Building a pet aftercare business presents a unique opportunity to have a meaningful impact on a family during a time of loss and transition. That’s why pet aftercare professionals must uphold the highest level of dignity, compassion, and professionalism in their work.

The journey of becoming a pet aftercare professional is not just a career choice; it's a deeply emotional path. It's about forming a strong connection with pet families and showing unwavering dedication. This role requires not only technical expertise but also deep empathy.

My family's venture into the pet aftercare profession stemmed from a strong desire to offer comfort and respect to grieving pet parents. As a third-generation deathcare family, we are dedicated to carrying on the legacy that my father, Doyle L. Shugart, began in 1972. Providing support to pet parents and the pet aftercare professional community continues to bring fulfillment and purpose to our family today.

According to the Pew Research Center, 97% of U.S. pet owners say their pets are part of their family. About half (51%) say they are as much a part of their family as a human member. Given those statistics, it is imperative that pet aftercare professionals provide services and experiences that don’t just meet the needs of pet parents seeking aftercare but exceed their expectations.

The role of pet aftercare professionals is not just about providing a service, but about being a supportive guide through the journey of grief. To maintain the highest standards when delivering these sensitive services, the International Association of Pet Cemeteries and Crematories (IAOPCC) develops professional certification programs that address the unique aspects of pet loss and aftercare. Our work with CANA has been essential in bringing those programs to our industry, raising the standard for pet aftercare professionals.

Understanding the specific benefits of certifications in the pet aftercare industry and how they contribute to better care for pets and their grieving families is vital when exploring the pet aftercare sector. Acquiring those certifications can significantly improve the quality of your pet services, help you grow your business, and unlock the full potential of your staff.

As the Executive Director of the IAOPCC for 14 years and a pet aftercare professional for more than 36 years, I have seen our industry undergo many changes and evolve. In a largely self-regulated industry, I have been privileged to work with and learn from pioneers in pet aftercare. The development of the IAOPCC’s Accreditation Program is the industry’s only approved program with published and recommended standards and best practices for pet aftercare. These Accreditation standards, processes, and inspection programs are followed and recognized worldwide as a symbol of care and service to families in grief.

The IAOPCC Certification programs offer best practices and ethical considerations unique to the pet aftercare industry. Through our many levels of Pet Bereavement and Pet Funeral Director Programs, participants are introduced to strategies for working with grieving pet families, responding to difficult situations, preparing a pet for witness viewing and cremation service, answering the tough questions about pet death, and responding to ethical dilemmas common to the pet aftercare world.

Professional certifications in the pet aftercare industry are more than just credentials; they represent a commitment to high standards, ethical practices, and compassionate care directly related to pet families. For pet aftercare professionals, these certifications validate their expertise and dedication. By upholding these high standards, certified pet aftercare professionals contribute to a respectful and supportive community, making a meaningful difference in the lives of those who have lost a cherished furry member of their family.

Donna Shugart-Bethune is part of the Shugart Family operations of Pet Angel Memorial Centers in Georgia. The Shugart Family has been in the pet aftercare profession for over 53 years.  Pet Angel Memorial Centers operates four locations and two pet cemeteries specializing in pet and equine cremation services and burial.  Considered one of the nation's premier pet funeral homes, the Pet Angel Memorial Center, located in Atlanta, features three counseling rooms, two chapels, and the largest showroom in the nation, offering more than 450 pet memorial products. Offering same-day services, viewings, and visitations, along with superior client care, Pet Angel Memorial Center has led the way in establishing excellence in pet aftercare.

Donna, who grew up in the Shugart family business, pursued her Bachelor of Business Administration (BBA) from Georgia State University. With 36 years of experience in the pet aftercare industry, she has been the Executive Director of the International Association Of Pet Cemeteries & Crematories (IAOPCC) for over 13 years. Donna played a crucial role in developing the IAOPCC's online certification programs, which are available today. She also introduced digital badging certification programs for IAOPCC members and implemented the Accreditation Mobile App Program, providing worldwide access to Accreditation.

Imagine you’re at CANA’s 105th Convention in Washington, D.C., listening to a session you’ve been looking forward to for months. The presenter is known for their excellent communication skills. How do you picture this scene?
If we think about the three types of communication – verbal, nonverbal and written – then:

1. Verbal communication. When communicating verbally, you use your words and tone of voice to share information with others. If the speaker is a great verbal communicator, you might hear them clearly pronouncing their words, telling a straightforward story and emphasizing key points.
2. Nonverbal communication. Nonverbal messages include your body language, facial expressions, physical appearance and actions. If they are a skilled nonverbal communicator, you might see them dressed sharply, standing tall on the stage and pairing facial expressions and gestures with words.
3. Written communication. Written messages are text-based and communicate meaning when read. If they are a great written communicator, you might see their points clearly summarized in their presentation or read a concise and persuasive email recap in your inbox.

Just like this presenter, you can become a more skilled communicator by using verbal, nonverbal and written communication effectively.

So what are some key considerations when you’re working to improve your communication? Let’s look at the same types of communication again:

VERBAL

“HithankyouforcallingABCFuneralHomemynameisJames”

Their first response to that greeting might be along the lines of, “…um?” – not an engaging start.

When the ringing phone has interrupted something we’re doing, it can take a moment to shift gears. But you shouldn’t let your communications suffer for it. Pause and take a deep breath to ready yourself for the call. Adopt a warm tone and speak slowly and confidently to tell them you’re present and engaged. Your tone should match your message and make your first impression the right one. Not to brag, but I’ve often been confused for a pre-recorded message when I answer the phone. Sure, it means people often start pressing buttons in my ear, but I know they’re convinced of my professionalism!

NONVERBAL
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Even if you’re not paying attention, your actions will communicate meaning. Be aware of your gestures, facial expressions, clothing and body language. Pair these nonverbal cues with your words to make your message and meaning clear.
And even when you’re not actively communicating, your body can give the impression of attentiveness, interest and confidence. Try sitting up straight and keeping your body language open by uncrossing your arms and legs.
Still need to be convinced? Get a little help from Friends:

WRITTEN

​“Thnak you for meeting w/me today. I look foward to serving you famly.” 
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Even if you had a productive meeting with the client-family, you could ruin your credibility if you sent a follow-up riddled with errors. Always re-read before sending, keep communications brief but clear, and have a plan before you start writing so you remember everything that needs to be included.

