Mindful Preparation for End-of-Life Care
By Jessica L. Knouse | Photography by Melissa Ring
Examining our own mortality is arguably one of the most difficult topics to discuss.
Death is the great equalizer that connects us across all cultures, religions and backgrounds, yet to talk about it is often uncomfortable, taboo or a topic we wish to avoid altogether. Many of us have watched our loved ones decline slowly, and others have experienced loss suddenly and without warning. A myriad of local services is available to prepare us for this season of life so that we may enter it with dignity and celebration.
Much like a birth doula assists in bringing new life into the world, a death doula assists in the process of preparing people for the end of life. Preparations of this nature may include creating an advance directive, writing a living will, establishing power of attorney, organizing financial documents
and outlining future funeral arrangement wishes.
At a glance, these preparations may seem time consuming and emotionally cumbersome, but Jeremy Mitchell, bereavement coordinator at BAYADA Home Health Care and certified death doula, is encouraging and mindful of these challenges, knowing that many aren’t prepared or aware of what may be involved. Indeed, death doulas are there to serve and assist anyone through these processes with respect—and also with an intention of celebration.
“It’s not about the end of life,” Jeremy says. “It’s about the celebration of life.”
A living funeral is one way to celebrate a life, Jeremy explains, when the person is still alive. A living funeral may occur at any time, but typically occurs in advanced age with or without a terminal prognosis. For example, if you wish to say thank you to the people in your life who have meant the most to you, a living funeral provides this unique opportunity. In the case where a terminal prognosis has been given, a living funeral may allow one to say final goodbyes and review, in the presence of family and friends, a life well lived.
A legacy project is another way a death doula may assist in the process of celebrating an individual’s life. “A legacy project is a visual representation (e.g. scrapbook, video, etc.), which a doula would help put together with someone to show that person’s life events, accomplishments and their personal message for their present and future loved ones,” shares Jeremy.
To locate a death doula, search online to connect with someone who is certified. Some death doulas may ask for a small donation in exchange for their services, but most of the time services are offered at no cost whatsoever. “For me, I’m just looking to help people,” says Jeremy.
When an individual is facing a life-limiting illness, defined as having a life expectancy of six month or less, hospice offers support and care.
Hospice care is not “doom and gloom,” explains Jamie Keller, medical social worker at the Visiting Nurse Association (VNA) of Hanover and Spring Grove.
“It’s very much celebrating the life we have left to live versus dwelling on the short amount of life that’s remaining.”
Hospice is more than simply offering medical assistance. “We provide support and assistance not only to the patient; we tailor care to the combination of the patient plus their family and caregivers as a unit.” This extends beyond experienced medical professionals administering care. A team of experts, from registered nurses, aides, social workers and chaplains to trained volunteers and bereavement counselors, is available to support the physical, emotional and spiritual needs of the patient and their family. At VNA, for instance, social workers like Jamie connect patients with appropriate community agencies that may provide counseling or make sure a family is fed during a difficult time by connecting them with services like Meals on Wheels. Or hospice clients may wish to take a family trip that takes them out of the Adams-York service area, and social workers at VNA of Hanover and Spring Grove will help facilitate coordination of unique needs a patient may have while they travel.
“We help set up care for them along the way with different hospices and link patients to them so that when they get to their destination, they can still get any medication that they need or a nurse to help care for them along their journey,” Jamie explains.
To receive the full benefit of hospice at the end of life, it’s ideal to begin hospice care as soon as possible. Arriving at the decision to utilize hospice services may be difficult, but doing so may provide the support to have a better quality of life — “making that end of life is as positive as a life they’ve already lived,” says Jamie.
When researching hospice providers, factors to consider may include whether the organization is for profit or nonprofit, if their services are based locally or if caregivers must travel several hours to your home or care location.
“Hospitals, doctors or nursing homes may refer to you to a specific hospice, but you have every right to choose your own,” she says.
