Home Dying and Death Care
Caring for our own
We do have choices about being close to our beloved family member or friend at the time of the final passage from life. The purpose of this information is to give you and yours permission to find your own way to say goodbye in all aspects of the death process.
Each death is unique. Taking care of our own in the hours and days after death is returning as an option for many people like it was commonly 100 years ago.. What is a challenging time can also be a precious healing time, filled with spirit.
Conscious Dying We can hold the dying process more consciously and allow for completion and conversations regarding the wishes of our beloved will be explored at the same time we are living fully. Information on Conscious Dying includes hospice, alternative care, learnings from caregivers and families, and alternatives for those on the threshold. I
Home Death Care
This section, while titled home death care, applies to all circumstances of home, care facility or hospital death. Any experience can include time with the beloved after death and this can be coordinated with a cooperating funeral home. Legal information regarding right to not embalm, vital information about how to care for the body after death, the three day vigil, and cremation.
THIS IS AN EXAMPLE OF THE STEPS OF AFTER DEATH CARE AND A THREE DAY HOME VIGIL
BEHIND THE SCENES:
How this Vigil came about and how it supported the family and community (written by Linda Bergh)
David’s request for future help June 2006: After David’s wife Deborah was faced with cancer metasizing to her bone, David asked if I would help with the crossing of his beloved Deborah when that time came.
Preparation Meeting Six Days before Deborah’s Passing: In January of 2008, when she was in Hospice, and failing, David felt it was time to prepare. She went into a coma four days later. He and I met to go over his wishes and questions. We knew that close friends and some community members would be willing to help.
David’s inner wishes became a list of actions others could fulfill
Wish to contact the community : A friend sent email notice, approved by David, the variety to family, school parents, work colleagues, friends, This letter included an explanation of a three day vigil,ways people could be involved.
Contacting the Cremation Society: David contacted them to make the arrangements for picking up the body after the three days, for the cremation , and for the paperwork, including the death certificate
Casket: David chose to use a community casket provided by the Twin Cities Threshold Group. The casket was lined in purple silk by a group of friends on Thursday eve, and then delivered to their home on Saturday morning. David chose to have the casket come to its place in the room where the vigil would be held that day, as a part of the preparation for her crossing, which he knew was imminent.
Sacred body washing and preparation: David chose close friends to be present with him the morning of Deborah’s passing to prepare her body (washing, blessing, dressing). The girls choose her dress. It was a very intimate and special time of saying goodby. Then her body was placed in the casket.
Preparation for the Vigil Many friends and family prepared the space for vigil. Pictures of Deborah and her family; Beauty of silks, candles and flowers. In choosing the room for the vigil, David decided to have a quiet small semi-private space, leaving the living,dining, kitchen rooms as social areas where families and children could converse, eat, and play normally and people could chose to go and spend time in the vigil space.
The Vigil:After Deborah crossed over, friends of all ages came to support the family and say goodby, bringing songs, poems, pictures, and mostly themselves, to be with David and the girls. Sometimes there was one person in the vigil room, sometimes many people singing or talking. And in the rest of the home, people were gathered to remember, and eat, and share. The children who came were able to play with the two girls, bringing an aliveness and joy along with the deep sadness and sorrow.
Vigil Readers/Holders : Every hour of the three days someone was with Deborah in the quiet vigil area to hold her soul/spirit and share what they wished. It could include silence, prayer, reading, singing, playing, stories, conversation. People could e mail or call one organizer.
Hearth Holders : Two people were at the home at all times to support any needs for family, or guests. These friends greeted family and friends, kept the kitchen clean, made sure there was enough food,and saw what was needed for the children.
After the Vigil. The casket closing David gathered with close friends at the end of the three days when the casket was closed. It was a further moment of saying goodby. Special roses were given by the girls to each person before he or she spoke. These roses went inside the casket with Deborah for her journey
The Cremation David wished to accompany Deborah’s body to the cremation. The Cremation Society hearse came, and the same group of friends and family followed the hearse to the Crematorium. It is a very final goodby, and a challenging moment.
