Thank you to Dr. Maurya D. Cockrell for contributing this guest post. Dr. Cockrell, a member of the VOYCE Board of Directors, is an established SDoH Solutionary from St. Louis, Missouri. She holds a BS in health management from Saint Louis University, with a minor in theological studies, an MA from Webster University in human resources management, and a doctorate in health professions education from Logan University. Dr. Cockrell founded YKNOT Consulting in 2015 and Leaves Speak Healthcare in 2017.

What is a Doula?

The term “doula” was formed from ancient Greek, meaning “a woman who serves.” Many are most familiar with birth doulas, trained professionals who provide therapeutic, emotional, physical, and educational support to women from the beginning of birth through the postpartum period. As the death positive and death empowerment movements continue to evolve and grow, we see an ever-increasing need for a doula at the end-of-life stage. Doulas are advocates and allies who provide continuous, compassionate, non-judgmental care and informational support. Overall, doulas are there when individuals face the two major transitions in life: birth and death.

Death Doula, Elder Doula, and Other Griefwalkers

The death doula movement began in the early 2000s. Death doulas are known by many different names, such as; end of life doulas, thanadoulas, soul midwives, end-of-life specialists, providers, practitioners, death buddies, coaches, and guides. They focus lovingly and specifically on the wishes of the client/family and help to facilitate a comfortable, peaceful, and meaningful death. Many death doulas enter the field after working in hospice, palliative care, spiritual care, or social work. It is essential to note the role of a death doula is non-medical. These doulas provide soul care. From a soul’s eye view, they understand that introspective work can help clients through the inevitable. A death doula can also work with the terminally ill and families who have lost or are in the process of losing a loved one. There is even a specialty for pet death doulas.

End-of-life doulas can also serve the elderly for years before their expected time of death. These doulas may like to be called Elder Doulas. Elder doulas are also non-medical professionals who are specifically trained to provide holistic physical, emotional, and spiritual care for the elderly. Clients are often proactive and want to discuss their mortality now and actively plan for end-of-life decisions regardless of their health status.

Death doulas can serve the client and work as an advocate. Some spend time 1:1 servicing clients, while others spend time advocating for positive aging, high-quality long-term care, and reducing elderspeak through the use of compassionate communication.

Services Offered

Care Coordination

  • Help schedule medical appointments
  • Research insurance providers, find in-network providers, and coordinate prescription pickups
  • Oversee support services and connect clients to resources

Closure Work

  • Mediate difficult conversations around last wishes and advanced care
  • Guide and assist clients in writing letters of forgiveness

Deep Listening and Holding the Space

  • Remain nonbiased and supportive, listening without judgement
  • Serve as a non-anxious presence

Guided Meditation

  • Lead chair yoga, breathwork, and visualization exercises

Legacy Work

  • Coach clients through life review questions and help them articulate their legacy
  • Facilitate or create gifts that represent the client

Meaning Making

  • Serve as a listener and recorder as clients sort and assess life events and lessons learned

Planning

  • Discuss living wills, DNRs, advance care directives, and Five Wishes documents
  • Coordinate and plan living wakes, burials, funerals, and memorials

Respite Care

  • Assist with household tasks like laundry, dishes, groceries, and errand running

Vigil Sitting

  • Spend time with client during the last moments of life
  • Support the family in hours following the death
  • Create and safe, calming space ready for the transition

Role on the Interprofessional Team

Though death and elder doulas are non-medical, they make an excellent addition to the patient care team.

Relationship with Hospice

Death doulas are better equipped to handle pre and post-death care. Death doulas are not restricted by time.

Relationship with Palliative Care

Palliative care health professionals provide comfort medication and care, while elder doulas can provide holistic spiritual and emotional care.

Relationship with Spiritual Care

Death doulas can also serve as spiritual generalists assisting with meaning-making and legacy pathing. Death doulas may find a client in spiritual distress and then need to refer them to a chaplain, clergy member, or spiritual care advisor.

Where You Can Find a Death Doula

Independent Death Doulas

Many death doulas start their own practice or service in a collective.

Role in Adult Day Care

End-of-life doulas may conduct legacy workshops at the facility or work with clients to transition from the home to adult day care environment. The service can help with the frustration accompanied by the loss of independence.

Role in Funeral Homes

Death doulas can serve as staff members or contract workers who assist families through the grief and burial process. Doulas can help write the obituary, select a casket, and even choose clothing for the deceased. Death doulas can also provide in-time support at funerals or help facilitate live stream services.

Role in Healthcare Offices

As Boomers continue to age and insurance limits the amount of time doctors spend with patients, offices hire elder doulas to help with after visit support. Healthcare professionals see elder doulas as a way to offer companion care and combat social isolation.

Role in Hospitals

Death doulas can volunteer with spiritual care, hospice, or a No One Dies Alone (NODA) program to sit vigil. Death doulas can also serve on staff working in medical ethics or the Office of Decedent Affairs.

Role in Home Health

Death doulas are found at home health agencies serving as respite care workers or care coordinators.

Role in the Long-Term Care Setting

Some death doulas may first serve as a nursing home ombudsman before starting their practice. Some families, mainly the sandwich generation, also hire a private death doula to visit their loved ones on a routine basis.

Partnership with Law Enforcement

Death doulas can specialize in trauma care. Emergency death doulas partner with law enforcement, firefighters, and other first responders to provide immediate, on-scene care for unexpected losses.

Support and Resources

Remember, the grieving process fluctuates and is not always a linear journey. Doulas provide emotional support and lean into suffering, understanding the only way over grief is through it. Some caregivers may be serving as a death doula without realizing it. If you are balancing both roles, be sure to practice self-care and see support.

To learn more visit:

Gateway End of Life Coalition

HealthyAging.org

IAP Career College Death Doula Certificate Course

International End of Life Doula Association

Leaves Speak Healthcare

VOYCE’s 2021 Professional Long-Term Care Education – September 28

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