Without thinking about it, funeral professionals might use jargon and euphemisms to be accurate and convey dignity and professionalism. Unfortunately, families often use different words, and this can lead to misunderstandings. When using verbal and written communication, take time to think about your phrasing and always use language the family is comfortable with.
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The difference between ashes and cremated remains is the most common example in cremation. While we use cremated remains to distinguish between chimney ash and the bone fragments following cremation – plus the emotional distinction between wood and a loved one – a family is less aware of what to expect.  Not to mention operational terms like first call and casket can require additional clarification and sensitivity to what clients know about funeral service. We don’t need to correct their language or word choice. We should mirror their language and, as appropriate, respectfully share the professional term to describe what they can expect.

By using these three types of communication more effectively, you can become a more skilled communicator. Here’s a helpful checklist of questions to ask yourself:

• Verbal: Am I speaking slowly and confidently? Am I staying on topic? Does my tone of voice match my message?
• Nonverbal: Does my body language and appearance match my message? Am I pairing my nonverbal cues with spoken words? Are my gestures open and friendly?
• Written: Did I plan out my writing? Is my message clear and concise? Did I proofread my work for correct grammar, spelling and punctuation?

The best part about practicing your communication is that you don’t have to wait until you’re at the arrangement table. You can see how approaching the check-out counter with an open expression and eye-contact changes the interaction at the register. You can cut back on your *darn autocorrect messages by taking that extra second to re-read before sending. Effective communication makes a difference throughout your life!

In my work as a suicidologist and thanatologist, I have observed that suicide is one of the most misunderstood causes of death in our society and that our culture has stigmatized and silenced suicide with devastating results for individual survivors and communities. Approximately one million people die every year of suicide worldwide, leaving millions of grievers who are bereaved due to suicide death loss, yet often, survivors feel the weight of suicide stigma and do not receive the supportive and helpful responses they need to navigate their complex grief journeys.

When I work with students and clients who want to support someone they care about who has lost a loved one to suicide, the most frequent concerns they express are, “I don’t know how to help them,” and “I don’t know what to say.” These frustrations are understandable – we live in a culture that often silences open and educationally-supported conversations about suicide, so many people feel at a loss for how to assist a loved one’s grief journey after suicide.
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It is my hope that the following information will assist you in being an empathic and helpful presence in the lives of suicide loss survivors.

In my blog post, “Surviving Suicide Stigma,” I discuss several of the most harmful myths still circulating in dominant culture:

• Suicide is always the result of clinical depression.
• The suicide death was a “quick fix” for problems that could easily have been solved or an “easy way out.”
• If we talk about suicide, or about a loved one who died of suicide, we may risk becoming suicidal or causing another person to become suicidal.
• Suicide is an act of cowardice or personal weakness; while everyone feels badly sometimes, suicide is “wrong,” “selfish,” or “weak.”

Several of these myths stem from the ultimate misunderstanding of suicide, the belief that it is an act of free will or a rational choice. In fact, we now understand that suicide is a complicated phenomenon rooted in pain. Usually, there are many sources of pain – psychological, sociological, spiritual, and even biological – that accumulate for some people who are suicidal until the pain becomes so great that the suicidal person literally cannot see another way to end their pain.
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If we can understand that someone who died of suicide was experiencing complex suffering and that suicide was the product of a mind that was not working right, then we can begin to be of support to suicide loss survivors without the confusion and stigma that myths about suicide reinforce.

Because of the intense stigma associated with suicide, suicide loss survivors may internalize feelings of guilt and shame on their own behalf and on behalf of their deceased loved one. These feelings are often reinforced by thoughtless or harmful responses from co-workers, friends, and family members. In recent years, social media has increased incidences of suicide loss survivors feeling shamed and isolated, both through posted speculation about the death and judgment, often from people not even known to the survivor.

The shame and isolation often experienced by survivors complicates their already-difficult grief over the loss. As we know, all grief experiences are unique, but for suicide loss survivors, the interpersonal and institutional responses they receive following the death can introduce unique elements to their responses to the death. In the months following a suicide death loss, many survivors report an increase in physical problems such as brain fog, insomnia, gastrointestinal issues, and chronic headaches. The sociological stressors due to silence and shame may increase survivors’ isolation and make them less likely to reach out for support. Psychologically, suicide loss survivors are at high risk for disenfranchised grief and prolonged grief. And while studies differ in terms of numbers, we also know that primary survivors of a suicide death loss are at higher risk for developing suicidality over the course of their lifetime.
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Being a suicide loss survivor is like being in a club that you never wanted to join. I encourage survivors to speak to others bereaved by suicide because it can be easier to tell their stories without fear of judgment, but it is equally important that people who have never lost a loved one to suicide feel equipped to support loved ones who have.

Use appropriate and non-criminalizing language. Instead of using terms like “committed suicide” or “killed himself,” use language that demonstrates that you understand that the person who died was not a criminal for their suicidality but was suffering: “John died of suicide.”

Acknowledge the pain of the person who died. “John’s death is a tragedy. I am so sorry that he was in so much pain that he could not see another way to end that pain.”

Do not ask inappropriate questions. Asking someone about the specific means by which their loved one died of suicide, the condition of their body, or other details that can provoke trauma responses is never appropriate.

Practice empathy. Work to dismantle any biases you might hold about suicide and try to resist mapping your own belief system or judgments onto survivors. Be receptive to the feelings they can identify or express, and validate all of those feelings. Survivors may be experiencing shock, anger, and confusion in addition to other grief responses – be ready for it and be patient.

Follow their lead. When talking with a suicide loss survivor, give them space to tell the story of their loss without probing them. After a suicide death, survivors may talk about the timeline of the day of death in minute detail in an attempt to come to terms with the reality of the loss. They may be very repetitive, or they may not want to talk about the details at all in the early days following the loss.

Engage in attuned listening. When talking to a suicide loss survivor, maintain eye contact, demonstrate that you are hearing them, and engage in non-threatening physical touch if appropriate. Importantly, do not look away if they begin to cry.

Keep confidentiality. If a suicide loss survivor shares details, feelings, or worries related to their loss, assure them that you will not share that information with others. Because of the stigma associated with suicide, having someone trustworthy in which to confide is crucial to survivors feeling supported.

Offer to help them make meaning of the loss. While everyone’s trajectory of mourning is different, many suicide loss survivors actively seek to make meaning from the loss, either through doing public education on suicide, creating public memorialization of their loved one through scholarships or other donations, or via community involvement for suicide prevention. While I would not advise encouraging survivors to throw themselves into these kinds of activities in the first few months following a suicide death loss, I have seen the value in them for many survivors even years after the loss has occurred. If the person who died valued education, ask if you can start a scholarship fund in their loved one’s name. If they were a nature lover, ask if you can organize a tree planting for them.