A Gathering for closure : After leaving the Crematorium, David and this group of family and friends gathered at a nearby restaurant to be together after these intense times. It was very important to breathe out.
Memorial : David’s decision was to have a Life Celebration in May, so that he could focus on being present to the three days and on saying goodby without feeling overwhelmed.
DETAILED HOW TO GUIDELINES FROM THE BOOK UNDERTAKEN WITH LOVE
U N D E R T A K E N W I T H L O V E downloaded from the internet. This book was designed for groups to study together in preparation for having a community group who can care for those who wish a home vigil.
W i t h O u r O w n H a n d s
This chapter focuses on care of the body after death. It is very helpful to read. Details are helpful.
In assisting the family with the practical care of the body after death, the home funeral committee helps to meet emotional and spiritual needs, as well. In all that they say and do, your committee members can model an awareness of these dimensions by going about their work in a quiet,
slow-paced and mindful manner. Take your time. Remember, there is no hurry. Pause from time to time to reflect on the emotional and spiritual di-mensions. Be so centered you can even observe your own breathing.
If you are initially uncomfortable about touching the dead, this is not unusual. Because we have so little contact with our dead in today’s society, it is normal to be afraid at first. Just remember that this
has been considered a sacred act for thousands of years and, even though dead, he or she is still beloved. It is also safe to handle a dead body except in rare instances. Unlike a living person, the dead do not cough, spit, breathe or sweat. In the case of transmittable disease, simply take the same precautions that were used in life such as the use of medical gloves. You do not have to worry about hurting your loved one. Ask a friend with nursing experience to help if that makes you more comfortable.Washing and dressing of the body can be done by two people, but, if possible, arrange to have up to six people on hand to help carry the body or place it into a coffin. It is usually easier to care for the
body soon after death before rigor mortis has set in. Times vary widely, but the body usually begins to stiffen within an hour or two. If you are going to have a home vigil or viewing, plan in advance where you want the body located and whether it will be laid out in a casket or on a
table or bed. If practical, prepare the body in that location.
P re p a r i n g t h e Wo r k S p a c e
If you decide to wash the body, have all the supplies on hand so you can work without interruption. Create enough space to comfortably move
around the body. Remove medical items, supplies and as much clutter as you can to make the space feel serene. If you have a hospital bed or a portable massage table, you will find that the height and width are more convenient and easier on your back than a regular bed. A sturdy folding table or rectangular table can also be used.
M o v i n g t h e B o d y
It usually takes a minimum of two people to turn the body. It is easier if you have three or four people. To turn a body onto its right side, stand on the left side of the bed (as viewed from the footboard), bend the left leg at the knee, and bring it toward the chest. Then set the left arm on top of the body. Hold the back of the bent knee and the back of the upper arm
and pull toward you. Allow the body to rest against your body. Reverse the procedure to turn the body onto its left side. Transporting the body of an adult usually requires six people. With three people standing on each side, roll the sheet, which is underneath the body, as close to the body as possible. This creates a handle for lifting. Count to three, and have everyone lift at the same time. A sideways shuffling step is required to clear the bed, and it helps to count and step in unison. You may also want someone at the head of the body to keep the head slightly elevated. Alternately, a body board can be used. If the body will be placed in a coffin, make sure to plan in advance how you will get it in and out of the house and how best to maneuver it through doors and up or down stairs. Go through a trial run with the empty coffin.
