Deficiencies In End-Of-Life Care Extend Across Ethnicities


By Barbara Feder Ostrov

What kind of care do you want at the end of your life?

elderlyStanford University researchers put that question to members of three major ethnic groups in the San Francisco Bay area and found little variation in their responses.

“There is a common humanity – people want to live as long as they have good quality of life. When it is their time, they want to be consulted so they die in a way that they are respected, and they don’t want their families burdened,” said the study’s lead author, Dr. V.J. Periyakoil, director of the Stanford Palliative Care Education and Training Program and associate director of palliative care services at the VA Palo Alto Health Care Center.

Regardless of ethnicity, however, the researchers found that access to high-quality end-of-life care is often hampered by lack of financial means, poor communication with health providers, cultural mores and family conflicts. The study, involving more than 300 white, Asian and African-American seniors, was published Nov. 18 in the Journal of Palliative Medicine.

Periyakoil, whose earlier research focused on how doctors discuss end-of-life care with patients from different cultures, said physicians often believe that talking about end-of-life care with patients of certain ethnic groups is taboo and that patients and their families are reluctant to have these sensitive conversations. The new study, though small and limited in geographic scope, suggests otherwise. The participants may have been more affluent and better-educated than their counterparts nationwide, given the region’s demographics, Periyakoil noted.indian elder

The researchers interviewed 315 people over 50 at senior centers in Fremont, Palo Alto, San Francisco, San Jose and Walnut Creek. The group included 38 African-Americans, 160 Asian-Americans and 117 Caucasians. Interviews, conducted in English, Burmese, Hindi, Mandarin, Tagalog and Vietnamese, examined participants’ attitudes toward end-of-life care and whether they had experienced barriers to getting quality end-of-life care for relatives or others in their community.

Researchers are still collecting data on Latino participants and plan to publish a separate study on their views, Periyakoil said.

While all of the participants in the study said they valued high-quality end-of-life care, about 60 percent said they had experienced barriers to getting it, most notably financial difficulties and a lack of adequate health insurance. Medicare typically covers only short-term nursing home care and offers hospice benefits to patients whose doctors certify they have six months or less to live and who are willing forgo treatment intended to cure their terminal illness.

white eldersThere were no statistically significant differences among ethnic groups in reporting barriers to care. But participants with less education were more likely to report that their biggest barrier to care was financial. Patients with more education were more likely to cite doctor behaviors that hampered end-of-life communication. And women were more likely than men to cite barriers to care overall, perhaps because they were more likely to be direct caregivers and have more experience with end-of-life needs.

Regardless of ethnicity, patients felt that “doctors were just too busy to initiate [end-of-life] conversations, reluctant to listen to their concerns and questions about EOL decision making, and often gave vague responses, making it difficult for the patient to comprehend their choices and make informed decisions,” the researchers wrote.

An estimated 2.6 million Americans die every year, but how the American health care system handles their last days is problematic across ethnic groups, according to “Dying in America,” a landmark report released in 2014 by the Institute of Medicine. Too many people end up having aggressive treatment that is ineffective and expensive and doesn’t contribute to the patient’s quality of life, the report found. Other research examiningracial gaps in attitudes toward hospice care and other studies has found differences among ethnic and religious groups in how they approach end-of-life decisions.

But people want to talk about it regardless of background, says Dr. Steven Pantilat, a University of California, San Francisco professor of medicine and director of UCSF’s palliative care program, who was not involved in the study.

“What this study tells us is that all of our patients want us to have these conversations,” Pantilat said. “They’re waiting for their doctors to bring it up, to not be rushed, to communicate sensitively.”Asian Senior

A new federal policy may make those conversations easier – and more routine. Starting in January, Medicare will reimburse physicians for discussing end-of-life care. That policy infamously – and incorrectly – was derided as promoting “death panels” during the debate over the Affordable Care Act and a version of it was dropped from the legislation. The counseling will cover what kind of medical care patients want to receive as they approach their last days.

Periyakoil urges patients of all backgrounds to prepare for these conversations, and new planning tools are available in different languages to help. Among them is the Stanford Letter Project, which helps patients write a letter to their doctors about the end-of-life care they do and don’t want in languages including English, Spanish, Mandarin, Vietnamese, Hindi, Urdu, Tagalog and Russian.

In one redacted letter provided by Periyakoil, a woman named Patricia writes: “I do not want my longevity to be more important than my comfort.”

Pantilat advises the doctors he trains that they don’t need deep knowledge of the beliefs of every religion and culture they might encounter, because every patient, of whatever ethnicity, has different goals.

“If we come in with true curiosity, respect and openness, we can learn a lot about how to take care of someone in a sensitive way,” he said. We need to ask: “What do I need to know about your culture and your family to take good care of you?”

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3 Ways For Dealing With Grief, From Someone Who Lost A Parent As A Teenager

“Death is natural — but that’s precisely why we should be open to talking about it.”

teen grief

By Susannah Keogh

Grief is all around us. It’s not something tangible, not something you can necessarily see or pinpoint. The tentacles of grief have no expiry point; no magic moment where it stops. It can subside, sure, but leave? Never.

One in every 1,500 secondary school pupils dies each year. One in seven Americans will lose a parent or sibling before the age of 20. So why aren’t we, as a society, talking about grief?

Perhaps it’s because, like anything new, we are scared. Scared of saying the wrong thing, of offending someone, or just of showing any signs of weakness in a society where being perfect is valued above all else.

Of course, it’s easy to argue that death is inevitable, a natural part of life and not something weneed to be made aware of. And to a certain extent, this is true. Death is natural — but that’s precisely why we should be open to talking about it, and the grief that comes with any bereavement. By not raising awareness of an issue that is a huge part of so many people’s lives and has a huge effect, especially in adolescence, society is doing everyone a disservice.

Grief can be neglected not out of malice, but simply out of how it’s perceived as being alien territory. But seriously, it’s OK not to know how to approach someone suffering the loss of a loved one. There are no magic words you can say to make their pain go away, no instant guidelines to follow. Every person’s grief is different, but with today being Children’s Grief Awareness Day, here is what to bear in mind, based on my own experiences:

1. Don’t ignore the elephant in the room.

If you or a friend is suffering from grief, acknowledge it. I don’t mean asking your friend 24/7 whether they need to talk, but it’s important to reach a happy medium point. You don’t want to push someone into talking if they’re not ready yet pretending nothing’s happened and carrying on as normal can be just as harmful.

Even now, eight years on from the death of my dad, there’s still that awkward silence whenever I mention him to people other than my closest friends. It’s that sense ofohgodIdon’tknowwhattosaysoI’llsaynothing. Check with your friend whether talking about their loss makes them feel uncomfortable. Above all else, if you’re not sure what to say, then say that. Explain that you are there for the person suffering, even if you might not have the words. As the old saying goes, actions speak louder than words. In the case of grief, they really do.

2. Grief is normal.

Think about it. You’ve lost someone who was a part of your life. Come on, what are you expected to do? Continue on as if nothing has happened? Dealing with the emotions associated with that lossis okay. You can cry, shout, throw yourself into work and should be able to do what feels normal to you without judgement. No one should be able to dictate to you what is grief and what isn’t. Grief just is.

