Final Rights: Reclaiming the American Way of Death
Final Rights is the definitive book on the modern funeral industry. Written by national FCA executive director Josh Slocum and Funeral Ethics Organization leader Lisa Carlson, Final Rights combines journalistic investigation with practical consumer advice. The only book of its kind, Final Rights unveils the tricks of the funeral trade (and how to avoid them) while calling out government regulators who dance to the $15-billion death industry's tune when they're supposed to be protecting you, the funeral consumer.
Jessica Mitford’s classic exposé, The American Way of Death, drew back the curtain on the funeral industry’s excess. Final Rights investigates the $15-billion funeral and burial industry in 2011, exposing consumer abuse, financial exploitation of the bereaved, and how government regulators can’t be counted on to protect the grieving.
Final Rights takes on these topics and more, offering consumers a road-map to help themselves find a funeral that fits their needs and their budget. The only book of its kind, Final Rights includes a chapter on the laws in each state, written in plain English, with suggestions for needed reforms.
Here's what Library Journal had to say:
Slocum (executive director, Funeral Consumers Alliance) and Carlson (executive director, Funeral Ethics Organization) offer a guide intended to prepare consumers to deal with what the authors claim is a deceptive and greedy funeral services industry. They look at the components of burying the dead, including choosing caskets and markers, dealing with cemeteries and funeral homes, understanding pre-need funeral purchases, and new and revived trends such as home funerals and green funerals. They offer numerous real-life examples of manipulation and questionable practices and provide tips for consumers to help avoid rip-offs, such as misleading perpetual-care arrangements and exorbitant embalming costs. There is practical advice on filing a complaint when wronged by the industry and a cautionary chapter on the Federal Trade Commission and what the authors see as its failure to enforce its own consumer protection rules. VERDICT This book is a boon for those looking to simplify and personalize caring for the dead. The inclusion of a compilation of each state's funeral laws, including statutory citations and guidance for those investigating home funerals and burials and body donation, make this an essential purchase for consumer-protection collections.—Joan Pedzich, Harris Beach PLLC, Rochester, NY
We have it in our library for you to peruse, or you can order copies directly from the national FCA. Final Rights: Reclaiming the American Way of Death, Josh Slocum and Lisa Carlson. 512 pages, Upper Access Publishing. $19.95 (with shipping included, total $22.50).
Curious? Read the first chapter, Circling the Hearses, free!
Advance planning will ensure your wishes are followed.
Mr. J. had an implantable cardioverter defibrillator (ICD) for advanced heart failure. Having survived one episode of cardiac arrest, in which he nearly died, he was at high risk for another episode caused by a rapid, unorganized heart rhythm called ventricular fibrillation. Should this happen, the ICD would shock his heart back into normal rhythm. But at his daughter’s wedding, the ICD fired nine times. Each time, it saved his life, but the painful episodes terrified him, and he asked that the ICD be turned off.
Dr. Eva Chittenden, associate director of palliative care at Harvard-affiliated Massachusetts General Hospital, met with Mr. J. to explore his decision further. He stated that he had already been hospitalized five times with 12 months, and he felt this took too much time away from his family.
They discussed his personal values and what action he would want taken if his heart stopped, and the ICD was no longer there to revive him.
After long talks with Dr. Chittenden and his family, Mr. J. chose a “Do Not Attempt Resuscitation/Do Not Intubate (DNAR/DNI)” order. The decision meant he could continue seeing his cardiologist and other doctors, remain on his medications, and return to the hospital for intravenous diuretics. But he would not be revived if his heart stopped.
“Discussing these wishes and decisions with those who are closest to you is equally important, because one of them may need to make decisions for you in the event of an emergency,” she adds.
In addition to an advance directive, there are two measures you can take to ensure your wishes are respected.