Help them remember the life of their loved one. Those bereaved due to suicide do not ever forget their loved one, though strangely, they often report friends and family not talking about the loved one after the first few weeks of the loss. Do not be afraid to speak the name of the person who has died, share memories you have of them, or remind the person you care about of memories they had told you about with their loved one. Because our culture often reduces the life of someone who has died of suicide simply to their cause of death, it is both valuable and meaningful to remember the birthday and date of death of the deceased and check in on those days. It can also be immeasurably helpful to talk about the person who has died regularly in conversations, acknowledging their interests, work, hobbies, and unique qualities, rather than only talk about their death.

This year, International Survivors of Suicide Loss Day is Saturday, November 18, 2023. As both a suicidologist and suicide death loss survivor, I will be spending the day thinking of the lives that ended tragically and honoring the pain with which they suffered prior to their deaths. I will also be thinking of all the other suicide death loss survivors I have known and wishing for them an easing of their grief. Finally, I will be renewing my promise to help end the epidemic of suicide in our culture in hopes for a future in which so many are not lost and so many are not bereaved.

Thank you for your commitment to supporting the suicide loss survivors in your life.

My second week on the job as CANA’s Executive Director took place during the joint CANA-NFDA convention in October 2011. I remember many excellent presentations and I vividly recall one speaker asking the audience, "Are you a cremation specialist? Raise your hand if you are." There were hundreds of people in the room, and not one raised a hand. The speaker then chastised us, saying, "Of course you are a cremation specialist, because you say you are."

Is it really as simple as that? Not exactly.
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CANA has been conducting research to determine the actual competencies and related knowledge, skills and abilities (KSA) that a funeral director and arranger use when serving their community. Based on this, we've developed continuing education classes that teach these important KSAs, validate good habits and introduce best practices. Together they make up the new CANA-Certified Cremation Specialist credential—a labor of love crafted by the leadership and staff of CANA over the last five years.

You’ve all heard the lament: no one teaches cremation in mortuary science or funeral service schools, so why do some funeral directors excel at connecting with consumers who choose cremation and why do some fall short? CANA set out to find the answers.

One of the four pillars of CANA’s strategic plan is Education, with one of the goals under that pillar being to constantly scan the state of the profession and address training needs through progressive education. To that end, in August 2017 CANA board members engaged in a hands-on activity where they identified their greatest training struggles across their businesses. The major categories identified were: 1. arrangement conferences, 2. crematory operations, 3. sales, 4. managing a service, 5. technology, 6. leadership development, 7. phone skills, and 8. oral communication, business communication and writing.

The CANA Education Committee then set CANA’s top three priorities: arrangement conferences, crematory operations, and sales. With a firm theory about where our profession was struggling, it was time to test our ideas, so we invited rock star funeral directors from CANA member firms across the US and Canada to convene in Chicago and participate in a DACUM (Developing A CUrriculuM) study.

These successful professionals were asked to describe, in exhaustive detail, each task they engage in to serve families who choose cremation. I wish you could have been in the room. This open exchange of ideas and strategies was a type of training in itself.
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The DACUM study identified seven domains of competencies from which we developed training.

Anyone familiar with the curriculum at mortuary science and funeral service programs will recognize these areas. You’ll find obvious connections and echoes to the mortuary school classroom curriculum, which we found to be a reassuring reminder: there’s no divide between cremation and burial families, just in how they can be perceived.
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CANA engaged consultants to do research on this new education initiative, including a large survey. Those respondents overwhelmingly identified a need for training that distinguishes between the knowledge and skills required to serve families choosing traditional casket burial and those choosing cremation. That’s where CANA found its niche.

n keeping with CANA’s mission to serve as the leading authority on all aspects of cremation, the association identified a gap in cremation-focused, online continuing education courses – content that develops and supports the competencies that best prepare funeral directors to serve people choosing cremation. Current courses are outdated, repetitive, provide little to no cremation content, and don’t advance competencies in the areas we identified.

The path forward was clear: fill the gap between the type of specialized training needed and the level of interest in the actual content areas—all with CANA’s brand of cremation-first content to set it apart from the other the education options currently on offer.

The primary audience for this project is early to mid-career funeral directors and arrangers. The primary competition is low-cost or free online training programs. We committed to the development of a self-paced educational program, providing licensed funeral directors with CE which leads to a cremation specialist credential at an accessible price.

CANA members are the leaders in cremation innovation so that is where we started. We identified subject matter experts from across the association to develop and deliver specific courses targeted to each of the seven competencies:

The Cremation Choice – works to explain the cremation consumer by using research to break down biases about what motivates them and what they want.

Communication Skills Fundamentals – created to get at the many ways we communicate, verbally and silently, to clients.

Cremation Phone Shoppers: Your Best First Impression – focuses on making the connection with the caller and showcasing the value you offer.

The Power of Presence: An Introduction – developed with the blessing and support of Glenda Stansbury and Doug Manning, experts in the topic.

Ethics in Funeral Service – moving beyond compliance with regulations, this class addresses ethical codes of conduct for the business and the individual

Complying with the FTC Funeral Rule – uses cremation–focused scenarios to teach how to follow The Rule in different situations

Presentation without Preservation – in what many would consider a foreign concept to CANA this class examines minimally-invasive body preparation techniques for the customer who wants a viewing but doesn’t want embalming.

Each class is highly interactive with exercises, video clips and case studies.
Looking for recorded webinars? Look elsewhere. These classes will capture your attention, present you with interactive scenarios and are always cremation-first.

This preparation work revealed the core issue: most funeral directors have learned over time—or are actually taught—the cremation myths and biases that have influenced business models and created a disconnect between consumers and funeral professionals. These biases are evident, even among funeral professionals working in cremation businesses.

The CCS content challenges participants to confront biases and learn new strategies to connect with grieving families. Participants reported that communication tips and exercises to cultivate empathy and other communication skills resulted in greater satisfaction and success.
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In Fall 2021, CANA offered the first test cohort and graduated eight CANA-Certified Cremation Specialists. During this test offering we learned a number of lessons, including:

​The Second Cohort launches March 7 and you are invited to participate. If you work for a CANA member or are the owner/manager of a CANA member and wish to register employees find out more here.
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It took five years to identify the competencies, build the courses and plan the launch, but here we are introducing the CANA-Certified Cremation Specialist! Join their ranks and raise your hand with confidence the next time you are asked if you are a cremation specialist.

