As individuals reach the end of their life, the options for care and support can greatly influence the quality of their remaining time and make the dying process easier for family members. In California, the landscape of end-of-life care encompasses a variety of approaches, from legacy methods to modern alternatives. By understanding the care options available, end-of-life can be a meaningful journey that respects the values and wishes of the dying while providing closure for loved ones.
End-of-Life Care Options
Hospice and Palliative Care
In California, hospice care is available to those with six months of life expectancy or less, as determined by a licensed health professional. Hospice care focuses not on extending life but on making the individual’s remaining time comfortable and meaningful while providing physical, emotional, and spiritual support. Hospice care can be provided at a variety of locations including the home, a congregate living facility, a residential care facility, or a skilled nursing facility.
Hospice care is often confused with palliative care. Palliative care can begin at any stage of a life-threatening illness and focuses on treating the illness with the goal of recovery. It can last from a few months to a few years. Palliative care via telehealth, such as the services provided by Carelon Health, is an option for patients living in remote areas or who want to remain at home for longer. Studies have shown that palliative care via telehealth is equally as effective as in-person care.
End-of-Life Doulas
An end-of-life doula, death doula, grief doula, doula for the dying, or death midwife is a non-medical professional who assists with the dying process, similarly to how a birth doula assists with the birth process. While hospice or palliative care provides medical care at the end of life, death doulas can fill an important additional role by providing holistic support to the dying, taking a more personal approach that can be integrated into hospice care. Some roles of death doulas include providing comfort, emotional and spiritual support, and a bedside presence; ensuring that dying wishes are honored and carried out; and working on life legacy projects. End-of-life doulas can also provide support to loved ones, helping them understand the dying process, and family members of the dying can seek grief support from doulas independently.
While all end-of-life doulas are non-medical professionals, the International End-of-Life Doula Association (INELDA) offers training and certification as well as a directory of INELDA-trained doulas. You can learn more about Bay Area resources by visiting the East Bay End Of Life Doula Network, the East Bay Center for Living and Dying, and the Bay Area End of Life Doula Alliance.
The California End of Life Option Act
Enacted in 2016, the California End of Life Option Act (EOLOA) allows for an aid-in-dying drug to be dispensed to a terminally ill patient who wishes to end their life. To qualify, the person requesting the drug must be at least 18 years old, have a terminal disease that cannot be cured and is expected to result in death within six months. They must have the mental capacity to make medical decisions and have the physical capacity to ingest the drug themselves. Patients must request the drug from their doctor twice verbally and a third time on a form, which must be signed by two witnesses. Patients must also be able to prove that they are a California resident. Once the drug has been retrieved from the pharmacy, the patient can take it at any time in a private place. Another person must be present when the drug is ingested. After the patient has died, a caregiver or loved one disposes of any remaining aid-in-dying drug. Because the patient must have the capacity to make medical decisions, requests to providers for the necessary medications cannot be made by a Health Care Proxy nor by someone who can no longer communicate.
Green Burial Options
In addition to traditional options such as conventional casket burials and cremation, there are several options for green burials (also called natural burials). Green burials involve no embalming fluids and allow the body to decompose naturally with minimal or no negative environmental impact. Typically, the body is wrapped in a biodegradable shroud or placed in a biodegradable casket before burial. The Green Burial Council certifies three types of cemeteries: hybrid cemeteries are areas within conventional cemeteries where green burials can occur; natural cemeteries are dedicated entirely to green burial practices; and conservation burial cemeteries preserve the land that is used in part for the burial through a land trust.
Fernwood Cemetary, located in Mill Valley, offers green funeral home and burial services, including a natural burial Jewish cemetery, in addition to traditional burial options. Graves at Fernwood are either marked with small engraved boulders mapped with GPS and allowed to blend into the natural environment. The cemetery is a National Wildlife Federation Certified Habitat, providing a space for wildlife to live and raise their young.
At TrustParency, we have resources and experience helping clients navigate their end-of-life options. For more information or to schedule a free consultation, please contact us at info@trust-parency.com.
