End-of-Life Doulas: A Podcast with Jane Euler, Beth Klint, and John Loughnane

Eric: Welcome to the GeriPal podcast. This is Eric Widera.

Alex: This is Alex Smith.

Eric: Alex, we’re going to be talking about end-of-life doulas. Who do we have on with us today?

Alex: End-of-life doulas. We are delighted to welcome Jane Euler, who is lead doula and co-founder of Present for You, which is a benefit LLC company that provides doula support at the end-of-life. Jane, welcome to the GeriPal podcast.

Jane: Thank you for having me.

Alex: And we’re delighted to welcome John Loughnane who is a palliative care doctor and end-of-life doula and co-founder of Present for You. He’s joining us from Boston. Jane’s joining us for Virginia. John, welcome to GeriPal.

John: Nice to be here.

Alex: We’re delighted to welcome Beth Klint who is executive director of Goodwin Hospice and is joining us from the DC, Northern Virginia area along with Jane. Welcome to GeriPal, Beth,

Beth: Hi.

Eric: Again, we’re going to be talking about end-of-life doulas. I have a lot of questions, because I have never worked within end-of-life doula in my 20 years of doing palliative care. But before we jump into that topic, John, do you have the song request for Alex?

John: I do. It’s Jimmy Buffett’s song, Bubbles Up. It was on his last album. As you may know, Jimmy Buffett passed away in August of a rare skin cancer. When I heard Bubbles Up, I was really struck by two things. One is it is about how to get through hard times. Bubbles Up is following Bubbles Up as the song will elucidate. And then second, I was someone who was a Parrot Head for years and years and it was just amazing how the community came together. That was really the theme song of how the community came together. How do you see the light? How do you move through difficult times in your life? It was, actually, I think, started for veterans and over time it metamorphosized as Jimmy reached the end of his life.

Eric: What was that called? You were a what?

John: A Parrot Head.

Alex: Parrot head, it’s like the people who followed Jimmy Buffett.

John: Translate San Francisco, it’s like Deadheads, right?

Eric: Deadhead, I get it.

Alex: We understand that.

Eric: Back in college, I worked security at a Jimmy Buffett concert and it’s very hard not to get high secondhand on a Jimmy Buffett concert.

John: Let me say this, people are older these days. The last thing I’ll say is I actually saw his very last performance. I happened to go to an outdoor show with his wingman Mac McAnally and Jimmy Buffet showed up for his last time ever in public to sing. He looked very ill. My wife is also a physician and she said he’s dying. I didn’t want to believe it, so I thought it was apropos. Jimmy Buffett was a doula for a lot of people. Maybe not an end-of-life doula, but he was a doula.

Alex: Yeah, well said. Yeah, this is a great choice. I understand it was released after he died and you can tell he was thinking about the end of his life in this song. Great choice. I still have a broken hand, so I figured out how to play this with two fingers. Here we go. Here’s a little bit.

(singing)

Eric: That was lovely, Alex.

John: Yay.

Jane: Yeah.

Alex: Thank you. Fun choice. Thank you.

Jane: Thank you, Alex.

Eric: I’m very apropos of the subject. Let’s jump into end-of-life doulas. Jane, what is an end-of-life doula?

Jane: Right. Right. An end-of-life doula is a non-medical support person that provides a longitudinal relationship with aspects of medical, I mean, aspects of companionship, presence, holding space, some logistics, some practical help, decision making perhaps. All of this really turns into an emotional partnership with someone. We are doulas for those with serious illness and those at end-of-life, just a longitudinal relationship, nonmedical support to provide presence.

Eric: Is end-of-life doula death doula? What’s the proper terminology? Are they the same?

Jane: They are the same. Right. End-of-life doula or death doula. Recently, I was working with a woman who has glioblastoma, young woman, and her mother-in-law called me a brain cancer doula. Whatever works in the situation with just a nonmedical support partner.

Eric: I’d love to hear from each of how you got interested in this, but before we do, Jane, what’s the history? Is this a new thing, end-of-life doulas? Has it been going on for a long time? I know I’ve heard a lot about birthing doulas. Labor and delivery, that’s kind of where I’ve heard of doulas. How long has a death doula or end-of-life doula been around?

