This year at the CANA convention, I’m proud to cover a new topic on how we all serve our cremation families. As a group, we value the presence of the person and often encourage the family to see their loved one for not only identification purposes, but also because we know that the experience can be valuable in grief processing. We discuss this concept from a “front of the house” perspective often, but what does it mean to our prep room staff?

All of us who are in funeral service and caring for the dead are well aware that they come to us in various conditions. We also know that it is our job to observe these various conditions and prepare them in a way that is suitable for whatever disposition they are going to have. The industry term for preparation without embalming is “minimal care” however, that does not mean our efforts should be minimal. If we consider the most thorough method of preparation embalming, we can use it as our benchmark. However, not everyone gets embalmed, but that doesn’t mean that any preparation we do should not meet the highest level of care that embalming provides.

Those of you who are reading this are likely embalmers (or know embalmers), so you are well aware that embalmers feel very strongly about giving the correct treatment to the deceased in their care. However, what does that actually mean, and how does it apply to preparing someone who is not going to be embalmed?

CLEANLINESS
The first step of any thorough embalming is to bathe the person. Not only do we do this for safety reasons, but also to conduct case analysis (see the next section), and have a better understanding of what we are dealing with.

Embalmers are sometimes told by institutional care staff, death investigators, and even sometimes the family that the condition of the body is worse than it actually is, and a thorough bathing can actually create more of a peace of mind rather than reveal problems.
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During this phase, all medical devices should be removed whether the person is going to be viewed by their family or no one other than the person placing them in the cremation container. We do this for safety in the crematory, because some implants can explode or melt, but also because used medical devices are trash and should be disposed of properly.
A reasonable embalmer removes all of the medical devices they can from a person before presenting them, and if this is our ethical standard of care, then this should be done regardless. You wouldn’t expect a person to be buried with garbage, in fact the idea is repulsive.

CASE ANALYSIS
One of the first things embalmers do when presented with a body is their case analysis. We observe the physical condition of the body in order to decide our strategy for fluid selection, feature setting, and dealing with any possible unknowns that may occur during the embalming such as swelling, purge, etc. But, if we are not embalming, what can we do? In this case, we still observe any pathological or other medical treatment outcomes this person may have. Medical devices should be removed and dealt with, and lesions should be treated appropriately with surface preservation (if allowed), sutured, or wrapped in bandages to prevent leakage.

BEDSIDE MANNER
By definition, embalming is always mutilation, which is one of the reasons we have to receive permission from the family before doing it. However, we embalmers bristle at this idea, because we are not in the business of mutilating people, we are preparing them for the most difficult event in a family’s life. We rectify this more negative perception by always minimizing the number of invasive procedures necessary, and we do so in a way that is careful and surgical.

Believe it or not, embalmers must have a bedside manner even though their patients have no idea how – or even that – they are being treated. We know how they are being treated. When we are preparing an individual who is not going to be embalmed, we always have to consider the technique we are using and recognize what is surgical and what is mutilation.
Further, perhaps one of the reasons a family is choosing not to have someone embalmed is because they do not recognize the care we put into it. Exceptional care of the deceased and proper bedside manner in any invasive procedure is not only ethical but respects the family’s wishes as well.

So now we have established three points on what to set our benchmark at when caring for an individual, but how do we apply this to a more practical manner? Presupposing compliance with all OSHA regulations and Universal and Standard Precautions, as well as observing the family’s wishes, providing minimal care does not mean compromising the quality of your care for their loved one.

To create a basis for our continued conversation on best practices of care, I have created an outline for you to consider. The outline described below is just that, an outline. This list is not meant to define limitations on best practices, but rather create marks on a spectrum.

CLEANLINESS
When it comes to embalming, the word “clean” is often used interchangeably with the word “disinfected.” So how does that apply here? Closely observing and cleaning the person often uncovers medical outcomes such as bedsores or fluid pockets that are the result of the ante mortem or post mortem settling of fluids. Furthermore, moving the body from one side to another will reveal possible purge that may have not been otherwise apparent when the person was lying supine. There are different levels of cleanliness that may be available based on what the family wishes and what is possible based on the condition of the body.