3. Don’t be afraid to ask for help

My father died before I was a teenager. Looking back, if it had happened say now, when I’m in college or when I was in high school, I honestly don’t know whether I would have point blank refused the kind offer of counseling from the family support worker at the local hospice. Point is, there are so many different support networks out there. Take advantage of them — what have you got to lose?

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Our Bodies, Ourselves

A funeral director wants to bring death back home.



Caitlin Doughty

Caitlin Doughty, a funeral director, says, “Maybe we need to look and say, ‘Wow, let’s look at this beautiful, natural corpse.’ ”

Caitlin Doughty, who was about to open her first funeral parlor, in Los Angeles, gazed at a skull that she had put on display above the desk in her office. Although it was plaster, the skull was a provocative presence in a room where Doughty planned to receive grieving families. It was mid-June, and that afternoon John Gettys, a field representative of the California Cemetery and Funeral Bureau, was coming to give the business a final inspection. Doughty, who is thirty, said, “I want the office to look like me, but I don’t want it to look too Arty Death Hipster.” This was possibly a futile hope. She grabbed the skull and sat contemplating it; in her vintage wooden swivel chair, she looked like a noble in a memento-mori portrait. “I don’t want the state inspector to think I’m testing him,” she said. “Maybe I’ll put it on a lower shelf. That way, I will stay true to myself.” She checked her phone: Gettys was running late. “Maybe he died,” she said. “How funny would that be?”

Doughty’s office, which is in a medical building on the gritty end of Santa Monica Boulevard, has a view of the 101 from one window and a glimpse of the Scientology campus from the other. On one wall hangs a painting, by a high-school friend, of a coffin that has been bent in half and placed atop a chaise longue, in the manner of Magritte’s “Perspective: Madame Récamier by David.” The bookshelf bears volumes of poetry, including Whitman’s “Leaves of Grass,” as well as a compendium of nineteenth-century funeral practices titled “The Victorian Book of the Dead.”

When Gettys finally arrived, Doughty rose to shake his hand. She is six feet one in ballet flats, and has pale skin, long mahogany hair with bangs, and a penchant for vintage dresses with nipped-in waists. (Today’s outfit was emerald green, which matched her eyes.) Gettys read through her price list, which offered a biodegradable willow casket for thirteen hundred and seventy dollars and, for a hundred and twenty dollars, a newborn’s casket made from recycled paper embedded with pressed flowers. Doughty considered her business an “alternative funeral service” that would bring mourners into closer contact with the dead by helping people to tend to corpses at home. She did not plan to offer embalming services, although she was qualified to do so, having graduated in 2010 from the mortuary-science program at Cypress College. Regulations of funeral homes vary from state to state, and in California one can go into business without having taken a class in embalming, or even having learned how to securely close the eyes of a corpse. (A piece of cotton from the end of a Q-tip slipped under the eyelid usually does the trick.)

Doughty has a low, mellifluous voice and an ironical manner. “Are you going to give us a cool license number? Like, all the same digits?” she asked. Gettys, a middle-aged man whose pants and shirt were both of an olive hue, was not perceptibly amused, and replied that the number would be up to the bureau, in Sacramento. “We plan to be massively compliant,” Doughty told him. Her funeral parlor does not have its own crematory, so she and Gettys drove to examine the nearby facility that she planned to use. Gettys told her that, thirty years ago, he’d entered the business as an apprentice embalmer. “The funeral industry doesn’t change a lot—it’s been around for a long time,” he said. “Everybody tries to reinvent the wheel. Well, let me tell you something. The wheel has already been invented. O.K.—there are little permutations that can be done to the business model, but by and large the idea is to dispose of dead bodies.”

It was clear that Gettys was not aware of Doughty’s public profile—that he had not, for example, come across her popular series of online videos, “Ask a Mortician,” in which she fields such viewer questions as “Are these really my mother’s ashes?” and “What is the best way to write into my will that my children will receive no inheritance unless they have my dead body taxidermied and propped up in the corner of the living room?” In 2014, she published a best-selling memoir, “Smoke Gets in Your Eyes: And Other Lessons from the Crematory.” (“A girl always remembers the first corpse she shaves,” it begins.) And she is the founder of the Order of the Good Death, a mostly online meeting place for morticians and academics who are interested in exploring new ways to guide mourners through the experience of death.

A week after Gettys’s visit, Doughty posted on Twitter an image of an official letter that she had received from Sacramento. It began with a cheery “Congratulations!” Doughty tweeted, “I am a funeral home owner. There can be miracles, if you believe.”

Doughty grew up in Hawaii, on the island of Oahu. When she was a teen-ager, she fantasized about opening a funeral home that would combine retro charm with up-to-date service. As she writes in her memoir, she even came up with a name for her imaginary establishment: La Belle Mort. She saw herself creating tailored events that celebrated the life of the deceased in a highly personalized manner: sending cremated ashes into space, or shooting them out of a gun, or compressing them into a gemstone.

After graduating from the University of Chicago, she worked for about two years at Pacific Interment, a mortuary and crematory in an industrial district of Oakland. Without ceremony, she processed corpses through preparation and incineration. This work changed her vision of the ideal funeral practice. “When I first thought I wanted to get into the industry, I thought people needed a more friendly death—for death to be more accessible,” Doughty told me. “That changed very quickly. Now I think people need to get closer to it. It should be up in your face, not ‘Let’s turn Mom into a diamond.’ ”

Her new funeral parlor has a blunt name: Undertaking L.A. Along with Amber Carvaly, her business partner, Doughty intends to help people take care of their own dead, rather than outsource the task to professionals. “When I found myself in all these big industrial warehouses, alone with all these bodies, I thought, If Im doing all this, there are all these other people who arent doing this,” Doughty said. “That’s too much death for one person and not enough for all those other people.” Among the services offered by the fledgling company are help with home funerals, in which the body is bathed and dressed, then kept on ice for a few days, while the family grieves; natural burials, without casket or marker, at a green burial ground in Joshua Tree; and witness cremations, which permit family members to help load the body into the cremation machine and push the button that starts the fire.

Sherwin B. Nuland, in his 1994 best-seller, “How We Die,” wrote, “Modern dying takes place in the modern hospital, where it can be hidden, cleansed of its organic blight, and finally packaged for modern burial.” Doughty’s goal is to end our deliberate estrangement from the dead body. “There really are so many places in our culture where we demand something unnatural,” she told me. “As of right now, what most people find acceptable is either no body at all or something that has been highly mediated. Someone comes in, they take the body away, and, the next time you see it, it has been disinfected and treated and made safe and beautiful.” A dead body is not immediately dangerous, except in cases such as Ebola, and in those instances infectious-disease protocols apply. “And maybe a dead body doesn’t need to be pretty,” Doughty went on. “Maybe we need to look and say, ‘Wow, let’s look at this beautiful, natural corpse.’ ” The conventional funeral industry has given people the impression that death is an emergency. “But death is not an emergency,” Doughty said. “Death is the opposite of an emergency. Look at the person who died—all that stress and pain is gone from them. And now that stress and pain can be gone from you.”

