Time and roles. The hospice nurse is the medical manager of the terminal patient with limited time at the bedside. The End-of-Life Doula is the non-medical professional that is the eyes and ears of the case with no time limitations. The Doulagiver alerts the hospice team to any changes in the patients presentation so that the hospice nurse can assess and update the
care plan for maximum daily comfort of the patient (the goal of hospice.).
An End of Life Doula can do everything EXCEPT give a medication and do any form of medical treatment or wound care. The hospice volunteer needs to follow Medicare regulations that prohibit any form of touching, moving, feeding, bathing, toileting etc. The hospice volunteer in most US states is limited to a maximum weekly bedside visit of 4 hours. The average volunteer visit is 1-2 hours a week. This does not provide the adjunct support that patients and families so desperately need at this stressful time.
No. End-of-Life Doulas are private pay. All “companion” services such as Home Instead, Visiting Angels, Comfort Keepers etc. are all private pay. Most End-of-Life Doulas have a sliding scale payment option.
No. An End-of-Life Doula never gives any medication whether prescription or over the counter.
Yes. An End-of-Life Doula has a ”scope of practice” that includes everything from the time of a terminal diagnosis to helping patients and families as the illness progresses, to the vigil, time of death, after death care, understanding and honoring grief, and finally recovery of life after loss.
Most hospice teams leave a case after the patient has died. Many times families are feeling this as another loss. Hospice does offer bereavement services for up to a year or 15 months in most states. This is usually initiated by a call from a volunteer and the living family member is told about monthly support groups that they may attend. The original hospice team that worked with the family is not part of this service.
A doula has the unique opportunity to develop a lasting relationship with the family even after the patient's passing if the family and the doula desire. Grief support can include active listening, resource sharing and legacy work, as well as assisting the family through any unfinished emotional business that may be left following a loss.
Provide time. Most hospices provide HHA services up to a maximum of 2 hours a day 5 days a week. This is based on acuity of the patient and is only available if the hospice has an available aide. The role of a doula does not necessarily include performing personal care however they may choose to assist the patient at their own discretion.
No. End of Life Doulas are a Non-Medical Profession. Just like the establishment of Birth Doulas 40 years ago, this is not regulated by a government license.
YES! ( NEDA ) The National End-of-Life Doula Alliance has set a national practicum with Core Competencies for the practice of professional End-of-Life Doulas. All End-of-Life Doulas that pass the assessment receive the NEDA National Credential and can become members of the national membership organization.
YES. The National Hospice and Palliative Care Organization (NHPCO ) is the membership organization for all the hospices in the US. They have just put together The End-of-Life Doula Council to be able to share with Hospices and families how the Professional End of Life Doula can assist and complete the hospice team to fill in “the gaps in care” and allow for the best end of life experience for both the patient and their loved ones.
No it is not required that a person be on hospice care to use a doula at the end of life. However it is advisable to educate the family on the benefits of hospice especially related to providing medication and equipment that is out of the scope of a doula. Hospice can sometimes have a stigma attached to it that it is "giving up," or "a last resort." Having the conversation with families about the beauty of hospice care can help to ease their minds that death does not have to be a negative experience and that they are doing what is best for their loved one to keep them as comfortable as possible in their last days.