Embracing the Role of the Death Doula for Your Hospice Patients

Many people know about the role midwives and doulas play in managing pregnancy and childbirth, but few are familiar with the concept of the death midwife, also known as a death doula. This person helps patients and their loved ones cope during the end-of-life phase. Life and death are both natural processes, but many people struggle to come to terms with the emotional difficulties of dying. Your homecare agency can enhance emotional support during this time by hiring a death doula to accompany your services.

Let’s go over the role of death doulas and answer some questions about how they operate and how they can deepen your homecare agency’s services during the end-of-life process.

What is a death doula?

A death doula helps manage the transition between life and death. During this time, a doula may act as a companion to the dying patient or as an advocate for the family’s needs. By nature, this role is holistic and highly personal. It depends a great deal
on what extra support the patient and family may require.

Death doulas are becoming more popular because they are filling a need created by the way families and communities are currently structured. In the past, communities were closer-knit and family members were nearby; today, that may not be the case. Death doulas can play a key role in bridging the gaps that can arise  in companionship and end-of-life care, especially when a patient chooses to die at home.

What services does a death doula provide the dying patient?

A death doula will work to comfort the dying patient and coordinate legacy activities. Some common activities may include:

• Listening actively, leading light conversation, answering a patient’s questions, helping them find peace
• Providing comfort through reading and companionship
• Using anxiety-reducing techniques such as guided visualization, meditation and massage
• Refreshing their room with pillows, candles or beloved objects
• Suggesting and supporting legacy projects, gifts and/or letters
• Discussing end-of-life wishes

What services does a death doula provide the family?

A death doula works closely with family members to meet their needs during this difficult time. Many family members describe a death doula as a calming, supportive presence in the process. A death doula can provide a variety of support options, including:

• Identifying the needs/preferences of the family
• Providing respite care
• Discussing end-of-life planning, such as advanced care directives, vigils, after-death body care, funeral planning and memorial services
• Planning last hours of life, including goodbyes and favorite activities
• Suggesting and supporting legacy projects, gifts and/or letters
• Facilitating difficult conversations and advocating for the family’s rights
• Coordinating domestic care, such as housekeeping, lawn care or pet care
• “Just being there” to provide companionship and support

In addition to the acts of care listed above, a death doula can be beneficial to the patient and family in other ways. Often a professional caregiver isn’t there 24/7, so there are long breaks when a patient may be alone. Death doulas can cover some of these hours, providing comfort in those final weeks of life.

Death doulas may also provide emotional and spiritual support that is missing from the traditional hospice care experience. With their mere presence, a death doula can provide a shoulder for a family to lean on.

Why should home hospice providers partner with a death doula?

Your home health and hospice agency may need extra support during the end-of-life phase, as the act of dying can be a time for all hands on deck to ensure patient and family comfort. In this case, you should reach out to a death doula. They will listen to both your agency’s needs and the patient’s needs to create an end-of-life care plan that works for you and the patient. It’s important to find a doula that you and the family feel a certain chemistry with, as this person will be involved while care services are performed.

Home hospice providers who have experience working with death doulas find that it’s great for enhancing the end-of-life experience. A death doula will coordinate with your agency’s hospice nurses and workers to fill care gaps and provide more emotionally oriented activities for the family and patient. They should work closely with family and professional caregivers, taking the time to understand the caregivers involved and coordinate with them to provide end-of-life care. It’s also common for doulas to get a clear sense of caregiver gaps, such as respite care. You should work together in order to make sure that their services complement those your agency already provides. The overarching goal is for each patient to receive an enriching end-of-life experience.

Are death doulas certified?

It’s important to note that a death doula is not a medical professional and doesn’t have a medical role in a patient’s care. For example, they can’t prescribe pain medication or take vitals. Instead, a death doula provides emotional and spiritual support.

There’s currently no credentialing body for death doulas. However, all death doulas should have appropriate training. Training courses are offered by accredited organizations such as the International End of Life Doula Association (INELDA), the Lifespan Doula Association and the University of Vermont. When you search for a doula, make sure they have the required training.

Also note that death doulas aren’t typically affiliated with any particular religion. In fact, doula services are often designed to be universal. Whether your patient adheres to a specific religious tradition or not, a death doula can still be appropriate.

How do you find a death doula?

You can start your search for a death doula on the INELDA website, which lists trained death doulas by locale. I also recommend talking to friends and family about their experiences with death doulas. Ask your patients and their families if this is a service they would benefit from.

While being a death doula is a service to the dying patient, it is not typically a volunteer position; however, you may also be able to work with an organization that provides volunteer death doulas to work at some care facilities. Some death doulas will charge rates by the day or by the hour, or they may charge an overall fixed price. If you are bringing a death doula onto your staff, you should discuss pricing to understand how the service will affect the patient’s final bill.

Death doulas play a comforting role during the dying process. Consider hiring a death doula for your homecare agency to get the emotional support your patients need during their transition from life to death.