Month: January 2024

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How it is

— Dealing with ‘disenfranchised grief’

By Dianne Hendricks

I have reached an age where reading the obituaries has become a routine activity. According to statistics, about 50% of Americans born in my birth year are still alive. So reading the obituaries is also a math exercise addressing the question of how many people eulogized today were younger than I am, and how many were older? Oddly, the answer is often about 50-50.

I feel blessed to have made it this far relatively intact. I don’t come from a family of long-lived people, so I am somewhat surprised to still be here. There are so many upsides to my life, but there is one significant downside — repeatedly grieving those who have been removed from me through death.

Sometimes, usually late at night, I Google names from my long-distant past, looking for traces of people I used to know. My generation does not have a particularly large internet presence so finding any information can be challenging.

I have found the kindly Ohio oboe teacher who shared silly jokes during my lessons, the Connecticut neighbor with eight daughters who doted on my two young sons and the California nurse I shared shifts, lunches and gripes with in the 1970s. These memories are bittersweet, but there is also comfort in revisiting them.

A few months ago, an obituary popped up online, bringing with it painful and unexpected feelings of grief and loss. Working through that experience has been different from all the others, and different as well from losses suffered up close in real time. I needed to discover how and why in order to deal with my profound sadness.

The man I’ll call Harold was, for two years, my high school boyfriend. On the day he died, we’d had no contact for 55 years. I found a lengthy obituary with a photograph on Legacy.com.

It was not difficult to unearth the teenage boy hidden among the folds and wrinkles of the completely bald old man I was viewing. I saw the little scar on his left cheek that had resulted from an elbow to the face during a varsity football game. I noted the half-smile that looked a great deal like an expression I remembered.

So, what was I grieving for? Through the years, I’d thought about Harold many times, always with fondness and always wishing him well. I harbored a fantasy that someday we would see each other again — at least once more before we died. Was the grief for the death of that fantasy or for my lost youth? If so, I felt rather silly.

In 1989, Dr. Kenneth Doka created the term “disenfranchised grief” to describe a loss that is not “openly acknowledged, socially sanctioned or publicly mourned.” This covers relationships that are not generally viewed as significant or valuable by others. The loss is not seen as worthy of grief, nor is the grief-stricken person recognized as a legitimate griever. Thus, I found myself in a position of being reluctant to discuss my feelings of loss with others.

Doka recommends finding a personally meaningful way to memorialize the deceased, and I took his advice. A few weeks ago, I changed the passcode on my phone to reflect the letters of Harold’s name — 427653. Now, every time I open my phone, I think of him briefly, and I smile. The sadness has finally drifted away.

Complete Article ↪HERE↩!

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“That’s for remembrance”

– A recipe for garlic and rosemary lamb

Rosemary in bloom

By

I wrote half of last month’s column in an airport, trying to get to my grandmother before it was too late. Neither of us made it; she was gone before I even boarded. When I was done ugly crying – on the phone to my cousin as he broke the news, then again in front of the alarmed workers of the airport Costa – I wanted to metaphorically tear up everything I’d written and start on this instead, even if I didn’t have a clear idea of what this was yet, beyond something about rosemary’s tie to memory and a roast lamb no one would ever make for me again.

But it was the Winter Solstice coming up, and my first entry in a column on the place where food and magic intersect; and, crucially, it was too close to that moment of raw grief to pull it together into something coherent, something worthwhile. So I finished that piece on tea and mead and spices and the interwoven debts that we owe each other, and I’m bringing this to you now instead.

Rosemary is the herb of memory. I miss my grandmother.

When dealing with traditional herbal correspondences it can be hard to separate the magical from the mundane. Partly because our ancestors didn’t make that distinction themselves, seeing magic, faith, and physical medicine as part of a single whole in a world entirely imbued with the sacred. But also because, as traditional herbcraft has faded out of practice, attributions which were once meant to be understood literally can seem like metaphor or mysticism, only to then surprise us when we rediscover their physical nature. Rosemary, and the impact it has on memory, is one such example.

When Ophelia includes the herb in her list of accusatory flowers, it’s easy to assume her famous quote, “rosemary, that’s for remembrance” is as metaphorical as the rest. But rosemary has long been a herb associated with funerary rites, with death, and with remembrance of the departed, traditionally being placed on the biers of the dead. Its strong smell, which lingers in the room like a memory, would have helped to cover the beginnings of decay, as well as indelibly tying itself to that moment of grief and loss in the mourner’s neurology. Scent is one of the key triggers of memory, even with substances that don’t specifically effect cognition – how much more powerful rosemary’s impact then, with the discovery that it does.

