An advanced care directive, living will and healthcare proxy all document important choices with regard to medical treatment preferences. But what about day-day life leading up to that? If you were to learn that your time of functional living was about to end, where would you like for that to take place? With or without people around you? If with, who might they be? Making choices and knowing they will be honored can help loosen fear’s grip when it comes to dying. End-of-life preferences help to define what one considers a good life to the very end to be and most importantly, how best to live in support of that. I think of what I do as end of life doula work, supporting good life through final breath for good death in the end. If that sounds right for you, contact me - the sooner you plan, the better life can be!
My Process for Providing End of Life Care
Getting to Know You
During a complimentary consultation, I ask prospective clients and their care circle to provide some relevant background, along with current needs and future wants. Reviewing this information helps to determine what kind of value and comfort I can provide. It also lets me know about arrangements, documents and plans that may already be in place. Depending on circumstance, our work together may begin in that same visit or be scheduled for soon after. Given the commitment required, I rarely accept more than one actively transitioning client at a time. Consults may take place in person, over the phone, or remotely via web, based on logistical practicality. Easily commutable destinations are within a 1 hour drive of Red Hook, Dutchess County, New York. Travel with overnight accommodations are an option anywhere in the US.
Scope of service and fees are provided in writing based on assessment at the time of agreement. Dying is not a process that can be predicted with guaranteed accuracy, therefore a mutual sense of fairness and trust is necessary. Service fee range is $75 - $250 per visit, with option for comprehensive services at one set fee. When travel and lodging are required, additional fees apply. Appropriate in-home accommodations will be considered.
Work With the Dying
I’m a friend, confidante, advocate, and assistant. This starts by sitting down and talking, with sincere interest in learning about you. Whether it is in a hospital room or at home, my purpose is to gauge and support needs beyond clinical. I strive to maintain the kind of open, candid communication that helps to smooth the bumps in the end-of-life road. Even when communication is not possible through spoken word, soothing touch, presence, and observation enables connection in ways that support you. In the best ways possible, your choices will be upheld. You and your care circle will be well tended to, and also, given space as needed for the process. Concerns will be addressed, dignity will be honored.
Care Circle Work
One of the biggest misconceptions about being an end-of-life doula is that the work is 100% focused on the dying. It’s actually a balance between the dying, their loved ones and their caregivers. Because these roles are often fluid, overlap, and go beyond family of origin, I simply call it the care circle. To get started, I strive to understand what everyone’s comfort and awareness levels are with end-of-life care, and what they’d like to know more about. My role is to support everyone’s ability to be as comfortably present as possible with things as they are, providing information with compassion as things progress. Whether waiting in the wings, offering guidance, or taking the lead, the level of my active involvement is dictated by the needs of all in the care circle, respecting preferences of the dying above any other.
Determine a Care Plan
Once I get to know all of the parties involved, we will determine a cadence where I can check back in and also respond as needed. Sometimes it might be a longer period of time until I am needed again; other circumstances may require daily or weekly check-ins and phone conversations. Progression and support needs are the determining factors.
Physical Care Standards
I am willing to assist with basic care needs, washing up, food preparation, room freshening. Needs change as stages change. At some point, those tasks will be replaced with different services. Instead of washing up, I may be placing and replacing cool compresses. Instead of food preparation, I might be explaining to loved ones why ingestion of food or drink could actually cause greater discomfort than following the natural tendency to forego nourishment when the body is no longer able to swallow, digest or assimilate it. In addition to room freshening, I may be setting up things to abide by predetermined final choices. Even without having discussions in advance, I find it easy to learn and follow ways to create a conducive atmosphere for who the person is and what their preferences might be. I am not a nurse or licensed personal care assistant, therefore I do not provide medical or personal hygiene services. I will, however, assist in advocating for them as needed from those whose purpose is to provide them.
Other Things We Can Do
Beyond talk, beyond standard care, yoga, breath work, meditation, and reiki are things we can do to ease the process that is unfolding. Yoga, not the kind portrayed on glossy magazine covers but the seed of the roots of yoga...coalescing body, mind, and breath through practices that include one or a combination of the three. At least 5000 years old, there is no arguing the success of that kind of longevity. Reiki, the hands-connecting-energy system developed by Usui Mikao, is still in its infancy by comparison. As a Reiki master and long tenured yogi, both are so natural to me that I think they were in my dna before training certifications gave me license to share them. If these things are not within your comfort zone, they are not tools I will use. If you do not have experience with them but are open to learning about them, I will fully explain and like all my services, customize accordingly to preference and need.
With the emergence of certain indicators that active death is in-process, a corner is turned and the view changes. Organ function markedly decreases, with lessening response to stimuli and a seeming withdrawal from connection to the external world . While vital signs do provide physical indicators of death’s progression, time left is highly variable on factors known and unknown. Things such as age, pre-condition health, inner readiness, unresolved conflict, and even presence of others may impact its trajectory. At this time in the process, I am very clear in support of the language and presence needed for optimal nurturing of the individual experiencing these changes. The intensity may be too difficult for some to witness, or, it may be that the care circle is dedicated to remaining present with support to do so. Whatever the circumstance, it is with deepest understanding and reverence that I serve to hold hands and hearts as determined by each changing moment.
Coming back to your life after the death of someone meaningful to you can be deeply affecting. The aftercare I’m able to provide is not professional mental health counseling, nor is it meant to be a substitute for it. It is simply loving human connection that allows for gentle honesty in recognizing all that took place. Having a non-judgmental, yet intimately familiar sounding board allows one to acknowledge and vet the myriad of feelings that are a natural part of processing death. Aftercare conversations honor connection with the person who died, and just as importantly, the lives of those remaining. While death may bring profound grief, relationships in life can be complicated and sometimes conflicting feelings swirl around. When you’re ready to bring them to the surface, I’m ready to listen.
Are you an eldercare administrator, or does your healthcare facility intersect with patients and caregivers who are dealing with death? Integrating end-of-life doula services with your practice can be transformative in providing comfort and companionship for everyone involved. Let's promote quality end-of-life care together!
Holistic Wellness Partners
Positive death awareness arises through learning to venture beyond feelings of fear and anxiety about death and dying. Deeper realization about what matters most in life and death can expand capacity to consciously choose living a good life to the very end, and inspire greater support of others to do the same. Holistic wellness centers are fertile ground for germinating these seeds, day by day, life by life. Let’s work together to cultivate conscious wellness, one and all!
Events and Workshops
My experiences and uplifting stories about life and death could have strong positive impact and be a memorable addition for your next retreat or workshop. If your organization is holding an event that is adjacent to living well/dying better, hospice care, or aging, invite me to speak!