Posted By Administration,
Wednesday, July 24, 2019
Updated: Friday, July 19, 2019
The 21st century is changing North American life. There are more of us, and more different kinds of us, than ever before. Our traditions are numerous and varied, and, in many ways, the marketplace shifts to address this new reality. No facet of our culture is immune to this transformation—and certainly not the way we memorialize loved ones who have passed on. In 2015, CANA Second Vice President and Funeral Director Archer Harmon told the cremation symposium audience how Fairfax Memorial Funeral Home responded to changing demographics.
Know Your Data
Fairfax Memorial Funeral Home and Crematory is located in Fairfax County, a suburb just eleven miles from the border of the District of Columbia. Washington, D.C. is a very, very diverse community. Government jobs bring people there, embassies bring people there, a booming economy brings people there. In a very short time, in the ten years between 2000 to 2010, the non-Hispanic white population decreased in Northern Virginia by 10% percent to be replaced by an Asian population of 12.5% and a Hispanic population of 4.8%. In just ten years, that population change is incredibly rapid.
I got these data off of websites from Fairfax County, the federal government, and the media. This information is free, it’s readily available to you, and it’s a road map for you to understand what’s going on and why your business is changing. You can look at these data and see where your business is going to go. At our funeral home the software we use tracks everything. Our directors and apprentices are trained that there are specific things that are entered into our computer program. I can tell you where our deaths come from, the ZIP code, the average age, I can tell you the race—I can tell you all of this with just a few requests through the software program.
If you don’t know your past or your present, your future can be uncertain. Fairfax Memorial Funeral Home opened in 2003, within a couple of miles of well-established funeral homes in Northern Virginia that have been there 60, 70, 80 years. So it was a pretty big risk for the Doherty family to open a funeral home in 2003 when cremation rates were skyrocketing. But their risk paid off, and we served almost 900 families last year.
A lot of you have cremation rates of 60-80%, but there are many populations out there who want ceremonies. If you try to discuss direct cremation with them, they just don’t get it. How do you locate, serve, and track these groups for whom direct cremation is not an option?
The Importance of Outreach
When we first opened, I met with the funeral preparer for a local Buddhist temple. She came to us to inquire about using our funeral home because it’s close to where the population served by her temple lives. She helped me get set up with all of our Buddhist equipment and helped me to tailor a package to accommodate the needs of her families. What all this means for our industry, with our shrinking profits, growing cremation rates, and how diverse we’re becoming as a population in North America, we learned to reach out to specific groups. Now, Fairfax Memorial has created packages tailored to a specific temple that uses our services.
You have to have an outreach program for various groups so you can have a dialogue with them. You need to have a way to tell people what you can do for them. Our website is a great way we reach out to a particular population. The populations we are talking about are very savvy with technology, so we include specific religious and cultural keywords to help people find us. That way, when someone in Northern Virginia Googles “Buddhist funeral,” “Hindu funeral,” whatever the case may be, our information pops up. We are in the number one position with this.
If you look at a map that shows an overview of what your area looks like by the fastest growing religions, you can see where to put your efforts. Looking at the information on the national map, if I owned a funeral home or crematory in Washington State, Nevada, Arizona, and California, I would be knocking on the doors of these temples saying, “I have a funeral home and we’re here to help.”
The Laotian Buddhist Funeral
I think most of the directors at my funeral home agree with me that the Laotian funeral is one of the most interesting funerals we do. When we first opened in August of 2003, I was at the funeral home and we had a Laotian family walk in. They wanted to have a funeral. They liked our chapel because it was big and could accommodate 200 people. It was our first Laotian funeral and we didn’t know anything about a Laotian funeral. They helped us and they were very kind. To this day, we still have Laotian funerals and I still see some of the same people who were there for the original funeral service. We did something right the first time, and it has paid off.
Laos is a Southeast Asian country bordering Thailand and Vietnam. In a traditional service, relatives of the deceased serve in Laotian funerals as novice monks, or “monks for the day,” and this is a great honor – but one they have to shave their heads and their eyebrows for. In addition to the novice monks, full Laotian monks from the local temples are the ones who do the chanting for the deceased during the ceremony. Services are very beautiful. The Laotians bring in their own Buddha. It’s a Thai Buddha and it’s very thin. It doesn’t have the Chinese characteristics to it.
After the funeral has ended, the monks from the temple hold a rope. The rope is tied to the casket, and they lead the casket out our chapel door, through our front door, and throughout our entire funeral home. They make their route to the crematory where they witness the cremation.