1. Basic disinfection: Basic disinfection procedures should be taken regardless of whether or not a family is planning to view their loved one. This would include the removal of all medical devices and bandages, surface disinfection using a spray, and removal from a soiled container into a clean one.
2. Mid-Level disinfection: This would include all of the above listed steps in addition to bathing the person, including washing their hair. Once the person has been thoroughly dried, it would also include the replacement of bandages over punctures from medical devices, and suturing of any surgical incisions. It would also include the draining of any fluid pockets that have formed. Orifices should be packed with cotton.
3. Thorough disinfection: Thorough disinfection includes all of the above steps, but it would also allow for some chemical preservation. While it may not call for vascular injection of embalming fluids, there is the possibility of surface embalming of any lesions, treatment of drained fluid pockets, the chemical cauterization of any surgical incisions, and the chemical treatment of any artifacts of medical device removal. Cotton for packing orifices can be coated in a topical preservative.

CASE ANALYSIS
When preparing an individual at any level of service, we must consider the techniques we are using and ensure that they are appropriate based on family directions.

When caring for a loved one whose family has requested minimal care, we have to be sure not to be mired in our own hubris, but rather consider if our course of treatment is going to go well for our case. We must also consider our bedside manner matches the wishes of the family; are the procedures we are using in accordance with their wishes? If a family desires to view their loved one prior to disposition, but requests the least invasive techniques possible, do we understand what that means and are we able to execute that? For example, when closing the mouth in this situation, are you using a dental tie as opposed to a needle injector? Are you opting to use cotton to close the eyes as opposed to an eye cap? This is evaluated during case analysis and applied through bedside manner.
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As funeral service purveyors, we are all very cognizant of the importance of the body and how it is honored. Just because a person has chosen not to be embalmed, does not mean we need to negate the philosophy of care that embalming entails. By observing these best practices, we can provide better customer service to our families in the assurance that their loved one will be cared for in a skilled and thoughtful manner.

I would like to go back in time to the early ‘60s when cremation first came on the profession’s radar, and find that first funeral director who said, “Well, I guess I shouldn’t charge as much for this since I’m not embalming or casketing” and take him out. I’m not a violent person by nature, but really?? That idea got started somewhere and we all just went along with it. Sure, let’s charge less for something that takes just as much time to accomplish, has much more liability, and requires just as much staff involvement. That makes perfect business sense.

Within that nonsense also was created the message to families that they were somehow lesser-thans or 2nd class funeral customers. I actually worked for an owner who said to families, “We bury our dead, we burn our trash.”

Because we didn’t take these families seriously and did not take their needs for a meaningful funeral service to heart, they left. Why would I pay $8,000 to someone who thinks I’m not as important as the people who buy the box? I can be ignored at the $695 box-and-burn immediate disposer who is more than willing to take my money and do nothing else for me.

Families are hiring us to perform a service. If I hire an orthopedist to perform surgery on my shoulder, his price is for the surgery. He doesn’t talk about which instruments he might have to use or the amount of time it might take or how many nurses will have to be in the room. He says, “This is my price to fix your shoulder.” Why can’t we have a price for body preparation? Yes, we’d have to figure out the correct GPL language but we could certainly have more productive conversations with our client families if we didn’t have an if/then/or approach to pricing.

Yes, for a small group of people the cremation choice is made based upon cost. But the large majority are choosing cremation based upon control. These people have attended bad services in their past and are determined that they are not going to go to another one. If I have a burial, then I’m beholden to the funeral director to get the casket from point A to point B and so I’m stuck with whatever service is offered to me. I can’t throw the casket in the back of my car and drive off and arrange a service that fits me. But I can walk out with an urn in my hand and have control over the type of service that I hold.

We’ve all been to “bad” services. The cookie-cutter, insert name here, hope someone says the name correctly, impersonal ritual that offers nothing about the person and what his death will mean to those mourning his loss. Every time one of these boring, hurtful or meaningless services occurs, another immediate disposition/no service is created. People say “When I die, don’t do that!”

Cremation offers a choice, a sense of control over what happens in a memorial service. Does that mean that most are held at someone’s house or at a bar or a restaurant with toasts and stories? Probably. Does that mean that the value of having a gathering that celebrates the life and explores the grief and provides a guidepost for mourning the loss is lost? Definitely.

