Human Composting

— Become Living Soil After You Die

Ashes to ashes, dust to dust. This age-old poetic reference to cremation and burial faces a modern controversy. Are ash and dust from current death care practices eco-friendly? According to the Green Burial Council, current practices poison the land with over 4 million gallons of embalming fluid, including 827,060 gallons of formaldehyde, methanol, and benzene.

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  • Five states, Washington, Colorado, Oregon, Vermont, and California, allow a new, eco-friendly death care option: human body composting.
  • Body composting is scientifically known as natural organic reduction (NOR). Some also call it termination.
  • For those who choose NOR, it takes two-six months to transform their bodies into rich composting soil to nourish the earth.
  • Loved ones may take home all or part of the soil or donate it to a land restoration project through their green funeral home.
  • NOR improves soil biodiversity and reduces carbon emissions. Meanwhile, neither traditional burial nor cremation is eco-friendly.

Meanwhile, by some calculations, U.S. cremations alone burn enough fossil fuels to power a car to the moon and back 1307 times per year.

A new, earth-friendly death care alternative is now legal in five states: transform your body into rich, living soil through body composting.

What is human composting?

Compost is a mixture of organic material added to soil to enrich its contents. Natural products like food scraps, leaves, and grass trimmings are mixed to decompose over time into the type of compost you buy at the store.

Green funeral homes apply this same scientific process to human bodies, allowing them to decompose into rich compost. The official name for body composting is natural organic reduction (NOR). The process requires carbon, nitrogen, and oxygen with optimal temperature and moisture to transform the body into the soil. This rich environment allows beneficial bacteria and other microbes to quickly break down the body into compost.

In 2012, Katrina Spade of Washington state learned that farmers have composted animal bodies for decades. In pursuit of greener burial options, she wondered if human bodies could also be composted.

After seven years of research and development, she stood with Washington state governor, Jay Inslee, on May 2019 when he signed body composting into law. Today, NOR is legal in Colorado, Oregon, Vermont, and California, with bills pending in several other states as well.

Natural Organic Reduction (NOR) is eco-friendly

Like any healthy compost, natural organic reduction repairs soil feeds living organisms and absorbs carbon dioxide by restoring forests. This is the same outcome as a natural burial – death care completed without chemicals added to the body or burial supplies – but at a faster rate.

Recompose claims NOR uses 1/8 of the energy used by conventional burial or cremation and reduces carbon emissions by nourishing soil, plants, and forests.

It’s hard to argue when you look at the numbers. Modern burial not only leaks 4 million gallons of embalming fluid into the land yearly, but it also feeds the earth 1.6 million tons of concrete and 64,500 tons of steel, as well as iron, copper, lead, zinc, and cobalt leached from caskets and vaults.

Meanwhile, cremation is growing in popularity as many people find modern burial overly expensive, complex, and unnecessary. But fire cremation isn’t great for Mother Earth, either.

According to the Cremation Association of North America, 57.5% of America’s dead were cremated in 2021, while Canada’s rate was 74.8%. 40 years ago, only 5% of Americans chose cremation.

To cremate a body within two-three hours, the furnace temperature must reach about 1500°. One cremation burns 30 gallons of fuel and produces about 535 lbs of carbon dioxide. The EPA estimates that a typical passenger car emits about 845 lbs of carbon dioxide monthly.

With its necessary machinery and transportation, human composting isn’t completely carbon-free. The natural process also releases some greenhouse gases, mainly carbon dioxide. However, body compost feeds plants and trees that remove carbon dioxide from the air and release oxygen, which means NOR is possibly carbon-neutral. Impressively, one composted body produces nearly a pick-up truckload of healthy soil.

Plants and trees need biodiverse soil to thrive. More microbes live in one teaspoon of healthy soil than all the humans on the planet. Among those billions of microorganisms, there should be 10,000 – 50,000 species of these tiny creatures. Due to various modern practices, however, our soil’s microbial diversity is declining. Composted bodies help tackle this problem by restoring soil and nourishing damaged land.

Another benefit of NOR is that it uses 90% less water than aquamation, another green alternative, which uses water to cremate remains instead of fire.

How does body composting work?

Also called termination, NOR begins when a body is wrapped in a biodegradable cloth and cradled into a vessel, often a steel cylinder. The body rests on a bed of organic material such as alfalfa, wood chips, and straw. Some composting services use wildflowers as well. Each body is placed in its container about eight feet long and covered with more organic material.

Depending on the method used, the body typically stays in the vessel for 30 – 45 days. The environment inside the container reaches about 140°, a perfect atmosphere for microbes to transform the body.

Bones and teeth remain when the rest of the body is fully decomposed. They are ground – just like cremation – and returned to the soil.

Medical devices, metal fillings, and implants are also sorted out at this point and recycled when possible.

Once the body is transformed into compost, it is removed from the vessel and cured in a finishing container for two-four weeks to stabilize the soil’s chemical process.

Nature’s a brilliant transformation process

NOR eliminates nearly all harmful viruses and bacteria as the body decomposes, including SARS-CoV-2. Currently, only three diseases disqualify bodies from being composted: Ebola, tuberculosis, and rare prion diseases such as Creutzfeldt-Jakob Disease, which causes severe brain damage.

Embalmed bodies are not allowed to be composted. Embalming chemicals are toxic and kill the microbes needed for the composting process.

Radiation seeds implanted for cancer treatment must be removed from the body before composting if the seeds were placed within 30 days of death.

What do loved ones do with the soil?

