FREQUENTLY ASKED QUESTIONS

Death doulas, death midwives and death counselors serve those who are at the end of life, as well as their loved ones, in a myriad of ways. Although the titles end-of-life doula, transition doula, death doula, and death midwife are used interchangeably, each doula or midwife tends to have their own unique style, experience and gifts that define their practice, with a shared ethos of working from a compassionate heart.

Death Doula: In general, doulas serve within an end-of-life care team that is typically comprised of medical physicians, medical personnel (palliative and hospice) family and/or professional caregivers. Doulas are often referred to as the sacred glue. They connect the team by understanding the big picture, as well as understanding each team member’s contribution, and then providing emotional, informational, physical and spiritual support where needed.  A doula is trained to listen with a non-judgmental compassionate heart and facilitate a more cohesive and peaceful experience for the patient and their loved ones.

Death Midwife:

Death Midwife: A death midwife’s day-to-day services are very similar to that of a death doula, but sometimes a death midwife has a more hands-on role in the after-death care. A death midwife can wear many hats, including death doula, home funeral guide, funeral/memorial celebrant, and a grief support guide.

Death Counselor: 

A death counselor is a spiritual companion, who helps the dying move through the final transitions at the end of life process, while providing them with the opportunity to discover deeper meaning to their lives and an understanding of sacred awareness in regard to the death process as a journey. A death counselor is highly attuned to the emotional and spiritual aspects of dying, and particularly emphasizes peace, presence, and meaning in their practice. 

Cindie is a trained death doula and death midwife, and she has the added distinction of being a death counselor. She has counseled clients for several decades to understand the circle of life and its transitions. In her role as a death counselor, she brings all of her training as a death doula and death midwife to her work, as well as provides spiritual guidance, if requested, to assist the dying in this step-by-step process of transition.

If you have further questions or would like to work with a death counselor, request a complimentary 50-minute consultation call (phone or zoom) with Cindie. This session is an opportunity for you to meet Cindie, ask questions and explore the possibilities of working with her.

Request a Free Consultation Now 

During Cindie's first visit to your home, Cindie will meet with the patient and primary caregiver to develop an initial rapport. Her goal here is to create a connection so that she may properly assess your situation and develop a mutually agreeable plan to address the emotional, mental, spiritual and physical needs of the patient and their loved ones during this time.

As part of this plan, you and Cindie will decide on the frequency of her visits which may be daily, weekly or monthly (depending on your preference) and can change over time.  Going forward, Cindie will work closely with you, your doctors, nurses, hospice personnel, caregivers, clergy, and out-of-town family members to provide or facilitate what is needed for the most peaceful end-of-life experience possible. 

Grief is a natural response to loss. It is characterized as the emotional suffering we experience when someone or something we love is taken away. Anticipatory grief often occurs before death or dying and revolves around periods marking the end of certain abilities such as standing up, walking on one’s own, or feeding one’s self, as well as when death is anticipated. 

The pain of loss can feel overwhelming and isolating if we have to endure it alone. Although Cindie highly recommends grieving persons work with a professional grief therapist, counselor or support group alongside her work with you, one added benefit of having her as your end-of-life guide is that she will be fully present and able to witness, listen, and hold safe space for the emotions that surface around you and your loved one’s losses.

Due to the intimate nature and trust Cindie develops while working with a patient and their loved ones during the end-of-life process, she is a strong, non-judgmental, safe space for people to express their emotional pain surrounding the losses that occur during end-of-life and post-death phases.

Grief is an emotion not well supported by our modern culture or the media, so part of working with Cindie means she will bear witness and acknowledge the pain that is so often misunderstood. You do not have to endure it alone. 

Every death is unique and there is no way to predict for certain how or when someone will die. However, when a patient approaches death there are some physical signs that give doctors, loved ones and all of the care team clues as how much time might be left.