The pace of change driven by consumers is the greatest challenge facing funeral service. No option has fallen off the menu, and yet more options pop up each year. How is it possible to create or reposition a business to fulfill these diverse requests? The 70 practitioners, suppliers and explorers who convened in Albuquerque in October 2019 for the First Ever Green Funeral Conference were up for the challenge. Their interactive and engaging experience is challenging to reproduce in a blog post, but there is too much great content not to share.
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Passages International was the obvious sponsor for this Conference. However, some potential speakers and participants and social media commenters—and even members of the media—weren’t so sure why CANA was hosting. Cremation is widely considered to be more environmentally friendly than traditional burial, but where does it fit on the continuum of green funeral practices? That is the kind of conversation I like to start. CANA doesn't shy away from hard questions, or from asking those questions of itself. We're proud to provide the space to have these frank discussions and attract the right voices to contribute.

​Since this was the first conference of its kind created for funeral directors and cemeterians, it was important to establish context and the intention to be inclusive in our definition of green practices. I will attempt to follow the flow of the conference in this post. Glenda Stansbury served as our emcee and she set the stage from the beginning, establishing that this conference was an exploration of green practices along a continuum. In that spirit, I invite you, dear reader, to identify where you are on that continuum. Are you a light spring green with plenty of traditional burial and cremation offerings? Or maybe you offer eco-friendly products, but want to promote more family participation and natural burial? Are you a deep forest green and all in? This post is an opportunity to learn more about the Conference content and how it may apply to your business and community.

Ed Bixby, owner of Steelmantown Green Burial Preserve and President of the Green Burial Council, kicked off the Conference with a presentation describing the wide range of green burial practices he employs in his cemeteries and has seen around the world. He challenged the audience to recognize that the spectrum includes traditional burial as well as established businesses seeking greener practices—including cremation. Yes, the attraction of green burial is related to environmental concerns, but it also appeals because it is simpler, involves less fanfare, and facilitates enhanced participation from mourners. Ed said, “Participation changes everything. You have the right to care for the dead the way you feel they should be cared for.” He challenged us—and I extend the challenge to you—to shift the mindset. You can work within regulations and laws, but you can reconceive the services you offer to families. In CANA language, "find a way to get to yes for your families."

During Ed's presentation, the topic of embalming came up. Why are embalmed bodies excluded from green cemeteries? Is this based on science or policy? Embalmers in the room shared why embalming remains an important tool for some families, but others expressed the belief that preserved bodies had no place in a green cemetery. While no consensus was reached, it was refreshing to hear so many opinions and suggestions respectfully discussed. However, many questions remained unresolved:

Next, Darren Crouch and Kilian Rempen of Passages International joined the conversation by discussing green products and marketing tactics to help businesses remain relevant and profitable. In the 20 years since Darren founded Passages International, he has learned many lessons. His customers are serving families that value green, but also unique and beautiful options. Darren asserted that the challenge of incorporating green options into businesses should feel familiar. It is similar to the challenge of embracing cremation 30 years ago. It was once controversial to add cremation to the sign in front of your funeral home and commonplace for funeral directors to send the rare cremation customer down the street to the cremation society. Ignoring cremation didn’t turn out well for funeral service, so Darren challenges funeral practitioners to not repeat past mistakes.
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Darren offered practical advice, such as offering scatter-friendly urns for the 50% of your cremation customers who intend to scatter. He argues that scattering does not equal low-end, but rather that an urn that contains cremated remains for a time can be used as art or to hold keepsakes after scattering. Darren echoed Ed’s message of changing your mindset to envision new offerings.

​Once attendees considered the various aspects of green funeral practices and started to plot their positions along the continuum, they heard from cemeterians and a funeral director who have added them to their operations.

Jody Herrington described her success in converting funeral home selection rooms to include green merchandise. She acknowledged how overwhelming it seems to offer yet more options in an already crowded space. Jody shared that her success was directly linked to the communities she has served and their green values. Incorporating local artists along with eco-friendly products and more familiar caskets can be appealing, but every community is unique. You know the communities you serve and should reflect that knowledge.

Jody posed a challenging question for me to hear – Is cremation a fall back? At this point some of you are probably nodding your heads in recognition, but I didn’t get it at first. Jody asserted that when faced with traditional burial caskets and merchandise, some consumers know they don’t want that so they fall back to cremation. Her experience showed that offering more eco-friendly merchandise and caskets resulted in more personalization and more sales to a satisfied customer. This leads me to wonder if green burial will slow the cremation rate increases we have seen. Only time will tell.

Our practitioner panel featured Donal Key and Linda Canyon of La Puerta Natural Burial Ground, Gracie Griffin of Bellefontaine Cemetery, Salvador Perches of Grupo Perches and Recinto de la Oracion, Ed Bixby, and Jody Herrington—continuing the conversation around green burial practices and tips for creating and offering green options in existing cemeteries. It is impossible to summarize the rich content generated by the discussion between panelists as well as with participants. Each panelist shared specific examples of practices they employ to promote participation and innovate new traditions. The questions from participants did touch on business models, pricing, training and incenting employees to dig graves and assist families to dress their loved ones. The key takeaway is that you can get to yes with families. It may take more time and creativity, but you can and should do it.

Next up was Tanya Marsh, a professor at Wake Forest University School of Law, who examined the legal trends surrounding green burials and green cemeteries. Tanya presented a framework for understanding green funeral trends. She started by sharing the macro trend of consumers looking for more control and input while also seeking authenticity and a meaningful experience. This is a trend influencing all aspects of our lives. And it poses a challenge for funeral directors and cemeterians who are typically risk-adverse.

Tanya outlined considerations to take into account when considering something new – i.e., natural burial or a new disposition.

The example she gave was natural organic reduction, commonly referred to as human composting. Washington state law explicitly stated that burial, cremation and removal from the state were the legal forms of disposition. This meant they needed to change the law in order to pave the way for a new form of disposition. In states that don’t affirmatively identify the forms of disposition, a court order or opinion from the board or attorney general may pave the way.
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Tanya led a free-wheeling Q&A session that touched on grave reusage, family participation, disinterments, indigent cremations, and what happens when cemeteries are abandoned.

The last sessions focused on consumers’ experiences and insights. Gail Rubin shared her perspective on consumer views of death and mourning and emphasized the ongoing theme of promoting participation and education.

