Personal Health

Challenging the High-Priced Funeral Industry, More Americans Are Choosing Home Funerals and Death Midwives

Major shifts are underway in dealing with the aftermath of death in a more personal way.

Photo Credit: Chakrapong Zyn / Shutterstock.com

My grandmother, Nana, had piercing blue eyes that beamed against the zigzag of creases and age spots on her 92-year-old face. Her voice always carried a trace of a brogue, though she immigrated from Ireland to the U.S. in her 20s. Following a series of recent strokes, my sister was living with Nana and caring for her alongside hospice. She told me one night last week on the phone that Nana was entertaining conversations with relatives long passed, chatting up a storm with her mother, sister and brother as if they were sitting there in the room.

“She’s between the worlds,” my sister said. The next night, Nana died.

Death is present in this season; the trees will be skeletons soon and they carry out their autumnal cycle scattering amber and yellow leaves across the soil. I pick one up on a walk one day and crumple it into dust, remembering funerals I’ve known, pondering the impending fate we all share with my Nana.

On the phone my sister told me she lay with Nana's body for a couple of hours, and while we spoke the funeral home workers arrived.

“It feels kind of soon,” my sister said. “It’s weird to think about her body sitting in a refrigerated drawer.”

The modern Americanized handling of the end of life—plastic body bags minutes after the last breath, injection with chemical preservatives (a.k.a., embalming), impenetrable metallic coffins, expensive burials arranged by strangers on acres of groomed lawn, and funerals that cost between $5,000 and $40,000—is a relatively new thing. Few people realize it’s not the only option.

Image via  / Shutterstock.com

Death Midwifery

There is a small but growing movement across the country to re-educate people about alternatives to the big, expensive funeral industry: home funerals and death midwifery. Death midwives almost all of them women, are spearheading the movement. Not unlike the way a birthing midwife works with a pregnant woman, a death midwife (sometimes called an end of life guide, or death doula) supports a person through the process of dying, helping them prepare mentally, emotionally and logistically for the upcoming event. They counsel the dying through their fears, concerns and questions, and help plan the ceremony for after their death.

“This is something sacred, the thread of which we have only lost for a few generations,” says Nancy Ward, a death midwife based in Portland, Oregon. She explained how, with the emergence of funerals-for-purchase, came an elitist “1-percenter” mindset about death.

“It became a status symbol: 'I no longer have to take care of my own because I have so much money I can hire somebody to do it for me,’” she says. “And as a result we have become so fearful of death.”

Ward says her favorite part of her work is sitting with a dying person, and “pulling the strings" of the great mysteries of birth and death.

“We're born, we live a bunch, we have some experiences, and we die; what the heck does that all mean? What is this all about?”

When she talks about death and grieving, Ward is markedly joyful, smiling often and laughing easily.

“We have a great belief in this puritanical bullshit about a stiff upper lip around death,” she says. “That's really not appropriate. What is appropriate is grieving. Done right, grieving is such a beautiful experience. It is so honoring for the person who has died. ... If you can't accept the fact that this hurts terribly, you miss them terribly, that is a dishonor to you and the relationship you had with that person.”

She says our cultural avoidance of painful emotion perpetuates a self-fulfilling fear that once we’re dead, we’ll be forgotten.

“As long as we are talking about our ancestors, they are alive,” she says. “But because we live in such a youth-oriented culture here in America, we tend not to bring our dead into any meaningful sense of conversation, even in our family get-togethers. We don't remember our dead. And that's what all of us are afraid of: we're gonna be totally forgotten when we're dead."

She continues, “There’s this idea that we get over it, you know, that we move past it and heal. You never fully heal, I hope, from the death of somebody you love. There is always a part of you that aches for that person.”

Ward says dying people are often so concerned with protecting their families from the psychological and financial burden of their death that they fail to prepare themself for the experience. Working with an end of life guide can be “very cathartic.”

“If you're lucky you go through this whole life and you come to the other end and you’re dying—and you know it,” she says. “If you have any sense of your own humanness, you know when things are turning around. You know when you are close to leaving this Earth. And here you are, left all alone because nobody wants to talk about it.”

Enter the death midwife.

