End-of-life doulas can support hospices' efforts to improve health equity in difficult-to-access settings while improving the quality of life's final days.
The quantity and quality of patient visits during the last days of life are important quality measures for hospice providers. Diane Sancilio, director of counseling and support at Gilchrist Cares, said having a doula at the bedside during the final days of life can improve hospice care, including for underserved populations. It is said to have had a positive impact.
The home health and hospice nonprofit began offering end-of-life doula services in 2010 and currently has 75 trained volunteers, Sancilio said. Doulas can help improve hospices' ability to support patients and families in their final moments of vulnerability, she said.
“We have doulas available 24 hours a day who are available when our clinical staff is unavailable,” Sancilio said. “They can be with a loved one for hours when family members or caregivers are not available to make sure they don’t die alone. There is absolutely an impact. We are really seeing the impact of the care that people go through in the last few days.”
The role of the doula in hospice care
Sancilio said patients and their families often need greater support in the last days of life. Doulas added that hospices can help reach these patients further upstream in a variety of ways, including increasing touchpoints with families at the bedside.
Hospices have a variety of models for end-of-life doula support, including volunteer-based services, contract-based services, and some hospices include these professionals as part of their multidisciplinary team.
End-of-life doulas often don't face the same time constraints as hospice providers and are able to spend more time with patients, said Tracy Taylor, a nurse and certified end-of-life doula with Heart to Heart Hospice. That's what it means. In the meantime, doulas help people deal with non-medical psychosocial needs, such as anxiety, guilt and fear of death, Taylor said.
“End-of-life doulas can spend hours on end with patients and families for as long as needed,” Taylor said. “By educating people and helping them face their own death in a healthy and safe environment, we can eliminate some of the regrets that come with dying.”
Heart to Heart has expanded its base of end-of-life doula providers in recent years, including hiring more end-of-life doula specialists in its Houston and Indiana service areas.
One of the factors driving these services is the impact on quality, said Shanna Sullivan, a chaplain at Heart to Heart Hospice and a certified end-of-life doula. Sullivan said doulas receive training in various areas of the dying process, which allows them to support terminally ill patients and their families in their final days of life.
In addition to assisting families with funeral and memorial service planning, wakes, handoffs, and providing proactive grief counseling, doulas are trained to communicate about sensitive topics, she explained. He also has a skill set that includes music, aromatherapy, Reiki, yoga and meditation, which can reduce symptom burden for patients, Sullivan added.
“Doulas have a lot of different skill sets that they can bring to bear,” Sullivan told Hospice News. “Doulas are essential assets for hospice teams because: [that] They bring a style of support [and] Provides families with lots of quality time that other care team members may not be able to provide. It is invaluable to the family. ”
Doulas also help hospices improve their ability to provide goal-aligned care to rural and culturally diverse patient populations, Taylor said.
“Rural and diverse areas can present challenges for other providers,” Taylor said. “Respecting our patients' beliefs, community roots, and local diversity are all part of how Heart to Heart respects the patients we serve. Public support and community education in rural areas is the key. [and] Knowledge is part of life planning and dignity. ”
Doulas bridge the gap in the last days of life
Health disparities exist, and the most underserved groups include people of color. seriously ill elderly people who are incarcerated; Especially rural populations and LBGTQ+ communities.
Doulas can help hospices better understand the wide range of unmet needs and barriers to support in the final stages of life for underserved populations, said Eric Floatow, a certified end-of-life doula. It's said to be helpful. Mr. Flotow has first-hand experience providing hospice care to incarcerated people.
“I've seen a lot of what happened in the Department of Corrections, but it still haunts me about the hospice environment and the way people are treated,” Floutow told Hospice News. “This has brought awareness to this grave injustice and challenge from a humanitarian perspective that continues to be ignored. Death doulas create safe spaces, offer advice and help people heal. We can help them die peacefully. We bridge the gap between death and hospice care at the end of their life journey.”
Misunderstanding, fear and mistrust of the health care system are also major barriers to care for underserved populations, said Lauren Carroll, founder of The DeathWives. The Colorado-based organization offers death doula certification and training, as well as doula placement assistance.
End-of-life doulas are often underserved because they have deep roots in various community groups and have different cultures, beliefs, and unique understandings of the death process among diverse populations. Carroll said it can break down common barriers between people.
The end-of-life doula workforce is becoming increasingly diverse, Carroll said. She added that men, women, transgender and cisgender people are becoming interested in death doula work, as well as people from diverse cultural and ethnic backgrounds.
Doulas' insight and ability to build relationships with the community are invaluable in reducing hospice disparities among underserved populations, she said.
“Many underserved populations don't have representation at funeral homes or hospice facilities,” Carroll said. “The best thing about being a death doula is that we can help close that understanding gap. A lot of our work is defending the rights and aspirations that people have and providing education. This is often the case for doulas, who feel more comfortable working with people within their community, as opposed to health care workers, who may not be aware of their situation at a time of great vulnerability. It’s easy to build a communication relationship with them.”
