5 Questions to Ask Before Choosing Hospice Care (So You Feel Confident in Your Decision)

Choosing hospice care for yourself or a loved one is one of the hardest decisions a family will ever face. The good news is that not all hospice providers are the same, and asking the right questions upfront can make all the difference in the quality of care you receive during this deeply personal time.

Whether you're planning ahead or facing an urgent need, here are five essential questions to ask before selecting a hospice provider.

1. What Services Are Included in the Care Plan?

Hospice care is meant to cover far more than pain management. A quality provider should offer a full range of services, including nursing visits, medical equipment, medication management, spiritual support, and counseling for both patients and family members.

Ask the provider to walk you through exactly what's included and how often care team members will visit. Some agencies offer daily check-ins during critical periods, while others may only provide care a few times a week unless you request more. Understanding the baseline level of support helps you avoid surprises later and gives you a clear picture of what daily life will look like.

2. How Experienced Is the Care Team?

The people providing care matter just as much as the services themselves. Ask about the qualifications and experience of the nurses, aides, social workers, and chaplains who will be involved. Find out how long staff members typically stay with the organization, since high turnover can disrupt continuity of care during a time when consistency matters most.

It's also worth asking whether the same nurse or aide will be assigned to your case throughout the process, or whether you'll see a rotating group of caregivers. Familiar faces can bring real comfort to patients and families alike.

3. What Happens During a Medical Emergency?

Even with hospice care in place, symptoms can escalate quickly. A trustworthy provider should have a clear, 24/7 on-call system so you're never left wondering who to contact in the middle of the night.

Ask how quickly someone typically responds to an urgent call, and whether a nurse can come to the home outside of regular hours if symptoms become severe. Some agencies also offer short-term inpatient stays for symptom management when home care isn't enough. Knowing this plan in advance can ease a lot of anxiety down the road.

4. How Does the Hospice Support Family Caregivers?

Caring for a loved one at the end of life takes a toll on families, both emotionally and physically. A strong hospice program recognizes this and offers support that extends well beyond the patient.

Ask about respite care options, which give family caregivers a short break while a trained professional steps in. Also ask about grief counseling and bereavement services, and how long that support continues after a loved one passes. Many providers offer these services for a year or more, which can be an important resource long after hospice care has ended.

5. What Do Other Families Say About Their Experience?

Reviews and testimonials can offer a window into what daily life with a particular hospice provider actually looks like. Look for feedback about communication, responsiveness, and the overall compassion shown by the care team.

Don't hesitate to ask the hospice for references from other families they've worked with, or check with a hospital social worker or discharge planner who may have insight into local providers. Word of mouth often reveals details that a brochure or website simply can't capture.

Making the Right Choice for Your Family

There's no perfect formula for choosing a hospice provider, but asking thoughtful questions puts you back in control during a time that can otherwise feel overwhelming. Take your time, involve other family members in the conversation, and trust your instincts if something doesn't feel right.

The goal of hospice care is comfort, dignity, and support, not just for the patient, but for everyone who loves them. Finding a provider who understands that mission can make an incredibly difficult chapter feel a little more manageable.

If you're currently researching hospice options, consider scheduling consultations with two or three providers before making a final decision. Most agencies are happy to answer questions in person, and that conversation alone can tell you a lot about the kind of care your family can expect.

Navigating Family Conflict at the End of Life

When someone dies, it's rarely just their story that closes. It's never that simple. More often than not, a loved one's death drags an entire family's unfinished business out into the open. Old sibling rivalries, clashing values, guilt, and fear all seem to find their way to the surface right when someone is dying. And it can get ugly fast. I've watched families go from a quiet bedside vigil to a heated argument about funeral flowers within the same hour. I've seen grudges that were decades old reignite right there in the hospital room. If you've lived through it, none of this will surprise you.

Here's the thing: end-of-life isn't only about medical choices and logistics. If it were, this blog post wouldn't need to exist. It's really about navigating relationships while everyone is under enormous emotional pressure. So how do you manage family tension when the stakes feel this high? As a death doula, this comes up more often than I’d like.  Here's what I tell people.

The Real Issue Is Rarely the One on the Surface

Conflict at the end of life is almost never about what it appears to be about. An argument over which hymn plays at the funeral usually isn't about music.  Someone is feeling overlooked or unappreciated. A disagreement over who inherits a wedding ring might actually be rooted in old wounds around favoritism or feeling neglected.

When you can pause and name what's actually happening; something like, "I think this is really about all of us wanting to feel close to Dad, not about which rehab facility we pick", it takes some of the heat out of the room. People may still disagree, but the real hurt is finally visible instead of buried underneath the argument.

Sometimes it takes someone outside the family to ask that question and surface it.

Choose Your Battles

Not every disagreement is worth the fight. Near the end of life, you'll face plenty of real crossroads.  What kind of care your loved one receives, where they'll be buried, who speaks at the service. These choices matter. But they don't all matter equally.

Ask yourself; will this still matter to me a year from now? If not, it might be worth letting it go. Sometimes the kindest thing you can do isn't winning the argument — it's choosing peace instead. Everyone is doing the best they can with the information they have in that moment. None of us know how it will all unfold.

Establish Clear Roles Early

Confusion about who's actually in charge is one of the biggest sources of family conflict. Without a designated power of attorney, an advance directive, or an agreed-upon spokesperson, everyone ends up feeling entitled to make the calls.  Chaos tends to follow.

Where possible, encourage your loved one to name a decision-maker before things become urgent. If that window has already passed, try dividing up responsibilities instead: one person liaises with the care team, another handles meals, another keeps extended family in the loop. Defined roles go a long way toward defusing power struggles.

Bring in Someone Neutral

Sometimes the most helpful thing is outside help. A hospice social worker, chaplain, or death doula can help guide difficult conversations. Families are often far more receptive to hard truths when they come from someone without forty years of shared history and baggage.

Don't underestimate what a calm, compassionate outsider brings to the room. They can hold space, translate confusing medical language, and gently redirect everyone's attention back to the person who's actually dying and not the argument happening around them.

Expect Big Emotions

When someone is dying, the room fills with grief, fear, love, and regret all at once. People are going to say things they don't mean. They're going to snap under pressure. Expecting everyone to stay composed is setting yourself up for disappointment.

It can help to reframe the tense moments: this isn't someone being difficult, it's someone being heartbroken. That doesn't excuse hurtful behavior, but it's a reminder that pain is usually the root cause. Softening how you interpret someone's outburst can soften your own reaction to it.

Anchor Back to Love

Underneath it all, most people in these situations all want to honor the person they're losing, to show up with love, and to feel like they did right by them. When tensions rise, it helps to name that shared goal out loud: "Dad wanted us together.  This is bigger than what we're arguing about." Or, "We're all grieving differently, but what matters is that Mom feels our love." Coming back to that shared purpose can reset the tone, even briefly.

Final Thoughts

At the end of life, don’t expect some perfectly harmonious, conflict-free experience. Grief makes people raw, frightened, and sometimes unreasonable, and the work is choosing compassion anyway.

If you're in the middle of this right now: take a breath. You don't have to get every moment right. Focus on what's actually within your control: showing up for your loved one, protecting your own wellbeing, and steering the family back toward love, imperfectly, again and again.

Because when it's over, people rarely remember who won the argument about flowers. What stays with them is the tenderness, the hands held, and the quiet presence in the room. That's the legacy worth protecting.

If you're navigating difficult family conversations and could use support, reach out.

What Forgiveness Really Does at the End of Life

Forgiveness has a way of sounding like a greeting card, or a homework assignment your therapist hands you. But when someone is actually dying, forgiveness stops being an abstract idea. As time runs out, old wounds, long-simmering conflicts, and quiet regrets tend to surface at the bedside, uninvited. And here's the part people don't expect: it's not only the dying person who feels the weight of those things. The people left behind carry it too.

So what does forgiveness actually do for someone at the end of life?

It's Not Only About Forgiving Someone Else

When people picture forgiveness near death, they usually imagine one of two scenes: asking for forgiveness, or deciding whether to grant it to someone who caused harm. But that's only part of the picture.

The bigger truth is that forgiveness is often turned inward. A lot of people facing the end of their life are working through how to forgive themselves.  For not parenting the way they wished they had, for working too much, for the drinking, the silence, the distance, the mistakes. Maybe even something as small and absurd as the year they nearly burned down the garage deep-frying a Thanksgiving turkey. Often, the hardest thing to sit with is what they did, or failed to do, for someone they loved.

And that kind of shame doesn't dissolve just because hospice has been called. Left unaddressed, it tends to show up with interest.

Think of Forgiveness Like Emotional Hospice

Physical hospice care is about comfort, not cure. Emotional forgiveness operates the same way. It doesn't undo the past or erase the hurt. It doesn't excuse what happened. But it can lighten the load. It can move someone from pain toward peace, even when nothing about the actual situation has changed.

Forgiveness isn't a trade. It's not "I'll forgive you once you apologize" or "I'll let it go the moment you admit what you did." Sometimes the apology never comes because the person is gone, or they're still causing harm. Even so, choosing to release the grip of that pain can be one of the most generous things a person does for themselves.

Near the end, people often grasp something the rest of us try hard to avoid thinking about: there's no do-over. Every ounce of energy spent gripping an old wound is energy that could go toward one more "I love you," one more hand held, one more chance to close your eyes in peace rather than fear.