The professionalization of death care in America didn’t get under way until the second half of the nineteenth century. Modern embalming—in which the bodily fluids inside a corpse are drained, through an incision in a vein, and replaced with a preservative solution, through an incision in an artery—was popularized during the Civil War, as a means of allowing the bodies of fallen soldiers to last long enough for them to be shipped home for burial. Embalming became the signature skill of the professional mortician, setting his services apart from those of people—usually women—who had previously been responsible for preparing a dead body for the grave, by bathing it, anointing it, and dressing it, often in a shroud. In 1863, Louisa May Alcott, who served as a nurse during the Civil War, wrote of an encounter with the body of a soldier whom she had tended until death. “The lovely expression which so often beautifies dead faces, soon replaced the marks of pain,” Alcott wrote. “I longed for those who loved him best to see him when half an hour’s acquaintance with Death had made them friends.”

As Gary Laderman, a professor of religion at Emory University, explains in his 2005 book, “Rest in Peace: A Cultural History of Death and the Funeral Home in Twentieth-Century America,” the first embalmers made house calls. Early techniques were sometimes primitive: in 1898, an article in the Journal of Medicine and Science complained that the arsenic used to preserve corpses had leached into the soil and the groundwater near cemeteries. The article cited a critic of the practice—“Gallons of poisonous solutions are squirted into bodies indiscriminately”—and called for the establishing of standards in the handling of corpses. Around this time, the first mortuary schools were established, and the National Funeral Directors Association, which is still the leading industry association, was founded.

The turn of the twentieth century saw the emergence of the first funeral homes—literally the homes of professional morticians, who lived over their shops. It became the norm to remove a body from a home or a hospital as quickly as possible. The death industry boomed: a survey published in 1928 revealed that between 1900 and 1920 the number of funeral directors grew by more than fifty per cent. (The annual number of deaths increased by only 2.3 per cent in the same period.) For most of the twentieth century, the majority of funeral homes were family businesses that were passed from father to son—and rarely to a daughter. In the seventies, ninety-five per cent of funeral directors were men, and even by 1995 there were still almost twice as many male mortuary-science students as female ones.

Today, sixty-five per cent of mortuary-school graduates are women. The gender shift reflects a significant change in funeral practices. Rates of burial—and, hence, of embalming—have undergone a drastic decline. In 1960, fewer than four per cent of corpses were cremated. Today, the cremation rate is forty-five per cent. (Industry projections estimate that it will reach seventy per cent by 2030.) The image of the funeral director has undergone a parallel evolution. Although undertakers are still often portrayed as black-suited men in possession of dour scientific expertise, the funeral director has emerged as a member of the caring professions.

Until recently, it was common to believe that women were not physically capable of doing removals. Though such sexist fictions have been upended—lifting a dead body is mostly a matter of technique—explanations for the recent rise in women’s “death work” are often no less dependent on restrictive stereotypes. Women in the industry often declare that they have an innate empathy for others, and that they excel at providing emotional support to the grieving. It’s also argued that women are especially skilled at dressing the dead—and at restoring the appearance of vitality through the tasteful application of cosmetics and styling of hair. “People are more comfortable about crying, about showing emotion, in front of a woman,” Erin Whitaker, a funeral director from South Carolina, told me. “And it’s easier, as a woman, to put your hand on their hand as a sign of comfort.”

With an increasing demand among baby boomers for customized funerals that reflect the individuality of the deceased, funeral directors are expanding into the business of event production. Today’s funeral director might stage a memorial service featuring the release of butterflies at the grave site, or with the deceased’s Harley parked ceremonially at the entrance to the chapel. In such instances, the skills of a funeral director can seem to fall somewhere between those of a nurse and a wedding planner.Mortuary Management, a trade magazine, offers articles about such innovations as the tribute blanket—an instant heirloom that incorporates photographs of the deceased into a custom-made tapestry—and urges funeral directors to be open-minded when faced with families who want pop songs played at a service. It’s a profitable strategy to, as a feeble witticism of the industry has it, “put the fun back into funerals.”

Since the nineteen-eighties, the National Funeral Directors Association has held an annual professional women’s conference. This year, it took place in Chicago, and it attracted more than two hundred women from across the country. They attended an embalming workshop and listened to speakers who delivered “Lean In”-style exhortations.

Many women at the conference were helping to run, or had taken over, their family’s funeral home, but there were also women who had been drawn to the work for other reasons. Patty Decker, of Woodstock, Georgia, who has been a funeral director for nearly thirty years, told me that she’d wanted to become one since she was eleven years old. “I just saw the respect that the funeral director in my home town had—how much he was admired,” Decker said. “You have to love this job. You are faced with your own mortality every day. We are like the directors of this show that no one wants to attend.” Maria Thomas, an apprentice embalmer in Virginia, had worked in the performing arts before starting her training. “The first time that a family threw their arms around me, thanking me for making their mom look so beautiful—that really touches something,” she said. Strangers were curious about her job, she said, and she welcomed it. “We worship youth and beauty—those are the things that are celebrated in our culture,” she said. “But we do have to accept that over here is the death corner, and you are not going to escape it. You might as well talk about it.”

Doughty didn’t attend the conference: she isn’t a member of the National Funeral Directors Association, and notes grandly in her book that the group “won’t comment on me.” But some of the funeral directors present were aware of her advocacy of alternative funeral practices. One afternoon, there was a roundtable discussion of ways that funeral homes might use social media.

“Who is going to follow a funeral home’s Twitter account, really?” one participant asked.

“Weirdos,” someone replied.

“Competitors,” added another.

Doughty’s online prowess came up, and one participant remarked that she thought it was healthy for the public to get a glimpse of a funeral director’s reality. But another participant expressed concern about Doughty’s perspective. “I feel like she’s the one who’s big on ‘You don’t need a funeral director,’ ” she said.

Affixed to the refrigerator in Doughty’s apartment is a photograph of the class of 1973 at the California College of Mortuary Science, which later became part of Cypress College. Forty-four men, nearly all of them white, are dressed in black tie; there are two women in the class. Hanging next to that image is a 2010 photo of Doughty’s class. Its thirty-one graduates form a racially diverse group, and twenty-two of them are women. At her new business, her colleagues are mostly female, too. “I don’t think it’s because we have some kind of helping gene—I don’t think it’s some deep need to nurture,” she told me. “For me, working with dead bodies is almost like a feminist act. I don’t want people to come in and say, ‘Oh, no, little lady, you don’t know what to do with this body,’ because they already say that about our reproductive systems. I know I am qualified to take care of this body.”

Many funeral directors like to say that they had a calling for the profession. Such statements are no doubt sincere, but it might also be convenient to characterize the career as having been thrust upon one: few people admit to being motivated by a deep interest in corpses and death. Doughty has no qualms in admitting to such a fascination. She says that she became “obsessed with death” in the nineties, while growing up as an only child in Kaneohe, on the east side of Oahu, where her father was a high-school teacher and her mother a real-estate agent. When Doughty was in grade school, she says, she witnessed a small girl tumbling from a height in a shopping mall. (Doughty presumes that the girl fell to her death, though she never found out for sure.) The incident made her conscious of her own mortality and that of everyone else. “Everybody has their moment when they realize that death is very real,” she says.