Loved ones choose to receive all or part of their person’s soil. Like any compost, the soil can feed their deceased loved one’s garden, nurture an orchard, or nourish a memorial tree.

But not every family wants a truckload of their loved one’s composted body. Instead, with the help of the funeral home, the family can donate the soil to a land restoration project.

Burial laws differ from state to state. The placement of human compost must comply with state regulations.

Natural Organic Reduction (NOR) costs about the same as cremation

Depending on the company, costs of terramation with a memorial service range from $3500 – 8000. Some companies subsidize the rate for those who need financial help.

In the United States, the median price for a ceremony with cremation in 2021 was $6971. The median cost of a ceremony with viewing (which requires embalming) and burial was $7848. This burial cost does not include a plot, a cement vault, or a headstone, which can increase the cost substantially.

For people living in a state where NOR is not yet allowed, it is legal to transport a body between states. Delivery of human compost can also be arranged across states.

Leaving a legacy

Green burial options are growing as the public pushes for improved death care practices. Natural organic reduction feeds and nourishes the earth as it has fed and nourished you. For a final act of gratitude, consider returning your body to the earth as rich, living soil.

Complete Article HERE!

Queering the Good Death

When it comes to protecting chosen family, LGBTQ couples face unique struggles.

By Sara Harrison

Before he met Charles Koehler—and before he married a woman, got divorced, and came out—Dennis Hostetler was a college student who needed money. In the summer of 1962 he began working in the W.R. Grace mine, cleaning the tools used to drag vermiculite ore out of the ground. The shiny, flaky mineral would be refined at the plant, and when heated, it would balloon into puffs that could insulate buildings. Libby, a town in northwest Montana, was a beautiful place, but Hostetler had bigger ambitions, so he took the $1,443.72 he’d made and got the hell out.

But pieces of Libby stayed with Hostetler, buried deep in the outer lining of his lungs. He unwittingly carried toxic mineral fibers from the mine to college in Missoula, to the Peace Corps in Tunisia, to Paris’ Left Bank, and to St. Louis, where one day, at age 67, he discovered he was dying. After experiencing fatigue, chest pain, and shortness of breath, Hostetler was diagnosed with mesothelioma, a deadly cancer probably caused by inhaling asbestos that tainted the vermiculite he mined. In 2009, a year after Hostetler’s diagnosis, the Environmental Protection Agency declared a public health emergency in Libby and initiated a massive cleanup effort that’s still ongoing. Hostetler had no illusions about what came next—he needed to put his affairs in order.

Death is an inevitable fact of life that most people prefer not to discuss. According to a 2012 survey by the California Health Care Foundation, 60% of Californians said that when they die, it’s very important to them not to burden their families with tough decisions. Despite that, more than half of the respondents hadn’t communicated their end-of-life plans with the people they wanted making decisions for them. Some were too busy with other things to think about it; others said thinking about dying made them uncomfortable. But having those conversations can make the experience better for the person dying. There’s less regret about what might have gone unsaid, and less anxiety and confusion for caregivers because they know their loved one’s wishes. Numerous studies have linked conversations about death to better, more peaceful deaths. 

For members of the LGBTQ community, dying without the legal protections of a living will or power of attorney could mean spending their final days without the support of the people who love them. A 2010 study by the National Gay and Lesbian Task Force Policy Institute found that LGBTQ elders are twice as likely to live alone and four times less likely to have children than their straight counterparts. That means their caregivers are often friends, exes, or chosen family who aren’t always recognized by the medical and legal systems. “There’s no automatic protection in place to make sure that someone can choose the person that’s going to be making their [end-of-life] decisions,” says Kimberly Acquaviva, a professor of nursing at the University of Virginia who specializes in palliative and end-of-life care. “You have to put those things in writing.” Before same-sex marriage was legal, there were horror stories about families swooping in and making medical decisions that didn’t accord with people’s wishes. “Those things still happen,” she says.

Charles Koehler, wearing a blue polo shirt, holds a black-and-white photo of his late husband, Dennis Hostetler, at age 68. He is standing outdoors, with trees and foliage visible in the background.
Charles Koehler holding a photo of Dennis Hostetler at age 68.

A Better Way to Die

Hostetler met his partner, Charles Koehler, in 1984. While the two could never have prepared for how their relationship unfolded over the next two decades, they always had a plan for death. Before Koehler met Hostetler, he’d read the 1969 bestselling book Everything You Always Wanted to Know About Sex* (*But Were Afraid to Ask) and decided it would be better if he wasn’t gay. The book told him gay people led awful lives, an idea affirmed in an abnormal psychology class where he learned that homosexuality was in the Diagnostic and Statistical Manual of Mental Disorders. 

If homosexuality was classified as a mental illness, then Koehler reasoned that it too must be a diagnosable disorder. But then Koehler actually met some gay men and realized their lives were just as varied as anyone else’s. Even then, it took years for Koehler to accept himself; when he did come out at age 27, he thought his life would remain solitary. “I had no idea what was possible,” he says. “I assumed that I would be basically closeted.” Both Koehler and Hostetler were hesitant when they met. Hostetler, who was older by a decade, had two daughters he still wasn’t out to. When Koehler moved in, Hostetler told the girls he was just renting a room. But in time they came out to Hostetler’s daughters and ex-wife. 