Why Some People Won't Open That Door (And That's Okay)

To be clear: this isn't a pitch for tying every relationship up in a neat bow before dying, like some tidy series finale. Life doesn't work like a feel-good drama. Some people hold onto anger for good reason. Some wounds run deep. Some relationships are genuinely unsafe. Not everyone earns a seat at the bedside, and forgiving someone doesn't mean inviting them back in.

What does matter is this: people often wait, thinking there will be time later for the hard conversation, the letter, the softening. And then that time runs out. That delay can leave behind a heavy legacy for the person dying, and for everyone who loved them.

Some people whisper forgiveness to someone who can no longer respond, because saying it out loud while they could hear it felt too exposing. Just as often, that forgiveness comes out only after death, in tears, too late for the other person to hear it. And sometimes families are left holding their own unresolved grief because the dying person never took that step, or couldn't.

What Forgiveness Can Actually Look Like

It rarely comes as a grand speech. In practice, it might look like:

• Writing a letter you never intend to send

• Speaking the words "I forgive you" out loud to a photograph, a grave, or an empty room

• Offering an apology that's imperfect but genuine

• Releasing the need to ever hear "I'm sorry"

• Choosing to hold someone's whole story in mind, not just their worst moment

A Final Gift

At the end of life, forgiveness becomes a gift for the person dying, and for everyone around them. It frees up room for love, for connection, for legacy. It creates space to simply be present. In a season of life where so much feels beyond anyone's control, forgiveness remains one of the last real choices a person gets to make.

If you're sitting beside someone in their final days, or thinking ahead to your own, it's worth asking:

• Is there something that still needs to be said?

• Is there someone you need to let go of?

• Is there a weight you're still carrying?

There's no guarantee of a perfect ending. But a peaceful one is still within reach.

Green Burial, Home Funerals, and Other Things You Didn't Know Were Options

Most people assume there are only two choices when someone dies: a modern funeral with embalming and a casket, or cremation. That's what the funeral industry has quietly trained us to expect for the last century or so. But those aren't the only options, not even close, and a lot of families are surprised to learn what's actually available once they start asking questions.

If you're planning ahead for yourself or a loved one, here are some alternatives worth knowing about.

Green Burial

Green burial skips embalming chemicals, metal caskets, and concrete vaults, and instead returns the body to the earth as naturally as possible. That usually means a biodegradable casket or simple shroud, a shallower grave that allows for natural decomposition, and a burial site that often looks more like a meadow or forest than a traditional cemetery.

Beyond the environmental appeal, a lot of people are drawn to green burial because it feels honest. There's something grounding about letting nature take its course instead of working so hard to preserve or seal a body away. Green burial sites exist in most states now, and many conventional cemeteries offer green burial sections as demand has grown.  For my local peeps; check out Kokosing Nature Preserve!

Home Funerals

Yes, you can legally keep a loved one's body at home after death in most states, care for them yourself, and hold the funeral there instead of at a funeral home. This is often called a home funeral, and it's actually how most families handled death for the majority of human history, before the funeral industry became the default middleman.

A home funeral might involve washing and dressing the body, keeping it cool with dry ice, and inviting family and friends to visit and say goodbye in a familiar space instead of a sterile viewing room. It's intimate, and for a lot of families, deeply healing. A death doula can walk you through the legal requirements in your state and support you through the logistics, so you're not figuring it out alone in the middle of grief.

Human Composting

Also called natural organic reduction, human composting is a newer option that's now legal in a growing number of states. The body is placed in a vessel with organic materials like straw and wood chips, and over the course of several weeks, it's transformed into nutrient rich soil. Families can use that soil to plant a tree, start a garden, or spread it somewhere meaningful.

It's an option that resonates with people who want their death to actively give something back, quite literally becoming part of new growth. If this route interests you, check your state's laws first, since availability is still expanding. (Not currently available in Ohio)

Alkaline Hydrolysis

Sometimes called water cremation, alkaline hydrolysis uses water, heat, and alkaline chemicals instead of flame to break the body down, leaving behind bone fragments similar to traditional cremation. It uses significantly less energy and produces far fewer emissions than flame cremation, which makes it appealing to families looking for a gentler environmental footprint. Like human composting, it's legal in a growing but still limited number of states.  (Not currently available in Ohio)

DIY and Family-Led Funerals

You don't need a funeral home to plan a meaningful send-off. Families can legally handle much of the process themselves in many states, including transporting the body, filing paperwork, and designing a service that actually reflects who the person was. That might mean a backyard gathering instead of a formal chapel, or a celebration of life built around the person's favorite music and stories instead of a scripted program.

This route takes more legwork, but it also offers more freedom, and often costs a fraction of a traditional funeral.  If you’re lucky, you can find an independent funeral director that can help you through this process. 

You Have More Options Than You Think

The traditional funeral industry isn't wrong for everyone, and if it feels right for your family, that's a completely valid choice. But it's not the only path, and knowing your options ahead of time means you get to choose what actually feels meaningful, rather than defaulting to whatever's presented first in a moment of grief.

Green burial, home funerals, human composting, water cremation, and family-led services all offer different ways to honor a life and a death. The best choice is simply the one that feels most true to the person being honored, and to the people left to grieve them.

End-of-Life Care for People with Dementia: What Families Need to Know

Watching someone you love move through the later stages of dementia is one of the hardest kinds of grief there is, because so much of the loss happens before the person actually dies. (Death by a thousand cuts) You lose pieces of them along the way: memories, recognition, conversation. Then, at some point, the disease itself becomes life limiting. That shift into end-of-life care catches a lot of families off guard, mostly because nobody prepared them for what it actually looks like.

If you're standing at that edge right now, here's what you need to know.

Recognizing When Dementia Becomes Terminal

Dementia is a progressive, terminal illness, though it doesn't always get talked about that way. In the advanced stages, the brain gradually loses control over basic bodily functions. Swallowing becomes difficult. Mobility disappears. Infections become frequent and harder to recover from. Weight loss and decreased appetite become the norm rather than the exception.

These changes are often gradual, which makes them easy to miss or explain away. A hospice or palliative care evaluation can help families understand where their loved one actually stands, medically speaking, and what to expect in the months ahead. Getting this evaluation sooner rather than later gives everyone more time to plan instead of reacting in crisis mode.  (This is what you want to avoid)

Comfort Over Cure

Once dementia reaches its final stages, the goal of care usually shifts from treatment to comfort. That can feel like a hard pivot, especially if the family has spent years trying every possible intervention to slow the disease down. But comfort-focused care isn't giving up. It's meeting your loved one where they actually are.

This might mean stepping back from aggressive interventions like feeding tubes, hospital transfers, or invasive testing, and leaning instead into pain management, gentle repositioning, mouth care, and a calm, familiar environment. Hospice teams are especially skilled at this kind of care, and they can guide families through decisions that otherwise feel impossible to make alone.

Communication Looks Different Now

One of the hardest parts of dementia is that verbal communication often fades long before the end. That doesn't mean connection disappears. People in advanced dementia can still respond to touch, tone of voice, music, and presence, even when they can no longer follow a conversation.

Sit with them. Hold their hand. Play a familiar song. Talk to them like they can hear you, because on some level, they likely can. Presence matters more than words at this stage, and simply being there communicates something that language no longer can.

Supporting the Family, Not Just the Patient

Dementia caregiving is a marathon, and by the time end-of-life care begins, many families are running on fumes. Caregiver burnout is real, and it often gets ignored because everyone's attention is focused on the person who is dying.

This is where a broader care team makes a real difference. Hospice social workers, chaplains, and death doulas can support the emotional and logistical load, not just the medical one. Respite care exists for a reason. Asking for help isn't a failure. It's what makes it possible to keep showing up.

Anticipatory Grief Is Real and Valid

Families often start grieving long before their loved one actually dies, especially with dementia, where the person you knew may have "left" well before their body does. This is called anticipatory grief, and it's a normal, valid response to a slow, layered loss.

Give yourself permission to grieve the version of your loved one you've already lost, while still being present for the version in front of you now. Both things can be true at the same time. You are allowed to mourn and love simultaneously.

Planning Ahead Brings Peace

If dementia runs in your family, or if you're caring for someone in the earlier stages, having conversations about end-of-life wishes now, while your loved one can still participate, is one of the most valuable gifts you can give everyone involved. Advance directives, healthcare proxies, and clear documentation of wishes remove painful guesswork later, when emotions are running highest.

Dementia takes so much from families, but it doesn't have to take away peace at the end. With the right support, information, and care team, this final chapter can hold space for comfort, connection, and even grace.

Navigating end-of-life dementia care and want support? Please reach out! No judgment, just honest guidance for one of the hardest seasons a family can walk through.

Top 5 Grief Myths That Make Healing Harder (And What's True Instead)

Grief already feels like enough of a mess without a bunch of outdated myths piling on extra pressure. Somewhere along the way, our culture picked up a handful of "rules" about how grief is supposed to look, and most of them are just plain wrong. Worse, they can leave grieving people feeling like they're failing at something that was never a test to begin with.

Let's clear the air. Here are five grief myths that need to go, and what actually helps instead.

Myth #1: Grief Follows Five Neat Stages

You've probably heard of the five stages: denial, anger, bargaining, depression, and acceptance. Here's the thing most people don't know: those stages were originally described for people facing their own terminal diagnosis, not for people grieving a loss. Somewhere along the way, they got repackaged as a universal roadmap for grief, and that framing has stuck around for decades.  (Elizabeth Kubler-Ross, the founder of these “stages” and even said herself this is not meant to be a checklist!!!)

