End-of-life doulas (Sometimes referred to as “death doulas, end-of-life coaches, or transition guides) provide non-medical, holistic support and comfort to people preparing for, or experiencing end of life.
End-of-life doulas (Sometimes referred to as “death doulas, end-of-life coaches, or transition guides) provide non-medical, holistic support and comfort to people preparing for, or experiencing end of life. EOLDs come from a variety of backgrounds and experiences with a shared desire to educate, guide, companion, and assist the dying and their families/carers in myriad ways. People who desire such support may engage with EOLDs as early as initial diagnosis, or as late as the beginning of the active dying phase or even after death, if bereavement care is what they are seeking.
Some doulas charge for their services, and others work on a volunteer basis. Either way, end-of-life doulas complement and supplement the work of family and other caregivers (including hospice providers). An EOLD can serve as a kind of project manager, coordinating care and services requested and required by the client and/or family—before, during, and after death. Although there is no definitive list of services offered by EOLDs, education and guidance, logistical and practical assistance, as well as emotional, social, and spiritual support are fundamental. Specific offerings vary by individual doula—some concentrate their focus on specific issues and tasks, while others offer a broad spectrum of services. Not all EOLDs offer the same modalities or expertise; if an individual or family desires services that they cannot or do not provide, the EOLD endeavors to make referrals and help locate needed resources. Above all, EOLDs seek to help those dying and their loved ones achieve an end-of-life experience that is as meaningful, peaceful, and well-prepared as possible for all involved.
At this time, insurance does not cover EOLD services, and therefore, the way EOLDs are compensated varies greatly. In most cases, the individual or family contracts directly with the EOLD, however, as more and more hospice and palliative care organizations are utilizing doulas, this may change. Salaries for EOLDs can vary depending on the region, experience, and type of work they are doing (e.g. whether they are on-call, staying overnight, traveling great distance, etc.). Some doulas may decide to charge a flat fee to assist the person in their dying process. Others may charge an hourly fee which can range from $25 to over $100 an hour depending on the needs of the client. Some EOLDs offer a sliding scale, others don't charge any fees for their services, but instead provide support in a volunteer or pro-bono capacity.
It is important to note that support services provided after-death generally fall into the realm of a highly regulated funeral industry. There are very different legal requirements governing what practitioners can and cannot do, and what services they can and cannot charge for once the last breath is taken. It is imperative that all EOLD and ADCE practitioners understand and heed this difference. By failing to recognize and abide by the laws that pertain to after-death care, end of life doulas can undermine, or even threaten, all the hard work that the home funeral community has established over the years to protect the innate rights of families to care for their own dead.
For more details: (include links to the ACDE resources)
- Serving as a liaison between client/family or patient advocate
- Coordinating community resources and/or medical personnel
- Practical, emotional, social, psychological, and spiritual support
- Personal death awareness education
- Problem solving and logistical assistance
- Advance care planning
- Helping people get their affairs in order and saying good-bye.
- Life review and legacy work
- Planning funerals and memorial services
- Providing respite, companionship, and sitting vigil
- Assisting with household tasks
- Facilitating conversations with loved ones
- Performing ritual and ceremonies and acting as celebrant
- Facilitating guided imagery, prayer, and meditation
- Offering grief support
Following is a list of many of the typical services that may be provided by EOLDs.
How EOL Doulas (and ADCEs) are compensated?
How to become an EOLD
End-of-life doulas come from rich and varied backgrounds. Some are formally trained, some are self-taught; some are new to the field, and some have been serving their communities and families for many years. Some charge for their services while others work as volunteers. Many in the role have previous experience and education as clinical care providers or hospice professionals and volunteers. Others come to this work through some other type of calling—often a personal experience they had or expect to have with a family member or friend without formal training. This diversity is important. End-of-life care is not a “one size fits all” scenario. Different people want and need different things. Having a wide variety of options from which to choose is something we champion.
Q How do EOLDs get trained?
A. There are many EOLD training programs in the US and elsewhere—many of which are listed in NEDA’s Trainers Directory. These programs are facilitated both by private individuals as well as renowned educational institutions—each with their own individual strengths, philosophies, and teaching styles. Some are offered on-line, some are solely in-person, and some are a hybrid of both approaches. In addition, there are EOLDs who have obtained their training through other end-of-life related educational offerings, hospice volunteer training, or through practical experience by serving in their community for years or by working in other related professions. Because NEDA’s purpose is to elevate the work of all of our members, we do not recommend or endorse any particular educational approach over another. Everyone listed in our directories is self-described, with no oversight or approval by NEDA. However, we do encourage people to do due diligence before making a commitment. This includes talking to trainers and to doulas who have participated in different training programs.
Q. What do students learn in the average training?
A. Trainings vary widely. The general categories of doula training include knowledge of: scope of practice, HIPAA requirements, hospice conditions of participation; communication skills, personal and professional boundaries, needs assessments; the doula model of care, hands-on, non-medical comfort care modalities, self-care; the dying process, legacy and life review; developing community resources; multicultural awareness/diversity, equity, inclusivity, and justice, vigils; respite care, immediate after-death care; and bereavement. Throughout, doulas learn how to recognize and address the physical, emotional, and spiritual needs and desires of both the patient and the caregivers within the end-of-life doula's scope of practice. Some training programs fully prepare EOLDs to take the assessment and to obtain a proficiency badge, while others may not address all of the core competencies established by NEDA. NEDA recommends that you choose your EOLD training program carefully to ensure that the curriculum covers all that is needed to pass the exam and obtain an NEDA EOLD Proficiency Badge. Please inquire about this before taking training.
Q. Which training programs are best?
If you ask any of our members to tell you about their training preferences, you will likely get a different answer from each of them—demonstrating that there is no one best way to learn how to provide quality support to people preparing for or experiencing death—they are all different. And the “best” for you may not be the “best” for someone else. It really depends on personal goals and objectives.
NEDA does not accredit or evaluate any individual EOLD training program. Because NEDA’s purpose is to elevate the work of all of our members, we do not recommend or endorse any particular educational approach over another. Everyone listed in our directories is self-described, with no oversight or approval by NEDA. However, we do encourage people to do due diligence before making a commitment. This includes talking to trainers and those who have also participated in different trainings.
Link to Suggestions for Selecting an End-of-life Doula Training
by Karen Reppen, NEDA Board Member, July 2021. Revised March 2022
