Posted By Administration,
Wednesday, April 24, 2019
Updated: Monday, April 22, 2019
So you're looking to generate more revenue for your local cremation services business. Where do you start?
Your website will rank better in local organic search results if you work to improve its search engine optimization (SEO), but while that's a valid strategy, it takes a while to kick in. It could be six, nine, or even twelve months before you see significant ranking improvement vs. your local competitors.
I recommend improving your SEO, but that's more of a long-term (or at least medium-term) strategy. In the short term, it's all about pay-per-click advertising, aka PPC. When it comes to bang for your buck, this tool is awfully hard to beat.
You get the benefit of immediately appearing atop search engine results pages (SERPs) on searches for cremation providers in your area. You can customize your ad on the fly to better attract clientele. And because you only pay when someone clicks on your ad, there's no wasted money on old-school "impressions" or unqualified leads.
And the top priority for employing PPC, of course, is to do so on Google Ads. Sure, there are other PPC platforms — including Bing, Yahoo, Facebook, LinkedIn, Twitter, and even Amazon — but you must always start with Google.
Google currently owns about 90 percent of search engine market share, so there's literally no point to starting anywhere else. Once you're up and running with Google, you can branch out further if you have plenty of marketing budget left over for PPC.
To that point, you need to be aware of recent upgrades to Google Ads (previously "Google AdWords"), specifically its Expanded Text Ads. Thanks to these changes, you really are getting far more bang for your buck.
The short version is that you now can include more text, and thus more information, in your cremation services ads. Prior to the change, you were limited to two headlines and one description line: a total of 140 characters (including spaces) to get your message across.
By comparison, Google displays (at minimum) about 150–156 characters of text in meta descriptions, the summary you provide of your webpage content, which are designed to convince people to click on organic links to your site. You can see the challenge in having only 140 characters to persuade people to click on an ad.
But now you get an extra headline ("Headline 3") and description line ("Description 2"). Each headline allows for 30 characters. Descriptions used to be limited to 80 characters, but Google has since bumped that to 90 characters each.
That's a total increase from 140 characters max to 270 characters in each ad (not including the "path fields" portion of the display URL, which indicates where the searcher ends up after clicking the link). When you put that extra text space to use, you virtually double the amount of info you convey without increasing per-ad spend.
How It Works
Google reports that larger PPC ads tend to see click-through rates 15 percent higher than smaller ads. When Google last made a move to include more real estate in each ad, advertisers reported click-through increases of 20 percent. That means more people reading about what your company offers and landing on your website.
With that said, understand that the extra space won't always appear to searchers. Google's big on responsive design (web pages that display in a friendly fashion on any type of device or screen), and it practices what it preaches. That means ads display differently when they're viewed on mobile devices vs. desktop computer screens.
One way to accommodate disparate displays is to show a smaller version of an ad, which means truncating Header 3 and Description 2. So make sure you use those spaces for extra information that potentially drives more conversions and not for information that's absolutely critical to the meaning of your message.
Making the Most of 130 Characters
With that in mind, how do you put the extra space to work advertising your business? First, consider how you can expand previous messaging to be more effective or clear.
Did you take out words (or use acronyms instead) in previous text ads? If so, you could put that text back in to ensure meaning is more readily apparent to those outside the industry.
For example, if you previously abbreviated "celebration of life service" to "COL service" or "alternative container" to "alt container," you might be able to spell out those terms for greater clarity.
Also, you could add another feature or benefit message in your ad. Your secondary messaging might include the availability of a large urn selection or assistance in arranging unique final dispositions.
Expanded ads make it possible to share more about your business with searchers at the first touchpoint. Leverage them wisely to increase traffic to your pages and generate more cremation revenue.
Welton Hong, is the founder of Ring Ring Marketing® and a leading expert in creating case generation from online to the phone line. He is the author of Making Your Phone Ring for Funeral Homes, 2019 Edition.
tips and tools
Posted By Administration,
Wednesday, April 10, 2019
Updated: Tuesday, April 9, 2019
Conflict. Confusion. Controversy. Crisis.