As part of the procession, there’s a family member behind the casket with a bowl of money that’s wrapped in foil. The packets are thrown up in the air, and if you are the funeral director or funeral assistant or apprentice on that casket, you will get pelted with money. The family throws the money to distract the attention of the evil spirits away from the deceased so the loved one can be cremated and move on to the next world. The rope signifies the monks pulling, and the indirect route taken to the crematory is meant to confuse the spirits.
There are wreaths carried by family members with money attached to them. The family folds paper money into triangles and affixes it to the wreaths. This is for the temple monks. At the end of the ceremony, there’s a wreath for each monk as alms, or an offering to the monks, thanking them for their participation in the journey of the loved one from this life into the next life. The last Laotian funeral I had, there were ten wreaths. I counted one wreath and it had over a thousand dollars in twenties folded in triangles. Each of the ten wreaths was presented to the monks, so that is their form of payment, thanking the monks for what they have done for the family.
If you ever have the honor to serve a Buddhist family and they give you a tip, take it. If you don’t take the tip, you’ve insulted the deceased and you’ve insulted the family. It’s the same as the alms for the monks. The family is thankful for everything that you do for them.
Learning to Listen
It’s interesting to talk to people about their different cultures and religious traditions. It’s similar to the way people share food recipes. They want to share these things with you, and the more interest you have, the more they will tell you. And that’s how we’ve all become experts in this. Listening to the families we serve and putting it back together for them and giving them everything that they want. When we hire a new director, especially if they’ve come from another area, it can take a while for them to acclimate. I see them sometimes, just standing there wondering, “What’s going on here?” But in six months to a year, they’re fully immersed.
In Northern Virginia, we have a huge Asian population. In many of these cultures, cremation is a practice that’s been done for thousands of years. Sometimes they choose burial, sometimes they choose cremation. We can accommodate them, and anyone else in our community, with whatever their needs are, by being willing to listen to their needs and learn.
The data referenced in this post is based on the most recent US Census in 2010. The 2020 Census will provide even more perspective on how our communities are changing. CANA will continue creating innovative content about how change can work for traditional funeral homes facing new and different clientele.
This post excerpted from Archer Harmon’s presentation at CANA’s 2015 Cremation Symposium titled Meeting the Cremation Needs of a Growing and Diverse Population in North America, as transcribed in The Cremationist magazine Vol. 51, Iss. 2 titled “Know Your Community: Build Your Business” which includes more photos and traditions from services of many different cultures. The Cremationist is an exclusive benefit to CANA members — explore our website to learn about the other resources CANA provides to members.
Archer Harmon is a licensed funeral director and embalmer and the General Manager of Fairfax Memorial Funeral Home. With over 30 years of experience, Archer is well versed in many funeral traditions, including military funerals and state funerals for dignitaries. He has attained a vast amount of invaluable knowledge regarding the funeral customs of highly diverse populations. Archer serves on CANA’s Board of Directors as Second Vice President.
Posted By Administration,
Wednesday, June 12, 2019
Updated: Tuesday, June 11, 2019
Many funeral directors are facing more and more direct cremations with no services. They are at a loss as to how to overcome that trend. There are many ideas, theories, notions and educated guesses as to why families choose cremation. Cost. Environmental footprint. Control. Convenience. Lack of information. Religious affiliation, or lack thereof. All of those certainly are factors and can play a part in any one person’s decision. So we are going to look at the three Big C’s in Cremation.
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.
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.
Because the celebrant is a ceremony expert, focused solely on the ceremony and often devoting much more time to the ceremony than funeral directors and clergy can, the celebrant can be a tremendous resource. What celebrants offer can even be attractive to those who initially think they don’t want a ceremony at all.
—Diane Gansauer, Director of Celebrant Services, SCI Colorado Funeral Services in Metro Denver
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.
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.
High “nones” equal high cremation rates. It’s just that simple.
The greatest impact a Celebrant can have with a family is the one on one interview time, an opportunity to sit down and become part of the decedent’s family, by hearing and learning first-hand about the life of their loved one, and sharing a personal glimpse into the life of the decedent with friends and family at the funeral service. That is one of the greatest gifts you can ever give to the family. Out of that experience comes the most gracious of compliments that you will ever receive, which is to hear at the conclusion of the service how well you knew the loved one. The Celebrant experience gives you that opportunity to serve the family in ways you may have never dreamed possible.
—Kevin Hull, Vice President and Location Manager, Cook-Walden Davis Funeral Home
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.
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.
