Posted By Administration,
Wednesday, July 15, 2020
Updated: Monday, July 13, 2020
“Offer all of the options, to every family, every time.” – Dave Daly
No matter a family’s religion or cultural background, there will be times when it is appropriate for a family to see the disposition to completion, wherever it may be. When I served my first Hindu family during my internship, I was struck by the reverence,
the beauty and meaning imbued in the ritual of the sendoff at the crematory. Perhaps the West Coast is unique in that many of the families we served in that region were already familiar with witness cremation, even if they did not have a religious
requirement to do so. It was not until I moved back to the Midwest that I learned that so many funeral directors and consumers found the concept of going to the crematory shocking.
Families’ imagination is often far worse than the reality of cremation. Many may envision a stark, cold, clinical environment that smells like a hospital. They may imagine a chamber full of flames, and that the entire process is short, lonely, and perfunctory.
This is why families are less likely to ask, When will we be able to watch the cremation? as they would be to ask, When will we be able to watch the lowering of the casket into the grave? Typically, this is an offer that the
funeral director poses to the family who may need time to decide if that is something they can handle.
From the late 1890s until the 1930s, the profession had invited the family to attend the cremation, as many marble-walled crematoria began to be built in Europe and North America (Jupp, 2005).
Early cremationists treated the cremation ceremony in a manner virtually identical to committals. However, postwar funeral reform in the U.S. began to
treat cremation as a threat to the industry, with several professional associations focusing on how to deal with the “problem of cremation.” Too many American funeral professionals determined that cremation was ugly and even our contemporary books
on cremation describe witnessing ceremonies in a negative tone:
“As late as 1932, the Forest Home Chapel and Crematory in Milwaukee was encouraging family members to witness the placing of the corpse in the cremation furnace” (Prothero, 2002).
Putting the Service Back in Cremation
Is the consumer to blame for direct cremations? Or, as a profession, have we urged families away from ceremonial cremation in the hope that families who desire
more time and a chance to say goodbye will opt for casketed burial instead? It is my belief that we are doing a disservice to families who select cremation if we do not offer them an opportunity to witness their loved one being laid to rest. Most
funeral directors will invite the surviving family to be present at the graveside service. Witnessing the remains being placed into the chamber is like watching a casket be lowered into the grave, but for cremation. Similarly, this event creates a
lasting memorial and final farewell for the family.
Offering ceremonial witness cremations to families allows a unique, hands-on experience that creates an additional opportunity for the family to gain closure in a meaningful way. When we set up a graveside service, we plan for ceremonial comforts: a tent,
chairs, perhaps an ice bucket filled with bottled water and, more often than not, someone to officiate the ceremony whether this is a clergy member, celebrant, family member or the funeral director. There is a prescribed and widely accepted order
to the event. To appropriately create this memory of physical separation from a loved one’s remains for our families who select cremation, we need to ask ourselves some questions and shift our own perspectives.
A Standard of Excellence
When was the last time you had a client family ask for a three-day viewing in a Promethean bronze casket with limos for everyone and a plot in the highest spot in the cemetery that overlooks the lake? The fact is that we will continue to serve a growing
number of cremation families in the future. Why not create a standard of excellence in your market for cremation ceremonies imbued with meaning and ritual.
Regardless of the type of disposition, families want to ensure that the remains they are entrusting into your care are that of their loved one. Witness cremation ceremonies offer both an opportunity to gather in remembrance of the departed as well as
rapport-building transparency with positive identification of the deceased. Families will consider your firm as more credible if you have nothing to hide, and many will want to participate in the hands-on experience of saying goodbye. Seeing their
loved one right before the cremation—and potentially participating by initiating the cremation process—will help create a peace of mind, dispel fears about the process, and create greater goodwill and trust. It will allow the families you serve to
recognize the permanence of death (Wolfelt, 2016).
Witness Best Practices
As the public becomes more familiar with “do-it-yourself” and hands-on experiences, while self-educating about cremation, it makes sense to offer private crematory experiences as part of our standard services just as we include visitations and graveside
Let’s consider the optics of practicing witness cremation ceremonies. When my mother passes, I plan on being present at the crematory to see my mother one last time. Will I be comfortable with her being cremated in a cardboard alternative container? I
consider myself a pragmatist, but it would be much harder for me to select a minimum cardboard container over an alternative cremation option that comes with a pillow and is the same color as all her furniture. Even though I know, rationally, that
it will be consumed during the cremation, the likelihood of upgrading my mother to a ceremonial cremation container is 100%.
Even if not embalmed, setting a decedent’s features and performing a minimum preparation of remains should be planned for regardless of whether the
family has expressed a desire to view the remains at the crematory. The majority of crematory operators I have worked with in the past have told me that if a family is willing to travel to the crematory, then there is a greater chance that they may
wish to view the remains at the time of the cremation even if they were previously undecided about viewing.
As with planning any other type of service, it is important to allot enough time and set expectations and constraints to the family, the funeral home, and the crematory. This will require clear communication between all parties involved to schedule a
well-organized event. Families want a memorable and favorable experience; they do not want to feel rushed.
As the families we serve become increasingly participative, including them in the planning and tone of this event lends them a greater sense of control. Survivors may opt to place special photos, letters, or trinkets into the cremation container; they
may wish to have a significant song played while their loved one is being placed into the chamber. The benefits outweigh the additional time and effort spent planning the service.
Communicating with Families
Fear comes from a loss of control. Not having a realistic picture of what the crematory looks like, feels like, smells like, or sounds like will cause undue stress. It is important for practitioners to help their client families understand what to expect
so they will know what the outcome of the event will be and rest at ease knowing that nothing terrible will happen, like their imagination suggests.
