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Inside the rise of human composting and other green burial practices

The quest to save the planet doesn’t end when your life does.

By Vanessa Taylor

Everybody’s going to die. That’s a fact of life. And there’s one thing everybody who dies has in common: We all got bodies. And when we die, something needs to happen with them. Most of the time, this involves cremating or embalming and burying — processes that tend to emit a lot of harmful chemicals into the atmosphere. But with our climate apocalypse creeping ever closer unless we change our ways, conventional funerary practices are no longer cutting it. Enter: the green funeral movement.

Many Americans have been trying to pursue green funerals for a while. Traditional embalming and bury-in-a-coffin approaches involve the use of about 20 million feet of wood, 4.3 million gallons of formaldehyde and other embalming fluids, 1.6 million tons of reinforced concrete, 17,000 tons of copper and bronze, and 64,500 tons of steel, according to the Green Burial Council. Cremations are increasingly popular, likely because they’re often billed as the more environmentally friendly option of after-death care, but it’s harmful in its own way: It’s estimated that cremations in the U.S. alone account for about 360,000 metric tons of carbon dioxide emissions every year.

If you look online for truly green funeral practices, you might see the more creative forms like eternal reefs or biodegradable burial pods. There are also companies like Return Home, which specializes in human composting, getting into the game. Return Home’s human composting method is a 50-day process that begins with the body being placed into a wooden cradle with organics like alfalfa and sawdust at the bottom. From there, the body is covered with more plant material and placed into a special HVAC system.

“The most important part of this [is] that we believe the body should not be altered at all,” Return Home CEO Micah Truman tells Mic. “By that we mean we don’t cut, grind, or separate at any point.” At most, Truman explains, Return Home sometimes has to reduce down the remaining bone at the end of 30 days to make for a suitable end product. But after that, he says, “We have soil that we give back to the families.”

In order to make a burial “green,” says Caitlyn Hauke, president of the Green Burial Council International, you just need “to not inhibit decomposition, allowing the body to go back to the earth naturally.”

That means a green burial can be as simple as ditching aspects of conventional burials that are bad for the environment. For example, each year, over 8,000 gallons of formaldehyde — one of the chemicals used in embalming — is put into the ground with dead bodies. But this chemical doesn’t stay inside of dead bodies forever; it leaks. Forgoing the embalming process can do a lot for sustainability.

Caskets themselves can be quite an issue, too. According to Milton Fields, the amount of casket wood buried each year is equivalent to about 4 million acres of forest. There’s also the use of concrete. As Carol Lilly, a professor of history and the director of international studies at the University of Nebraska at Kearney, tells Mic, “Many cemeteries insist on using concrete vaults for all burials because they help to prevent ground sinkage and thus serious maintenance problems.” But to produce just a single pound of concrete releases 0.93 pounds of carbon dioxide.

“Green burial” is a new term for an old practice.

Changing the funeral industry to be more sustainable might seem like a big undertaking. But the problems with conventional funerals are actually quite new. As Lilly explains, “Death rituals and funerary practices in the United States have changed dramatically over the past 200 years.”

And because funeral traditions vary widely between different faiths and groups, some communities’ death rituals are closer to being sustainable than others. “Funeral service is a highly segregated industry, both in terms of race and in terms of religion,” Truman, the CEO of Return Home, explains. “I’m Jewish, and there are Jewish funeral homes. There’s an African American funeral home downtown that builds a lot of community there. And that’s the way it’s always been.”

This separation isn’t necessarily bad. Sarah Chavez, the executive director of the Order of the Good Death, a death acceptance organization, tells Mic, “There are often so many small details that need to be adhered to [in funerals] … It can be a big comfort to know that your needs will be accommodated without having to teach someone what has to be done, and explain why it is so important.”

In looking at how death rituals vary, it’s important to remember that “green burial” is a new term for an old practice. “What we call green burial has always been practiced by people of Muslim and Jewish faiths because of their beliefs,” Chavez says. In Islam, it’s customary for bodies to be washed and shrouded, in a process known as ghusl. The bodies are then buried as quickly as possible either without a coffin (if local laws permit) or in a plain wooden one, which is biodegradable. Similarly, in Judaism, bodies are washed without embalming, wrapped in a plain shroud, and buried in a wooden casket without any metal or nails.

In the U.S., handling the dead used to be much more of a family affair. The phrase “funeral parlor” comes from visitations once being held in a family’s home “parlor” room, Lilly explains. It wasn’t until after the Civil War that embalming become hugely popular and funerals became professionalized. Death rituals — once deeply personal — were gobbled up by the new funeral industry.

“Although funeral home employees are largely well intended … Americans have become too far distanced from our deceased loved ones as a result, which may make the grieving process even more difficult,” Lilly tells Mic. “Death in American society during the 20th century became overly sanitized and often almost invisible.”

The U.S. has once again been taking up a cultural transition — this time towards green burials. In 2018, a survey by the National Funeral Directors Association found that nearly 54% of Americans are considering green burials, and 72% of cemeteries said they were seeing an increased demand, too.

“Our younger generations are teaching us how to die better.”

Since its launch in July 2020, Return Home has helped 45 families across various communities. Truman has found a bittersweet theme among his clients. “One of the most amazing things that’s happened to us is that young people are personally requesting it,” he shares. “It’s been unbelievable. Painful, but amazing. … We’re realizing that our younger generations are teaching us how to die better.”

But this shift in learning how to die better is about more than changing how people are buried. Overall, it’s a massive reexamination of how death is approached in the U.S. As Chavez says, it’s not just about “how these spaces can be used to care for the land, but each other — especially people from historically marginalized communities who are often not able to access the end-of-life options they desire.”

This can take shape in a number of ways. There can be community funds to help address funeral costs. Green burial practitioners can also do more to honor cultural differences, like accommodating ancestral rituals that need to be held at gravesites or holding ceremonies like Quinming, Obon, or Dia de los Muertos on funeral grounds. In the same vein, cemeteries can also respond to tragedies within their communities, rather than seeing themselves as a depoliticized site.