When two of their lesbian friends asked them if they’d consider donating sperm so they could have children, both men obliged. At first the men agreed to just be “uncles” to the children, but eventually the moms wanted the boys to know who their fathers were. “We had to do DNA testing to find out who was whose,” says Koehler. “The boys were really excited for about five minutes and then they wanted to go outside and play games.” Koehler began volunteering in a program that provided support buddies to men living with HIV and AIDS. He watched a man die and then watched the man’s partner get thrown out of the home they shared. Though the house was owned by the man who died, there was no will to ensure his partner could keep it. “The family came in, took everything, kicked the kid out on the street,” Koehler says. 

Afterward, Koehler and Hostetler—who were both healthy at the time—drew up documents specifying what should happen to their assets in case of death. Now, there are academics and organizations helping LGBTQ people make clear, concrete plans for death. In doing so, they’re modeling a better way to prepare for, think about, and embrace death. Sherrill Wayland, who directs operations at the National Resource Center on LGBTQ+ Aging, saw many of their older friends struggle to get the care and support they needed at the end of their lives. “It was really personal for me,” they say. “No one should die alone if they want support.” In their role, Wayland has helped create a series of guides to help LGBTQ people plan for serious illness and caregiving. 

Sage USA, an advocacy organization for LGBTQ elders, is also pushing for cultural competency training in long-term care facilities. Compassion & Choices, a group that champions the importance of end-of-life planning, has LGBTQ-focused programs like Pride in a Box, which encourages people to take time during Pride Month to talk about how they want to die. These conversations can seem at once ghoulish and mundane: Do you want to be cremated or buried? Do you desire an open- or closed-casket funeral? What clothes would you like to be buried in? What pronouns should appear in your obituary? “LGBTQ people have realized that if we don’t make a plan, things are probably going to go sideways because other people won’t be looking out for us,” says Acquaviva, who helped develop an LGBTQ-inclusive curriculum for The Conversation Project, an organization that helps people discuss their end-of-life plans. “We have to figure out ways to look out for ourselves.”

Charles Koehler, in a blue polo shirt, stands next to his son Spencer, age 28, wearing a red T-shirt. Both men are smiling, and standing outdoors with trees and foliage visible in the background.
Charles with son Spencer, age 28.

Because Hostetler had an amalgamation of chosen and genetic family members, he wanted to make sure everyone was on the same page. He organized his will and called his daughters, his ex-wife, the sons, and their mothers. Hostetler was adamant that he wanted to die at home, so he arranged for hospice care. Instead of hiding his identity, Hostetler informed his health care providers that he was gay and that Koehler was his life partner and caregiver. Koehler says that without exception, every single person was supportive and respectful of their relationship.

In the final two weeks of Hostetler’s life, a hospice nurse suggested setting up his bed in the living room so he wouldn’t be alone. His eldest daughter and her family moved in and traded shifts with Koehler and a hospice nurse. His nurses provided massage and music therapy to make him more comfortable. Hostetler was sedated, hovering at the edge of their everyday routines. Finally, on New Year’s Eve 2010, his daughters and his life partner surrounded his bed and held hands as he took his last breaths. Koehler checked his pulse and said, “I think he’s gone.” Koehler describes the whole experience as peaceful. Having months to accept that Hostetler would die helped make the process less traumatizing for everyone.

Three framed photographs sit on a wooden shelf. The photos show, from left: Charles, age 45 (left) with Dennis, age 55 (right) holding their sons Connor, age 2 (left) and Spencer, age 4 (right) on Christmas 1997, in front of a decorated Christmas tree. Center: Charles, age 45, with Dennis, age 55; both wearing patterned sweaters and smiling broadly. Right: Jocelyn, Dennis’ daughter from a previous 12-year marriage, smiles while holding her two children; one an infant, and one a toddler with their arms around their sibling.
Left: Charles (left), age 45, with Dennis (right), age 55, holding their sons Connor (left), age 2, and Spencer (right), age 4, on Christmas 1997. Center: Charles, age 45, with Dennis, age 55. Right: Jocelyn, Dennis’ daughter from a previous 12-year marriage, with her children.

“In a strange way it was both sad and yet somehow comforting at the same time knowing that he died being surrounded by us at his home, just as he wished,” Koehler says. But not all LGBTQ patients receive such affirming care: A 2020 survey published in the Journal of Palliative Medicine found that nearly one-quarter of health care providers witnessed discrimination against LGBTQ patients in palliative care settings and nearly 30% of the respondents reported witnessing discrimination against LGBTQ spouses, partners, or people whom the patient had legally designated to make care decisions for them.

Preparing for the Inevitable End

Experts like Acquaviva and Wayland say that health providers need to take time to understand the barriers that create health inequities in the LGBTQ community and undergo cultural competency training to avoid making the same mistakes. Because LGBTQ families are more likely to be families of choice, providers need to be sensitive to those dynamics and spend time learning who is part of a patient’s support system instead of automatically deferring to genetic family members. There are also simple ways to acknowledge the range of human gender and sexual identities, such as including nongendered pronouns on forms, asking for patients’ pronouns and using them correctly, and including LGBTQ-affirming language in nondiscrimination clauses.

Those steps may seem like small gestures, but they’re important signals. If an organization doesn’t commit to doing something as minimal as adding inclusive language to a statement, says Acquaviva, then it’s reasonable to expect that they won’t treat a patient with the dignity they deserve. Acquaviva has both written about and experienced this discrimination: She and her wife talked extensively about their plans when her wife was diagnosed with ovarian cancer in 2019 and ultimately decided to use hospice care to help her die comfortably. But then they discovered that none of the hospice services near their Virginia home included LGBTQ-affirming language in their nondiscrimination statements. Despite the fact that both women were experts in end-of-life care, they faced death without the support of hospice because they felt they wouldn’t receive respectful care. Acquaviva was the one managing her wife’s pain meds, bathing her, and making sure she didn’t get bed sores.

