What to Expect When an Autopsy is Required

INGMRF-00092853-001Recently a young mother of five became a widow. Her husband and the father of her children was coming home at dusk on a Friday evening.

They lived in the country and their home is nestled in-between dirt roads. He’s usually home by 6:45 p.m. and the ritual of their Friday night pizza was already in the works. There was nothing unusual about this day except for the fact that he was late.

His wife didn’t become too concerned until she looked at the clock and realized almost two hours had gone by and he hadn’t called or texted. As she began to reach into her purse for her cell phone the doorbell rang. Her 13-year-old son answered the door as she was rounding the corner only to see two state policemen standing there. Before they could say anything, she instinctively knew that her husband wasn’t ever coming home. She was right. He had died just three miles away from their home in a car accident.

What was odd, is that there were no other vehicles or individuals involved and the car had appeared to roll over numerous times requiring the”Jaws of Life” to extract him from the car. What was even more disturbing to her was that he had driven this road hundreds if not thousands of times and knew every inch of it like the back of his hand.

The police had shared that they ran his license plate and it matched his driver’s license, which of course led them to what they assumed to be both his home and family. During this very painful and unexpected conversation, the police attempted to explain what their standards and protocols were, which also included decisions regarding a funeral home to contact.woman-1006102_1920

She tried to comprehend what the police were saying as her world came crashing down around her and all she could think or say was take me to him I want to see him.”I need to see him,” she screamed.

The police very factually explained that she would be unable to see him as he had been taken from the accident scene and had been transported at the request of the medical examiner to the hospital for an autopsy to be performed. She didn’t understand – autopsy, why? There were so many questions she needed answered and decisions to make, all of which she was unprepared for. The police handed her a card that had the Medical Examiner’s contact information on it along with a number assigned to her husband’s case. From this point on, any questions she had regarding her husband’s death, were to be addressed by the medical examiner.

Before the police left she gave them the name of the funeral home she would like for him to be taken to.

The above story is true, right down to the Friday night pizza ritual. The balance of this content is to share with you both what to expect when someone you love dies and the medical examiner requires an autopsy.

First and foremost, if you aren’t clear on the definition of autopsy, it’s a term used to determine the “how” death occurred, after death or commonly referred to as postmortem. The law requires that if a person dies and they are not under are not under the care of hospice, admitted and under doctor’s care in a hospital, or diagnosed as being terminally ill, a medical examiner must be contacted.

This is required even if individual dies in an emergency room or the elderly simply die in their sleep. The purpose is to ensure there is no foul play and or determine the exact cause of death.

Science and experience has taught us that things aren’t always as they appear. In this case, the police had ruled out alcohol but needed the blood work to back it up. Distracted driving via the telephone and texting was also ruled out. Due to the numerous roll overs, the assumption was he was driving at a high speed and hit a bump in the road and lost control. This is what the physical evidence points too.

What can’t be ruled out is a heart attack, stroke or other physical aliment. The only thing that can rule this out is a complete examination of the internal organs.

32060530823_8bde2382acWhen an autopsy is preformed, the body is off limits to anyone except the care team conducting the autopsy. Depending on when death occurred and the county death happened in, this process can take anywhere from 24 hours once the medical examiner receives the body upwards to a week before the body is transported to the family’s funeral home. Once the body is released into the funeral home’s care then and only then can the next of kin view the body.

It’s important for the next of kin to understand this timeline. It’s also critical to understand that when the body is returned to the funeral home, it’s not view-able, at least right away. This does not mean that the person has been dismembered as seen on television or the movies. What it does mean is that the body and any bruises, distinguishing marks or tattoos were documented.

Typically, a “Y” incision is made in the chest and abdomen to gain access to the internalbody chart organs. An incision is made beginning from each shoulder down to the center of the chest and then a single incision down to the pubic bone. The medical examiner then removes the internal organs one by one and takes samples, examines and weighs each one. Some of the samples are sent to the lab for further testing. A second incision is sometimes made on the back of the head from behind the ear all the way around to behind the other ear. A portion of the skull is then cut out and the brain is removed for examination. When the medical examiner is satisfied with everything the organs are returned to the abdominal and cranial cavity in a plastic bag and the incisions are loosely sewn back together.

It’s now up to the science and the medical community to confirm the actual time and cause of death. This portion of the process can take anywhere from six hours to six months. If the cause of death can not be determined right after the autopsy then the medical examiner provides the funeral home with a death certificate that states the cause of death is “pending.”

Once the above process is complete, the deceased is released to the care of the family’s designated funeral home. If the family (and most of them do) want to say a final farewell and physically view their loved one, several things must take place.

The funeral director will need at least one day to make the body presentable for their next of kin to see. It’s important to understand the steps involved so you can appreciate the necessary delay from the time of the body was received by the funeral home, till the time the next of kin can view, touch and hold their loved one’s hand.

First the body must be bathed and the hair washed. From there, the director must set the person’s features. This means closing their eyes and mouth. If the body is to be embalmed this takes place, if not the organs are place inside the body and incisions are tightly sewn closed. Finally, the deceased is dressed and the hair is styled. What’s described above is a text book situation. Depending on “how” death happened (gunshot, accident, etc..) there are modifications that will be made.