I moderated two manufacturer panels—Luis Llorens of US Cremation Equipment and Paul Seyler of Matthews Environmental discussed the environmental impact of cremation and made presentations on the macro and micro impacts of cremation on the environment. This warrants its own blog post and one is in the works for publication in 2020. Stay tuned!

A second panel, with Sam Sieber of Bio-Response Solutions and Nicki Mikolai of Resomation America, discussed the science and practical application of alkaline hydrolysis. There was significant interest in alkaline hydrolysis among the participants, with some current and future practitioners represented. The questions from participants ranged from inquiries about the fundamental science, presence of radiation and mercury, to viewings and zoning challenges.

Legally, alkaline hydrolysis is considered to be cremation, but the process that occurs in the machine is completely different than flame-based cremation. Does that make it greener? That depends on the formula that is used. Is there a lower carbon footprint? Yes—or probably. Fewer fossil fuels are used to heat the water or dry the remains, but water and chemicals are used—so how does one account for that in the green calculation?

While more questions were raised than answered on the overall environmental impact of all dispositions, Sam did point participants to an important a recent study conducted in the Netherlands by Elisabeth Keijzer, who attempted to calculate the true costs of different types of disposition. Sam presents a useful framework for understanding the various environmental impacts and “shadow costs” discussed in the study.

Consumers are significantly ahead of funeral directors and cemeterians in seeking, performing and creating greener end-of-life options, so this conference represented an opportunity to engage in facilitated conversation, query panel presenters, and learn from leading experts. All walked away with practical ideas to implement now, and probably some ideas they considered but discarded for their own businesses. Here are three of my takeaways.

TAKEAWAY #1: DEFINITIONS MATTER
Language matters and it was important from the beginning to tackle some tough topics in order to facilitate open conversation and advance our collective understanding. We named this meeting the Green Funeral Conference to encompass a variety of green practices, and people came with many different ideas and opinions on what “green” truly means. However, everyone left seeing the full continuum of green funeral practices.

So, what shade of green are you or do you aspire to be? Have this conversation with your staff and seek to understand what your community wants or will respond positively to. And then have this conversation with your vendors to educate yourself on more eco-friendly options. Figure out your carbon footprint and how you can offset or reduce it.
Are your own policies and procedures standing in the way?

TAKEAWAY #2: EVERYTHING OLD IS NEW AGAIN
For cremation, it took a few evangelists (and 100 years) to make cremation a tradition. Green funerals are completely different. For some, the practice is cultural tradition and anything else is desecration. For others, it's an attempt to mitigate their carbon footprint on the world by removing external interference (letting nature take its course). So, whether it's to save money, to save the planet, or to honor tradition, it means every option, every time. And providing that is hard work.

You know your communities and have served them for the length of your career or possibly generations of your family. Incorporating green funeral practices does not mean starting over from scratch, but it does mean shifting mindsets. You may consider following the path you took to embrace cremation.

TAKEAWAY #3: START NOW!
It took nearly 150 years, but cremation in the West evolved from a European fad to the dominant form of disposition in the US with the help from multiple types of leaders. First came the evangelists—those spreading the good news of the hygienic and aesthetic virtues of cremation. Then came the practitioners who formed CANA as a forum to share best practices and promote the practice of cremation. Those practitioners innovated products, technology and services to support cremation practice. Many of these practitioners ultimately formed companies that supplied practitioners nationwide. As those companies matured and merged and competitors formed, cremation products and services further developed to support the industry.

Will green funeral practices follow a similar pattern? Probably. Likely following a significantly shorter timeline, but it certainly will happen, thanks to a similar mix of contributors. Yet again, consumers are leading the way by demanding greener funeral practices. The participants and speakers in the Green Funeral Conference represented a mix of champions of funeral practices along the continuum, both current and future practitioners.
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This conference was a true meeting of minds and collaboration in exploring green funeral practices. I'm proud of the conversations that happened at this meeting and have attempted to capture some of the content and the spirit of the event.

When I started in this profession, in 1991—remember there was less use of the internet then—funeral homes and cemeteries relied on loyalty and location to promote their businesses. Funeral directors and cemeterians were all involved in the local rotary clubs and chambers of commerce to connect with their communities. I’ve known a few funeral directors who even attended services at more than one church each week. That’s my memory of community outreach programs of that era.

In 1996 or 1997, I was working for Wilbert Corporate. One of our licensees in Minneapolis called me and said, “Julie, come with me tomorrow night because one of my clients is having their first-ever cremation seminar for consumers.” He and a Batesville representative were planning to talk about burial for cremation. I was so impressed with what I saw. That night, from 6-8pm, McReavy Funeral Home in Minneapolis had about 50 consumers come in, mainly couples, and the Batesville representative talked about cremation in general and the different things that you could do, and the Wilbert representative talked about burial as one of the final placements for cremation. Then, in one of their visitation rooms, they had products set up with coffee and soft drinks, and consumers could roam and talk. I was so impressed, I still talk about it to this day because I’m passionate about education, and to see that back then was wonderful. And that is just one example of effective community outreach.

Now, you all know that we live in a transient society and there are a lot of people who do not currently live in their hometown, so getting your company out there is more important than ever. When CANA asked me to facilitate this presentation, I started doing a little investigating. I was very surprised and happy to see some of the unique, creative community outreach programs that our profession is putting out there. You should all be really proud of yourselves. These events help to educate consumers that never would have known the different things that you do, so they can go, have some fun, learn something, and visit your business in happier times.

I have gathered some examples from CANA members on their successful community outreach activities. We’ll focus on events hosted by companies ranging from smaller firms to larger cemeteries. Our hope is that you don’t sit there and say that you can’t do that because you don’t have the time or the staff, but get sparked by interest and inspiration to do something—even something smaller in scale.

A lot of the things we do, because we have so many active senior centers in our neighborhood, is to either visit them or have events at our locations. We have found that, when we get them out of their element, you can have a lot of fun and you can educate them. Afternoon Movies is exactly that. We partner with a senior center, they promote it by email, newsletter and bulletin to their members, and we meet up at the movies about a half hour before the show time. Then, we introduce Mountain View and educate the seniors on the value of preplanning. We keep it fun and they love the chance to see the movie for free, so they’re happy to listen. A lot of the local movie theaters are happy to let groups in on an otherwise slow Tuesday afternoon. We buy the tickets, popcorn, and soda, and they get the movie and information.

