by Carson Kessler
For the funeral industry, the COVID-19 pandemic has meant flush times. Revenues have surged at Service Corporation International, the largest such chain in the U.S., with more than 1,500 funeral homes and 400 cemeteries. And “COVID impact,” according to a recent investor fact sheet, helped SCI more than double its earnings per share between 2019 and 2021.
Prices for funerals have always been steep. Funeral homes charged a median of $7,848 for a viewing and burial last year, according to the National Funeral Directors Association, and $6,970 for a cremation. Those costs don’t include the charges from cemeteries, which can add thousands more. ProPublica recently investigated one cemetery whose charges could run into the tens of thousands of dollars.
The federal government has done little to regulate the industry. Thirty-eight years ago, the Federal Trade Commission tiptoed into this realm, mandating that funeral homes disclose their prices. But cemeteries, some of which are overseen by states, were exempted from those rules. For two years now, the FTC has been conducting a rare review of its rules and examining a wide series of proposals, including extending its rules to cemeteries, requiring that prices be posted online, and disclosing that embalming is not legally required. Presented with a series of questions about the status and timing of the process, an FTC spokesperson would say only “the review is ongoing.”
Joshua Slocum, executive director of the Funeral Consumers Alliance, the only national consumer organization that monitors the funeral industry, has been advocating for changes to the FTC’s Funeral Rule for decades. Regardless of what the agency decides, Slocum wants consumers to know their rights, as well as have a few tips at their disposal when preparing to put a loved one to rest.
This conversation has been edited for length and clarity.
Many people might be surprised to know that at least part of the death industry is regulated. What is regulated and what isn’t?
Let’s talk about the federal [rules] because that’s most important to the basics of what people need to know. There’s something called the Funeral Rule, a regulation from the Federal Trade Commission, which gives consumers particular rights, and they would be very wise to exercise these rights.
One, they have a right to get price quotes by phone.
Number two, when they go to a funeral home in person to talk about a funeral arrangement, they have a right to a printed, itemized price list — think of it just like a menu at a restaurant.
Number three, they have a right to pick and choose item by item. Funeral homes are not allowed to offer you only a package. They will try to offer you a package and they will often say, “You save money if you buy everything together in a bundle.” But just like all bundles, you have to take a look and see, is this actually something I would have spent money on, on its own? Am I really saving money? Or am I just getting a bunch of things that I wouldn’t have picked anyway?
What are the first steps to take after a loved one’s death?
Number one, remember that death is not an emergency. When death occurs, by definition, that means the emergency is now over. The worst thing that can happen has already happened. The person isn’t going to get any deader, to put it plainly.
Get on the phone and call at least five different funeral homes within a 20- to 30-mile radius of where the dead person is. Get price quotes. Take the time to at least look it over and compare some of the prices before you commit to having the funeral home remove the body. If the person dies at a hospital, which is more common, you have more options. Ask the hospital if the body can stay in the morgue for a couple of days while you make a considered decision about which funeral home to call.
Two, take stock of your budget. You need to know that figure. Decide ahead of time what you can comfortably afford. And for God’s sake, please don’t do this: “Oh, money is no object. It’s my mother. She deserves the best,” and then three months from now, you’ve got a $15,000 bill that you can’t pay.
What happens when you comparison shop?
Anytime you pick five or six funeral homes, all within the same city or region, and you canvass them, you will find that there’s a price difference of thousands of dollars for exactly the same service all within a service area available to you. And you will not know this because the vast majority of people will say, “Oh, well, we just use our family’s funeral home.” And I will ask them, “Why is that the one you always go to?”
The bottom line is nobody has a family car dealer, nobody has a family utility company, nobody has a family anything else. They compare prices and services. The problem here is that because this is the death transaction, and it’s a transaction we’re only going to sign a check for on average once in our lives, we don’t have practice with it. And because it is the most emotional business transaction we will ever encounter, many make the mistake of thinking of the funeral home in the same emotional category that their church lives in. That’s a mistake. Your funeral home is not your minister. Your undertaker is not your counselor. Your undertaker is your car dealer for death. And I do not mean that in an insulting way. I mean it in a straightforward business way.
How did it come to be that funeral homes are governed by some federal regulation, but cemeteries aren’t?