Those are NOT the 4 C’s of effective messaging. Instead, those often are the negative ramifications of poor key message development. Think about nearly any life situation where there is conflict, confusion, controversy or crisis. Nearly every time, one root of the problem is failure to communicate important information.
We’ve all seen the results of bad messaging. People misunderstand a public policy because the explanation is laced with complex jargon understood only inside the Capitol building. Or, the reputation of a person or institution becomes woefully out of date because no one has made time to refresh the words they use to describe themselves. Often, bad messaging thwarts success when it comes to public awareness and reputation management.
A fundamental component of any communications campaign is crafting effective key messages that support the organization’s overall goals and accurately convey information to the most important audiences. Simple, but far from easy to do.
The four C’s of effective messaging are:
Simple, non-ambiguous terms are best. The faster you make the main point, the better. And, if you can inspire the listener to imagine a mental picture of exactly what you have in mind, that’s fantastic.
Consider President John F. Kennedy’s speech to Congress on May 25, 1961:
“First, I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to the Earth.”
The immediate reaction to most must have been, “Wow!” And, to this day, Americans remember that it was Kennedy who proclaimed the United States would put an astronaut on the moon… and then in 1969 we did.
Think about how scientific jargon and bureaucratic language could have killed the inspiration of the moment if they’d crept in. What if the President’s speech had led with a recitation of complicated technological advances that would make space travel better? What if he’d talked for five minutes about metals, plastics, thermodynamics and aerodynamics? What if he’d waited until the end to mention that a human being would walk on the moon – and then come back to Earth?
Highlight the gold nuggets of your messages distinctly and right away.
Employ well-chosen words and phrases that are unique to your organization, are memorable and distinguish you from others. You don’t want to sound like everyone else. So, identify words and phrases that are pinpoint-accurate, novel, and best describe you, yet are terms that your competition absolutely cannot use. Curate a collection of the most alluring words possible that stay true to your mission and purpose. Avoid the generic.
After facilitating countless messaging sessions for clients over the years, I can assure you that everyone is promising “high quality” products and services, “providing outstanding service,” and “excellence.” So many call themselves “the premier” organization in their field (some spell it “premiere,” but that’s a different conversation). And, it seems that every other organization will guarantee you they’re making an “impact,” helping you achieve “impact,” or even more cringe-worthy, they’re “impactful.”
Transform those overused words into bigger, aspirational ideas. Dare to be fresh and shake up the status quo.
Well-chosen words also help you build and maintain credibility. If you’ve adopted messages that are true and unique to your organization, people will understand and believe what makes you special. You want to use charismatic words in a balanced way, so they convey enthusiasm without hyperbole and support credibility at the same time.
Use fewer words. The best key message sentences are short and pithy, packed with powerful words that speak for themselves. Concise language and writing always win the day. In today’s “click, click, click” world, it’s even more imperative to speak and write in shorter, more interesting sentences.
A “No Trespassing” sign is concise and clear, and the treacherous dune cliff behind the sign is consistent with the message.
Resist the urge to use a whole paragraph to explain each key message sentence. If the key message needs explaining, it’s not an effective key message sentence. Start over. Simplify. Break it up. Go back to your mission statement. Think about what a 30,000-foot view would look like. What is the one, simple point you need to make? Re-write the key message. Repeat with other key messages.
Boiling down the essence of an organization to three to five key messages is an ideal way to start. Organizations that communicate best do this. Those three to five key messages need to stand on their own with no propping up and no footnotes. Every organization can do this. Again, it’s simple, but not easy.
To some, three to five key messages may seem too constricting. Keep in mind that once you’ve crafted those overall messages, you may choose to write supporting key messages. However, those supporting messages are reserved for use only in situations where your audience – not you – wants more detail and supplementary information. Don’t foist unwanted words on people you are trying to engage. Be ready for them to tell you that they want more. Your supporting key messages also must use clear, concise and well-chosen language.
Whether you are the leader of a corporation, a nonprofit, an association or the United States of America, it’s your responsibility to ensure consistency of message. You and everyone else who speaks or writes on behalf of your organization must use your organization’s painstakingly-crafted key messages every time.