In this story, death was unexpected and tragic. It was a young man with a family. The funeral home receive word from the medical examiner that the deceased would be coming into our care. Death happened on a Friday night. The widow (in shock and denial, rightfully so) called numerous times demanding to see her husband before the autopsy. When the police shared that there was going to be an autopsy, they didn’t explain the timeline. The timeline began with everything starting during normal working hours, which began on Monday. (If they did, she didn’t comprehend this.)

The point of the story is that people don’t know what they don’t know, especially around issues that revolve around death. The internet is a powerful tool, but the key is to know the difference between facts and well intended miss-information.

Autopsies are just one component of death and dying. A good funeral home and director can and will explain the process. They won’t go into this much detail, however in the name of being transparent – the process is what it is. Unless you’ve directly experienced it, there are many self-proclaimed experts.

For more information download my free e-book here What Expect when an Autopsy is required eBook

 

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Nurse Should Know, a Little Empathy Goes a Long Way!

The below is a true story. The names have been changed but the story-line has not been altered. It’s my fear that this situation happens all too often. If that’s the case, my heart goes out to families who are treated like a number and a commodity. It only takes a minute to show kindness, empathy and respect.

food-dinner-steak-forkIt was a typical New Year’s Eve. Grace and Tom always stayed in and made a gourmet meal, shared a bottle of wine or two, watched Dick Clark’s Rock‘n New Year’s Eve on the television and somehow managed to stay awake long enough to watch the ball drop in Times Square welcoming the New Year – except this year. They were enjoying their meal which this year consisted of all organic vegetables, grilled filet mignon when Tom looked up at Grace with his eye bulging and his face turning red. Grace realized Tom was choking. She leaped from her chair knocking her plate on the floor as she managed to get behind Tom and place her hand around his sternum, attempting to do the Heimlich maneuver. Tom knew what was happening but was unable to verbally communicate. He knew Grace wasn’t strong enough to help, so he had instinctively picked up his cell phone, dialed 911 and handed it to Grace. The operator heard the confusion and Grace yelling as she frantically was trying to dislodge the object caught in his throat. Thirty minutes later, the attending emergency room doctor pronounced the time of death to be 8:36 p.m. on December 31, 2016. All this had transpired in less than ninety minutes.

Grace was trying to wrap her mind around the fact that less than an hour ago, they were enjoying a quiet meal and emergency-1137137_1280now her perfectly healthy, although overweight husband of thirty years was dead at the age of 56. There she stood alone in the emergency room looking at Tom with tubes down his throat, IV lines in his arms, shirt wide open, his skin colorless and eyes lifeless when a nurse approaches her and said that they would have to call the county medical examiner, who in turn would want to know what funeral home to call. Grace replied, “Medical Examiner? Why, I don’t want an autopsy! Funeral home, never thought about it. I can’t answer that right now.” The nurse then said “You may want to think about what organs will you allow us to donate?” “What do you mean organs to donate! We didn’t talk about this. Tom hasn’t even been dead ninety minutes and you expect me to give you an answer! ” Grace shouted. It was that moment Grace realized she had no car as she rode in the ambulance and no support.  The only children they had were their two cats who almost 20 years old, she needed to call a friend. She called Derek and Ann, their best friends.

Upon receiving the call, Derek and Ann immediately left their New Year’s Eve party and headed to the hospital. gift-of-lifeWhen they got there, the charge nurse lead them back to the emergency room where they met Grace and saw Tom.  Derek went over to pay respect to Tom, when the charge nurse briskly walked in told him to step aside as she started placing drops in his eyes and then taped them shut with surgical tape. Grace cried out, “ What are you doing?” . The nurse replied, “Getting him ready for Gift of Life – most people at minimum donate their eyes.” Derek looked at Grace and asked if she approved this. Grace did not. In fact, she didn’t want to donate anything. She felt it was expected by the hospital and that she was being pushed into something she was not comfortable with. Derick asked Grace if she signed any donation authorizations, she answered no. He took her by the hand and they walked up to the nurse’s station and explained to the head nurse that organ donation would not be an option, nor would there be any more discussion about this. The nurse then requested that Grace sign a form stating that “Gift of Life” was explained to her and she declined. Grace signed it, but mumbled something to the effect that “Gift of Life” was not explained and that she felt bullied. Derek put his arm around her and walked her back to Tom’s room.

Derek nor his wife Ann were not new to death care. Derek’s a supervisor for the township cemetery and had also worked for many years on the county’s transport team. He knew the crew well. Ann had worked at a funeral home for the past three years and kept close ties with her past employer. They could clearly see that Grace was being treated benignly. There was no empathy nor explanation, just an attitude of checking things off a list. While this may have been a routine death for the emergency room staff, it was Grace’s first. This was not an expected death, it was a very unexpected and tragic death. Being made to feel like just a number and having Tom’s body being treated like a commodity with vultures circling up above take his body parts was unconscionable. Grace had so many questions and no one from the hospital staff was taking the time to answer them.

The three primary questions that were not addressed were:

  1. Why did the medical examiner have to be called?
  2. Why would we need an autopsy, if he died choking on a piece of steak?
  3. Why do I have to donate Tom’s organs?