Jane: We’re following behind the birth doula movement. I would say 15 to 20 years, death doulas have been around. There’s an organization that I took my training from, which began, I want to say, in 2012. It’s been around for a while. It was started by a social worker who really saw some gaps in care with those at end-of-life, particularly those with chronic long-term illness, having important conversations. We do conversations on goals of care and advanced care planning as well. That overlaps a little bit with the palliative space, so maybe 15 to 20 years.

Eric: Yeah. Wow. And then John, I’d love to hear from you starting off, you’re a palliative care doc, right?

John: I am what I am, which is a family practice doctor. Whenever I take care of a patient, I see myself as a family practice doctor, but I’ve been a hospitalist, I’ve been a primary care doctor, and I’ve done palliative. But in the end, I see these as my patients and I’m trying to define what is the right model. I think what really called me to being an end-of-life doula was during COVID and just realizing again and again, which I kind of already knew the limitations of my medical training and my medical interventions, and bluntly how freeing it was not to have the role of a physician walking into a situation where people already have figured out what they need to ask you, what the power differentials are.

During the pandemic, I trained at the University of Vermont, where Jane also went to, to try to figure out how I could be of help and service in a different modality. Even though, as you know, as you go in and your doctor so-and-so which is not what you usually use, it sets expectations, it sets boundaries, it sets limitations. It sets space between us and the individuals we’re trying to take care of. I really found that being an end-of-life doula had a different opening of people’s hearts. I often say that doulas are mirrors. Providers are not providers that people want answers and determinations and decisions. Doulas are reflections. I think that’s a crucial aspect that really drew me to it.

Eric: That’s fabulous. I want to hear more about that, especially that probably hard role crossing between the two and whether or not you have to set up boundaries. But I want to hear from the others first, too. Jane, how did you get interested in this?

Jane: My mother died about 12 years ago. Looking back on it, it wasn’t necessarily… Well, I think it could have been better for her and for me. I was alone with her in the end of a long hallway at a nursing home health center. There were aspects… Look, a few years later I was reading an article about death doulas and I thought, “I should have had someone like that with me.” They could have said, “Jane, why don’t you get into bed with your mother,” which she would’ve loved. That just didn’t even occur to me. Or I should be playing music or I should be… I just wasn’t using the time that I had, which was not much time like I maybe should have. That dawned on me. And then, I did a lot of introspection and realized that I’ve actually been doing this for folks in an informal way, family church members and friends, but I didn’t do it so well with my own mother.

I thought that was an interesting take on doing this, because a mother-daughter relationship can be complicated, can be wonderful, and it’s hard to navigate when you lose your mother. I thought if I could do this for other people, I said, “That would just really please my heart.” I spent 32 years in information technology, would you believe, and switched over to this full time a few years ago. It really has been transformational for me to hold space with people in this time of such emotion and angst and love.

Eric: And then lastly, Beth, from your perspective, you’re not a doula, is that correct?

Beth: That is correct.

Eric: But you are the executive director of a large nonprofit hospice, Goodwin Hospice. Where did you start intersecting with doulas?

Beth: I’m a nurse by training and then, obviously, the executive director. I’ve worked with end-of-life doulas in hospice generally in a volunteer role and usually in hospice at sitting bedside vigil, but having someone a supportive presence. That had been my experience. And then, I met Jane and we were just talking about healthcare in general and how we have patients who are losing their loved ones and how mind-blowing it is that they’re losing a partner of 70 years and just what would that be like to watch someone that you can’t really even remember your life without, and how the healthcare providers, we come and we provide support… We are there to meet the needs, but then once the needs are met, we need to move on, and sometimes the needs are just not being alone and having someone to be able to be there. Healthcare, just the way healthcare is structured, that’s not something that’s feasible unless there’s a specific symptom management need that allows for more care, but just to provide simple care doesn’t exist. Wouldn’t that be lovely if we could support our staff so they could feel like their resident or their patients would have that support, should they need it since we weren’t able to provide that kind of support?

