Ashes, Now What

A story in the Pittsburgh Post-Gazette reaffirms the importance of talking to one’s family about end of life decisions.  I never gave this much thought until now.  When a person requests cremation, I assumed the family or designated person would either take the cremains in a container, make arrangements to bury the container, or spread the ashes in a designated place.  Nationally, in 2018, 15,000 containers were not picked up; that’s 1% of all cremations.  While the percentage is not high, funeral homes have boxes going way back…even for 40 years.  Some funeral homes may decide to bury the containers in a single grave after a specified period of time.

One solution may be to request payment from the family for burying the cremains and if the family claims the container, the family will be reimbursed.  Asking for a fee, according to one funeral home, has led to a decrease in abandoned cremains. 

There are no easy answers.  And family members who were deemed responsible for handling end of life wishes may themselves take ill or die before they can carry out their responsibilities.   So, it is important for us, as responsible citizens, to make our wishes known to our family, including what we want done with our ashes.

Thoughts?   Please share and start a conversation in your own community.

What a Great Idea!

From The Washington Post, November 14, 2019:  A family is downsizing after living in their home for 45 years.  They decided to throw a party and encourage their guests to take an item or ten from their home.  Is this the beginning of a downsizing party phenomena? 

From the pictures in the article, it looked like the couple had many keepsakes, souvenirs from years of travel, and political memorabilia.  Included in the giveaway were plant cuttings and books.  It also appeared they had lots of friends who had children and grandchildren who needed things. 

The author likened the party to the Swedish practice of “death cleaning” which I have written about.

Reminds me of the clothing swap that was the rage years ago where a group of women would bring clothes they no longer wanted to a designated location and swap with their friends.   A clothing party! Nowadays, there are websites where you can sell your clothes or buy used clothes. 

Since I am in smaller quarters, I have to carefully decide if I have space when I am considering a purchase- clothing, shoes, canned goods, health and beauty items, and even refrigerated items. 

Think about this when making a purchase.  Is it a need or a want?  No easy answers.

Let me know your thoughts.

No Regrets

A story on nextavenue.org/talk-about-death, discusses Katie Couric’s regrets.She wanted to be positive as her first husband was dying of colon cancer.  She said she never discussed with him the idea that he might die. 

She is now writing her memoir and met with the doctors who took care of Jay Monahan to “revisit” those days. 

I was surprised by her admission.  I thought Katie Couric “has it all together”.  She’s smart, articulate, and has all the resources at her fingertips.  I was wrong.  Very wrong.   She was as vulnerable as any of us and when we are in a crisis mode, we don’t think straight.  That’s why it is so important to make plans ahead; to talk with family about the “D” word. 

The story goes on to say that the $16 billion US funeral industry is being shaken up by the new thoughts of death rituals and burials.  I have not watched the HBO documentary Alternate Endings: Six New Ways to Die in America, released August 14, 2019.  However, I have written about many of the show’s topics: green burials and urns among others.  What I have not discussed and what is a new idea to me is the “living wake” which “force people to say things to each other while still alive.”    I’d rather have a birthday or holiday party than a living wake!  The key, as I see it, is to talk to your family about your death and how you want it to be handled. 

The D word doesn’t take away hope or research; it merely makes it less frightening.  And while I’m on the subject of talking about death, I will be hosting another Death Café in Pittsburgh in December.  There is even a Facebook group for Death Café Pittsburgh!  Let me know if you are interested in attending and I'll send you info as it becomes available.

Until next time…

Music at a Funeral

I held onto an article from the Pittsburgh Post-Gazette for over a year.  It was a feel-good piece by Brian O’Neill about a duo (keyboard and guitar) who play for weddings and funerals in the Pittsburgh area.  What a concept!  I think background music in a funeral home would be comforting.  While I have not experienced this- yet- I think music would be calming.  What are your thoughts? 