Doughty studied medieval history at the University of Chicago, and she eventually focussed on the cultural status of the corpse and the representation of dead bodies in art and religious iconography. “I was interested in how much they had a relationship with the dead,” she said. “If you went to a church in the Middle Ages, there would be bodies buried under the floor and in the wall and in pits outside the church, and absolutely everywhere. The church was the center of life, so you would go there and have sermons and plays and outdoor markets. Everything you did—you were surrounded by corpses. Of course, they feared Hell—it’s not like they were totally comfortable with death—but they were a lot more comfortable with the dead body than we are now.”

Upon graduation, in 2006, Doughty sought to convert her academic interest into real-world experience. At Pacific Interment, the Oakland crematory, she worked on bodies in the prep room and loaded them into the cremation machine. No special credentials were needed for the job, besides a tolerance for the brute facts of mortality. She gained intimate knowledge of the process of decomposition when it is unhindered by embalming: first comes a loosening of the skin, followed by bloating, putrefaction, and blackening. She chronicles her experiences in “Smoke Gets in Your Eyes,” which is filled with unflinching observations. (“The left side of her chest was caved in, giving the impression that someone had removed her heart in some elaborate ritual.”) Doughty learned that it is difficult to arrange the deceased’s facial features into a semblance of heavenly rest after rigor mortis sets in, a few hours postmortem. And she learned in what order corpses should be cremated when several must be processed in a single day. (Start with the heaviest decedent, when the cremation chamber is cold; if one waits until the chamber is hot, the body will burn too quickly, producing excessive smoke.)

For the most part, Doughty performed what is known as direct cremation, in which the body is removed from a hospital or a home, then incinerated without ceremony, the desiccated remains mechanically processed into unidentifiable fragments that are collected and given to a relative. This is the least expensive way of dealing with death: in the U.S., the cost of a direct cremation averages between seven hundred and twelve hundred dollars, whereas an in-ground burial typically costs about seven thousand dollars. Cremation gained in popularity in America largely in response to consumer groups that, starting in the nineteen-sixties, publicly questioned the expensive services of the funeral industry.

In 1963, Jessica Mitford published “The American Way of Death,” a scathing investigation into the practices of funeral directors. They were, she suggested, “merchants of a rather grubby order, preying on the grief, remorse, and guilt of survivors.” Funeral directors lined their pockets, in part, by promoting questionable psychological arguments, such as the claim that the viewing of an embalmed corpse was a necessary step in the grieving process. They recommended “eternal sealer” caskets to protect the corpse from even greater ravages than death. Mitford championed cremation as a sensible alternative to burial, and her book, which became a best-seller, helped set in motion an investigation of the industry by the Federal Trade Commission. When Mitford died, in 1996, she was cremated, at Pacific Interment, for a cost of four hundred and seventy-five dollars. A decade later, Doughty took considerable satisfaction from the fact that she was operating the same machine in which Mitford had been reduced to ash.

Like Mitford, Doughty reviled the excesses of the funeral industry. But the longer she worked at Pacific Interment the more she found her own attitude toward the dead body at odds with Mitford’s approach, which struck her as unsentimental to the point of callousness. Doughty began to think that Mitford’s effort to combat the commercial excesses of the traditional funeral industry had ended up reducing the dead body to something to be dispensed with as cheaply and efficiently as possible. This approach swept aside an important aspect of human experience: that of tending to loved ones in death, just as in life.

All Caring Cremations, the company that handles the burning of bodies for Undertaking L.A., is in a bleak industrial area in the San Fernando Valley. When Doughty took me there, she pointed out a building down the block that had served as the exterior of the Dunder Mifflin paper company, on the NBC show “The Office.” “In an ideal world, this is not the neighborhood I would choose if we had the option to go with a wooded-stream crematory,” Doughty said. “But that’s not an option we have.”

The lobby of All Caring was decorated with anonymous good taste: wingback chairs, a low table. There was an unplaceable unpleasant aroma. A small chapel was painted in institutional beige, with chairs and a lectern and, up front, space for a casket. “They have said we could do some décor stuff in here—not, like, a feminine touch, but we might put up different art, a different color on the walls, better lighting,” Doughty said. We heard a noise that I first took to be the loud rumble of the air-conditioning system; it was the sound of the cremation machine at work.

Doughty and Carvaly, her business partner, expect that many clients of Undertaking L.A. will seek out their services because of their advocacy of home funerals. For a fee of three hundred and forty dollars, Doughty and Carvaly will come to the home of a dying person and consult with the family about the best way to take care of the body in situ. (Opening windows can be useful, and so is planning to place the body on a bed or a couch that can be reached without climbing stairs.)

A person who helps families with a home funeral is often called a death midwife. (In most states, the services of a professional funeral director are not required by law.) Clients who like the idea of not handing off a loved one’s body might not have the space or the stomach for caring for a corpse at home, and so a visit to All Caring’s prep room—hidden behind a door marked “Employees Only”—is available. There they can help with bathing and dressing the body, then proceed to the chapel and sit with the deceased in valediction.

Carvaly, who is also thirty, was a women’s-studies major at college, and worked at a homeless shelter for women before enrolling at Cypress College’s mortuary program, where she began corresponding with Doughty. She had aspired to be an embalmer, which she thought would combine science and art. But she was disillusioned after working briefly at Forest Lawn, the vast L.A. funeral complex that inspired Evelyn Waugh to write “The Loved One,” his satirical 1948 novel. “Forest Lawn was very competitive,” Carvaly told me, over lunch at the SteamPunk Café, not far from the crematory. “How many bodies can you do in a day? How quick and efficient are you? It’s a business, and you should be able to do it quickly and efficiently. But I didn’t like it.” Undertaking L.A. is in the process of registering as a nonprofit.

Doughty and Carvaly do not expect their services to become mainstream choices. The notion that the dead body is a source of pollution is a deeply ingrained belief in many cultures. In Jewish law, a kohein, or priest, is not permitted to be under the same roof as a corpse (except in the case of close relatives). In Japanese tradition, undertakers belonged to the burakumin, society’s lowest and most reviled caste.

It would be more commercially viable to embrace the trend of selling the funeral as a kind of farewell party. I recently spoke with an entrepreneurial funeral director named Paula Staab-Polk, from Chatham, Illinois. Having grown up in her family’s funeral home, she struck out on her own a few years ago and decided to combine funeral and hospitality services. “The way I look at it is: our death is an event, and our life needs to be celebrated when we pass from this life to the next,” Staab-Polk told me. A few years ago, she added a reception center to her funeral home. She has given a funeral luncheon that featured the favorite recipes of a woman who died at ninety-eight; she has held a service for a ten-year-old girl who died of cancer, at which guests were invited to “adopt” one of the many stuffed animals that had been sent to the sick child’s bedside. Staab-Polk offers floral services and bagpipers, and she also hosts non-funerary events. “I’ve got three high-school proms coming up,” she told me.

Doughty understands the appeal of Staab-Polk’s model. “People are afraid of death,” she said. “Do you want to go sit with the corpse or do you want to party? If you put it like that, it’s not a very hard question.” She is not denying that people can find great comfort in a personalized funeral ceremony. “But I would still argue that it doesn’t give you the full engagement with death and grieving that you need,” she says.