“Community altars are often created in response to deaths stemming from violence or police brutality,” Chavez says. These altars are often torn down by state officials in ways that can compound a community’s trauma. “Green burial grounds might consider creating a community altar or garden, providing an alternate space for collective mourning.”

Death itself isn’t evil. And while some might find it uncomfortable, neither is decomposition. At the end of the day, people are from the earth, and we’re meant to return to it. As Truman says, “It’s absolutely vital that we make sure the last thing we do on this planet is give back.”

Complete Article ↪HERE↩!

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What It Feels Like to Mourn a Parent in Your 20s and 30s

Grieving is never easy, especially when you belong to a generation that can find it difficult to grow up.

by Olivia Atkins

We expect to outlive our parents, but dealing with their death while still transitioning into adulthood hits hard. Millennials are increasingly adulting later in life, whether through choice or due to a lack of job and housing security, continuing to act care- and commitment-free for longer. With the late 20s and early 30s believed to be the best years of your life, as suggested by a recent YouGov survey, what happens if this generation – commonly characterised by their inability to grow up – lose a parent?

“Grief is difficult at whatever age but it’s particularly challenging for people bereaved in their 20s and 30s because it’s likely that not many of their friends have experienced something similar,” says Nici Harrison, grief worker/transformational coach and founder of The Grief Space, a platform supporting loss through workshops, retreats and grief circles.

A parent’s death can be a long and drawn out process or a sudden and unexpected event. Young people may take longer to adjust and accept their situation because they have less infrastructure and routine in place, and fewer resources to fall back on.

Harrison knows this all too well. She launched The Grief Space in 2020 after losing her mother to suicide, when she was 23. Despite her mother living with depression for many years, her death was still a shock and the recovery process, painful.

“My grief took me to unimaginable depths,” she says. “I felt separated from the world. It changed me; I had therapy but I needed space to express the magnitude of my experience and meet others who had lost parents. I learned about grief tending [the practice of allowing time and space to nurture grief] and the philosophy around welcoming [grief] in. I wanted to create what I wish I’d had… so I started The Grief Space.”

The Grief Space provides a platform to learn and understand grief. She cites poor communication as the biggest issue around processing death: “People don’t have the language to explain that they don’t want others to make it better; they just need to be witnessed. It’s difficult talking about the persistence of grief, how it can change the entire landscape of our lives and leave us in a perpetual state of loneliness.”

“I didn’t know anyone who had been through anything similar,” says Rachel Wilson, who lost her mother to cancer when she was 26 and is releasing a book about her experiences next year titled Losing You(ng): How to Grieve When Your Life is Just Beginning. Although her mum was diagnosed a year earlier, rather than preparing her for what was coming, the news brought on anticipatory grief.“I felt isolated and disoriented following the initial diagnosis,” she says. “I was in denial for most of the time she was ill. It was difficult leading a ‘normal’ 25-year-old life; finishing my Master’s degree, interviewing for jobs and going on dates, knowing that at some point I was going to have to face up to my mum dying.”Guilt can be induced through disassociation around a parent’s death. This can be triggered by not being fully present during a parent’s final moments or detaching from your own life experiences. While Wilson’s friends were supportive, she felt disconnected by their inability to relate. She reached out to her favourite – now defunct – podcast, The High Low, for advice and was connected to listeners with similar experiences, whom she met.

These meet-ups quickly expanded, forming The Grief Network, which now runs monthly meetings, events and talks. Rallying a community together and leaning on available support networks – whether through remaining family or friends – can help with grounding emotions, while being surrounded by those that know you prior to the loss or knew the deceased can be reassuring.

In 2015, at 26, Emily Thornton lost her mum to a brain tumour-induced seizure. Despite throwing herself back into work, she credits her friends for getting her through. Luckily, many understood having also lost a parent, but she admits: “Everyone copes differently… Selfishly you expect the world to stop when your loved one passes. Grief is full of ebbs and flows but my friends have been the kindest, most patient people. Small gestures help massively.”

Her friends send her flowers annually on her mum’s birthday, Mother’s Day and the anniversary of her death; they even ran Race for Life to commemorate her passing. Thornton also uses tarot cards to guide her through life; they connect her to her mother, who was also interested in tarot. She is at ease with her journey, having had visits from her mum in dreams affirming her process.

Lina Barker’s mother died suddenly and unexpectedly when she was 25. Hailing from a Muslim family where traditions require the dead to be buried as soon as possible complicated things for her – especially with her mum based abroad: “Everything happened extremely fast. I found out that my mum had died around 7AM in the morning and by 8PM, I was on a flight to Tanzania. The minute my sister and I landed, we were ushered into her funeral. I didn’t have a moment to digest or process my thoughts.”

On returning to the UK more people came to pay their respects, but Barker was so overwhelmed that she moved abroad to process the death on her own terms. “That’s when it hit home and the real mourning began. It was hectic when my mum died; moving to the Netherlands provided time for me to focus on my grief.”

Logistically, pulling together a funeral can be a stressful and emotionally-triggering affair, but it can also serve as a cathartic process, reinstate autonomy in an otherwise uncontrollable situation. “I helped arrange the funeral with my brother and father,” says Wilson, “I wrote my mum’s eulogy and did a reading; and we carried her coffin together. Because she died of cancer, she was also involved in the planning, which was comforting.”

Inevitably, there can be even greater strains with processing the death of a parent if all responsibilities fall to the child. Lisa Smith, who requested anonymity to protect her identity, lost her estranged father aged 23, after his long battle with a debilitating illness. Though she’d had a difficult relationship with her father since her parents had separated – he had been emotionally abusive towards her mother and stolen from others – she was legally tasked with handling immediate practicalities, like organising the funeral and wake.

“​​There is a surprising amount of admin related to a person dying,” says Smith. “My dad died without leaving anything behind to pay his funeral costs so I had to arrange a payment plan to deal with it. I felt extremely let down that he hadn’t thought to set aside some funds to ensure it wouldn’t fall to me. It was crushing watching the payments leave my account each month; they only made my grieving process harder.”