Eric: I got to ask the question then. What’s the difference between end-of-life doula and a hospice volunteer?

Beth: It depends on the volunteer. Hospice volunteers do lots of things. They’re not all end-of-life doulas. Many of them are companions or do shopping or will come and read. Volunteers can do any sort of thing, have therapy dogs… We have volunteers that do a lot of different things, but an end-of-life doula and hospice is meeting a need. The struggle that we had found is that volunteerism, you’re totally relying on volunteers and that’s based on availability. Needs don’t come up when available; needs come up when they come up. Having a partnership with someone that made sure we’d be able to provide end-of-life doula services, should there be a need, we have a relationship with Present for You and not through volunteerism.

John: Yeah. I would add, too. Volunteers are wonderful, but I think there’s two differentiations here. One is I talked a little bit about this as a mirror, right? A volunteer brings a service. I think doulas are much more about defining what services are needed and then figuring out how to create the care around that situation. I think that’s crucially important. Two, I do think there’s consistency with the doula training. There’s a consistency of understanding and approach that I think is helpful.

I remember when I first worked with birth doulas at a large West Coast university where I was doing my residency. There were rules a little bit, because the healthcare system likes to have some level of consistency as people move in. To go back to your point, I think part of our goal at Present for You is not to be end-of-life doulas, but to be serious illness doulas, to be able to bridge serious illness to palliative to end-of-life. I think that consistency of what is the expectation of our roles is crucial in a lot of ways, but that role is determined by the individuals we’re serving.

Jane: I actually think that our superpower is that we are not role defined. We can come into a situation… A nurse enters a situation and needs to be a nurse, whereas a doula can enter the situation and figure out where the needs are in conversation with the family.

Eric: This is interesting, because this all reminds me… We did a coaching podcast and part of this came a similar thing is, again, what a coach is may look very different from one coach to another coach. Does everybody get the same training? What does the training look like and is there some uniformity?

Jane: It’s a little bit of the Wild West still.

John: A little bit.

Jane: You are only a certified end-of-life doula by the organization that trains you. There is no licensing or overarching body that oversees this at the current time. I can name probably 10 organizations across the United States where you can get education on being an end-of-life doula and they’re all slightly different. The basic part, the fundamental part is being present, I think, and holding space for people. Some doulas move into the home funeral and celebrant space. Others are more very dedicated to legacy, working on legacy projects and dignity therapy and videos and photo albums and quilts and all of those things. It depends on your niche. Everyone is different. We have one doula who is really well-trained and well experienced in advanced care planning, and that’s kind of her thing that she does. It just depends.

Eric: When I try to think about what a doula does, should I call it a consult? That’s probably too medical. I’m using my medical brain.

John: A partnership.

Eric: A partnership? A visit? What does a typical visit from… Not a visit, but what services can we think are offered by a doula? When should I think of one?

Jane: Beth, do you want to tackle that? What the social workers are …

Eric: Yeah. Beth, from a hospice standpoint, when do you think, “Oh, this person needs a doula”?

Beth: From a hospice standpoint, we obviously have the nursing support, social work chaplaincy. We have volunteers, we have CNAs. We provide a lot of care to someone receiving services from Goodwin Living, but I think what an end-of-life doula does is when we find ourselves really trying to provide, to meet people where they are and walk them through what to expect. We do it through a medical lens and we’re planning for what the needs are, but a lot of times the needs are quite simply just normalizing where you are. It’s not all the medical stuff. That just takes time and being present, and we don’t have the luxury of as much time, unfortunately, as other end-of-life doulas do.

We have to do our assessment, our documentation, all of the things that we need to do from providing good care and then also from a regulatory and to be filling the roles that we’re there providing, and, frankly, what we’re being reimbursed for. And so, having someone that can be present and really meet people where they are and give them the time and the space to walk through what’s happening is something that, unfortunately, we don’t get to do all the time, but having a resource available does take away that feeling of like, “I know there’s a need, but I just can’t give them everything they need, but I have a resource to help me provide that.”