She is particularly skeptical of funerals that offer the bereaved a very brief look at an embalmed corpse. “If you are one of those people who, when you were eight, walked by a hyper-embalmed, preserved corpse, with the makeup and the suit, that quick glimpse in the casket can be scary, because there is no time to process it, and it stays with you, and the fear stays with you,” she told me. Spending time with a dead body in its natural state may be more challenging, she says, but it “normalizes” the experience. “When you talk about families that have worked with their dead body, and sat with their dead body, first they come in and just kind of touch the hand gently, like they are going to break Uncle Bob. Then, three or four hours later, they are telling jokes about Uncle Bob and giving him a hug.”

Doughty contends that elements of Undertaking L.A.’s approach can be applied to the most traditional of funerals. Carvaly recently participated in the funeral preparations for a friend named Marea Balvaneda, who had died suddenly, of cardiac arrest, at the age of thirty-six. “She had a traditional Catholic funeral, and she was embalmed,” Carvaly said. “The only thing that was different was that, the day before she was buried, I went to the funeral home with her sisters, and we dressed her body.”

At first, one of Balvaneda’s sisters, Ashley Wodke, lingered outside the prep room while the others worked. Carvaly told me, “It was, like, super-intuitive—they didn’t even need me.” Wodke said, “I knew I needed to do it, too. And it wasn’t as disturbing or traumatic as I thought it was going to be.” Balvaneda was the oldest of five sisters and had always taken care of her younger siblings; Wodke said that she felt a responsibility to take care of her sister in return. “We made sure her last outfit, and her last application of makeup, was done right,” Wodke told me, her voice breaking. “We made sure she had the right red lipstick. She wore a very vibrant red—a stoplight red. If we hadn’t done it, it wouldn’t have been the right red.”

The death-care movement can be seen as echoing other attempts to celebrate the artisanal and reject the over-industrialized, over-sanitized, and over-medicalized way of life that prevailed in twentieth-century America. Home births, while still very much a minority choice, rose by more than fifty per cent between 2004 and 2012. The flourishing of farmers’ markets has supported local agriculture, and the eat-what-you-kill movement has emerged as an extreme critique of industrialized food. When Doughty adopts her exaggerated “Ask a Mortician” persona, it is so glibly morbid as to be almost a caricature of the Portland-Bushwick axis of cool. (In one episode, which explains that metal implants survive a cremation intact, she jokes, “My father has had to have both of his knees replaced, and if we decide to cremate him, guess what his beloved daughter will be keeping on her mantelpiece.”)

Doughty’s business is not, she insists, a hipster lark or a “vanity project.” She explained, “There’s no vanity in funeral service—you are in rooms with corpses all day. This is not to make ourselves look good. If you want to look good, you start a really rad Instagram account, or bake gluten-free cupcakes. You don’t cremate people.”

Undertaking L.A.’s support of home funerals is aligned with the death-with-dignity movement, which advocates for the right of the terminally ill to die at the time of their choosing. Doughty is on the advisory board of Compassion & Choices, a group that campaigns for right-to-die laws, and she believes that the way we treat the dead body in our culture has a great influence on the way we think about the care of an individual close to the end of life, be it our loved ones or ourselves.

Being afraid of the sight of a dead body is quite different from being afraid of dying, which is the province of the confessional, the therapy suite, or the insomniac bedroom. But Doughty has found that spending time around dead bodies has helped her accept her own mortality. Working at a crematory led her to a realization: “O.K., this is going to be me—so this body is, so I shall be one day.” She explained, “If you have that opportunity with your family or community to come around the body, it is not only good to honor the dead person—they probably don’t really care—but it’s for you, too.”

In late June, Doughty took a road trip with her boyfriend, Landis Blair, to Crestone, a former mining town in Colorado. Doughty met Blair, an illustrator whose pen-and-ink drawings evoke the work of Edward Gorey, in 2012, after giving a lecture in Chicago. When she posted an item to her blog titled “My Morbid Art Crush on Landis Blair,” they struck up a relationship. They have lived together for a year, in an apartment filled with macabre Victoriana and the odd taxidermy specimen. Blair owns a unicycle that is usually propped up in a corner of the living room.

Blair is illustrating Doughty’s next book, a globally informed look at the future of death care, and he was serving as navigator. Crestone is about four hours south of Denver, and it is eight thousand feet above sea level, at the edge of a plain surrounded by mountains. Over the past several decades, Crestone, which at its most recent count had a population of a hundred and thirty-seven, has become the site of a wide variety of religious retreats. The landscape is thought to have a spiritual aura like that of the Himalayas. It is also home to an open-air funeral pyre, which was built by the Crestone End-of-Life Project, a small but avid group that champions natural funerals. Doughty was visiting it for the first time.

After arriving in town, we met up with Stephanie Gaines, the End-of-Life Project’s founder, and Paul Kloppenburg, a rugged Dutch expatriate who holds the title of fire-master. Kloppenburg told Doughty that the first open-air cremations in Crestone, in the early nineties, were conducted on a mobile pyre—a hundred cinder blocks and a metal grate that could be set up on an individual’s property. “I would see the eagerness of the people,” he explained. “I would pull up with my truck and build the hearth, and let them have it.” But after the group received a letter of complaint from local residents it built a pyre four miles outside of town, on land belonging to a Buddhist center. To a metropolitan eye, the site is in the middle of nowhere, but Gaines reported that a neighbor a mile away was not happy about being downwind of it. “And people didn’t want the traffic,” she told Doughty. “Six cars is a lot of traffic around here.”

The plain was spectacular in its vastness, and snow-crested mountains rose craggily in the middle distance. The cremation site was strangely beautiful. There was a circular enclosure, about seventy-five feet in diameter, fenced with bamboo palings. Standing inside it, you had a sense of safety and intimacy, yet the grandeur of the wider landscape remained visible. Inside the fence were four teak benches; they were arranged around a ring of large stones that had been set into the dusty ground. At the center of the ring was the pyre: a structure, about as high as a workbench, consisting of an iron grate suspended between two thick walls of concrete. The grate sagged slightly in the middle, like a well-worn mattress.

Affixed to the pine posts that supported the bamboo enclosure were copper plaques with the names of the fifty or so people who had been cremated in Crestone. Some of them had moved there specifically to die; these included a woman with cervical cancer. Others had grown up in the area, among them a twenty-two-year-old man who’d died in a car accident.

The ceremonies take place around dawn, before the wind whips up. The body, wrapped in a shroud, is placed on the grate, and then family members with flaming torches ignite logs that have been placed underneath. The body is also overlaid with logs and fragrant juniper branches, so that onlookers see only flame, not the body as it incinerates. For the first quarter of an hour, there is usually silence among the onlookers as the flames roar; as the fire matures, people chant, pray, beat drums, sing songs. It takes about two and a half hours for the body to be reduced to ash—hardly longer than a conventional cremation, Doughty noted with surprise. Gaines told her that mourners “say they are never the same after this.”

That afternoon, we had tea at the mountainside cabin where Gaines lives. She explained to Doughty that in Crestone a body is given a three-day period of repose before it is burned on the pyre: chilled gel packs help keep the body fresh, and the corpse is placed on a wooden pallet, obviating the need to lift it from a bed or a couch several days after death. Doughty talked about a recent trip that she had taken to Japan, where she’d visited a corpse hotel, which allows families with apartments too tiny for a home funeral to participate in the ritual preparation of a body. She liked the idea of setting up something similar with Undertaking L.A. “What I am really interested in is asking whether it is possible to have a communal center,” she said. “Family comes from out of town and it’s, like, a three-day wonderland process.”