1 - Health care proxy
It is important to designate a surrogate decision maker who will have the legal authority to make medical decisions for you, if you unable to make them for yourself. The situation may be temporary—when you are under anesthesia, for example—or permanent. The person you choose might be a spouse, child, or trusted friend. “Having a legal medical surrogate is very important because, if two family members disagree about what should be done for you, the legal surrogate has the final say,” says Dr. Chittenden.
In many states, all you need to do is ask your doctor’s office for a form, complete it, and have it witnessed by two people. In other states, you may need the assistance of a lawyer or notary. Ask your doctor’s office for direction.
2 - A new type of living will
Thirty-four states have adopted legislation encouraging people with life-limiting illness to fill out a form with their physician that directs their care in a medical emergency or other situation in which they are unable to make decisions for themselves. It is call a Medical Orders for Life-Sustaining Treatment (MOLST) form (or POLST, for Physician’s Orders). It is more specific than a living will, which is often too vague to direct care in a meaningful way.
The MOLST form may document your preferences only about resuscitation, or it may also specify your wishes regarding hospitalization, dialysis, artificial nutrition, or hydration. The form serves as a medical order if an ambulance is called to your home or if you are hospitalized away from home. It should be completed with your physician following a discussion on the goals of your care. You many change your decision at any time and replace the form with an updated way.
Don’t wait until it’s too late
Advance planning should be done while you are able to make and articulate your decisions. “You may never need these documents, but if you do, your wishes for life-sustaining care are more likely to be respected,” says Dr. Chittenden.
To learn more about advance directives, click on the title to order the special report, The Health Care Power of Attorney and Living Will.
The FCA frequently receives telephone calls inquiring about cremating or burying a loved one without the services of a funeral home. Callers often want to know about the legalities of doing this, and what, if any, permits are needed. According to information provided by the California Department of Consumer Affairs, Cemetery and Funeral Bureau, the law does not prohibit consumers from preparing or transporting a body for disposition themselves. If you, as a consumer, make that choice, you must:
You will be required to present the Permit for Disposition upon arrival at the cemetery or crematory.
The FCA phone rang one morning last spring. The caller had discovered his mother-in-law dead when he arrived to visit. Taken by surprise, the family called the FCA – “now what??” Within the hour, the family had found a well-marked DEATH FILE and any questions they had were answered.
So…what is the message here? Create a box or file and begin putting your thoughts and wishes for what you want should your life end unexpectedly. This pertains to all of us, young and old. As a younger person, you may find your wishes changing over the years, but the important thing is that this file is begun, issues addressed and that it is shared with family and those who will be dealing with your affairs upon your death.
Plan Ahead and Rest in Peace
Many members establish a Pay on Death (POD) account at their bank or similar financial institution designating their representative as the beneficiary of the funds in the account upon the member’s death.
Be sure to inform your representative, family members, funeral establishment, Attorney-In-Fact under your Durable Power of Attorney, Executor and your estate planning attorney of the provisions of the account. Occasionally, POD accounts have service fees, and interest earned is taxable. Usually, the account can be canceled without penalty.
You may also prepay the mortuary using a pre-need trust or funeral insurance policy. It is important to be careful if you prepay the mortuary. Review the cautions contained in the Consumer Guide to Funeral and Cemetery Purchases by the California Department of Consumer Affairs. The guide is available online here.
Prepaying the mortuary can have these advantages:
Prepaying at the mortuary can have these disadvantages:
Coverage for Children
Parents are reminded that the children they request to be covered under their membership become legal adults at 18 years of age and they need to apply and pay for their own membership at that point. Some parents give memberships as a gift to their adult children.
Probably not. The experience is that pre-paying usually costs the consumer more.
"Pre-Need" is a term used by the funeral industry to describe payment for funeral and cemetery services and merchandise prior to death. Such plans usually are in the form of insurance payable on an installment plan. Financing and service charges increase the cost. Both mortuaries and cemeteries sell pre-need plans.
“Pre-Planning” is a term used by the Funeral Consumers Alliance of Humboldt. We do not sell insurance funeral merchandise and services, nor make funeral arrangements. Therefore, there is no cost to the consumer. Our group (and groups like ours) assists members in pre-planning to keep costs as low as possible, while respecting their wishes.