Derek and Ann knew the answers, only because they are familiar with end of life protocols due to their professions. Together they explained to Grace the following:

  1. Unless a person is under hospice care or has a terminal disease that’s on record, its standard operating procedure – even if death occurs in a hospital, to call the medical examiner. The medical examiner’s (ME) role is to ensure there was no foul play and to sign the death certificate. If the ME suspects, there is something beyond the obvious they will request an autopsy. Things aren’t always what they appear. The cause of death may be a heart attack that triggered Tom choking. Sometimes there is foul play is involved. Regardless of the “why” Michigan’s law states the ME must review the situation.
  2. Once the ME has conducted an investigation, a decision will be made regarding an autopsy. If the ME decides to conduct an autopsy, the deceased is taken to a local hospital for it to be performed by a pathologist. Once it’s completed the deceased will be transported to the funeral home the family selected. If the ME makes the decision not to conduct an autopsy, the county’s care team will transport the deceased from place of death to the family’s funeral home of choice.
  3. Organ donation is something the medical community supports. By no means is it a requirement. From a medical viewpoint, if organs or body parts are going to be harvested, the sooner the decision is made after death and the faster this process is conducted the better chance of success. Long story short, time becomes a critical factor.

emotion-556794_1920After listening to the explanations, Grace blurted out, “ I don’t want an autopsy performed! It doesn’t matter how he died, he’s dead. Nothing will bring him back.” The thought of him being dismembered and studied like a science project physically was making her shake.  Derek looked her in the eye and told her that by law she didn’t get to make that decision. He went on to further share that medical examiners don’t always require an autopsy to determine the cause of death. Bottom line, she needed to understand the role of the ME and respect the decision.  While she didn’t like what was happening, at least it was beginning to make sense. She couldn’t understand why the head nurse didn’t take the time to explain this to her, she would have been less angry and anxious. If the truth be told, she would have felt like the hospital cared that her husband died, versus feeling like she was just another case file.

Fifteen minutes later the head nurse came back into the room and said, “The county removal team is here, you’re going to want to leave the room. You don’t need to see this.” Just then, the county’s care team walked in the room. They had heard what the nurse said and acknowledged Derek.  The lead care team member Brent introduced everyone to Grace. He immediately stated that she did not have to leave. In fact, they would prefer if she stayed. Brent began his conversation by asking if Tom was a Veteran. Grace shared that he was not. She asked why.  Brent explained that if he was, they would honor him by placing a flag over his body as they wheeled him from the emergency room to their vehicle. Grace let them know that although he wasn’t a veteran, he loved the military and was active in politics. She asked if he could still have a flag draped over him. “Absolutely,” Brent responded. He then  further explained what the transport team was going to do, how they were going to do it and asked if she would like to participate. Grace responded no, but Derek jumped in and said he wanted too.  At that moment, the head nurse became visually upset and stormed out the room. Everyone looked at each other with dismay. Brent turned to Grace and said, “Please don’t let her lack of empathy ruin this moment. Together we are going to honor your husband the best we can. We will treat him with the dignity and respect he deserves. There is nothing to be afraid of. Would you like to walk with us down the hall and to the van to see him off?” Grace replied yes. Together Derek and Brent placed Tom on the gurney, draped a flag over his body and walked down the hallway to the transport van. Grace kissed the top of his head as watched as his body was loaded into the vehicle.

So what’s the lesson?  The fact that Tom died couldn’t be changed. What could have been avoided was the lack of empathy-9550064_lempathy from the head nurse. Grace had no idea what the head nurse had been dealing with prior to Tom’s arrival. Frankly, nor should she care. The head nurse is paid to handle stressful situations. It doesn’t matter if Tom was the first or tenth death that day, it was the first for Grace. If the head nurse had taken the time to set the expectation of what must happen over the next few minutes and why, Grace would have felt a little more in control and much anxiety would have been eliminated. A little bit of empathy would have gone a long way. When death happens in an emergency room, the first thing that should be addressed is educating the survivors of the next steps and decisions that must need to be made – including the why. Organ donation can be a part of the discussion but should never be the focal point. One should not assume nor openly have the family feel like their loved one is a commodity with vultures circling up above for their next meal.

Regardless if you are a business or a person, you only get one chance to make a good first impression. In this case, the first impression is an experience. Regardless of the message, it can be delivered with professionalism and respect. As a person experiencing this, it’s important that you keep in mind, you have rights. If you are not comfortable with what’s happening, ask. It’s imperative that you or a family member are your own advocate.

A new concept for many pet parents: Pet Palliative Care and Pet Hospice

Pet palliative care and pet hospice is a new concept for many pet parents.

As people, when we reach the end stages of our life, it’s become normal practice in the medical community to transition from treatment, to quality of life care and pain management. This is often referred to as palliative care. In the pet world, this type of care is just starting to catch on. It’s only been within the last ten years or so that the veterinary world has started embracing this. Pet Hospice and palliative care is now one of the largest growing areas of veterinary medicine. In fact, some doctors of veterinary medicine have made the decision to only focus on end of life care and become a mobile practice. Mobile practices enable client care in the comfort of their own home. This type of pet care is becoming increasingly popular and starting to be in high consumer demand.

Why? For numerous reasons. We all know how difficult it can be to transport a pet. Some pets have anxiety issues, others may have physical ailments making them incapable of getting into a vehicle unassisted and finally, the pet parent may not be able to drive or physically control the pet due to their own health.