Charles shares drinks with members of his local PrimeTimers social group, of which he was founding president, on the back patio of Just John Night Club in St. Louis, Missouri. He wears a red, white, and blue-checked shirt, glasses, and holds up a pint of beer to toast with a friend who is off-camera.
Charles shares drinks with members of his local PrimeTimers social group, of which he was founding president, on the back patio of Just John Night Club in St. Louis, Missouri.

There’s no single definition of a good death. Not everyone knows when their death is coming and not every death can follow a specific plan, but every death can be expected and discussed ahead of time. “We all want to imagine we’re gonna live a really long time, and it’s human nature to imagine that everything’s gonna be OK, but the reality is 100% of us are going to die,” Acquaviva says. Have the conversation—even if it’s awkward, uncomfortable, and hard. 

Now, more than a decade later, Koehler remains an active retiree. He’s single but he isn’t alone. He’s the vice president of PrimeTimers Worldwide, a large social group for older gay, bisexual, and transgender men. On Sundays he catches up with Hostetler’s daughters and their mom over Zoom, and when the younger daughter needed surgery, he helped with child care. “Having grandkids is something that I never dreamed of as even a remote possibility,” he says. “It never even crossed my mind at all.” His documents are in order and he encourages his peers to make end-of-life plans. But while he’s still here, he’s keeping busy, tending to the life and family he and Hostetler built together.

Complete Article HERE!

Letting grief make you stronger

By Nancie Wiseman Attwater

Grief is powerful and can break your heart for the rest of your life, or you can learn from it and become stronger. Losing a loved one is something that everyone will go through, but not all come out as survivors in the end. It’s part of life, but a very difficult part. Think of your loss as a lesson to help you live the rest of your life.

How do you survive grief? It’s a difficult question and everyone will have a different answer. You must find your own answer and let that be your focus rather than the sorrow you are feeling. Death is final, there is no going back, but your grief can slowly ebb if you work at it and learn what you can do to feel better for yourself. I don’t have all of the answers, but I have done some real soul-searching to make my new lifestyle work for me. No one can do this for you, you have to take care of your own heart and soul.

I write. That helps me get through the hard days and the difficult nights. Not everyone will feel comfortable writing their thoughts down, but there are some other options, and hopefully, one or two will fit your lifestyle.

1. Grief is like a chronic illness. Some days will feel better, and others will be just like the first day after your loved one died. You will always have grief, but it can be managed. You will never forget them, and remembering the time you had together may be more helpful than thinking only of the time you no longer have with them. It’s always there, in the same room with you at all times. It might be right next to you or across the room, but it is there.

2. Reading about others’ grief and what they did to feel better may help you. How did they survive every day? There are dozens of books and resources about grief. I received an email every week for 12 weeks from the Neptune Society, the folks who cremated my husband, on the stages of grief and how to work through them. Try and read this helpful information if you receive anything like it. It truly is invaluable.

3. Speaking to others who may have gone through the same loss. Choose carefully as the person who lost a child, or a parent may have a different experience than someone who lost a spouse.

4. Finding things to do that focus your mind elsewhere. Not easy to get out and exercise when you just want to go back to bed. There are other things like reading, crafts of some sort, or even just cleaning out the cupboards in the kitchen.

5. Your appetite may change. For most, I think eating becomes an issue because they don’t feel hungry. They live alone now and don’t want to sit at the table across from an empty chair. Wander the grocery store aisles and find things that appeal to you. Even if it is just a chocolate rice cake, it’s something.

6. Alcohol. Be very careful. Using alcohol to calm your nerves or go to sleep can turn into a bigger problem than your grief. I used brandy every night for a month to help me sleep. I knew I was headed in a bad direction, so I had to find other ways to help me sleep. Music is at the top of the list.

7. Get help. Please get some counseling and let your grief pour out during your sessions. It’s a safe place to talk with no judgment. Online counseling is easy to get now. Contact your health care provider to see what they have to offer.

8. Exercise of some sort is a great stress reducer and will increase endorphins that help make you feel better. I’m not a bit gym person, but I have one where I live, and I get there when I can. My exercise is walking the dog. We walk up to 10,000 steps a day, sun, rain, or wind. It helps us both. I feel better, and I think the dog does too, after a long walk. We have several walking paths where I live, and I think we have walked every one of them. One day, my dog saw someone using a walker and ran to catch up with them. Bill used a walker, and I think she thought it was him. She came to a screeching halt when she realized it was a woman. I felt so sorry for my dog because how do you explain death to a pet? She is grieving too, and I’m sure she wonders when Bill is returning.

9. I have to walk by my husband’s clothes hanging n the closet every day. I am not ready to get rid of them. Some days I wear one of his flannel shirts. It’s huge and will always make me cry for a minute, but it’s a closeness I’m not ready to give up.

10. The one thing that I miss is Bill saying, “Good night, sweetheart” every night when we went to bed. I still think he is going to walk out of the bathroom in the morning and say, “Good morning,” but that is wishful thinking and all part of the grieving process. I still can’t believe he is gone, and my brain and my heart need some time before acceptance is part of my reality. I spoke with our accountant the other day, and when we were saying, “Goodbye” he said, “I love you.” This was so sweet, and I have never even met him, only talked on the phone. I sat in my chair and cried for a bit and realized I miss that sentiment too and will always long to hear it again from Bill.

