Why I’m Preparing to Die

— And Why You Should, Too

Most people don’t want to think about preparing for death. But we’re all “future corpses” and need to plan accordingly.

by Jennifer Dines

I love the illusion of immortality. The $18 billion anti-aging market gets a portion of my weekly paycheck, and the belief that I just might stop my biological clock from ticking quashes any qualms I might have about spending my hard-earned money on a bevy of beauty products. I slather on sunscreen—atop layers of self-tanner, of course—to keep my skin from wrinkling, avoid both alcohol and sugar to keep the weight off, and practice Pilates to keep my spine young and flexible. Despite the increasingly popular gray-hair trend, I treat my locks the old-fashioned way: I line my hall closet with boxes of bleach-blonde drugstore hair dye and avoid looking at my roots under bright lights between colorings.

Keeping death at arm’s length in modern America means not only keeping its markers off the body, but its specter far from the home. A mere century and a half ago, American funerals were mostly family affairs, the body displayed for visitation in the parlor of the home and then buried on family property or in a nearby churchyard. It was only when embalming became popular—following the two-week cross-country viewing of President Abraham Lincoln’s body after his untimely assassination in 1865—that dealing with death became a professional affair, the purview of the undertaker, mortician, and funeral home. Norms shifted accordingly, and by the early 20th century, even the Ladies Home Journal took a stance against death being allowed in the domestic sphere. The publication’s editor banished Victorian-era front parlors from the magazine’s pages and rechristened those spaces as “living rooms” meant for interaction with anyone other than dead family members. Parlors were “perceived as dark, gloomy, and oppressive,” according to one architecture professor in a 1995 Washington Post article about the evolution of living rooms.

Of course, no matter how hard we try to stop the clock or to sweep the shadow of death from our doorsteps, the human body will not last forever. Each and every one of us will die, and, when we do, someone—if we haven’t made arrangements—will have to deal with our funeral expenses. So, despite how uncomfortable people may feel about contending with their eventual death, pre-planning for the end of your life will save your loved ones from facing the distress of making huge financial decisions at a time of loss and grieving. A few simple steps and family conversations can go a long way in preventing additional stressors.


In the past few years, I’ve faced the deaths of several family members, including that of my 94-year-old grandfather, who struggled with dementia at the end of his life, in January 2017, followed by that of my 67-year-old father-in-law in August 2019. How their deaths were handled could not have differed more.

My grandfather, a lifelong Baltimore Catholic, passed away in a hospital. He had pre-planned for his funeral arrangements, which followed the schema of practically every funeral I have ever attended. The funeral parlor embalmed, made up, and laid out his body. My family members and I hosted visiting hours at the funeral home for two days to greet mourners and spend time together looking at photos of my grandfather’s life. Each of us approached the kneeler in front of his casket one by one to pay our respects. On the second day, a pastor from my grandfather’s parish led a service, which included readings by my mother and her sister. The attendees then headed to their cars and followed the hearse for the procession to the cemetery where, after a few words from a religious official, we watched the coffin get lowered into the ground. These final ceremonial moments in the proximity of my grandfather’s body allowed for sufficient grieving and provided me with a sense of closure about the end of my grandfather’s life. Afterwards, we gathered for lunch at a waterfront seafood restaurant

But when my father-in-law Rob died unexpectedly, everything felt terribly wrong. His neighbors in Oregon—across the country from where my husband and I live in Massachusetts—found his body after he failed to walk his dog for several days. The police in Oregon made the required calls to reach my husband, Rob’s next of kin, in order to make the arrangements. Over the next few days, in the throes of bereavement, my husband juggled the many challenges that come with laying to rest someone who hadn’t left behind any instructions for the living for how to handle their death.

Unlike my grandfather, Rob had no money set aside to pay for his arrangements. No one in the family knew how he wished to be memorialized. And even if we had known his wishes, we did not have much money of our own to spend. His body ended up at the Pacific View Memorial Home in Lincoln City, Oregon. My husband and his brother paid $1,095 for his cremation and $15 for a cardboard box for the remains. I stayed home in Boston with our three young daughters while my husband went to clean out Rob’s trailer and receive Rob’s ashes, which he released from a cliff into the ocean below. I still grieve the fact that I never got to say goodbye.

The shame of how poorly Rob’s life ended causes my husband and me pain to this day. On our most recent anniversary, we avoided looking at our wedding album because seeing photos of Rob felt too painful. We cried in one another’s arms, discussing how he deserved not only more time to live, but a far better memorial. Reflecting on these two deaths convinced me that I needed to make a plan to ensure that my family will know what to do when I die. But I had no idea how to actually take action. I put the item “death planning” on my long term to-do list, alongside items like “kids’ college savings” and “look into solar panels”—you know, the type of things that can always “wait until later” (whether that’s true or not) compared to more pressing matters, like putting food on the table, paying the bills, driving the kids around, and everything else it takes to keep a young family afloat.


The most terrifying vision of death I can conjure has nothing to do with, say, violence or disaster. Instead, in this rather banal vision, my husband passes away before me in a hospital bed. A flat green line appears on a monitor accompanied by a long piercing beep—and I am left to live without him for the first time since we met when I was 21. Between this unnerving thought and the fact that I really had no idea where to begin, no wonder I postponed death planning—everything from legal documents to funeral arrangements—over and over again until, finally, last spring, a lawyer set me straight.

“You have three minor children and no will?” he asked, sounding more than a little incredulous. I felt taken aback by his tone but quickly understood the urgency when he explained that, without this document in place, our children would be put in the hands of the Massachusetts legal system if we passed away. I found the thought of my school-aged girls being at the mercy of the Massachusetts Department of Children and Families absolutely horrifying given this institution’s history of overlooking and even enabling sex trafficking and child abuse.

The attorney I hired to write my will also emphasized the importance of term life insurance. I had previously thought of life insurance as a way to cover burial costs and funeral expenses, but during this appointment, I came to understand that these policies would cover my children’s basic expenses until they become financially independent adults. I see how society treats those in need. If I don’t plan for my children’s living expenses, I know that no safety net out there will catch them.