STORY 1
Once I served as a Celebrant for an 80 year-old-man who died of suicide. It was a difficult service, but we honored his life and talked about the depression over health issues that caused him to make such a choice. We discussed what the grief journey was going to look like for those who were trying to make sense of the death. We encouraged the standing room only crowd to be an integral part of the family’s next steps as they turned tears into memories. It was a pretty good service.

That afternoon I received an email from a woman who was in attendance begging me for a copy of the service. This lady tracked me down and said she needed a copy of my words. So, I asked the family for permission and I sent her a copy. Her backstory was this—her son died of a heroin overdose and her daughter, his twin, died of suicide four years before. They did not have funerals either time. They cremated, then met at a restaurant and told stories. They did not trust that someone could handle such delicate and hard situations, so they just avoided. She needed those words to help her on her own grief journey. This happens hundreds of times across the country to our Celebrants.

Until we change the service experience for those families, they will continue to walk away. Our pricing, our lovely chapels, our offers of assistance—they’ve been there and done that and don’t trust us to be able to do something that is meaningful.
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Which brings us to the final C:

My bedrock message is “Celebrants can change your business, Celebrants can change your families, Celebrants can bring your cremation families back to your firm.”

The religious landscape of our country is changing. The percentage of people who identify as a “None”—not religiously affiliated, not engaged with a church—is rapidly growing. Statistics from the Pew Research report show that almost 25% of the overall population now considers themselves “nones” and over 35% of millennials are disenfranchised with religious experiences.

This has incredible implications for funeral service. Some funerals homes have stained glass windows, Bibles in the foyer, hymns on the speakers and scriptures on their websites. There is nothing wrong with having an ability to serve your religious families, but today anywhere from 25% to 80% of your community does not identify or resonate with those representations. If all you have to offer is a minister and a religious experience, they are going elsewhere.
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High “nones” equal high cremation rates. It’s just that simple.

Celebrants are the answer for a majority of your cremation families. So many of them are not offered any options by their funeral professional. So, they either opt for the rent-a-minister or do nothing. Another immediate disposition walks out of the door.

When someone attends a service where every word of the service is focused on the life, on the family, and on the grief experience, their decisions can change significantly. “Oh. . .we can have this kind of service? Then I’m willing to talk to the funeral director about paying for THAT” Over 50% of the services I perform through referrals from funeral homes in my city come from someone who attended another service and came back and asked for that Celebrant. People pay for value. People pay for meaning. People pay for gatherings that heal.

My friend, Ernie Heffner from York, PA, ran numbers on his Celebrant services and found that cremation families who used a Celebrant spent 36% more on other goods and services. It’s not about the money. It’s about the value, the experience, the assurance that someone is going to hear their stories, to honor the life and work with them to put together a service that fits them. People pay for meaning.

STORY 2
I did a service for a man in his 40’s who drank himself to death. He left an estranged wife, a 19 year old daughter, 18 year old son, and a brother who was a recovering alcoholic himself. This meant two hours of slogging through a lot of baggage and feelings to get to the stories and to give them permission to say what was needed. But we put together a service that honored his life while being honest about his struggles and his demons.

After the service, the brother handed me a thank you card with $300 in it. The funeral home had already given me a check for my Celebrant fee of $400. I said, “Oh, you’ve already paid me.” He said, “Please just take it.” The card read “Thank you for performing J’s service and I especially thank you for the time you spent with us Sunday evening. I’m hoping it provided as much healing to the others as it did for me. Thank you.” People pay for healing gatherings.

We’ve been saying this since 1999: Families need a service to begin their grief journey in a healthy and honest way. Unless we are willing to provide the professionals and the services that they are looking for, they are going to walk away. When families have options, funeral homes are going to lose every time unless their option is better, more appealing and soul touching.
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Looking at everything we do when it comes to serving the cremation family—pricing, style of service, presentation of choices, availability to Celebrants who can do exactly what the family wants and needs – is the only way that full-service funeral professionals are going to stay in business. How we deal with all of the C words will determine how much farther down the road we get to travel.