In 2009 Amir Shanan, DVM, founded the IAAHPC (International Association for Animal Hospice and Palliative Care). I had the pleasure of attending their first conference in Ft. Worth, Texas and recently just returned from their 2016 conference.

iaahpc

This association’s mission is:

“The International Association for Animal Hospice and Palliative Care is dedicated to promoting knowledge of, and developing guidelines for, comfort-oriented care to companion animals as they approach the end of life.

dr-cooney-with-dogs-small-squareIn June’s 2016 Veterinary Practice News, Kathy Cooney, DVM, immediate past president of the International Association for Animal Hospice and Palliative Care, noted that a multimodal approach is helping dying pets live pain-free. “The time is right to improve care at the end of a pet’s life,” said Dr. Cooney, the owner of Cooney Animal Hospice Consulting in Loveland, Colo. “Pets are like family, and many caregivers are searching for more options, especially when euthanasia has been the only option presented to them.”

I couldn’t agree with her more! This type of end of life care for pets is both one that I actively support and am currently participating in with Yama, my Siamese cat, under the supervision of Peter Jackson DVM, owner of Lifetime Veterinary Care in Nunica, MI.dr_jackson

Yama was a rescue and we believe her to be close to eleven years old. She is a lilac Siamese and has always had an irritable bowel and sinus issues.  Not long ago she stopped eating. We didn’t notice it immediately as she sat by her bowl regularly. (We have three cats and keep their bowls full.) She didn’t act sick. Yama was a chubby cat and I happened to look at her and notice she had lost some weight. I called

Dr.Peter and brought her in. We did blood work and x-rays, much to our surprise everything was within a normal range. Yama was hydrated and immediately perked up.  We made the decision to feed her a high protein canned cat food to put some weight back on her. Measures were also taken to measure her fluid intake. Yama refused to eat or drink on her own terms. She did, however, continue to interact with the other animals and snuggle with us.  I decided to force feed her with a syringe several times a day in hopes she may come around and begin to eat on her own again.  In felines, their liver can stop working if they do not eat. Some cats have been known to take up to 6 weeks before eating again. Yama is not in any pain, she purrs regularly, sits in front of her kibble and even the water bowl. She does not fight being hydrated or fed.  She does use her litter box, so we know her bowels are working. If Yama doesn’t start eating on her own, at some point I’m going to have to make some decisions. What I do know, is that presently she has quality of life.

Yama Clock is receiving pet palliative care by Peter Jackson, DVM Lifetime Veterinary Care
Yama Clock is receiving pet palliative care by Peter Jackson, DVM Lifetime Veterinary Care

She clearly demonstrates that and communicates it. I’m confident that whatever transpires, she will also communicate that and I will honor it. What I won’t do, is let her suffer. When it’s time, together Yama, Dr. Peter and I will walk that journey.

 

 

 

 

 

Cremation – 7 Steps You Need to Know!

Cremation Memorial Service
Cremation Memorial Service

Many of us have attended a funeral service for a family member, friend or co-worker, however, odds are most of us have not had to make funeral arrangements. Today with people living longer, the average age of a person making funeral arrangements is over fifty.  One would think that the person making funeral decisions is the surviving spouse, but it’s becoming more the norm for the adult children to make the arrangements. Why? Because the widow or widower’s decision-making ability has become compromised due to their own declining health. The spouse may have full comprehension of their partner’s death and even be able to articulate the type of funeral service desired, however, the lack of clarity revolves around financial decisions. Understanding the financial obligations, along with any insurance claims is where the major confusion occurs, therefore it’s always best to have another family member or advocate present. In this conversation, you will learn what takes place at a cremation service arrangement conference. The next article will discuss the traditional burial conference; they are two very different discussions.

If you haven’t downloaded the e-book 5-legal-requirements-before-cremation, now is the time. All too often, people think that the cremation itself takes place once a body is brought into a funeral home’s care. Let’s debunk this myth immediately! To be clear, a body can NOT be cremated until numerous checks and balances take place and it all begins at the arrangement consultation.

Below are the seven items that must be addressed in a cremation arrangement conference.

  1. Address questions and concerns.
  2. Share service options.
  3. Adhere to the Federal Trade Commission requirements.
  4. Gather the required information and signatures for permits and certificates.
  5. Explain the cremation process.
  6. Set the expectation when the cremated remains will be returned.
  7. Discuss payment options.

When families try to by-pass this process by doing on-line arrangements and not talking to their end of life provider is where errors happen and consumer satisfaction levels decline.  While the process may seem straightforward, it’s not. To quote an age-adage “Things are not always as simple as they appear!”

fact-list

  1. Address questions and concerns

Shortly after death, your funeral home will contact you to schedule a time to meet. During this conversation, you may be asked to bring in insurance documents, possibly clothing or even photographs. This is the time for you to begin asking questions or start gathering a list of questions so you can have them answered when you meet. It should go without saying that there is no question that is out of bounds. While this may be a first for  you, it’s not for your cremation provider. They will be able to answer most everything, if not, they will know what direction to point you in.

  1. Share service options

There is no such thing as a “simple cremation”. The definition of a cremation service has a very broad range.  Don’t be offended when you are asked, “and what does a cremation service mean to you?” or “what does that look like to you?”.  Why? In the funeral service profession, a cremation service or simple cremation has many different meanings depending on you talk with. To give you an example, listed below are the many types of cremation service offerings that most places provide.