The day after my meeting with the lawyer, I began the process of taking out a $1 million life insurance policy. This seems like an overwhelming amount of money, but it’s what would be needed to provide for our children—their food, clothing, extracurricular activities, preventative health care, and more—until my youngest, now 7, turns 22. My husband and I will pay about $1,000 a year for this policy, but it is necessary in a country where family is made to be the strongest social safety net.

All in all, I tried to keep these conversations businesslike and non-emotional, but tears came to my eyes and my voice cracked more than a few times. I feel like I have done my duty as a mother in ensuring that our children get at least some financial stability if I cannot personally take care of them.


With the will and insurance out of the way, I could finally get to the “fun” part: contemplating my own funeral and burial. I might not know when my life will end, but I can at least plan my memorial service and decide where my body will rest.

Even prior to starting this journey into serious pre-planning, I had a place in mind: Forest Hills Cemetery in Boston. This 275-acre garden cemetery, founded in 1848, features a rolling landscape, Victorian and contemporary sculptures, historic markers, and a central lake. It may sound strange to modern ears to spend one’s leisure time amongst the dead, but I have always considered Forest Hills less of a graveyard and more of a park, and I go walking there at least weekly. And, in fact, that’s what its designers intended: during the mid 19th century, garden cemeteries like Forest Hills not only solved the problem of crowding in urban churchyard burial grounds, but their beautifully manicured grounds also made them a “regular gathering places for strolling and picnicking.”

Because Forest Hills serves as the final resting place of many of Boston’s elite, I assumed this option would be out of my financial reach. But I decided to make an appointment with the cemetery office to find out what it would take to land my dream burial space.

For the first part of my visit, I joined the Assistant Director of Operations at Forest Hills to get information on all of the available options. Burial spaces range from $3,950 for a grave with a flat marker—perhaps, perversely, the most affordable route to land ownership in Boston’s exorbitantly priced and low-inventory real estate market—up to $60,000 for above-ground internment in the exclusive Dearborn Pavilion. Full-casket burials cost $2,300, while cremation burials are set at $1,500; adult cremation alone, sans burial, costs only $435. My visit—which was, dare I say, delightful—ended with a tour of the grounds, during which my guide pointed out the burial sites of the cemetery’s most famous denizens.

None of these prices set off alarm bells. I learned that financing is much like a mortgage. We could put a third down for a plot and pay the rest later. For basically $1,300, my husband and I can secure a shared spot for two urns, one for my remains and one for his. If we buy our plots in advance, we can absolutely afford to place our remains in Forest Hills, a place that has brought us great joy in life.

But before the burial comes the funeral, which—like any good party—comes at a price: the funeral home, the site for the embalming, the casket, and the cosmetic treatment of the body can all add up. I definitely want the royal treatment when I die—ideally, my mourners will find me looking youthful and gorgeous with a perfectly made-up face and a Victoria’s Secret model body, laid to rest in an elegant satin-lined casket à la Stephanie Seymour in the Guns N’ Roses “November Rain” video—but I realize that my money may be better put to use in life than in death.

How much might my dream funeral cost? At the funeral home nearest me that actually had prices listed online, a “complete traditional funeral service” including visitation, embalming, body preparation, and hearse costs $5,795. (While the Federal Trade Commission is currently considering making online price lists the law, many funeral homes still want the customer to get in touch with someone who will persuade you to spend a little bit more on your loved one’s arrangements than you had initially planned.) That $5,795 package does not include a casket, though the funeral home does provide a price list for caskets, ranging from $850 for a flat cloth-covered particle board to an $8,690 solid bronze model. Since the funeral home cannot legally require me to purchase a casket from their stock, I could also shop around on my own, perhaps even through Costco or Amazon.

Technically, no one even has to use a funeral home, at least in my state of Massachusetts. But even if I elect the more fiscally conservative option of having my body cremated at Forest Hills Cemetery, bypassing embalming and viewing entirely, I still need transportation from my place of death to the crematorium. For example, if I pass away in a nursing home, the facility would expect someone to quickly remove my body from the premises. My friends and family can legally take care of this themselves to save a few bucks, but do I really want them to have to find a sizable container and vehicle on the fly when funeral homes have workers on call 24/7 to take care of this?

I hope that, by the time I die, I have made all of these arrangements, so my family can focus on dealing with their emotions and then getting on with their lives. Despite all my planning, the uncertainty of death itself still frightens me.

Will my mind simply shut off, like the black screen at the end of the series finale of The Sopranos? Will I turn into a ghost, perhaps floating above my body and then hovering around the spaces I inhabited in life? Will a Virgil-like figure guide me through Inferno, Purgatorio, and Paradiso? What scares me the most? Not knowing how my last breath will feel. Will I gasp, trying to hold on, or will I feel relaxed? I like what True Detective’s Rustin Cohle, who spends many of his work hours—and a great deal of personal ones as well—looking at photographs of the deceased, puts forth: “They welcomed it. Not at first, but right there in the last instant. It’s an unmistakable relief. See, ’cause they were afraid, and now they saw for the very first time how easy it was to just let go.” I hope it’s easy.

It seems that most people don’t want to think about death planning. Victoria J. Haneman, a professor of trusts and estates, has noted that an estimated 70 percent of deceased people are found not to have done estate or burial planning. And this creates the perfect storm when emotions take hold during the aftermath of someone’s death. Without such planning, many families are put in a precarious financial situation.


Haneman’s 2021 article “Funeral Poverty,” published by the University of Richmond Law Review, lays out the financial impact of the American funeral on families. The average cost of an adult funeral with a viewing exceeds $9,000. This fact is all the more remarkable, Haneman points out, considering that 40 percent of American families say they would struggle to cover an emergency $400 expense. Whatever their finances, the bereaved are in an emotional state that makes for a “vulnerable consumer who is unlikely to be price sensitive and is susceptible to emotional manipulation” at the time of purchase. After all, who wants to cheap out on a particle board casket for a beloved relative—especially at a time when you are probably thinking on a loop about how much you loved them, how much you will miss them, or perhaps how poorly you feel for not treating them better or spending more time with them? In a society that often equates spending with love, financing an elegant funeral may symbolize affection or atonement for the bereaved.