Rosemary has other folkloric ties to memory outside of the funeral parlour – with Ancient Greek students supposedly using it as a study aid, and Sir Thomas Moore declaring the herb sacred to friendship because it provokes remembrance of the living, not just the dead.

As modern medical research examines herblore to see if there are effective treatments that have been overlooked, or that can be made effective with modern scientific techniques, rosemary has had its turn in the laboratory. Studies indicate that ingesting rosemary enhances recall speed as well as improves episodic and working memory, and may even have a positive impact on Alzheimers, though more research needs to be done to understand why.

Even inhaling the scent of rosemary seems beneficial, though the impact is smaller, and works best if the subject is exposed to the scent both during the learning process and then again when asked to recall things later on – scent as a memory trigger, enhanced by the effects of rosemary’s unique chemical composition on the brain.

A bouquet of herbs, including rosemary, in a bowl

This puts us in a position where rosemary is uniquely suited to remember and honour the beloved dead. Symbolically linked to the dead through religious rites and burial practices, tied to love and the transition from one life stage to another (it is worn at weddings as well as funerals), rosemary also helps us to remember in a literal, physical way. Eaten regularly, it may help preserve the memories of those departed, as well as prompting us to remember meals shared or time spent cooking together when the familiar scents reach us and work their neurological magic.

To combine the spiritual with the physical is a very powerful thing, grounding us in both realms at once, and binding them together in us. That which is gone is never really gone.

Garlic and Rosemary Lamb

Growing up, my grandmother was the only person who could cook a roast lamb I actually enjoyed eating. I don’t know how she did it, and she was a cooking by instinct sort of person so there are no recipes left behind. I still don’t eat lamb that much, though it’s appeared more often in my house since I married a New Zealander, but I knew it was exactly what I wanted to make for this column, and my grandmother. I hope you like it.

Lamb with rosemary and peppers

Lamb shoulder (900g)

Fresh rosemary (2 – 3 tablespoons, chopped)
3 bulbs of garlic
500g baby potatoes
125 ml red wine
Olive oil
Salt and pepper
Flour

Start by setting the oven to pre-heat at 240 C (220 C fan, ~450 F). While that’s heating up, mix four tablespoons of olive oil with eight cloves of crushed garlic, the rosemary, and the salt and pepper. When thoroughly mixed rub it all over the lamb shoulder. Halve the remaining garlic bulbs and place them with the potatoes in a roasting tray, drizzle with olive oil, crack salt and pepper over them, and then place the lamb on top. Finally, pour the wine over it all and cover with a tinfoil tent before placing it into the oven.

Let the lamb roast for fifty minutes and then remove the tinfoil for the final ten minutes to let it crisp up nicely. Once it’s done let the lamb rest for fifteen minutes. While the meat is resting, remove the garlic and potatoes from the tray so you can turn the drippings into a gravy by whisking in flour over a low heat until it reaches your preferred consistency.

Complete Article ↪HERE↩!

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Digital afterlife

– How to deal with social media accounts when someone dies

Untangling digital interactions after someone dies is becoming increasingly complicated.

Deciding what to do with a dead friend or relative’s online presence is complicated and time-consuming but there are shortcuts

By

Gavin Blomeley was lucky his mother was incredibly organised before she died. She left a note that included the passcode to her phone and access to all her online passwords.

“I can’t even begin to imagine how difficult this could have gotten not having these passwords or knowing this note with all of her passwords existed,” Blomeley says.

“In the note, my mum had an alphabetised, formula-based logic to all her passwords including banking, pensions, social media – everything.”

Untangling the web of someone’s online life after they die creates additional stress on top of grief and funeral planning, and it is getting increasingly complicated as more and more daily tasks are carried out online. There are bank accounts, email accounts, online bills and streaming subscriptions, as well as various social media accounts to consider.

There is no one-stop-shop or single method to memorialise or delete accounts. Some companies, including Google, are now deleting accounts after two years of inactivity but there is no consistency across platforms.