11. If your loved one had a long illness and you experienced anticipatory grief before the actual death, you may find that your grief now doesn’t seem strong enough. You might ask, “Why am I not feeling more sorrow?” You’ve already done a lot of the work, and even though “grief” has not left the room, your day-to-day struggle may be slightly less. Some days will always be brighter than others, no matter when and how you experience grief.

12. Grief will stay in the room with you wherever you go. It might be next to you or over in the corner, but it will always be there. I went to my local grocery store, where I always bought cream puffs for my husband. He loved them and asked for them whenever I went shopping. I just happened to walk past the cream puff section of the store while shopping the other day and started crying. That’s how grief stays with you. A simple reminder of your loved one can – when you least expect it – bring sadness and tears. I had to walk away and wipe my tears and told myself to stay away from that section of the store if I possibly can. I’m in charge of my grief, the cream puffs are not, so I need to manage when I think I can walk by them again and not break down in tears. It’s the age-old phrase, “Choose your battles.” Always choose where you are the winner.

13. I have found that at least once a day since my husband passed away about three months ago, I have had to tell someone, “My husband passed away in August.” For some reason, it happens every day. The bank, Social Security, the state, or the HOA where I live, someone! Even the pest control people needed to know. I found after a while that it became easier to say the more I said it. I can now say “Bill passed away” without crying. I may tear up, but saying it more often sort of takes the “sting” out of the words and their meaning. This made me stronger and more accepting of what has happened and the need to let everyone know.

14. When someone asks me how I am doing, I’m still not able to answer without tears. I went out to lunch with a friend the other day, and she kept asking me over and over how I was doing. I told her I couldn’t answer right now, which may have been hurtful for her because she really cares, but I had to stop the tears. It ruined the lunch I was looking forward to, and could not eat another bite. It was a well-meaning gesture, but I didn’t want to cry at the restaurant. I need to get stronger on this issue and with my answer. Usually, I say I’m “OK,” but that isn’t enough for the people who really care sometimes.

15. Keeping busy helps, but don’t overdo it. One task, a phone call, or a chore a day is useful for keeping up with everything, like paperwork for a government agency or retirement income changes. Some of these calls are very frustrating. I talked to Social Security at least once a week for a while, but I made the call when I was rested, had eaten something, and felt I could handle their questions as well as they could handle mine. You never know what kind of day the person on the other end of the phone has had, and if it feels like all you get is rudeness and no answers, maybe it’s best to try again another day.

16. I had to learn to cook for myself. This was a benefit to me. Bill always did all of the cooking, and I had to take over when he could no longer work in the kitchen. I’m not a great cook, but I do try to manage something for breakfast and sometimes dinner. I was going to look into cooking lessons next year and see if this gives me a new place to meet some people and make a friend or two.

17. Let kindness become a part of your life. I have a pretty good temper when provoked or feel someone isn’t giving me the service I think I deserve. I am working on being more gentle with my fellow humans because I have learned that life ends too soon. I want to be remembered for being nice, not crabby. My husband lived that way every day. I should have learned it sooner but was always so busy taking care of him that I didn’t give it much thought. I am learning from him still, and my grief makes me remember him and his “moral compass” that always seemed to be in the correct direction. I’m also trying to get my compass in the correct direction while I manage everything on my own.

18. A friend told me that it takes about two months to get everything straightened out – the insurance, social security, banks, and retirement accounts. I scoffed at this, thinking I’ll give it about a year. That’s also what they say is the length of time to accept the death of your loved one. I’m three months out, and the money issues seem to be clearing up, but I’ve got a long way to go to get used to the loss of Bill. I’m OK with that, I’m still working on this and will for a while, I’m sure.

19. Make your home all about you. You don’t have to remove mementos or photos, but now you can arrange the furniture or bathroom. Bill used a walker, we had to have wide paths for him to get through the house. I can now change this and rearrange things for my comfort. Bill also had several photos of old relatives hanging on the wall. I had no idea who any of them were, so I removed them and put up photos of my family and some of my artwork. It’s hard to do, but his family photos belong to his children, not me.

20. And finally, it’s OK to laugh despite your grief. In fact, laughing is good for you. A good sense of humor can’t cure all ailments, but data is mounting about the positive things laughter can do. Laughter enhances your intake of oxygen and stimulates your heart, lungs, and muscles. It also increases endorphins that are released by the brain. Laughter can cool down your stress response, soothe tension by stimulating circulation, and aid muscle relaxation. Laughter also has long-term side effects like improving your immune system, relieving pain, making it easier to cope with difficult situations, and improving your mood. I do my best to be around people who either make me laugh or at least seem happy. If someone has so much sadness themselves that it makes me feel sadder, I will say hello, but walk away as soon as is comfortable.

Complete Article HERE!

After a loved one dies, red tape adds to the grief

Bureaucratic delays and paperwork are frustrating, exhausting, emotionally crushing — and often unavoidable

by Allison Engel

In quick succession last spring, my family experienced three wrenching deaths: My brother-in-law died of a late-diagnosed cancer, my husband, Scott, died of a different late-diagnosed cancer and my mother died at age 100.

The last thing you want to deal with when you’re wrapped up in grief is red tape. It’s frustrating and exhausting and emotionally crushing. And yet it is unavoidable.

My family thought our financial affairs were organized. We had wills and beneficiaries were listed there and on all financial accounts. Many people don’t do that, which makes the post-death red tape so much worse. But even so, we’ve endured months of maddening experiences with banks, insurance companies, employers and the Social Security Administration — among others.