Gaines, who is in her seventies, had a radiant air of calm. She explained that she was a devout spiritual practitioner: a contemplative with a special interest in the Gnostic traditions. Many of the other members of the Crestone End-of-Life Project had similar inclinations, but, Gaines explained, anyone was welcome to participate in the community of care, which embraced both the deceased and their survivors. “You want everyone to have this opportunity, because it is so filled with grace, and such an opening,” she said. “It is so transformational for everybody—not just for the person who died.”

Doughty nodded. “I am pretty secular, but the transformation from body to ash is still incredibly meaningful to me,” she said. “I may not think the soul is necessarily going anywhere—but just the physical transformation and the transformation of the mourners are transitions. It is ritual, and it is very real, and it is important, no matter what ideas of the body and the soul and the spirit the family comes in with.” She petted Gaines’s cat, which was moving promiscuously from lap to lap, sparing nobody. “It’s an exciting time to be in death,” Doughty said. 

Complete Article HERE!


This Is What Happens to Your Debts After You Die

By Aubrey Cohen

Your debts become the responsibility of your estate.

Coffin on stage

When you die, any debts you leave behind could eat up assets that you had hoped to leave to heirs. In some cases, family members could even be on the hook for your debt. Many people buy life insurance not only to leave something behind for their loved ones but also to help deal with any debt and final expenses.

Will your debts die with you?

After you die, your debts become the responsibility of your estate — which is everything you owned at the time of your death. The process of paying your bills and distributing what’s left is called probate.

Your executor (the person responsible for dealing with your will and estate after your death) will use your assets to pay off your debts. This could mean writing checks from a bank account or selling off property to get the money. If there isn’t enough to cover your debts, creditors generally are out of luck.

But specific kinds of debts have their own wrinkles.

Mortgages and home-equity loans

If a property has a mortgage, the lender has some protection, at least up to the value of the property.

But federal law bars lenders from forcing a joint owner to pay off the mortgage immediately after the death of another co-owner. This also applies to any relative who inherits the home and lives in it. Practically, this means the family member or co-owner can simply take over the mortgage payments.

An outstanding home-equity loan against the property is different. A lender can force someone who inherits a home to repay the loan immediately, which could require selling the house. That said, lenders might work with new owners to allow them to simply take over the payments on the home-equity loan as well.

Auto loans

In the case of an auto that is not fully paid off, the lender has the right to repossess the car. But typically whoever inherits the vehicle can simply continue making payments, and the lender is unlikely to take action.

Credit cards

Once the estate runs out of assets, credit card companies are out of luck, because this debt is not secured by assets the way mortgages and car loans are. Any joint account holder would be responsible for the bill, but people who are simply authorized users of a card would not.

In community property states, listed below, spouses are responsible for any debts incurred during the marriage, including credit card debt.

Student loans

Lenders have no recourse if the estate does not have assets to repay other unsecured obligations, such as student loans.

If your relatives are not responsible for your debts, collection agencies may still legally call to discuss debts and to try to find someone authorized to pay them, according to the Federal Trade Commission. But collectors cannot mislead family members into thinking they’re responsible for the debts.


There are circumstances in which spouses or other people would be personally responsible for your debts. These include if they:

  • Co-signed for a loan.
  • Are joint account holders.
  • Are spouses in community property states: Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington and Wisconsin. Spouses are not responsible for debts that predate the marriage, although half of any community property from a marriage could be put toward such obligations.

About 30 states have “filial responsibility” laws that could make adult children responsible for debts related to caring for parents or parents responsible for debts related to care of their children. These laws once were rarely enforced, but there have been recent cases in which creditors have used the statutes to pursue family members.

What’s protected?

Creditors typically cannot go after your retirement accounts or life insurance proceeds. Those will go to the named beneficiaries and are not part of the probate process. But if the life insurance beneficiaries you named are no longer living, your death benefit may go into your estate and can be subject to creditors. That’s one reason why it’s important to make sure your policy names the proper beneficiaries.

Life insurance can help with debt payments

To decide whether you need life insurance to cover debts after your death, consider these questions:

  • Do you have family members who would be responsible for your debts?
  • Do you have debts that would eat up assets you want to pass on to family members?
  • Do you want to pass on money that couldn’t be diverted to pay your debts, even if you owe those debts?

Life insurance can help in any of these scenarios. Term life insurance policies, which provide a death benefit for a set number of years, are suitable for most people’s life insurance needs. NerdWallet’s life insurance tool is a good place to compare prices. If you want to consider a permanent policy, such as whole life insurance, consult a financial advisor.

Complete Article HERE!


My view: Salt Lake City’s homeless deserve hospice care

By Kim Correa

homeless and hospice care

Death is a natural process, and since the dawn of humanity, people have been dying at home. But where do homeless people go to die? The shelters are not equipped to deal with the end of life.

Is Salt Lake City a city of compassion or a city of abandonment? About 50 homeless people die here annually. Death is a natural process; since the dawn of humanity, people have been dying at home. But where do homeless people go to die? The shelters are not equipped to deal with the end of life, hospitals can’t keep these patients for weeks or months on end, and most lack insurance to pay for a skilled nursing facility. Without a stable place to live, they end up in and out of the emergency room, straining our city’s fire, police and hospital resources, and eventually dying on the streets or in parks.

The INN Between provides a real solution to this small but critical segment of our city’s homelessness crisis. We opened in August in the old Catholic Convent on Goshen Street, providing a safe and comfortable place where about 13 of Utah’s terminally ill homeless men and women can experience the end of life with dignity. Our residents are grateful to have a place they can call home for their final time on this earth. Since opening, we have provided death with dignity to three people and provided over 420 housing nights to a total of 22 people. We have beautified the grounds and our presence has reduced loitering and potential criminal activity around a previously vacant building. The INN Between is almost full — a major concern as winter sets in.

The INN Between had been approved to operate in our other building, the former Guadalupe School, in May, under the zoning use of Eleemosynary Facility — “a facility operated by a nonprofit charitable organization or government entity to provide temporary housing and assistance to individuals who suffer from and are being treated for trauma, injury or disease and/or their family members.” The school building can house an additional 10 to 20 residents.

On June 19, the Salt Lake City Council blocked our use of the school by excluding “end of life and respite care” from the Eleemosynary definition. Now it is proposing an additional restriction to exclude “facilities not licensed by the Utah State Health Department.” The public hearing takes place Tuesday.

The proposed changes were intended to address a gap in zoning law and ensure people’s health and safety. We agree that there is a gap, but we disagree on its nature. The gap is the lack of housing for terminally ill homeless people. And there is nothing healthy or safe about dying on the street.

The INN Between is an ideal solution that offers safe housing — better than any housing our residents have had in years. In fact, the Utah State Department of Health has determined that our program complies with health and safety standards, exempting the INN Between from licensing. The Department of Health understands that all these people need is a home in which to die naturally.

The council’s proposed changes effectively mandate that the homeless die in state-licensed facilities, like nursing homes. But who will pay the $4,500 to $6,000 cost per month? The city, i.e., the taxpayers? If this were a viable solution, we’d already be doing it.

