Dying at Home by Elizabeth Fournier
When a family member dies, most Americans instinctively grab for a telephone and call on their loyal undertakers. But there was a tradition, before the telephone and the advent of licensed morticians, where women came to lay out the dead.
Even today, a family support group has the right to handle death arrangements without the assistance of outside professionals. It is completely legal in most states to care for our own loved ones at death, and Oregon and Washington are no exception to that rule. A funeral director does need to be a part of the situation if someone is acting in lieu of a funeral service practitioner.
For the last 100 years the care of our dead has gradually been turned over to businesses. But the recent decade has seen resurgence in families providing end-of-life care to loved ones through home hospice care. As a natural extension of hospice, more and more families are choosing to care for their loved one—before and after death—in their homes.
The general public is not always aware of their choices, such as the fact embalming is rarely mandatory, nor necessary. The public also isn’t commonly informed that bodies can stay at home, and that the actual logistics of doing so are fairly straightforward and manageable, in most circumstances.
These little known facts provide us a great opportunity to re-think and re-create how we are cared for at death, so that our passage more closely represents who we are as people and what is important to us.
Let’s consider the legal and moral considerations, and the practical procedures to be followed in the event you or your family member opts for a funeral without an undertaker.
Involving Yourself in the Mourning Process
In Lisa Carlson’s book, Caring For Your Own Dead, she writes that this can be one of “the most meaningful” ways to “say goodbye to someone you love.”
There is a reclaiming of death as being a part of the natural order of life, instead of a failure of treatment or a medical event. Since many of us have not been part of this process with our families over the years, midwives are those gentle guides as we keep our loved ones close to home and out of the hospitals.
Like homeschooling, homebirth, and homecare (hospice) for the terminally ill, home funerals allow us to take control of a critical area of our lives. Not everyone may be emotionally prepared for this choice, but grief therapists of long ago recognized that the American way of death usually offers no satisfactory way of socially and physically involving the bereaved in the mourning process.
The family who experiences the death of their loved one, and desires to handle the arrangements will have a list of things to do. They must be prepared to provide the services and products normally supplied by a funeral home.
The following is a basic guide of factors to consider that a family would otherwise pay a funeral director to handle.
Someone will need to issue a pronouncement of death. If the death occurs in a hospital or nursing home, tell a doctor or nurse right away. He or she will need to fill out the forms confirming the time, place and cause of death. If the person has been under hospice care at home, then it is usually the hospice caregiver that you need to call. If not, and the person dies at home, you may have to contact your local police department or medical examiner. Contrary to what television teaches us, a Coroner’s Inquest and immediate autopsy don’t take place, and a forensic crime unit doesn’t normally arrive on the scene.
If a person dies at home, at work, at a business or in a public place, call 911; police must investigate all deaths that occur without medical personnel in attendance. If the person was under hospice care, call the hospice nurse first. If they passed away in the hospital, then the staff will contact the authorities if necessary.
The most urgent decision to make is organ donation; collection must be made within a few hours of death. If your loved-one signed a donor card, then under the Uniform Anatomical Gift Act, the donation must be honored by survivors.
The next pressing decision to make is disposition of the body. This is an important decision not to be made without considering your options and your budget. The choices are: earth burial, entombment, cremation or donation to science. Each alternative has different services, rituals, conveniences and inconveniences, and all at different prices. The least expensive option is donating the body to science, but the body may be rejected due to organ donation, autopsy, age, physical condition or disease.
What type of funeral or memorial did the deceased want and what do the family members want, and where is the balance between the two?
Very important to note: We have a 24 hour rule that needs to be obeyed. If human remains have not been buried or cremated, and therefore are held longer than 24 hours, they must at minimum either be embalmed or refrigerated at 36°F or less until final disposition.
Obtain blank Certificate of Death and permit for final disposition and other forms as needed. These forms vary from state to state. This task alone may take two or three team members depending on if the family is handling the details of the burial or cremation, or using a funeral home.
Great care must be taken in completing the death certificate. Whiteout or other corrections are not usually permitted. If an error is made, you may have to start over again with a new certificate. A death certificate signed by a doctor stating the cause of death must be filed—usually in the county or district where death occurs, or where a body is found, or where a body is removed from a public conveyance or vehicle.
The information usually needed on a certificate of death: full legal name, legal residence, length of time at current residence, date of birth, place of birth, mother’s birth name, father’s birth name, date of death, place of death, ethnicity, education, social security number, occupation, employment or business history, marital history, military history, spouse’s full name, next of kin, addresses, relationship.
State Filing Fee
There is a one-time, $20.00 Oregon State Filing Fee for deaths occurring inside of the state. The Oregon Center for Health Statistics (Vital Records) will need to be notified.
Your local Social Security office requires that the deceased’s social security number is retired. A one-time payment of $255 is payable to the surviving spouse if he or she was living with the beneficiary at the time of death, OR if living apart, was eligible for Social Security benefits on the beneficiary’s earnings record for the month of death.
If there is no surviving spouse, the payment is made to a child who was eligible for benefits on the beneficiary’s earnings record in the month of death.
Washing and Dressing the Body
Have between two and six people wash and dress the body within a few hours of death, before rigor mortis sets in. Close the eyes and lay an eye pillow on them for a few hours to keep the eyelids shut. If the mouth drops open, wrap a cotton bandana under the chin and tie it at the top of the head.
Keeping the Body Cool
Keep the body cool with pieces of a 20- to 30-pound block of dry ice placed in bags under the torso. Replace the dry ice as needed. The body can be kept at home for two to three days at a temperature of 60 to 75 degrees with little or no decomposition.
Transporting the Body
If you need to move the body, you can call a service that will take care of this for you, or you will need a suitable vehicle (van, SUV, pickup truck, station wagon). Placing the body on a rigid board and loading the apparatus into the back or bed of a vehicle tends to work the easiest.
Since friends and family can duplicate the services of the funeral director (except embalming the body) there is absolutely no reason why they should be prohibited from caring for their own dead.
While it is quite possible to save money, the primary motivation for caring for your own dead should normally not be financial. It should be a moral, caring concern, regardless of what choice is made.
Elizabeth Fournier is affectionately known as The Green Reaper in her tiny community of Boring, Oregon. She is the owner and operator of Cornerstone Funeral Services and works as a green mortician, educator and advocate who is always ready to lend a hand, or a shovel. She is the voice of the autopsy exhibit in the forensic wing at the United States National Museum of Medicine, and recently published her memoir, All Men Are Cremated Equal: My 77 Blind Dates. She writes a monthly column for The Black Lamb, and her freelance work has been seen in American Funeral Director, Community Seeds, and the Green Living Journal.