How Do Death Doulas Differ from Hospice?

by | Apr 24, 2024 | About Death Doulas, Hospice and Palliative Care

Death doulas and hospice agencies provide services with the same goal in mind: assisting people who are dying to have a peaceful death, and to provide caregivers and those surrounding the dying person with practical and emotional support including education about the dying process. Although each specialty has distinct skills, death doulas and hospice complement each other to serve people through the end of life.

I, as a death doula, serve by: 

  • Holding space and guiding people in creating a conscious death where loose ends are tended to, meaning is cultivated, and fear is addressed. 
  • Determining the atmosphere the dying person may want to experience before, at the last breath and after death. 
  • Being present at bedside during active dying to hold space for the profundity of leaving one’s body and provide perspective for the family and caregivers.
  • Assisting with advanced planning, last wishes, funeral planning and after-death care.
  • Delving deep into one’s history to conduct a life review, identify regrets and areas where healing can take place.
  • Creating legacy projects honoring the life of the dying person for the descendants who follow.
  • Creating a post-death experience by creating artifacts and messages from the dying person to be shared six months after death with a celebratory gathering.
  • Contributing a light touch of guidance or be very involved depending on the needs of the dying person.  

Through their team approach, hospice provides:

  • Medical and clinical comfort care for the dying person to help manage pain.
  • Many but not all hospices provide an intake unit where a patient can stay for a few days giving the caregivers a break and/or it can be a place to die.
  • Nursing support to answer medical questions and provide guidance. 
  • Aides who provide showers two times a week. 
  • Chaplaincy services to provide spiritual care. 
  • Social workers to help families secure local resources and complete advanced care planning. 
  • Volunteers who provide companionship for the dying person and respite care for caregivers.
  • Most importantly, hospice provides education about the dying process to help prepare everyone about the eventuality. 

Clinical care and pain management are essential to help a person die peacefully. I am a strong believer in using hospice at the end of life. My mom used hospice care twenty years ago while she was dying from metastatic cancer, and they were wonderful from beginning to end. 

Differences between Death Doulas and Hospice 

One distinction between death doulas and hospice is the pay model. Hospice services are reimbursed by Medicare, Medicaid or private insurance, making it free for most people. Doula services are paid for out-of-pocket using a private pay model. 

Hospice workers use the term “patient” because it is a medical model, whereas, as a death doula, I use the term “client” because I am not providing medical care and am working in a consultative capacity.

Hospice workers receive clinical training – the doctor, the nurse, the social worker, the chaplain, the aide – the medical model has extensive licensures to provide medical and clinical care. At the time of this writing, death doulas in the US are not required to be licensed or certified because they do not provide clinical care. The doula role is more educational and supportive rather than therapeutic or clinical. Although there is not a legal requirement for death doulas to obtain specific training, there are many credible organizations providing training for death doulas which is highly recommended.

This distinction is key: The role of death doulas is NOT part of the medical model. Hospice is fully attached to a medical model that creates pressure, stress, and extra work in terms of documentation requirements to receive reimbursement. It’s the medical model that decides who is eligible and not eligible for care and the model largely dictates how hospices provide care in their communities. 

Many death doulas would appreciate being reimbursed by Medicare or private insurance, but it would most likely come at the cost of the medical model dictating a doula’s offering. Private pay can be prohibitive for people who need and want the services, and doulas can choose to work with individuals who have difficulty paying. 

Personally, I prefer remaining independent and autonomous of institutional models and am committed to providing services that are deemed worthy of the money being charged. To help mitigate the risk or discomfort a person might feel paying for doula services out of pocket, I offer a 100% satisfaction guaranteed promise. If the services aren’t worthwhile, you get your money back. At the heart of serving dying people and their families, hospice and death doulas provide complementary services designed to help make the dying passage peaceful and comfortable. Most people are aware of hospice’s role but are learning about the possibility of working with a death doula because it is a new and emerging specialty.  If you or someone you know is in need of these services, please explore how both hospice and death doulas can help bring meaning and comfort at the end of life.