Death is not a fun topic, but failing to talk about end-of-life plans results in a lack of preparation and exacerbates emotional strain when a loved one passes away at home.
If your loved one opts to live out their final days in their house, or if you care for an elderly spouse or parent who’s in the advanced stages of Alzheimer’s disease, they could die at home. Are you prepared? What are your loved one’s end-of-life wishes? Would they choose to pass away at home? Is hospice care an option, or is a hospital setting a better choice for your circumstances? Medicare often pays for hospice care.
Why some people prefer to die at home
Passing away at home is often preferred by critically ill or older individuals. According to the Stanford School of Medicine, studies indicate that 80% of Americans would choose to pass from this life surrounded by what’s familiar to them, preferably at home. However, many don’t get their wish. Only 20% of Americans die at home, while 60% die in acute care hospitals and 20% die in nursing homes.
People prefer to die at home for various reasons, but perhaps control is a primary contributor. The family can manage who comes and goes, providing an opportunity to gather, reminisce, and properly say goodbye. Caregivers administer palliative care in a comfortable, familiar environment rather than one that is foreign and starkly sterile.
Hospice care will assist with pain management, and no heroic actions are taken to resuscitate the patient, who is allowed to slip away. Depending on the laws in your state, you may be able to keep the body at the house for a period of time, and some families may choose to have the funeral at home, too.
How to prepare for a death at home
Preparing to die at home is a process that must occur before the person’s final days. If you or a loved one has been diagnosed with dementia, it is essential to decide in the early days of the condition, while the decision is still yours to make. Caregivers and loved ones, acting as surrogates, can carry out your wishes, but only when they know what they are.
Advance directive
An advance health directive is crucial to securing end-of-life wishes. It’s a legal document containing the patient’s desires. If the patient is incapacitated, the document expresses their values regarding end-of-life processes. These include whether first responders and healthcare professionals will administer CPR, if the patient will donate organs, and what comfort measures will be in place during the dying process.
When a person dies at home unexpectedly and without an advance directive, first responders typically can’t pronounce them dead, as required by law. Paramedics transport the remains to the nearest hospital emergency room, where a doctor will pronounce them. If hospice is in place, the hospice nurse can pronounce the person’s death at home, and the family arranges for a funeral home to remove the remains.
Without hospice, a living will, or an advance directive, the family must call emergency services when their loved one dies at home. Paramedics, possibly firefighters, and police officers will arrive at your home, but only a doctor or coroner can pronounce death.
Understand that without the proper documents in hand, paramedics have to follow protocol and will often begin administering emergency procedures and transport your loved one to a hospital where a doctor with authority to pronounce can do so. There are exceptions to this rule depending on where you live, and in some cases, paramedics are permitted to pronounce.
Following death
Some states require an autopsy when a person dies at home. If the deceased was advanced in age, an autopsy might not be necessary. In either case, you must make arrangements for transportation to a funeral home or crematorium. Don’t be shy to ask about cost. Funeral homes are required by law to provide that information when requested.
There is much more to preparing for death at home than what we can briefly discuss in this column, including the emotional and spiritual aspects and mourning through the grieving process. Mourning is necessary and healthy, and it’s futile to try and skip it. Grief will rise to meet you in unexpected places and at random times. A grief counselor, pastor, trusted friend, or family member can help you through the mourning process. You don’t need to mourn alone.
It’s impossible to aestheticize death, but we still try. Shortly before the pandemic reached lockdown level last year, my 101-year-old grandmother died. When my mom proposed that I help her dress the body for the viewing, I obliged despite the fact that I creep out with ease. My grandmother was such a central figure in my life and I wanted a more private opportunity to say goodbye.
The experience fulfilled that expectation, but it also taught me that the process of prepping a body for burial is a vivid reflection of our relationship with societal beauty standards—an interminable dance that continues even after we die.
When we arrived at the funeral home the day before the viewing, the staircase leading us to the room where her body was kept felt like it spanned miles. What if she suddenly reanimates? If I tugged on a limb too hard, would it detach from the rest of her body? Once we got started, my anxieties were assuaged but my curiosity piqued. I knew that mortuary makeup was a common practice, but I didn’t anticipate how thorough the grooming would be; her skin had to look supple, her cheekbones had to look lifted and her complexion had to appear even and, at minimum, rosy-adjacent, given the circumstances.