The cemetery regulation is so poor that I consider it an unregulated industry, even if it is technically regulated under state law.
Cemeteries before the 20th century were never considered a capitalistic, profit-making venture. They were, either by law or by community consensus, conceived of as doing a public good, something closer to what the church does. So they were seen as nonprofit community service entities that weren’t subject to regular business regulation. That changed in the 20th century when it did become possible in many parts of the country to run a for-profit cemetery.
But the regulations never caught up. The same kinds of deceptive practices that were documented that led to the Funeral Rule have always been going on at cemeteries.
I think there’s very little chance that the FTC is going to bring cemeteries under the funeral rule this time around. We’ve tried many times. There are complicated reasons for it. One of the reasons is that many cemeteries in many states are organized under nonprofit corporation law. The FTC does not have jurisdiction over that, which is an actual genuine, systemic problem.
What kind of deceptive cemetery practices are you referring to?
The same things as what funeral homes did before the law changed. The FTC rule doesn’t apply to cemeteries, so they don’t have to give out a printed price list. They don’t have to let you pick a la carte. Many cemeteries get up to nonsense games, like if you don’t want to buy that cemetery’s headstone, they get sore that they’re not getting that profit out of you. So if you go to a third-party monument dealer, the cemetery will tack on what they will call an “inspection fee” that just happens to be the exact difference in cost that they lost if you didn’t buy their stone.
What has changed now for the FTC to consider amending the Funeral Rule and what needs to happen for some of these proposals to be implemented?
Well, the FTC needs to act. It’s been two years since the FTC announced that they were reviewing the rule, and a review means considering changes. I don’t have a lot of inside knowledge, but what I can say is in communicating with the staff, I believe that they are taking this issue seriously. I believe that they are seriously considering updating the rule to mandate online pricing for funeral homes.
The current federal regulations entitle you to a paper price list if you show up in person at the funeral home. We believe that funeral homes should have to post their prices on their website. But until they do, you are probably going to have to telephone shop.
Do many funeral homes post their prices online, even though it’s not legally required at this point?
We, the Funeral Consumers Alliance and our partner organization, Consumer Federation of America, have done two surveys on the rate of online price posting. We did one in 2018, sampling 25 cities. We found only 16% of funeral homes posted their price lists online. We just did a new version of the survey, which was greatly expanded to a sample size of 1,046 funeral homes in 35 different states, and we only found 18% of them posting their prices. So no, most funeral homes hide their prices online.
Do you think the industry’s profits from COVID-19 will affect the FTC’s decision?
I think our perception and reaction to COVID has played roles in most things. One of the things that was really unfortunate for funeral consumers is that COVID was exactly the period when an online price list would have been most helpful to grieving families and we didn’t have it. People were afraid to go into businesses in person, or there were actually state-based restrictions about transacting business in person. So a lot of people were making arrangements over the phone or in some long-distance way.
The big corporations, which own hundreds of funeral homes and cemeteries across the country, are opposing changes to the rule — what’s their stated reason? What’s your take?
Things like, “We believe that this is a very personal transaction, and we believe it’s most appropriate for the price discussion to be had in the traditional manner, and consumers aren’t shopping for price anyway, so there’s no need for this.” That’s what they say. It’s not complicated. It’s simply that they don’t want to be regulated. From my point of view, they have a very weak case. First of all, requiring online posting of price lists literally costs the funeral industry $0. Do you know what it costs them? It costs them the time it takes to click that button that says “upload PDF.”
ProPublica asked SCI to comment on the FTC’s rules and Slocum’s characterizations of the company’s position. In a statement, an SCI spokesperson acknowledged that “we oppose additional federal regulations.” The company asserted that “the Funeral Rule has worked well at the federal level” and that “our industry is primarily regulated at the state level, and additional regulation at the federal level is unnecessary.” It emphasized the importance of “having a personal conversation with a licensed funeral director, who acts as the consumer advocate” and said that its research shows consumers believe “price is the least important consideration when comparing service quality, reputation, convenience of location and price.” It also stated that SCI’s pricing is “competitive and reasonable.”