Wa s h i n g t h e B o d y
Feel the sacredness of what you are doing. You can start with a ceremony, poem or prayer that feels right to you, even just a few words to set the tone. In some traditions, it is customary to wash the body as a form of ritual. You may want to create your own ritual. If so, there is no right or wrong way to do it. Let your personal preference guide you. To begin, remove the clothing and any medical devices. If the body is going to be cremated and there is a pacemaker, additional steps will need to be
taken. Please see the note at the end of this chapter. Clothing can be cut off if necessary. As you work, consider using a sheet to preserve modesty as you would if the person were alive. This may also help
people feel more comfortable with the process. Before bathing, place a folded towel or disposable plastic pad under the hips and bottom, and
slowly apply firm pressure just above the pubic bone to remove any urine from the bladder or bowel contents. Then remove the soiled towel or pad.
G a t h e r i n g S u p p l i e s
For washing the body:
shower curtain or plastic sheet to protect the mattress if you’re working on a bed, bath towels, washrags, soap, wet or dry shampoo, cotton swabs or balls, large bowl(s), rubber or latex gloves, and essential oils.
For cooling the body:
20 to 30 pounds of dry ice, preferably cut into 1-inch slices; thick cloth/leather gloves or a washrag; Styrofoam ice chest; paper bags or pillowcases. (note from Linda Bergh: Techno ice (can be ordered on internet or we have enough locally in Twin Cities to help one situation)
For dressing the body: final outfit or shroud/wrapping.
For the vigil: : clean bed sheets, special coverings or quilts, scarves or silk, flowers, candles, religious items, family photos, decorative elements; reading lamp, chair, inspirational literature, and paper or a blank memory book.
For final disposition: Purchase or make the burial or cremation container, and decorate if desired. You can purchase caskets and urns online, from Costco, from funeral homes and from local craftspeople, or you can make your own. Arrange to rent or borrow a van, pickup truck, hearse or SUV that will accommodate the casket (Note from Linda Bergh : or choose to work with a funeral home for this aspect; also the MTN has a casket available).
Use a gentle soap with warm water. If desired, sprinkle a few drops of essential oil and flower petals in the water. The following is a suggested order for washing the body: Wash the face and neck. To dry, pat the body
instead of rubbing since the skin may be delicate. Cleanse the mouth and teeth with cotton swabs, a small rag or moisturizing sponges for the mouth. Mouthwash can be used as an antiseptic rinse to reduce odor. Wash the hair if desired. Dry shampoo works surprisingly well. Or move the body so that the head is off the end of the bed and supported and use
regular shampoo and water. Wash the arms and hands, and gently pat dry. If needed, manicure the nails as you normally would. Turn the body on its side. Wash the upper body front and back, and gently pat dry. Turn the body to the other side, and repeat. While the body is on its side, lift the upper leg a few inches so you can wash the genital area. If you are not comfortable doing this, an alternative method is to draw a washrag or towel back and forth between the legs a few times. If the deceased
received a thorough bath shortly before he or she died, you may omit this step. Lay the body back down. Wash the legs and feet,
and gently pat dry.
Before dressing, you may anoint the body with oil or moisturizing lotion to keep the skin hydrated.You can also apply powder or cornstarch to the body to ensure dryness. If there are open or unsightly sores or wounds,
cover them with gauze pads and seal in place with waterproof medical tape. Although bodily discharge is not usually a problem, you may wish to place a disposable adult diaper on the body after bathing and before dressing as a preventative measure. If you are seriously concerned, you may place cotton in the rectum to make sure any leakage is contained.
When finished, place a clean sheet or blanket under the body. The simplest way to do this is to roll the body to one side, roll up and push the soiled sheet against the side of the body. Then roll the body to the other side, and remove the soiled sheet. Follow the same procedure to put clean linen under the body. This sheet becomes the means by which you lift and carry the body later on, so it is important that it be sturdy and dry.
P re p a r i n g t h e Fa c i a l Fe a t u re s
(Note from Linda Bergh: You may want to do eyes and mouth before rest of body
If you prefer the eyes be closed, it is easier to accomplish before rigor mortis occurs. Simply close the eyelids with your fingers, and place an eye pillow or a bag of beans, rice or coins on top of the eyelids. Once rigor mortis sets in, you can remove the weights, and the eyes will usually remain closed. A dab of petroleum jelly or a small swab of cotton placed under the eyelids will also help the eyes stay closed.