This consistency underpins credibility and builds staying power in brand identity and reputation. Message consistency also is paramount in internal communications and is a lynchpin of healthy corporate culture. I’m not endorsing robot-like recitation of scripts. Instead, the goal is that all communications use the key words and phrases of the organization. This leaves room for each speaker to adapt the key messages to his or her speaking style. And, it allows people to write about the key messages in ways that are consistent with the overall meaning.
Organizations that communicate best ensure that all representatives know the key messages and are well-practiced in conveying them. This starts with board members who spend time internalizing key messages, so they can present them to internal and external audiences to advance the goals of the organization. It continues with rigorous training for executive leaders and communications professionals whose jobs require them to define and explain the organization every day. And, many organizations ensure that every front-line professional is well-versed in key messages, so all of them can handle workplace situations in ways that support organizational goals and culture.
We PR types always preach that consistent messages and repetition are the hallmarks of effective communications. But can being consistent and repeating a key message become tired and boring?
How do you keep messages fresh and vital while still repeating them so that your intended audiences remember your main points? How do you strike a balance between repetition that builds strong brand recognition and repetition that makes your story so stale that people say, “Oh, no, not THAT again?”
It boils down to one communications rule that may be more sacred than staying consistent with messages:
Know your audience.
It’s always about the audience first. The best communicators formulate what they’re going to say based on their audience’s needs. Why should this group care about what I want to tell them? What’s in it for them? What words and anecdotes will best resonate with them? The way I perceive the situation is less important than how the audience will receive it, so how do I immediately hook their interest in my topic? If I tell the old chestnut story again, will this audience relish it or disdain me? Answering those questions before you open your mouth will make your key messages fresh and tailored to the audience and prevent you from boring them with old chestnuts.
Sort and Balance the Chestnuts and Messages
The audience’s appetite determines whether your story is a luscious treat or a stale old chestnut. Before you address a group, understand their point of view and tailor your consistent messages to the audience’s needs. If they hunger for chestnuts, go ahead and tell those old stories that resonate best with them. If not, stay with the consistent key messages, freshened up.
This post is excerpted from Kathy Schaeffer Consulting, LLC blog posts: Chestnut or Consistent Message? (August 14, 2018) and 4 C’s of Effective Messaging (April 11, 2018). You can read these and more recommendations for public relations strategies including public speaking, persuasive writing, and communications on their publicly available blog: http://www.ksapr.com/ksa-blog.
Public relations activities help you build a positive reputation and educate important audiences in your community long before members of those audiences need your company’s services, and long before you need their support, such as for plans to build a crematory in your community or expand your operations. The CANA PR Toolkit, developed with professional PR firm Kathy Schaeffer Consulting, LLC, is designed to help you craft your PR strategy to grow your reputation and educate your community. This exclusive member benefit is available online and on-demand, whenever you need it most.
Kathy Schaeffer, principal of Kathy Schaeffer Consulting, LLC (KSC), is a lifelong Chicagoan who now spends her time in Chicago and Michigan. Kathy founded Kathy Schaeffer and Associates, Inc. (KSA), her issues-oriented Chicago PR firm, in 1994. Today, through KSC, she continues to serve clients trying to make the world a better place. CEOs praise Kathy’s media and spokesperson training and strategic counsel. Intuitive, inquisitive and straightforward, Kathy stands apart from sycophantic publicists. When she’s not working, you'll find Kathy swimming, biking, cooking or tasting wines.
tips and tools
Posted By Administration,
Wednesday, March 27, 2019
Updated: Monday, March 25, 2019
This one is a special blogpost for our supplier members — and anyone else who's ever had to transfer the excitement from their table to the masses walking by.
In 2017, the Center for Exhibition Industry Research (CEIR) released an eight part Attendee Floor Engagement Report from a comprehensive study of exhibitors at trade shows. We read it through and identified a few key takeaways that we hope will provide inspiration for enhanced engagement with attendees at your next trade show.
People to Product
This is the ultimate goal for anyone at a trade show and everyone knows it. You have something you want someone else to buy. That could be an urn, software, intellect, or a preneed contract. And CEIR reports that this is the number two reason why attendees keep going to trade shows: so they can interact with the products themselves. So your focus should be on getting people to your booth and selling them on the value of your product.
