I offer the following services based upon the specific needs of the client and their caregivers.
Health Care Advocacy ~ First, I listen
Partnering with the client, and/or family caregiver to help clarify current medical issues, identify any unmet needs, and facilitate access to appropriate resources.
Supporting the client and/or family caregiver to navigate a complex healthcare system and be better prepared to ask the right person, the right question at the right time.
Offering education, as needed, to support informed decision making and to increase confidence in the ability of the client and/or family caregiver to cope and manage with a progressive illness.
Explaining the role and services of palliative care and hospice, as well as when and how to access, should that be requested or beneficial. An End of Life Doula can offer services alongside hospice and work collaboratively with their team. On the other hand, should a client be eligible to enroll in hospice, but chooses not to, the End of Life Doula can be an ongoing source of support.
Providing a safe place to share thoughts, feelings, and stories. This can help to process emotions, reflect on changes that are happening and feel more connected.
Grief Support
It can be helpful to have a safe place to share these emotions and have them validated.
Anticipatory Grief: A sense of grief may begin with the diagnosis of a life-threatening illness and there may be accumulating losses along the way. This can be felt by the client, as well as their caregiver and family members. This has been called anticipatory grief and often goes unrecognized.
Normal Grief – there really is no such thing. Grief is a uniquely personal experience and there is no rule book or time frame. Following a death, telling (and retelling) your story and sharing your thoughts and feelings can help to acknowledge and process the loss, especially in the early days, weeks, and months. Discussing how to adjust and move forward while still honoring the memory of a loved one can be another component of grief work. Setting aside time to talk helps in the healing and can be scheduled in whatever way is most comfortable.
scheduled calls or appointments for an arranged period of time
flexible calls or appointments to be set up as needed
Referral to a Grief Therapist (versus grief counseling) would be discussed for more complicated situations.
A complementary follow-up call or visit to the family caregiver would be incorporated into the Doula’s services following the death of a client.
Advance Care Planning ~ Documenting what matters most
Advance care planning documents can indicate who would make medical decisions (the health care proxy) for someone, if and when they were too sick to make decisions on their own. These documents can also share the individual’s values, goals, and preferences for future medical care. Advance care planning is a process and goals may change along the way and documents can be amended. Knowing the wishes of a loved one, can lessen the burden on the family of making difficult medical decisions, especially during a crisis.
ACP can be completed with the individual client, with family or a health care proxy present, or with a health care proxy alone if the client is no longer able to speak for himself/herself. This process could include the following:
Promoting discussions around the goals of care (what really matters to someone), ideally, prior to a healthcare crisis if the client, or family caregiver agree.
Providing education regarding options for care at the end of life.
Assisting in understanding the relevant state documents for ACP.
If appropriate discuss and explain the MOLST (Medical Orders for Life Sustaining Treatment) form. This form needs to be reviewed and signed by a physician, nurse practitioner or physician assistant.
Reviewing how to share any ACP documents that are completed.
Legacy Work ~ How to be remembered
This process can be important, as someone is approaching the end of a life and provides an opportunity through words, objects, or images to share one’s story and lessons learned. Discussing creative and personal ways to be remembered can lead to a collaborative project with family members. Examples include: a collage, a shared playlist, scrapbook, letters, a collection of recipes, videos, memoir, audiotapes or an ethical will (sharing your values and life lessons). Some may want to participate in their own funeral planning as a final remembrance.
Vigil Support ~ At the bedside of the dying
The last few days of life (the active dying phase) can be exhausting and an emotional roller coaster for family caregivers. They are also opportunities for continued growth, connection, and beauty with loved ones. At this point, the dying person may or may not be aware of their environment, but the family is often sitting vigil at the bedside around the clock to offer comfort measures. Having additional support of an EOLD during this transitional phase can be reassuring.
Practical guidance and education for physical, emotional, or spiritual needs as death seems imminent can be offered virtually via phone calls, texts, face time, emails, or scheduled on-line conferencing as well as in person (ideal).
End of Life Planning ~ The bits and pieces
Sharing and discussing plans for how to care for the body after death, what type of ceremony is preferred, and getting affairs in order can relieve family members from last minute decisions during a stressful time. These plans can be simple or detailed based on personal, cultural, and spiritual preferences. The bits and pieces can include getting important documents in order and sorting through belongings. There are websites and reference books to assist, but if this feels overwhelming or someone is unwilling or unable to participate, an EOLD may be helpful.
An EOL Doula can help to facilitate this planning process when requested.
Decisions regarding care of the body might include, important rituals/prayers, who should be present at the bedside, and who might want to prepare the body after death. Is the preference for cremation, embalming or neither? What are the burial requests, including “green burial” with no embalming and a biodegradable casket. Has a cemetery plot or mausoleum been chosen? Are there wishes regarding how to handle any cremains?
Ceremonies could include: a funeral (traditional or home), special requests for music, readings, flowers, suggested donations, and eulogies. A memorial celebration or life celebration following the burial are additional options. Writing the obituary can also be discussed in advance and some people even write their own.
Getting organized means the family will have more guidance when handling your affairs. Think ahead and get documents, passwords, and financial information sorted and share this with someone you trust. Do you need to simplify the possessions of a lifetime? Do you want to gift certain items to friends and family? If this is too much to consider and you need someone to help you think through your options, an EOLD may be able to find appropriate resources for you. (refer to my helpful-links page, EOL Planning - Getting Organized)