Asked about its profits, SCI said, “As the largest provider of funeral, cemetery and cremation services in North America, we served many families who lost loved ones in the pandemic. The growth was driven by elevated COVID-19 mortality, which resulted in an increase in both funeral services performed and burials in our cemeteries.” The statement added that “we had to scale to serve our communities, often when other funeral homes were overwhelmed and simply could not do so.”
More broadly, how have multibillion-dollar conglomerates like SCI changed the funeral industry?
Here’s the reality: They still only have about 12% of the funeral homes in this country. And that’s been pretty steady over 20 to 30 years. In some cities, places like Seattle, many cities in Florida, where there’s a heavy concentration of elderly people, then SCI has a much greater percentage of the market share. That is true. In those places, SCI particularly tends to be the highest-priced funeral home in any market. So if it matters to you, find out who owns your local funeral home. Just because it still says McGillicuddy on the sign doesn’t mean Mr. McGillicuddy still owns it.
Are there practical things that consumers can do to bring the cost of a funeral down?
The most cost-effective thing is to choose a funeral home that already has reasonable prices. Your choice of funeral home is the No. 1 driver of cost. Once you choose a funeral home, look carefully at their offerings and see how much of it you can afford that’s within your budget. Remember that you can shop a la carte. So if your budget says $2,000, you need to face reality. $2,000 is not going to buy you a traditional funeral with embalming, public viewing of the body, metal casket, graveyard burial. You are not going to get that for $2,000 anywhere in the United States. That means your choice is going to be something like simple cremation, even if that’s not your favorite. People have to be realistic.
Is price negotiation ever an option? How would that work?
Yes, just the same way you would do it with any other business that you were negotiating with. They don’t have to haggle with you, but you have the right to do so. We get people who are like, “Well, the funeral home has already picked up the body and we do like this funeral home, but they’re more expensive than another one we found in town, we simply can’t afford it.” And my suggestion is talk to the funeral director and say, “Listen, you’ve taken good care of us before, we appreciate that you came to pick our grandmother up, but we literally cannot afford your price on this direct burial. We would love to give you our business. Can you meet your competitor’s price? We realize you don’t have to lower your prices. But we would like to do business with you. If you can’t lower your prices, we’ll have to have her body removed to a different place.”
And that’s OK to do?
Well, why wouldn’t it be OK? Here’s what I hear underneath this, and I think you’re channeling it correctly from people: What people are doing is asking for permission. But you’re not breaking a social rule. You’re not being cheap. I know what people are thinking: “I don’t want to do that. It’s gauche. It means I don’t care about my mother.” Stop that. That’s nonsense talk. If you showed how much you loved your mother by how much you spent on her funeral, you’d go bankrupt. Love cannot be expressed by money.
Lastly, what are some of the biggest misconceptions about navigating this process?
Most of what people think they are required to purchase is not true. For example, many people think embalming is legally required if you’re going to view the body. That is not true in any U.S. state. It’s also not true that embalming is required as a condition of being buried in the ground. These are in-house funeral home policies, not laws. So there’s very little that you are legally required to purchase. Basically, the only thing that has to happen, when a person dies, in order to satisfy the laws, there has to be a death certificate signed by a doctor, the body has to be buried, cremated or donated to anatomical science within a certain period of time, and that’s literally all that is required. Everything else is optional.
Go into this transaction knowing that although it’s emotional, you are a consumer, you get to decide what you put in your cart. You’re not obliged to buy these things. These are choices and you should make choices that fit your family’s budget and your family’s emotional preferences.
Complete Article ↪HERE↩!
By Madeline May
11 End of Life Documents for Mesothelioma & Cancer Patients
Although patients can outlive a prognosis and even reach remission, mesothelioma remains one of the worlds most deadly conditions. This is why mesothelioma patients should take as many measures as possible to ensure their personal finances and responsibilities are covered. Many people have a will prepared, but there are several other end of life documents that are essential family members or patients dealing with mesothelioma. Without these kind of documents, loved ones will have to make difficult decisions on your behalf with no guidance. Although it may be difficult to discuss, Mesothelioma Hub feels it is still necessary to prepare for the worse. Here is our list of eleven essential documents that all families should prepare while dealing with a mesothelioma prognosis.