Real grief doesn't move in a tidy line. It loops. It doubles back. You might feel okay for a week and then get flattened by a wave of sadness triggered by a grocery store song. That's not regression. That's just what grief actually looks like.  And sometimes all those crazy feelings or stages….they happen all at once.  And that is exhausting.

Myth #2: There's a Timeline You Should Be On

Six months. A year. "By now you should be over it." Grief doesn't come with an expiration date, and setting a timer for it only adds shame to an already crappy experience. Some losses reshape your life in ways that show up years later, in completely unexpected moments. A song, a smell, a birthday can bring grief roaring back long after everyone assumes you've "moved on."

I hate to break it to you but you’re never going to cross some imaginary finish line where grief disappears. HOWEVER, you will learn to carry the loss differently over time. Give yourself permission to grieve on your own schedule, not one dictated by other people's comfort.

Myth #3: Staying Busy Helps You Heal

Keeping busy might distract you for a while, but distraction and healing are not the same thing. Grief that gets shoved aside doesn't go away. It tends to resurface later, like holding a beach ball under the water, bapping you in the face. And often in ways that are harder to recognize and deal with, like anxiety, irritability, or exhaustion that seems to come out of nowhere.

Feeling your grief, even in small doses, actually moves you through it. That might mean setting aside time to cry, talk to someone, journal, or simply sitting with the ick instead of outrunning it. Rest and stillness are doing more work than a packed calendar ever could.

Myth #4: You Need to "Let Go" to Move Forward

This one causes a lot of unnecessary guilt. The idea that healthy grieving means completely detaching from the person you lost, boxing up their memory, and moving on without them, misses what grief researchers have actually found. Maintaining a connection to someone who died, through memories, rituals, or ongoing conversations with them, is a normal and healthy part of grieving.  (I talk to my mom ALL THE TIME)

You don't have to let go to heal. You get to carry your person with you while still building a life that includes joy, new relationships, and forward motion. Continuing bonds and moving forward can and do coexist.

Myth #5: Strong People Don't Fall Apart

Somewhere along the way, holding it together became some kind of a badge of honor, or something.   And falling apart got labeled as weakness. That belief keeps a lot of people isolated in their grief.  I can’t imagine how hard it must be to hold it all in for that long!

Grief is not a weakness contest. Crying in front of people, asking for help, taking a day off work, or admitting you're not okay are not signs of failure!! They're signs that you're human and that you loved someone enough for their absence to hurt. Strength in grief often looks like letting people see the mess, not hiding it.  Sure some people may be really uncomfortable witnessing others’ grief, but that’s their problem.  Not yours.

Grief Deserves Better Information

Grief is already hard enough without these myths that pile on shame, pressure, or false expectations. The truth is messier and more forgiving than the myths suggest. There's no perfect timeline, no required stages, and no gold star sticker for holding it all together.

Give yourself, and the grieving people in your life, more grace. Healing is about moving through it honestly, at your own pace, in your own way.

Want more honest conversations about grief, death, and everything in between? Come hang out with me. No judgment, no timelines, just real talk.

4 Common Fears About Death (And How to Actually Deal With Them)

Let's be honest: thinking about dying is uncomfortable, and maybe even scary. You can intellectually accept that death is part of life But you still feel a wave of dread sneak up on you out of nowhere. If that's you, take a breath. You're not broken, and you're definitely not alone. Most of us carry a mess of fears around death, and naming those fears is usually the first step toward loosening their grip.

Here are four of the biggest fears people share with me, and what actually helps.

Fear #1: The Pain

This one tops the list for a reason. "Will it hurt?" is a completely fair question to ask. Nobody can promise you a perfectly painless death, but here's some good news: modern medicine has come a long way, and hospice and palliative care teams specialize in comfort. Their entire job is keeping you as pain-free as possible. Suffering through the end of life is not a requirement, and planning ahead gives you a real say in how much comfort care you receive.

And while we're here, let's clear up a myth: hospice isn't there to hurry things along. Their goal is comfort and dignity, not a shortcut to the finish line.  I promise this.

Fear #2: The Unknown

The classic "what happens after I die?" question has probably kept you up at night at least once. I remember having my first little existential crisis as a seven year old, lying awake trying to make sense of something that has no clear answer. Whether you lean toward heaven, reincarnation, energy returning to the universe, or genuinely have no idea, that uncertainty is allowed to just sit there unresolved.  (Easy for me to say, I know)

Fear of the unknown loses some of its power when you get curious about it instead of avoiding it. Read books on the topic. Ask people what they believe and why. Bring it up at dinner parties, even if it makes things a little awkward. (ask me how I know!) Consider checking out a death cafe, a casual gathering where people talk openly about mortality over tea and cake. The mystery itself won't go away, but familiarity has a way of softening fear.

Fear #3: Leaving People Behind

Worrying about the people you love is one of the most natural fears there is. We want to protect them, fix things for them, stay connected to them. Here's the honest truth: the people you love will grieve you.  And they will go on living, too. Life continues, even when it feels impossible to imagine.

What actually helps with this fear is connection now, while you can still act on it. Have the real conversations. Write the letter you keep putting off. Record a voice memo or video for the people who matter most. Say the things that feel too vulnerable to say out loud. Love doesn't have to die with you! And don’t wait until you’re dying to say these things, do it now!!

Fear #4: Losing Control

The thought of becoming dependent, or losing your voice in decisions about your own care, is genuinely unsettling for a lot of people.  (Myself included) This is exactly why advance directives matter, and why building a solid care team, (including a death doula!), can change the entire experience. Planning ahead hands some of that control back to you. That's not a small thing. It's powerful!

Bringing Fear Into the Light

Talking openly about death doesn't summon it any faster, no matter how much it might feel that way. What it actually does is give you, and the people around you, more peace. Fear tends to shrink the moment you stop avoiding it and look at it directly.

So go ahead and look under the bed. Death is there, sure. But so is love, legacy, and more grace than you might expect.

Want more honest conversations and resources on dying well? Come hang out with me. No judgment, no creepy vibes, just compassionate, real talk about the one thing we all have in common.

Top 5 Comfort Measures That Matter Most at the End of Life

When someone we love is nearing the end of life, the instinct to help can feel overwhelming, especially when there is no cure left to chase. That shift, from fixing to comforting, is one of the hardest emotional turns a family makes. We love fixing things, don’t we?  But comfort care is not a lesser form of care. It is deeply intentional, and it can bring real peace to both the person dying and the people who love them.

Here are the five comfort measures that hospice and palliative care experts consistently point to as the ones that matter most.

1. Effective Pain and Symptom Management

Pain control is the foundation of comfort care. Unmanaged pain affects everything else, including sleep, mood, appetite, and the ability to connect with family. Hospice teams work closely with physicians to adjust medications as needs change, often using a combination of long-acting and fast-acting options to keep discomfort ahead of the curve rather than chasing it after it spikes.

Pain is not the only symptom that needs attention. Nausea, shortness of breath, restlessness, and anxiety can all be treated, and doing so allows a person to remain present and engaged for as long as possible. Families should never hesitate to report new or worsening symptoms. Hospice nurses expect and welcome these updates, and small medication adjustments can make a dramatic difference in a person's quality of life.

2. Emotional and Spiritual Support

The end of life often brings up big questions. Fear, regret, gratitude, and a need for closure can surface even in people who rarely talked about their inner lives before. Chaplains, social workers, and counselors trained in end-of-life care can help a person process these feelings without judgment or an agenda.

Spiritual care does not require religious belief. For some, it looks like prayer or ritual. For others, it is simply the space to reflect on a life well lived, to say what needs to be said, or to sit quietly with someone who understands the weight of the moment. This kind of support also extends to family members, who often carry their own fear and grief while trying to stay strong for their loved one.

3. The Presence of Loved Ones

Few things bring more comfort at the end of life than the simple presence of people who care. Studies on dying patients consistently show that touch, familiar voices, and closeness reduce agitation and anxiety, even when a person is no longer able to respond.

This does not mean loved ones need to fill every silence with conversation. Holding a hand, playing a favorite song, reading aloud, or just sitting in the room can matter more than words. For family members who feel unsure of what to do, being told that showing up is enough often brings relief. Presence itself is a form of care.

4. Physical Comfort and Environment

Small physical details add up. Frequent repositioning prevents pressure sores and eases stiffness. Careful attention to room temperature, lighting, and noise can turn a clinical space into something calmer and more personal. Gentle mouth care keeps a person comfortable when eating and drinking become difficult, which is common in the final days.

Hospice teams also pay close attention to skin care, breathing support, and positioning that eases labored breathing. These measures rarely make headlines, but they are often what a dying person notices most directly, moment to moment.

5. Dignity, Autonomy, and Personal Wishes

Respecting a person's wishes, even small ones, preserves a sense of control during a time when so much feels out of their hands. This might mean honoring preferences about who is in the room, what music plays, or how personal care is handled. It might mean supporting a decision to stop certain treatments or to focus entirely on comfort rather than prolonging life.

Advance directives and honest conversations about goals of care make this possible. When family members know what their loved one wants, they can advocate for those wishes with confidence instead of guessing during an already difficult time. Dignity at the end of life often comes down to being seen and heard as a full person, not just a patient.

Comfort Care Is an Act of Love

There is no single formula for a peaceful death, but these five measures, pain relief, emotional support, presence, physical comfort, and dignity, form the core of what hospice and palliative care teams work to provide. Families do not need to have all the answers. Asking questions, staying present, and leaning on the hospice team's expertise is often the most powerful thing anyone can do.