Before you enter into a "pre-need plan," make sure the plan:
Pre-paying is not the same as pre-planning. “Let the buyer beware” before entering into a pre-need plan.
By Aisha Coriell
I recently had a conversation with my mother about her end-of-life wishes. She stated her wish is to be buried on her land out in the mountains. Well, we all know we can’t just bury someone on the “back forty,” but having this conversation inspired me to learn more about what might be the next best option. While it may not be legal for her to be buried on her property in the mountains, maybe it would be an option to be buried in the small rural cemetery located closer to her home? For example, there is a small rural cemetery on the side of the road on the way out to her property. After contemplating it, I thought of two other small cemeteries close to her home. I wanted to learn more about rural cemeteries.
Is there public access to rural cemeteries? Is it possible for new gravesites to be added to rural cemeteries? I did an Internet search, read through the California health and safety codes pertaining to death and cemeteries, and emailed back and forth with the Cemetery and Funeral Bureau of California.
Most rural cemeteries are family cemeteries created years ago. Family cemeteries are located on family-owned land and public access would require explicit permission from the landowner. Many laws and regulations that now exist may not have been in place when most of the family cemeteries started. It is possible that when a family cemetery was created, wooden markers were used to distinguish one gravesite from the next. Over time, wooden marker may have disintegrated. It may be difficult to determine the boundaries between gravesites, leading to the risk of disturbing existing remains.
When looking for information about a rural cemetery in Petrolia, I came across a website that stated the public is permitted to visit the cemetery. It is called the Pioneer Cemetery and the first burial was in 1857. According to the website, there haven’t been any new plots available since 1978 but there are potential plans to start a new cemetery so residents of Petrolia can have an option closer to home.
Among the many rules and regulations that exist today, one barrier to creating a new family cemetery is that “burial must be in an established cemetery, so you will need to check with the county registrar for local zoning laws to see about establishing a cemetery for home burial.” According to a 1939 statute, six or more bodies buried in one place – not the cremated remains of six – constitutes a “cemetery” (Final Rights by Slocum and Carlson, 2011).
Is it possible for new gravesites to be added to existing rural cemeteries? I found that that depends on a number of factors. The sites would need to be well marked so as not to disturb existing remains. According to Ellis M. Kjer from the Cemetery and Funeral Bureau in California, “The County will not give you a permit until you have written permission from the land owner and you can provide such to the Office of Vital Records in Eureka.” A Permit for Disposition would have to be obtained and approved by the public health department. In the end, the official whose job is to approve the Permit for Disposition has the final word. In addition, I wonder what would happen to access if the ownership of the land changes hands?
For those who live in rural areas of Humboldt County and wish to be buried, the options appear to be (1) going through the process of obtaining proper documentation and permission to access a site on a family owned cemetery close to home, or (2) purchasing a site at one of the established cemeteries in the more populated areas of Humboldt. A list of these cemeteries and their prices can be found on the FCA of Humboldt website.
“Green” burial is a natural process that allows one’s body to return gently back to the earth. It avoids the use of modern caskets, concrete vaults and toxic embalming fluids all of which hinder the decomposition process and waste resources.
Currently there is only one place in Humboldt County where the general public can have a “green” burial. A section of the Blue Lake Cemetery has been set aside for this purpose.
North Coast Natural Burial is a local nonprofit organization with a mission to 1) establish a natural burial cemetery on the North Coast and 2) educate the public about their disposition rights and responsibilities. They are actively seeking land for the cemetery. For further information email Georgianna Wood.
From a NY Times article By Jane E. Brody, January 18, 2011
The specter of “death panels” was raised yet again this month, prompting the Obama administration to give in to political pressure a second time in its effort to encourage end-of-life planning.
