The Future of Death Care in America

On Leap Day 2024, CANA joined Wake Forest Law Review for an opportunity that comes around even more rarely than February 29: this gathering of thought leaders from across the death care spectrum — practitioners, reformers, lawyers, advocates, and more--to talk about the biggest legal and regulatory topics in the profession. While the Law Review hosts similar events annually, the topic varies and this happened to be a banner year to talk about changes to death care.

The goal was to develop scholarly content and discussion on legal and regulatory topics in death care. This was a law symposium after all, and there are myriad legal questions related to disposition, licensure and the Funeral Rule that are in the news--and sometimes in dispute--right now. If you were unable to attend in person or via livestream, recordings are available. Additionally, the Symposium will be covered in an issue of the Wake Forest School of Law Review to be published in fall 2024. This post will be updated with a link at that time.

The result of our day together was discussion that covered familiar, progressive ideas from the profession and new takeaways from reformers. Panelists were passionate about their topics and outright disagreements surfaced around licensure and the Funeral Rule, but arguments were thoughtfully presented and everyone walked away with new ideas to consider.

When I reflect on my involvement in planning, implementing and presenting during the Symposium, I have identified a number of takeaways and questions that remain. Let this post capture some of those thoughts and questions and serve as fodder for future conversation.

New Ideas with Roots in Funeral History

Caitlin Doughty served as keynote for the day and delivered a thoughtful, researched and provocative assessment the historical influences on the modern funeral profession and death-curious community. I won’t attempt to summarize her talk in this post, but invite you to listen to the recording.

Funeral service as a profession has been stubbornly gendered since its inception in the mid-19th century. It was a gentleman’s profession that embraced embalming and developed many of the customs and traditions that endure today. There are parallels to this trend within cremation and in cemeteries.

Women have always been involved in caring for the dead but, until the last decade, were not well represented among licensed funeral directors and embalmers or cemeterians. Professional funeral service is now proving attractive to women, and 80% of new mortuary school and funeral service graduates are female in 2024. 

When other professions, such as teaching, nursing, librarianship, have shifted from largely male to female, it has resulted in lower pay or a diminished reputation for its workers. There is such a shortage of licensed funeral directors currently that this seems unlikely, but the danger remains.

While many women enter traditional mortuary science and funeral service programs as students, many others are carving out their own studies and career paths to become death doulas, death educators and consumer advocates. Both groups cite leaders like Caitlin as inspiration to embrace caring for the dead. Can we, the death care profession, provide a career path for new workers to satisfy their impulse to serve?

Irreconcilable Differences?

It may seem counterintuitive that funeral reformers and practitioners could find common ground, but we managed to agree on some of the elements of the most controversial topics in death care today.

Licensure

If the more than 700 registered attendees at Wake Forest, in the overflow room, and on the livestream are any indication, interest in death care is high. But for those uninterested or unwilling to pursue licensure as a funeral director, a career path is unclear. The profession is experiencing a workforce crisis. The number of new licensed funeral directors has held steady in recent years, but that is not sufficient to offset the higher rate of baby boomer retirees and, eventually, baby boomer deaths. Discussions during the Symposium continued to come back to this topic and raised questions without easy answers:

Do licensure requirements accommodate and support new dispositions and prevent scandals?

The assertion from reformers and some practitioners is that the current licensure system is somehow insufficient. That is true in the sense that criminals will ignore laws and regulations and will be stopped by enforcement. Licensure and regulations are designed to create barriers to entry and establish minimum levels of competency to promote public safety. This is a good thing, but also up for interpretation as to the nature of those barriers and definitions of competency. 

The path to legalization of new forms of disposition is not without barriers, but our elected officials and the funeral profession are responding positively to consumer interest in greener technologies. End-of-life care is evolving, are current laws and regulations keeping up?

Why is it important for a funeral director to also be an embalmer?

Roughly half the states allow one license for a funeral director and another for embalmers, while the other half require a funeral director to do both to be licensed. There was much discussion about “ready to embalm” requirements, including licensure and specific equipment at establishments, that raise costs for businesses and barriers for entry into the profession for new professionals and companies. For businesses that offer embalming, it is logical to have trained professionals, equipment and facilities to offer embalming. But for an increasing number of establishments that offer direct cremation, arrangements only, or new forms of disposition, a requirement to be “ready to embalm” runs counter to their business practice.

Is discussing funeral arrangements a matter of free speech or consumer protection? 