In today’s world, the most crucial element in helping a family lies in the ability of the Celebrant to actively listen and recreate what they have heard into something with meaning and value. Celebrant Training is funeral service’s best option to develop the skills to become an outstanding funeral professional. At our firm, all of our funeral directors must go through the Celebrant Training so they can understand the importance and value of working with our Celebrants to help the families have a truly outstanding experience. This is especially important for cremation families that are looking for something other than traditional services. Celebrant Services play a major role in making Krause Funeral Homes a place of exceptional funerals.
—Mark Krause, President
Krause Funeral Homes & Cremation Service
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.
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.
CANA is partnering with Glenda Stansbury and the InSight Institute for the second time this July to offer Celebrant Training. Limited to 40 attendees, this course packs a lot of information, emotion, and training into three days but is increasingly considered a must for the most successful businesses in the US.
Learn more about this class coming to Louisville, Kentucky from July 29-31 and register online.
Glenda Stansbury joined InSight in 1996 as Marketing & Development Director. She has worked as an educator, teacher trainer, and seminar developer. She is a practicing Celebrant, adjunct professor at the University of Central Oklahoma Funeral Department and is a licensed funeral director/embalmer. Glenda is available for speaking to funeral professionals at state and national conventions or for private staff training. For more information, contact Glenda at firstname.lastname@example.org.
Posted By Administration,
Tuesday, May 21, 2019
Arguing. Fighting. Physical violence. Destruction of property. Extreme denial. When I ask funeral professionals about their most difficult challenges, I frequently hear about extreme behaviors in the arrangement room. Not only are the stories jaw-dropping, but they seem to be getting worse and more common over the years. In the face of anger and rudeness, it can be difficult to generate empathy for the bereaved. That’s why I think it is valuable to do our best to understand the source of these extreme behaviors. We may be able to be more patient and gracious if we understand what is causing these behaviors.
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!”
In the Arrangement Room
While many other defense mechanisms come into play, these are three that appear frequently. After learning about these defense mechanisms a natural question is, “How does a funeral professional respond in these situations?” That is the focus of my presentation: “Defusing Conflict in the Arrangement Room: Strategies from Family Therapists” at the CANA’s 101st Annual Cremation Innovation Convention. I will be reviewing how funeral professionals can better understand the conflict that sometimes arises in the arrangement process as well as strategies funeral professionals can use to defuse these situations. I hope to see you there!
With a wide range of valuable networking and educational opportunities, the CANA Convention features sessions from presenters carefully chosen to make the most of your time away from the office and ensure you leave with practical takeaways.
We can’t wait to welcome Dr. Troyer to the CANA stage in Louisville this August. See what else CANA has planned for our 101st Cremation Innovation Convention: goCANA.org/CANA19.
Can’t join us? We’ll have recordings available so you don’t miss out on this amazing content.
Dr. Jason Troyer is a grief expert, author, former psychology professor, and therapist. He provides grief support newsletters, Facebook content, and informational videos at www.GriefPlan.com/funeral. He also provides community presentations, professional workshops, and trainings on behalf of funeral homes and cemeteries. Dr. Troyer can be reached at DrJasonTroyer@gmail.com.
tips and tools
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.
tips and tools
Posted By Administration,
Wednesday, February 13, 2019
Trade shows make for a great opportunity to check out innovations in memorialization—scattering urns, the latest keepsake jewelry, contemporary stationery designs, and cemetery monuments. These products offer new ways for you to match the unique personalities of families and their loved ones.
But true personalization is so much more than products. From the moment you answer the phone, you have the chance to differentiate yourself from your competition and enhance that family’s experience. Then, once they walk in the door, you have the opportunity to infuse ceremony in each interaction and make a difficult process meaningful to the family.
Extracted from examples provided when Lindsey Ballard facilitated an interactive discussion on Best Practices in Personalization and Ceremony at CANA’s 2019 Cremation Symposium, we offer the following ideas as inspiration.
Transfers and removals offer a unique opportunity to gather helpful information about the family through observation of the home and the items of comfort that surround the deceased. Encourage your staff and removal technicians to take notice of décor, family photos, items on display that might reveal a passion or treasured activity, and even the colors that fill the space. Empower your staff to engage with the family—it’s here they can learn some of the stories behind these beloved objects and see what motivated people in life. These initial impressions can help start the conversation about ways to make a service personal and demonstrate that you care.
Symposium attendee Franklin Rainier, of Franklin J. Rainier, Jr. Funeral Home, shared a story about entering the home of a 95-year-old woman and finding it decorated with Pink Floyd memorabilia and album covers. When asked, the woman’s son confirmed that she had been a true fan. Back at the mortuary, Franklin and his staff played Pink Floyd and lit candles to honor her as they prepared her body.
