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Hospice, Families, and Funeral Service

Posted By Administration, Wednesday, February 27, 2019
Updated: Monday, February 25, 2019
Hospice, Families, and Funeral Service

 

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.

Hospice

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:

  1. Research
    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.
  2. 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.
  3. 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.

In Conclusion…

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.

 


Ernie Heffner Ernie Heffner 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 Kim Medici Shelquist joined Homesteaders 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.

Tags:  aftercare  arranging  celebrants  consumers  education  marketing  preplanning  services  tips and tools 

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Celebrant Training

Posted By CANA Staff, Wednesday, June 21, 2017
Updated: Tuesday, July 18, 2017
Celebrant Training

 

From May 18-20, 2017, CANA staff members were privileged to participate in the InSight Institute’s Celebrant Training presented by Doug Manning and Glenda Stansbury.

As association staff, we're responsible not only for responding to the needs of our members and the industry, but also monitoring the changing winds of consumer preference and practitioner trends and understanding the difference between fads and forward thinking. InSight’s excellent celebrant training spoke to all of these concerns, describing new consumer preferences in an increasingly secular world and illuminating what the role of a funeral director is and can be.

Taking the class with industry professionals allowed us to hear stories about their work with families outside of their crematory operations and their perspective on the role of the funeral director. The thoughtful class lectures, case studies, and the final project assignment challenged preconceived notions of how our members interact with families, what consumers want, and the heart of real service to communities. We've all gained an understanding we did not have before.



Personalization Isn't Product.
I once read an unintentionally humorous article about the right number of accessories to wear based on a codified point system where certain items were worth certain points and you weren't ready to leave the house until you'd scored well. I think we can all see that, while well-intentioned, this method is ridiculous. And, like something as personal as style, you can't codify quality and sell keepsakes and products to add up points and score something as personal as memorialization. It's about knowing your audience—your own style in the case of accessorizing—and listening to a family's wants and needs in end-of-life planning.

The funeral director is the expert in options, but listening and guiding is the next step to making personalization a matter of course. Families can't be coded and assigned urns, keepsakes, and options based on assumptions about their spending, love for the deceased, or style. And it's only when consumers trust that they're being heard without judgment that they will talk and share. From there, the right products, like the right accessories, will come.

Brie Bingham, Membership Coordinator

Watching Doug Manning and Glenda Stansbury present this workshop was a revelation. It was evident that they’ve spent many years thinking about people and grief and a meaningful way to help families and friends work through the deaths of the significant individuals in their lives—and find deeply personalized ways to remember them. Amidst the current revolution in consumer interaction with the death care industry, Doug and Glenda have developed a powerful response that was inspiring to witness. They’ve truly brought the art of listening to a new level and they lay out clear strategies to incorporate listening into interactions with those that seek their assistance.

The wealth of information and the creative and insightful approach shared by these experts has broad applications to the issues we consider as we work to serve CANA’s members and their best interests. CANA’s staff does not include any funeral directors or cremationists, so we benefit from hearing real-world experiences. Such stories helps us to see the through the eyes of the people who belong to CANA.

Sara Corkery, Communications Manager

As the education director, I was excited to participate in Celebrant training to make sure CANA education incorporates best practices and well-rounded perspectives. But I got more than I was expecting. My father died when I was 19. He was cremated and we had a memorial service for him. During the celebrant training, we talked a lot about the importance of a funeral or memorial service in beginning the healing process. As I thought back to my father’s service, I began to appreciate what my step-mother did, instead of resent it. She had taken control of planning my father’s service and what resulted was far different than anything the rest of the family was expecting. In other words, a traditional service. What we attended instead was a highly personalized celebration. Various people told stories about my father that I hadn’t heard before, and we played his favorite music. It was exactly what it should have been, but twenty years ago I didn’t understand that and still didn’t until I attended the celebrant training. And once that understanding took root, I was overcome by a desire to make sure everyone I know gets to experience that kind of funeral or memorial service when they lose someone they love.

At the same time I was experiencing a personal healing, I was also learning a lot about the funeral industry. As someone with no training in funeral service, I was shocked to learn that funeral directors aren’t the ones leading funeral or memorial services, and they aren’t the ones helping families plan them either. It’s usually a clergy person who may or may not know the family or the deceased. That explains why my step-mother did most of the service planning. The concept of a celebrant was almost non-existent in the US in 1996. Now I’m excited whenever I talk to funeral directors who have been through celebrant training or incorporate them into their business models. But I also see a huge missed opportunity for those who have not.

Jennifer Head, Education Director

I'd rather be ignored for $2,000 than $10,000.
I found celebrant training to be a transformative experience. I didn't expect to relive every funeral and grief experience of my life on day one, but that is exactly what happened. At the end of the session I was emotionally drained, but also exhilarated. Doug Manning and Glenda Stansbury provided the language to describe so many of my negative and positive experiences.

In response to a question about the increase in direct cremation, he told an anecdote when he was told, "I paid $10,000 for my father's funeral and my grief was ignored. The funeral director didn't direct anything, just took my order. I'd rather be ignored for $2000."

This story struck me profoundly. I thought about the behaviors of funeral directors that made the most impact on me, such as anticipating my need for a tissue or water, hugging or touching me when I needed comfort and saying my family member or friend's name. I have never been ignored, thankfully, but no one deserves to be ignored.

Barbara Kemmis, Executive Director



InSight

CANA Staff send our warmest thanks to Doug Manning and Glenda Stansbury of the Insight Institute for sharing their passion and professional expertise during the Celebrant Training course. We congratulate our fellow new Certified Celebrants who joined us for this course!

Tags:  celebrants  consumers  services  tips and tools 

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