A recent lawsuit in California and an ongoing lawsuit in Indiana raise this question in relation to the work of death doulas. The answer will impact the future of licensure for funeral professionals as well as career paths for death doulas and educators.

Can we find a way to meet in the middle and identify a path to employment for death curious people, as well as future funeral directors, embalmers and cemeterians?

Money

The Funeral Consumers Alliance is dedicated to lowering costs for consumers and is promoting revision of the Funeral Rule to require online price posting to accomplish this goal. Funeral professionals remember that the original Funeral Rule implementation did not result in lower prices overall and any new Rule provisions or revisions are unlikely to do so. More regulation increases costs for businesses that are passed on to consumers. 

Funeral poverty is a real concern and any funeral home owner knows it as they scan through their accounts receivable. What the public does not see is the common practice of discounting services for veterans, children or victims of crimes. 

There is a larger societal pattern of lower savings and insufficient financial planning for retirement or common emergencies. If the average American does not have enough savings or credit to pay for a flat tire, will they be able to afford an unexpected death? This reality was on full display during the pandemic and resulted in discussions about potential solutions.

Dr. Victoria Haneman shared the strongest argument for preplanning and preneed that I have ever heard from industry insurance and trust professionals. Dr. Haneman then laid out her proposed solutions, centered around income tax and savings incentives. These ideas are fascinating and likely to proceed as expansions of HSA or 529 plans. The NFDA has sponsored a bill that has attracted bipartisan support and would represent progress toward addressing saving for end of life expenses.

Public Trust

The Funeral Consumers Alliance asserts that the funeral profession is routinely harming consumers via high prices and confusing practices; however, there is little evidence of harm as measured by complaint volume at federal or state level or via consumer ratings and feedback. Funeral practitioners have high online ratings and positive customer feedback survey results. The FTC identified funeral related complaints to be #29 in their rankings. This disparity in experiences is hard to reconcile, but we must continue to communicate the value of funeral service.

Posting pricing online is a current practice for many practitioners, and may soon be required by the Federal Trade Commission. No one likes to be told what to do or how to run their businesses, hence the opposition to this requirement. Practitioners also know that price posting alone will not increase consumer knowledge about end-of-life planning or make it easier. Price is only part of the equation. When choosing an end-of-life provider (death doula or funeral director), trust is more important than price for most people. 

Scandals also undermine public trust. Caitlin Doughty asserted that additional regulation and licensure may not be the solution to avoid scandals as we have seen in recent headlines. She suggested instead that inspections and enforcement of existing laws could have a major impact. This dynamic is playing out in Colorado right now with a bill to require individual licensure under consideration as well as debate around funding enforcement of existing laws. 

What did we leave out?

Whether intentionally or not, we lacked the time to cover every death care topic of interest to participants. We didn’t convene a panel about green burial or burial conservation trusts. These are established dispositions with fewer outstanding legal questions. But are they viable dispositions in the future of death care? Absolutely!

We hoped that the Symposium would bring together passionate people who don’t often interact and we succeeded. The following is a quote one participant shared in the post-event evaluation:

I appreciate that the symposium included views from the legal community and what I would consider funeral-adjacent professions and organizations. We don't often get outside of ourselves at funeral association classes/meetings/conventions, and at times risk becoming echo chambers. But there is so much to learn from other professional communities. I would love to hear more from professionals in the hospitality industry (which I consider funeral-adjacent, as we're all just creating experiences) that have been transformative in their businesses and industries. Thank you, for creating the opportunity to hear new--and sometimes uncomfortable--perspectives through this symposium.

I share this hope that these conversations continue and we satisfy our mutual interests to advance death and end of life care.

The Wake Forest Law Review is a student-run organization that publishes five issues annually. The Law Review also sponsors symposia. In 2024, the Symposium arranged their Spring Symposium on The Future of Death Care in America. Through the publication of articles, notes, comments, and empirical legal studies, the Law Review provides the profession with timely evaluations of current problems in the law and serves students as a valuable educational tool. The Spring Symposium was livestreamed and recordings can be watched here with students' publications on the topics to be published soon.

When planning the Symposium, we knew that Professor Terry Brock’s research and work on abandoned cemeteries did not fit neatly in the theme, however we recognized that if we don’t study our history, we are destined to repeat it. Look for a future post to CANA's Cremation Logs blog on this interesting and important research.

Barbara Kemmis is the Executive Director of the Cremation Association of North America (CANA). Barbara has over 15 years of experience developing and marketing member benefits, providing leadership in professional associations, fundraising and creating professional development opportunities.