1) Letter of Competency
A letter of competency is one of the first end of life documents to complete during your planning. A letter of competency is a statement from a mesothelioma doctor or specialist stating that a person is capable of making informed, stable decisions. This end of life document could apply to health care, finances, or estate. A common side effect of mesothelioma treatment is memory loss, confusion, and brain fog. Therefore, it is essential to obtain a letter of competency if applicable.
2) Living Trust End of Life Document
A living trust is another essential piece of end-of-life paperwork. A trust is created and funded during a patient’s lifetime that they can amend or revoke as time goes on. A living trust appoints a person or corporation to act as a “trustee” after their passing. The document also designates the “beneficiaries,” aka the people who receive income or other property from the trust. This trustee manages the trust property for the benefit of the beneficiaries.
The average lifespan for a mesothelioma patient after receiving a diagnosis is 4 – 18 months. A living trust is an end of life document that you should assemble as quickly and efficiently as possible during your end-of-life preparation and especially during the more advanced terminal stages.
3) Last Will and Testament
A last will and testament is the legal end of life document specifying a patient’s last wishes pertaining to assets and dependents after death. Although similar to a living trust, the last will controls property directly under the control of the individual and does not include jointly owned assets whereas a living trust controls all assets. Details included in the last will and testament include what to do with possessions, and what will happen with their responsibilities including dependents and management of financials.
4) Letter of Intent
Although not a legal document, a letter of intent can be beneficial for your executor and family members. A letter of intent can act as an end-of-life checklist for your loved ones for wishes not covered in a will. The document can include the location of important legal end of life documents, names and contacts, care for pets, and many more details. It should remain a high priority for those with wishes that can’t be fully explained within other documents.
5) Financial Power of Attorney
The purpose of a financial power of attorney is to designate an agent to handle financial affairs. This person has the legal ability to make decisions about a person’s finances when someone is ill, disabled, or physically not present. The agent should make arrangements in line with the person’s wishes but has full authority to make autonomous decisions until their authority is challenged or revoked by the law.
Many people on their life journey were negligently exposed to asbestos and developed mesothelioma. This is where your a financial power of attorney can come in and assist with the legal side of things and even pursue legal help and compensation.
Need to Obtain End of Life Documents?
A late stage mesothelioma diagnosis can bring up difficult questions. Request an evaluation and let us help you with your case.
Evaluate My Case
6) Health Care Power of Attorney
If a patient is unable to make medical decisions for themselves, they may choose to have a health care power of attorney. A health care agent should be someone trustworthy and noble as they can:
- Accept, withdraw, or decline treatment
- Agree to admit or discharge a patient from any medical center or institution
- Access medical and mental health records and share them with others
- Carry out plans or make decisions about the body or remains
Throughout the mesothelioma journey, several health-related decisions will need to be made. Whether you are going through treatment or are staying in an assisted living home, a health care power of attorney can assist you in these decisions and maintain important end of life documents.
7) Living Will End of Life Document
A living will is a vital facet of a patient’s end-of-life plans. This document declares a patient’s desire to have death-delaying procedures withheld after being diagnosed with a terminal illness. This end of life document can assist doctors and loved ones if a decision needs to be made about withholding death-delaying procedures.
The medical community considers mesothelioma a terminal illness. If you are interested in death-delaying procedures being withheld, you should complete a living will.
8) Organ Donor Care
Those interested in donating their organs should complete a health care directive stating their wishes. If arrangements have already been made, specifying an end of life document should include all necessary information. If a patient has a health care agent, they can also make the decision with guidance from the patient.
9) HIPAA Release
Health care information of everyone is not accessible by others before or after their death. However, a HIPAA release form shares otherwise protected health information with other individuals or organizations. Patients should file a HIPAA release form if they would like their health care agents or loved ones to have access to their important end of life medical details.
10) DNR Order End of Life Document
A health care provider will typically begin CPR and life-saving activities if the heart or breathing stops, however, people can choose to not receive care under these circumstances. A do not resuscitate (DNR) order states that a patient prefers to not receive CPR in the case that the heart or breathing stops.
Many mesothelioma patients that pass, developed the condition due to negligence. The patient’s loved ones may be eligible to file a wrongful death suit against the individual or company believed to be responsible for negligence. Thats why it’s so important for to keep all your family members end of life documents secured and organized.