The good news is that data shows that people like free stuff. The pens, candy, and hand lotion you pass out are appreciated. This is especially true at a CANA show — our association doesn’t give our attendees bags, paper, pens, or any of those goodies so they’re extra appreciated from you! Plus, these end up back at home or the office where they are shared with colleagues.
The bad news is that the paper handouts aren’t as appealing as the free stuff. We know this from both the data and the folders, business cards, catalogs, and more they’ve collected from you but left on the cocktail tables at the end of day at a CANA show. Instead, people are looking for digital versions — a screen in the booth for a quick glance or a pdf to share back home right then (especially if they can send it themselves). That way, they still have two hands free for a drink and a handshake.
If your product or service isn’t a tangible thing, or is too large to demo in your booth, you’ll need to get creative to allow attendees to engage with the product or service information in a meaningful way. Here too, a screen can allow someone to get the feel for your product with a demo, a video, or tutorial. After all, the goal is for them to understand how your product or service meets their business need.
If your product or service supports it, a sale on the premises and a receipt emailed to the office yields instant gratification for the attendee, and a satisfied customer for you. The data shows that many exhibitors aren’t doing on-site purchases, but the ones that do report high usage by attendees. Going through the whole sales cycle on-site is easier for some products than others, but there are still opportunities with big ticket items: if you can at least schedule a phone call to explore their needs further, or even better, send a quote then and there, you’re that much farther into the process.
People to People
But we’re getting ahead of ourselves, because we forgot Sales 101: people buy from people. Data shows that the most valuable tool on the show floor is emotion. Initially, it’s friendliness and approachability that welcomes someone to your booth, and we don’t have to tell you that means eye-contact, a smile, and stepping from behind the table or display. Then, trustfulness and credibility shows that you’re not some flash-in-the-pan product that’s here today and gone the next — we’re an industry of long relationships and they want to know that their business (and equally importantly, their families) can count on you when they need you most.
But to really hook them, it’s the connection of their problem to your solution and the resulting weight off their mind. Giving them that “aha” moment or that warm feeling that comes with a meaningful product to serve their communities better will go a long way to building your loyal customer. That comes from listening. There are no silver bullets, one-size-fits-all in our profession (even though your product probably comes pretty close). So you need to start by asking them about their business, their community, the persistent challenge that occupies them on their commute, and offer a solution that meets their unique needs.
In some cases, it’s the marketing or sales person that’s best for this job, but data shows that it really depends on your product and goals. Highly technical products — like software and hardware — can often benefit from a technical person at the booth. This person can answer questions, provide recommendations, and tell attendees how this product can work for them. In other cases, someone from upper management is your ace in the hole. With their credentials, the executive can wield their position to build stronger relationships and shorten the sales cycle.
Technology to People
Across the board, data shows that exhibitors have been slow to add a technological component to their attendee engagement strategy. Whether through social media, the event app, or even emails, few exhibitors are doing it. But, those that are have seen value.
In general, these broadcast platforms are about buzz and thought leadership, not the sales cycle. This means that you’re working to stay in people’s awareness as a resource they might need in the future. These avenues are also great places to tell people where they can see your product in action and meet people with answers — your end goal is getting them to the booth for that emotional response.
Before you even register for the event, you want to demonstrate thought leadership or ways to think about problems they face and provide solutions your audience can use. But when you know you’re going to be at a trade show, treat it like the event it will be and start getting excited. Tap into the culture of the event and share the host’s posts to grow your audience both online and on the floor. Build buzz about the event and your booth — who will be there and what will you feature? On site, you have two audiences: the ones that are with you and the ones at home, but sharing photos will appeal to both! Other offers like free stuff, purchase discounts, and raffles will bring the people to your booth and keep the buzz going at home.
After the show is over, it’s back to thought leadership — hopefully a bit wiser from all the great event programming. When people get back to the office, they’re usually playing catch up with everything, and the energy they got from the ideas at the event quickly fades to the background. Anything you can do to recapture that emotion and keep the momentum going (while solving something with your product) will be welcome.