  • A no-cost cremation option
medcure-fb-profile-pic
Medcure – A no cost cremation option.

Many cremation providers work with a company called “Medcure”. This is a third-party organ harvesting company who will pay the funeral home for their services and sell the harvested organs for profit. If a family  agrees to this type of end disposition, the remains that are left after harvesting, are then cremated and returned to the family. The advantage to this type of option is that is no cost incurred to the family related to transportation, arrangements and the cremation itself. Medcure does have the right to reject an individual based on the cause of death or condition of the body.

  • Body-Donation

A body donation to a teaching university is often confused as a cremation option. When a body is donated to science, after a period of time, the unused body parts are cremated and returned to next of kin.  It’s important to understand two things about this type of cremation option.

  1.   There are costs involved – this typically is not a “free” service.
  2.   A body can be rejected; therefore, the family must have a backup option.
  • Cremation with the body present for viewing. (Commonly referred to as a Rental Package)

    Oak "rental casket" with insert
    Oak “rental casket” with insert

 Many families who prefer the aspect of a “traditional service”, meaning viewing of the body, a visitation and a service often select this. The only thing that is different about this type of option is that instead of the deceased being buried in a casket at a cemetery, they are cremated after the service. The advantage to this is cost.  It’s referred to as a “Rental Package” because the casket itself is can be reused multiple times. There is a container  inside the casket, that contained the body. It’s removed and cremated with the deceased. When choosing this option, the next of kin must give permission to embalm. Why? When there is a public viewing can become a health and safety issue.

Being buried in a casket at a cemetery, they are cremated after the service. The advantage to this is cost.  It’s referred to as a “Rental Package” because the casket itself is can be reused multiple times. There is a container inside the casket, that contained the body. It’s removed and cremated with the deceased. When choosing this option, the next of kin must give permission to embalm. Why? When there is a public viewing it becomes a health and safety issue.

  • Memorial Service / Gathering

This is when there is a service and or gathering for the deceased without the body present. This provides a time for sharing and celebrating a life lived.

  • Immediate or Direct Cremation

This is exactly what is say. There is no service provided and the body is cremated after meeting with the family.

  1. Adhere to the Federal Trade Commission requirements.

ftc

In the arrangement conference, before any discussion of price can be addressed by the funeral home, it is required by the FTC that the director/arranger present what is referred to as a general price list. This usually will come in two forms.

  1. A menu looking version that itemizes each service and product
  2. A packaged price version that already is bundled.funeral-rule
  3. Gather the required information and signatures for permits and certificates

This is the most critical portion of the arrangement conference. All information is gathered now becomes a legal document. This information must be accurate the first time, to generate a death certificate and cremation permit in a timely fashion. These documents literally drive everything!

  1. Explain the cremation process.

Cremation doesn’t just happen. There are numerous checks and balances that must take place before the cremation can occur. If any of the processes are not completed, the cremation can be delayed. Know that you have the right to physically be present to witness the cremation process. If you aren’t offered this opportunity – just ask. Transparency is everything! At minimum ask the following question, “Who will be conducting the cremation?” Why? Many funeral homes outsource the cremation to a 3rd party provider. This is not a bad thing, but you should know who will be conducting the cremation and where they are located. If you want to be present or want to tour the crematory this should be arranged. If there is any hesitation, you have the right to select another cremation provider.

  1. Set the expectation when the cremated remains will be returned and to who.

As discussed above, there are standards and protocols that must take place before a body can be cremated.  Once the cremation is completed, not just anyone can stop in and pick up the cremated remains.  In today’s world with blended families, it’s imperative that the funeral home know who they can release the cremated remains too. Just because you are a son, sister, mother or father does not give you the legal authority to have an individual released onto your care. If the remains are not to be returned to the immediate next of kin/informant – you will be asked who the funeral home can release the remains too. The same goes for the separation of ashes and distributing them to friends or family members. The funeral provider must have the names and the written consent to separate the cremated remains.

  1. Discuss payment options

Once all the above steps have completed, now is where you are asked how you intend to pay. Most places expect payment in full upfront unless the service was pre-paid, or the family produces an enforce life insurance contract and assigns it to the funeral home for them to receive payment first with the balance remaining sent to the policy beneficiary. If you are unable to handle this – now is the time to speak up! Do not leave without talking this through. A good funeral home will work with you, however, there are some fees that must be paid up front. Many times, the funeral home must pay out of their pocket and front costs for the permits and even the crematory.

In closing, the average cremation arrangement conference at minimum is an hour if you are sitting face to face, sometimes longer. If you complete the biographical information online, it will save some time, but remember everything becomes a legal document and if your intent is to save a few nickels, we want to get the information right the first time.

Please follow my blog “Ask Jodi” at www.jodiclock.com. Here you will find trusted answers that revolve around tough topics for end-of-life issues for people and pets.

If you found this helpful, please download an expanded version of the “The 7 Step Cremation Process ” .

Out of Town Cremation Companies Take Advantage of Customers – Know the Difference!

Out of Town Cremation Company Takes Advantage of Customers –  Know the Difference!