Active dying in the medical world is considered the final phase of dying, when a person’s body functions slow down and cease. Active dying typically lasts about 3 days, but it can also happen more quickly or endure. Some of the signs of active dying include irregular breathing patterns, faint pulse and heart rate, a drop in blood pressure, and changes body temperature and skin coloring.

Pre-active dying typically happens about 3 weeks before last breath.  Some of the signs of pre-active dying include: increased sleep and withdrawal from social interactions, visions of loved ones who have already died, agitation.

Comfort care at the end of life is a term within the medical industry that refers to patient care of the terminally ill that is focused on symptom control, pain management and quality of life. Comfort care can be used as an umbrella term for both palliative care and hospice care and is administered by a team of professionals referred to as the comfort care team. Comfort care can be provided in a private home, nursing home or hospital.

There are many professionals who offer expertise, services and support at the-end-of-life, including palliative and hospice care personnel, death doulas, chaplains, psychotherapists, home health aides, grief and loss counselors, support groups, professional and non-professional caregivers, massage therapists, alternative healers, drivers, meal chefs and meal providers, personal helpers, and errand runners. The number and type of comfort care team members, and the amount of support a person receives is very personal and varied, depending on a lot of different circumstances.

Palliative care consists of a team of medical and non-medical professionals, including doctors, nurses, social workers, chaplains and others who offer their time and services to those who are terminally ill. The focus of their care is on patient comfort, symptom control, pain management, quality of life, and when requested a team of physicians will guide the patient through medical treatments with curative intent.

Hospice care is similar to palliative care, as it is also comprised of a team of medical and non-medical professionals who offer their time and services to those who are terminally ill. However, the focus of hospice care is on comfort, symptom control, pain management and quality of life without curative intent.

A medical social worker is a licensed professional who has special training in end-of-life care. They have a wide range of responsibilities, including coordinating medical and non-medical support for the patient/family, informing the patient/family of various community services and resources to benefit their situation, assisting the family members with filling out medical paperwork and helping the patient/family understand and make healthcare decisions.

Grief or bereavement counselors and support groups offer patients and their families grief support and education before, during and after their losses.

An in-home professional caregiver is someone who is hired by a family to care for their loved one. In California, in-home caregivers are not required to be licensed and quite often focus on the patient’s personal care and homemaking.  Caregiver responsibilities can include bathing, dressing, and grooming; planning, preparing and serving meals; shopping and running errands; transporting patient; companionship; basic health monitoring; ensuring healthcare routines, and light housekeeping. 

A primary in-home caregiver is typically a spouse, family member or friend who has taken on the roles of a professional caregiver either in addition to or in place of a professional in-home caregiver.

A home health aid (HHA) is similar to a professional in-home caregiver, but HHAs are formally trained and must be certified to assist a patient with personal care (bathing, dressing, grooming) and more complex issues. Although some HHAs do light household activities and errands, they are trained and can be more attentive to day-to-day medical care including taking basic vitals (pulse, respiration, temperature), medical administration, changing simple dressings, skin care, and special diet regimes. While an HHA could perform any and all of the in-home professional caregiver responsibilities, it’s not expected that a professional In-home caregiver would have the medical knowledge and skills of an HHA.

Hospice volunteers travel to a patient and offer their company in a myriad of ways. Any patient who is under the care of hospice is entitled to these personalized visits, that vary depending on the individual. Sometimes volunteers talk with the patient, sharing life stories and favorite topics of interest. Other times they sit in silence together. Volunteers might read out loud to a patient or play games. Some volunteers even transport patients to their doctor visits, run errands, prepare meals, or help with simple chores around the house. Volunteers do not provide any kind of medical care, but do stay in close communication with the hospice care team to let them know how the patient and loved ones are doing and if there are any new special needs.

Chaplains are an integral part of the palliative and hospice care teams, assessing the spiritual needs of a patient and their family. Chaplains provide spiritual guidance, nurturing and support to people of all religious faiths and backgrounds, and are familiar with a broad range of cultural and spiritual beliefs.