But what if you simply can’t afford it? Haneman writes: “When all potential resources have been exhausted … the last remaining options are to beg, borrow, or surrender” the body. In recent years, online crowdfunding has become a popular means of fundraising for funeral expenses. GoFundMe staff even coaches people on how to make their pleas go viral. Prior to learning the true cost of funerals, when I would see these campaigns on my social media, I didn’t understand exactly why families needed the money. Now, I make a small donation whenever I can.

Another option is borrowing, either via credit card or, for those with bad credit, a loan with an interest rate of up to nearly 36 percent (for comparison, interest rates are around 7 percent on average for a home mortgage or 20 percent for a used car for someone with a low credit score). Families can also surrender the deceased, a situation which, depending on the state, results in either cremation or the burial of remains in a common grave. It’s one thing to surrender the body to the state; in some cases, bodies are never claimed by anyone. While the United States does not track the burial of unclaimed bodies, the Washington Post reported in 2021 that these indigent burials are the fate of tens of thousands of Americans each year.

Desperate and grieving families may become vulnerable to a far less savory option: non-transplant tissue banks. While organ donation for transplants is closely regulated, these unregulated “chop shops” dissect the bodies, sometimes even dismembering them with a chainsaw, then sell the parts, for profit, to medical researchers and even unspecified “other buyers.” A 2017 Reuters investigation detailed the corruption endemic to the commercial market for bodies. They solicit the donation of a corpse, promising that, after organs and cadaver tissues head to medical facilities, they will cremate the rest of the body and return the ashes to the family. But sometimes families don’t get back what they expected from these fraudulent companies.

What solutions exist to mitigate funeral poverty and debt? In 2021, FEMA dedicated $2 billion in funeral expense reimbursement to those who lost a loved one to COVID-19. With proper documentation, families can receive up to $9,000 in relief. (Compare this to the $255 death benefit—a maximum dollar amount that has been capped since 1954—received by the spouse of the deceased from Social Security.) The FEMA funeral benefit appears to be ending in September 2025.

Birth and death constitute the two life events that all people, since time immemorial, have in common. Since the public currently provides funding for nearly half of all births, why not socialize the cost of funerals for everyone? While some states provide financial assistance for low-income people, these funds fall far short of the national average funeral cost of $9,000. Why should anyone go through financial distress because of the death of a loved one? When mourners can gather together at a funeral and move through the grief cycle together, they can more readily move towards acceptance and continue on with their lives.


FUTURE CORPSE. A black T-shirt with these two words in capital letters across the chest lies at the back of my dresser. I bought it a year ago but have yet to muster the courage to wear it.

I purchased this provocative piece of clothing from the Order of the Good Death, a group whose stance is simple: “Everyone deserves a healthy relationship with mortality grounded in accurate facts, science, and history.” The group promotes awareness of and advocacy for meaningful and affordable death experiences for “your own death, the death of those you love, the pain of dying, the afterlife (or lack thereof), grief, corpses, bodily decomposition, or all of the above.” As a frontrunner in the international “Death Positive” movement, the Order encourages people to, at the very least, have conversations about death, including informing family and friends about end-of-life wishes. Looking back, I see that an hour-long conversation with my father-in-law could have saved so much of the pain I continue to endure because of his loss.

While I hope to work up the courage to wear my tee in public, perhaps in the meantime I can begin to wear it around the house when making my calendars and to-do lists. With my death planning mostly done, I want to get back to living.

Complete Article HERE!

Death Is a Part of Life

— A mindfulness of death practice inspired by the Buddha’s teachings in the Maranasati Sutta

By Nikki Mirghafori

The Buddha taught mindfulness of death teachings in many different discourses. Today we will discuss the Maranasati Sutta (Anguttara Nikaya 6.19). Maranasati means death awareness—marana (death) and sati (awareness or mindfulness). At the beginning of the Maranasati Sutta, the Buddha is said to address the monks, or practitioners (we’re all practitioners), thus:

When mindfulness of death is developed and cultivated, it’s beneficial. It culminates in the deathless, and ends with the deathless—but how does one develop mindfulness of death?

I’d like to go over these benefits before talking about the specific instructions he gave the monks.

The Benefits of Practicing Mindfulness of Death

Many of us in the West might be afraid of death—we don’t want to think about it, we don’t want to talk about it—and yet, bringing death into our awareness has many benefits—benefits for ourselves and our loved ones, benefits in how we live, and benefits for how we die. This practice prepares us to have a sense of peace, not being scared and fearful, when the moment of death arises.

The moment of death is said to be a liberating moment. So doing this practice is supreme training for that important moment of transitioning. However, this practice isn’t just for the potential of liberation. It impacts the way we live and how we show up for ourselves and others—loved ones, people we don’t know, and people we have challenges with.

Living according to our values is one of the many benefits of this practice. When we know that our time in this body and in this life is finite—when we fully embrace finitude—we don’t waste time. When the scarcity of our time comes into the forefront of our consciousness, we tend not to do the unskillful actions that cause harm. When we “greet and hold death as an advisor on our shoulder all the time,” as Carlos Castaneda said, the way we live our life changes.

We live with more freedom, peace, ease, love, and care because we know there is nothing to hang on to. We are a traveler on this earth. This body is not mine. It’s for rent. This life is for rent.

When we realize this, we live differently, we live more freely. We let go of our clinging, our sense of attachment to me, me, me, mine, mine, mine. It shifts our perspective. We can live with more freedom, generosity, kindness, and forgiveness. There is nothing to take with us. There’s nothing to hang on to. So this practice is liberating, just as the Buddha says, and it has the deathless as its fruit.

What does the deathless mean?

The deathless refers to nibbana (nirvana). The deathless is another translation for nibbana, freedom, liberation, awakening. So mindfulness of death practice is a liberating practice. It leads to freedom in the way we live and in the moment that we die—the ultimate letting go.

Summarizing the Sutta

So with that as the preamble, let’s continue with the Maranasati Sutta.

So then, as I read, the Buddha asked the monks:

Do you develop mindfulness of death? How do you develop mindfulness of death, knowing how important it is?

One monk raises their hand and says:

Oh, yes, I develop mindfulness of death. If I’d only live for another day and night, I’d focus on the Buddha’s instructions and I could really achieve a lot. That’s how I develop mindfulness of death.