The following is a true story. You will read about one family’s experience that thousands of people across the country who want a “simple” cremation fall victim too. The names of the family have been changed, however the story was not embellished. (The name of the business misleading the public has not been changed.)

Funeral homes are left time and time again picking up the pieces for families who make well intended choices without understanding what’s involved. After reading this, please go to my website jodiclock.com and download my free e-book 5-legal-requirements-before-cremation

Hands of two elderly people isolated, senior couple holding each other's hands

Sam died peacefully at home under the care of hospice on a Sunday morning. His wishes were to be immediately cremated and returned to the family for burial at a future date. Having grown up in the great depression, he was adamant about spending as little money as possible for a cremation. Written Instructions were left requesting his family not spend money on an obituary, memorial service, flowers, even an urn. His intentions were to ensure that his wife of 65 years would have enough money to live comfortably. Together his wife Mary and their seven children agreed to honor his final wishes.
The day that Sam died, their oldest child Karen began price shopping for a cheap cremation. Like most baby boomers, she turned to the internet. The keywords used in the search engine were “cremation providers in my town.” As you would suspect, after the paid ads, all the area funeral homes appeared, followed by a list of “non-funeral home” cremation society imitators wcallcenterelite_hero_458x353v3ho not only advertise on low price, they give the appearance of being local.
Therefore, if price is the driving factor and the service appears to be local, the average person would make the assumption that this service provider was the solution for their situation. After all – how difficult could a “simple” cremation be? Or so you would think. Here in lies the problem.
Karen chose to call Heritage Cremation Provider based strictly based from their website. She called what appeared to be a local phone number. What she encountered on the other end, unbeknown to her was a call center that was re-routed someplace else. The voice on the other end of the phone took the necessary information and shared that they would get back with her regarding when to expect someone to come pick up her father. In the meantime, she was told that they would need signatures from all of Sam’s children on a cremation authorization before the cremation could take place. The form was to going to be emailed to her.
Once Karen hung up the telephone, Heritage Cremation Provider began calling all the local funeral homes trying to negotiate a price for in our profession is commonly referred to as a “trade call.” A trade call is when a funeral home that was not originally contacted by the family, is subcontracted by a funeral home out of town or a death care provider to:
  • make a removal.
  • file the death certificate to become the funeral home of record.
  • if requested to embalm or oversee the cremation.
By federal and state law it necessary to have a funeral home/director be accountable for the above responsibilities.
Heritage Cremation Provider then hired a local funeral home and called the family back. They said someone would be there within the hour to pick up their father. Shorty a removal team arrived at the house and brought Sam to the contracted funeral home’s care. (Let me be clear -the funeral home had no conversation with the family)
Karen didn’t understand the paperwork and Heritage Cremation Provider could not answer her questions satisfactorily over the telephone.  This communication debacle resulted in a two-week delay of Sam’s cremation. With no success, the contracted funeral home on a daily basis called Heritage Cremation Provider trying to obtain the information necessary in order to get things done. Finally, after 14 days the contracted funeral home demanded that Heritage Cremation Provider give them the family’s contact information as they were going to take matters into their own hands.
The contracted funeral home’s director was able to reach Karen and discovered that Sam was married and had a surviving spouse. The director explained that by law, the surviving spouse is always considered to be the next of kin, unless there was a pre-appointed funeral guardian assigned prior to death. This provided relief for Karen as she was trying to reach all six of her siblings to sign the cremation authorization. It was abundantly clear that Karen was angry and distraught, so the director asked her when she and her mother could come to the funeral home, sign papers and talk.
Before the end of the day, Karen, along with her mother and another sibling, walked through the front doors of the contracted funeral home. Within minutes of sitting down with the director, the family began launching questions fast and furiously. Rightfully so, their emotions were running high and was fueled by grief and fear from the unknown.
Karen hadn’t slept in days. She was having nightmares about where her father was, let alone how he was being care for. The visions in her head were those of a bad B rated horror film. No one understood why cremation hadn’t taken place after 14 days. After all, this was supposed to be a “simple” cremation.
In a very gentle, but matter a fact manner, the funeral director addressed each concern the family had. The family’s biggest fear that Sam was not being cared for with dignity. No matter what the director said, they could not hear the answer between the sobbing and morbid visions they had in their head.
In order to gain control of the situation the director had to address their two major fears. The first being the visual of Sam decomposing in some back alley and the second, that the cremated remains that they will now receive back will not be his.
At this point, it’s not about finishing a “trade call” and gathering the right information to see the cremation process out. It’s about doing the right thing for two very important reasons: to provide the family the peace of mind necessary for them to begin to heal and showing the family that there are honest death care providers.
The director asked the following two questions:
  1. Would you like to see Sam and say a final farewell?
  2. Would you like to be present and witness his cremation?
By offering those two simple acts, the family’s anxiety level began to decrease. The family was apprehensive about what they would see and once again had numerous questions. The director explained that whatever they are envisioning, is not what they are going to see. Educational information was shared about cold storage and how it preserves a person’s body. The cremation process itself was explained from A to Z. They were told that their involvement could range from simply being present, witnessing Sam physically being placed in the cremator or even pushing the button to start the process.
The family wanted to see their father. After few minutes, the director escorted them into a visitation room where Sam had been placed. The funeral home’s care team, closed his eyes and mouth, combed his hair and placed a pillow under his head and a blanket over him. Why? Because that’s what a funeral home does. Funeral directors know that if there is visually, there was nothing to fear the family will start to heal.
The family spent about 15 minutes privately with Sam and then thanked the funeral home profusely. They said they did not want to be present when the cremation took place. They just wanted to know a “when” it would occur. When the director asked why they did not want to witness after everything they had encountered over the past two weeks. Both Karen and Sam’s wife said that they trusted the funeral home.
Sad WomanBefore leaving ing, Karen completely melted down and was asking for her family to forgive her for choosing Heritage Cremation Provider. She expressed she had no idea what all was involved in a “simple” cremation, nor did she realize the value a funeral home and or funeral director. She just wanted to follow her father’s wishes and not overspend. Her family was more than understanding. They made all the same assumptions. After all – the media and many other uninformed mediums portray funeral homes and funeral directors to be salesmen who prey upon families in their weakest time.
In retrospect, who is preying upon families at a weak moment? A low cost provider who over promises and under delivers or a funeral home? One could argue that this is an isolated situation. Facts, reviews and a little detective work will prove that this is more the norm than not.
Yes, death care is expensive, but if you work with a reputable funeral home it doesn’t have to be unaffordable. Well regarded funeral homes will work with families so they don’t overspend.
Think if it this way, you don’t have surgery without meeting your surgeon. You certainly wouldn’t leave your child with a daycare provider you didn’t interview or visit. Please, don’t entrust your loved one’s final care with a funeral/cremation provider that does not have a physical facility locally or have a professional who you can’t talk to in person. Transparency is everything! Like anything else, “If it’s too good to be true, it probably is!”
Please go to my website JodiClock.com and download my free e-book 5-legal-requirements-before-cremation