John: To answer to your que-… Everybody deserves a doula. I would invite you as a palliative care provider to think about everybody deserves a doula because there’s no downside. I think that that’s something really interesting, which, again, I talk about that role-based component. When we go in there, we have a job to do, shall I say, however that job is defined. Again, I go back to this. Jane and I have taken care of some folks together as doulas and it’s very different. The role is defined by the individual of what they need and I found that to be the biggest difference. You asked earlier, when I go in, I’d never go in as a doula and a provider. I go in as a doula or a provider and it’s turning off the medical brain. I go in as a provider saying, “Tell me what’s going on,” I synthesize it as I’ve always been trained to do. As a doula, I don’t synthesize as much. I try to open myself up to understanding what their needs are in essence and not bringing any of my brain. I really do mean this. It’s like my brain’s there, but I want to hear what they are so I can reflect back and say, “What is going on? Tell me how you can help. Tell me how I can help.” Broadly defined, right?

Eric: Must be hard, though, John, because you probably go into situations where something triggers your medical brain, that fix-it mode that doctors are often trained in. “Problem, fix it. Problem, fix it.” Do you have a hard time separating that? What happens when you’re in someone’s home and they need a doctor?

John: Remember, I’m a hospitalist. I learned a long time ago how to let it go.

Jane: But Eric, we have come to the conclusion that John is a better physician than he is a doula, so there you go.

John: But the doula component has helped me be a better physician. I think what it is… You asked a really good question. I’ve done this recently is how do I defer it and get back to the licensed providers taking care of the patient with nonjudgmental suggestions? You can go in there and say, “Hey, listen, I’m working with this patient as a doula. This is what I saw and heard. No recommendations, but this is what I saw and heard.” I think the family would like you to consider how to work with that.

Eric: Yeah, that’s interesting because a lot of doulas, too… Well, not a lot. I’m guessing some, because I’ve read a lot of articles, are social workers and nurses, past hospice nurses. It’s not just like your boundary, John, but I’d imagine setting boundaries as a doula may be important, especially since summative is relatively undefined. Is that right, Jane?

Jane: Yeah, that’s right. Because I don’t come from a clinical background, so I have a whole different set of language in the way I approach something than someone with a medical background. We know the medical system is fairly transactional. Nothing against the medical system, but it’s kind of transactional. This is not that. This is organic. This is emotions. This is the non-medical part of someone being ill.

Alex: Jane, one thing that I didn’t hear as much when people were saying, “Who is a doula for? What’s appropriate? What are the triggers to start thinking, ‘Oh, we should try and get a doula involved?'” One thing I didn’t hear was prognosis. I wonder, is this only for patients in hospice? Is this for patients who are at earlier stages who have longer than six months left to live?

Jane: Yes.

Alex: Yeah. Are there triggers there that our listeners should look for and think about when they’re thinking, “This might be a situation which we should call in a death doula”?

Jane: Right. If you’re having angst about a new diagnosis, if you aren’t getting answers that you need, if you need an advocate, if you need someone who’s been in this space before, if you’re having family conversations that aren’t necessarily going well with respect to treatment and looking at prognosis, bring in someone who can bring the group together. I often think that bringing an outsider in helps the conversations that I have with a loved one that may be entering a serious illness or may be dying. Can open up in ways that maybe they can’t to their daughter. I think anytime there is… Well, actually, I think everyone deserves a doula, but if you’re going to be recommending, I would say when there is gaps, there’s care that needs to be given from the human aspect and not the medical, and that could be anything from just advocacy or conversations.

Eric: Alex, I’ll ask you as we’re doing the dinner table conversation. How do you know someone’s going to die in six months anymore? Our folks all die of congestive heart failure and dementia, even oncology diagnoses with new immunotherapies like the old days. I’m aging myself a little bit. I’d love to ask you and Eric. When do you think you need that level of support? At what point were you engaged with the patients either as a geriatrician, primary care, or a palliative care or hospice? Where you think that extra layer of support with a human focus is most helpful?