If you are caring for a loved one nearing the end of life, know that comfort care is not giving up. It is choosing to make the time that remains as peaceful and meaningful as possible.

If you or someone you know is navigating end-of-life care and struggling with the emotional weight of it, please reach out

Secondary Losses: The Thousand Little Deaths Inside the Big One

Someone you love dies, and everyone understands that part. They send the casseroles, they say the right things at the funeral, they check in (for a while). The big loss gets seen. It gets a name, a date, a sympathy card.

But nobody warns you about everything else that dies along with that person.

I'm talking about the inside jokes nobody else will ever get. The person who used to text you "did you see this" right when you needed someone to see it too. The future you'd planned.  The one with them in it, growing old, meeting your kids, finally taking that trip you kept putting off. All of that goes too. And it goes quietly, without a funeral, without anyone sending flowers for it.

That's secondary loss. And honestly, it might be the part of grief that catches people most off guard.

The loss under the loss

Grief researchers talk about this idea a lot: the primary loss is the death itself. The secondary losses are everything that loss takes down with it like a tree falling and crushing the smaller plants underneath it. Your routines. Your sense of safety. Your identity, sometimes, if the relationship was central to who you were. Your social circle, if it turns out half your friendships were really their friendships. Your financial stability. Your plans for next Tuesday, let alone next year.

None of these get their own grieving ritual. Nobody holds a small service for the fact that you no longer have anyone to call at 11pm just to talk about nothing. You're just supposed to... notice it's gone, and carry on.

And here's the crappy part:  these secondary losses often hurt in sharper, more disorienting ways than the primary one. The death itself is the loss you braced for, even if you didn't know it. The secondary losses are the ones that sneak up on a random Tuesday when you reach for your phone to send them something funny, and then remember.

Why this matters

If you're in the middle of this, here's the thing I really want you to hear: you're allowed to grieve the small stuff. You're allowed to be wrecked by the empty side of the bed, or the fact that you don't know how to do the taxes because they always did the taxes, or the realization that you've lost your built-in plus-one for every wedding from now on.

These aren't silly griefs. They're not "lesser than" the real grief. They are the real grief, just broken into pieces small enough that you can actually feel them one at a time. The big loss is almost too enormous to hold all at once. The secondary losses are how it gets in anyway, a thousand small doors instead of one.

This is also why grief doesn't resolve in a neat line. You don't grieve the person and then you're done. You grieve the person, and then six months later you grieve the version of your career you'd planned around having them in your corner. A year later you grieve the family gatherings that don't feel like anything anymore. Every secondary loss gets to arrive on its own schedule, and every one of them deserves its own moment of being noticed.

What actually helps

Mostly, it helps just to name them. You can’t fix them, but to say out loud, "I'm not just sad they're gone. I'm sad about this specific thing too." That sentence alone can take some of the disorientation out of it. It turns a vague, formless heaviness into something you can actually look at.

If you're supporting someone else through this, the kindest thing you can do is ask about the specific losses, not just the big one. "How are you doing without her?" is a good question. So is "What's been the hardest part to lose that nobody else would think of?" That second question often opens something up that the first one can't reach.

Grief was never going to be one clean wound. It's a thousand small ones, radiating out from the center. Let yourself feel all of them, not just the one with the official name.

When Your Person Comes Home on Hospice: What the First Week Actually Looks Like

Nobody hands you a manual when hospice care moves into your living room. Yes, you get pamphlets, a binder full of phone numbers, and a nurse who says to call anytime, day or night. What you don't get is a clear picture of what the next seven days will actually feel like. So here it is, as honestly as possible.

Day One: The House Rearranges Itself

The first day is mostly logistics. A hospital bed arrives and somehow needs to fit in a room that wasn't built for one. Oxygen tanks, a bedside commode, and a rolling table show up, and your home starts looking less like itself. A nurse walks you through medications, explains what each pill does, and leaves a folder of paperwork that you will not read that day because you are too busy watching your person settle into this new version of their space.

There's a strange numbness to day one. You're moving furniture and signing forms while your brain hasn't caught up to what's actually happening. Many people describe this day as functioning on autopilot, and that's a normal response to an enormous shift.

Days Two and Three: Learning a New Rhythm

By the second or third day, the adrenaline of setup fades and a routine starts to form. You learn the medication schedule. You figure out how to angle the bed so it's comfortable. You start noticing small things, like which position eases their breathing or what time of day they're most alert.

This is also when exhaustion tends to creep in. Caregiving is physical work, and grief is exhausting even before someone has died. If you have family or friends offering to help, this is the window to actually let them. Make a list of small tasks, like grocery runs or sitting with your person for an hour, so people have something concrete to do.

Day Four: The Emotional Weight Settles In

Around the middle of the week, many caregivers notice the emotional reality landing harder than the logistical one. The busyness of day one quiets down, and there's more space to sit with what's happening. This is often when sadness, anger, or a strange kind of relief and guilt all surface together. None of these reactions mean you're doing something wrong. They're simply what grief looks like when it arrives early, before the loss has even happened.

Your hospice team should be checking in by now, and this is a good time to ask questions you were too overwhelmed to ask on day one. What changes should you expect? What does decline typically look like? Having even a rough map can ease some of the fear of the unknown.

Days Five and Six: Small Adjustments, Small Moments

By this point, you've likely had a visit or two from the hospice nurse, aide, or chaplain, depending on what services your person chose. Medications might be adjusted. Sleep patterns might shift. You might notice your person sleeping more during the day or needing help with tasks they managed alone just days earlier.

These days often hold unexpected tender moments too. A conversation that goes deeper than usual. A shared laugh over something silly on television. A long stretch of just sitting together without needing to fill the silence. These moments tend to stick with people long after the week itself is a blur.

Day Seven: Catching Your Breath

By the end of the first week, most families have found some version of a rhythm, even if it's a wobbly one. The house has adjusted to its new equipment and new schedule. You've likely figured out who to call for what, whether that's the hospice nurse for medical questions or a friend for an hour of relief.

This is a good moment to check in with yourself. How are you sleeping? Are you eating? Caregivers often pour every ounce of attention into their person and forget that their own body needs care too. Hospice teams typically support the whole family, not just the patient, so don't hesitate to ask for that support for yourself.

What to Remember

The first week on hospice is disorienting because so much changes so fast. Equipment fills your home, schedules rearrange themselves, and grief begins before goodbye has even arrived. There is no single correct way to move through these days. Whatever you're feeling, whether it's numbness, anger, tenderness, or all of it tangled together, is a reasonable response to a situation that asks more of you than almost anything else.

You won't have it figured out by day seven, and that's fine. Few people do. What you will have is a little more familiarity with this strange new chapter, and permission to ask for help as you keep moving through it.

If you need help navigating hospice or have someone in your life contemplating starting on hospice please reach out.

5 Weird but Comforting Things to Say to a Grieving Friend

I’ve written on this topic so many times, but I STILL get asked this a lot.  First let’s just get this out of the way.  NOTHING YOU SAY CAN MAKE THE PAIN GO AWAY.  There are no magic words or phrases, there is no perfect thing to say.  

Most advice about comforting a grieving friend sounds the same. Say you're sorry for their loss. Tell them you're there if they need anything. Ask how they're holding up. These phrases are well-meaning, but they often land flat. They're so familiar that they slide right past a grieving person without actually touching anything.

Grief doesn't follow a script, so maybe comfort shouldn't either. Some of the most healing things you can say to someone in mourning aren't the polished, expected lines. They're a little odd. They surprise the person out of autopilot and make them feel truly seen. So with that here are five unconventional phrases that might do more good than the standard condolences.

1. "Tell me something annoying about them."

This one catches people off guard, and that's exactly the point. Grief tends to flatten a person into a saint, all soft focus and perfect memories. But the people we love were also messy, frustrating, and occasionally infuriating. Inviting your friend to talk about the eye-rolling habits or stubborn quirks of the person they lost gives them permission to remember a whole human being, not a shrine. It often produces a real laugh, which grief desperately needs in between the heaviness.

2. "You don't have to be okay around me."

This phrase works because it removes a job nobody asked for: performing wellness for the comfort of others. So many grieving people quietly manage everyone else's discomfort, putting on a brave face so friends and coworkers don't feel awkward. Telling someone they're allowed to fall apart, go quiet, or be irritable in front of you hands them a rare kind of relief. It says your friendship doesn't come with conditions attached to how composed they appear.

3. "I have no idea what to say."

It feels counterintuitive to admit you're at a loss for words when the whole goal is to comfort someone. But this honesty often lands better than any rehearsed line. Grieving people can usually sense when someone is reciting a script, and the gap between a generic phrase and genuine feeling can make them feel more alone. Admitting you don't have the right words, while still showing up anyway, communicates something a smoother sentence can't: that you're not hiding behind comfortable distance.

4. "What was today like?"

Rather than the broad and slightly exhausting "how are you doing," this question narrows the scope to something manageable. Grief can make the idea of summarizing your entire emotional state feel impossible. Asking about just today invites a smaller, more honest answer. Maybe today was a blur. Maybe there was a moment in the grocery store that wrecked them. This question signals that you're interested in the texture of their actual experience, not a tidy update.

5. "I still think about them too."

People often worry that mentioning the deceased will “remind them” (I promise they did not forget) or reopen a wound, so they avoid saying the name entirely. In reality, this avoidance can feel like the world is moving on without acknowledging the person ever existed. Letting your friend know that you still carry a memory of their loved one, completely unprompted, can be a quiet gift. It tells them the person mattered to more than just them, and that the loss isn't something to be tucked away out of politeness.