5-legal-requirements-before-cremation

Saving Gray

 

Meet Gray, otherwise referred to as “itty bitty kitty”! He was just hours away from death due to the fact that his pet parent died without having a pet trust or pet protection plan as a part of their estate plan. Gray’s story is not uncommon. Fortunately, the eldercare attorney overseeing the estate believed in rehoming abandoned animals.

Gray is a feral kitten that was born in an outdoor shed just about the time his owner died. It was estimated that Gray, his mother and siblings lived with minimal food that was in the shed, rainwater and endured days of 90-degree heat. Prior to the mother cat giving birth, it was estimated that there were about nine other feral cats that lived on the property.

After the owner died and before the funeral, the owner of the home’s two adult children got into a heated discussion.  They were arguing over what to do with the deceased mother’s indoor dog as well as the many indoor cats. One child wanted to euthanize the perfectly healthy dog, cremate it and then bury it with its owner.  The other child wanted to take the dog but was unsure if their spouse would agree to bringing another pet in the home.  They knew that their mother had been working with an eldercare attorney and had made the attorney the executor of the estate. The two decided to consult the attorney to see if any instructions were left on what to do with the pets. There was not. Fortunately, the attorney’s internal compass felt that just because the pet parent died, the dog nor the rest of the animal’s lives should not end.

Since, no arrangements were made for the pets and the children were unable to care for them, decisions had to be made and a plan had to be put into action acutely.  One child’s spouse agreed to care for the dog, but was not willing to acquire any of the other animals.  They did however agree to leave food and water out for the cats until arrangements could be made.  Later that day I received a call from the attorney who was looking for recommendations on how to re-home the cats. The good news is the county where the deceased resided has both a feline no-kill shelter, as well as a rescue that is dedicated to helping feral cats. The bad news is that this type of rescue/rehoming situation, is not what is considered to be an “owner surrender”, meaning the owner knows the health history of the animals and had made arrangements to bring the pets to the facility.   First, someone from the no-kill shelter would have to go out to the home and assess the situation.  Second, volunteers who are willing to help crate the indoor cats and bring them to the shelter would need to be found and finally, someone will need to arrange for a trap, spay/neuter & return program for the outdoor cats.  All of this takes money. Fortunately, it was mutually agreed upon that the deceased’s estate would cover the cost through a charitable donation as a part of the estate settlement.

So, what does it cost to rehome, trap spay/neuter and return? More than you might think! While each situation is different, there are some fixed costs as well as information that must be taken into consideration. Before we toss out a dollar amount, here is the very basic information that will need to be known regarding the animal itself.

  • Type of animal (dog, cat, bird, horse…)
  • Breed
  • Age (estimated)
  • Overall appearance or health of animal
  • Animal’s behavior or demeanor
  • Indoor or outdoor
  • Domestic, feral

This information will let the rescue know if the pet can tolerate a foster home, must be quarantined or can reside at the shelter and finally need veterinary care.  It will also help with the qualities necessary to rehome. If a pet is not good with other pets or children – this situation can be avoided.  If the animal is declawed or has been an indoor companion only, being rehomed to a barn or spacious indoor/outdoor living area is not a good fit. As you can see, there is much to take into consideration when rehoming a pet.