Alex: Yeah. Well, I’d agree, John, for palliative care ideally starts around the time of diagnosis. That’s where we have the largest evidence base for palliative care in the outpatient setting, in the setting of serious illness around the time of diagnosis. I don’t know what evidence exists for doulas, another question I’d love to ask. We’re talking about death doulas, right? That’s the name of the podcast. Death doulas or end-of-life doulas, right?

Eric: Yes.

Alex: That is not around the time of diagnosis. It’s not like serious illness doulas. It’s death doulas, end-of-life, doulas.

John: We’re all dying, Alex, slowly.

Alex: Right. Well, that is part of the question, right?

Eric: Yeah.

Alex: Death in the name or end-of-life in the name, isn’t that a barrier to-

John: Yes. Yes. Yeah. We don’t want to be death doulas. We want to be serious illness doulas.

Jane: We have had this conversation a million times, Alex, about what to really call ourselves, because we want to be effective and helpful in a longitudinal relationship beginning at onset of serious illness, because I think there’s value there is just getting the word out. People don’t know that this is a resource. I think this came about with this whole death positive movement that you may have heard about.

Alex: Death Cafe, right?

Jane: I’ve done many Death Café and all that. There’s a funeral director down in Southern California, Caitlin Doughty. Have you run into her? She’s credited with this death positive movement. But I think the baby boomers of which I am one, we don’t want to die in the medical way that our parents did. We want some other things. We want to talk about meaning, bringing meaning to it, actually bringing some intention to the end-of-life space, which has traditionally been just medicalized.

Eric: Let me ask this. We talked about how far before death end-of-life doulas come on. We also hinted at their stuff that end-of-life doulas do after death. How does that… I mean, we talked about the differentiation between palliative care and hospice and end-of-life doulas. What’s the difference between funeral home directors, mortuaries, and end-of-life doulas?

Jane: Right. There’s licensing things that go along with being a funeral director in a funeral home. Present for You, currently we work with a funeral home and so does, actually, Goodwin Hospice. The same woman-based owner of a small funeral home here. She’s also a celebrant and she can be called in and we work with her a lot, but you can be certified as a celebrant and some doulas are absolutely doing that. That’s getting a little off-topic because that’s after death, but I think with what doulas do is reprocessing and helping with some grief we can. With Goodwin Hospice patients, not as much because they have that support from the bereavement group at Goodwin Hospice. But our direct to consumer or our private pay, I’m doing follow-ups quite a bit with just reprocessing what happened. It’s a story, and the story likes to be told again and again. For that story to be not so horrible is what we try to do, because the people that are left, the family who are left are going to tell the story again and again and again. We help with that.

Eric: John, you mentioned everybody should have a doula. There’s no downside. I’m going to push back. There’s always a downside to everything that we do. The one that I can think about is there’s always time. Even a hospice volunteer, there are downsides because now you got to train hospice volunteers. There’s always some sort of downside. Who pays for end-of-life doulas?

John: Yeah, that’s a very good question. I’d love to get Beth’s two cents, so I’ll give you why I was also drawn to the end-of-life doula component. My entire career has been taken care of in primary hospitalists and palliative underserved populations, either dual-eligible, Medicaid, and Medicare or community health centers, so I’ve always worked in that environment. In fact, I worked for senior care options payer-provider in Massachusetts, where I am coupled end-of-life care from hospice back in 2009. it looks a little bit like VBID back in 2009, because I realized that populations are traditionally underserved and have mistrust of the healthcare system. Discussions around end-of-life, death, and hospice are not popular and, in fact, are extraordinarily difficult. The reality is that those folks don’t get enough hospice benefits.

I think everybody should be in Goodwin Hospice at Beth’s services long before they’re at the end of their life, but there are so many barriers among those who have distrust in the healthcare system. The reality is how do you pay for it right now? This is one of the barriers. The reason why we made a benefit LLC was to try to broaden the component of having a representative workforce in communities to open this up to discussions and to open doors to people to talk about this in whatever way they want to talk about it. That will translate into earlier higher quality journey of series to palliative end-of-life.