Education to People
Attendees report three primary objectives when attending a show — engagement with people, product and learning. These become the three pillars which all exhibitor and show organizer activities should fall under.
The first two objectives — engagement with people and product — are usually met in the booth. Attendees gain knowledge through their interactions with booth staff, whether that be with product/technical experts, sales staff or management. The quality of these interactions is the top ranked reason that attendees come to an expo, CEIR reports. They also love to interact with products- whether that’s picking them up and holding them, playing with a software program, or pressing buttons on a demo unit.
The third objective — learning — can be fulfilled in multiple ways. Providing skills-based education on your product, whether it be sales tips for cremation products like urns, short-cuts for software programs, or best practice tips for equipment, goes a long way toward meeting attendee objectives and building those relationships. If your show host offers it, participate in skills-based education or learning sessions outside of your booth. Finally, one-on-one, small group learning sessions are very popular; host short sessions at your booth at scheduled times and provide education (not sales gimmicks) on hot button topics about which attendees crave more information.
Set Your Goal
Exhibitors report three main goals when exhibiting at an event:
This was 73% of all companies, looking to introduce their product to new people. While this sounds like you can count how many people are at the event compared to how many people you talked to, the math isn’t that simple. As valuable as people are, contact with decision-makers is key — just like having management staff man the booth shortens the sales cycle, so does talking to management attending the event.
That said, lead capture was the easiest way to track this. At many shows, this is digital now with badge scanning to capture contact information allowing the conversation to flow faster.
More than half (58%) of all companies say getting their name out there is key. Called “impressions” on social media, this means you want to know how many people can now say they’ve heard of your company, your product, and seen your logo. And it doesn’t take a table to do it, which is why exhibitor profiles and digital engagement is so important, and why alternatives like sponsorship can be so valuable.
Here, it’s most useful to know where exhibitors are featured and how many people saw and interacted with listings there, often from the show host.
The third most common reason for exhibiting is relationship management (46%). Connecting with current clients and furthering the sales cycle with strong leads is key in this category. In many cases, this is measured by time away from the booth — side meetings, dinners, a tab at the bar, and other things that convey a mutual investment between your clients and the company.
In that case, the amount of time you spend on each of these activities is the real measure of success.
To a much lesser extent, exhibitors attend to announce a new product (23%), to offer special promotions (18%), establish themselves as thought leaders (13%), or connect with other exhibitors as partners or distributors (12%).
Overall, both trade show hosts and participants are thinking about the attendee experience. This move toward experiential design brings everything from the above plus the atmosphere and the culture of the host organization and location into account. From CANA’s perspective, we’re thinking about the most enjoyment people can get out of our event locations, not just our programming. We host exhibitor training to teach them what a CANA event is like for everything from arranging shipping to our vibe. And we make sure that our promotional materials for the event are on brand for the conference and our association. As exhibitors, you do the same: choosing your events for their match with your goals, sending the right people to work the table, telling prospects to join you there, and getting your logo front and center. It’s the goal of every event host to work together with the exhibitors to make sure that the attendee experience is one to remember and tell others about.
So, how do we make changes, as exhibitors and hosts? (1) Be intentional about choices. Don’t just look around and see what collateral is cluttering the office and who hasn’t gone to a show recently. Know your audience, know your event, make the right choice for them. (2) Get feedback about the event. Don’t add the notch to your chair and move to the next. Ask the host for data about who attended, what your exposure was like, and do your own data collection from attendees on the floor or after about your booth and offerings. (3) Keep the experience alive. Don’t end the show and the conversation. Build some lead up excitement for the event, host a client or just promote your presence on the floor, and follow up about the show and the experience after.
Face-to-face is still one of the best ways to connect, and trade shows provide a perfect way to start. In the spirit of continuous improvement, CANA has implemented new tools for the upcoming convention to help you act on some of these suggestions. Our new event website and event app offer you the opportunity to increase your exposure by having expanded exhibitor profiles in both places, as well as more places for your logo to be displayed. Through the event app you’ll now have the option to add lead-retrieval. Finally, the event app allows you to send messages to attendees as well as invite them to meet with you through a calendaring function. We hope these new features make your next show with us even better. And if you won’t be at the CANA convention, we hope you can use these ideas to make your next event great, wherever that may be.