“Facebook, in some ways, is probably actually pretty progressive and a leader in this space,” says Bjorn Nansen, a digital media researcher in the “death tech” team at the University of Melbourne.

“Over time, they’ve developed their policies; you can nominate a legacy contact, so that when you pass away that person … can follow your wishes, and either close your account or memorialise it.”

Nansen says other platforms don’t have the same policy.

“You just have to follow the same old workarounds, which is, you leave your passwords to somebody and your wishes as to what you want to be done with the accounts and content. Often, you’re breaching the terms of service.”

He says it is getting more complicated with the advent of two-factor authentication using biometrics to ensure that only the account holder can access the account.

Nansen says online companies should make the process easier but increasingly people are including directives in their will and this is likely to increase over time as baby boomers die.

“We’re entering a period that’s been referred to as ‘peak death’. The baby boomer bubble means there’s going to be a high volume of deaths and it’s always going to be the next generation that’s going to have to deal with it … it will make awareness of the issue wider and may help bring around change.”

Standards Australia says about 60% of Australian adults have made a will but not all of those have accounted for their digital legacy.

The nongovernment standards body is part of a group of organisations from 35 countries proposing core principles and guidelines for how organisations should manage the process when a relative or executor requests access to an account of someone who has died.

Adam Stingemore, general manager of engagement and communications at Standards Australia, says that means developing a common set of definitions that companies can then build into terms of service.

“The worst time to be dealing with a challenge like this is if you know someone in your family has died, and there’s a feud between parties,” he says. “What we want to do is get ahead of that on these different types of platforms. There’s common sets of questions and people can make choices about what happens to their data and assets.”

Nansen says another factor is the privacy of the person who has died, and whether they want personal messages and content to be seen by family members or deleted.

“There’s complexity and nuance,” he says. “You might have emails, you might have messages, you might have photos, you might have videos that for a whole range of reasons you might want deleted or not want certain people to see.

“If you really want to be thorough, it’s not just providing access and instructions to a digital executor; it might be quite detailed instructions about different platforms and different content.”

Blomeley says his best advice is to ensure power of attorney is arranged beforehand, and access to accounts included as part of a regulated will.< He says the process of shutting down his mother’s accounts was time-consuming, despite having all the passwords. It took several weeks to sort out, through the grief of losing his mother. “Thankfully, we were all in a position where we were able to take time off work … but I can imagine this being much more complicated for certain individuals, based on varying circumstances.” Complete Article ↪HERE↩!

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Talking About Death and Dying

— There are many benefits of having an open and honest discussion about our eventual death with those who love and care for us.

By

Last summer, my 88-year-old mother was diagnosed with late-stage colon cancer and opted for in-home hospice. She died three months later.

Talking about death can be difficult. It can bring up feelings of fear, anxiety, and sorrow. It can also feel awkward as it requires acknowledging one’s own (or a loved one’s) mortality. In some cultures, death is openly accepted and celebrated (think of Mexico’s lively, colorful, loving Day of the Dead ceremonies, which include costumes, parades, and feasts), but in others the topic is ignored and avoided.

However, there are many benefits of having an open and honest discussion about our eventual death with those who love and care for us. It can offer solace to grieving families to know what a family member most desires. When a person is nearing the end of life, family may be under enormous stress. Letting those who love and care for you know about end-of-life decisions ensures your wishes are known and respected, eases the burden on loved ones, and helps prevent the kinds of in-fighting that sometimes surface. Additionally, to talk openly about such things can be a profoundly intimate act.

I was lucky that my parents spoke openly about death. Years before my mother’s diagnosis, she asked me to be her healthcare proxy. After signing paperwork to that effect, we met with her primary care doctor, working through our questions and concerns together.

Around the same time, when Mom was still perfectly well, she showed me what she called her death file, which contained paperwork she felt I’d need later, including information about the family tomb in New Orleans, people she wanted notified upon her death, insurance information, and more. Over the years, we added papers that we thought might be helpful (a copy of her birth certificate, a notarized letter reiterating her wish to donate her organs, etc.).

Because we had been so open with one another, when Mom chose hospice at the end of her life, I asked her a question that some might find unusual. “Mom,” I said, “would you like to help me write your obituary?” She very much wanted to. I wrote a rough draft, which she marked up in pencil from her bed. We worked until she felt it was right; then she chose the photo she wanted to accompany it. Reviewing her life and legacy together in this way is one of my most cherished memories.