This financial burden and associated stress isn’t surprising given that the average cost of dying in the UK totals £8,864, with a basic funeral priced at £4,056 – which is staggering considering that millennials (those currently aged between 22-39 years old) earn an average annual salary of £29,180.25.

Soon after losing her father, Smith had a friend go through the same process but rather than relate to her experience, she couldn’t help but compare situations. Her friend inherited enough money to go travelling and buy a house.

“I really struggled with the fact that there were no silver linings for me,” says Smith. “I dealt with this by spending recklessly when I couldn’t afford to. I felt that after what I had been through, I deserved to have nice things and enjoy my life so I racked up thousands of pounds of credit card debt buying clothes, getting my nails done and going out. I am now working to pay off my outstanding balance.”

Grief can provide the affected with new ways of thinking and an opportunity to reassess priorities. Smith admits she was relieved by her father’s passing. She relied on Cariad Lloyd’s Griefcast podcast and Swedish “death cleaning” – a process of decluttering life and organising – to restore her peace. For Barker, the process connected her to her emotions despite initially avoiding the pain of losing her mum. Wilson prioritised her physical and mental wellbeing, while Thornton realised the importance of spending time with her remaining family.

Losing a parent while still easing into adult life can remind you how precious and fleeting time is. Young people are willing to creatively seek community and find alternative coping mechanisms to support their grief – whether in the form of spirituality, therapy, escapism or friendship – but it’s an individual process.

“Everything that you feel is welcome,” says Harrison. “Find support and look after your body; grief is exhausting. Tend to your grief, create space and allow it to shift – I promise it always changes. You never have to ‘get over this’ but you will expand your capacity to hold it and find a way to build a new life around it.”

Complete Article ↪HERE↩!

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Doctor accused of killing 14 patients with fentanyl acquitted of murder

William Husel hugs his wife, Mariah Baird, after the doctor was found not guilty on 14 counts of murder in connection with fentanyl overdose deaths of former patients on April 20 in Columbus, Ohio.

By Brittany Shammas & Timothy Bella

William Husel, an Ohio doctor who was accused of killing 14 patients with what prosecutors described as “wildly excessive” doses of fentanyl between 2015 and 2018, was acquitted on all counts of murder Wednesday, concluding one of the most significant murder cases of its kind against a health-care professional.

Husel, a onetime physician of the year trained at the Cleveland Clinic, faced one count of murder for each of the 14 critically ill patients he was accused of killing. The jury deliberated for seven days before finding him not guilty on all 14 counts in what was one of the largest murder trials in Ohio history.

He had been charged with causing or hastening their deaths amid a period of lax oversight of fentanyl at Mount Carmel West, a Catholic hospital in Columbus. Husel would have faced life in prison with just one guilty verdict.

While the synthetic opioid is significantly more powerful than morphine and has wreaked havoc on American streets, it can provide pain relief in medical settings that is crucial to end-of-life care. The alleged victims in the Ohio case suffered critical medical conditions including overdoses, cancer, strokes and internal bleeding. Prosecutors acknowledged that all were being kept alive on ventilators and that many of them were dying.

“In truth, William Husel was an innocent man, and thank goodness the justice system prevailed,” Jose Baez, one of Husel’s defense attorneys, told reporters.

The 46-year-old’s acquittal came after a two-month trial that triggered a debate on end-of-life medical care. Husel and Baez argued in the trial that the doctor offered comfort care for dying patients and was not trying to kill them. They pointed out that the doctor’s actions did not occur in secret — nurses were the ones to administer the doses — and alleged that hospital officials made Husel the villain after realizing the systemic failures at play. The fallout over the allegations at Mount Carmel West had repercussions: the firing of 23 employees; the resignation of the hospital’s chief executive, chief clinical officer and chief pharmacy officer; and Medicare and Medicaid funding for the institution was put in jeopardy.

But Franklin County prosecutors alleged that Husel gave patients amounts of the opioid far beyond the norm. He ordered 1,000 micrograms of fentanyl for multiple patients — about 10 times the recommended dosage, according to prosecutors. One of the patients, 82-year-old Melissa Penix, was given 2,000 micrograms of fentanyl — 20 vials of it, all at once. The amount of fentanyl given to her, which was about 20 times the recommended dosage, depleted the entire supply of the medication available in the ICU that night, Franklin County Assistant Prosecutor David Zeyen told jurors.

Joel Zivot, an associate professor of anesthesiology and surgery at Emory University and the sole witness called by Husel’s defense, told The Washington Post that he was relieved the jury determined that disease, not fentanyl, caused the 14 deaths.

“Physicians intend to provide comfort at the end of a person’s life, and the idea that the intent was murder simply by the action by giving someone pain control was unprecedented and ultimately shown to be a false accusation,” Zivot said.

The Franklin County Prosecutor’s Office released a statement commending the prosecution and defense for their work, adding that the office accepted the jury’s finding Husel not guilty.

“The Jury after review of all the evidence was not convinced beyond a reasonable doubt that William Husel was guilty of any charges submitted to them,” the prosecutor’s office said in a statement. “We accept the jury verdict.”

The case came to light in the fall of 2018 when, Mount Carmel West has said, pharmacists voiced concerns about doses ordered by Husel, an anesthesiologist who had been employed at the hospital about five years and worked on the skeleton crew of overnight intensive care. He was well liked in the ICU and known for his willingness to teach those who worked alongside him.

In total, at least 35 people may have been given excessive doses, the hospital said after a review. All of them died; the hospital said five might have had a chance to improve. Officials alerted police, and Husel was charged in June 2019 with 25 counts of murder. Prosecutors dropped 11 of the charges.

During closing arguments in the trial this month, Zeyen argued that even if the patients were dying and Husel thought he was acting in their best interest, killing them still constitutes as a crime.