And then another monk raises their hand and says:

Me too, me too! I practice mindfulness of death. If I’d only live for a day, then I’d focus on Buddha’s instructions.

Another one raises their hand and says:

Me too, me too! I practice as if I’d only live as long as it takes to eat a meal of alms food.

And then the fourth one raises their hand and says:

Oh, Buddha, Buddha, I practice, thinking if I lived only as long as it takes to chew and swallow four or five morsels of food.

A fifth one raises their hand and says:

Actually, the way I practice is, if only I lived as long as it takes to chew and swallow one morsel of food.

And then the last one, the sixth one in the story, raises their hand and says:

Buddha, the way I practice is, I might live only long enough to breathe out, after breathing in, or breathe in, after breathing out. That’s how I practice mindfulness of death.

And then the Buddha says:

Okay practitioners, those of you who said, “I think I’m going to live another day or night and I have time,” or said, “I may live another day,” or said, “I may live to eat another meal,” or said, “I may live to eat three or four morsels of food,” all of you are living heedlessly. All of you are living heedlessly.

Those of you who are practicing while thinking, “I might only live long enough to chew this bite of food,” or “I might only live long enough to eat this bite of food,” or “I might only live long enough for the duration of this in-breath or the duration of this out-breath, that I might die after this in-breath or after this out-breath”—you are practicing heedfully.

So as practitioners, how do we heedfully practice the instructions of the Buddha? The invitation is not to think, Oh I’ll have time, I have another year, or another month, or another week.

Heedlessly was considered thinking I have another day, another few bites of food. The Buddha is inviting us to consider that we could die in this moment, at the end of this in-breath or this out-breath, at the end of this bite of food, right here, right now. The Buddha is inviting us to bring death intimately into each breath.

The Practice of Mindfulness of Death

So with this, I would like to lead a guided meditation for us to practice with these instructions. I would like to invite you to close your eyes, if that’s comfortable for you. To feel yourself sitting or lying down, whatever posture is comfortable for you. Feel yourself having a sense of integrity, a sense of uprightness, letting the body be relaxed while rooted to this earth, to your sit bones, to your feet. Feeling your hands and yet the sense of uprightness, dignity.

Let us begin by bringing our awareness, our attention, into this body. This long fathom body, breathing in this moment. Feeling the breath where it’s comfortable for you, or in your abdomen, sensing the life force moving through.

This body is alive in this moment and breathing. Let’s connect with the sense of aliveness in this body. Breathing, pulsating, this amazing piece of nature. Through this in-breath, through this out-breath.

After we connect with the living, pulsating, alive nature of this body, let us connect to the fact that this body too shall die. This body is nature. It’s not a mistake. It’s not an aberration. It’s not a problem. Death is a part of life. Everything that is born also dies, and this body too.

Letting the awareness connect with the in-breath, with the out-breath. Settling, calming, and appreciating that death is so close. It’s always close. I might only live as long as it takes to breathe in, that’s all. Or I might live as long as it takes to breathe out after breathing in.

Death is so close and intimate. Can we bring it close and intimate, like a friend who advises us, on how to live, how to practice, how to be in this moment attending to the Buddha’s teachings on love, compassion, letting go, and generosity.

What if I only have the length of this in-breath to live? The length of this out-breath to live? Can we open our hearts to relax and embrace this liberating truth of impermanence?

For some of us, this practice can bring up a sense of agitation. It’s okay. You’re not doing it wrong. If agitation arises, let yourself relax with the out-breath. Connect with the sensations in the body in a spacious way, making space for the agitation or the fear that may have arisen. It’s not a mistake. As we allow ourselves to make space and be with what is difficult, arising in this moment. As expand our capacity for peace. To be with what is challenging, we extend our capacity and we cultivate fearlessness, another synonym for nibbana.

So as you do this practice on your own, bring in this contemplation: Death is so close, I might only live as long as it takes to breathe this in-breath or out-breath.

At the end of this morsel of food, how do you want to live? How do you want to show up? How do you want to cultivate your heart and mind in this short flash that is our life?

Remember that this practice of mindfulness of mortality is a liberating practice. It ends in the deathless. In nibbana, in freedom, awakening.

Complete Article HERE!

Children in mourning are curious about death, grief and afterlife, study finds

New Curtin University–led research has found that children who have experienced the death of a loved one will benefit from gaining a better understanding about why and how people die and how to make sense of this.

The research, published in the Journal of Child and Family Studies, asked 220 bereaved children aged between 5 and 12 who attended one of 10 Lionheart Camp for Kids to submit questions about and to better understand their curiosity and feelings about these important life events and changes. The paper is titled “What children want to know about death and grief.”

The research identified that children were most curious about why and how people die, how death can be prevented or delayed, how to make sense of death, understanding and managing grief, understanding life and death, how medical interventions work, and what happens after you die.

Lead researcher Professor Lauren Breen, from the Curtin School of Population Health, said the children’s questions in this study offered important insights into their thoughts and feelings, as well as their curiosity about death following the loss of a loved one.

Children in Mourning

“Approximately 5% to 7% of children in Western countries will experience the death of a parent or sibling before the age of 18, increasing to 50% when including the loss of a close family member or friend. Bereaved children are also at a higher risk of developing anxiety, depression, poor academic performance, and engaging in substance use,” Professor Breen said.

“These statistics are alarming and have only increased following the rise of COVID-19, where an estimated 1.1 million children worldwide experienced the death of a parent in the first 14 months of the pandemic. It is critical to ensure effective and appropriate strategies are in place, such as camps like Lionheart Camp for Kids, to support grieving children, while also ensuring parents have the best tools to help them cope with the death of a loved one.

“Our study was able to show that children who are experiencing the death of a loved one are curious about death and may want to openly discuss their feelings and ask questions to better understand why someone close to them is no longer around and how they can best cope with this major life change.”

Some of the questions asked by children included: Why did he leave me? How does the body actually die? Why do kids bully me at school now? What type of sicknesses can people die from? How does a pacemaker work? What is the meaning of life? What does it feel like to be in heaven?

Professor Breen explained that a lot of the information provided to grieving children by and in school is based on their age and their development, but it may be more appropriate to base these decisions on the child’s curiosity and own level of understanding.