One afternoon just a few days before she died, she asked the hospice nurse, “Why is it so painful for me to swallow?” The nurse told her something perfectly reasonable, but for some reason, Mom asked again. I leaned over where she lay in her hospital bed and said, “Mom, you’re having difficulty swallowing because you’re dying.” The hospice nurse looked shocked at my directness, but Mom clutched my hand and said, “Oh, honey, that’s very reassuring.” Because I had listened to her over the years, I knew that she did not want to be spoken to like a child, and that she longed for direct, open talk.

If I were to offer advice about how to begin such conversations, I would suggest listening with a nonjudgmental heart. If a loved one brings up the subject of their own aging or death, try to just listen. Ask about their wishes and thoughts rather than immediately offering opinions. Being a good, loving listener without judgment allows the people we love to explore and develop their own personal philosophy around end-of-life issues.

Our culture has many taboos around illness, aging, and death, and we are directed in may ways to never speak about it. As my mother demonstrated, though, death can be approached with kindness and pragmatism. Like the proverbial “monster under the bed,” avoiding the topic altogether only increases people’s anxiety.

I’ve taught Death Studies classes, and while every family and situation is unique, my college students almost uniformly wished they could talk about such things more openly with their families, but they didn’t know how to bring up the subject. The Conversation Project — a nonprofit dedicated to helping people talk about their wishes for end-of-life care — created a free guide to help get the conversation started (theconversationproject.org/get-started). And there are many other resources available — books, videos, and podcasts — that can be a huge help.

I have found enduring comfort from the certainty that I was able to help my mother have the death she wanted, at home, pain-free, watching the birds from her bedroom window. It was a gift from her to leave me with no lingering regrets. I suspect it will comfort me for the rest of my life, and I wish for this level of intimacy and comfort for all families.

Complete Article ↪HERE↩!

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Vatican Museums Open Ancient Roman Necropolis To The Public For The First Time

— A Fascinating Addition to the Vatican City Museums

The Vatican Museums, located within the awe-inspiring Vatican City, are renowned worldwide for their vast collections of art and historical artifacts. Serving as a beacon for art enthusiasts and history buffs alike, these museums offer a unique glimpse into the grandeur of the Catholic Church and its rich cultural heritage. However, a recent development has taken place that has further enhanced the allure of the Vatican City Museums. The Vatican Museums have now opened an ancient Roman necropolis to the public for the first time. This exciting addition allows visitors to journey even further back in time, exploring the intriguing burial practices and customs of ancient Romans. Let’s delve deeper into this newfound treasure and dive into the wonders of the Vatican Museums.

Delving into the Vatican City Museums: A Haven of Art and History

The Vatican City Museums have long been regarded as a treasure trove of masterpieces. With an extensive collection spanning various epochs and artistic styles, these museums grant a mesmerizing experience of the pinnacle of human creativity. Every year, millions of visitors flock to marvel at the Sistine Chapel, the monumental Saint Peter’s Basilica, and the breathtaking Raphael Rooms. However, until recently, the Vatican Museums had yet to unveil an untapped gem within their vast complex: an ancient Roman necropolis.

Journalists visit an ancient necropolis along the via triumphalis, an archaeological area containing a Roman burial ground during the presentation to the press of the new entrance to the site at the Vatican, Tuesday, Nov. 14, 2023. (AP Photo/Gregorio Borgia)

Unearthing the Past: The Roman Necropolis of the Vatican

Located below the Vatican City, the Roman necropolis offers visitors a unique opportunity to immerse themselves in ancient history. The term“necropolis” derives from ancient Greek, meaning“city of the dead,” and refers to the burial grounds used by ancient civilizations. These necropolises hold immense historical and archaeological value, shedding light on aspects of daily life, beliefs, and burial practices of the people who lived during those times. The Roman necropolis beneath the Vatican City encapsulates this sentiment and offers an intriguing insight into the lives of ancient Romans.

From Tombstone to Time Machine: Exploring the Roman Necropolis

As visitors embark on their journey through the Roman necropolis, they will be transported back in time through a series of well-preserved burial chambers and tombs. The necropolis spans several centuries and allows visitors to witness the evolution of burial practices, from simple chambers to elaborate mausoleums adorned with intricate artwork. The subterranean network of tunnels and chambers showcases the diversity of tombs, offering a glimpse into the social structure and beliefs of ancient Roman society.