A healthcare advocate (also called a healthcare agent, healthcare proxy or healthcare surrogate) is the person you identify in your advance health care directive to interact with the comfort care team and make health care decisions on your behalf, in the event you are unable to do so.

Death counselors/midwives/doulas are the sacred glue that connects the whole care team. They understand the big picture and small details, as well as understand each team member’s contribution, and can provide a wide range of non-medical support for emotional, relational, informational, physical and spiritual wellbeing. They are skilled at listening and guiding as things come up, with a non-judgmental compassionate heart. Their ultimate goal is to facilitate a cohesive and peaceful experience for the patient and their loved ones. Depending on where you are in the process, they can help you prepare for or make an end-of-life plan. Death counselors offer all of this with the added value of being wisdom teachers who help people understand the circle of life and its transitions. When called upon as spiritual companions they help those who are dying move through the final transitions at their end of life process, and provide them with the opportunity to discover deeper meaning to their lives and an understanding of sacred awareness in regard to the death process as a journey.

For a more comprehensive list of Cindie’s offerings that include legacy work and advance directive support, check out the detailed descriptions on her Services and Additional Services pages.

Yes. As a death counselor, Cindie will be a member of your comfort care team, whatever it may look like. She will work closely with you, your doctors, nurses, hospice personnel, caregivers, clergy, and out-of-town family members to help provide what is needed for the most peaceful end-of-life experience possible. 

In the state of California, an Advance Health Care Directive is a legally recognized document that states a person’s wishes for medical treatment and care at their end of life and designates a health care agent to make health care decisions on their behalf, in the event this person is unable to do it for themselves due to an accident, progressive disease or other conditions such as dementia and comatose.

It’s never too early to put your health care wishes down in writing. In fact, I highly recommend it to anyone who is 18 years or older.  As long as you are “sound of mind,” you can change these instructions as often as you like. In fact, I highly recommend that you periodically review and update your directives, as it would be quite common over time for you to change our personal values around medical care, due to a lot of personal and external influences.

If you would like guidance in understanding and completing or updating your California Advance Health Care Directive, Cindie offers Advance Health Care and Dementia Directive Support.

Dementia Directives are relatively new and designed for you to provide (in advance) more nuanced instructions for your healthcare at each stage of dementia, in the event you incur this disease. When completed and signed, this document should be attached as an addendum to your Advanced Health Care Directive.

If you would like some assistance in the process of understanding and completing your dementia directive, Cindie offers Advance Health Care and Dementia Directive Support.

Each state has its own versions and nomenclatures for advance directive forms, along with regulations around the required content, use of their forms, execution requirements, and whether or not they recognize forms from other states, third parties or hand-written.

In California, Advance Health Care Directives and Dementia Directives do not required a lawyer, but the documents must be signed in front of a notary, or two witnesses to make them legally recognized.

Some other versions and names used for an Advance Health Care Directive are: medical directive, health care proxy, and living will with a durable power of attorney for health care.

Each state has its own versions and nomenclatures for advance directive forms, along with regulations around the required content, use of their forms, execution requirements, and whether or not they recognize forms from other states, third parties or hand-written.

There are many benefits to having signed directives on file with your doctors and loved ones. These documents have the foresight to empower you as a patient if you are unable to speak for yourself, by providing you with the opportunity in advance to declare what kind of health care you prefer in this situation. You can also express your philosophical and religious beliefs around death and dying, as well as your preference for dying at home or in a hospital. Medical directives can also reduce confusion and conflict among your loved ones and caregivers for them to know what you want in advance. And they can offer you peace of mind that will enhance your end of life experience, because your personal wishes and needs for healthcare will be known and honored.

If this all feels a bit daunting or confusing to you, Cindie can help.  For guidance in understanding and completing or updating your California Advance Health Care Directive, Cindie offers Advance Health Care and Dementia Directive Support.