What is an End-of-Life Doula?


Death is often difficult to discuss, especially with those we love the most. Talking about death means talking about our own mortality, and the thought of not being here with our loved ones can bring deep hurt, longing, and fear. Rather than address the necessary subject of end-of-life care, we tend to put it off as long as possible.

End-of-life doulas are changing that. You’ve probably heard of a “doula” – a childbirth coach who helps a woman bring her child into the world. A birth doula provides support throughout the pregnancy, the moment of birth, and the time afterward while mother and child are adjusting to their new life together. These doulas provide the emotional and mental support that the hospital system does not offer.

An end-of-life doula, also known as a death doula, does much the same thing, but for terminally ill people. They are there throughout the weeks or months prior to death, providing support to the person who is dying as well as their family members. They might be there at the moment of death to provide some peace during the transition. And they are there to comfort the family after their loved one has passed away.

Rather than sweep death and all its associated issues under the rug, end-of-life doulas provide a safe space for people to talk about what they’re feeling, no matter what it might be, and they also serve as a strong support for family members who need some emotional bolstering through a very difficult time.

Understanding Death Doulas

According to Healthline, an end-of-life doula is “a nonmedical professional trained to care for a terminally ill person’s physical, emotional, and spiritual needs during the death process.” They might be referred to by many other names, such as a “death midwife” or even a “transition coach.”

Though their job can involve many facets, a very important one is to approach death in a way that takes away a measure of fear. Being able to talk about death can allow a person to open up about their memories, regrets, hopes for their final days, and philosophical or religious beliefs that might be leading to fear or worry. By creating a safe space for discussion, end-of-life doulas provide a valuable service to a society that often denies the reality of death[1].

What End-of-Life Doulas Do

These compassionate professionals provide a wide range of valuable services to a terminally ill senior and their loved ones. They establish a relationship with the patients and their families with the goal of supporting and respecting their wishes at the end of their lives. This can include things like:

·         Talking with them about the dying process and explaining what to expect, thus taking away some fear of the unknown

·         Helping prepare certain documents, such as living wills and do-not-resuscitate orders

·         Sitting vigil with family and friends

·         Taking family photographs or creating legacy projects

·         Helping patients in transition stay focused on what is important to them

·         Providing basic comfort measures such as offering water or physical touch

·         Assisting in writing letters or otherwise contacting loved ones

·         Trying to manage the patients’ final days to reflect their wishes as best as possible

·         Keeping family members informed on how the patient is doing

·         Helping with obtaining basic services the patient needs, such as a medical bed or medical alert technology

·         Creating an environment that meets the wishes of the dying patient

·         Assisting in planning the funeral or wake

During the COVID-19 pandemic, social distancing and isolation protocols meant that end-of-life doulas were suddenly limited in their ability to meet with their patients. However, if a doula faces a problem like this, they can be as present as possible through phone or video conferencing.

Wait – Isn’t an End-of-Life Doula a Hospice Worker?

There is often a misconception about end-of-life doulas and how they compare to hospice care workers. While hospice care can do an excellent job of helping a person physically during their transition to end of life, they don’t often provide the strong spiritual or emotional support that many need as their final days approach. Hospice workers are often beholden to insurance companies and have many patients to deal with at once, while death doulas can focus on providing services to one patient at a time. End-of-life doulas can step in well before a person is put on hospice to help them with the emotional support they need to face their final days.

Where to Find an End-of-Life Doula

Many hospice services and hospitals can put you in contact with an end-of-life doula. Though an end-of-life doula doesn’t have to be certified to provide excellent service, it might make a person more comfortable to work with someone who has certification from one of these places:

·         International End of Life Doula Association. This organization provides training for doulas as well as optional certification – certification requires working with at least two patients, which means you will be hiring someone with experience.

·         International Doulagivers Institute. These doulas must pass a background check, pass an exam, and provide at least 30 hours of bedside service to become certified.

·          National End-of-Life Doula Alliance. The individuals in this directory must fill out an application to be included. The organization allows doulas to earn “proficiency badges” that give them more well-rounded training.

Doulas typically do not have a medical background. Even if they do, they don’t provide medical care. They do, however, usually go through training to become a doula. For instance, training through the International End-of-Life Doula Association (INELDA) requires attending training sessions, performing hands-on work, and meeting other requirements to obtain certification. It can take anywhere from six to nine months to complete the rigorous training[2].

Just as you would do your research when choosing a medical alert pendant or other aging in place options for yourself or an elderly family member, it pays to do your homework concerning the right end-of-life doula for you or a loved one. As with choosing a professional caregiver, sometimes it takes a little searching to find a person who “clicks” with you. When choosing the right person, talk with several death doulas to get an idea of their approach to their work. For instance, you might want to choose a doula who has a particular religious belief or has certain life experiences in their background.

How Much Does an End-of-Life Doula Cost?

The cost of doulas varies depending upon the extent of their assistance. Those services are usually not covered by insurance. Kelly Sanders, an end-of-life doula from Michigan, told Healthline that a patient might pay $700 for 20 hours of time, which can be extended if the patient needs that. An end-of-life vigil, during which the doula is present during the active dying process, can range from $1,500 to $3,500[3].

Some doulas might charge an hourly rate on a sliding scale, but typically between $45 and $100 an hour, according to WebMD. A flat fee of anything from $500 - $5,000 might be quoted as well. The costs depend upon the number of visits, where the visits occur, the potential for overnight stays, and more services the patient might want.

Obviously there is a very wide range of prices. When speaking with an end-of-life doula, don’t hesitate to ask about their costs and payment policies up-front.

Keeping a Senior’s Final Days Secure and Affordable

Though it’s tough to think about budgets during the final months or weeks or someone’s life, it’s an important consideration. While it might be tempting to hire a professional caregiver or a death doula to be on hand 24/7 while a person is experiencing the decline that comes before they die, sometimes that constant care is just not financially feasible. Therefore, it’s important to find other ways to make finances work so that there is less of a strain during those last days.

How do you do that? Focus on the things you can control. For instance, if you have an elderly parent who wants to stay at home during their final days, make sure they stay as safe as possible. A good example is the use of aging in place solutions.

Accessories for aging, such as a walker or cane (if necessary), a proper bed to ensure their safety, a medical alert device (emergency button alarm) to call for help immediately if needed, and railings on both sides of staircases can help someone stay independent for as long as possible. These things also allow them to stay at home, which can make their transition much easier by providing comfort and peace of mind. How to stay safe during those final days is yet another thing you can discuss with an end-of-life doula. Alert1 wishes peace and safety to you and all those you love.