While there are similarities, the roles EOL Doulas play are distinct from hospice care. We provide a non-medical service and, as such, do not participate in creating the plan of care nor provide clinical support. Doulas don't lead the care, nor are they presenting themselves as such. The Hospice team includes physicians, nurses, social workers, chaplains. All the primary professionals attending to the person who is dying are licensed in their roles. CNA's or certified nursing assistants complete a state-approved certification process. Volunteers are vetted and go through a "hiring" process similar to professional staff. They receive extensive training.
End of Life Doulas Provide Non-Medical Care to Clients
Doulas are certified professionals who serve as an adjunct, a complement to hospice service. The people we serve are referred to as clients, not patients. My previous blog, entitled Doulas Listen for Unmet Needs, addresses the significance of our role as deep listeners. We also provide practical support. These are examples where there's an overlap in our role and that of hospice. Our primary role is to provide emotional and practical support with compassion and an end-of-life knowledge base (reference: Deanna Cochran, Hospice nurse, educator, and EOL Doula).
Hospice Care is free to patients over 65, and Doulas are fee for service or private pay. Our service is not covered by insurance. Some may offer payment on a sliding scale, while others may choose to provide their services as a volunteer.
A physician's referral initiates hospice care, and EOL Doulas are hired often by the family - via word of mouth, social media, or through a professional directory. I am a member of the National End of Life Doula Association, NEDA, and listed in their directory.
End of Life Doulas Are Often Hired by the Family
Hospice is firmly established in the US since1974, and roles are clearly understood as they are the same from state to state. EOL Doulas or Death Doulas is a developing profession, and some, like Deanna Cochran, have been practicing for over 10 years. There are several organizations offering training. Some are more intensive than others. I received my training through the University of Vermont Larner College of Medicine's End of Life Doula Professional Certificate Program.
The bottom line is that EOL Doulas complement hospice care. There are services we offer that hospice does not, which I will focus on in future blogs. Other "hats" we wear include acting as project managers, supporting clients in creating legacy projects such as writing memoirs, scrapbooks, interviews, and letter writing. Some doulas offer massage, meditation, visualization, or energy work. We may help create rituals during the dying process and, when requested, sit with our clients as they are actively dying, until the last breath. Some doulas participate in after death ceremonies and rituals, while others are also funeral officiants or offer bereavement care. When a need arises outside our scope of practice, we offer a directory of resources. Doulas often have mentors and coaches who support in processing experiences.
End of Life Doulas and hospice embrace the same fundamental belief:
You matter because you are,
and you matter until the end of your life.
Dame Cecily Saunders, founder of St. Christophers Hospice, London, UK