11) Digital Asset Instructions
Nowadays, the average person has almost 200 digital accounts including bank, investment, insurance, cryptocurrency, and social accounts. Some of these accounts, if not all, will need attention after a person passes. If these accounts are password protected, a patient should assemble a list of login information. Patients can even assign a digital executor to manage online accounts after they pass.
Complete Article ↪HERE↩!
What the programs cover, and what they don’t
by Tamara Lytle
What role does the federal government play in assisting Americans in need of long-term care? The answers, which lie primarily within two programs — Medicare and Medicaid — may may surprise you. Here is a breakdown of the services they do and don’t offer.
Does Medicare cover the costs of long-term care?
No. This is a common misconception. As a reminder, Medicare is strictly a health insurance program that covers costs related to illnesses and injuries (and, to some extent, their prevention). As such, it will help pay for up to 100 days of rehabilitation or skilled nursing care after a major health issue, based on a doctor’s recommendation. But longer stays, such as a permanent move into a nursing home, are not covered.
What about Medicare Advantage?
You can check to see if there’s a Medicare Advantage plan in your area that offers limited caregiving assistance. You may be able to find one that provides meals or pays for installation of grab bars, says Howard Gleckman, senior fellow at the Urban Institute. A small number of so-called special needs plans offer some in-home support services. If a Medicare Advantage plan has a five-star rating, you may switch to it outside of the annual enrollment period.
What about Medicaid?
Medicaid does pay for long-term nursing-home care, but only for people with very low income and modest savings who can no longer handle basic daily tasks like dressing or feeding themselves. Gleckman says a good rule of thumb is that if you have less than $750 in income per month and less than $2,000 in financial assets (not counting a home), you likely qualify for Medicaid.
This excludes a large number of people who draw Social Security, given that the average monthly benefit check is more than $1,600. Remember that Medicaid is meant to help just the very poor. Most middle-class people and even low-income people do not qualify, although sometimes people use up their savings and spend so much of their income on care that they do become eligible.
But also note that the Medicaid program is a partnership between the federal government and each state, meaning criteria for who qualifies and what benefits are available can vary based on where you live. Some states provide some benefits to people with low incomes who are over the basic qualification limit, but they are expected to pay for part of the care.
What about care services at home?
It’s important to distinguish between medical care and daily care needs like bathing, eating, moving about and such.
As noted, Medicare will pay for assistance like physical therapy or skilled nursing care, whether in a facility for short periods or at home, where there is no specific time limit, while a patient is recovering from an illness or injury. A supplemental Medigap policy may help with some at-home medical care costs, Gleckman says.
“But for people who are unable to care for themselves at home and don’t have a family member to help manage their daily activities, Medicare doesn’t fill that gap,” says Tricia Neuman, head of the Kaiser Family Foundation Program on Medicare Policy.
Medicaid is another matter. If you meet its stringent requirements, some recipients can get coverage for aides to help with activities like dressing and toileting, says Sara Rosenbaum, a law professor at the George Washington University Milken Institute School of Public Health. But even those benefits only go so far. “Medicaid is not going to provide anything remotely like 12 hours of help,” Gleckman notes. And again, benefits — and funding levels — vary by state. Oregon and Minnesota, in particular, have robust programs to help people live at home or in the community instead of in nursing homes.
Veterans should check with the U.S. Department of Veterans Affairs, which has some programs for those needing ongoing care, including a foster care program through which veterans live with families who can help them. For broader background on long-term care, visit longtermcare.acl.gov. The Area Agencies on Aging are a good clearinghouse for information on nonprofits or other community resources. Go to eldercare.acl.gov.
What if I just need a break as a caregiver?
Some state Medicaid programs pay for adult day programs that offer medical services. And some Medicare Advantage plans are beginning to offer coverage for adult day care and other breaks for family members, says Robert Saunders, senior research director for health care transformation at the Duke-Margolis Center for Health Policy. “There are more options now than there used to be.”
In end-of-life situations, Medicare will pay for respite care in hospice. That palliative care coverage is available when someone is considered to be in the final six months of life.
Complete Article ↪HERE↩!