Of course, the goal of this effort was not to make it easier to “pull the plug on grandma” in order to save the government’s money, as some opponents would have it. The regulation in question, which was withdrawn just days after it took effect on Jan. 1, simply listed “advance care planning” as one of the services that could be offered in the “annual wellness visit” for Medicare beneficiaries.
The widespread misconceptions about the regulation were exemplified in a letter to the editor published Dec. 29 in The New York Times. “Death panels,” the writer said, would have denied her 93-year-old mother colon cancer surgery that has given her the chance to live “several more years.”
But that is not at all what the regulation would have done. Instead, “by providing Medicare coverage for end-of-life planning with a physician, it would have encouraged doctors to talk to their patients about their wishes and made it far easier and more likely for these important conversations to take place,” said Barbara Coombs Lee, president of Compassion & Choices, an organization that helps people negotiate end-of-life problems.
With payment schedules that limit doctor visits to a mere 15 minutes or so, it is unreasonable to expect physicians to spend 30 or more unreimbursed minutes discussing with patients the many decisions that can arise at the end of life.
Encouraging such conversations might indeed save money in the long run. Doctors and hospitals are paid only for treating living patients, so there is always a possibility that financial incentives, conscious or unconscious, would prompt many expensive if futile life-extending measures – efforts that many patients would veto if they could.
In a study of patients with advanced cancer published in March 2009 in Archives of Internal Medicine, the costs of care during the last week of life were 55 percent higher among those who did not have end-of-life discussions with their doctors.
At least as important, the quality of life in their final days was much worse than among those who did have such discussions. Countless studies have shown that extensive medical interventions can make the last weeks of life an excruciating experience for patients and those who care about them.
An Individual Decision
Although talk about end-of-life options has often emphasized avoiding unwanted, intrusive and futile care, that does not mean everyone would or should make that choice. Many patients, especially younger ones, might be inclined to ask that every conceivable measure be taken.
Dr. Josh Steinberg, a primary care physician in Johnson City, N.Y., routinely discusses end-of-life desires with very ill patients. He told me about an AIDS patient who was down to 77 pounds and had no strength, no appetite and failing kidneys. But the man refused hospice care, saying he wanted to go home and live as well as possible for as long as possible.
“Though we didn’t think he’d last more than a day or two, we got lucky,” Dr. Steinberg said. “We stumbled on a new treatment, he rallied, and he’s home doing well right now.”
For other patients, hospice care is the right decision. Studies have found that terminally ill patients are likely to live longer, with better quality of life, when they choose hospice over aggressive treatment to the bitter end.
The point is that end-of-life care is an individual decision that should be thoroughly discussed with one’s family and physicians. Studies have shown that when doctors don’t know a patient’s wishes, they are inclined to use every possible procedure and medication to try to postpone the inevitable. More often than not, this shortens patients’ lives and prolongs bereavement for the survivors.
In an interview on the syndicated news program “Democracy Now!” on Jan. 5, the writer and surgeon Dr. Atul Gawande said that patients with terminal cancer who discuss end-of-life choices with their doctors “are less likely to die in the intensive care unit, more likely to have a better quality of life and less suffering at the end, do not have a shorter length of life, and six months later their family members are markedly less likely to be depressed.”
Plan While You Still Can
For many more of us these days, the end does not come swiftly via a heart attack or fatal accident, but rather after weeks, months or years battling a chronic illness like cancer, congestive heart failure, emphysema or Alzheimer’s disease. When doctors do not know how you’d want to be treated if your heart stopped, or you were unable to breathe or eat and could not speak for yourself, they are likely (some would say obliged) to do everything in their power to try to keep you alive.
A year ago my husband was given a diagnosis of Stage 4 cancer. As his designated health care proxy, I had agreed long before he became ill to abide by the instructions in his living will. If he was terminally ill and could not speak for himself, he wanted no extraordinary measures taken to try to keep him alive longer than nature intended.
Knowing this helped me and my family avoid agonizing decisions and discord. We were able to say meaningful goodbyes and spare him unnecessary physical and emotional distress in his final weeks of life.