To close the mouth, loop a scarf under the chin and tie it at the top of the head, or prop the jaw with a rolled-up hand towel fitted snugly under
the chin, and place a pillow under the head. If the muscles are too stiff, massage the lower part of the jaw until it loosens enough to close. Once rigor mortis sets in, the tie or towel can be removed, and the mouth will usually remain closed. At this point, you may wish to take a moment of silence and say a prayer, or offer a blessing for the one who has died.
Dressing and Laying Out the Body
If the body is going to be placed in a casket, dress the body first. If the body is going to be laid out on a bed or table, move the body to that location and then dress. Rigor mortis can make dressing difficult, but
limbs can be worked or massaged to remove much of the stiffness. You can be quite vigorous with the bending of the limbs; you will not harm the body. Dress the body in whatever you deem most appropriate. A garment can be cut up the back to make it easier to put on. Undergarments, shoes and socks are not necessary, but use them if you feel it is important. If you want to shroud rather than dress the body, encircle the body in several layers of cloth, a quilt or sheets. Since the torso of the body will be elevated slightly by the dry ice, you may need to place folded towels under the arms and legs to allow the body
to lay flat. (Note from Linda Bergh. We put ice around, not under the body which takes care of this problem) If the feet fall away from one another in an unattractive way, tie a scarf around the ankles or cover the lower half of the body with a favorite quilt or scarf. Apply makeup and nail polish as desired. A sheer scarf can be placed over the face or any part of the body to cover anything unsightly. A scarf covering the face is a time-honored technique that conveys the message that the person is truly gone. Finally, place a pillow beneath the head for a more natural look, which will also help restrict fluid that may be in the stomach or lungs. You may wish to arrange the hands crossed over the heart or rest
-ing on the belly.
C o o l i n g t h e B o d y
To slow the breakdown of the body, you should keep the body cool. In some states, this may be a legal requirement. You can easily cool the body with dry ice, which can be purchased at many grocery
stores or specialty vendors for about $1 per pound. note from Linda Bergh : Techno ice is now available on line and MTN has access to enough for one family and will deliver it in the Twin Cities Metro. Also on website is list of local sources of dry eye in Twin Cities ) If possible, use a specialty vendor, such as an ice cream supplier, who can slice the dry ice in convenient 1-inch sheets. If that is not possible, then you can drop the dry ice on a very hard surface or use a hammer to break it into small chunks. Since dry ice evaporates, purchase it daily rather than buying and storing a large quantity. Start with about 30 pounds. Thereafter, you will usually need 10-20 pounds per day. Immediately place dry ice in a cooler. A Styrofoam container is preferred because dry ice can crack plastic. Do not set the cooler on wood or tile floors, which can be damaged from the extreme cold. As dry ice evaporates, it emits carbon dioxide, so leave the cooler slightly open to allow the gas to escape, and make sure a door or window to the room is left open for ventilation. This is also the reason we recommend wrapping the dry ice in cloth or paper, not plastic bags, when you place it under the body. You can also use a moisture barrier, such as bubble wrap or a shower curtain, between the dry ice and casket to help reduce condensation. To handle dry ice, use leather or cotton gloves or a washrag to protect your hands. Place a slice of dry ice into a paper bag, pillowcase, newspaper or
towel. Tuck a bundle under each shoulder blade, the lower back and the upper thighs of the body. You can also use dry ice under the head and on top of the lower abdomen. An alternate method is to place three sheets of 1-inch thick slices of dry ice side by side under the torso starting at the shoulders and extending to the lower back with one slice on top of the lower abdomen. The goal is to cool off the torso and internal organs, not freeze the entire body. The skin should have a little give to it when pressed. For small bodies, such as a child, frozen gel packs may be a better option so the body does not freeze. Check the dry ice once or twice a day. (Note from Linda Bergh: Techno ice needs to be replaced every 12 hours and body does not need to be moved it is placed around the body and under silk or fabric ) As it evaporates, add more. Be prepared to have someone help roll the body to the side when you check or replace the dry ice. Keep the head slightly elevated as you do this. Have a washcloth nearby, and protect the clothing and bedding with a towel just in case the movement causes a bit of fluid from the stomach or the lungs to exit the mouth or nose.