“I’m just sitting with somebody and listening to their questions, maybe guiding them to think about things in another way,” she says. “I never have any answers, believe me. I don't even have them for myself. I am still totally questioning this whole process. ... What the heck does this all mean?”

Image via Lightspring / Shutterstock.com.

Home Funerals 

Death midwives like Ward often offer home funerals as part of their services, meaning instead of turning a loved one over to strangers, families have the option to keep the body at home for one to three days, and host the funeral ceremony on their own terms from home. The home funeral coordinator (often, but not always, the death midwife herself) talks the family through the process, from washing and dressing the body, to laying out dry ice to preserve the body in a designated space if it's staying for more than a day, to carrying out the loved one's burial wishes.

The website of the National Home Funeral Alliance (NHFA) is a veritable encyclopedia for do-it-yourself funerals, from state-by-state legal resources to directories of death midwives and home funeral coordinators (including a good number of clergy members). NHFA president Lee Webster says her organization’s “ultimate goal" is to become obsolete.

“At the very root of all that we do is a fundamental understanding that the care of our dead is an innate right as human beings,” Webster says. “That is further supported in this country by our constitutional rights to family intimacy—how we care for our newborns, our children, our life partners, our dead. Until everyone knows that they have the choice and home funerals are a household word, we have work to do.”

Olivia Bareham is a death midwife and home funeral guide in Los Angeles who runs one of the few death midwifery training programs in the country. She says it takes time for people to integrate the experience of a loved one's death, and home funerals allow for a healthy slowing down of that process.

"There’s no need to rush this, and it’s so often rushed," she says. "Death, natural death, is considered an emergency now, like you've gotta get the body out of there within two hours—but you don’t. The body can lay 24 hours [without refrigeration] ... it can just lay there peacefully. It’s a beautiful thing that’s housed the spirit of somebody you loved very much, and I think it’s honoring to give it a little more time."

When Bareham's mother died, a hospice nurse invited her to wash the body, which she says was her “initiation into being with the dead.” The experience changed the way she looked at death as well as life.

“It was so powerful for me to hold my mother’s body in my arms while we were washing and dressing her,” she says. “I had such an amazing experience of the depth of my love and gratitude. It profoundly changed me. It turned death from this sort of spooky, unknown, creepy thing into holy ground.”

Image via  / Shutterstock.com

The experience inspired her to train in home funeral and death midwifery. On her website Bareham offers photos, video and slide shows depicting the home funeral experience in detail.

There are financial incentives behind home funerals as well. Mainstream funerals organized by a funeral home can cost families between $7,000 and $10,000 on average in the U.S. Between 2004 and 2014, the median cost of an adult funeral increased 28.6%, from $5,582 to $7,181, according to the National Funeral Directors Association (NFDA). Depending on where you live, funeral services and mortuary costs can often add up to $15,000-$40,000.

Home funeral guides typically volunteer their services on a donation basis, or charge between $1,000 and $2,000 for their work, which includes counseling (death midwifery) and help with organizing and education.

While the movement remains small, NHFA's Webster says it’s growing gradually. Over the past eight years NHFA has evolved from “a handful of people” to more than 1,300 members. Where the media once overlooked death midwifery and home funerals, NHFA now receives weekly requests for interviews and information from major news outlets.

There aren’t hard statistics on exactly how many home funerals are taking place nationally, but Webster says NHFA has “convincing anecdotal evidence from our members that there has been a significant rise in awareness.” In the last two years NHFA members record a steep increase in the number of calls they receive.

Nancy Ward says she spends more time educating the public about home funerals and death midwifery than actually guiding them.

She became interested in the work after feeling traumatized by the aftermath of the death of her parents. She remembers after her father, died a man showed up with a “black rolled-up object on top of a gurney.” It was a body bag.

“Inside my head I’m screaming bloody murder—you are not going to put my father in this ziplock bag!" she recalls. Because she didn’t know another option, she kept quiet and watched a stranger pack her father’s body into the bag “like a piece of meat.”

She figured there had to be another way. She started investigating and found Final Passages Institute of Conscious Dying, Home Funeral and Green Burials in Sebastopol, Calif. Headed by a woman named Jerrigrace Lyons, whom Ward calls “the mother of all of us doing this work on the west coast,” the group says it is, “dedicated to the reclaiming of traditional funeral and burial practice.” 