“That is what you do to sick animals. That’s fine in veterinary science,” Zeyen said. “That is not fine in the ICU at Mount Carmel.”

Baez responded by referring to Husel’s pledging to provide comfort to the patients, noting that the doctor had much to lose.

“Why would this man risk his family, his career, 17 years of trying to be a doctor, every single thing he has worked for, to hasten someone’s death or to kill them?” Baez asked during closing arguments.

Zivot told The Post that he reviewed each of the cases and concluded that Husel offered the kind of care that any doctor would have provided for end-of-life treatment.

“Dr. Husel did the thing that doctors do in that he provided some fentanyl for the purpose of mitigating what we imagine to be the pain of dying, and that’s it,” he said. “We cannot know what it feels like to die; we can only imagine it. We fear it, and we are concerned about that. If we can’t stop someone from dying, at least we can reduce the pain associated with dying.”

When Common Pleas Court Judge Michael Holbrook read each verdict of not guilty, Husel’s wife, Mariah Baird, watched and smiled before hugging her sister, reported the Columbus Dispatch. After all 14 counts came back as not guilty, Husel wiped away tears.

Even with his acquittal in the murder trial, Husel still faces more than 10 lawsuits from the families of patients. Several of the families have settled lawsuits worth about $13.5 million, according to NBC News.

Baez emphasized to reporters that he felt “terrible for all of the patients’ families suffering again.” But, he said, he hoped they took comfort knowing that a jury concluded that it was their loved ones’ critical illnesses, and not the opioid, that resulted in their deaths.

“Hopefully they take solace that their loved ones’ last moments were in peace and not as a result of a doctor being afraid to make them comfortable,” he said

Complete Article ↪HERE↩!

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The stunning rise of cremation reveals America’s changing idea of death

It’s now more popular than a traditional casket burial, and twice as common as it was two decades ago. What does that say about us?

An urn-filled atrium inside Green-Wood Cemetery’s crematory building in Brooklyn. By 2040, 4 out of 5 Americans are projected to choose cremation over traditional burial.

By Karen Heller

In his half-century in the death business, Richard Moylan has never experienced years like these.

As president of Brooklyn’s Green-Wood cemetery, he spends his days managing the historic site where families have spent the past couple years tending to loved ones lost to the pandemic. But the bigger change had been building before then: the choice to routinely cremate over traditional casket burial of years past.

At the height of the pandemic, Green-Wood’s crematory burned constantly, 16 to 18 hours daily. A wall recently collapsed. Maintenance costs spiked. Last year, 4,500 bodies entered the five chambers, a 35 percent increase over 2019.

So many ashes to ashes, so much dust to dust. Cremation is now America’s leading form of final “disposition,” as the funeral industry calls it — a preference that shows no sign of abating.

In 2020, 56 percent of Americans who died were cremated, more than double the figure of 27 percent two decades earlier, according to the Cremation Association of North America (CANA). By 2040, 4 out of 5 Americans are projected to chose cremation over casket burial, according to both CANA and the National Funeral Directors Association (NFDA).

>This seismic shift represents potentially severe revenue losses for the funeral industry. It’s leading innovators to create a growing number of green alternatives and other choices that depart from traditional casket funerals. And rapidly shifting views about disposing with bodies have also led to changes in how we memorialize loved ones — and reflect an increasingly secular, transient and, some argue, death-phobic nation.

“Some people want it over and done with. You wonder if they’ll come to regret that later,” Moylan says of cremation. “With cremation families, a lot of them don’t want to know what we do or how we do it or don’t care to know what you can do with a cremated body. This generation just doesn’t want to do the three-day-long funeral home thing.”

The stunning increase in cremation is “the single greatest change in our funeral practices in our generation or, I’d venture to say, in the last couple of centuries,” says Thomas Lynch, a Michigan poet and funeral director of 50 years. “People want the body disappeared, pretty much. I think it reminds us of what we lost.” In the United States, Lynch notes, “this is the first generation of our species that tries to deal with death without dealing with the dead.”

Other countries have been quicker to embrace the practice, like Japan, with a rate of almost 100 percent, in part because of its high density and paucity of burial grounds. Cremation is central to Hindu and Buddhist funeral practices, releasing the soul from the body. But Judaism, Catholicism and Islam resisted it, because of views about the sanctity of body and spirit in death. Though the United States’ first crematory opened in 1876 in Washington, Pa., Americans were slow to acceptance. They were just queasy about the practice. It took a century or more to evolve.

The rising cremation rate is “upending truly conventional ideas of how death and commemoration work,” says University of Southern California professor David Charles Sloane, the author of “Is the Cemetery Dead?” who grew up in one, his father a cemetery superintendent in Syracuse.

Traditional burials often use valuable space in high-density areas and may involve embalming chemicals, and non-biodegradable caskets with metal linings. But critics of cremation counter that it is dependent on fossil fuels and emits greenhouse gases.

They argue that cremation can also have a desensitizing effect on families. It can be too easy. For some, it’s drive-through death. For others, cremation offers the opportunity to control and personalize life’s final ritual.

CANA estimates that 20 to 40 percent of cremated remains are interred in a cemetery — placed in the ground or a columbarium, a storage area for urns — while 60 to 80 percent are buried in another location, scattered (Walt Disney World a favored site) or kept at home, on the mantel or stashed in a closet. Some families bypass any ritual, be it saying goodbye to the body at the crematory, holding a funeral or establishing a permanent memorial. There’s resonance in a body that forces families to deal with death. “The body is the incarnation of our mortality and our emotional loss,” Lynch says.

“Some families see it as: ‘I did my job. They’re cremated.’ They just get frozen about making a decision from there,” Sloane says. “I don’t think it’s a lack of caring. It’s just confusion

CANA executive director Barbara Kemmis counters, “There’s this assumption that the funeral director is the only person who can provide a meaningful death ritual.” Her family chose to travel to Colorado and scatter her brother’s remains in a national park, a celebration that still resonates almost three decades later. “The cremation rate is 100 percent being driven by the general public. It’s all about what grieving families want. They’re creating their own traditions, their own experiences.”