“Ensuring there is adequate support in place for grieving children is important to helping them manage their emotions, process the grief and provide them with a set of coping skills that will help them through the next stages of life,” Professor Breen said.

“It is very challenging for many adults to openly discuss grief with their children when they are also experiencing the same grief and loss. Our research shows that instead of shielding children which may be the natural instinct, it may be more beneficial for caregivers who are anticipating a death of a loved one to have open discussions with their children about what is happening and what this means for them.

“Further research is needed to better understand the experiences and perspectives of grieving children. By understanding this, more appropriate strategies could be set in place to provide the right level of support in a . This study shows that may benefit from considering not just what children need to know, but what they want to know about death and grief.”

Lionheart Camp for Kids CEO and Founder Shelly Skinner said adults are often awkward when talking about death and grief, while children are curious and tend to have both general and in-depth questions about illness, the of dying, what it feels like to die and what happens after we die.

“Lionheart not only offers children a safe space to explore their grief, but we also educate and support adults to have appropriate, connecting and healthy conversations with children. When find their voice and can articulate and understand their personal experience of death and grief, they better understand their thoughts and feelings, allowing them to build resilience, connect with others and better prepare for future life challenges,” Skinner said.

More information: Caitlin Joy et al, What Bereaved Children Want to Know About Death and Grief, Journal of Child and Family Studies (2023). DOI: 10.1007/s10826-023-02694-x

Aging for Two

— How a longtime husband copes with his changing appearance. Humor helps.

Vincent O’Keefe

By Vincent O’Keefe

“Are you the father of the deceased?”

This jarring question came from a woman I did not know at a relative’s memorial service a couple years ago. The reason it was jarring? The deceased had died at age 59, and at that time I was 52. Plus, I was with my two daughters, ages 18 and 21, who couldn’t resist a chuckle as I pointed to the 86-year-old father of the deceased and said: “No, that’s him over there.”

That was the first (and so far, the only) time I have been mistaken for an 86-year-old. But it was the latest incident in my complicated, triangular relationship with my chronological age (how old I am), my “subjective” age (how old I feel) and what I call my “apparent” age (how old I look).

I have always looked older than my age, which was a benefit back in high school when I grew a mustache and beard by tenth grade.

I have always looked older than my age, which was a benefit back in high school when I grew a mustache and beard by tenth grade. As a teenage boy, looking older creates mystique and prompts awe-stricken fellow students to ask if you can buy them beer.

The flip side, however, was my early signs of balding. As a baseball teammate exclaimed one day, “Dude, you’re going to have a widow’s peak!” I didn’t know what that meant, but it did not sound good.

By the end of high school (and the beginning of my hairline’s retreat), I decided to embrace my “inner balding man” and go for laughs, in part because he’s always visible on the outside anyway. My first performance of this approach occurred in my early 20s during my toast at my older brother Mark’s wedding.

After informing the crowd that I was Mark’s older brother, I mentioned that I used to be his younger brother. Then I recounted our recent trip to a bar where my four-years-older-than-me brother had to show his I.D. while I did not, which “proved” that my age had bypassed his age.

My 20s also featured meeting and eventually marrying my beautiful wife, Michele, who is two years younger than me and has always had a “baby face.” We have been together for 34 years, and thanks to genetics, rigorous self-care and regular moisturizing, she still looks much younger than her age (more on that soon).

The Hits Kept Coming

When I was 28 and took her to my 10-year high school reunion, I was embarrassed for her to hear a former classmate who was gobsmacked by my hairline state: “Vince, you look so … old.” All I could think to say was “thanks, it’s nice to see you too!”

“My dad doesn’t need many haircuts because he only has half-hair!”

In my 30s, the hits kept coming. Michele and I now had two young daughters, and one day the five-year-old boy who lived next door was playing with our older daughter, Lauren. When the kids were on our backyard swings, the boy pointed at me and said: “Hey, maybe your grandpa can push us!” For a moment, I thought my father or father-in-law had shown up behind me.

This embarrassing incident was followed by six-year-old Lauren making me squirm at a salon. During one of her chatty haircuts, she was telling the stylist about the hairdos of her mother and sister. Then she pointed at me and announced to a crowd: “My dad doesn’t need many haircuts because he only has half-hair!”

In my early 40s, as I continued to age and Michele continued to moisturize, the inevitable happened: my wife was mistaken for one of my children. At a science center, our family of what I saw as obviously two adults and two children approached the ticket window. The woman glanced at us and said to me: “One adult and three kids?” Michele shot me a sympathetic smile but also got a laugh out of that one.

Our Aging Discrepancies

Laughter, indeed, has been a way for Michele and me to bond over our aging discrepancies. At one of our recent wedding anniversary dinners, I gave Michele a bonus present right before dinner. The gift? Admitting that after I dropped her off, parked the car, and entered the restaurant, the host said to me: “Let me show you to your daughter’s table.”

Better coping mechanisms have been humor and an appreciation of my health, which continues to be good thanks in part to regular exercise.

Now in my 50s, I have learned to accept the things I cannot change about my appearance. There were times when I considered Rogaine or a hairpiece, but those didn’t feel right for me. Better coping mechanisms have been humor and an appreciation of my health, which continues to be good thanks in part to regular exercise.

Another coping strategy has been to reframe my aging conundrum into sunnier terms. Rather than lament that I’m in my 50s but appear to be in my 80s, I take pride in how spry I must look to strangers whenever I do yardwork, lift something heavy, or just move quickly. I imagine their low expectations leading to thoughts like “that 80-year-old moves like a 50-year-old!”

People sometimes describe pregnant women as “eating for two,” though my baby-faced wife never liked that phrase during her pregnancies years ago. But it seems that during our long relationship I have been taking the burden of aging off her plate, so to speak, by “aging for two.”

Granted, there are far more cultural pressures placed on women than on men when it comes to aging gracefully. And the unfair social penalties for women in their 50s who may look older than their chronological age are nothing to laugh about.

Still, my wife and I continue to enjoy the absurdities of (mostly my) aging. At a recent wake, a relative who had not seen me in many years actually asked Michele out of my earshot: “Where is your husband?” When Michele pointed at me, the woman asked as if seeing a ghost: “That’s Vince?!” Clearly, I had become unrecognizable — you might even say “deceased” — to the woman.