Oliva Bareham, who also trained with Final Passages, says, "Jerrigrace said something once that stuck with me: When a person dies, it's like all the angels in heaven enter that room."

Ward enrolled on the spot and has been working closely around death ever since. She says since hospice care has reintroduced death into the home, family members are already taking care of their loved one's physical needs during the dying process. It makes sense that they’d continue to do so after death.

Many religious, traditional and spiritual texts specify a three-day mourning period following death, Ward says. Some philosophies believe three days is the time the soul needs in order to leave the body, while others specify three days because it provides a level of comfort to the surviving kin.

“It’s like, Okay, I don't have to let my mom go immediately,” Ward says. “Our psyche takes a while to get used to the idea that here's your body, but it's totally lifeless. And that is one of the beauties of washing a body, is when families get in touch with this.”

She notes that rather than do it herself, she teaches the families she works with how to wash and dress their loved one’s body.

Home funeral is a perfectly legal—and much cheaper—option in every state, though 10 states have specific restrictions that require everyone, including home funeral families, to hire a professional. However, few people know about home funerals because of the successful marketing and lobbying of the powerful $20.7 billion per year funeral industry, which would prefer to keep its hands on our dead bodies.

Image via  /Shutterstock.com 

Commercializing Death: The Emergence of the Funeral Industry

The American detachment from death began after the Civil War, according to Bareham. During the war, the army assigned special units to the task of embalming bodies to preserve them long enough so family members could pay their respects after the battle. After the war, these specially trained embalmers turned the trade into a business, offering their services door to door and eventually opening up funeral parlors. As the age of industry, mass production and “modern conveniences” dawned, the funeral industry was born.

Bareham says as funeral services took charge of the after death care process, our society became increasingly separated from death and it became the taboo topic it is today. Before the advent of funeral parlors, families used to lay their dead out in the parlor for several days to spend time with the body, Bareham says. When funeral parlors took over that task, the term “living room” was born, renaming the space in the family home.

“We threw out the teachings with the body,” she says. “When we gave it to the funeral home, we lost our connection to death. Gradually over the last 100 years or so, we’ve become more and more removed from it. It’s become this distasteful, scary thing that no one wants to think about.”

Bareham says her personal mission is to help people recall a lost piece of the human experience.

“I try to illustrate what they’ve lost, and help people realize they do want to understand and touch death, and need it back to make their lives feel more meaningful and fulfilling and less based on fear and dread,” she says, noting that women in particular have lost an ancient connection with the cycles of birth and death as society moved toward "men in white coats" overseeing birth and "men in black suits" overseeing death. 

She believes women are innately connected with the processes of "the soul entering and exiting" because women create life in their own bodies. 

"It’s interesting that those two sacred moments, entry and exit of soul, have been taken over by men," she says, noting that while more women are becoming doctors, some wisdom has been lost within these male-[dominated] institutions.

"Now when a laboring woman goes into a hospital, she's told what to do and is most often drugged, and is powerless during her own birth experience," she said. "Where before she went into labor, like animals do, through her own innate knowing that her body was built for this and it can do it. So, she became disempowered in giving up that role for herself during birth."

She says the same has happened with death and dying.

"[Women] know innately how to die and how to care for our loved ones and hold space for death," Bareham says.  "Everyone can do this, but I think women have an innate connection to it in a way that is more difficult for men."

So, she says, it speaks to society and its values that women have given up their power in the arenas of birth and death.

The idea behind Bareham’s business, Sacred Crossings, which offers one of the few existing educational trainings in death midwifery, is to bring families closer to the old way of viewing death as a sacred part of the cycle of life.

“It is a circle,” she says. “We’re coming in and going out. Birth and death are always happening.”

Bareham notes that nobody is trying to compete with or do away with the funeral services industry.

“I don’t think we’re any competition, and many people would much rather hand over the task to someone else,” she says. “We’re interested in providing options for those people who would prefer some more time. There’s no reason you have to rush the process.”

Photo Credit: 
Shutterstock.com

Image via Shutterstock.com.

Legal Hurdles

While it’s legal to some degree in every U.S. state to opt out of the mainstream funeral parameters, the lucrative funeral industry isn’t partial to the idea of families taking things into their own hands.