The most shocking sight, though, was seeing the funeral director stuff my grandmother’s bra. After eight children and 101 years, the jig on perky breasts had long been up. So, what was the reason?
“I don’t know how I feel about stuffing bras, but it’s definitely something that embalmers do,” says L.A.-based funeral director Amber Carvaly. “It’s very commonplace and the idea is that people will look different laying down. But they’ll obviously look different because they’re dead and they’re lying in a casket.”
In a 2018 episode of Keeping Up with the Kardashians, Carvaly gave Kim Kardashian—who is, by many standards, an archetype of the eternal fascination with youth and beauty—a step-by-step on mortuary makeup. To elucidate the idea behind the practice to me, Carvaly compared it to the philosophy behind Kardashian’s controversial Balenciaga Met Gala look. Basically, we each have distinct signatures that we like to be known by while we’re alive and ideally, these become the attributes that we’re remembered by after we’re gone. Which means that it’s never ideal for a dead person to actually look dead.
“Kim’s image and who she is and what she looks like is so iconic that you don’t even have to see her face or an article of clothing. She can just be draped in black and you know exactly who she is. Like that’s her brand and her icon.”
In the funeral industry, this would be likened to a “memory picture”, a term Carvaly introduced me to during our chat. In essence, it refers to the lasting image of a decedent that’s ingrained in the minds of their loved ones. “It’s a memory of who they used to be,” she explains.
It wouldn’t be a stretch to liken our desire to make the dead look life-like to the ongoing obsession with looking younger, or to attribute the latter to a society-wide fear of dying. This is something that can’t be color-corrected, concealed, or glossed over.
“We are obsessed with image as society and as individuals,” Carvaly says. “But this idea is implanted while we’re alive. As women, we’re so obsessed with anti-aging and it sort of emerges from a fear of death.” Carvaly says that this even shows itself in how beauty trends evolve. “They change to keep us looking younger and if you wear a trend that’s from the past, it dates you,” she says.
We want the memory picture to capture our loved ones at their best, so the measures that we go to to bring corpses to a perceived standard are just symptoms of the widespread idea that younger is always better.
“We’re a death-denying society,” Carvaly adds. “We don’t like to talk about it, we don’t like to accept it, we don’t like to look at dead bodies because all of it just reminds us of our own mortality. We do so much of that while we’re alive, so of course it carries into death. We don’t even want to look at old ladies on screen—we only want to see people when they’re young and beautiful.”
But while this is a reflection of Western culture’s image-conscious underbelly, the process itself was therapeutic for me. My grandmother died overnight and I slept through my mom’s calls and texts to come to the hospital. Helping to dress her felt like an atonement for not being there, beckoning back to times when I would paint her nails, help to pick her church hats, or watch her apply baby powder with a glamorous, fluffy powder puff. It’s how I cared for her and how she cared for herself. “I think that from a standpoint of beauty as a ritual and beauty as a way to care for people, it’s something different. It’s grooming as a form of love instead of beautification to suit industry standards,” Carvaly tells me.
When Carvaly’s friend Maria passed away, applying makeup to her corpse was a way of honoring how she liked to be seen; while she was alive she was seldom seen without a red lip. “If someone had been like, ‘Don’t put lipstick on her!’ or, ‘She’s dead. Don’t glam her up,’ she would have haunted us,” Carvaly recalls.
Both my experience and the concept itself are multifaceted: I was comforted by the ritual, but alarmed at the extent to which it was practiced. We beautify the dead mostly with the living in mind: to filter the intensity of seeing a corpse, to create a comforting pre-funeral ritual, and to pacify the most pressing reminders of our own mortality. But our discomfort with aging and death is tampering with how we live, and that’s something that no amount of makeup can mask.
Olena Koval found out that her husband was dead via text message. He was shot by Russian soldiers inside their home in Bucha while she was sheltering nearby, their neighbors told Human Rights Watch. In the days that followed, despite the brutal cold and her spinal disability, she made repeated attempts to recover his body but was turned back each time by the soldiers’ threats.