This is no surprise. 

– Jerry Roberts, Flanner Buchanan Funeral Centers & Crematory: Indianapolis, Indiana

A lot of people haven’t been to a funeral home or cemetery in a long time, and they don’t want to go. You’ve experienced this: they consider it to be gloomy and depressing. By providing community outreach events in our profession, what we’re doing is bringing the community in in happier times. That way, when they see you, they’re not only going to think that this is where you go only when there’s been a death. You keep a connection with them throughout the whole year besides just when there’s a death of a loved one.

Some of the establishments are embracing celebration events that are not death related such as weddings or other family gatherings hosted in their venues. These are bringing people in for a non-death situation — it says you can have fun here too.

To many, traditional media means an ad in the local paper or a direct mail piece, but this is not where you’re going to get the most impact. Email newsletters are good, but only reach the people who already know you. I always opt for websites and social media, and you’ll all agree, these are the avenues that we should use to promote our events. Some funeral homes and cemeteries will include “events” or “community” in their main navigation to place these activities front and center.

With social media, you can reach the community and let them know what you’re doing—and it’s less expensive than traditional media. Plus, it offers the opportunity to talk to the community – to thank them for participating in an event, for supporting you, etc.
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In closing, a lot of these programs might be intimidating. You may think you don’t have the resources, you’re not big enough, etc. You have to start by thinking that you can try just a piece of it, just a small component at a time. As Tony Robbins says:

Lights! Camera! Action! Movies are a great way to teach, learn and tell stories that people remember. Studies indicate most humans are visual learners, so movies are a powerful medium to make a memorable educational impression – especially on touchy topics like death and grief.

Movies can be a great way to introduce funeral directors and cremationists, especially those new to the industry, to the diverse reactions that families may exhibit after a loved one dies.

When you look at examples from movies, coupled with background information from thanatology – the study of death, dying and bereavement – you can learn about the different ways people express or repress their grief. You can better understand grief responses without fear of offending a client family.

Consider these movie scenes and the types of grief they illustrate.

Drew, a young man who lives in Oregon (Top 5 in cremation rate), has come to his father’s home town of Elizabethtown, Kentucky (Bottom 5 in cremation rate). Dad had unexpectedly died of a heart attack while visiting family there. Mom instructs Drew to have Dad’s body cremated and return with the remains to Oregon. The family in Kentucky wants to bury Dad in the centuries-old family plot.

In one scene, he’s having a phone conversation with Mom in Oregon about the cremation choice. She says, “Honey, I don’t know when I’m going to crash, but as of right now, we are learning about the car, and I’m learning organic cooking, I’m going to tap dance, and later on today, I am going to fix the toilet. It is five minutes at a time.”Drew says, “Mom, I think you need to slow down.” She replies, “Look, everybody tells me that I should take sedatives, but hey, I am out here and I am making things happen. All forward motion counts.”

The instrumental grieving style focuses on practical matters and problem solving. Mom is busy, busy, busy – that’s her way to deal with grief. This reaction is not determined by gender, as reported in the book Grieving Beyond Gender: Understanding the Ways Men and Women Mourn by Kenneth Doka and Terry Martin (2010).
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You might think men are more inclined toward the practical approach, but Doka and Martin found it’s a pretty even split for men and women to experience an instrumental grief reaction. If you see a family member working a list of things to do prior to the funeral, understand that person is likely an instrumental griever.

At the opening of A Single Man, George, a gay man mired in grief over the death of his partner, wakes up and gets ready for his day. He gets out of bed, showers, shaves, gets dressed, and goes into the kitchen. He narrates his thoughts in this monologue:

An intuitive grieving style emphasizes experiencing and expressing emotion. Rather than getting busy with activities that may distract or channel emotional pain and sadness, the intuitive griever is immersed in mourning. While we may think of women as emotional, men are just as likely to embrace this style of grieving, although they may retreat to the privacy of a “man cave” to mourn.

Overt sadness, tears and withdrawal in the arrangement conference or at the funeral/memorial service are signs of an intuitive griever.

In the film, George is experiencing profound sadness eight months after his partner’s death. While there is no timeline for grieving, at this point, he may be experiencing complicated grief – when deep mourning is unremitting. Addressing complicated grief is best handled by working with a trained grief therapist.

Because A Single Man illustrates mourning for a partner in a homosexual relationship, it’s the perfect segue to discuss disenfranchised grief. Disenfranchised grief is “the grief that persons experience when they incur a loss that is not or cannot be openly acknowledged, publicly mourned, or socially supported.” (Kenneth Doka, 1989)

While people may be more understanding of mourning the death of a same sex partner now, A Single Man is set in 1962, well before homosexual relationships gained acceptance. Other examples of disenfranchised grief: a mistress unable to publicly mourn the death of or breakup with an illicit lover, mourning other losses, such as jobs, health or friends, or pet owners who are devastated by the loss of a beloved companion animal.

At the opening of the film, friends gather for a graveside funeral, complete with a celebrant, flowers and a photo of the deceased. It turns out the funeral is for a woman’s dog. One attendee checks her watch. Others roll their eyes.

At the reception afterward, a man says, “Let’s get some perspective here. I mean, do you think if Jocelyn was married with kids she’d be giving her dog a state funeral? This whole thing is warped.”

The love of a pet is intense, and with the loss, there is intense grief. Yet, grief over the loss of a pet often does not get the same level of public recognition given for the loss of a person. Mourners may turn to social media sites like Facebook to receive supportive comments from friends.

Savvy funeral homes are expanding their services to include sensitive death care to help pet parents. Such services can provide an opening and connection with families that leads to human death care business later on.
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Other films cover the many faces of grief, including Grief and Past Trauma (The Big Lebowski), Grief and Talking and Repressed Grief (This Is Where I Leave You), Processing Grief (Walk The Line), You Can’t Tell Someone How To Grieve (Six Feet Under), Elisabeth Kübler-Ross’ Five Stages (All That Jazz), and Moving Beyond Grief (Gravity). I have a presentation called The Many Faces of Grief: Mourning in the Movies which offers two CEUs through the Academy of Professional Funeral Service Practice and looks into all of these films in-depth to help funeral professionals see different forms of grief on display.

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.