There are several opportunities to convey the value and experience of witness cremation ceremonies: wherever you explain what services you offer. This service should appear on your General Price List, under the Services tab of your website, and be addressed
during the arrangement conference with every family who selects cremation. Several funeral homes have the witness cremation option built in to their cremation authorization form, where the authorizing agent will initial “Yes, we want to witness the
cremation and here are the names of the people who will be present”, or “No, we would like to opt out of that ceremony.” If appropriate, a gallery of photos or YouTube video can give a
sense of the crematory, so you do not have to schedule a pre-cremation tour of the space (although an open-door policy is a recommended best practice).
When making funeral arrangements, a consumer may not have enough background information to understand what you are asking if you say, “Do you want to witness the cremation?” Without context, this sounds more like a threat, rather than an invitation. Over
time, a funeral arranger can become more familiar with how to present witness cremation experiences by explaining the ceremony and inviting the family to be present for the event. Here’s a sample script:
“The cremation will be held at our crematory, which is located at our funeral home and cemetery on the northside. There, your mother will be held until the day and time that the cremation will occur. Our crematory allows for immediate family to be present
to watch the cremation container be placed into the cremator. We welcome you to be present for one last goodbye in your mother’s send-off, which is completely optional. If you are interested in this, please initial here on the cremation authorization
where it says, ‘Yes, family present.’ I will contact the crematory operator to schedule a time. I will be there with you by your side and if you wish to start the cremation process, you have the option of pushing the button.”
Whether your crematory space is “industrial,” or built specifically to host families for witness ceremonies, managing that expectation is key. Would heavy rain deter you from attending the graveside of your spouse or parent? If not, then a “no-frills”
functional crematory space should not be a deterrent for a family, but having a weather forecast and knowing ahead of time to bring rain boots is always appreciated.
In an ideal world, every family who selects cremation would be present to see their loved one. If that were the case, the chances of an erroneous cremation would be nearly impossible. Realistically, the percent of families who choose to be present at
the graveside to see the casket lowered is likely what you can expect of families to witness cremations.
As with a burial or any ceremony in funeral service, there must be an order of events to ensure a smooth cremation. Funeral directors must partner with crematory operators and schedule times for witnesses at the crematory’s discretion (e.g., “The crematory
operator says that we can plan the witness ceremony on Tuesday at 1:00 pm. Does that work for your family?”).
If you have a distrusting family who does not want to “receive someone else’s ashes”, crematory experiences are the solution. You can collaborate with the crematory operator to allow the family to be present for the transfer of their loved one’s cremated
remains to the urn, giving the family a greater sense of trust and peace of mind. It is critical to coordinate the scheduling with the crematory. It may make sense to hold the witness cremation as the last one of the day and schedule the pickup of
the urn for first thing in the morning; this gives the crematory operator ample time for overnight cooling and an additional opportunity for the family to watch the identification process post-cremation.
Many funeral service providers may be reluctant to offer witness cremation ceremonies because it is more work. But you would be surprised by the number of “direct cremation” families who are ready and willing to see their loved one, they just did not
know it was an option. We don’t know what we don’t know. It doesn’t hurt or cost anything to ask those you serve if they want to press a button, place the cremation casket into the chamber, insert a letter or drawing from a child in the cremation
container, or order flowers when they see a photo of an all-concrete crematory space.
Giving the consumer a say in the cremation service helps add value to the experience. It offers another opportunity to mourn and be together in a difficult time. Plenty of funeral homes routinely ask the family if they want to see the lowering of the
casket during a graveside service. Why not start with witness cremation ceremonies?
Heather Braatz takes a deep dive into "Witness Cremation Ceremonies" at CANA's Virtual Cremation Convention on August 5. The session will focus on differentiating your cremation business
by providing witness cremation choices to families and practical guidance on how to add value through ceremony.
See what else CANA has planned and register at goCANA.org/CANA20
Heather Braatz is a learning experience designer at Worsham College of Mortuary Science in Wheeling, Illinois. She is a licensed funeral director in Washington State and has worked for low-cost cremation providers,
family-owned funeral homes, and combo location corporations. She has arranged several hundred witness cremations with family present.
processes and procedures
Posted By Administration,
Wednesday, March 4, 2020
Updated: Friday, July 31, 2020
At the end of February, CANA hosted our annual Cremation Symposium in Las Vegas. That’s right, we encouraged people to travel to meet up with more than one hundred people and network in a popular tourist destination — it was a different time. Unsurprisingly,
the topic of discussion on the floor was the coronavirus pandemic, or the spread of COVID-19.
Fortunately, the US Center for Disease Control (CDC) has released guidelines with information on handling infected, or potentially infected, cases at your funeral home, crematory, prep room, etc. These preventative measures align with current best practices
in the prep room or crematory (i.e. wear universal PPE, limit exposure to the disease, and clean all surfaces carefully) that protect you from everything from the common cold to tuberculosis.
Current estimates suggest that
more than 220,000 people will die from COVID-19 in the US by November. But your cases are not the only potential source of infection in your businesses. Of those that contract COVID-19, 80% are estimated to be mild which means they are
more likely to transmit the disease. Experts are warning that rest of 2020 will be difficult depending on our response, and likely to continue until there is a readily available and adopted vaccine.
With state and local governments setting the current restrictions and guidance, current and accurate information is important to track. Consider designating one staff member in your office as point person to monitor reports and updates from the CDC and
your local jurisdictions, at least daily, to make sure your business is operating with the best information. As this post is updated,
newest content will appear in gold to highlight latest information.
So what do you need to know to prepare your business when an outbreak hits?