Preparing these advance directives should not wait until someone develops a potentially fatal disease. Patients in the throes of terminal illness may resist discussions suggesting that death may be imminent, and close family members may be reluctant to imply as much.
Indeed, judging from national studies and people I know (including a 90-year-old aunt), most Americans regardless of age seem reluctant to contemplate the certainty that one day their lives will end, let alone discuss how they’d want to be treated when the end is near.
A study published in January 2009 in The Journal of the American Geriatric Society showed that 40 percent of people questioned had not yet thought about advanced-care planning and 90 percent hadn’t documented their wishes for end-of-life care.
Ideally, everybody over 18 should execute a living will and select a health care proxy – someone to represent you in medical matters.
Compassion & Choices has an excellent free guide and “tool kit” to help people prepare advanced directives. Click here to download from the organization's Web site, or call (800) 247-7421 for a free hard copy of the documents.
From a NY Times article By Kevin Sack, December 9, 2011
As Toni Kelly battled lymphoma, first with a bone marrow transplant and then with brutal rounds of chemotherapy, she worried obsessively that her four-year struggle would destroy her family’s finances.
Her husband, Doug, refused to consider her pleas to stop pursuing costly therapies. But she knew that after she died, which she did on Sept. 29, there was one way she could keep from adding to the $200,000 in medical debt she would leave behind. Like a growing proportion of Americans, she said she wanted her body to be cremated.
“We did everything we could to cut down other costs, and one of the things that Toni said was, ‘Let’s find out how much it costs to be cremated,’” Mr. Kelly said. “If there was a way we could save even $500 or $1,000, it didn’t make a difference. Her major thing was not ruining the family.
All but taboo in the United States 50 years ago, cremation is now chosen over burial in 41 percent of American deaths, up from 15 percent in 1985, according to the Cremation Association of North America. Economics is clearly one of the factors driving that change.
The percentage of bodies that are cremated has risen steadily for years, for reasons ranging from spiritual to environmental. But a recent study shows that the increase has accelerated during the downturn, and many funeral home directors say they believe the economy is leading people to look for less expensive options.
The disposition of Ms. Kelly’s remains cost about $1,600, and that total included a death notice, a death certificate and an urn bought online. It was a fraction of the $10,000 to $16,000 that is typically spent on a traditional funeral and burial.
Family and friends remembered Ms. Kelly, a 54-year-old artist, at a simple memorial service at the golf course in Virginia Beach where Mr. Kelly works as an assistant pro and where she liked to walk their dogs. It was the first cremation on her side of the family, Mr. Kelly said.
“Neither of us felt that the body itself was really all that important,” said Mr. Kelly, who raised two sons with his wife during their 28-year marriage. “We had no interest in being put in the ground, no need for a memorial for the whole world to see. Her concern was the financial devastation she was bringing to the family.”
Many others share that concern, according to a national telephone survey of 858 adults conducted last year by the Funeral and Memorial Information Council. It found that one-third of those who chose cremation in 2010 said cost was a primary factor, up from 19 percent in 1990.
With the cremation rate rising one-third faster than at the middle of the last decade, the cremation association projects it will pass 50 percent by 2017 (still lagging behind Canada and much of Europe and Asia). Although state cremation rates vary widely, from 13 percent in Mississippi to 73 percent in Nevada, every state has experienced an increase since 2005.
Until recently, said Michael W. Nicodemus, president of the cremation association, concerns about cost rarely entered into his discussions about cremation with families at the Hollomon-Brown funeral homes in Virginia’s Tidewater region, where he is a vice president. The rationale for cremation in the past was more typically that the family plot had become anachronistic in today’s transient society and that cremation afforded residents and friends more time to gather from afar for a memorial service.
Today, he said, nearly half of his consultations eventually turn to worries about money, and the cremation rate at the company’s nine funeral homes has risen to 55 percent, up from 35 percent six years ago.