For most of history, death was a constant of daily life. Disease was rampant. Children died all the time. Mothers died in childbirth — where often the child died, too. Wars created entire graveyards of young men and boys. People acknowledged life’s transitory nature by placing reminders on the paths they traversed routinely — not by sticking cremated remains in an urn in the basement. The dead were laid out in homes and buried on family property. They were memorialized in art and photography; their hair became keepsakes tucked in lockets and pins. They were commemorated in stone, both modest and grandiose

In the 19th century, “rural” cemeteries at the edge of growing cities, like Mount Auburn in Cambridge, Mass. (1831), Laurel Hill in Philadelphia (1836) and Green-Wood (1838), were welcomed as parks.

Six decades ago, when the U.S. cremation rate was less than 5 percent, Jessica Mitford advocated for it as an affordable option in her searing, best-selling expose of the funeral industry, “The American Way of Death.” Her advice was not widely heeded, even with the Catholic Church’s 1963 lifting of its prohibition on cremation (though Islam and Conservative and Orthodox Judaism still prohibit it). Rates barely budged for years.

“Of all the rituals that humans do, death rituals are the most stable and least likely to change,” says Boston University professor Stephen Prothero. In the two decades since he published “Purified by Fire: A History of Cremation in America,” Prothero has been astonished by the soaring acceptance. “I’m a historian. I’m always skeptical of projections. I thought they were way too high — but I was wrong.”

Cremation finally skyrocketed as America became increasingly secular. Last year, the number of people belonging to a house of worship dropped below 50 percent for the first time since Gallup launched the poll in 1937.

Americans also started to recognize the convenience of cremation and its lower cost. Comparisons are challenging because of the many options, but the median price of a funeral with burial and viewing is $7,848, according to the NFDA, while the median cost of direct cremation is a third of the price at $2,550. Cremation with viewing and funeral is comparable to traditional burial, with a median cost of $6,970.

For families scattered across multiple states, there often seems little point in investing the effort and expense to bury a loved one in a cemetery no one will visit. Like pet food and leisure footwear, cremation is now available through direct-to-consumer websites such as Solace and Tulip.

Cremation is more popular in states that vote Democratic, include large transient populations or endure brutal winters that make the earth frozen solid. (Canada’s rates are notably higher than those of the United States.) Cremation rates already hover near or over 80 percent in Nevada, Washington, Oregon and Maine. They remain half that in Utah and many Southern states with large religiously observant populations.

Caitlin Doughty, a mortician, advocate and author, says funeral directors haven’t done enough to address contemporary Americans’ wishes.

“The cremation rates are telling us something. They’re screaming at us that people are not happy with what is available,” she says. “Cremation is more a rejection of the traditional funeral industry than an acceptance of cremation.” She craves innovation and meaning: “We need safe, beautiful ways to engage with death.”

The pandemic generated profound loss. In 2021, almost three-fourths of American counties reported more deaths than births. The age-adjusted death rate spiked more than 19 percent, according to the Centers for Disease Control and Prevention, following a nearly 17 percent increase the previous year

Americans are nowhere near finished with spikes in death. The number of residents over 65 will nearly double in the next three decades, according to the Social Security Administration. The nation will experience a quarter more deaths by 2050 than it did in 2019. Deaths are projected to peak in 2055, according to the U.S. Census Bureau

Despite these escalations, many families have become no more adept at planning for the inevitable. “There is this hyper-optimism of America. You’re supposed to look on the sunny side of life, which also mitigates a full experience of grief,” Prothero says. Mourning is not always accorded its due. Bereavement leaves transpire in days.

Some who have lost a loved one revel in defying convention and remaining joyful. Families uncomfortable with the solemnity of traditional funerals have replaced them with birthday-like celebrations of life

When families choose cremation, they sometimes do so without a sense of long-term consequences. Elisa Krcilek, a funeral home vice president in Mesa, Ariz., where 80 percent of the families request cremation, says: “We’ve got to do a better job informing people that there’s a time to say goodbye and a place to say hello. The moment you scatter someone, you’re done. People need a memorial, to be remembered.”

As our supermarkets make clear, Americans crave choice. And with an increase in annual death has come more choice for dealing with bodies.

Many new ideas pick up on people’s willingness to eschew a casket, but are considered more environmentally viable than cremation. They include green burials (where the body is interred in a shroud or a biodegradable container so it naturally decomposes in the ground), natural organic reduction (human composting), promession (freeze-drying the body), infinity burial suits (a mushroom suit accelerating decomposition), and alkaline hydrolysis (a water-based, energy-efficient cremation process).

“If there’s anything that is going to slow down or reverse the cremation rate in the United States, it is green burials,” says Kemmis, the CANA executive director. “People are looking to the greenest final disposition so that our deaths will reflect our lives.”

Founded in spring 2019 Recompose in Seattle is the nation’s first company to offer natural organic reduction. The body is laid in a vessel on a bed of wood chips, alfalfa and straw and transformed into soil over 30 days, enough to fill a pickup truck, for a flat fee of $7,000. Some families take some soil for personal use; about half donate it to a forest or farm. Subscribers to Recompose’s newsletter about “the death care journey” have swelled to 25,000. “People are looking for different options,” says Recompose outreach manager Anna Swenson. “Cost is a factor. Cultural beliefs are a factor. Guilt is a factor. The environment is a factor.” Recompose plans to expand to 10 facilities during the next decade.

New initiatives have met resistance from state legislatures and the funeral industry. Change is costly for the nation’s 18,874 funeral homes, many operating on slim margins, with consolidation frequent. Cremation, where the chamber heats to an optimum temperature of 1,400 to 1,600 degrees Fahrenheit, requires an average of two to three hours; alkaline hydrolysis, with Bio-Response Solutions’ machines starting at $174,000, can take 16 to 20.