Registration is open to exhibit at CANA’s 101st Cremation Innovation Convention! Join us in Louisville, Kentucky and get your product in front of key-decision makers for funeral homes, crematories, mortuaries, and cemeteries across North America. We place our trade show in the same room as our programs to keep the funeral directors and cemeterians interacting with our exhibitors all day — plus, you can benefit from the presentations, too!
Jennifer Head is the Education Director of CANA. She plans the events and works closely with exhibitors and attendees to constantly improve CANA events and shows.
tips and tools
Posted By Administration,
Tuesday, March 12, 2019
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.
Where it started.
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.
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."
Where it went.
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.
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.
What we know.
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.
- 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).
- Safe levels are determined by federal regulation. For the US general public, this is anything up to 100mrem in a year (excepting medical treatment — a full-body CT scan provides approximately 1,000mrem), while for people who work with the substances it’s 5,000mrem each year. A fatal dose is more than 500,000mrem. And we are exposed to radiation by taking an airplane, using the microwave, and from nature (both Earth and space).
- Radiation treatments also vary in strength. Alpha waves are stopped by paper, or blocked by your skin. Beta waves are blocked by soft tissues and thin metal of aluminum. Gamma waves travel much farther. Distance from the radioactive material also changes exposure — the medical community measures the potency at one meter to determine when a patient can go into public spaces. In most of the cases described above, treatment is outpatient (even the implanted seeds) meaning the person can leave that day.
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.
What we do next.
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.
Sources of information referenced in this article:
Barbara Kemmis is Executive Director of the Cremation Association of North America.
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Posted By Administration,
Wednesday, February 27, 2019
Updated: Monday, February 25, 2019
There are a number of proactive measures we as a profession can take in pursuit of remaining relevant to contemporary consumers. Developed from ideas presented by Kim Medici Shelquist, Senior VP of Planning & Development for Homesteaders Life Company, and Ernie Heffner, President of Heffner Funeral Chapel & Crematory, this post focuses on the relationship between end-of-life care and death care and the family’s experience.
The first US hospice was established in 1974 and viewed as an alternative to current heathcare options for those at the end of life. Kim explained that, in many cases, traditional healthcare establishments were not welcoming, so hospice professionals had to fight for respect. The largest growth of hospice care providers in America occurred after Congress passed legislation in 1982 to create a Medicare hospice benefit allowing Medicare/Medicaid to fund hospice care. As of 2014, there were 6,100 hospices nationwide and more entering the market every year.
Facts About Hospice Providers
Most hospice care is not a non-profit endeavor but rather care provided by for-profit organizations and keenly attuned to demographics, networking, market shares and the competition. Ernie described that hospice organizations have changed significantly from the volunteer-based approach some of us may remember from the early days of hospice care and now have first-class marketing graphics and a business plan to match. The close personal relationship of a hospice care provider with surviving family members does not end with the patient’s death but can extend for more than a year after.
Ernie researched and reported many of the following statistics from the website of the National Hospice and Palliative Care Organization.
- Free standing hospice organizations not affiliated with a hospital are on the rise, 58.3% in 2013 increased to 72.2% in 2015.
- Not-for-profit hospices are decreasing, 34% non-profit in 2011 down to 31.9% in 2016.
- Of all US deaths, 44.6% in 2011 occurred under hospice care, 46.2% in 2015. 59% received in-home care.
- The average length of care decreased from 72.6 days in 2013 to 69.5 days in 2015. The median length of care decreased from 18.5 days in 2013 and to 17.4 days in 2014 and increased to 23 days in 2015.
- Aftercare: Few if any funeral homes have an aftercare program like hospice. 92% offer community bereavement support. Through ongoing bereavement activities by a “bereavement coordinator,” the hospice organization maintains a relationship with the family long past the time of the patient’s death, in fact monthly for 13 months after the death.