A mosaic is displayed inside an ancient necropolis along the via triumphalis, an archaeological area containing a Roman burial ground during the presentation to the press of the new entrance to the site at the Vatican, Tuesday, Nov. 14, 2023.

Unveiling the Ancient Art of Funeral Rites

The Roman necropolis is not only a testament to the architectural brilliance of the ancient world; it is a showcase of the artistry and reverence held for the deceased. Visitors will discover beautifully carved sculptures and intricate tomb decorations, depicting scenes from mythology and capturing the essence of the departed individuals’ lives. Elaborate frescoes, mosaics, and inscriptions add depth and texture to the necropolis, unveiling the customs, traditions, and spiritual beliefs associated with funeral rites.

Roman Necropolis: A Portal to the Past

For centuries, the Roman necropolis has remained hidden beneath the Vatican, preserved in remarkable condition. Now, with its doors opened to the public, visitors have the opportunity to traverse an underground time capsule. Walking through the narrow passageways, visitors can ponder the stories of those who lived centuries ago, imagining the lives they led and the legacy they left behind. It is an experience that not only piques curiosity but also fosters a profound understanding of our shared human history.

Preservation Challenges: Balancing Access and Conservation

The decision to open the Roman necropolis to the public was undoubtedly a challenging one. Preservation efforts need to strike a balance between providing public access and ensuring the ongoing conservation of these invaluable ancient artifacts. The Vatican Museums have vigilantly implemented measures to protect the necropolis, including environmental controls, regular maintenance, and visitor limits. This delicate equilibrium ensures that future generations can continue to enjoy and learn from this extraordinary archaeological site.

The Power of Immersive Education: Learning through Exploration

By offering access to the Roman necropolis, the Vatican Museums enrich the educational experience for visitors of all ages. Instead of merely observing artifacts from a distance, visitors can now actively engage with history, fostering a deeper understanding and appreciation for ancient Roman culture. The opportunity to explore these hidden chambers and decipher the stories they hold creates a sense of wonder and ignites a desire for further exploration and learning.

A Glimpse into the Past

The Vatican Museums’ decision to open the ancient Roman necropolis to the public provides a remarkable opportunity to step back in time and immerse oneself in the mysteries of ancient Rome. This newly accessible site adds another layer of fascination to the already captivating Vatican City Museums. As visitors traverse the subterranean corridors and stand before monumental tombs, they can forge a connection with the past, appreciating the richness and complexity of ancient Roman culture. We can only hope that this extraordinary archaeological treasure will continue to be preserved and shared for generations to come, allowing future visitors to be inspired by the wonders of the Roman necropolis.

Complete Article ↪HERE↩!

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Terror Management Theory

— How Humans Cope With the Awareness of Their Own Death

By Cynthia Vinney, PhD

Terror Management Theory (TMT) suggests that human beings are uniquely capable of recognizing their own deaths and therefore they must manage the existential anxiety and fear that comes with knowing their time on Earth is limited.

The theory was developed by psychological researchers Jeff Greenberg, Sheldon Solomon, and Tom Pyszczynski, who published the first TMT article in 1986.1 They based TMT on the writings of Ernest Becker, who spoke of the need to protect against the universality of the terror of death.

In this article, we’ll review key concepts of TMT, look at empirical evidence in support of TMT, explore real-life examples of TMT, and discuss how it is used across different fields.

Key Concepts and Principles of Terror Management Theory

Terror Management Theory explains that people protect themselves against mortality salience, or awareness of one’s own death, based on whether their fears are conscious or unconscious.

If they’re conscious, people combat them through proximal defenses by eliminating the threat from their conscious awareness. If they’re unconscious, distal defenses, such as a sense of meaning, like cultural worldviews, or value, like self-esteem, diminish unconscious concerns about death.2

Cultural worldviews and self-esteem are key concepts of TMT. They are both central to protection against mortality salience. David Tzall, PsyD, a licensed psychologist in New York, notes, “TMT suggests that individuals gravitate towards and defend their cultural worldviews more strongly when confronted with thoughts of mortality.”

Through cultural worldviews, people can achieve literal or symbolic immortality. Literal immortality, the idea that we will continue to exist after our death, is usually the domain of religious cultural worldviews. Symbolic immortality is the idea that something greater than oneself continues to exist after their death, such as families, monuments, books, paintings, or anything else that continues to exist after they’re gone.