Natural organic reduction is legal only in Washington, Oregon and Colorado. Promession is approved in Sweden and South Korea. Alkaline hydrolysis, which requires expanding the legal definition of cremation to include water, has been approved in 22 states but is available for humans in only 14.

Pets are another matter. West Laurel Hill Cemetery in suburban Philadelphia is home to the state’s first alkaline hydrolysis machine, which resembles an oversize fish poacher. In four years, 90 pets have been reduced to a fine white powder similar to baking soda, beginning with a five-foot-long alligator named Sheldon.

With a move away from burial and as families opt for less expense, some industry officials worry that some cemeteries will fall into disarray. “We’ve always had dead cemeteries, family cemeteries where family died out or the farm got sold or the church was disbanded,” Sloane says. With fewer burials, he notes, many cemeteries “are struggling to maintain themselves.”

Older, urban ones have different challenges. “The march toward cremation is a good thing for a cemetery like Green-Wood that’s running out of room,” Moylan says

Many historic sites have transformed themselves, hosting cultural events, membership programs and death cafes where people discuss life’s final passage. Hollywood Forever, founded in 1899, was on the brink of foreclosure in 1998 before new ownership added author discussions, podcasts, outdoor movie screenings and a massive Dia de los Muertos celebration. These events not only provide additional funding but build awareness at a time when cremation is king. “Ultimately, we’re building affinity with the community,” says Laurel Hill and West Laurel Cemeteries president Nancy Goldenberg.

Cemeteries are adapting to attract families interested in green alternatives, promoting them as a return to earlier practices. At West Laurel Hill, 258 people have pre-purchased space in the natural burial site, which was once the cemetery’s landfill site. In a century, the burial ground will be transformed into forest. Graves are hand-dug by shovel, rather than a gas-fueled backhoe loader. “People want to return to the earth in a very purposeful way,” says arboretum manager Aaron Greenberg.

More Americans are choosing to die at home or in hospice with loved ones nearby, according to a 2019 study by the New England Journal of Medicine, as people did for centuries, rather than in hospitals. “Passing away at home is bringing death into a place that matters,” Sloane says. “This could lead to more personalization and how we memorialize.”

Lynch, the poet and undertaker, says he would like to see more cremations that are witnessed, with families present at the last moments before the body enters the chamber. “Cremation should be public, not private.”

Death needs to be honored as it long was, advocates contend, as fully observed as life’s other events. “It would be great if more emphasis was placed on something special for the individual. If it’s personalized, it will have more meaning for the family,” Moylan says. He’s excited about green burial and alkaline hydrolysis, choices that are better for the environment. And when his time comes, Moylan says he will probably choose cremation, “probably because it’s the easiest thing to do.”

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In end-of-life care, hospice can ease angst

Knowing what to expect and when to begin will benefit patient and caregiver

By Lisa Kanarek

In fall 2020, my 94-year-old father was discharged from a hospital with orders for hospice. I didn’t know what to expect. Although over three months, his appetite had diminished along with the strength in his legs, I avoided researching end-of-life care. It turns out I’m not alone.

“People stay away from discussing hospice because they feel like it means they’re giving up and can’t do anything further,” says Diana R. Kerwin, chief of geriatrics at Texas Health Dallas Presbyterian and president of Kerwin Medical Center.

Hospice services were introduced in the United States in 1974. The goal of hospice is to keep someone as comfortable as possible when they’ve decided to stop seeking further medical treatment. With hospice, a team of health-care professionals — including a physician, a nurse, a social worker and a spiritual care provider — work together to minimize patients’ pain and focus on their needs.

Unfortunately, the confusion and misconceptions surrounding hospice can keep a family from seeking the service for a loved one and cause them to suffer needlessly. Knowing what to expect and when to begin hospice can help alleviate the anxiety and uncertainty surrounding end-of-life care, experts say.

“Everyone in this country is entitled to hospice,” says Dawn Gross, attending physician of Palliative Care Service at the University of California San Francisco, and medical director of ANX Hospice.

“To be eligible,” she says, “two physicians must agree that the person has a prognosis of six months or less to live, should the illness run its natural course without intervention. That does not mean the person must die within those six months.”

In 2018, 1.55 million Medicare beneficiaries in the United States used hospice. But according to a study in the Journal of the American Geriatrics Society, each year, nearly 1 million individuals who may be eligible for hospice die without using it.

According to a 2018 study in the Journal of Pain and Symptom Management, “a significant cause of low overall hospice utilization and intractably low median lengths of stay, reflective of late admissions, can be attributed to” difficult and variable prognoses “for most of the leading causes of death among Medicare beneficiaries.”

So, when should a patient or their family talk to their physician about starting hospice care?

“You should think about hospice when your daily quality of life is significantly impaired and when the treatments are not going to change the outcome,” Kerwin says. “That includes a person’s ability to stand up and walk around, eat, feed themselves, get up and go to the bathroom, communicate, and recognize others.”

Hospice falls under the umbrella of palliative care, but some people confuse the two. Gross says hospice focuses on maximizing the patient’s quality of life using all treatments necessary to relieve the symptoms of a terminal illness, including physical (such as pain, nausea and shortness of breath), psychosocial (anxiety, depression and insomnia) and spiritual (existential suffering, which need not be connected with a religious belief). On the other hand, palliative care is designed to support quality of life at the same time a person is receiving cure-focused/disease-modifying treatments.

Gross emphasizes that hospice-care professionals do not move into a person’s home. If someone has worsening symptoms that are out of control, a licensed vocational nurse, a registered nurse or a home health aide could stay for eight-hour shifts until the patient is once again comfortable.

“The hospice benefit covers all care provided by hospice,” she says. “This includes medications that are treating symptoms as well as equipment intended to improve quality of life, such as an adjustable hospital bed, bedside table, an oxygen compressor, and all hospice team member visits.”

During my father’s time in hospice care, nurses stopped by my parents’ home twice a day and were available by phone to answer questions. But I was responsible for administering medication — morphine and a small amount of Ativan to relieve anxiety — and ensuring that my father was comfortable in between visits.