- Volunteers in Hospice Care: Statute requires that 5% of people hours are provided by volunteers. Many hospice organizations have a person dedicated to recruiting volunteers. In 2014, 430,000 volunteers provided 19 million hours of service.
- Spiritual Advisor: Hospice organizations are required to have a spiritual advisor on staff. Hospice chaplains are often very well-trained in non-denominational, non-religious approaches to the spiritual side of life and death.
The Role of the Hospice Worker
Hospice care providers are a very special, caring group of people. They are held in high regard by the families they serve. Their opinions and advice are trusted. They are passionate, dedicated, and tenacious. There is little turnover, and even those who do leave often move to another hospice.
No other healthcare professional actively talks to family about the end of a life and planning the way a hospice care provider does. Kim explained that they do whatever is in their power to reunite families and meet patients’ needs, they are flexible and open-minded, and they figure out how to provide the best end-of-life experience possible. Ernie recommends the chapter “The Power of Presence” in Doug Manning’s book, The Funeral, to appreciate the connection and relationship hospice care providers have with families.
Almost half of all deceased people in the US last year were under hospice care before they ever got to a funeral home, crematory, cemetery, or anatomical gift registry. That’s significant, because unless you have a great community engagement program, a family’s first contact about funeral plans is hospice staff. Social workers ask patients and families about their wishes and intentions long before you see them. Statistically, these caregivers have built a very personal relationship with almost half of these families immediately prior to the death of their loved ones. If that doesn’t motivate you to think about what you’re doing in your community and your hospice outreach, I don’t know what will.
The average length of hospice stay is about 70 days. That’s a long time to create a relationship with the family. 59% of hospice patients receive in-home care. Hospice staff go in, day after day, and build that relationship and gather the details of their lives and their family dynamics. It’s a very different situation – we get three days, they get almost three months to hold those really hard conversations about really hard parts of a patient’s life. In that role, they become trusted advisors and the go-to people for all things related to death and dying.
Serving Hospice Families
The average hospice caregiver, no matter how well-intentioned, only knows as much about funeral service as someone who goes to a lot of funerals. Most are invited, and attend, many patient’s services and thus see many local funeral homes. But, there’s no aspect of hospice training that goes into the ins and outs of funeral service.
We use a lot of trade-specific information and technical jargon that is confusing to families and just as confusing to those caregivers. And if these people go to a lot of funerals, it means they go to a lot of bad ones, too. What does that caregiver think after they leave? If the next family asks, “What should we do?” they might not recommend your funeral home because they remember that bad service.
Some funeral directors ask, “Why do they tell them to do the cheapest thing?” Kim reminds us that the social worker has seen their hospital bills, heard about maxed-out credit cards, and sat with the widow afraid of losing the house after losing her husband. That social worker is not concerned about whether the funeral home is interested in offering an upgraded casket. If the social worker sees you trying to sell the family anything, they might remind them that they don’t need it. It’s not right or wrong—it’s just the way it is. We can talk about “that’s not her role” or “the family might have wanted to do something nice and she took their choice away,” but you’re talking about a dynamic where she was protecting them. Hospice social workers and caregivers take their role as advocates very seriously. They value collaboration. That means if you can create a relationship and build trust, you can position yourself as an advocate of the family, and you can collaborate on the process. If they see you acting in the best interest of their families, they will support you.
By the time the hospice family comes to the funeral home, you need to understand what they’ve been through. You are professional and passionate members of funeral service, but terminal illness is different. In a hospice situation, the family often has the opportunity to come together and say goodbye. Sometimes, they’ve done it three or four times. They’ve done the first part of the grieving process. They've had a lot of time to talk about death, to think about death, and often have additional support via hospice resources to prepare and guide them. The family is often present at the time of death, and it’s not unusual for them to have a brief ceremony right then. Kim explains that, the presence of the family, the words of the chaplain, the goodbye to their loved one – after that, they may not need a traditional funeral to process their grief. And it’s important for funeral professionals to understand that.