One way to make sense of these behaviors is through the lens of “defense mechanisms” – a concept originally developed by Freud. When you hear the name “Sigmund Freud,” you might immediately dismiss anything developed by a pipe-smoking, sex-obsessed, Viennese physician from the early 1900s. Even as a psychologist myself, Freud isn’t my favorite guy; I believe many of his perspectives are outdated, misogynistic, and outright wrong. However, some of his theories and perspectives have stood the test of time and can provide valuable insights into human motivation and behavior. I hope you will continue reading to discover if these 3 examples of defense mechanisms match your experiences in the arrangement room. I suspect you will discover that you actually agree with Freud on several of these concepts.

While I love giving a good lecture on Freud (seriously, just give this former college professor half a chance…), we don’t have the time or space for a full exploration of defense mechanisms. In a nutshell, Freud said all people use defense mechanisms to reduce anxiety or mental discomfort. Most of the time, these defense mechanisms are relatively normal and healthy; they only become problematic when they are used in extreme ways. For example, “denial” is one of the most commonly used defense mechanisms. A common experience of denial related to bereavement is when you reach for your phone to call a loved one, only to quickly remember they are deceased.

There’s absolutely nothing abnormal or pathological about this – our brains are simply used to them being alive and it takes a moment for that reality to reappear. On the other end of the continuum of denial is an extreme reaction. For example, when the police find that a family still has grandpa sitting at the dining room table – eight months after he died. All defense mechanisms can be viewed on a continuum; mild and common uses of reducing anxiety and pain or extreme situations when the individual’s reaction is much more dramatic and often pathological.

It is important to note that defense mechanisms are largely unconscious responses. Or put another way, these are not deliberate or premeditated strategies. They still hurt if you are on the receiving end, but I don’t want you to think these are intentional efforts designed to attack others. They are the unconscious reactions of someone trying to deal with painful thoughts and emotions.

Although Freud and his daughter, Anna, described several dozen defense mechanisms, we are going to focus on three that you may see in the arrangement room: displacement, projection, and reaction formation.

Like denial, displacement is a very commonly used defense mechanism. Displacement is when we take the angry or aggressive impulses toward one person and “displace” them on another, usually safer, target. For example, let’s say your boss yells at you and it makes you angry. You realize that it isn’t smart to strike back at your boss, so you go home and yell at your spouse, yell at your kids, or kick the dog as a way to displace your anger onto a ‘safer’ target. (I fully realize that getting angry at your spouse may not be a “safer” target – this is just an example. Also, don’t kick dogs.)

A common example of displacement in funeral service is when the bereaved are angry at the deceased. Perhaps the deceased wasn’t a kind person. Perhaps the bereaved are angry that the deceased didn’t take better care of themselves or go to get a check-up when they suggested it. But even though they are angry, Western culture states that it is not acceptable to “speak ill of the dead.” So where does that anger and frustration go? Sometimes it goes to a “safe target” like the funeral professional. They may assume they won’t see you after the services conclude and therefore you are a safe target for their anger – even if you haven’t done a thing to deserve it. Have you had situations where the bereaved are angry at you for no apparent reason?

Have you ever had someone accuse you of only caring about money? A second defense mechanism, projection, might be a part of their response. Projection is the process of taking our own feelings and thoughts that make us uncomfortable and then dealing with them by projecting them onto someone else. A common example of projection is when we deal with our own self-hate by projecting that view onto others. Projection takes “I don’t like myself” and turns it into, “He/She hates me for no reason” or “Everybody hates me.” It reduces our anxiety and negative self-worth to suggest it is coming from others, not from oneself.

Here are some examples of what a person might be feeling and how they may project that onto the funeral professional:

Bereaved individual’s thought: “I’m curious about death and death-related procedures, but am worried about how others will judge my curiosity.”
Projected onto funeral professional: “Why are you so obsessed with death!”

Bereaved individual’s thought: “I’m so angry at my mother for not taking better care of my father and look what happened.”
Projected onto funeral professional: “Why are you treating my mother so badly!”

Bereaved individual’s thought: “I wonder how much this is going to cost. I could desperately use some extra money right now.”
Projected onto funeral professional: “You’re only obsessed with money!”

A third defense mechanism that may arise in funeral situations is the use of reaction formation. Reaction formation is when a person takes a thought or feeling that is uncomfortable and attempts to convince themselves (and others) that they don’t really have that view by making an extravagant display that is the opposite of their true feelings. For example, if a man found himself sexually attracted to his best friend’s wife, he might deal with the anxiety caused by those feelings by suggesting that he doesn’t like her at all. (We see an example of this exact scenario in the movie Love Actually: It’s a self-preservation thing, you see.).

In funeral scenarios, reaction formations arise when the bereaved hates the deceased yet acts as if they were perfect. The bereaved reacts by choosing extravagant funeral products and having an elaborate funeral. Freud would suggest this individual is attempting to convince themselves that their feelings of hate don’t exist. Of course, later the bereaved individual may resolve those feelings of hate and wonder why they spent so much on an elaborate funeral. I suspect this is when they unfairly turn the blame on the funeral professional and say things like, “You tricked me into spending a fortune on the funeral!”

When CNN’s article regarding the JAMA radiation letter first hit the CANA newsfeed on February 26, 2019, we knew immediately it would be a big deal. And yes, the story has become a many-headed hydra of confusion, concern, and misinformation, accompanied by increasingly scary rumors.

We constantly field concerns from suppliers about cremated remains placed inside keepsakes, from crematory operators and embalmers about their cases, from families about their options, from regulators about all of the above, and from you — in the middle of it all — trying to serve your families, comply with regulations, and protect your staff.

CANA has curated several of the most useful questions in one place to counter some of the fear, anger, and rumors. And it’s all publicly available, so please share this resource far and wide, bookmark it for later reference, come back to check for updates, and, most of all, DON’T PANIC.

The radiation misinformation saga began with a research letter, titled Radiation Contamination Following Cremation of a Deceased Patient Treated With a Radiopharmaceutical and published on February 26, 2019 in the Journal of the American Medical Association (JAMA). In the letter, Dr. Nathan Yu (et. al) discussed a case study of a business in Arizona that cremated a 69-year-old man with pancreatic cancer in 2017. The deceased had been treated with an intravenous radiopharmaceutical for a pancreatic tumor and died five days later. When the medical staff became aware of the cremation, they notified the crematory and the cremation chamber, equipment, and staff were all tested for exposure to radiation. The equipment was found to have traces of contamination, as was a urine sample from one crematory operator (but it was a different isotope from the one used in the patient’s treatment). The contamination levels were below the limits set by the US Nuclear Regulatory Commission. In conclusion, because this is only one studied instance, researchers recommend further testing for more data and better understanding.
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CNN was the first major media source we found to bring the letter to the general public awareness. To round out the story, the network solicited the opinion of Dr. Daniel Appelbaum, chief of nuclear medicine and PET Imaging at the University of Chicago Medical Center. He said, "If there are reasonable and fairly straightforward and simple things that we can do to minimize radioactivity, why not do that?” Applebaum also acknowledged the need for better understanding and regulations that keep workers safe. In the case of crematory operators, the doctor recommends "robust enforcement of mask and gloves and handling techniques."