Musical selections, in addition to hymns if that is in your tradition, is one more way to honor the deceased and is another option for someone who wants music at his/her funeral to be proactive.  Recently there have been several obituaries that are funny and/ or sarcastic that have gone viral on the internet.  The deceased either wrote it in advance or the family created it as an homage to their loved one.  Planning ahead is the key and sets the stage for the long period of grieving for friends and family.

Please share your thoughts.

Resources for Advanced Directives

While we know we need advanced directives, many of us have not taken the steps to create this document.  Here are several resources:

1.      Five Wishes, https://www.agingwithdignity.org

2.     PREPARE^TM for Your Care, https://www.prepareforyourcare.org/welcome

3.     Put it in Writing: American Hospital Association (AHA),  https://aha.org/2017-12-11-put-it-writing

4.     The Conversation Project, http://theconversationproject.org

This website also has resources for communities to create a Conversation Project Sabbath.  Log on and share the information with your clergy.


And, of course, there is always an attorney who can help you work through your decision making process.

Writing an Advanced Directive is Hard

The Washington Post August 12, 1029 issue contained an article written by an ICU nurse.  She discussed her hesitation and indecision to write a living will, yet she sees the agony when families of patients under her care do not have one.  According to her information based on a 2017 study, only one-third of Americans have any sort of advanced directives. And this statistic includes health care professionals.


So why is their such a gap between thinking about advanced directives and actually creating them?


“The first barrier to advanced-care planning is often understanding what is involved…. An advance directive is a document that usually includes two separate elements: naming a health-care surrogate and creating a living will.”


The author points out the difficulty of looking at a form that may not have any bearing on the patient’s condition.  When a person is healthy and creating a living will, fantasizing about what may happen in the future can be a useless exercise.  The suggestion is made to appoint a surrogate or health care power of attorney with whom you can talk to about what you really want and about what’s really important to you when you are facing end of life decisions.


Another barrier to creating the document or discussing the issues with family is fear of talking about death.  So how do we overcome the fear?  Perhaps by “Framing end of life planning as a service to loved ones…”  The author of the article filled out “Five Wishes” which is an online document. She named a health care proxy and two backups.  She then wrote she did not want her life to be artificially prolonged by machines. She then had 2 friends witness the document which was legally necessary in her state and she put the form in her file cabinet.  


The important element is she has shared the location of the document with the important people in her life.  It’s great if one takes the steps to create the documents only to hide the documents where no one will find them.  


If you would like to read to entire article, look for “I’m an ICU nurse.  I know I need an end-of-life directive. So why can ‘t I bring myself to write it?” by Andrea Useem, August 12, 2019, The Washington Post. 

What are your thoughts about this dilemma?  Do you have advanced directives and a health care proxy?

Photo by Andy 'Thrasher

Payment for Caregivers

Several months ago an article appeared in the local newspaper about being compensated for family caretaking.  While I knew about programs for low income families in my county, I was not aware of concerns for middle and upper income families.  It seems that if the individual made gifts to their caregiver and then went into a skilled nursing facility and applied for Medicaid, the individual would be under the “5 year lookback” period (monies that were given to others for 5 years prior to the application for Medicaid) and if the amounts were substantial, the gifts might create an ineligibility period for Medicaid.

The attorneys (the authors of the article) suggest creating a written document that spells out exactly what services will be offered and the reasonable amount of money given for each service.  For example, with meals (who will do the shopping, cooking and cleaning up), who will do home maintenance, who will do the bookkeeping (bill paying, balancing the checkbook), and who will provide transportation (who buys the gas, services the car, pays for insurance and/ or car payments).  Also, it is suggested that a written log be kept of the time and money spent. 

Record keeping is essential.  Look into a “Caregiver Agreement” with an attorney to make sure the individual will not be penalized if he/she needs to go on Medicaid.  Also, talking with an attorney may educate you as the caregiver about your responsibility to report your income to the IRS. 

Thoughts?  Comments?