TMT suggests that individuals gravitate towards and defend their cultural worldviews more strongly when confronted with thoughts of mortality.

Self-esteem plays a significant role in TMT too. “When faced with the awareness of death,” Tzall says, “people often engage in activities or behaviors that boost their self-esteem as a way to manage the anxiety associated with mortality.” In so doing, they provide the sense that they are a valuable participant  in a meaningful universe.3

These have led to two important hypotheses in TMT. First, the mortality salience hypothesis says we have negative reactions to individuals from a different group, called “outgroupers,” who present a threat to our group, and have positive reactions to those who represent our cultural values, referred to as “ingroupers.” Second, the anxiety-buffer hypothesis says strengthening our anxiety-buffer by, for example, boosting self-esteem, should reduce the individual’s anxiety about death.4

Review of Empirical Evidence Supporting Terror Management Theory

There are over 500 studies conducted in countries around the world supporting TMT. For example, one study found that raising self-esteem reduces anxiety in response to images of death.5 Similarly, increasing self-esteem reduces the effects of mortality salience on the defense of one’s worldview. When the researchers provided positive personality feedback instead of neutral feedback, their preference for a US-based author was equivalent to that of the control group, whereas participants who received neutral feedback far exceeded the control group in preference for the author.6

Another study found that worldview threats increase accessibility of death thoughts. When Canadians were exposed to a website that either derogated Canadian values or Australian values, they had far more thoughts about death when they encountered the anti-Canadian information.7

Real-Life Examples Illustrating the Application of Terror Management Theory

There are many ways that terror management theory can be applied to real life. Tzall provides some examples, such as “religion where religious beliefs and practices offer explanations for life’s meaning, purpose, and what happens after death. People will turn to religion to alleviate existential anxiety and find solace in the idea of an afterlife.”

Believing in religion may provide a chance at literal immortality, but beyond that, it can provide a cultural worldview that brings meaning and purpose to life and can alleviate mortality salience.

Likewise, Tzall gives the example of belonging to a nation that “provides a sense of identity and belonging, which can help individuals feel connected to something enduring. People may strive to achieve success, create meaningful relationships, or contribute to society in ways that leave a lasting impact.” There are all sorts of ways that people can find meaning and achieve symbolic immortality, including being part of a nation that will go on after their death.

In addition to feeling like a part of the nation, people will want to put their own stamp on the nation whether through success in industry, meaningful relationships that have a lasting impact, or other options like volunteering, having a family, or writing a book.

Implications of Terror Management Theory across Different Fields

Different fields can use TMT in different ways. For example, the most obvious may be the field of therapy and counseling. As Tzall explains, “TMT sheds light on how individuals’ psychological well-being, self-esteem, and behavior are influenced by thoughts of mortality.” Tzall continues, this “can help therapists understand existential anxiety and develop strategies to address it.”

The theory can similarly be used in marketing and advertising, but the emphasis is different. “TMT can inform advertising strategies that tap into consumers’ desires for symbolic immortality,” Tzall says. In this conception, marketers and advertisers advertise goods or services in a way that communicates their desire for symbolic immortality can be met.

Similarly, political science “can help explain the polarization of political ideologies,” explains Tzall, “and the ways in which leaders appeal to their followers’ existential concerns to gain support.” Through cultural worldviews that appreciate others like them but reject others that are not like them, leaders can exploit their followers and even lead them to rise up against others that do not agree with them, in wars, conflicts, or events like January 6th, where a small group of like-minded citizens stormed Congress.

Significance of Terror Management Theory in Understanding Human Behavior and Beliefs

Though some studies about TMT have failed to be replicated, Terror Management Theory has continued to resonate with many people. And researchers still use it to describe various events.

For example, a group of researchers used TMT to detail the COVID-19 pandemic during its height, explaining that regardless of how deadly the virus is, the risk of dying was highly salient.8 As a result, in response to the pandemic, people responded to the constant fear of death in both proximal and distal ways.

In proximal ways: drinking and eating in excess to arguing that the virus isn’t nearly as lethal as health experts claim. And in distal ways: affirming an individual’s cultural worldview to maximizing one’s self-esteem, in line with the TMT literature. As threats that remind us of our own deaths continue and expand, TMT will continue to be a leading source of understanding human behavior and beliefs.