This type of work is often considered a calling.
“Working for hospice has changed my life,” Jamie says. “It’s about making the best out of the amount of time we have left, no matter if it’s 100 years or 100 minutes.”
Pre-planning funeral services is another way to be prepared for the final stages of life. At Brandenburg and Stein Funeral Parlor, located immediately outside of Gettysburg off Route 97, one can explore a vast array of options for memorial services, including modern options like a green burial or nondenominational observances.
Opened in 2020 by Rhea Brandenburg and Jim Stein, their funeral home provides a level of service and care that goes above and beyond. “We’ve both worked in dealing with cemeteries,” says Rhea, “and we are currently the only cemetery in Adams County that provides green burial services.” For those who aren’t familiar, a green burial considers the conservation of natural resources when it comes to burying remains, and it may not include traditional burial practices like using a vault, casket or embalming.
“I think that what makes us different is that we offer, in our showroom, biodegradable, green options for burial and cremation,” says Rhea. These options include biodegradable cremation urns made from natural Himalayan sea salt or gelatin and sand, which both dissolve in water after four hours. “We also have a company that offers different trees,” says Rhea, for tree pod burials. Tree pod burials process cremated remains organically, supporting the growth of a tree that can be planted on-site in a natural, open landscape setting at Brandenburg and Stein.
“There’s something for everyone here,” explains Rhea, as they also offer traditional casket and vault burials with embalming services. Custom wicker baskets, woven with various styles of wood and bamboo, are another unique offering for those who are environmentally conscious.
Not only are these caskets designed for human remains for burial or cremation, they also may be purchased for pet remains as well.
Speaking of pet remains, many cemeteries have restrictions on burying pet remains with human remains. Yet at Brandenburg and Stein, customers may opt to be buried alongside their beloved furry friend. “One of the reasons why we went into business for ourselves is to offer home funerals or green funerals. That’s the beauty of this property; we had to take over the cemetery as well as the funeral home,” highlights Rhea.
Brandenburg and Stein also offers the ability to process the remains of loved ones in an intimate setting—which also may include conducting a home funeral service.
While some funeral homes may not allow loved ones to view remains of departed family members prior to cremation or funeral services, Brandenburg and Stein offers a private room for preparation or for having a quiet moment to pay respects. “That’s one thing Jim and I like to do is offer a more hands-on experience. For example, if a daughter wishes to do her [mother’s] make-up or paint her nails one last time, we can accommodate that request easily,” explains Rhea.
The special treatment for their clients extends to veterans as well, as they also offer free burial for veterans with an affordable plan for perpetual care for their burial sites.
“We try to make the experience here as personalized as possible,” says Rhea, “with new, more modern approaches and options for funeral arrangements.” Indeed, the slogan for their business fits perfectly: a new way to honor an
Jeremy Mitchell, Bereavement Coordinator, BAYADA Home
750 E. Park Dr., Ste 102, Harrisburg
Jim Stein & Rhea Brandenburg, Owners, Brandenburg and Stein Funeral Parlor
3045 Baltimore Pike, Gettysburg
Jamie Keller, Medical Social Worker, Visiting Nurse Association of Hanover and Spring Grove
440 Madison St., Hanover
Death Cafés Increase Awareness
Started in England by Jon Underwood, Death Cafés were created to increase awareness of death while helping people make the most of their lives. Often, strangers can be found enjoying each other’s company while talking about death.
“I have facilitated many of the Death Cafés because I find them an excellent way to give people an open forum to discuss all types of issues about quality of life, end-of-life care planning and advance care planning,” says Roberta Geidner, manager of Horizon/Advance Care Planning at WellSpan Health.
Hosted by WellSpan Health through its Advance Care Planning Coalition, these informative sessions take place on the third Thursday of the month from 6 to 8 p.m. To register, call Roberta Geidner at 717-812-6065 or email firstname.lastname@example.org.