Make a Business Plan
Since "workers performing mortuary services, including funeral homes, crematoriums, and cemetery workers" have been officially listed as Essential Critical Infrastructure Workers,
it is even more important to make sure your business is prepared for this challenge. Inform, educate, and train your staff of the CDC recommendations.
Now that this post is getting so long, we've added a Table of Contents linking to information below:
- Caring for the Deceased
- Operating the Crematory
- Business Support
- Serving the Living
- Managing Staff
- Directing the Funeral
As a reminder, if there are federal and local orders/laws in conflict, follow the most restrictive to ensure that you comply with both, and ask for additional guidance and support as needed. Some resources to consider are: your state governor,
local mayor, local health agency, as well as the Disaster Mortuary Operational Response Teams (D-MORT),
Emergency Management Agencies (EMA) or Community Emergency Response Team (CERT) plus the Council of State and Territorial Epidemiologists (CSTE) and the National Association of County and City Health Officials (NACCHO). Be sure to check with health and government authorities any time you have questions to ensure safety and compliance
for you, your staff, and your business. If you are designated an essential worker in an area under an enforced lockdown, consider carrying staff identification, state professional license, or some other information that demonstrates your status for
ease of movement.
Caring for the Deceased
For any staff who handle the dead, the National Association of Funeral Directors (NFDA) and the Funeral Service Association of Canada (FSAC/ASFC) have useful resources for embalming, prep room, and removal staff in accordance with CDC guidelines (including specific guidelines for funeral homes)
which clearly state recommendations for Personal Protective Equipment (PPE), transporting the deceased, and cleaning surfaces. Many authorities believe that cases and deaths are under-reported,
so anyone coming in contact with the deceased should operate assuming that the case is positive.
In the case of embalming, funeral homes are encouraged to follow families wishes assuming that the firm and embalmer have access to PPE and the time to embalm safely. Remember, as important as it is to wear PPE when handling the deceased, it is also important
to follow the recommended sequence for putting on and removing the equipment.
Cremation is a sure way to destroy any contagion on a deceased body, which is why it's preferred for Creutzfeldt-Jakob Disease and Ebola,
but the WHO has stated that "people who have died from COVID-19 can be buried or cremated. Confirm national and local requirements that may
dictate the handling and disposition of the remains." The CDC has not released definitive information on how long the coronavirus lives in a deceased body, but they do say that "there is currently no known risk associated with being in the same room at a funeral or visitation service with the body of someone who died of COVID-19."
As always, families should do what's right for them, which can include caring for the deceased themselves.
They can have funerals and burials as long as they follow their state and local mandates regarding the number of people and social distancing guidelines.
Operating the Crematory
Most guidelines that have been released do not specifically mention the crematory or operator. The following assumes that the crematory operator does not come into direct contact with the deceased, rather handles the container. If the operator in your
business handles the deceased, see above.
CANA recommends the following:
- accept only cases in leak-proof, sturdy cremation containers per CANA Crematory Operations best practices
- the use of Standard Precautions should ensure safest possible work conditions. This includes PPE, as mentioned above, which is in short supply so follow
optimize your use per CDC guidelines.
- clean all shared tools, equipment, and surfaces frequently - e.g. the cremation container, door or loader, refrigerator, door handles and light switches
- maintain social distancing between co-workers and other people who may enter the crematory
- Limit witnessed cremations to ten or fewer people total, including the funeral director and operator or other staff present.
Generally, viruses are killed above 200 degrees Fahrenheit, so the cremation process kills the coronavirus. There is no concern about virus exiting the building
via emissions through the stack or remaining in cremated remains, however the operator should wear PPE to ensure transmission from operator to urn does not occur.
When releasing cremated remains to the family, limit the size of groups to ten or fewer, but also consider bringing the urn and paperwork to the client waiting in the car. Try to minimize physical paperwork with electronic documents and signatures, or
providing gloves, to cut back on touching paper. Similarly, keeping clearly marked sanitized and used pens to take and return for cleaning will cut back on multiple use.
In this pandemic situation, some crematories are concerned about regulations which limit the cremations a business can perform. CANA is supporting state associations who are working with these regulators to address these permits in the hardest hit areas.
With the Families First Coronavirus Response Act (FFCRA), passed March 18 and effective April 1 through December 31, 2020, businesses have new requirements for managing staff. All
employers with 500 or fewer employees must provide paid Family Medical Leave Act (FMLA) leave and paid sick leave – this is new for those who manage companies with fewer than 50 employees who were previously exempt from such requirements. The Department
of Labor, Wage and Hour Division has required posters and useful information to communicate with your staff.
As an employer who was previously exempt, this could be overwhelming, so it’s important to open lines of communication with your staff and establish a clear chain of command to address rapidly developing information. Don’t assume that all staff will immediately
take advantage of these benefits and leave the business in a time of crises. Provide guidance and support in addition to addressing their concerns about
what to do if they or a family member get sick. Don’t be afraid of questions or to admit that you don’t know. Importantly, communicate often to make sure staff are okay and keep lines of communication open.
The Coronavirus Aid, Relief, and Economic Security (CARES) Act, passed March 27 and retroactively effective to February 15, 2020, offers financial assistance to small businesses and large corporations alike. The US Senate Committee on Small Business &
Entrepreneurship has provided the Small Business Owner’s Guide to the CARES Act resource. If your business is having financial difficulty, you can apply for relief through the Payment Protection Program (PPP) with the US Small Business Administration (SBA) and your current bank. Alternately, you can seek support from the Employee Retention Credit (ERC), however a business cannot receive both the PPP and the ERC.