Here are a few of the most aggravating roadblocks:

Face recognition, voice recognition and fingerprint recognition speed up access when someone’s alive but present tremendous barriers for survivors trying to wind down accounts. When I sign in to my late husband Scott’s password manager and investment accounts, access codes are sent to his phone. Despite many tries, I find I cannot change that phone number. This means keeping Scott’s phone active, a needless expense.

Credit card mix-ups

If you think you and your spouse share a credit card, because each of you has a card with your name on it and the same account number, guess again. That card belongs only to the person who applied for the account. Credit card companies are alerted to a death quickly by the Social Security Administration, and will freeze a survivor’s ability to view the account online. Providing a paper statement seems logical, but our bank’s representative told me, “Once you’ve opted to get online statements, our policy is you cannot go back to paper statements.” It took six full months of begging to the bank’s “Deceased Management Team” (actual name) to be mailed statements for the months following Scott’s death. And it wasn’t easy to cancel some recurring charges.

At Best Buy, a customer service representative said I had to take a death certificate to a Best Buy store to cancel a Geek Squad subscription. I considered dressing in black with a veil but went dressed normally, with death certificate in hand, and got the refund.

Personal visits are discouraged

When your frustration level rises after marathon sessions on hold, you might be tempted to visit the bank or insurance office in person. Don’t. At one bank, an employee would not make an address change when I arrived, and referred me to the financial institution’s website.

I visited a Social Security office in person twice to try to change the address where Scott’s post-death Medicare bills were sent since I had moved — and was now paying those bills. An address change could not be done in person after a death, I was told; use his online account. But it is the one account not in his password manager and it has a unique username I don’t know. I hope his medical bills, arriving at a snail’s pace, all come before the Postal Service stops forwarding his mail to our old address.

Documentation overload

I bought multiple copies of Scott’s death certificate, but I was unprepared for how companies string out requests for other documents. Scott’s longtime employer clawed back his monthly pension without notification, then refused to tell me what documents it required other than the death certificate. The company needed to investigate Scott’s pension wishes, it said.

Scott had had only two choices: a higher pension that ended with his death or a lower pension that continued to me. From the dollar amount of the checks, it was obvious he had chosen the lower pension.

Two weeks after receiving the death certificate, the company rep asked for Scott’s birth certificate. Two weeks after that, our marriage license. Two weeks after that, she requested the original Social Security card I applied for at age 16. A friend, a retired district judge, pointed out that companies get only 30 days to resolve such issues. I called and told the representative that this limit had been exceeded. Amazingly, she called the next day and said everything was resolved.

Still, she insisted on sending the three months of withheld pension payments to my old address, even though I had provided proof of my new address weeks earlier.

Lengthy waits

Expedia required a death certificate and 30 days to quit sending Scott emails. I couldn’t just unsubscribe him because he once had been booked on a flight through Expedia, the online travel agency’s fine print disclosed.

At our bank, I had to make one appointment with an official to delete Scott’s name from our joint checking and savings accounts, and another to change beneficiaries on that account. I was told to plan 90 minutes for the first visit. (It took two hours.)

Most of the time was spent sitting in the banker’s cubicle, waiting while he tried to get the bank’s estate management group to answer the phone. He waited on hold for 43 minutes while I sat there. Deleting Scott’s name took a few minutes. The banker hung up without asking about the credit card linked to that account and had to call back. We waited another 18 minutes for the phone to be answered.

My return appointment for the beneficiaries took another hour sitting in that cubicle.

Many of these red-tape problems are made more galling as they often require phone calls with endless waits on hold. When representatives finally connect, they invariably start by the rote and insincere “sorry for your loss” scripts.

Grief is hard enough. Dealing with tech barriers and nonsensical policies make the months after a death into a second career of aggravating phone calls, emails and visits.

How to reduce these irritations

To minimize these frustrations, here are a few suggestions learned the hard way:

1. Keep an updated list of recurring credit card charges, organized by each card.

2. Make sure you have a credit card you applied for in your name.

3. Get a password manager to hold all your user names and passwords and make sure your executor knows your master password. If you have some accounts that are not included in a password manager, make sure your executor knows what they are (and also remember to update any list in case you change them periodically).

4. Buy at least six copies of the death certificate. Some companies allow you to email copies, but others require the physical certificate.

5. Do an inventory now and make sure you have birth and marriage certificates, adoption or divorce documents and Social Security cards. After many decades of marriage and multiple moves, some of these documents may have gotten lost. It can take weeks to get copies from the various agencies.

6. Don’t put the will or other important documents in a safe-deposit box. Getting access to it can be a lengthy process, particularly if your loved one misplaced the key. Even with a key, if family members suddenly need to get a loved one’s medical power of attorney outside of bank hours, for example, they are out of luck.

Complete Article HERE!

When the patient is family

— Perspectives on caring for loved ones during end-of-life

By Lora Parisien

Every day, hospice workers bring comfort to dying patients so that they may die with dignity and on their own terms. They extend grace and compassion to all, regardless of who they are or where they come from. This is the humble work of a Hospice of Michigan employee. This is the promise they keep: Every Person. Every Time.

But what happens when the hospice worker’s patient is a family member? Does having a hospice background make it easier to navigate the challenges of caring for a terminally ill patient when that patient is a loved one?

When she was just 10 years old, curiosity drew Sarah Beegen to the room in her family’s home where hospice staff were attending to her dying grandmother. “I wanted to know. I needed to know what was going on in there,” said Beegen. This same inquisitiveness led her to a career with Hospice of Michigan, where for the past 17 years, she worked her way from certified nurse assistant to her current role as manager of the not-for-profit’s referral center.