Other media outlets picked up the story and it spread quickly, with information traveling like a game of telephone. My mother’s church group argued against cremation for spreading radiation in the community. One CANA member’s staff are expressing concerns about “the crematory operator who died from radiation” (when none have). Each of which are exaggerated concerns about what we know.
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Because while the case study is new, the knowledge about radiopharmaceuticals and brachytherapy is not. And the medical community is quick to reassure that there is Low Risk of Radioactive Contamination from Cremation When Proper Safety Procedures Followed. CANA is aware that these concerns and fears are rooted in a lack of awareness and understanding, so we want to provide information to help.

RADIATION 101
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At CANA’s second Alkaline Hydrolysis Summit, we invited Jeff Brunette, Health Physicist and Manager of Radiation Safety at the Mayo Clinic, to talk about nuclear medicine and its impact on death care. His full presentation is available as a free, on-demand webinar for you, your staff, and anyone to access anytime on CANA’s Online Learning platform, but here are some highlights:

• Nuclear medicine, as administered by a medical professional, is very different than a nuclear warhead. These treatments are administered at doses for safe and healthful diagnostic imaging and cures, not mass devastation.
• These treatments have known efficacy windows which range depending on the use. Diagnostic imaging (e.g. PET scans) can take 20 minutes to 67 hours to clear the system. Radiopharmaceuticals can take 3-12 days (this is where the case study falls). Radiation oncology, like brachytherapy, implants treatment into the body to deliver targeted doses over a treatment window and these isotopes can take weeks or months (or longer) to decay to acceptable exposure levels.
  • These implants are often the size of a grain of rice and inserted throughout the impacted area, thus impractical to be removed by a funeral or medical professional.
• The variations in the length of radiation are due to different materials (called isotopes) used in treatment and their half-lives (i.e. how long it takes the radiation to degrade to half its original mass).
  • Recommendations from the Canadian Nuclear Safety Commission state that "if the therapeutic nuclear medicine procedure or manual brachytherapy procedure took place more than two years ago, the decedent can be treated in the usual manner. No precautions are necessary for autopsy, cremation, embalmment or alkaline hydrolysis."

WHAT'S THE RISK?
The US Nuclear Regulatory Commission has set specific levels (mentioned above) to regulate emissions and uses. In the case of cremating a body treated with nuclear medicine, the Commission and medical community agrees that the potential exposure is too low to record. Though cremation volatilizes the radiation treatment, Brunette says even extreme cases are not likely to exceed the limits set for safe exposure due to the combination of medically accepted isotopes, their half-lives, and treatment use. He explains it with an analogy: taking a daily recommended dose of aspirin is fine (around 325 mg) but taking a year’s worth at once (118,625 mg or more than three bottles) is fatal.

Canadian Nuclear Safety Commission has their own rules and regulations and reviewed them extensively last year. CANA recommends their comprehensive Radiation Protection Guidelines for Safe Handling of Decedents as a great resource to learn more about the isotopes in question and safe handling procedures, even for non-Canadians.

Ultimately, Brunette argues that radiation is a limited concern because the levels you will encounter on the job are small, and not very common. Your bigger concerns are the activities that your staff do every day: musculoskeletal injury from lifting, exposure to disease during embalming (HIV; Hepatitis B & C; Tuberculosis; MRSA), and exposure to harsh conditions during cremation operations (heat, noise, dust or chemicals).

HOW CAN WE OPERATE SAFELY?
CANA recommends asking all families for detailed medical information to properly understand and respond to potential risks. Just as you ask about the presence of pacemakers, ask about nuclear medicine treatments.

Paul Harris of Regulatory Support Services encourages all funeral home, crematory, and cemetery owners to ask the pertinent questions of their families. Cause of death is the first indicator that a case is at risk for radiation therapy, but all families should be asked in the case of death unrelated to their ailment. In many cases, families may be unaware or not understand the procedures the decedent has undergone. In these cases, you may need to ask for a Health Insurance Portability and Accountability Act (HIPAA) release form (in the US, rules in Canadian provinces vary) to contact the medical provider yourself. Asking the radiologist for information on the treatment and about the specific isotope and its half-life is the best way to determine when (or if) it is safe to cremate or embalm the body.

The medical community also recommends installing a simple radiation detector to quickly alert staff to the presence of radioactivity (some states require them in all morgues). Brunette recommends a pancake Geiger-Mueller counter which can be acquired cheaply (particularly if you have them left-over from the old nuclear-powered pacemaker days) and built into your case acceptance procedure.  The Arizona Bureau of Radiation Control recommended a combination metal/radiation detector, such as the MetRad, which one school in considering adding to their intake process curriculum.

Mostly, Brunette recommends the following steps to reduce exposure:

• Awareness: Talk to families, ask the radiologist, consider purchasing and/or installing detectors.
• Protection: Wear appropriate PPE when potential for contact with body fluids, cremated remains, or AH fluids.
• Disposal: Drain blood and body fluids during embalming directly into the sanitary sewer system and don’t aspirate unless necessary.
• Proximity: Maximize distance to the body and minimize time in close vicinity to the body.

The medical community should do what Drs. Yu and Applebaum say: research. Learn more about these situations so everyone can make informed choices about safety. In the long-term, this will serve us better than knee-jerk reactions and blanket rules to refuse all cases who have ever been treated.

Our professional community should continue to do what you do best: serve your communities safely and compliantly. Enforce PPE, add this to your list of questions for families, do your due diligence. You should review your existing policies, processes, and procedures to ensure that you are screening for the use of radiopharmaceuticals and staff are taking proper precautions. Inform yourself and staff with basic information about diseases that could indicate potential treatments and which isotopes are used. Know who to contact with questions like your local hospital’s radiology department (or the decedent’s doctor) or regulator.

Mostly, DON’T PANIC. Now that the public is aware of this issue, this is an opportunity to educate our communities and ourselves with good information from reliable sources. CANA will periodically update this post with new knowledge, so bookmark this for later.