That’s not to say that there isn’t need or opportunity for service and ceremony, but we must remember that those in hospice have declined for a long time. Their survivors often say “I don’t want people to see my loved one like that.” It’s hard for families to think about a visitation because of the change that illness has brought. They don’t want their friends and families to remember the deceased that way, or worse, not recognize their loved one anymore. But they don’t necessarily understand what you can do about that. They don't always understand how body preparation can make a big difference—whether they agree to full embalming (which can reduce swelling or return moisture) or merely a shave and a haircut (which can make them look like themselves again).
Lastly, you know that these families are spread out, so they’ve spent time and money on travel in addition to the financial costs of long-term care, lost time at work and time with their immediate families. They are exhausted physically, emotionally, and financially. And this stress has likely heightened any kind of disagreements about medical care and funeral planning.
How to get started in developing a hospice outreach program
Developing a meaningful relationship with hospice care providers in the community is not about dropping off cookies at Christmas. It is a commitment to education that can benefit all concerned, providing the families we mutually serve with seamless and meaningful end-of-life transition. Ernie provides three key strategies for starting your hospice relationship:
Read all you can to learn about the hospice profession. Then research your state’s licensing requirements for Registered Nurses (RNs) specifically the continuing education (CE) requirements and what qualifies for program content.
- Build formal PowerPoint presentations
These need to be compliant with RN CE requirements. Include reporting, record-keeping system and handout material to be used. Then apply to get your program(s) certified by your state’s nurse licensing division.
- Recruit a hospice care provider as your outreach person
This could be a part-time position about 18 to 24 hours per week. Consider recruiting a retiring hospice social worker interested in a part-time position. Have this person be your representative to offer continuing education. This person should also attend monthly networking events relevant to serving seniors.
Dr. Alan Wolfelt, internationally acclaimed grief counselor, author and educator, has said “Education starts with understanding the people we serve.” To that point, it is helpful to review the demographic and societal statistics of your community, understand how these facts dramatically impact end-of-life service providers, and embrace the adaptations needed by the profession—including further education and training—in order to remain prospectively relevant to contemporary consumers.
Like Ernie says, life is about relationships and experiences. We are in the business of celebrating the life of the individual by recognizing how they touched the lives of others. Our mission is to orchestrate and direct a meaningful ceremony with compassion, flexibility and options and in way that is as unique as the person who died.
Kim Medici Shelquist's remarks excerpted from her presentation at CANA's 2017 Cremation Symposium titled "Seek First to Understand: How will changing demographics and end-of-life care options impact the funeral profession?"
Ernie Heffner's full article is featured in The Cremationist, Vol 55, Issue 1, titled “Staying Relevant in a Changing World” featuring important discussion on the role of Celebrant services, the importance of minimum standards, hospice, and more. The Cremationist is an exclusive benefit of CANA Membership.
is President and Owner of Heffner Funeral Chapels & Crematory
, York, PA. After graduation from Pittsburgh Institute of Mortuary Science, he joined his father in a two-location firm serving about 100 families annually, with a cremation rate of about 4%. The firm grew to 22 locations in 2 states with 100 employees. That growth was during the acquisition mania of the 1990’s. Subsequent to strategic contraction, the firm today serves from six Pennsylvania locations, continuing as a “Mom & Pop” firm owned by Ernie & Laura Heffner and operated by Heffner and John Katora, V.P. and Heffner associate of 38 years. Ernie appreciates the truth of proverbs 22:10, which he paraphrases as, “Minimize the challenges in your life and your life will be better.” Focusing on organic growth and the pursuit of relevance to contemporary consumers has led to gratifying results.
Kim Medici Shelquist
in 2009 as Director of Marketing Communications after many years as Business Development and Communications Director of Hospice of Central Iowa. At Homesteaders, she added breadth and depth to the marketing department that resulted in the creation of several key B2C public relations and sales programs. Her efforts were also instrumental in helping Homesteaders become a recognized leader in preneed funding. Today, Kim oversees Homesteaders’ strategic planning and project management process as the Senior Vice President of Planning and Development. Her team is charged with identifying, evaluating and developing new opportunities that will help Homesteaders grow long into the future. Kim holds a bachelor’s degree in journalism and a master’s of business administration, and is a Fellow, Life Management Institute.
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