If anyone was fully prepared to care for a dying family member or insulated from the hardest aspects of death, certainly Beegen was. When her mother’s cancer became incurable, she “shut off my ‘hospice eyes’ and focused on other things. I didn’t want to see that mom was dying.”

The truth is, no amount of training or experience can prepare one for the death of a loved one — because dying is more than a medical event, it’s a deeply personal experience.

Hospice workers understand that both patients and their family members can struggle accepting life-limiting diagnoses. In 1969, Elizabeth Kubler Ross, a Swiss-American psychiatrist and pioneer in the worldwide hospice movement, identified five stages of grief. When faced with imminent death, denial, the first of the five stages, is a common reaction to change and loss. No amount of hospice training can derail feelings of grief. Denial is the defense against something that is impossible to accept.

“No matter how seasoned you are, you can never be prepared when the patient is your loved one,” says Beegen.

Tracey Pierce, director of marketing and communications for Hospice of Michigan, also found herself in unexpected territory when she reached out to her colleagues for help. In a matter of months, her mother- and father-in-law suffered falls, hospitalizations, and anxiety which led to a drastic decline in their health.

“It’s a different ballgame when you are on the other side. For as much as I thought I knew about hospice care, I realized how much I didn’t know. I’m grateful we had my work family to lean on. Hearing the stress in my voice, they calmly answered our questions and addressed our concerns with compassion and patience,” said Pierce.

That is the gift of hospice, a team of experts sweeps in and surrounds patients and families — and sometimes colleagues — with knowledge, skill, and compassion, providing wide-ranging physical, emotional, and spiritual support at a crucial time.

Beegen and Pierce both knew they needed help from the experts, the people she worked with every day. “If I learned one thing from my mother’s death, it’s not to be afraid to ask for help,” said Beegen.

“We always talk about providing care and dignity in hospice. It was evident in simple, nurturing acts, such as a hospice aide bathing my mother-in-law,” shares Pierce. That gave Pierce and her family the opportunity to focus on being present in all the precious moments they had left.

Redefining what was and shifting to what is now. Searching for meaning. Contending with change. Living day by day. Preparing for death. These are the hallmarks of coping with the terminal illness of a loved one. It is a highly personal experience, no matter who you are. Though it can be daunting, no one should face the end-of-life process alone.

Complete Article HERE!

Black Christian patients are less likely to receive their preferred end-of-life care.

— Researchers hope change that. 

by

Researchers from the University of Alabama at Birmingham published a paper in the Journal of Racial and Ethnic Health Disparities demonstrating the importance of respecting the deeply held beliefs of African American Christians to help provide equitable, goal-concordant end-of-life care to these patients.

There are two schools of thought among clinicians at end of life: aggressive care, which focuses on treating the illness or condition, and supportive care, which focuses on pain and symptom management.

In this publication, researchers demonstrated how the term aggressive care — used loosely by clinicians to describe care that can negatively impact quality of life for patients with serious illness — is often used to inappropriately label the preferences of African American patients.

“Our motivation through this article was to bring in not only the perspectives of African American Christians, but also to share the biblical and historical backdrop that can be instrumental in shaping their serious illness and end-of-life wishes,” said Shena Gazaway, Ph.D., assistant professor in the UAB School of Nursing and lead author of the study. “In collaboration with our wonderful medical colleagues, we wanted to acknowledge the origins of aggression and discuss how the labeling of care as aggressive with patients and their families can negatively impact care conversations.”

For patients with serious illness such as advanced cancer, dementia and terminal illnesses, the term aggressive care is used to describe courses of treatment that could potentially cause increased physical distress and psychological stress and a decreased likelihood of experiencing a “good death.” The Institute of Medicine defines a good death as “one that is free from avoidable death and suffering for patients, families and caregivers in general accordance with the patients’ and families’ wishes.”

“The data is clear — a larger proportion of African American families reported that their loved one did not receive care that is in accord with what they requested in the final days of their life,” said Ronit Elk, Ph.D., associate director for the UAB Center for Palliative and Supportive Care, and professor in the UAB Division of Geriatrics, Gerontology and Palliative Care and co-author. “We hope this article provides a careful explanation of why these values are so important to the African American Christian community and will strike a chord in many clinicians about the importance of respecting these values and not dismissing the beliefs that these patients and their families about hope and the miracles of God.”

In this article, researchers discuss how many Black Christian adults share a belief in miracles that shapes their end-of-life care decisions. The article states that this belief in miracles combined with an overall distrust in the health care system — due to a history of medical experimentation and centuries of health care disparities — have led many African Americans to depend on their belief in God’s healing power to perform miracles and heal family members who are seriously ill.

The UAB Center for Palliative and Supportive Care offers the African American Communities Speak program to clinicians. This skills-based training incorporates videos created by the African American community to train clinicians on the community’s cultural values, lived experiences and recommendations for care. Self-reflection and active learning techniques provide participants the foundation needed for changed behavior and improved communication with patients and caregivers.

This trust in God, belief in miracles and distrust of clinicians may lead to a seriously ill African American Christian patient to request life-sustaining medical interventions even when recommendations call for supportive care. When facing terminal illness, this hope in miracles often influences the patient’s medical decisions and fuels a desire for life-sustaining interventions. The paper states that these decisions are also rooted in a belief that God ultimately decides the outcome of life, not the health care system. 