At least I wasn’t mistaken for the ghost’s father.

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How Hospices Can Improve Health Equity for Rural-Based LGBTQ+ Seniors

By Holly Vossel

Aging LGBTQ+ populations have few options for quality end-of-life care – particularly those in rural areas – and hospices are ramping up efforts to reach them.

Access to hospice can be challenging for many seniors in remote or rural regions. Terminally ill seniors in these locales often experience higher levels of loneliness and isolation at the end-of-life due to a lack of nearby hospices or support from family caregivers.

This isolation can be compounded for LGBTQ+ seniors with terminal and serious illnesses, according to Dr. Jennifer Ritzau, vice president of medical staff services at HopeHealth, a Rhode Island-based hospice, palliative and home care provider. She also serves as medical director of palliative care at the nonprofit organization.

“I think one of the things that feels like the tip of the iceberg for my team is loneliness and hopelessness,” Ritzau told Hospice News during the Palliative Care Executive Webinar Series. “I think increasingly in our world, sadly, many rural people are alone. I think especially LGBTQ+ elders end up alone. There are lots of places where we see that words and actions fail in being loving and supportive in that part of their life.”

LGBTQ+ communities have historically faced discrimination across the care continuum, leading to fear and mistrust that complicate their ability to access hospice and palliative care professionals, Ritzau indicated. These issues can be even more challenging for LGBTQ+ seniors than other social determinants of health such as socio-economic status, she said.

“There are resources for some other [social determinants], but when someone really has nobody that is a harder one to solve sometimes. You and your team can’t be there for them 24/7,” Ritzau said. “It is really hard [for clinicians] to walk out of that house, close the door and know that nobody’s coming back until you do later.”

The dangers of isolation

Roughly 3 million LGBTQ+ adults live in rural areas across the United States, representing nearly 20% of the nation’s overall population of this community, according to a study from the Movement Advancement Project.

Though more hospices are trying to improve access to end-of-life care among underserved communities, more work is needed to ensure LGBTQ+ seniors have quality experiences, according to Dr. Michael Barnett, hospice and palliative physician at Four Seasons. The North Carolina-based organization provides adult and pediatric hospice and palliative care across three counties in western regions of the state.

Hospices stand to improve upon their recognition and understanding of what the LGBTQ+ rural community looks like and what challenges they often have as they age, Barnett indicated.

In addition to having smaller social circles of family and friend caretakers, LGBTQ+ individuals in rural areas can also have fewer hospice providers available in their geographic regions, he said. These isolation issues are layered by the practical challenges of rural living that can create barriers to end-of-life care such as spotty internet and phone connectivity, Barnett stated.

“As seriously ill LGBTQ+ adults get sicker, they’re increasingly isolated from an outside world that gets much smaller as they’re able to do less,” Barnett told Hospice News. “And that’s even harder for rural areas where patients can sometimes have little to no cellphone coverage or internet access. They’re disconnected socially, physically and distanced from medical support structures.”

As seriously ill LGBTQ+ adults get sicker, they’re increasingly isolated from an outside world that gets much smaller as they’re able to do less. And that’s even harder for rural areas where patients can sometimes have little to no cellphone coverage or internet access. They’re disconnected socially, physically and distanced from medical support structures.
– Dr. Michael Barnett, hospice and palliative physician, Four Seasons

Though telehealth can be a window into the worlds of rural-based hospice patients, it can also represent a barrier for LGBTQ+ individuals who may lack connectivity, as well as the trust to confide in health professionals, Barnett added.

“We’ve come to rely on technology for support, but that’s a real issue for LGBTQ+ seniors who are already experiencing technical challenges, let alone trust factors and isolation,” he said. “It’s looking at the real issues of this broader community in a whole different context.”

Gender-affirming hospice care hard to find

Not only are hospices in rural regions often stretched thin in terms of available clinical resources, they can also face regulatory challenges around providing gender-affirming training for staff. Evolving state laws represent a key challenge in striving toward more gender-affirming hospice care.

Some states have recently passed legislation banning the delivery of gender-affirming care including Idaho, Indiana, Mississippi and Tennessee, among others

About 574 bills have been introduced thus far in 2023 across 49 states nationwide that include legislation related to transgender rights, according to the Trans Legislation Tracker. Around 83 of these laws have passed, 366 are actively in consideration and 125 were blocked, the data showed.

Many of the states with some form of these laws in place have large rural regions with several pockets of seniors, including LGBTQ+ communities that may be less than well-known among providers due to fear of discrimination, according to Barnett.

“It’s still fairly common to hear hospices say, ‘I don’t really have many gay or transgender patients in my community,’” Barnett said. “The truth is, you do, and many of these aging LGBTQ+ adults have never had affirming health care providers. They come from generations where gay activity was criminal or treated as a pathologic mental illness. So to suddenly expect them to be open and create that safe space of respect, quality and a good death is a big challenge, especially in rural regions where they’ve often been mistreated by bias in their own communities.”

Despite regulations within their geographic service regions, hospices must recognize the importance of ensuring that staff at all levels are trained and educated in gender-affirming care, along with the leading reasons behind disparities among LGBTQ+ communities, according to Kimberly Acquaviva, social worker and professor at the University of Virginia’s School of Nursing.

Having interdisciplinary teams that are trained in gender-affirming health care delivery practices is a crucial part of breaking down barriers among underserved LGBTQ+ seniors, Acquaviva said. This type of training is a large responsibility for leaders to instill in their code of ethics and training policies to avoid discriminatory practices, she stated.

“They absolutely have to bring attention to human rights violations,” Acquaviva said during a recent American Academy of Hospice and Palliative Medicine webinar. “Nurses have a right to speak out. Social workers also have an obligation to engage in advocacy [and] should engage in political and social action that seeks to ensure all people have equal access to resources, services and opportunities they require to meet their basic human needs. Chaplains [and] spiritual care professionals are accountable to the public faith community, employers and professionals [and] must promote justice in relationship with others in their institutions and in society.”

How to improve

Hospices seeking to address this issue need to provide employee training that has “hard empathy pieces” woven throughout, according to Barnett.

