent may need some time to practice much needed self care. I offer my services to the family as an infant and child caregiver as needed.

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(For this service, I may offer it to those outside of the Death Midwife Profession for special cases)