Home funerals take root in California

Should hospices add this to their resource list?

In the early 1990s, Jerri Lyons got an unusual request from a friend: When she dies, she didn’t want her body to be cared for in a mortuary. Instead, she wanted Lyons and her other friends to take her home, bathe her, dress her, hold the memorial service at home, and have her body cremated.

"Is it legal?" Lyons wondered.

The friend had done some checking and it was indeed legal in California. Her friends agreed and said they would do their best.

In 1994, the friend died suddenly and her friends sought to fulfill her wishes. They were surprised to learn how much paperwork was required to care for the dead at home — everything from obtaining the death certificate to getting a permit to transfer the body from the hospital to the dead woman’s home.

"We took her body home bathed her, dressed her, and took her to the crematorium," Lyons said. "It was a very moving experience and was life-changing for me."

Eighteen months later, operating out of Lyons’ Sebastopol, CA, home, Home Funeral Ministry was born, an alternative to traditional funeral arrangements that whisks patients back to the days when family members prepared their loved ones’ funerals at home.

In 1996, Lyons’ first clients were a hospice patient and her husband. Lyons helped the man maneuver through the paperwork needed to bring his wife home for a funeral service and the hospice helped by bathing and dressing the woman after she died. Lyons also provided transportation to the crematorium and the required cardboard casket.

Hospices have long been supporters of alternative treatments for their terminally ill patients — everything from pet therapy to music therapy to art therapy. Lyons, owner and director of Home Funeral Ministry, has found another niche in the business of death and dying.

She has helped spawn a small movement called "home funeral guidance" that advocates — as the name suggests — caring for and memorializing the deceased at home. For an average of $700 — a bargain compared to traditional funeral home costs — Lyons helps family members plan funeral arrangements, instruct them in how to fill out a death certificate, provide the items needed to keep the deceased at home, and handle the required paperwork.

Family members feel more involved

Beyond providing a lower-cost alternative to traditional funeral arrangements, Lyon’s service helps family members feel more involved in the planning of their loved one’s funeral, it brings about a greater sense of closure for family members; and empowers dying patients to plan their own funerals.

Since her first case in 1996, Lyons has helped 130 families plan home funerals. "It’s like planning a wedding or anything else," Lyons says.

Two of those clients were patients of Phyllis Cimino, RN, BSN, PhN, hospice clinical supervisor at the VNA & Home Hospice of Northern California in Santa Rosa. "The families just wanted it to be as personal as possible," Cimino says.

Cimino, formerly a case manager at her hospice, speaks about the service in glowing terms. She recalls the husband who was able to hold his wife’s funeral at the home of a relative who was a park ranger that overlooked the picturesque northern California mountains.

"The family chose [Home Funeral Ministry] over traditional funeral homes because the family wanted to be more involved after the patient’s death," Cimino says.

Lyons delivered the cardboard casket and family members penned their farewells directly on the casket and decorated it with long, flowing ribbons. The family dressed the dead woman in her favorite clothes. They surrounded her casket with candles and played music for the three days her body lay in state.

"It was tremendous closure for the family," Cimino says. "I went to the funeral with a social worker and I can’t tell you how moving it was. It was incredible."

The service had a distinct impact on the husband’s ability to cope with his grief, she adds. "I was invited to the same spot a year later for a memorial service. The husband spoke of the service a year ago and how it helped him feel connected to his wife. For him, it was very healthy."

Because of the positive experience of the small number of hospice patients’ families that have used Lyon’s service, Home Funeral Ministry is on the hospice’s list of resources it makes available to patients. When patients are prompted by a hospice social worker to discuss their funeral plans, Home Funeral Ministry is offered as an alternative to traditional funeral homes.

"We tell them that there is something new," says Cimino. "Most people react by saying, Ooh,’ and some ask, Can we do that?’ And then there are those who say right away, That’s what I want.’"

Cimino sees a growing trend of patients opting for at-home funerals and believes this will become a popular alternative, if not for the emotional benefits but because of its cost benefits. "The cost factor is a big reason," Cimino says. "Because of the state people are in during this difficult time, many willingly accept the cost of a traditional funeral, but months or years later they question what they got from it."

But a glaring shortcoming of the service is its lack of industry standards, certifications, and licensure. Unlike their funeral home counterparts, there aren’t standards and licenses to help protect the consumer.

Lyons, along with Janelle Va Melvin, a former hospice nurse’s aide, formed a nonprofit organization called the Natural Death Project, which is charged with promoting home funeral guidance and developing a certification process for future providers of home funerals. Lyons, who shares co-director title with Melvin, says the certification process will include training programs and a minimum number of hours doing filed work.

In the absence of certification, hospices are left to determine the legitimacy of similar programs based on instinct. Lyons warns that hospices should be wary of providers who are preoccupied with profit. Other than trying to gauge one’s motivations for providing home funeral guidance, she is apologetic for the absence of better advice is spotting charlatans in this new industry.

The National Hospice & Palliative Care Organization (NHPCO) neither recommends nor condemns home funeral guidance. But its does recognize that hospices serve as a resource, linking patients and their families to services that meet their needs.

"One of many services that hospice programs provide to patients and their families is serving as a resource," says Angela Thimis, spokeswoman for the NHPCO. "Therefore, it is important that the hospice team keeps on top of the latest offerings of resources in their communities. They would evaluate businesses like the Home Funeral Ministry as they would any other potential resource to make sure that it’s reputable, serves the needs of their patients and families."

Because funeral arrangements are not a typical hospice service, hospices should feel compelled to offer a variety of services available within their community, including services that meets the financial needs of their patients.

"Whether a hospice would get involved in the actual planning of funeral arrangements, it really would depend on the wishes of the patient and family," Thimis says. "Usually the role of the hospice team is to assist in initiating the discussion, if asked, or assist in identifying resources for the patient and family."

Cimino was lucky. She had the luxury of knowing Melvin as a hospice worker before Melvin suggested she consider Lyons’ service. "We knew their intentions were in the right place," Cimino says.

Given opposite circumstances, Cimino says she would have to rely on the provider’s good faith that they will attend to the needs of patients and their families. VNA and Home Hospice also stresses — as it does with all community services it refers it patients to — that the service is no part of the hospice program and that they cannot be responsible for poor service.

She, too, believes that hints of motivations based on profit are a clear sign to steer clear. "Maybe it’s my naiveté, but I hope people won’t [use] death and dying as a way to make money," Cimino says. "For some funeral homes, it seems that way."