Lee Webster of NHFA points out that home funeral coordinators or guides remain limited in what tasks they can charge for as a business, as certain tasks are legally reserved for funeral directors.

“It's very important to make a distinction about the work of home funeral guides from funeral directors,” she says. “The only related ‘businesses’ home funeral guides may conduct are education-based—they may not be paid for hands-on care of the dead without violating regulations implicit in the licensing of funeral directors. They can, however, volunteer that aspect of the work, along with charging for consultancy and education, and their time.”

She says many home funeral guides form volunteer community care groups, or educational nonprofits, or LLCs, for the purpose of consulting.

Soon after graduating from the Final Passages training program, Nancy Ward was at the forefront of a particularly heated battle for the right to offer death midwifery and home funerals in the state of Oregon.

“The Mortuary and Cemetery Board had just introduced a bill to stop us from doing our work,” Ward says. She and fellow graduates of Final Passages spent early 2009 presenting their case to the Oregon legislature.

“They see us as a threat to their business, and it's really not so much that we're a threat; the threat is that their business model no longer services people's needs,” Ward says. “Very few people are still looking for the huge funeral display.”

She notes that as more and more baby boomers—her own generation, and the generation that launched the home birth and birthing midwifery movement—age and die, she foresees the popularity of simpler home funerals increasing.

“[People in the funeral industry] have spent a lot of money,” she says. “They have to take these two-year-long classes, they have to learn how to embalm, they have to do all these really gruesome things, and then here we come along and all we do is say, Well, hey, we don't have to embalm anybody.”

Embalming is not required. But funeral homes won’t usually tell you that.

My dad said when he and his sisters arranged for my Nana’s burial, asking that she not be embalmed, the funeral home was not pleased and kept trying to push the chemical preservation on them. They had to argue for their right to skip the embalming.

Ultimately, the state of Oregon ruled in favor of the status quo, making it illegal for people like Nancy Ward to do professional home funeral work.

“That was one of the most traumatic, discouraging experiences I’ve ever had,” Ward says. The state voted to require anyone working around home funerals to obtain a specific license, and under that license they are not allowed to participate “after death in helping families” Ward explains.

The caveat is that the law only holds if one is doing the work for money. So today, like any serious activists, Ward and her colleagues continue to offer home funeral services in Oregon—free of charge, though they do accepts donations.

“That is how we circumvent it,” she says. “Through the process they were blatantly saying, ‘This is about money,’ and we were blatantly saying, ‘This is not about money.’ And so, we put our money where our mouth is and said, ‘If we can't do it for money, we'll do it for free.’”

Ward can still offer her death midwifery services prior to death, and charges a $45-$75 an hour sliding scale.

She says many of the younger women interested in doing home funeral work have had to drop out because it doesn't provide much of a living.

"I'm lucky I'm old enough, I don't have to depend on it for income," she says. "I'm giving my services away in the hopes that this is building that future I'm looking for where you don't need me and you don't need the funeral director. You are perfectly capable of doing this all on your own. That will be my reward."

Completing the Circle

Ward says she finds working so closely with death “exciting,” because the impermanence of life gives it meaning. On her website, she describes an inexorable link between birth and death: “Death, as normal as birth, is a subject clouded in mystery where questions are often answered with either clichés or silence,” she writes.

“What I'm talking about is this: let's just bring death right up here with birth, let's don't let one be known without the other, because the minute that child is born, where is it headed? It's going to die,” she says. “We are going to all go through this, so let's bring those two events close together. Let's always keep in mind that as mom is dying, granddaughter is having a baby.”

Image via  / Shutterstock.com

Ward motions in circles with her hands.

“This is what it's all about, and how wonderful,” she says. “How wonderful that we can know that this is coming, because what embracing death does for all of us who enter into it fully is it makes us love life so deeply. All its problems, all its annoyances...it makes it so joyful. Because, I'm gonna die, but right now I’m alive. Whoopee!”

She continues, “Every person who discovers death, really, at a deep visceral level—it's like they've discovered new territory. They have plunged into the depth of their being and they have found something they never saw before. ‘I'm gonna die. I'm really really gonna die, it's not just a theory. But I'm not dead yet. Yay!’”

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April M. Short is a freelance writer who focuses on health, wellness and social justice. She previously worked as AlterNet's drugs and health editor.