V i g i l a n d V i s i t a t i o n
If you want to hold a vigil, it can take place with the body resting on a bed, a massage table, a table or in a coffin. This is purely a matter of personal preference and convenience. Arrange and adorn the body in a way that feels appropriate or sacred to you. If using a coffin, you can decorate it in any way you choose. If desired, put personal belongings or notes in it. When the body is readied, prepare the room for visitors. This may include placing flowers, greenery (rosemary, for example, is the herb of remembrance), essential oil in a diffuser, candles or incense around the room. If the body is clean, there is usually no problem with odor. However, a subtle fragrance is generally a pleasant and welcoming addition to the room. You might want to have extra chairs, a reading
lamp, paper or a blank memory book with pen or pencil, music, sacred reading material and decorative items like flags on hand. It is also nice to assemble photos of the deceased and mementos of her or his life.
The manner of the viewing may be religious or secular. The vigil or visitation can occur at hours or days convenient for the family. It may be simple or elaborate to fit the personality of the deceased or the needs of the family. During a vigil, people can sit together, share silence or talk, read inspirational texts, sing, chant, invoke blessings, gently touch the
body, pray, etc. (Note from Linda Bergh – see the story section for examples and writings about vigils)
F i n a l T r a n s p o r t
A vehicle to transport the body to the cemetery or crematory should be arranged for well in advance. You can rent or borrow a van, pickup truck or sport utility vehicle, or a funeral home can be called on to assist for a fee. Note from Linda Bergh : You will need transport papers ( see later section for example in MN ) in order to do this. You can also choose to have the funeral home help with the transportation.
O t h e r C o n s i d e r a t i o n s
include massive trauma or burns, autopsied bodies, and severe obesity, which makes turning or moving the body dangerous for caregivers. However, after a frank discussion of what to expect in these situations, it should ultimately be the family’s decision. While rare, there are also certain infections that make a home funeral inappropriate, including
septicemia, which is a virulent blood infection that produces odor and accelerates decomposition. In addition, if the deceased shows evidence of tissue gas, the body must be buried or cremated without delay. Commonly known as gangrene, the symptoms of tissue gas include strong odor and the blackening and distention of the skin. Notably, the skin “crackles” when touched. This infection spreads very quickly, and unpleasant effects can become obvious in as little as two hours. Once started, there is no way to prevent the spread of the bacteria other than
the use of embalming chemicals. If it is important for the family to continue with their home funeral plans, then a funeral director should be called upon immediately to embalm. Afterward, the body may be returned home. Note: Due to the danger of explosion, pace makers and other internal battery-powered devices must be removed before the body is cremated. If not removed, you may be held liable for damages to
the cremation chamber. Ask medical personnel to remove these devices or consult a licensed funeral director.
H o m e F u n e r a l S u p p l y K i t
•(note from Linda: we have used a much smaller kit. I have starred critical items. Many other items are in any household if needed)
Assortment of waterproof bandages
*Black garbage bags for waste
Brown paper grocery bags for dry ice
Brush and comb
*Chux waterproof underpads
*Disposable rubber or latex gloves
*Essential Oils and diffuser
*Fabric strip or belt to close the jaw (or scarf)
Face mask/medical masks
*Gloves for handling dry ice
Hydrogen peroxide (to remove blood)
Shampoo and conditioner
*Yards of fabric for decoration of casket