As a society, we place much thought into what kind of pet we bring into our home.  We make arrangements for pet sitters when we travel. Pets are taken to the groomers and vet clinics on a regular basis. Heck some of us even arrange for pets to attend daycare for socialization. These are just the tip of the iceberg regarding costs associated with the responsibility of being a pet parent.  We do this willingly and out of love.  As a pet parent, don’t we owe it to our pet(s) to ensure that their lifestyle is not compromised or ends, just because ours does. Sadly, in most states pets are considered property and don’t have rights.  Fortunately, this is starting to change. Until then, please consider establishing a pet trust when creating an estate plan or discuss this with your family make a plan. Please, don’t assume that everyone feels the same way about your pet as you do. Through thoughtful planning, you can ensure that your pet will be rehomed and loved, therefor not going to a kill shelter.

 

 

 

 

6 Rules to Follow When You Go to The Emergency Room

There are 6 important things a person must remember when being taken to the emergency room or having any form of medical treatment.

The story below is true.  All I could think about during my encounter in the emergency room was, if I was feeling this way – what were other people thinking or enduring.  Friends – I can’t express to you enough, you and you alone must be your own patient advocate. The more informed you are, the better your care and recovery will be.

Six
6 Rules to follow when going to the emergency room

After a falling out of a golf cart in a very random accident, I ended up a patient at the emergency room in South Haven, MI.  Outside of my ego being bruised, a bump on the head, miscellaneous cuts and bruises my right ankle had been severely sprained. After much ice and elevation, I came to the realization that I could not place any weight on my right foot, nor could I drive home. After calling close friend to come get my car, we went to the emergency room. The fact that it was a Friday night, didn’t help the situation.  After getting checked in and maintaining a sense of humor while waiting to be scene, about forty-five minutes later I was wheeled to an examining room.

A half hour later a nurse came in to take my vitals and re-confirmed my initial statement upon registration.  A few short minutes later, the doctor came in to see me.  He had a good bedside manner, was very approachable and listened.  He too agreed that an x-ray should be taken of my right ankle, just to be sure there wasn’t a stress fracture. He felt confident that nothing was broken.  Another half hour later I was then transported to the x-ray room.

The nurse who wheeled me from my room began to follow their standard operating procedures by asking me my name, date of birth and social security number. She then went on to ask me what I was here for. I answered to have my right ankle x-rayed.  She then corrected me by saying that the doctor wanted my left wrist x-rayed.  I responded that was incorrect.  We then went through the name, rank and serial number routine again to make sure she had the correct paperwork. Same end result. I asked her to contact the doctor as I refused to have an unnecessary x-ray.

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South Haven MI – Emergency Room Entrance

I wasn’t trying to be argumentative, I was not going to spend money regardless of insurance for a test that wasn’t necessary. Her response was, I’ll gladly do this, however it will be at least another half hour or so until the order is changed. At this point, my patience was wearing thin and I asked her to get her supervisor or the doctor immediately.

The supervisor came, realized someone had checked off the incorrect boxes, walked the paperwork over to the doctor for an amended signature and in less than twenty minutes the error was rectified.  The young nurse then said, “Okay – you can now walk over to the table and hop up for your x-ray.”  I looked at the nurse and said, “If I could walk, I would not be here”.  Her response was, “I’m a student, what do you want me to do?”  I answered, “Then let’s use this as a teachable moment.  If a person can’t walk over to the table on their own, don’t you think it could be helpful to roll the wheelchair as close to the table as possible and help guide the person out of the chair and on the table?” She replied, “Oh, nobody told me that!”  At the risk of being snarky – really? Did the vice president of common sense leave the building? She kindly rolled the chair next to the x-ray table and stepped away, with no offer to assist me. Fortunately, I was strong, healthy and alert enough to shift my weight and slide myself onto the table. The correct images were taken and the same non-assistance of getting back into the wheelchair was provided. I made the

IMG_7358 (1)
Right Ankle – Jodi

decision not to create a “teachable moment” to calmly provide feedback with the student, as it was clear she was not in a receiving mode.  I was returned back to my room with the expectation of having to wait for yet another hour. Much to my surprise, the doctor within 10 minutes entered the room and shared it was good news, no break and just as we suspected a very bad sprain. The prescription, ice, ibuprofen, ankle taping, an air cast and crutches. Sleep, elevation of the ankle and minimal weight on my leg. Before the doctor left, I voiced my concerns about the student nurse. He graciously listened and even acknowledged my concerns but I didn’t leave feeling confident that the feedback loop would be used for improvement.

I’d like to say that my experience was an isolated incident. Regrettably, many other community members have said they fear this health care system’s emergency room has come to accept mediocrity.  Many went on to say that they now drive an hour away for emergency care. Bottom line, there are so many variables that transpired during my single experience that are unacceptable.  Why would a health care system expose themselves to avoidable errors that could end up in lawsuits?

The only short fix that I see is encouraging everyone who goes to an emergency room have a patient advocate with them every step of the way. Ask questions, don’t assume each person you come in contact with is familiar with your case. Refuse a test if it doesn’t make sense to you. Ask to speak to someone else if you aren’t getting the information you need. If you don’t have a family member who will go with you to act as a second set of eyes and ears, ask a friend or neighbor. Don’t be shy. Don’t assume you are being an inconvenience; you can return a favor another time.

If closing, if I hadn’t been of sound mind, I would have:

  • had the wrong x-rays taken.
  • more tests charged to my insurance company.
  • a longer stay.
  • and possibly even more injuries due to lack of physical assistance.

Please, never be afraid to speak up and ask questions. No one cares about you and your well-being, let alone knows your body more than you!

speak up