Why the Weird Ones Work

There's a reason these unconventional lines tend to land. Each one breaks from the script that grieving people have heard a hundred times, and that surprise creates space for something real. They invite specificity, humor, honesty, or memory instead of vague sentiment. They each treat the grieving person as someone with a complicated, particular experience rather than a category of person who needs the same five sentences everyone else gets.

You don't need perfect words to support someone through loss. Sometimes the best thing you can offer is a question or comment that breaks the pattern enough to let something genuine through. Comfort isn't about getting the phrasing exactly right. It's about making someone feel less alone in a moment that otherwise feels unbearably isolating.

What Happens to the Body After Death? The Stuff Nobody Explains

Let's talk about something nobody talks about.

We've collectively decided that death ends at the moment someone stops breathing, and everything that comes after gets quietly handed off to professionals while the family waits in another room and nobody explains a single thing.

And then people are left with questions they're embarrassed to ask. Images they didn't expect. Moments that confused or scared them. And no context whatsoever for what they just witnessed.

So here it is. The honest, practical, not scary version of what actually happens to the body after death. Because knowing is almost always better than not knowing.

The Moment of Death

When the heart stops beating, the body begins a natural and orderly process of shutting down. Breathing ceases. Muscle tone releases, sometimes all at once. The face often relaxes in a way that can actually look peaceful, the tension of illness or pain finally gone.

The eyes may remain partially open. The mouth may fall open slightly. These things can catch people off guard if they've never seen them before, but they are completely normal. You can gently close the eyes with your fingertips if you'd like. (They may not stay fully closed, though and that's okay too.)

The skin color will change, becoming pale or taking on a grayish tone as circulation stops. This happens relatively quickly.

There is no rush to do anything immediately. You are allowed to sit with your person. To hold their hand. To talk to them, cry, pray, sing, or simply be quiet. The body is not going anywhere in the next few minutes and neither are you.

The Body Cools Down

Body temperature begins dropping fairly soon after death, a process called algor mortis. The body gradually moves toward the temperature of the room around it.

This is one of the things families sometimes notice when they reach out to touch their person after death and the skin feels different than expected. Cooler. More still. It can be a striking physical reminder that the person is truly gone, which is hard, and also sometimes part of how we begin to accept what has happened.

Muscle Changes: Rigor Mortis

A few hours after death, the muscles begin to stiffen. This is called rigor mortis and it happens because of chemical changes in the muscle tissue after circulation stops.

Rigor mortis typically begins in the face and jaw and moves downward through the body. It usually sets in fully somewhere between two and six hours after death and then gradually releases over the following day or two.

This is relevant if you are planning a home death or spending extended time with your person's body before the funeral home arrives. The body will become less flexible over the first several hours. There is no reason to be alarmed at this, it is just chemistry.

Skin Changes and Lividity

When the heart stops pumping, blood follows gravity and settles in the lowest parts of the body. This creates a reddish purple discoloration on the skin in those areas, called livor mortis or lividity. It typically becomes visible within an hour or two of death and becomes fixed in place after several hours.

If your person is lying on their back, you may notice this discoloration along the back and the backs of the legs. Funeral homes are aware of this and account for it in their preparation process.

You Don't Have to Call Anyone Immediately

This one surprises a lot of families and it's worth saying clearly.

If your person is on hospice, you call hospice first, not 911. A hospice nurse will come to officially pronounce the death and complete the necessary paperwork. You do not need emergency services unless something unexpected has happened outside of the expected dying process. (PLEASE do not call 911, this can cause a lot more trauma that is absolutely not necessary)

After the nurse has been there, you contact the funeral home. And here's the part almost nobody tells you: you do not have to call the funeral home the moment your person dies. You are allowed to take time. An hour. Several hours. Some families spend the better part of a day with their person's body, sitting with them, bathing and dressing them, allowing other family members to arrive and say goodbye.

This is legal. It is becoming more common. And for many families it is an incredibly healing part of the goodbye.  A good death doula can help you with this process too.

The funeral home will come when you're ready. There is no rule that says you have to rush.

What the Funeral Home Does

When the funeral home does arrive, they will transport the body in a dignified manner. From there, the preparation process depends on what you've chosen: burial, cremation, green burial, or another option.

If cremation is chosen, the process typically takes two to three hours and results in what most people call ashes, though the technical term is cremated remains. They are actually small bone fragments, gray and white in color, and are returned to the family in a container or urn.

If burial is chosen, the body is embalmed if requested or required, dressed, and prepared for viewing and service. Embalming is not legally required.  (Don’t let anyone tell you it is!)  Though some funeral homes or cemetery policies may have their own requirements. It is worth asking directly ahead of time.

Green burial skips embalming entirely and returns the body to the earth in the most natural way possible, in a biodegradable shroud or casket, without a vault. It is a growing option and one that more people are asking about.

Why This Matters

I know this post covers some territory that can feel uncomfortable. But I've sat with enough families in the aftermath of a death to know that the discomfort of not knowing is almost always worse than the discomfort of knowing.

When you understand what is happening, you feel less afraid. You make better decisions. You aren't blindsided by things that are completely normal but look alarming without context. And you can be more present for the experience instead of being derailed by confusion.

Death is not a medical failure or a crisis to be managed. It is a natural process that has been happening since the beginning of human existence. The body knows exactly what to do.

And with a little information, so do you.

If you're walking alongside someone at the end of life and you want someone in your corner who can answer the questions nobody else is answering, that's exactly what I'm here for. As a death doula, I help families understand what's happening, prepare for what's coming, and feel less alone in all of it.

Whether you're just beginning to think about end-of-life care or you're already in the thick of it, I'd love to connect. Reach out and let's talk about how I can support you and your family.

Top 5 Signs the Body Is Slowing Down Near the End of Life

One of the most common things I hear from families sitting at the bedside of someone they love is some version of this: "Is this normal?”  Valid question. 

They're watching changes happen and they don't know if what they're seeing is expected, and they can be upsetting or even alarming. They're exhausted and scared and trying to read a situation nobody prepared them for. And in that uncertainty, even natural, gentle changes can feel terrifying.

So let's walk you through what your person's body is actually doing during the dying process and why.  Understanding what is normal doesn't make this easy. But it does make it less frightening. And sometimes that's exactly what a family needs to find their footing.

1. Sleep Increases Significantly

This is usually one of the first things families notice. The person they love starts sleeping more. A lot more. They may be awake for only a few hours a day, or drift in and out without fully coming to consciousness.  This can be hard to watch, especially if you've traveled a long distance to be there or you've been waiting for a moment of real connection.

Here's what's actually happening: the body is conserving energy. As organs begin to slow down, staying awake simply requires more than the body has available. This increased sleep is not suffering. It is not giving up. It is the body doing exactly what it needs to do.

And here's the thing that matters most: hearing is widely believed to be the last sense to go. Your voice still reaches them even when they can't respond. Keep talking. Keep telling them what they mean to you. Keep playing the music they love. Presence doesn't require eye contact to be real.

2. Appetite and Thirst Decrease

At some point, food and water lose their appeal. Your person may stop eating entirely, drink only small sips, or refuse both altogether. For families, this is often one of the most emotionally painful changes to witness, especially if feeding has always been an act of love.

It can feel like watching someone choose to leave.  But I promise it’s not.

When the body is near the end of life it no longer needs fuel the way it once did. The digestive system is slowing down. Forcing food or fluids at this stage can actually cause discomfort rather than comfort. Small sips of water, ice chips, or a damp swab to keep the mouth moist are usually all that's needed.  They’re not feeling hunger the way we do.  The body simply doesn't need the food, and does not “crave” it anymore.

Offering food gently and without pressure is still an act of love. Accepting that it may be refused is too.  

3. Changes in Breathing

Breathing patterns often shift noticeably in the final days and hours. You might notice longer pauses between breaths, sometimes ten to fifteen seconds or more. This is called Cheyne-Stokes breathing and while it can be startling to witness, it is a normal part of the process.

You may also hear a gurgling or rattling sound in the throat or chest. This happens because the person can no longer swallow the natural secretions that accumulate. It sounds more distressing than it usually is. In most cases, the person is not aware of it and is not in pain.

Repositioning the head slightly or turning them gently onto their side can sometimes help ease the sound. Your hospice nurse can advise you on this in the moment.

4. Circulation Changes: Cool and Mottled Skin

As the body slows, it begins drawing circulation toward the core to protect the vital organs. The hands, feet, and legs may feel cool or cold to the touch even if the room is warm. The skin may take on a bluish, purplish, or blotchy appearance, particularly on the knees, feet, and hands. This is called mottling.

Mottling is one of the signs that actively tells us the body is in its final stages. It does not indicate pain. It is simply the circulatory system doing what it does at the end of life.

Light blankets for warmth are fine, but heating pads or electric blankets are not recommended as the skin becomes more fragile and sensation decreases. Gentle touch, holding a hand, or simply sitting close still matters deeply even when the body feels different than it used to.

5. Withdrawal and Turning Inward

In the days or weeks before death, many people become quieter. Less engaged with the world around them. They may stop initiating conversation, seem less interested in what's happening in the room, or appear to be somewhere else entirely even when their eyes are open.

Some people seem to be in a dreamlike state, speaking to people who aren't visibly present, reaching for something unseen, or describing places or experiences that don't match the room they're in. This can be deeply moving or deeply unsettling depending on what you believe and what you expected.