Payment options for hospice care include Medicare and Medicare Advantage, Medicaid (benefits vary by state), Tricare (which provides health benefits for active military personnel and retirees and their dependents), and CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs). Most private insurance obtained through employers or state exchanges also pays for hospice care.

“It’s important to know what your private insurance covers related to hospice costs,” says Amy Tucci, president and chief executive of Hospice Foundation of America. “Some policies will cover all hospice-related expenses, while others may cover much less.”

Tucci says that for those without insurance, hospice providers will often work with families and may charge on a sliding scale according to what the family can afford, or they may use charity funds if available to reduce out-of-pocket expenses.

My father, Joseph Kanarek, couldn’t wait to come home from the hospital. Without the help of hospice services, we would not have been able to provide care at home, where he was surrounded by family.

While 71 percent of patients prefer to be at home receiving hospice services, not everyone has family or friends available to tend to them, according to a 2016 survey. A nursing home, a hospital with a floor dedicated to hospice and palliative care, or a hospice facility are all options for receiving hospice care. Custodial care such as housekeeping or private caregiving, which hospice team members would not provide, is not covered by the hospice benefit.

“Before deciding on a particular agency, shop around,” says BJ Miller, a physician, co-founder of Mettle Health and co-author of “A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death.” “Hospice is a service like any business; there are different qualities. So if you live in a place where there are multiple hospice agencies available to you, interview them.”

Hospice is a two-way street; people can come and go as needed. Miller explains that sometimes people sign onto the service, feel better and are discharged from hospice. If patients do not like it and decide to try a new treatment that’s coming online, with the stroke of a pen, they can sign off legally, he says. This process is called revoking hospice care.

“It’s an administrative burden, but it’s no big deal,” he says. “Then your old insurance will kick in.”

Predicting the exact day of death can be challenging, but there are a few indications of when the end is near.

“We’ll see people have very distinct changes in the pattern of breathing,” Gross says. “They take pauses, or what is medically referred to as apnea, in their breathing. They seem to be holding their breath, leaving those at the bedside wondering whether they are going to take another breath.”

As the 2019 study in the Journal of the American Geriatrics Society found, hospice services are underused, especially among those with non-cancer illnesses. As more people learn about the benefits of hospice, they may be less hesitant to request the service.

“Hospice is not something to be afraid of,” Kerwin says. “It’s taking steps to be sure yourself and your loved one is provided comfort and compassionate care as well as support at the end of life’s journey.”

Less than four months after my father passed away, I helped my sister-in-law give her dying father morphine and other medication throughout the night. Instead of feeling anxious, as I did when I was in her role during my father’s final hours, I felt a sense of calm.

This time, I knew what to expect.

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Knowing Someone Has Your Back At The End Of Your Life

By Sara Zeff Geber, PhD

While we were celebrating Passover and Easter with our loved ones and family, National Health Care Decisions Day came and went. It was on Saturday, April 16. It was designated to remind us that no matter our age, planning for the inevitable day when we cannot make our own health care decisions is more than a good idea; it is essential. Not planning for that inevitable event is like flying a plane that you don’t know how to land. The only people who don’t need a plan are those who meet their demise like my father: standing and talking to a friend one minute, and in an instant was lying on the floor – dead. If you are sure that is your fate, then don’t waste your time doing any planning. However, be advised that the ultimate result of not providing end-of-life instructions is that when you find yourself in the hospital toward the end of life (as many people do), the hospital ‘care protocol conveyor belt’ takes over and you will be hooked up to whatever life-support is available to keep your body nourished and your heart pumping.

What Do People Want?

Let’s look at some facts and some history about end-of-life care. Studies on end-of-life preferences demonstrate quite clearly that the vast majority of people want to die at home. However, because of a lack of willingness to talk about preferences for end-of-life care and advance care planning, over one-fifth of patients still die in the hospital. If your wish for the end of your life is an extended stay in an acute care unit of a hospital, hooked up to machines designed to keep you alive, then by all means ignore all of these statistics and opportunities to make other choices. My friend Mitch, a retired ER doc, told me how frequently he watched as family members argued about whether to keep their elder relative alive through extraordinary measures (feeding tube, mechanical ventilation, urinary catheterization, dialysis, etc.) or to let them die a more natural death. Often these well-meaning relatives were confused about what the elder wanted, or remember hearing it differently than another relative. In the end, and in the absence of written instructions, the final decision was almost always “keep her alive.”

End-of-Life Care Will Cost You

For those who still are not convinced that planning is the best way to ensure an end-of-life experience that is under your control and as comfortable as possible, you may also want to consider the cost implications of hospital care versus palliative or hospice care at home.

End-of-life costs for people with chronic diseases can be $57,000/yr. and up. Medicare will generally pick up most of that, depending on medigap coverage, pre-approvals and cooperating providers, and how long you are expected to live, but one study found that out-ot-pocket expenditures for end-of-life treatments and care are still averaging close to $12,000., with a range that goes up to close to $100,000. in the final year of life.

Medicare has covered hospice care since 1983 and usage of this benefit has slowly been increasing. In 2018, for example, 50.7% of those who died had taken advantage of hospice care for their final weeks or months of life. The savings associated with using hospice, rather than in-hospital care or a nursing home is estimated to be $117.-$400. per day.

The best-known way of creating an advance directive (also known as a healthcare proxy or power-of-attorney for health care decisions), is to work with an attorney who specializes in estate planning. They will suggest that you create a full set of end-of-life documents, which usually includes a will, a power-of-attorney for financial decisions, an advance directive, and possibly a trust. They will give you a worksheet and have a series of discussions with you about your preferences for end-of-life care and who you would choose to make decisions for you about your health and finances if you could not make them yourself. In addition to denial about the urgency of creating these documents, the cost of a complete estate plan can range from $1000-$8000., depending on how complex it needs to be.