To better understand how both resources effect your business, CANA recommends contacting services who manage and administer your payroll, business insurance, health insurance, preneed providers, and bank. These are groups carefully monitoring how these
regulations and opportunities impact your work in your area, and know your business best.
For those in need of extra staff support, state associations in hard-hit areas and the NFDA have organized volunteer
programs to help. Reach out to these associations with your need or availability.
Serving the Living
But don’t forget that the living are actually your primary audience, and the ones your staff come into contact with every day. The CDC has special recommendations for the workplace in “Guidance for Businesses and Workplaces to Plan, Prepare, and Respond.”
Many of the roles at a funeral home, like funeral directors, embalmers, crematory operators, don’t do the kind of jobs that let you work from home. We cannot access the prep room from our living room, or arrange with families from our beds. So encouraging
proactive measures to keep employees well, then being flexible when people are ill, is key to keeping your staff and the community safe in any outbreak.
By now, everyone knows the top four guidelines on personal safety:
- Wash your hands often, for at least 20 seconds.
Are you sick of singing the A, B, C’s while washing your hands? The good news is some other popular songs have 20-second choruses,
including Landslide by Fleetwood Mac, Raspberry Beret by Prince, Jolene by Dolly Parton, Fever by Peggy Lee, Africa by Toto, Mr. Brightside by The Killers, and Truth Hurts by Lizzo. Mix it up and keep scrubbing.
- Avoid touching your eyes, nose, mouth, and ears.
- Cough and sneeze into a disposable tissue and discard it.
- Maintain at least six-feet (2-metres) around others, particularly sick persons.
When making arrangements or directing a funeral, these measures are important. The CDC now recommends, and many states mandate, "covering your mouth and nose with a cloth face cover when around others."
Of course, the most vulnerable populations are typically older generations and those with pre-existing conditions (including smokers). If a staff member is concerned
that they have been exposed, the CDC has issued guidelines for Safety Practices for Critical Workers which include frequent temperature
readings, mask wearing, and frequent disinfecting of work spaces. The CDC and Environmental Protection Agency (EPA) have released joint guidance on
appropriate disinfectants and cleaners. Shared work spaces include break rooms,
vehicles, and any shared equipment. The CDC has developed a toolkit with language and posters you can use to
communicate with your staff.
And don't forget your four-legged co-workers. Some animals have tested positive for the coronavirus, though it's unclear whether the virus can spread
from pets to humans. To protect your pets, service animals, and your community, the CDC recommends limiting their interactions as well.
In the event that someone does get sick, encourage them to stay home.
This is a difficult argument to make with the existing workforce shortage on top of a potentially growing caseload, because these jobs rely on you being in person to serve your families. But with the COVID-19 pandemics, you cannot serve your community
while being sick yourself. Sick employees need to stay home to recuperate and be well, but also to prevent the spread of disease in the community. As the disease continues to spread, you may encounter employee shortages from illness, school closures,
and caring for loved ones. Your business must have a plan for what you will do if you have too few staff.
Death Care Services are deemed as a low risk sector, and typically exempt from reporting to OSHA, the Bureau of Labor Statistics (BLS), or state agency incidents of illness, however CANA Member Regulatory Support Services recommends making a record of all work-related illnesses and injuries and placing that record in the affected employee’s file. For confirmed cases of COVID-19 or an employee that shows symptoms of COVID-19, this would include the employer’s directive
to an ill employee that he or she does not return to work until cleared to do so by health care professional.
The challenge with COVID-19, or any infectious disease for that matter, is knowing with absolute certainty that an illness is a result of exposure in the workplace. Especially with the high communicability of the coronavirus, sources of exposure outside
the workplace must be considered when assessing whether to report any fatality or hospitalization of an employee as a result of contracting COVID-19. However, some states are presuming that any essential worker who contracts the disease to have become
infected at work thus making them eligible for worker compensation. Check your state's department of labor for any specific requirements.
Directing the Funeral
And don’t forget that you also host community events and services with their own considerations. The CDC has special, updated guidelines for “Mass Gatherings or Large Community Events”
to help you plan and host safe services. Primarily, they recommend having posters and signs in addition to supplies on hand to keep everyone healthy, namely hand sanitizer, soap, tissues, and face coverings. Keep surfaces like door handles and light switches clean,
and remember to talk to your community volunteers about being safe, too. The CDC even has a toolkit with posters and language you can use to
communicate safe practices to your attendees.
With increasing emphasis on mitigating the spread of COVID-19, in areas with active outbreaks, the CDC recommends community-based interventions including "event cancellations, social distancing, and creating employee plans to work remotely,"
careful planning and communications with your families is important. Social distancing, in particular, runs counter to the spirit of the funeral by discouraging gatherings of more than 10 people, encouraging vulnerable populations to stay away, and
avoiding direct contact with others. Fortunately, you are professionals trained in talking to families with compassion and understanding. For ideas on making your communications meaningful, watch a
free, on-demand webinar from Lacy Robinson with "Practical Ways to Serve Families During COVID-19."
Now that federal guidelines from the White House have sunset, state governors' and state and local health authorities are determining how businesses and communities can operate — you can find this list of resources above. In some areas,
any visitation or service has been prohibited. White House guidelines to reopen businesses and services is recommended in multiple phases to keep employees healthy, prevent spread, and moderate
hospital cases and is helping states set their own reopening procedures. These recommendations will require your business to develop plans and policies to accommodate your families' preference for service while maintaining the health of your community.