These experiences are common. They are not signs of confusion that need to be corrected. Many families find comfort in simply going along with what their person is experiencing rather than redirecting them back to the present. If your mom says she sees her own mother standing in the corner, you don't have to agree or disagree. You can just say "that sounds peaceful" and hold her hand.

This turning inward is not rejection. It is the natural drawing of attention away from the external world and toward whatever comes next. Your presence still matters. Your love still lands. Even when it looks like they've already begun to go somewhere you can't follow yet.

A Gentle Reminder

None of these signs means you have failed. None of them means you missed something or should have done something differently. They are simply the body's way of completing a process that is as natural as being born.

You don't have to understand every moment of it to show up well for it. You just have to be there, as much as you're able, in whatever way feels true.

And if you have questions in real time and don't know who to ask, that is exactly what your hospice team and your death doula are there for. You don't have to interpret any of this alone.

Planning for a Home Death: What You Need to Know

For most of human history, people died at home. In their own beds, surrounded by familiar walls and the people who loved them. Somewhere along the way, dying moved into hospitals and facilities, and we collectively forgot that home is still an option.

Guys.  It is still very much an option.

More and more families are choosing home death, whether that means actively planning for it or simply deciding not to transfer their loved one to a facility when the time comes. If you're considering it, here's what you actually need to know before you find yourself in the middle of it unprepared.

First: It's Legal

Yes, you can die at home. Yes, in most cases, someone can be with you when it happens. No, you do not automatically need to call 911.  (please don’t, in fact.  Planned dying is not an emergency)

But I get it.  We've been so conditioned to treat death as a medical emergency that the idea of simply... letting it happen peacefully at home can feel illegal, or at least wrong somehow. It isn't.

If your loved one is under hospice care, the process is especially straightforward. Hospice will walk you through exactly what to do when the time comes, who to call, and what happens next. No ambulance required unless you want one.

If your loved one is not on hospice, the process is a little more involved, but still very doable. Knowing the steps ahead of time is everything.  (this is where a death doula can help!!)

Get Hospice Involved Early

If a home death is something you want, one of the most important things you can do is bring hospice in sooner rather than later. Families often wait longer than they need to, sometimes because it feels like giving up, sometimes because no one clearly explained what hospice actually offers.

Hospice does not mean abandoning hope. It means shifting focus to comfort, dignity, and quality of life. And practically speaking, having hospice involved means you have a team, equipment, medications, and a 24-hour nurse line available to you. It means someone to call at 3 a.m. when something changes and you don't know what to do.

That support is invaluable when you're planning for someone to die at home.

Set Up the Space Thoughtfully

You don't need to turn your living room into a medical suite, but a little preparation goes a long way toward making everyone more comfortable, including your loved one and yourself.

Think about the bed. A hospital bed, which hospice can often provide, makes it much easier to reposition someone, manage pain, and provide physical care. It also protects your own back, which matters more than people think after days or weeks of caregiving.

Think about access. Is the room easy for others to move through? Is there a comfortable chair nearby for whoever will be sitting with them? Are the things that bring your person comfort close at hand, their favorite blanket, photos, music, a candle?

Think about practical supplies. Hospice will provide many of them, but things like disposable gloves, bed pads, lip moisturizer, and a small cooler for medications can make a meaningful difference in day-to-day care.

Talk to Everyone in the House

If there are other people living in the home, including children, they need to be part of the conversation at a level appropriate for their age and understanding. A home death can be a profound and even beautiful experience. It can also be frightening if people don't know what to expect.

Talk about what the dying process might look like. Talk about what sounds or physical changes are normal. Talk about what everyone's role will be and give people permission to step out if they need to.

Informed people are calmer people. Calm is contagious, and it matters deeply in those final hours.

Know What Happens After the Death

This is the part families are often least prepared for, and it's important.

When your person dies at home under hospice care, you call hospice first. They will come to pronounce the death and handle the necessary paperwork. You are not required to remove the body immediately. You have time. Many families spend an hour or several hours with their person after the death, sitting with them, maybe even bathing and redressing them, saying goodbye, allowing the reality to settle.

When you're ready, you call the funeral home you've arranged in advance. And yes, arranging that in advance matters. You do not want to be making that decision in the fog of fresh grief.

It Can Be a Gift

Home death is not for every family or every situation. But for those who choose it thoughtfully and prepare well, it can be one of the most intimate and meaningful experiences of a lifetime.

Dying at home, in a familiar space, with loved ones nearby, is not a step backward. For a lot of people, it's exactly the ending they always hoped for.

And helping someone get there? That's one of the greatest acts of love there is.

If you need more help or guidance on this please reach out.  I’d be honored to help.  

Grandma’s China

It’s the hot topic among end of life workers, decluttering experts and minimalists these days. The china. And it seems universal: no one wants it.

As the older generations are downsizing, moving into smaller homes, condos or assisted living situations, they’re faced with the impossible task of offloading heirlooms that no one wants. There’s such little demand and high supply you can’t GIVE this stuff away. People aren’t hosting the fancy dinners as often and no one has the china hutch with the dishes we only use on special occasions, nor the china within. Heck about a decade back mom even stopped using the china at Thanksgiving because handwashing all that stuff was a nightmare. We went to paper plates.

When my parents downsized to a condo a couple years back, they sold off the dining room set and were baffled that it was basically worthless and they made practically no money on that sale. I tried my best to explain but their generation has a very different view on belongings than we do.

But back to the china.

I was in the same camp. I told mom I had zero interest in any of it. I’m a proud minimalist, and don’t hold attachment to physical items. She knew this. But she just did not have the heart to get rid of it. Guys….she had THREE SETS OF CHINA. Her mom’s, her great aunt’s and hers/dad’s from their wedding. She was able to offload her great aunt’s to one of her nephews, but this left the other two. (My niece expressed mild interest in hers/dad’s.) “I know it’s stupid for this to sit in boxes in the basement but I just can’t. When I’m gone, do whatever you want with it.”

Then she was gone.

I had a half a mind to take it all home and just rage smash it all in the street while deep in my grief. I wanted to shatter those dishes like her death shattered my heart. Instead….I brought it home.

I took each piece out of the boxes, all carefully wrapped by mom’s loving hands and laid them all out. This was clearly more than one set. 12 tiny little cups, 15 tiny saucers, 13 dinner plates….finger bowls? sigh Odd numbers and so many different sizes of plates, and who in god’s name uses a gravy boat anymore?

Screw it.

I took the boxes and bubble wrap and wrapped up my everyday Corningware and posted it on Facebook and set all of grandma’s china in my cabinets. (Save for half the plates that are back in a box in MY basement because OHMYGODSOMANYPLATES) I’m using the tiny little cups for my coffee in the morning, I’m using the fancy plates for my afternoon snackies, I’m using the dinner plates for….well…dinner. (Although I’m not entirely sure what to use the finger bowls for.) And I’m chucking the lot into the damn dishwasher. If they break, they break. (God knows I have enough plates for 3 lifetimes. SERIOUSLY WHY SO MANY PLATES?!?!) Life’s too short for handwashing dishes and why not be fancy with my morning coffee?

I use the fancy crystal glassware I was gifted for my first wedding for everyday drinks, and I put those in the dishwasher too. I have no children to burden with these items so why not use them now and enjoy them?

And when I plow through a plate of salt and vinegar chips or cheez-its, I can think about my grandmother. And all the Thanksgiving dinners we ate on those plates. All the laughter, dad’s blessings over hearty feasts, drunk ex husbands ruining an evening, off color jokes from the uncle. Those large holidays have dimmed to small gatherings on paper plates, but my solo dinners of reheated hamburger helper can feel a little more fancy now.

(My actual snack of a Zebra cake and BBQ chips while writing this blog)

Navigating the Healthcare System During End-of-Life Care

If you've ever sat in a hospital waiting room while someone you love is down the hall, you already know that the healthcare system was not exactly designed with grief in mind. It was designed for efficiency. For treating illness and moving on to the next patient.

Which means that when someone is dying, and the goal is no longer to treat but to comfort, the system can feel like it's speaking a language you never learned.

Here's a crash course in what you actually need to know.

Understand Who Is On the Team and What They Do

One of the most disorienting parts of end-of-life care is the sheer number of people involved. Doctors, nurses, social workers, chaplains, case managers, specialists. Everyone has a role, and not all of them communicate with each other as well as you'd hope.

Take notes. Write down names and titles. Ask each person what their specific role is and who the best point of contact is for questions. In a hospital or inpatient setting, the attending physician is usually your main contact for medical decisions, but the nurse is often the most accessible and most informed about day-to-day changes.

Don't assume information is being passed along. Confirm it yourself.

Having a death doula on hand to help herd all these cats can be invaluable.

Learn the Language

Medical terminology during end-of-life care can be genuinely confusing, and the confusion often leads to decisions being made without full understanding of what's actually being agreed to.

A few terms worth knowing:

DNR (Do Not Resuscitate) means that if the heart stops, no CPR will be performed. This is not the same as "do not treat." It simply means no resuscitation attempt.

Comfort care or palliative care means the focus is on managing symptoms and quality of life, not curing the illness. It can happen alongside curative treatment.

Goals of care is a phrase you'll hear often. It refers to the conversation about what the patient wants, what matters most to them, and what medical interventions are aligned with those wishes.

If something is unclear, ask for it to be explained again. Then ask again. You are not being difficult. You are advocating.

You Have the Right to Ask Questions and Push Back

This is the part a lot of families don't realize until it's too late.