Complete Article ↪HERE↩!

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Hospice Providers Must Be Better Regulated

— Too many hospice providers in the U.S. are run by private equity and for-profit corporations. A lack of regulation allows them to provide abysmal end-of-life care

By The Editors

Everyone deserves a good death—a choice about how they spend their final days, a peaceful, pain-free exit. That is the mission of hospice care. But as corporate profiteers take over end-of-life care in the U.S., the system is failing many people in their moment of greatest need. Policymakers must better regulate this vital service.

The hospice movement got its start in England in 1967. The brainchild of Cicely Saunders, a physician and social worker, it aimed to ease the suffering of the dying by managing their pain and other symptoms and by affording social support to them and their caregivers. The culture around death has long been one of denial. The medical establishment tended to push aggressive treatment on ailing patients and then abandon them once they were deemed incurable. With its emphasis on accepting death and offering compassionate, holistic care to patients and their families, hospice revolutionized the way in which society tends to the terminally ill. By the 1970s the movement had spread to the U.S. Volunteer-led and supported by donations, hospices offered their services free of charge, mostly in the comfort of people’s homes. Of the roughly three million Americans who die every year, around half now do so in hospice care.

The trouble began in the 1980s, when Medicare began paying certain hospice providers for care given to people with six months or less to live. Medicare pays a fixed amount to providers for each day that someone is enrolled in hospice, regardless of how much care they actually receive. With this turn of events, for-profit hospices began springing up to take advantage of the government contracts. Today nearly three quarters of hospice agencies operate on a for-profit basis. The sector has become so lucrative that in recent years private equity firms and publicly traded corporations have been snapping up previously nonprofit hospices at record rates.

This takeover of what was once an almost exclusively nonprofit service by for-profit firms has had pernicious effects on hospice care in the U.S. When patients enter into hospice care covered by Medicare, they agree to forego further attempts to cure their terminal illness. In exchange, they are supposed to receive comprehensive comfort care from a team of doctors, nurses, social workers, spiritual advisers and trained volunteers who work together to provide patients and their loved ones with the medical, emotional and social support they need. Although hospice generally does not offer live-in care, agencies promise regular visits from members of the hospice team and 24/7 access to on-call doctors and nurses.

For-profit hospices do a significantly worse job of providing this care than nonprofit agencies do, according to a study by the RAND Corporation. Looking at quality measures such as management of pain and other symptoms, communication with the hospice team, and timeliness of care, the researchers found that nonprofits outperformed for-profits in every category.

In addition, it’s easy for profit-seeking providers to use loopholes in the payment model to game the system—and worse. An investigation by ProPublica, co-published with the New Yorker in 2022, detailed example after harrowing example of hospice wrongdoing: agencies had bribed doctors to bring them new patients, enrolled patients without their knowledge and ditched patients when they approached the Medicare reimbursement limit.

Every so often perpetrators of hospice fraud get their comeuppance, as in the case of the owner, CEO, operations manager and medical director at the Merida Group, which runs a network of hospices across Texas. All four were found guilty of roles in a scheme to make false and fraudulent claims to Medicare totaling more than $150 million. Between 2020 and 2023 they were sentenced to more than 41 years in prison combined. But overall, there has been so little oversight of the hospice sector that the rot has spread largely unchecked.

Perhaps it should not come as a surprise, then, that according to a recent survey, the U.S. is a pretty lousy place to die. In an analysis of how well countries around the world deliver end-of-life care, the U.S. was ranked 43rd out of the 81 countries assessed, despite being one of the wealthiest nations. The U.K., whose hospices are generally not-for-profit, took first place.

We must fix hospice. It’s an unquestionably daunting task, but last April, after reviewing the effects of private equity on the system, the nonprofit Center for Economic and Policy Research proposed a three-pronged approach that serves as a road map to reform. It advocates for strengthening and enforcing existing policies, such as screening hospice providers carefully for eligibility to receive government payments. It also recommends updating policies to account for the involvement of private equity firms in hospice by, for instance, better preventing anticompetitive mergers and acquisitions. And it argues for developing new policies to close loopholes that can be exploited by corrupt agencies, including moving away from the flat-fee payment model toward one based on patients’ individual needs.

Complete Article ↪HERE↩!