Guidance from the CDC for consumers is written to help you educate your families on ways to hold services safely and the importance of taking social distance
guidelines safely. Ceremony expert Glenda Stansbury provided a free resource to help you and your families find creative solutions, such as livestreamed
services, to protect your business and the communities you serve. Grief expert Dr. Alan Wolfelt shared his suggestions on holding some form of ceremony at the Center for
Develop a plan with recommendations from the CDC including how to communicate with relevant parties. Mostly, be in touch with state and community partners to help respond to changing needs of your community. Working together facilitates communications,
response planning, and organizing when the need arises. The Council of State and Territorial Epidemiologists (CSTE) has a list of who to contact at the state-level and the National Association of County and City Health Officials (NACCHO) is a good resource for local-level needs. These are great new additions to your connections with first responders, hospices, and other community leaders.
Keep Supplies Stocked
PPE and other safety materials have been difficult to source, so it’s a good idea to take stock of the goods you use frequently and make sure you have supplies.
For those that are concerned about PPE supplies, the CDC has recommendations for Optimizing the Supply of PPE and and OSHA has issued interim guidance which brings their enforcement more in line with CDC recommendations.
The CDC has also provided a PPE Burn Rate Calculator to help facilities to plan and optimize the use of PPE. Also, reach out to suppliers, even those outside
of mortuary supply, if your need is severe. As a final resort, reach out to your local health authority, coroner, or medical examiner to explain your need and ask for recommendations. One CANA Member suggested ordering smaller quantities to prevent
large orders being flagged and redirected.
CANA Member Bass-Mollett shared their hard work finding the answer on how to request N95 masks as it was explained to John Flowers, CEO of Bass-Mollett:
- All N95s in existing stock and those being manufactured now are sent to the Federal Emergency Management Agency (FEMA)
FEMA allocates supplies to each state’s Emergency Operations Center (EOC) based on need
Each EOC manages requests from entities within its respective state — including death care professionals
To place a request for N95s, you’ll need to contact your state’s EOC.
The National Institute for Occupational Safety and Health (NIOSH) has issued recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators which suggests that equipment be alternated and discarded when damaged or dirtied. Some recommendations suggest to avoid wearing cosmetics, which could dirty the mask and reduce its effectiveness faster.
Keep Calm and Wash Your Hands
Situations like this, in times of increased caseloads and illness, require flexibility, patience and planning which is why you need to have these discussions and plans now. Like the radiation case study in 2019,
we want to help you plan, be safe, and prevent panic and misinformation. As information continues to change rapidly, the best resource for the most current information on your business operations is your local government and health authority.
Predictions say that "prolonged or intermittent social distancing may be necessary into 2022." Preparing now for the virus's resurgence in the Fall and Winter means
you can protect yourself and your business with proactive plans and preventative measures.
Situations like this also require extra care for yourself and your colleagues. "Stress prevention and management is critical for responders to stay well and to continue to help in the situation." Use the support resources from the CDC available by both call and text, and work together to stay healthy. Jason Troyer, PhD., specializes in helping death care professionals serve their families better. He wrote a post for us about
taking care of yourself in these ever-changing times. Additional resources unique to death care are available in his Finding Resilience program.
Thank you for the work you do.
For the next few months, CANA Members are invited to join us for monthly Open Forums to discuss how they're handling their response to COVID-19 and supporting their community. Check your inbox for instructions to join, or contact Membership
Manager Brie Bingham for more information.
US Center for Disease Control (CDC)
US Occupational Safety and Health Administration (OSHA)
Barbara Kemmis is Executive Director of the Cremation Association of North America.
processes and procedures
Posted By Administration,
Wednesday, January 8, 2020
Updated: Thursday, January 2, 2020
After the celebrations are over, the beginning of each new year reminds us to refresh and improve our habits. It is not too late to resolve to accomplish the following items this year and establish a new routine for years to come.
- Update and review current governing laws and regulations.
Regardless of your role in the industry, it is important to understand the current laws and regulations that govern your work. Put aside the necessary time to review the federal, state, and local laws and regulations which affect your day to day operations. Right to control final disposition and cremation authorization issues dominate legal complaints against people and businesses in this industry. If you have difficulty finding the statutes and regulations, try searching the web sites for your state association or licensing board – they often have links available.
CANA Members: If you need further assistance, use your legal consultation benefit and give me a call.
- Educate and train staff on any new laws or regulations affecting your business.
Keeping yourself updated on new laws or regulations is just a first step. The next is to educate and train your staff and co-workers on what you have learned. Hold a “lunch and learn” with your team and give everyone the tools to succeed.
- Update your forms to bring them into compliance with any law changes.
Out of date, non-compliant forms are an easy target for regulators and plaintiffs’ attorneys alike. Confirm that your form documents include all the required notices, consents, and disclosures. Consult with an attorney if you have any questions regarding current legal requirements.
- Educate and train staff on the changes in your forms.
Compliant forms are important, but the persons who use them every day must understand how to utilize them to the fullest. Avoid the problems caused by improperly filled out forms. If done and utilized correctly, forms often provide the best documentation in defense of legal complaints.
- Review and update your operational policies and procedures.
OSHA compliance is critical to a successful operation. So, too, are human resource policies, and so much more. If you need assistance in your review, CANA has partnered with Cremation Strategies & Consulting to offer a program which will help you compile operational policies and procedures customized for your business. Learn more here.
- Review and update your employee handbook (including social media policy).
Employment issues are a prevalent headache across all industries and business models. Address common concerns in your employee handbook, so that everyone is on notice of the standards to which they will be held accountable. Implement clear, unambiguous policies on work hours, time off, sick leave, vacation time, and dress codes. Have appropriate sexual harassment policies in place. Communicate your expectations regarding social media use and restrictions on employee posts on business matters. Make sure employees are aware that social media is not for airing of workplace grievances or complaints.
CANA Members: Read up on what my office suggests for these policies as part of the Crematory Management Program.