For some families, such as those who make a direct cremation choice, the arrangement conference may be the only time they will be acknowledging their grief before moving on. Sometimes, a special window opens up during these conversations and it’s important to pay close attention. Attendee Rita Alexander, of the Cremation Society of Illinois, recommended being especially sensitive to the pauses in the conversation and allowing people as much time as they need to grieve in the safe space you’ve provided for them.
Attendees agreed that a primary strategy is to make the arrangement conference into a conversation, to put the pen down and get to know the family before filling out the forms. You can introduce yourself and your company and describe how the process will work, then invite them to converse and share. Ask them about themselves, the deceased, and family and friends—that’s the time to take notes. At Simon Dubé’s funeral home, a Dignity Memorial location, these notes are discussed in staff meetings to brainstorm how arrangers can make sure the family’s experience is special. Not everyone on staff is equally creative, but together they can design the meaningful service that each person deserves.
Attendee Keith Charles suggested keeping the acronym FORM (part of the word information) in mind to guide your questions: “F” is for family and their relationship to the deceased. Make sure to acknowledge every single person in the room. “O” is for the occupation of the deceased. What type of work did they do and what was its impact? “R” is for recreation. Where did they go on vacation as a family and are there photos to use during the ceremony? And lastly, “M” for motivation—what put meaning in their life? With this acronym to guide you, you’ll be sure to touch on the major aspects of someone’s life and gather valuable stories to create a meaningful service.
Viewings, Visitations, and Services
Attendees agreed that getting the family’s permission to personalize the service is the first step to providing a unique and memorable experience. Many attendees shared stories of services they’d performed that conveyed real meaning to the family they served. A signature purple door for a Friends fan, a dress carefully chosen and displayed with a tuxedo to re-create a meaningful dance memory, or the seemingly modest touch of preparing the body’s fingernails with a signature teal polish and passing it out to the family to wear, too. Never underestimate the power of the small gesture of service: accents of a favorite color, the gift of a small pin (such as an American flag pin in the case of a service for a U.S. veteran) distributed to each guest, and other touches go a long way to demonstrating you listen and care.
Simon Dubé explained that taking time to requires a lot of work, but staff that are motivated by family service are willing to make the extra effort. Word of mouth is your most powerful advertisement. When you create an unforgettable experience, the conversation keeps going and spreads the word about how your firm goes above and beyond for the families you serve. Simon had many useful tips, including the recommendation that you invite the family to view the set up of the room an hour ahead of the service to make sure that they are comfortable with what you’ve done. This leaves plenty of time to remove a display if the family disagrees, and also provides them an opportunity to grieve and remember with the memorabilia in private.
Facilitator Lindsey Ballard pointed out that every moment can be an opportunity to turn service into ceremony. Handing a flag to a veteran’s family can be more than a simple keepsake if you use it to bring the family together to reflect on the symbol the flag holds. Lindsey does this by inviting close relatives to lay a hand on the flag while she recites a few words about commitment: a veteran to his country and theirs to his memory. In this way, a service for the family is transformed into a ceremonial experience they will remember.
Committal and Scattering
Be sure to inject ceremony at every pivotal moment, even during scattering. With a water scattering, you can pinpoint the GPS coordinates and give them to the guests. Balloon or butterfly releases can accompany an event. Processions will provide a really special memory for those in attendance. Don’t be afraid to ask local groups related to the deceased’s passions or occupation to participate as an honor guard. That could be firefighters, motorcycle groups, or high school athletic teams. At the end of a committal or scattering, as people are standing awkwardly, unsure about what to do next, give them an invitation to do something to finish with ceremony. For instance, they can leave a “handprint” by stepping up to touch the casket or urn before they leave.
Transfer of Urn Into Family’s Care
The urn transfer can provide an opportunity for ceremony, too. If the family is open to it, you can schedule a military honors ceremony for veterans with the military present and a flag-folding presentation. Another idea is to hand-deliver the urn along with the death certificate. You can wear a jersey when the family of a deceased fan comes in to pick up cremated remains.
It’s important to stay in regular contact with families before, during, and after the services. Suggestions for accomplishing this goal include memorial service for donors, annual remembrance events, and mailing special cards to the family on the date of the deceased’s birthday or the anniversary of the death.
This presentation included many images and stories that had several professionals tearing up in the audience. Interested in hearing the recording? The 2019 Symposium Recording is available for purchase. Visit the event page to learn more.
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