“People have lost money in the markets,” Mr. Nicodemus said. “Their retirements aren’t what they used to be. A lot are living off Social Security.” Some families, he said, have reversed burial plans because life insurance has lapsed or savings have been drained by uninsured medical expenses.
“We had six families to see yesterday, and all six were cremations,” Mr. Nicodemus said. “That tells me something.”
African-Americans, steeped in the traditions of open-casket funerals and rousing eulogies, remain the most resistant to cremation, according to surveys. But in the Virginia Tidewater, as elsewhere, even that cultural wall is crumbling.
Kenny Alexander, owner of Metropolitan Funeral Service in Norfolk, Va., said there was enough demand in the area’s black community to make him consider buying a crematory, a $125,000 investment. He said 2 or 3 of every 10 families that come to him now asked for cremations. A decade ago, Mr. Alexander said, he did not even know how to price one.
“Unemployment, coupled with the downturn in the economy, the realities of people losing their savings and not being insured, has certainly caused African-American families to look at cremation in a different light,” Mr. Alexander said.
In some instances, he added, families do not want friends to know because it may carry the stigma of financial hardship. “We just say the burial is going to be private,” he said.
Most mainstream religions have relaxed objections to cremation, which were tied to biblically based views of the body as a vessel for the soul and of a heaven populated by human forms.
“America is becoming Hinduized in this way,” said Stephen Prothero, a professor of religion at Boston University and the author of “Purified by Fire: A History of Cremation in America,” “We’re increasingly seeing the human as essentially spiritual and gradually giving up on the Judeo-Christian idea of the person in the afterlife.”
Still, Lorice L. Ottenbacher of Virginia Beach explained that her husband’s choice to be cremated, while largely motivated by his beliefs, also had an economic component.
“We talked about how expensive funerals were,” said Mrs. Ottenbacher, whose husband, Charles, died on Oct. 29 after a six-year struggle with Alzheimer’s disease. “He said, ‘Well, just take me out to sea and let me swim with the dolphins and I’ll be happy.’ So that’s what he’s going to get.”
Whatever the precise cause for the shift, the funeral industry is having to adapt, making up for lost revenue with higher volume and more services, like catered receptions and ash pendants.
Sales of crematories—there are about 2,200 across the nation, according to the cremation association—are growing steadily as funeral home directors decide to perform cremations themselves rather than paying others to do so, said Paul F. Rahill, president of the cremation division at Matthews International, a major manufacturer. The ovens burn at 1,800 degrees for 90 to 120 minutes, and a grinder crushes the remaining bone into powder.
To broaden cremation’s appeal to the environmentally minded, and to comfort people fearful of fire, the company is marketing a new “biocremation” process that dissolves the body with chemicals.
Families seem intrigued. “In their minds,” Mr. Rahill said, “it’s a gentler process.”
Experiences from Member Services Representative Jan Rowen:
I have been recently working with a social worker and the mortuary in a case in which a woman had joined FCA, but had not spoken to her family about her wishes. After she passed away the family met with the mortuary, but no mention was made of FCA. The mortuary assumed that she was not a member and did not bother to ask. The family began to arrange a lot of things that are not in the FCA contract and were quoted well over $1,100.
Also, our agreement now includes Goble’s Mortuary. If you live in Fortuna or south of it, please let Goble’s know of your enrollment in FCA either by calling or going in person to give them your name.
More and more today we are reading about and seeing in the media a step back in time in the ways some families are dealing with death. Natural Burial is a huge topic of interest. Caring for the body, sitting with it for a period of time, and finally transporting it to the final resting site are three of the common changes I see. All of this takes planning and often the deceased has had a say in it and there is a plan in place prior to death. Here are two stories that speak to the ways that families have dealt with death:
I just want to pass along a big THANK YOU for the support and guidance provided through the Funeral Consumers Alliance. As you know, my Mom was diagnosed with cancer in April of last year. Her doctor gave her a few weeks to 6 months to live. She passed away on November 14, 2010. From day one Mom made it very clear she did not want a memorial service after her death, but, rather, have a “living memorial” during her final time remaining. Mom also wanted to be buried next to her sister, mother, and other relatives in a small town in Central Oregon.