- Educate and train staff on your policies and procedures.
Periodic training and review of operational and employment policies and procedures are critical. There cannot be compliance without your employees first understanding your expectations and standards to which they will be held accountable.
CANA Members: You can keep your standard operating procedures current and your staff informed with the Crematory Management Program and support from Cremation Strategies & Consulting.
- Meet with your insurance agent or broker.
Make sure your insurance agent or broker understands your business. Too often there are gaps in coverage discovered when you need insurance assistance or defense to a legal claim, when is too late to put the protections you need in place. Many gaps in coverage result from your agent or broker not understanding your daily work and operations sufficiently to make sure that what you actually do is covered. Just because you have “professional liability” insurance, you have no guarantee that all of your professional services are covered. Proactive insurance strategies will serve you best.
CANA Members: Have you looked over CANA’s newest benefit, a professional liability insurance program for crematories? Read what makes this policy different and how it covers businesses like yours.
- Meet with your tax planning professional.
Do not leave money on the table. A tax professional’s advice can add value to your business and improve its bottom line. Mitigate your tax risks and exposures prudently.
- Budget for and plan to attend meaningful continuing education opportunities.
Take some time to think about the education and assistance which will benefit you and your business most in the upcoming year. Then, search for continuing education opportunities that will assist in meeting your goals. There are in person and online resources available to address almost any concern as an industry professional or business owner. Some jurisdictions even allow you to get your crematory operator certification online. If you attend CANA’s convention in Seattle this year, please say hello. I look forward to seeing you!
CANA Members: Not sure how to get started developing a defined professional development plan for your employees? CANA Education Director Jennifer Werthman is here to help you achieve your goals – reach out any time.
Getting your new year off to a good start can jumpstart accomplishing your business’s New Year’s Resolutions. Best wishes for your success in 2020!
CANA Members: Your association is here to help! If you ever need these resources or anything else offered by CANA, reach out.
Excerpted from The Cremationist, Vol 53, Issue 1: “First Quarter 2019 Top Ten Legal Checklist” by Lara M. Price. Members can read this article and any other advice in The Cremationist archive. Not a member? Consider joining your business to access this and all archives of The Cremationist plus the many resources referenced here to help you find solutions for all aspects of your business – only $495
Lara M. Price is a shareholder at Sheehy, Ware & Pappas, PC, in Houston, in the products liability and professional liability sections of the firm. She has extensive experience in a number of substantive areas of trial practice, including products liability, professional liability, administrative law, commercial litigation, health care law, premises liability, and personal injury and wrongful death. She regularly represents corporations, other business entities, and individuals in complex litigation against claims for personal injuries, wrongful death, and economic loss in state courts throughout Texas and in federal courts in Texas and elsewhere. Ms. Price is General Counsel for CANA and Texas Funeral Directors Association.
processes and procedures
tips and tools
Posted By Administration,
Wednesday, October 9, 2019
Updated: Friday, September 27, 2019
Nobody likes paperwork. It’s a pain in the rear and a nuisance. Filling out forms and checking off boxes is a waste of valuable time for the crematory operator, am I right? That statement is as wrong as saying the earth is flat.
I like paperwork – I'm a weirdo – and documentation and record keeping policies, and following them consistently, are just as important as any other task performed in the crematory. This includes the safe and efficient operation of the cremation equipment. I have seen first-hand the effect of poor operating procedures on a business and on the community. I am on a mission to change this, but I am only one guy.
So, if you understand the reasoning behind all of this paperwork and documentation, you can better appreciate its importance. Even more important is understanding the impact of not following your company record-keeping and documentations policy consistently.
The Point of Paperwork
State laws dictate what paperwork is required for the cremation of the deceased, and it is important that you comply with these regulations. Because cremation is irreversible, it is crucial that you document each and every step of the process. Proper and consistent paperwork reduces the risk of litigation in the event you are accused of doing something wrong. When you make a mistake, it’s easy to deal with. Admit your error, make good on it, take your medicine and move on with your life. The hard part is when you are accused of doing something wrong that you did not do. Without proper documentation it can be difficult to prove your innocence.
So what’s the key to a successful cremation business? There are countless books about strategy, procedures, and processes, but this is one of my favorite quotes:
Strong businesses have strong policies.
– Vicente Falconi, management guru
Crematory Management Program
So my company and CANA have partnered to create the Crematory Management Program to develop a framework – a table of contents if you will – for standard operating procedures that can be customized to each business. This is a resource for CANA Members to help them develop their own SOP Manual -- with samples and examples (and a free consultation with me) to get your existing policies and procedures in one place, in order, and identify what your company is missing.
We based it on four overview categories that we will introduce here, with a focus just on the paperwork:
Core Policies and Procedures
These are the things that are at the 30,000-foot view, meaning the overarching and guiding policies for your business. On the paperwork side, Document Retention Policies and filing procedures are important. These are determined in part by your state/provincial regulators, and part your business practices. If you can’t find something, even if it was filled out perfectly, it doesn’t exist. No one likes to file paperwork, but an organized file system could save your job someday. I often recommend, when I’m helping firms who use electronic file systems, to keep records forever. Why not? A lot of cremation professionals are used to the paper, but electronic files are not only responsible environmentally, but easier to store and locate.
Equipment Operations Procedures
Equipment is my favorite part since I built them for so many years. Here, you need to document your equipment and how to run it and maintain it. You need written procedures for how cases move through your operation. Your firm should have a comprehensive written procedure guide outlining the steps in the process from receipt of the deceased to return of the cremated remains, and it should include the associated forms, verification, and documentation required. In the crematory, there are forms for the operator to fill out and forms that are already complete. The operator is responsible for verifying the presence, accuracy and validity of these already completed forms prior to each next step in the process.