Researchers say the key to goal-concordant care is for clinicians to allow these patients to process clinical information through their preferred spiritual lens and to allow them time to have critical conversations with those in their network.

“We are hopeful that clinicians will read this article and take away the importance of religious and cultural belief systems in this particular patient population,” said Moneka Thompson, staff chaplain in the Department of Pastoral Care and co-author. “Specifically, we want everyone to understand how the values and beliefs of this particular population may impact their end-of-life preferences and decision-making. This article is the combined effort of five very different women from quite different backgrounds.  Our collective goal was to create a think-piece towards movement of health care for this population in a meaningful and more equitable direction. At the end of the day, we want to support health care equity as much as possible.”

Thompson says that there are a few steps clinicians can take to help ensure they are providing goal-concordant care to their patients.

“First, we encourage clinicians to be aware of their own biases towards this patient population that may fuel incongruent care,” Thompson said. “Second, we hope that clinicians will utilize communication practices that encourage cultural sensitivity, humility and curiosity. Finally, we want clinicians to be fully present to the variety of religious and cultural beliefs that this population will present without feeling the need to obtain this value system for themselves or compromise their own.”

Complete Article HERE!

Cooking Can Help Us Grieve, Heal, and Process Our Emotions

—Here’s Why

By Kayla Hui

Recently, I flipped the last page of Crying in H Mart by Michelle Zauner. For those of you who haven’t read it, the memoir is about Zauner growing up Korean in the United States, navigating life without her mother—who passed away after battling an aggressive form of pancreatic cancer—and rediscovering her identity. Down to its core, it’s a touching and fill-your-heart-up story about how cooking and food can help us heal after losing people we love (and warning: reading the book will make you sob).

Whether you cook or not, grief experts confirm that preparing dishes that loved ones used to make for us can play a crucial role in processing grief. To better understand the science, we spoke with a few professionals to learn how cooking can help us heal from loss. And in this week’s episode of the Well+Good Podcast, we had a conversation with Frankie Gaw, author of the new cookbook First Generation: Recipes from My Taiwanese-American Home and Susan Krauss Whitbourne, PhD, psychology professor Emerita at University of Massachusetts, Amherst to talk about the profound healing power of food and cooking.

Taste, memory, and keeping loved ones alive through our meals

Cooking is a sensory experience, involving touch, taste, sight, smell, and hearing.  Of all the senses, though, “the sense most strongly tied with memory is olfactory,” aka our sense of smell, says Peggy Loo, PhD, a licensed psychologist and director of Manhattan Therapy Collective based in New York. When we cook, we activate the hippocampus and amygdala, which are parts of the brain involved in memory and emotional processing.

Research shows that human olfaction can cue emotional aspects of our memory, most of which comes from the first decade of our life. “This is why certain smells can elicit visceral reactions and evoke memories from long ago,” says Shavaun McGinty, MA, LPC, CT, a licensed professional counselor and certified grief counselor at the Peacemaker Center in Dowingtown, Pennsylvania. This process is what some experts refer to as the “Proust phenomenon”—at the beginning of Proust’s novel, Swann’s Way, he details a scenario in which the taste and smell of a madeleine cookie dipped in a cup of tea brings back a character’s long-forgotten memory in detail.

What’s more, cooking helps us grieve is by minimizing the fear of forgetting our loved ones, whether it’s “their voice, their laugh, or that one facial expression they had when they were about to sneeze,” says Dr. Loo. “Knowing that our sense of smell is powerfully tied to memories means that you can access them when cooking dishes we associated with our loved one.”

By following recipes that our loved ones used to make for us or recreating dishes we once shared with friends and family, we keep the memory of a loved one or passed experience alive. In a way, the aromas and scents of the meal help us travel back in time—whether that means apples and cinnamon from your mother’s apple pie or in my case, the steaming broth from hot pot. Cooking is what keeps us connected to loved ones after they’re gone. 

When we lose that special someone in our life, it’s also not uncommon to feel like we lost a piece of ourselves, including our cultural identity. However, cooking can be a way to honor cultural ties, or the passing on of something you had with a loved one, explains Dr. Loo.

Like Zauner, I, too, grew up Asian in America and lost a loved one: my gong gong (grandfather in Cantonese), who immigrated to the United States in the mid-1950s to start a better life. When he passed away from a heart attack in 2002, not only did my family fall apart (he was the glue that held us together), I felt like I lost a large part of my Chinese identity.

A chef, my gong gong cooked for a living and for family, but his death meant that Cantonese dishes—stir-fried clams in black bean sauce, garlic-infused green beans, and steamed fish with ginger and scallions—were no longer served at the dinner table. Though his death occurred when I was just six years old, I’ve come to realize that I felt the gravity of it most in college, where I grappled with feeding myself and realizing that I couldn’t cook traditional Chinese food. I didn’t learn any of my gong gong’s recipes, and he was the only one in my family who knew them. I felt ashamed and disconnected to my identity. However, I found solace in the aisles of Asian grocery stores, picking and reminiscing foods and snacks he used to make for me, and learning recipes online. And in making a bold attempt to cook a version of my gong gong’s Cantonese food at home, I felt more connected to him and my culture.

Grief looks differently for everyone, but cooking is the glue that binds us closer together. “It can be helpful to plan intentional pockets of space for your grief—like the one you might have cooking a meal from beginning to end,” Dr. Loo says.

Whether you’ve lost a parent, sibling, grandparent, or friend, cooking is the driver that reconnects us, grounds us, and helps us heal.

Complete Article HERE!