With the advice from FCA I was able to obtain a “Permit to Transfer” and I and my two brothers took our mother in the back of my older brother’s pickup on her final road trip. Mom always enjoyed us taking her on road trips around the area. The trip took approx. 6 hours. A little snow over the pass on Highway 199 just south of the Oregon border, but we made the trip without delay. We were met at the gravesite by representatives of a local funeral services company. A few relatives and friends met at the cemetery as well. We all spoke about some of our most memorable and joyful times with my Mother. It was a more joyous than sad little ceremony. That’s the way Mom wanted it, and that’s what Mom received, all made possible by Funeral Consumers Alliance.
-- Excerpted from a NY Times article
When Nathaniel Roe, 92, died at his 18th century farmhouse the morning of June 6, his family did not call a funeral home to handle the arrangements. Instead, Mr. Roe’s children, like a growing number of people nationwide, decided to care for their father in death as they had in the last months of his life. They washed Mr. Roe’s body, dressed him in his favorite Harrods tweed jacket and red Brooks Brothers tie and laid him on a bed so family members could privately say their last goodbyes.
The next day, Mr. Roe was placed in a pine coffin made by his son, along with a tuft of wool from the sheep he once kept. He was buried on his farm in a grove off a walking path he traversed each day. “It just seemed like the natural, loving way to do things,” said Jennifer Roe-Ward, Mr. Roe’s granddaughter. “It let him have his dignity.”
Advocates say the number of home funerals, where everything from caring for the dead to the visiting hours to the building of the coffin is done at home, has soared in the last five years. The cost savings can be substantial, all the more important in an economic downturn. The average American funeral costs about $6,000 for the services in a funeral home, in addition to the costs of cremation or burial. A home funeral can be as inexpensive as the cost of a pine coffin (for a backyard burial) or a few hundred dollars for cremation or several hundred dollars for cemetery costs. The Roes spent $250.
While only a tiny portion of the nation’s dead are cared for at home, the number is growing. There are at least 45 organizations or individuals nationwide that help families with the process, compared with only two in 2002. The cost of a death midwife, as some of the coaches call themselves, varies from about $200 for an initial consultation to $3,000 if the midwife needs to travel.
In Connecticut, Indiana, Louisiana, Michigan, Nebraska and New York, laws require that a funeral director handle human remains as some point in the process. In the 44 other states and the District of Columbia loved ones can be responsible for the body themselves. Families are typically required to obtain the death certificate and burial transit permit so the body can be moved from a hospital to a cemetery, or, more typically, a crematory. But even in states where a funeral director is required, home funerals are far less expensive. Some families, like the Roes, choose burial on private land, with a town permit. In most states those rules are an issue of local control. “Can Grandma be buried in the backyard? Yes, for the most part, if the backyard is rural or semi-rural.”
Many death midwives are like Jerrigrace Lyons, who was asked to participate in the home funeral of a close friend, a 54-year-old woman who died unexpectedly in 1994. Ms. Lyons was initially frightened at the prospect of handling the body, but she participated anyway. The experience was life changing, she said, and inspired her to help others plan home funerals. Ms. Lyons educates the bereaved about the realities of after-death care: placing dry ice underneath the body to keep it cool, tying the jaw shut so it does not open.
Mr. Lakin, a woodworker, makes coffins specifically for home funerals. Ranging in price from $480 to $1,200, they double as bookcases, entertainment centers and coffee tables until they need to be used. He became interested in home funerals after his father died 30 years ago and he felt here was a “disconnect” during the funeral process.
During her battle with cancer, Diane Manahan also requested a home funeral, and the family did not know then how much it would help them with their grief. “There’s something about touching, watching, sitting with a body that lets you know the person is no longer there,” Nancy Manahan said. “We didn’t even realize how emotionally meaningful those rituals are, doing it ourselves, until we did it.”