Important training elements include teaching staff about the intersectionality of community structures and social determinants that add to layers of stress, discrimination and health inequities around sexuality, gender and class, he said. This allows staff to see how these factors “stack on top of one another” in the dying process for LGBTQ+ seniors, Barnett stated.

Hospices can also instill clear nondiscrimination policies and ensure staff understand how these apply to their roles, he said. Having a staff that includes representatives of the LGBTQ+ community can also improve reach among this group through trust building and understanding, Barnett stated.

“It’s about being thoughtful of how we train on these practical and discriminatory issues. It’s also being thoughtful about hiring LGBTQ+ staff,” Barnett told Hospice News. “Seeing someone in their care team that represent themselves in some way allows them to have the language and comfort level. These things will go a long way in responding and speaking to the suffering at the end of life.”

Hospices that invest in gender-affirming care delivery improvement stand to gain in terms of improved quality, reach and utilization of their services among LGBTQ+ seniors, according to Ben Marcantonio, COO and interim CEO for the National Hospice and Palliative Care Organization (NHPCO).

Focusing on these and other underserved populations can be part of how hospices shape their strategic growth plans, Marcantio said. Hospices that actively focus on quality measures aimed at reducing health inequities have demonstrated improved outcomes among these communities, he indicated.

“The key areas of focus right now in progressing those measures towards improved goals of serving underserved communities that hospices are doing is reflected in both their strategic plan and direction, the implementation and the execution of those,” Marcantio told Hospice News. “That’s where a lot of this work gets done where there’s evidence that organizations are committed to and carrying out those should be noted. It’s having measurable outcomes demonstrating that there is an increased impact in the community in the percentage of, for example, Latino, African American or LGBTQ+ community members now being served in relation to their presence in the population of that given region or or community.”

Complete Article HERE!

End of life nurse shares what people see when they die

@hospicenursejulie

By Ella Scott

A hospice nurse in America has revealed her experience working in palliative care as well as detailing something many experience in their final months alive.

Los Angeles-based carer, Julie McFadden, took to TikTok last year to explain a common sign of death – ‘Visioning’.

According to End of Life Doula, visioning is when dying people believe they are talking to their deceased loved ones. They can also think that they have come to get them, or that they are in the room with them.

@hospicenursejulie What dead relatives before you die. It’s called visioning, and it’s a normal part of death and dying. #hospicenursejulie #hospice #learnontiktok #visioning #educational ♬ original sound – 💕 Hospice nurse Julie 💕

In a clip posted to social media in October 2022, Julie said: “Here is my most comforting fact about death and dying. The craziest things we see on hospice is that most people will start seeing dead relatives, dead loved ones, dead friends, dead pets before they die.”

Continuing on, the 40-year-old said that her patients don’t just start seeing their loved ones days before they die – it can happen up to a month before their death.

“We have no idea why this happens,” Julie elaborated. “We are not claiming that they really are seeing these people. We have no idea.

“But all I can tell you as a healthcare professional, who has worked in this line of work for a very long time, it happens all the time.”

Julie McFadden regularly shares insights into hospice life with her social media followers. Credit: Instagram/@hospicenursejulie
Julie McFadden regularly shares insights into hospice life with her social media followers. Credit: Instagram/@hospicenursejulie

Julie said that visioning happens so frequently that hospice workers regularly work to ‘educate the family and the patient’ on the topic before it commences. This is so that they are not ‘incredibly alarmed when it starts happening’.

She added: “And usually it’s a good indicator that the person is getting close to death, usually a month or a few weeks before they die. This brings me comfort, I hope it brings you comfort.”

Since posting the video last year, Julie’s sentiments have wracked up over 48,000 likes and 570,000 views.

The one-minute clip has also garnered over 1200 comments, with many finding solace in the carer’s admission.

One platform user wrote: “The last morning my mom was coherent she said she could already see my grandma, who died 42 (sic) years ago. In our culture we believe our dead loved ones come to lead you. We know her mom was there ready to welcome her to the other side.”

A second said: “Yep! My mother in law was telling her sister that their mother was packing a suitcase for her trip and picked out a dress for her to wear.”

“Yep I had a patient tell me his dog was on the end of the bed told me full description and name, told his wife made her smile,” said a third.

A medium headed to the comments section and wrote: “Spirit will tell us in a session they are the ones to grab our family at their time of death so they are not alone during the transition.”

Another social media user said: “My mother would often tell me that she just had a talk with my dad or one of her sisters. Started about a month before she passed and they looked good.”

Complete Article HERE!

Inside The Festive Jazz Funerals Of New Orleans

By Richard Milner

When thinking of a funeral, many people might imagine a congregation of black-dressed folks staring at the ground while sad — perhaps with rain pattering on umbrellas for full, somber effect. But while sorrow itself is a natural response to the loss of life, funerals the world over often take on special flavors depending on culture, history, region, and so forth, some more lively or unusual than others. “Fantasy coffins” are all the rage in Ghana, shaped like lions, rockets, sneakers, Coke bottles, airplanes, you name it. Varanasi, India burns 24-7 funeral pyres to incinerate the dead before tossing their ashes into the Ganges river. Taiwan, meanwhile, has mafia-linked funeral strippers who dance and gyrate above coffins. And in New Orleans? It’s all about exuberance, joie de vivre, and music perfectly befitting them both: jazz.

In a way, nothing could suit New Orleans more than jazz funerals. A fusion of West African, British, Spanish, and French influences combined with Mardi Gras, Black Southern Protestantism, and the spirituals of enslaved Americans, jazz funerals are just as sui generis — a thing of its own — as New Orleans itself. As sites like Vox highlight, jazz funerals mourn the dead, but they also celebrate life and the hope of life after death for the one who’s passed away. Imagine a big, community brass band parade marching through the streets and you’ve got a good idea of what jazz funerals are like.

From the old world to the new

Senegal dancers in traditional garb

All sources point to New Orleans’ jazz funerals originating with indigenous, festive dance-and-music funeral processions in West African countries like Senegal and Gambia, as Vox explains. The Balch Institute for Ethnic Studies explains that ethnic groups like the Yoruba and Dahomean in the current-day nations of Benin and Togo have similar practices. Such practices revolve around celebrating the soul’s entry into the afterlife and connect to beliefs in the spirit world and a hierarchical cosmic order of God-spirit-human. This is why West African spiritual beliefs — when they arrived in the New World — ironically found a fitting home within predominantly Christian Americas.