As the atrocities escalated, Olena fled Bucha to save her remaining family. Before their departure, she left a note with a neighbor that marked where her husband’s body was, hoping someone could give him a burial.
War is synonymous with death, but its emotional toll extends beyond the loss of life. The inability to say farewell to one’s loved ones and lay them to rest can often be just as painful.
Humans have always cared for their dead – so much that archaeologists often consider mortuary rites among the traits that distinguish Homo sapiens from other species. In other words, it is a fundamental part of being human.
Paying respect
Humans’ close relatives also showed concern for the dead. The Neanderthals practiced burials, and other extinct hominids probably did too. Even chimpanzees appear to grieve over deceased relatives. But no other species goes to such extraordinary lengths to care for its dead.
As an anthropologist, I have spent two decades studying rituals, particularly those that can seem “extreme.” At first glance, these customs seem puzzling: They appear to have no direct benefits but can feel utterly meaningful. A closer look, however, shows that these seemingly senseless acts express deeper, profoundly human needs.
Take funerary rites. There is a practical need to dispose of a dead body, but most burial customs go far beyond that requirement. Among the Toraja people of Indonesia, for example, deceased family members are kept in their homes for months or even years. During that time, their relatives treat them as if they were still living: They offer them food, change their clothes, and bring them the latest gossip. Even after their funeral, their mummified bodies are exhumed, dressed up, and paraded around town on ceremonial occasions.
Residents participate in a funeral procession to honor ancestors in Tana Toraja Regency, South Sulawesi, Indonesia.
The Toraja are not alone. In Madagascar, I have visited communities where people lived in fragile reed huts, at the mercy of frequent deadly cyclones, as the only robust brick-and-mortar buildings in the area were used as tombs. And in the ancient city of Petra in Jordan, the architectural masterpieces carved into the rock by the Nabataeans two millennia ago were resting places for the dead.
Those practices may seem like outliers, but they are not. In all cultures, people clean, protect, embellish and carefully deposit their dead. Muslims wash and shroud the body before interring it. Hindus may bathe it with milk, honey and ghee and adorn it with flowers and essential oils before cremation. Jews keep watch over the deceased from the time of death until the burial. And many Christians hold wakes at which family members gather to pay tribute to the deceased.
Creating closure
Funerary rites are ostensibly about the dead. But their importance lies in the roles they play for the living: They allow them to grieve, seek comfort, face the reality of death and find the strength to move on. They are deeply human acts, which is why being deprived of them can feel devastating and dehumanizing.
This is what is happening in Ukraine.
In besieged cities, people cannot retrieve the bodies of their loves ones from the streets out of fear of being killed. In other cases, Ukrainian officials have accused the Russian army of burying victims in mass graves to hide war crimes. Even when they are retrieved, many of the corpses have been mutilated, making them difficult to identify. To people who have lost their loved ones, the lack of a proper send-off can feel like a second loss.
Tanya Nedashkivs’ka, 57, mourns the death of her husband at the site where he was buried in Bucha, on the outskirts of Kyiv, Ukraine, Monday, April 4, 2022.
The need for closure is widely recognized to be indispensable – not only by anthropologists and psychologists, but also first responders, governments and international organizations. This is why armies go to great lengths to return the remains of fallen soldiers to their families, even if that takes decades.
The right to a burial is acknowledged even for one’s foes. The Geneva Convention stipulates that belligerents must ensure that the bodies of enemies are “honorably interred” and that their graves are respected and “properly maintained and marked so that they may always be found.”
Given the importance of those rites, it is also striking that the Russian defense ministry has reportedly been reluctant to bring their own dead back home, because they are concerned with covering up the scale of the losses. This seeming indifference to the suffering of Russia’s own people and their need for closure may be yet another act of dehumanization.
Your end-of-life experience may be very different depending on where you live, according to a Policygenius report.
The report ranks the best and worst U.S. places to die based on funeral costs and services, green burials, palliative care, Medicare providers, at-home deaths and probate shortcuts.
Your end-of-life experience may be very different depending on where you live, according to a Policygenius report that ranks the country’s best and worst places to die.