Maintenance and inspection is one section that's completely populated in the CANA Member resource of the Crematory Management Program. Basically, your schedules and logs, maintenance records, outside/third-part inspection records are all there. I love the idea of the outside/third-party inspection -- that means if someone -- like a regulator or one of your families -- asks, you can pull that report that shows what an inspector found, how you addressed it, and what you're doing right. Plus, your maintenance records keep a clear list of your investment in your existing equipment and prepare for a future capital investment.
Forms and Authorizations
You likely know the necessary forms and authorizations to keep your business running, but all of the paperwork in the world is worthless without compliance and consistency. Be thorough and complete with every entry every time. If you leave a field blank it will raise a red flag. Was that field forgotten? Or was it really not applicable? If there is a space to record information, and you either do not have that information or it doesn’t apply to this individual, mark that fact down in the space. An incomplete form is worse than not having a form in the first place, when it comes to covering your backside.
Write legibly when filling out forms. A document that you cannot read is worthless. Never use whiteout if you make a mistake filling in a field. It’s better to cross out the mistake with a single line and put the correct information in next to the error. Initial and date the correction. Whiteout can make someone think you changed the document entry after the fact, to cover your mistake. Keeping a mistake transparent is always better when defending your actions.
What’s the importance of human resources? Your business can’t do anything without staff to run it. So think about roles-based operational procedures. The procedures should dictate what the results are – not the people doing them. The people doing them should fit the skill set and do them per your policy and procedures. Doing it the same way every time helps assure that mistakes are not made. If you never do it differently, you will do it right every time. Knowing and being able to say you do it right every time is a powerful statement to make.
Why We Do It
The most important reason to consistently follow all documentation and record keeping policies and procedures is the fact that doing so will virtually eliminate doing the wrong thing. It’s not just about the risk and the money. It’s the obligation to the families. A crematory operator is a vital part of the overall process of turning a dead body into a living memory for a family. It is absurd to think that any good operator would want to do anything less than a perfect job for the family of the deceased. After all, it’s more about the family than anything else, right?
A well-developed SOP Manual wrapped in a pretty bow is not the end-game. Once completed, it will not do you any good on the bookshelf, no matter how great the processes are. The final document, a customized and complete SOP Manual must be a continuous, living, breathing part of your day to day business. CANA's Crematory Management Program is a benefit to our members to help you ensure your policies and procedures are comprehensive, implemented and enforced.
Developed with Cremation Strategies & Consulting, this program provides step-by-step instructions to build a Standard Operating Procedures Manual to reduce liability, improve employee on-boarding and training, and ensure that operations are done correctly, efficiently, and consistently.
See more and get started: goCANA.org/crematorymanagement
This article is excerpted from "All Systems Go: The Importance of Paperwork and Record Keeping" by Larry Stuart, Jr. which first appeared in The Cremationist Vol. 54, Issue 1 — CANA Members can log in to see this and more articles from our quarterly publication. This is part of the recurring column All Systems Go! written specifically for the crematory operator and featuring an assortment of practical knowledge regarding operations, maintenance, and best practices for running an efficient, safe, and cost-effective crematory.
Larry Stuart, Jr. is a graduate of Kent State University and is a past member of the Board of Directors of the Cremation Association of North America (CANA) as Supplier Liaison. Through his experience Larry has seen first-hand the negative impact that poor crematory maintenance and improper operating procedures can bring about. Larry has spoken at numerous industry events and has conducted crematory operator training classes across North America with a mission to advance the safety of cremation facilities and their employees and to more positively impact our community and our environment. For more information please visit larrystuartjr.com/about
processes and procedures
Posted By Administration,
Wednesday, June 26, 2019
Updated: Monday, June 24, 2019
This year at the CANA convention, I’m proud to cover a new topic on how we all serve our cremation families. As a group, we value the presence of the person and often encourage the family to see their loved one for not only identification purposes, but also because we know that the experience can be valuable in grief processing. We discuss this concept from a “front of the house” perspective often, but what does it mean to our prep room staff?
All of us who are in funeral service and caring for the dead are well aware that they come to us in various conditions. We also know that it is our job to observe these various conditions and prepare them in a way that is suitable for whatever disposition they are going to have. The industry term for preparation without embalming is “minimal care” however, that does not mean our efforts should be minimal. If we consider the most thorough method of preparation embalming, we can use it as our benchmark. However, not everyone gets embalmed, but that doesn’t mean that any preparation we do should not meet the highest level of care that embalming provides.
An Ethical Approach
Those of you who are reading this are likely embalmers (or know embalmers), so you are well aware that embalmers feel very strongly about giving the correct treatment to the deceased in their care. However, what does that actually mean, and how does it apply to preparing someone who is not going to be embalmed?
The first step of any thorough embalming is to bathe the person. Not only do we do this for safety reasons, but also to conduct case analysis (see the next section), and have a better understanding of what we are dealing with.
Embalmers are sometimes told by institutional care staff, death investigators, and even sometimes the family that the condition of the body is worse than it actually is, and a thorough bathing can actually create more of a peace of mind rather than reveal problems.
During this phase, all medical devices should be removed whether the person is going to be viewed by their family or no one other than the person placing them in the cremation container. We do this for safety in the crematory, because some implants can explode or melt, but also because used medical devices are trash and should be disposed of properly. A reasonable embalmer removes all of the medical devices they can from a person before presenting them, and if this is our ethical standard of care, then this should be done regardless. You wouldn’t expect a person to be buried with garbage, in fact the idea is repulsive.