Aeon, meanwhile, also cites cultural back-and-forth between New Orleans and nearby Caribbean nations like Haiti as helping give rise to jazz funerals. Notably, Haitian Vodou (also spelled “Voodoo”) retains celebratory practices meant to appease spirits. And of course, as French Quarter says, New Orleans has always been a hotspot for Louisiana Vodou for the same reason it spawned jazz funerals: slavery. From about 1480 C.E. to 1888 C.E., the Transatlantic Slave Trade took enslaved peoples from various African tribes to the Americas. Some of these individuals wound up in New Orleans, founded in 1718 by French-Canadian explorer Jean-Baptiste Le Moyne, Sieur de Bienville. From that point, New Orleans’ syncretic culture brewed.

Brass band, Mardi Gras, and spirituals

New Orleans' Mardis Gras celebration

New Orleans’ founding as a French city added another critical piece to the jazz funeral puzzle: Mardi Gras, the French incarnation of the Catholic Lenten holiday of Shrove Tuesday, aka Fat Tuesday, the day before Ash Wednesday. As Father William Saunders says on Catholic Culture, Shrove Tuesday was the Catholic liturgical calendar’s” last chance for merriment” before showing restraint during Lent. Traditions date back to ancient Rome, connect to pagan holidays like Saturnalia, were documented by the Anglo-Saxon clergyman Abbot Aelfric in 1,000 C.E., and by the time we get to the founding of New Orleans in 1718 involved celebratory processions and parades down the street, as Mardi Gras New Orleans describes.

New Orleans, meanwhile, was passed to Spain in 1763. It soaked up Spanish culture for 40 years before the U.S. bought it as part of the Louisiana Purchase in 1803. Per Metro, it was common for military brass bands to play funerals during this entire time. Such bands played the same instruments wielded in jazz come the late 1890s, when BBC says the musical form evolved into its familiar, syncopated, up-tempo form. But the roots of jazz, much like jazz funerals, dated back to 1819, shortly after Louisiana became a state in 1812. Per the BBC, enslaved Americans congregated in New Orleans’ Congo Square on free days, where African tribal dances and rhythms fused with colonial influences, brass band instruments, and one final component: Christian spirituals.

When the Saints Go Jazzing On

Black and white jazz funeral photo

As 64 Parishes says, the first recorded version of a jazz funeral was witnessed by architect Benjamin Latrobe in 1819. West African influences were plain and apparent from the get-go, as those enslaved people engaged in “ring shouts,” a kind of call-and-response rhythmic dance circle that spins counterclockwise. Funeralwise says that the Catholic church wasn’t too keen on these kinds of gatherings — ironically so, given jazz funeral’s processional, celebratory connection to Mardi Gras. Nevertheless, it fell to Southern Protestant Blacks to engage in “public performances to consolidate a sense of community,” as J. David Maxson writes in Southern Quarterly.

On that note, Visit New Orleans says that jazz funerals typically incorporated the old folk spirituals that passed around the U.S.’ Protestant South, like “Nearer my God to Thee” and “When the Saints Go Marching In.” These spirituals strengthened community and united ancient traditions with present beliefs in a hopeful way. Even modern-day jazz funeral bands like the famed Dirty Dozen Brass Band still focus on spirituals, as their 2004 album “Funeral for a Friend” shows. Song titles include classic spiritual adaptations like “Just a Closer Walk with Thee,” “What a Friend We Have in Jesus,” “Down by the Riverside,” “Amazing Grace,” “John the Revelator,” and more.

Joining the Second Line

After jazz funerals fused with late 19th-century, recognizably modern jazz, they marched unabated into the 20th century. Jazz swept the U.S. in the 1920s following the end of World War I but petered off in popularity in the 1930s because Americans started struggling for disposable income. But come the mid-20th century jazz funerals started becoming more widespread, in part because funerals themselves became more affordable. This was especially the case for well-known New Orleans locals — such as jazz musicians — who were honored with jazzy outros befitting their lives.

It was during this time that jazz funerals took on a standardized structure. Musicians played sad, somber, hymn-like tunes on the way to a cemetery, where a memorial service took place, and then played lively, celebratory music on the way back. This “second line,” as it was called, is the typically bouncy and exuberant part of the jazz funeral that gives it its signature flair, as seen above. Locals could join the procession on the way to the cemetery — provided they were respectful — but more than likely folks joined during the celebratory second half of the funeral. As Ausettua Amor Amenkum of New Orleans’ Tulane University recalls on Vox, “I come from the era when you’re in your house and you hear music and you go ‘Second line!’ and you run outside.”

Modern homecoming ceremonies

Modern-day jazz funeral

Jazz funerals exist to this day and have taken to incorporating other elements of Black American culture, like funk, hip-hop, and rap. Currently, jazz funerals are held not just for jazz musicians or prominent New Orleans personages but also for young people or other members of the local community who died suddenly or tragically. Interestingly, Alive Network says that the 1973 James Bond movie “Live and Let Die” played a significant role in letting the wider world know about jazz funerals. That’s also when the term “jazz funeral” took root. Nowadays, jazz funerals can be found around the U.S. and the entire globe. In 2015, for instance, Memphis hosted a jazz funeral for blues legend B.B. King.

The biggest and most prominent jazz funeral likely happened on August 29, 2006, in the wake of 2005’s Hurricane Katrina. In case readers need reminding, Katrina and its flooding devastated low-lying New Orleans and killed a total of 1,833 people across Louisiana, Mississippi, and Alabama. Funeralwise says that thousands attended the jazz funeral conducted in honor of Katrina’s dead in downtown New Orleans, where residents had stood stranded the year prior.

While not everyone gets a jazz funeral, those interested can hire musicians for the task via agencies like Alive Network, including travel to cities besides New Orleans. And yet, on Vox musician Stafford Agee says, “I never liked considering a funeral being a gig. I’m performing for somebody’s homegoing ceremony.”

Complete Article HERE!