You can ask for a family meeting with the care team. You can request a second opinion. You can ask what happens if you choose not to pursue a recommended treatment. You can ask what dying will look like if a certain intervention is stopped. You can say "I need more time before we make this decision" and that is a complete sentence.

Hospitals have patient advocates and social workers specifically to help families navigate exactly this kind of situation. Ask for them. Use them. That's what they're there for.

And if something feels wrong, say so. Not every family member who pushes back is being difficult. Sometimes they're the only one paying close enough attention.

Get Paperwork in Order Before a Crisis

The worst time to figure out advance directives is in the middle of an emergency. The best time was years ago. The second best time is right now.

An advance directive or living will outlines what kind of medical care a person wants if they can no longer speak for themselves. A healthcare power of attorney designates someone to make those decisions on their behalf.

In Ohio, there's also a document called a DNR Comfort Care order, which is specifically for people with serious illness and communicates wishes to emergency responders and care teams outside of a hospital setting.

If these documents don't exist yet, a social worker, attorney, or yes, a death doula can help your family understand the options and get them completed. Do not wait.

Transitions Between Care Settings Are Often the Hardest

Moving from a hospital to a rehab facility to home to hospice involves a lot of handoffs, and handoffs are where things fall through the cracks. Medications get missed. Information gets lost. Families get contradictory instructions from different providers.

Every time there is a transition, ask for a full medication list, a summary of the current care plan, and clear instructions for who to contact if something changes. Don't leave a new facility or setting without knowing exactly who your point of contact is.

If your loved one is being discharged to home with hospice, make sure the hospice team has been contacted and a visit is scheduled before or shortly after arrival. There should be no gap in support.

You Don't Have to Do This Alone

The healthcare system is complicated on a good day. During end-of-life care, when emotions are high and decisions feel enormous, it can feel completely overwhelming.

A death doula can sit with you in those waiting rooms. Help you prepare questions before a care team meeting. Translate what was just said in that conversation that left you more confused than when you walked in. Advocate alongside you when your voice feels too small or too shaky to carry the weight.

You don't need to become a medical expert to navigate this well. You just need support, information, and someone in your corner who isn't afraid of any of it.

That help exists. Please reach out and use it.

How to Choose a Hospice You Can Actually Trust

Nobody should have to fight for better care while their person is dying.

But it happens more than it should. Families assume hospice is just something the hospital arranges, that all providers are roughly the same, that there isn't really a choice involved. And then they find themselves in the middle of one of the hardest experiences of their lives with a team that isn't showing up, literally or emotionally, and no idea they had the power to do anything about it.

You have more power than you think. Let's talk about how to use it.

Hospice Is Not Automatically Assigned to You

This surprises a lot of families. When a doctor recommends hospice, they may refer you to a specific agency, but that referral is not a requirement. It is a suggestion.  And it’s possible they’re getting a kickback from the hospice they refer you to, bear that in mind too.

You are allowed to research your options. You are allowed to ask questions before signing anything. You are allowed to choose a different provider than the one recommended, and you are allowed to switch providers after you've started if the care isn't meeting your needs.

Hospice agencies are not all created equal. Quality, staffing, responsiveness, and culture can vary significantly from one organization to the next, even within the same city.

Questions to Ask Before You Choose

When you're evaluating a hospice agency, treat it like an interview. Because it is one.

Some questions worth asking:

Are you Medicare certified? Medicare certification requires agencies to meet federal standards for care. It's a baseline, not a guarantee of quality, but it matters.

What is your nurse-to-patient ratio? Staffing levels directly affect how responsive a team can be. If a nurse is managing an enormous caseload, your calls may not get returned as quickly as you need.

Who do we call after hours, and how quickly will someone respond? A good hospice has 24-hour support. Find out if that means a real nurse picks up the phone or if it goes to a general answering service.

Will we have a consistent team, or will different people rotate through? Consistency matters. A lot. Having the same nurse and aide who know your person, their preferences, and their condition is completely different from meeting a new face every visit.

What services are included? Hospice should cover nursing visits, aide services, social work, chaplain support, medications related to the terminal diagnosis, and medical equipment. Know what's included before you sign.

How do you handle a situation where we're unhappy with a specific caregiver? This one is important. Ask it directly. A good agency will have a clear and non-defensive answer.

Look Up Their Track Record

Medicare publishes quality data on hospice agencies through a tool called Care Compare at medicare.gov. You can look up agencies in your area and compare them on metrics like how often they provided the right care, how families rated their experience, and whether they've had any compliance issues.

It takes about five minutes and it's worth every one of them.

You can also ask around. Palliative care teams, hospital social workers, and yes, death doulas often know which local agencies have strong reputations and which ones generate complaints. Don't be shy about asking people who work in this space what they've observed.

Ask a local doula too!  We know who’s on the up and up and who may have failed a previous client.

Know Your Rights If Something Goes Wrong

If a hospice provider is not delivering on what was promised, you do not have to accept it.

You can request a different nurse or aide. Agencies have multiple staff members and you are within your rights to ask for someone who is a better fit. You don't even need a dramatic reason. "This isn't working for our family" is enough.

You can file a complaint. Every hospice agency has a process for this, and your state also has a hospice licensing board that accepts complaints.

You can switch agencies entirely. If the care is consistently poor, you can discharge from one hospice and enroll with another. Your hospice team should be able to facilitate this, and if they won't help, a hospital social worker or patient advocate can.

Switching is not starting over. Your loved one's care continues. You simply have a new team.

Trust Your Gut

When you meet with a hospice team for the first time, notice how they make you feel.

Do they rush through the intake paperwork or do they slow down and actually talk to you? Do they look at your person as a human being or as a case number? Do they answer your questions directly or deflect?

End-of-life care requires trust. If something feels off in that first meeting, pay attention to that feeling. You are not being too picky. You are protecting someone you love during one of the most vulnerable seasons of their life.

The right hospice team will feel like a hand on your shoulder. Not one more thing to manage.

A Note to Anyone Who Has Already Been Through a Bad Experience

If your family went through what so many families go through, showing up for someone they loved with a hospice team that let them down, I want you to know that was not how it was supposed to go. You deserved better. Your person deserved better.

And if you're not there yet but heading in that direction, please use this information. Ask the questions. Look up the ratings. Trust your instincts.

Nobody should have to demand basic kindness while they're saying goodbye.

If you need help looking for the right care please reach out!

When You Grieve Differently Than Your Siblings

You all lost the same person. So why does it feel like you're living on completely different planets?

You're crying every day and your brother hasn't shed a tear. Your sister wants to talk about Mom constantly and you can barely say her name out loud yet. Someone wants to clean out the house immediately and someone else would like to leave everything exactly as it is until further notice, possibly forever. One of you is holding the whole family together with both hands and one of you has completely disappeared into their own life and isn't returning texts.

And underneath all of it, this low hum of something that feels a lot like anger, hurt, or betrayal. The specific sting of grieving next to someone who is doing it completely differently than you are.

Welcome to sibling grief. It is a lot.

Same loss, completely different experience

Here's the thing that gets lost in the fog of early grief: you did not all lose the same person.

I mean, you did. Same human, same death, same funeral. But your relationship with that person was entirely your own. Your memories, your wounds, your history, your version of who they were and what they meant, that belongs only to you. Your brother's relationship with your dad was shaped by twenty-five years of interactions you weren't in the room for. Your sister's grief is filtered through a bond that had its own language, its own unresolved chapters, its own particular tenderness.

You are all grieving a loss. You are not grieving the same loss.

This reframe does not make the conflict disappear. But it does make it make a little more sense.

The greatest hits of sibling grief conflict

Let's just name them. These are the ones that come up again and again.

The Stuff. Someone wants to divide it immediately and someone wants to keep everything and someone already took the thing you wanted and nobody talked about it first. Belongings carry so much weight when someone dies. They become proxies for love, for fairness, for who mattered most. Fights about furniture are almost never actually about furniture.

The Caregiver Rift. If one sibling did the heavy lifting of caregiving, that sibling is often exhausted, grieving, and quietly (or loudly) furious that they did it largely alone. The siblings who weren't there may be carrying their own guilt about that. Both of those things are painful. Neither automatically makes someone the villain, even when it feels that way.

The Performer vs. The Disappearer. One person holds the family together, handles the logistics, makes the calls, keeps showing up. One person goes quiet, pulls back, handles their grief privately and internally. The performer often reads this as abandonment. The disappearer often doesn't know how to be witnessed in their pain. Neither style is wrong. Both feel incredibly lonely.

Grief timelines that don't match. You're still in the thick of it six months later and your sibling seems to have moved on. Or you've found your footing and your sibling is falling apart and you don't have the capacity to hold them right now. Grief doesn't run on a shared schedule and it can create a painful kind of distance when you're not in the same place at the same time.

What this conflict is often really about

Grief cracks us open. And when we're cracked open, every old family dynamic, every unhealed wound, every years-old role we got assigned in childhood, comes rushing back in.

The responsible one. The difficult one. The favorite. The forgotten one. The one who always had to hold it together. The one who always got to fall apart.

You thought you'd outgrown those roles. Then a parent died and suddenly you're sixteen again at the kitchen table, and somehow it's the same argument you've always had, just wearing a different shirt.

Family grief doesn't create dysfunction. It reveals the dysfunction that was already there, waiting.

How to survive grieving next to people who are doing it differently

You are not required to grieve in the same way, on the same timeline, with the same expression. That was never the deal, even if it felt like it was supposed to be.