In order for the INN Between to meet community need, we must be allowed to operate under the pre-June 19 definition of Eleemosynary Facility. If adopted, the proposed zoning changes will demonstrate Salt Lake City’s lack of compassion for people who are dying and discriminate against Utah’s most vulnerable homeless people by severely limiting their access to housing and hospice care. Learn more on www.theinnbetweenslc.org/zoning.

Complete Article HERE!


Green burial movement advocates alternative to conventional interment


Mary Lauren Fraser

Mary Lauren Fraser, of Montague, with a casket she makes out of Willow branches.

As green living continues to take a more prominent place in the United States, there is now a growing movement that is focusing on green dying.

“Imagine living your whole life as an environmentally conscious person and at the end of your life, they pump you full of embalming fluid,” said Judith Lorei of Green Burial Massachusetts, and a member of the cemetery commission in Montague who spoke earlier this month at the Grace Episcopal Church in Amherst.

Green Burial Massachusetts is a grassroots organization that educates the public about the value and benefits of green burial. Founded in 2008, the group is a committee of the Funeral Consumers Alliance of Western Massachusetts and has formed a collaboration with the Mount Grace Land Conservation Trust in Athol to find a suitable site for the state’s first green cemetery.

“We are an all-volunteer group,” Lorei said. “Green burial may not be for everyone, but it is important that people know that they have choices.”

In the U.S., with the exception of certain religious traditions, a conventional burial involves the embalming of the deceased and placing the body into a metal or hardwood casket which is buried in a cement vault that lines the grave.

This practice of preserving the dead became popular during the Civil War when families of the Union war dead wanted the bodies of their loved ones brought home from the battlefield, and embalming was the only way to preserve the remains for the long, often hot trip back north.

Today, many environmental advocates say conventional burial is an unsustainable endeavor that uses too many chemicals, land and resources, including an estimated 827,060 gallons of embalming fluid nationally each year, according to the Green Springs Natural Cemetery Preserve at naturalburial.org. It also estimates that 90,272 tons of steel, 2,700 tons of copper and bronze, and 30-plus million board feet of hardwoods, much of it tropical, are used to make caskets every year in the U.S., with another 14,000 tons of steel and 1,636,000 tons of reinforced concrete going into burial vaults.

The green burial movement advocates interment that is easier on the earth. This involves natural burials that are chemical-free with no embalming, use of biodegradable caskets or simple shrouds, and grave sites that do not contain cement vaults.

Unlike conventional burials designed to stave off decomposition, green burials are frequently at a depth of three to four feet to permit access by aerobic bacteria and enhance decomposition.

According to the National Funeral Directors Association, in 2014 the national median cost of a conventional adult funeral with viewing, burial and vault was $8,508.

Jay Czelusniak, owner of Czelusniak Funeral Home in Northampton, said the average conventional funeral in western Massachusetts costs less than the national median, at between roughly $5,000 and $7,000.

A green burial may cost thousands of dollars less, depending on how and where it is done. “A lot of it depends on the products, but most do come out to be less expensive,” Czelusniak said.

Czelusniak added that his funeral home is happy to offer formaldehyde-free embalming fluids that he said can adequately preserve the body for up to several weeks, as well as eco-friendly caskets and urns which vary in price and can lower costs to about $3,000.

Cemeteries set rules

Currently, there is no green burial cemetery or preserve that is open to everyone in Massachusetts, though some municipal and private cemeteries do allow for green burials.

The closest all-green cemetery to Massachusetts is Cedar Brook Burial Ground in Limington, Maine.

“We do get a lot of calls from people asking about green burial,” Czelusniak said. “Funeral directors don’t have any problem with green burial, it is just that many cemeteries will not allow it.”

Czelusniak noted that individual cemeteries set the rules and regulations for burial, with most requiring cement vaults.

“The public needs to contact their mayor, DPW and the individual cemeteries to let them know they want to make green burial available,” Czelusniak said. “If they hear from enough people, it will happen.”

But many people are not aware that this is a choice that may be available to them.

“We talk to people all the time that think embalming is a state law and it is not,” Lorei said.

And the U.S. Centers for Disease Control and Prevention has never prescribed embalming as a public health measure.

Conservation burial

While a green burial in an existing conventional cemetery is a more eco-friendly final departure, Lorei said that a “conservation burial is really the gold standard for green burial.”
Conservation burial involves being buried on land that has been established as a nature preserve or is designated as permanently protected conservation land.

Bodies are unobtrusively buried in the natural landscapes and, depending on the individual preserve, graves may be marked by native plantings, a rock, a small flat wooden plaque, or have no marker at all. Some graves may contain GPS markers so that people can find their loved one’s final resting place.

Money raised from burial fees go back into the preserve or land trust.

Many see this as a win-win situation.

“To be able to be buried in a beautiful natural place, in a very natural way and to know that you are also contributing to the future preservation of the land, that’s a wonderful thing,” said Alicia Pike Bergman of Minneapolis, who was at the event in Amherst during which Lorei spoke this month. “It makes your last act on this earth a very meaningful one.”

Matthias Nevins, a land conservation specialist for Mount Grace Land Conservation Trust, agrees, saying that conservation burial on is an innovative way to leave a lasting legacy for future generations.

Roughly two years ago, Green Burial Massachusetts formed its partnership with Mount Grace.

“We are pretty excited to be working with Green Burial Massachusetts,” Nevins said. “We are currently looking for a property that has significant conservation value for wildlife habitat and recreation. The cemetery would resemble a natural landscape with partially open fields and meadows.”

Nevins said a property has been identified for the project but the sale of the land is still in negotiation.

If things go as planned, this would be the first conservation cemetery in Massachusetts. Mount Grace Land Trust would own the land and Green Burial Massachusetts would run the cemetery operations.

“We are very optimistic about this,” Lorei said. “We see this as a beginning step. Our goal is to eventually have lots of green cemeteries around Massachusetts.”

Willow coffins

Massachusetts may also have the first producer of natural willow coffins in the country.
Mary Lauren Fraser, 21, is a basket weaver who apprenticed with Karen Collins, a traditional weaver and basket coffin maker in Forres, Scotland.

“The UK is about 30 years ahead of us on this,” said Fraser, who lives in Montague where she is establishing her coffin-making business.

“I have been talking to other people in the green burial business and as far as I know, I am the only one in the country who makes these,” Fraser said.

While there is a selection of wicker caskets and coffins available through Mourning Dove Studio in Arlington, they are imported from overseas.

Fraser said it takes about 3½ days to complete a coffin, which uses roughly 20 to 25 pounds of willow that is locally sourced.

She said she is eager to take her work to different fairs and markets to let people know that there is a local green alternative to standard caskets. “I want people to be able to check it out, climb in and get excited about it,” she said.

Film showing

On Nov. 1, Lorei led a discussion following a showing of the film “A Will For the Woods” at Grace Episcopal Church in Amherst, which was attended by some 30 people. The film chronicles the journey of Ohio psychiatrist Clark Wang who sought a green funeral and burial after being diagnosed with lymphoma.
In attendance was Janet Bergeron, a cemetery trustee in Sunderland.

“There has been a lot of interest in green burial lately, so I wanted to get as much information about it as I can,” Bergeron said. “It had never come up before, but within the last year it really has.”

Lorei said that people choose green burial for many different reasons ranging from simplicity to ecological and spiritual motives.