The report gave each state and the District of Columbia a numerical score based on seven factors, including funeral costs and services, green burials, palliative care, Medicare providers, at-home deaths and probate shortcuts.
“I think the big takeaway of this project is to get people thinking about the costs associated with the end of life,” said Logan Sachon, senior managing editor of research at Policygenius. “Because some of them can be mitigated through planning.”
“If you look at the top 10 and bottom 10, there aren’t any specific things they all have in common,” Sachon said. “They are each kind of unique in their own way.”
Indeed, Vermont, ranked as the No. 1 place to die, was among the most expensive for funeral costs but scored highest for palliative care, which focuses on pain relief, management and emotional support.
Florida, known for its high population of retirees, came in last place, with the fewest Medicare providers per capita, and scored low for at-home deaths and palliative care.
The best places in the U.S. to die
Vermont
Utah
Idaho
Ohio
South Dakota
Maine
Colorado (tie)
Illinois (tie)
New Hampshire
Washington
The worst places in the U.S. to die
Florida
Alaska
Texas
Hawaii
New York
Georgia
New Jersey
North Carolina
South Carolina
Connecticut
It’s never too early for older Americans to prepare for end of life, Sachon said.
Experts recommend an advanced directive, also known as a living will, covering your medical care preferences. You’ll also need a health-care proxy or power of attorney, naming someone to make medical decisions on your behalf if needed.
Estate planning
The report also focuses on each state’s probate process, which determines the cost and time it takes to settle your estate.
As of June 2021, only 17 states and the District of Columbia have an estate or inheritance tax, according to the Center on Budget and Policy Priorities.
With different laws in every state, a local estate planning attorney may share some options to protect your assets and carry out your wishes, depending on where you live.
There’s no federal estate tax on wealth below $12.06 million for individuals in 2022, and with proper planning, married couples can transfer their unused exemption to their surviving spouse, effectively doubling it to $24.12 million.
However, this reverts to an estimated $6 million exemption in 2026 when provisions from the Tax Cuts and Jobs Act sunset.
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.”
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.
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.
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.”
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.”
Very few people are comfortable discussing matters related to death. In some cultures, it’s even taboo to do that. Despite social mores and psychological hurdles, there are businesses that thrive around the passing of family members and friends. The state environment might be the last thing on people’s minds when burying their loved ones, but it might shock them to learn that, even in death, we continue to harm the planet that has given us so much in our life. Since it’s a rather morbid topic that very few probably want to broach, it took vision, courage, and ingenuity to design a product that offers comfort to the bereaved while also giving back something to the environment, making sure that we continue to live on, even if in a completely different form.
Unless we have relatives or friends in the funeral business, we probably never give much thought to what pretty much becomes the last bed our body lies in. Presuming, of course, you don’t go for cremation or other practices and traditions. Few might have given any thought to the materials used for coffins, for example, and simply presume that they eventually decompose and disintegrate along with the human body. That, unfortunately, isn’t the case, and most of our funeral practices, be it burial or cremation, actually continue humanity’s crimes against Mother Nature.
The Living Coffin, which also goes by the less morbid name of Living Cocoon, shatters those misconceptions and even offers a way for people to make amends with the planet once they’ve ended their earthly journey. Instead of the typical materials used in coffins, which often use harmful chemicals or non-biodegradable materials, the “box” is actually made of mycelium. Or rather, the coffin is grown from a type of mushroom that is known for being nature’s biggest recycler.
The idea is not only for the coffin itself to return to the soil but also to transform dead organic matter into nutrients needed to grow plants. Yes, it basically turns your dead body into compost that could nurture new life. Instead of a cemetery filled with concrete, dead matter, and pollution, a burial site can actually become the start of a new forest, with each tree forever marking where your loved one was laid to rest. Inside the coffin is a bed of moss, rather than fabric or plastic, which helps the process along without poisoning the soil.
It is admittedly a novel concept that could unsettle some folks, but it is also a simple yet effective way to make sure that we leave behind a good legacy, no matter how we have lived our life. One of the things that people are advised to do in order to live forever is to plant a tree, but few of us are able to do so during our lifetime. The Living Coffin ensures that we’d still be able to do that after our death and could even have a tree to our own name.