One of the first things embalmers do when presented with a body is their case analysis. We observe the physical condition of the body in order to decide our strategy for fluid selection, feature setting, and dealing with any possible unknowns that may occur during the embalming such as swelling, purge, etc. But, if we are not embalming, what can we do? In this case, we still observe any pathological or other medical treatment outcomes this person may have. Medical devices should be removed and dealt with, and lesions should be treated appropriately with surface preservation (if allowed), sutured, or wrapped in bandages to prevent leakage.
By definition, embalming is always mutilation, which is one of the reasons we have to receive permission from the family before doing it. However, we embalmers bristle at this idea, because we are not in the business of mutilating people, we are preparing them for the most difficult event in a family’s life. We rectify this more negative perception by always minimizing the number of invasive procedures necessary, and we do so in a way that is careful and surgical.
Believe it or not, embalmers must have a bedside manner even though their patients have no idea how – or even that – they are being treated. We know how they are being treated. When we are preparing an individual who is not going to be embalmed, we always have to consider the technique we are using and recognize what is surgical and what is mutilation.
Further, perhaps one of the reasons a family is choosing not to have someone embalmed is because they do not recognize the care we put into it. Exceptional care of the deceased and proper bedside manner in any invasive procedure is not only ethical but respects the family’s wishes as well.
The Practical Approach
So now we have established three points on what to set our benchmark at when caring for an individual, but how do we apply this to a more practical manner? Presupposing compliance with all OSHA regulations and Universal and Standard Precautions, as well as observing the family’s wishes, providing minimal care does not mean compromising the quality of your care for their loved one.
To create a basis for our continued conversation on best practices of care, I have created an outline for you to consider. The outline described below is just that, an outline. This list is not meant to define limitations on best practices, but rather create marks on a spectrum.
When it comes to embalming, the word “clean” is often used interchangeably with the word “disinfected.” So how does that apply here? Closely observing and cleaning the person often uncovers medical outcomes such as bedsores or fluid pockets that are the result of the ante mortem or post mortem settling of fluids. Furthermore, moving the body from one side to another will reveal possible purge that may have not been otherwise apparent when the person was lying supine. There are different levels of cleanliness that may be available based on what the family wishes and what is possible based on the condition of the body.
- Basic disinfection: Basic disinfection procedures should be taken regardless of whether or not a family is planning to view their loved one. This would include the removal of all medical devices and bandages, surface disinfection using a spray, and removal from a soiled container into a clean one.
Mid-Level disinfection: This would include all of the above listed steps in addition to bathing the person, including washing their hair. Once the person has been thoroughly dried, it would also include the replacement of bandages over punctures from medical devices, and suturing of any surgical incisions. It would also include the draining of any fluid pockets that have formed. Orifices should be packed with cotton.
Thorough disinfection: Thorough disinfection includes all of the above steps, but it would also allow for some chemical preservation. While it may not call for vascular injection of embalming fluids, there is the possibility of surface embalming of any lesions, treatment of drained fluid pockets, the chemical cauterization of any surgical incisions, and the chemical treatment of any artifacts of medical device removal. Cotton for packing orifices can be coated in a topical preservative.
When preparing an individual at any level of service, we must consider the techniques we are using and ensure that they are appropriate based on family directions.
When caring for a loved one whose family has requested minimal care, we have to be sure not to be mired in our own hubris, but rather consider if our course of treatment is going to go well for our case. We must also consider our bedside manner matches the wishes of the family; are the procedures we are using in accordance with their wishes? If a family desires to view their loved one prior to disposition, but requests the least invasive techniques possible, do we understand what that means and are we able to execute that? For example, when closing the mouth in this situation, are you using a dental tie as opposed to a needle injector? Are you opting to use cotton to close the eyes as opposed to an eye cap? This is evaluated during case analysis and applied through bedside manner.
As funeral service purveyors, we are all very cognizant of the importance of the body and how it is honored. Just because a person has chosen not to be embalmed, does not mean we need to negate the philosophy of care that embalming entails. By observing these best practices, we can provide better customer service to our families in the assurance that their loved one will be cared for in a skilled and thoughtful manner.
Join embalmers and educators Damon de la Cruz, PhD and Ben Schmidt as they discuss best practices for preparing a decedent for identification, short term viewing, and cremation at CANA's 101st Cremation Innovation Convention. This lecture will include a discussion of safe handling procedures, the removal of medical devices, dressing, and cosmetizing deceased individuals. Ben and Damon will also differentiate between invasive and non-invasive procedures and the grey areas in between, sponsored by Ring Ring Marketing.
CANA's Annual Cremation Innovation Convention heads to Louisville, KY to bring together professionals across the funeral profession – funeral homes, cemeteries, crematories, cremation societies, and combos. Like CANA, Louisville celebrates a storied history even as it embraces its exhilarating future, making for the perfect pairing of location and association. Whether your thing is horse racing, whiskey, baseball, or shopping, you’ll find it in this charming city. Convention activities including social events, programming and exhibit time in the cremation innovation trade show merge seamlessly, keeping you on your toes and focused on the finish line.
Can’t join us? We’ll have recordings available so you don’t miss out on this amazing content.
Ben Schmidt is an instructor at Worsham College of Mortuary Science where he teaches Embalming Theory and Lab, Restorative Art Theory and Lab, Funeral Directing, and Funeral Service History. In addition to his duties there, he is the co-creator of MorTraqr, a web application for tracking embalming and funeral directing tasks. Furthermore, he is co-author of the textbook Creating Natural Form; Restorative Art Theory and Application. Follow the creation of the textbook, the further developments of Mortraqr, and the antics of his two year old son on Instagram @mortraqr.
processes and procedures
tips and tools