She also noted that people can work with funeral directors to request that their loved ones not be embalmed or to perhaps arrange for a wake at home.

“There are people who do want to take care of the body of their loved ones at home and be more involved in the ritual and care of that person,” Lorei said. “The point is, people don’t have to take the whole burial package from a funeral home, they can do it sort of a la carte.”

Joan Pillsbury of Gill, is a member of Green Burial Massachusetts and on the board of the Funeral Consumers Alliance of Western Massachusetts.

When Pillsbury’s husband Dennis died, she had a wake at home and her family then drove his body to Cedar Brook Burial Ground in Maine.

“We don’t like to think about death, but more and more people want to have that public conversation,” Lorei said. “We encourage everyone to ask questions and if you are in need of support, we at green burial can work with you.”

Complete Article HERE!


For Jewish Students, Field Trip Is Window on Death and Dying


Rochel Berman

Rochel Berman explained traditional Jewish burial shrouds to students from Yeshiva High School during a visit to the Gutterman Warheit Memorial Chapel in Boca Raton, Fla., on Tuesday.


Two yellow buses pulled away from Yeshiva High School here with a couple of class periods still left and the 77 seniors aboard giddy with the words “field trip.” They texted. They posed for selfies. They sent up clouds of chatter about weekend plans.

Then, less than a half-hour later, they walked into a cool, tiled room at the Gutterman Warheit Memorial Chapel and stared at the pine coffins and the inclined metal table used for cleaning a corpse.

“I thought I was cool about death,” one girl whispered to a classmate. “But this ——”

“This” meant more than the contents of the room, which is used at the Jewish funeral home for the body-washing ritual called tahara. It connoted the entire mini-course that she, along with the rest of Yeshiva High School’s graduating class, is taking about the Judaic practices and traditions surrounding death, dying and grief.

Few subjects run more powerfully counter to an American teenager’s innate sense of immortality than a confrontation with the reality of life’s end. The study of death became more common at the college level with the publication of Elisabeth Kubler-Ross’s influential book, “On Death and Dying,” in 1969. But it is rare that the subject is discussed at the high school level, particularly with an approach that includes fairly explicit instruction in caring for a cadaver.

Yeshiva High School

Yeshiva High School sent 77 senior students to the funeral home as part of a course teaching Judaic practices and traditions surrounding death, dying and grief.


“As a senior, you’re thinking about going to college, and as a teenager you have this feeling of invincibility,” Daniel Feldan, 17, said the morning after the visit to the funeral home on Tuesday. “I’ve never had that other feeling — of mortality, that life might end soon.”

Bailey Frohlich, also 17, nodded at hearing her classmate’s words. “It’s given us a reality check,” she said. “For us, it’s usually about college and friends and extracurriculars. You don’t focus on the grittier things. But even if you don’t have a personal connection to death, thank God, it affects the whole community.”

The 10-hour, eight-session course, titled “The Final Journey: How JudaismDignifies the Final Passage,” aims for sensitivity even as it provokes a certain degree of shock. Besides going to the funeral home, where they received detailed explanations of washing and dressing a corpse, the students have classroom lessons on topics including the history of the Jewish burial societies known as chevra kadisha, the Talmudic foundations of end-of-life practices, and issues involving autopsy and organ donation.

“When we started the program, there was a lot of hesitation and curiosity at the same time,” said Rabbi Jonathan Kroll, 45, the yeshiva’s head of school. “Jewish tradition for dealing with burial and the process of tahara is not that well known. Even for a lot of well-educated Jews, the chevra kadisha is like a secret society. But once you start talking about the values involved or the practical aspects, there’s a fascination.”

The program at Yeshiva High School began with Rochel U. Berman, a 79-year-old author and a former nursing home worker who moved near the school 13 years ago. Her well-regarded book on Jewish burial rituals, “Dignity Beyond Death,” was published in 2005. Over the years she lived in South Florida and the New York metropolitan area, and she served as a chevra kadisha volunteer in both places, preparing the bodies of about 1,000 women and girls, from centenarians who simply wore out to an 18-month-old baby felled by cancer.

In broad ways, Jewish rituals around death and dying trace back to antiquity, and they have been central to Jewish continuity in the diaspora. The system of chevra kadisha emerged in Central Europe in the 16th century. Initially almost a social institution composed of the elite, chevra kadisha groups transformed over the centuries into an example of communal or congregational voluntarism.

An unlikely adopter of religious tradition, Ms. Berman grew up in Winnipeg, Manitoba, as the child of secular socialists. Her Jewish language, rather than the Hebrew of worship and Zionism, was the Yiddish of the Old World shtetl and the New World slum.

By the time Ms. Berman’s father died in 1985, she had grown observant. Even so, between the final kiss she planted on his forehead in his deathbed and the lowering of the coffin into the ground the next day, she had no idea what had been done with her father’s body.

Jewish funeral process

From left: Sarina Solomon, Ariella Mamann and Jolie Davies, students at Yeshiva High School, practiced the Jewish funeral process that would be used to cleanse a body before burial.


“I didn’t know what I was missing, but I knew there was a hole there,” she recalled. “And the not-knowing made me even sadder.”

While living in New York, she and her husband, George Berman, both started volunteering in their Orthodox synagogue’s chevra kadisha, which has separate units for each gender. The processes of washing and purifying the body, of dressing it in a white linen shroud, of moving it into a plain wooden coffin filled her with a sense of communal purpose.

Not content with her own years as a volunteer or with her book, Ms. Berman resolved to reach young people as a way of imbuing the next generation with those Judaic values. “It’s a gift to give them, a part of the Jewish life cycle they didn’t know about,” she said. “And once they know it, they’ll be the ambassadors in sharing it.”

Rabbi Kroll assumed the leadership of Yeshiva High School in Boca Raton, Fla., three years ago. Coincidentally, it turned out that he, somewhat later than Ms. Berman, had belonged to the same synagogue and volunteered in the same chevra kadisha in New York’s Westchester County.

With $21,000 in grants from foundations and religious organizations, Ms. Berman devised a curriculum. Rabbi Kroll tested it last year with half of the seniors in the class of 2015.

“We had pushback,” he recalled, “but it wasn’t serious pushback. Several parents questioned the priority: ‘Why not use the time on something more pertinent, more relevant?’ My impression is that the pushback was about their own discomfort with mortality.”

As for the first batch of students, half of them reported on evaluation forms that, as a result of the course, they would consider being in a chevra kadisha. That response was more than sufficient for Rabbi Kroll to expand the program to this year’s entire senior class. Among the 78 students, he said, only three have had an immediate family member die. (One of those three was excused from the funeral home trip.)

Even those like Maya Borzak, 18, whose grandfather served in a chevra kadisha, found there was plenty to learn. In fact, the funeral home visit occurred just five days before the unveiling of that grandfather’s headstone, which in Jewish tradition takes place after a year of mourning.

“I always knew that, in general, it’s important to have a Jewish identity, that you’re born a Jew and you need to die a Jew,” Maya said. “You have a circumcision if you’re a boy, you have baby-naming if you’re a girl, and then, at the end, everyone is buried in the same way.”

“Now I know more than the sources for the processes and rituals,” she said. “I know the dignity that is supposed to be provided for everyone who dies. It’s the great equalizer. We’re all in this together.”

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