Quick and Easy Advance Directive Online

If you are now convinced that advance care planning is important and necessary but you aren’t ready to do the full estate plan, there is a way to produce and file just the advance directive document, online – and it’s free! Since 2009, Vital Decisions has worked with individuals through health insurers to set up their wishes, should they be unable to communicate their wants at the end of life. Today, in addition to their insurance partners’ clients, they also offer a free program for the general public. It’s called My Living Voice and it guides you through three stages of preparing an advance directive: 1) setting a healthcare proxy 2) Talking through values 3) Goals of Care and Treatment wishes. So check it out, in honor of National Health Care Decisions Day, and give your loved ones the peace of mind of knowing what you want at the end of your life. Plus, it will give you peace of mind that you have communicated your final wishes to those who will be making decisions for you when you cannot.

Complete Article ↪HERE↩!

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Sadness and Loss Are Everywhere. Books Can Help.

By Margaret Renkl

I was 10 when “Brian’s Song” aired in 1971 as an ABC Movie of the Week. It is the story of the abiding friendship that grew as Brian Piccolo, who was white, and Gale Sayers, who was Black, competed for playing time as N.F.L. rookies with the Chicago Bears. It’s also the story of Piccolo’s death of cancer at 26. I was a girl in Birmingham, Ala., then “the most segregated city in America,” when “Brian’s Song” reminded this country that race was not an insurmountable barrier to love.

Of course I read “I Am Third,” the 1970 memoir by Gale Sayers from which the film was adapted, as soon as I could get my hands on it. When the bookmobile librarian suggested that I might also like “Death Be Not Proud,” John Gunther’s heart-wrenching account of his 17-year-old son’s death from a brain tumor, I devoured it too.

I was not a child obsessed with death; I simply wanted to understand how the world works. My friend Mary Laura Philpott read the same kinds of books as a child, and for the same reason.

“The more I saw and heard of the real world, the more I came to suspect there was sadness everywhere, and if I was going to live in this world, I should understand its scale and reach,” she writes in her acclaimed new book, “Bomb Shelter.”

Reading stories is a gentle way for a child to encounter the hardest truth that shadows mortal life: There are no happy endings.

“The first problem love presents us with is how to find it,” writes Kathryn Schulz in her new memoir, “Lost & Found.” “But the most enduring problem of love, which is also the most enduring problem of life, is how to live with the fact that we will lose it.” Many stories solve the first problem. Far fewer admit that the second even exists.

Books about loss tell us something about our own nature. They remind us that we belong to a species capable of carrying on when we think we can’t carry on any longer. Death is just part of how the world works. It’s part of how we ourselves work.

“No part of an embodied life is guaranteed except for death,” writes Tallu Schuyler Quinn in her new essay collection, “What We Wish Were True.” To face it — however haltingly or furiously or tearfully, or on a carousel of all those swirling feelings — is to be fully alive.

Ms. Quinn was the beloved founder of the Nashville Food Project, which addresses food insecurity. Last summer, when I wrote about her life and mission, she was working on a collection of essays drawn in part from her CaringBridge journal about living with a terminal brain cancer. Ms. Quinn died in February. The book will be published on Tuesday.

I did not know Ms. Quinn personally, but even from a distance I know that her life was a bright testament to the power of serving others. I know, too, that she could write like an angel, with poetry and humor and a bone-deep understanding of the way love and grief walk hand in hand through the world together, twinned: “As these tumors hold court in my mind and mix me up in these sad and terrible ways,” she writes, “I find shelter in new thanks and new praise and in another day — and even in how healing these salty tears taste pouring into my open mouth as I wail my thanks for this unexpected, unbelievable, boundless shelter of love.”

There are reasons to worry that a book which confronts the essential inevitability of death, especially the untimely death of a human being in love with the world, someone who never seemed to waste a minute of her one remarkable life and is heartbroken to leave it behind, will be a book many readers will fear to face.

After all, we are still in the midst of a pandemic that has taken millions of people from their loved ones. We are watching in real time as bombs fall from Ukrainian skies and Vladimir Putin’s ground forces slaughter innocent people. The hunger Ms. Quinn fought so hard to alleviate will inevitably worsen as inflation rages. In such a world, who could bear to read a book which the writer herself did not live long enough to see into print?

But the human world has always been just this tragic, just this unbearable, and the literary world has always given us reasons to understand the gifts such books can offer — not in spite of the tragedies we witness and live through, but because of them — if we don’t turn away.

We’ve all had near misses that shook us to the core: when a hydroplaning car skidded to a stop in the nick of time; when a toddler, unwatched for half a second, teetered at the top of a flight of steps but was caught just before stepping over the edge; when the scan showed a shadow that had to be a tumor but turned out to be nothing at all.

And every near miss is almost always followed by a golden time, too brief, when the futile frustrations and pointless irritations of daily life fall away, when all that’s left behind is gratitude. We are here. Our beloveds are here. How remarkable it is to be together. How full of grace the fallen world can be.

“What We Wish Were True,” like so many end-of-life memoirs that came before it, and so many others still to come, is for readers a kind of literary near-miss experience. Its beauty reminds us to linger in the grace. Its wisdom teaches us to treasure the ordinary pleasures we ought to have been treasuring all along.

“I think about everything I will miss, and what I won’t be alive to witness or experience or endure or bounce back from,” writes Ms. Quinn. “No singing show tunes in the minivan. No burnt toast with butter in the mornings. No snuggling up to watch cooking shows. No walks together circling the neighborhood we love so much.”

Whether it comes before or after we turn the last page of a book, we know the ending of every human story. “If an ending could be changed through strategic planning or force of will or the sheer love of life, things would go differently, but this cannot be changed,” Ann Patchett writes in “These Precious Days.”

It cannot be changed. The finality of that truth is breathtaking.

But “What We Wish Were True” is not a book about dying any more than “Brian’s Song” is a movie about dying. It is a book about the life of an extraordinary person. It is a book about love and gratitude and making every day an opportunity to love, a chance to decide, again and again, to keep on loving for as long as we draw breath. And, through the miracle of books, beyond it, too.

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