A few things that can help, even a little:

Lower the expectation that your siblings will be your primary support right now. They are in the water too. They may not have a hand to reach back. Finding support outside the immediate family, a grief group, a coach, a therapist, a friend who knew your person, can take some of the pressure off relationships that are already strained.

Say the thing carefully, when you're ready. Not in the hot moment, not over text. But if something is sitting between you and a sibling, some hurt that happened in the immediate aftermath of the loss, it is worth naming eventually. Grief has a way of calcifying unaddressed resentment into something that lasts for years. You don't have to resolve everything. But naming it matters.

Give the benefit of the doubt, once. Just once. The sibling who didn't cry at the funeral is not heartless. The sibling who took three weeks to call you back is not indifferent. The sibling who already gave away the sweaters is not a monster. Grief makes people do strange things, behave in ways that look nothing like love but are coming entirely from love. Try, once, to read it that way.

And then, if needed, grieve separately. Not every grief journey has to be a group project. It is okay to find your own path through this, even if it means some distance from people you love, for a while.

You are not a bad sibling for grieving your way

Whatever you're feeling toward your family right now, the anger, the distance, the hurt, the exhaustion, the complicated relief, the guilt about the complicated relief, none of it means you loved the person who died any less.

Grief is not a competition. It is not a loyalty test. It is not a measure of who was the better child or who showed up more or who deserves to hurt the most.

You all lost someone. You are all doing the best you can with the very limited tools humans are given for this.

That's enough. You're enough.

Even when it doesn't feel like it at the kitchen table.

The Funny Things People Say When Someone Dies (And Why We Say Them)

I’ve covered this topic many times but I feel it deserves revisiting every now and again. 

"Everything happens for a reason."

"God needed another angel."

"At least they're not suffering anymore."

"They wouldn't want you to be sad."

Oh, sweet, well-meaning humans. We really do try.

If you've ever lost someone, you've collected a few of these gems. Maybe you smiled politely while internally screaming. Maybe you nodded so many times your neck hurt. Maybe you genuinely don't remember a single thing anyone said to you in those first days because grief does that, it swallows whole conversations whole, and all you're left with is the blur and the casseroles.

But the things people say when someone dies? They are a whole category of human experience worth talking about. Because they're awkward, and sometimes accidentally hilarious, and also, if you look at them sideways, kind of sweet.

The Greatest Hits

Let's just honor a few of the classics, shall we?

"Let me know if you need anything."

Said by approximately one thousand people. Followed up on by approximately none. This one comes from a good place, genuinely, but grief doesn't work like a customer service request. The grieving person is not going to email you a list of their needs. They don't know their needs. They're barely remembering to drink water.

"They lived a good long life."

This one is reserved for older losses, delivered as comfort, and received with a quiet internal "...and?" Because long life or short life, the person is still gone. The math of years doesn't make the missing easier. (seriously, I had a 102 year old tell me once “that went by so fast”)

"I know exactly how you feel."

Do you though? Do you really? (Morgan Freeman voiceover: they did not.)

"You need to stay strong for your kids / your family / your dog."

Ah yes. A gentle reminder to perform strength on behalf of others while your own grief quietly moves into the corner and starts building furniture.

"Time heals all wounds."

Said with such confidence. As if grief has a lease with an end date. As if you can just wait it out like a bad weather system.

Why Do We Say These Things?

Here's the part where I actually mean it: we say these things because we love people and we are terrified.

Death is the great disruptor and it makes everyone aware of their own mortality, their own helplessness, and the gaping inadequacy of language. And humans, beautiful chaotic humans that we are, respond to discomfort by filling the silence.  (Boy we really hate silence don’t we?) We reach for the nearest thing that sounds like comfort, even if it lands like a lead balloon.

Nobody hands you a script for standing next to a casket. Nobody teaches you what to say when your coworker's husband dies or your neighbor loses her baby or your best friend calls you from the hospital parking lot. So we pull from the cultural grab bag of grief phrases we've absorbed over a lifetime, most of which were written by people who were also, frankly, just winging it.

The intention is almost always love. The execution is sometimes…..a little rough.

The Things That Actually Help

For the record, the things grieving people consistently say helped them most are not particularly eloquent.

"I'm so sorry."  Now this is a classic go-to but I can tell you from experience you get really sick of hearing this one after awhile. So maybe….

"I love you."

"I'm here."

Showing up with food, or just showing up.  (ask first with food.  There is such thing as too many casseroles) Sitting in silence without trying to fix it. Saying the dead person's name out loud (please, please say their name, it means everything). Texting three weeks later when everyone else has gone back to normal and the grieving person is standing in the cereal aisle absolutely losing it because their person used to like that brand.

You don't need the right words. You need presence and a willingness to be a little uncomfortable. That's it. That's the whole thing.  Seriously.

A Permission Slip

If you've said any of the things on that list above: it's okay. Genuinely.  (Full admission, I have said at least 2 of these) The people who love you know you were trying. Grief makes the people around it reach desperately for something useful to say or do, and sometimes what comes out is "at least they're in a better place" when what you meant was "I love you and I would do anything to take this pain from you."

That translation? Most grieving people can feel it, even through the awkward phrasing.

And if you're the one who's grieving and you've been on the receiving end of some truly spectacular word choices: I see you. I hope you've had at least one moment of dark, private laughter about it. Because sometimes that's the most human response of all.

Grief and humor are not opposites. They've been sharing a couch for a very long time.

Grief in the Workplace: How to Function When You're Falling Apart Between Meetings

Nobody puts "currently grieving" in their email signature.  (Although maybe we should!)

You just show up. You open your laptop, join the Zoom call, answer the Slack messages, and try really hard not to cry in the bathroom between your 10am and your 11am. You smile at the right moments. You say "I'm fine" so many times it starts to sound like a foreign language you're not fluent in.

And somehow, inexplicably, the rest of the world keeps going. Your inbox doesn't care that your person died, nor do those pesky deadlines, and the quarterly review doesn't know your heart is in seventeen pieces.

Grief in the workplace is one of the most under-talked-about experiences there is, and honestly? That needs to change.

Your brain on grief is not your normal brain

You may already know this but grief does genuinely wild things to your brain. Memory fog, trouble concentrating, emotional responses that show up at the most inconvenient times (hi, crying at a spreadsheet, we've all been there). It’s science.  You’re not broken.

When we're grieving, our nervous system is under enormous stress. The prefrontal cortex, the part responsible for focus, decision-making, and keeping your composure on a conference call, is basically running on fumes. So if you're reading an email three times and still not absorbing it, or you blanked on something you absolutely knew yesterday, please hear this: you are not broken. You are grieving.

Survival strategies that don't require oversharing

You don't owe anyone a detailed explanation of your grief at work. You also don't have to perform being okay when you're not. Here's a middle path that actually works:

Give yourself permission to do less, temporarily. Grief is exhausting in a way that sleep cannot fix. If you can scale back non-essential tasks during the early waves, do it. Even one less thing on the list can make a big impact.

Create micro-moments of transition. Before you get on a call, take sixty seconds. Breathe. Put a hand on your chest. Let yourself arrive. Grief has a way of pulling you into the past; these tiny pauses can help you come back to the present, at least for the next hour.

Have a phrase ready. When someone asks how you're doing and you're not ready to get into it, it's okay to have something prepared. "I'm taking it one day at a time" is honest and complete. You said the true thing. You don't have to say all of it.  (I tend to say things like “Doing the best I can today, thank you”)

Cry in the car. Seriously. The car is a sacred grief space. No judgment, great acoustics, windows that fog up for privacy. Use it.  If you don’t have a car see if there is a private room somewhere.

What to do with the waves

Grief doesn't arrive on a schedule (jerk), and it definitely doesn't read your calendar. A song comes on during your commute and suddenly you're wrecked before you've even logged in. (I write this because it literally just happened to me yesterday on the way to a client) Someone asks if you want to order lunch together and you remember that your person used to do that with you, and now the break room feels impossible.

The waves will come. The goal is not to stop them. The goal is to get a little better at surfing them.

When one hits at work: excuse yourself if you can, name what's happening internally even if you can't say it out loud ("I'm having a grief wave, this is okay, it will pass"), and give yourself grace. You are doing something incredibly hard. Getting through a Tuesday while grieving is genuinely a triumph. Let it be one.

A note on asking for support

If you have a manager or coworker you trust, consider telling them, even just a little. You don't have to map out your entire grief landscape. A simple "I'm going through a loss and some days are harder than others" can open the door for a little more grace to come your way. Most people want to help. They just don't know what to say, and they're waiting for a cue.

And if you're the coworker or manager reading this: check in. Not once. Keep checking in, weeks and months later, when everyone else has moved on and the grieving person is still quietly carrying it. That follow-up matters more than you know.  Trust me.

You don't have to do this alone

The loneliest part of grief at work is the performance of normalcy. Pretending to be fine when you're not. Eating lunch alone because you can't explain why today is hard. Closing your office door and hoping nobody notices your eyes are red.

You deserve a space where you don't have to pretend. Where showing up as you actually are, grieving and real and still figuring it out, is not only acceptable but welcome.

That's exactly what The Good Grief Society is. A virtual peer support community built for people who are in the thick of it and need somewhere to land that feels human. There's 24/7 access and twice-monthly live Zoom groups where you can talk, listen, or just exist alongside others who get it.

Because sometimes the most healing thing isn't having the right words. Sometimes it's just knowing you're not the only one crying in a bathroom between meetings.

Join The Good Grief Society here.