The primarily way end-of-life doulas are paid in the United States right now are direct to consumer. Someone purchased direct to consumer processing of it and… I’d love Beth, too, on this. We have Beth through… Her organization pays for our services at this point, but in the end, if doulas are truly going to reach their full potential, they’re going to have to find a structured payment system. Birth doulas in a lot of states are now being paid by Medicaid and some private payers. We see a huge opportunity for doulas in general to be based under value-based systems, where their reach, scope, programs, or other controlling factors… We think end-of-life doulas combined with hospice are a powerful way to get patients into more aligned care much earlier, but I’d love to get Beth’s perception of this.

Eric: Yeah. Beth, there was a lot of talk about the value for doulas. What was the value proposition? Goodwin pays for the doula?

Beth: Yes, we do. We pay for the end-of-life doulas through our foundation. We offer a couple of different services or complementary services that are not covered under the traditional hospice Medicare benefit. We utilize the generous donations from our foundation to support the end-of-life doula program.

Eric: I’m guessing there had to be an argument like the value proposition. What was the value proposition? Can you share?

Beth: I mean, I think, for us, why we felt like it was important was a staffing issue. I think one of the things that really spoke to me was the amount of pressure that’s on the healthcare system and healthcare providers in general, especially after the pandemic, and how many people within the healthcare system are still working through the experience of the pandemic and we’re still facing the experience of it. I was really trying to find ways to think outside the box to support our staff and to allow them to be able to do the care that they love, but also to not feel the pressure of the world on them to be able to meet all of the needs, which personally I feel are greater. This was a way that we could offer a support, not only that would provide quality care and better care, but also more patient centered care and also take care of our staff.

Eric: Did it turn out the way you wanted it to?

Beth: I would say yes. I think we’re still learning how to use end-of-life doulas. I think there are times where I think, “Did we think about this?” And someone’s like, “Oh, no, I didn’t.” That’s kind of frustrating, but it’s an ongoing process and I think it’s encouraging people to really identify what your resources are and how can we be creative in how we meet people’s needs using the resources that are available to us. I think having options is a lot of what we try to do is provide options to people for their comfort or for where they receive their care. Options to our staff to be able to provide the care that’s needed was what I was trying to provide. In that case, yes, we did 100% provide more options for our patients that are under our care.

John: We keep metrics, too. I don’t know if, Jane, you want to share some of our metrics, but the next step of this is to find a partner who you could do literally good evidence-based work to figure out how to both quantify and qualify this a little bit, but I think it’d be great to share what we’ve experienced.

Jane: Yeah, we’ve had this contract for a little over a year with the Goodwin Hospice. We’ve supported 87 of their families with 446 encounters. Of those 446 encounters, just about 40 were phone calls. Most are in person. Average time, extra time that we spend with a family is 4.8 hours, and then we have some qualitative measurements that we’ve done. Emotional support was offered in 276 visits and 88 caregivers were provided with respite, things like that. We do have a community care record that we enter in this data and enter in these metrics and we pull out the data to show the impact and the success. But as you know, numbers don’t tell it all. I have awesome stories to tell helping folks. We have one woman we’re supporting, who, when the NP went in to recertify her, he asked her, in one word, what did the doula support mean to her. She said, “Family.” Someone said the doula was like warm air, knowing where it’s needed. That was from a Goodwin patient’s son, I should say.

Alex: It sounds like there’s a need for more evidence in order to justify expansion and policy to cover death doulas nationally or even on a state by state basis or insurance by insurance basis. I have a question about the rule of doulas in states where medical aid in dying is legal. We just did a podcast about medical aid in dying in Canada. We’d previously done a couple other podcasts about medical aid in dying. We’ve had guests with varying perspectives, many probes, some ambivalent, some opposed. No matter your perspective, I wonder what the role is for death doulas, end-of-life doulas in states where it’s legal or territories. I think DC, it’s legal and there’s a proposal for it to be made legal in Virginia where two of you are based. I don’t believe it’s legal in Massachusetts. Thoughts about that, the rule of death doulas in those sort of situations?

Jane: I have supported many medical aid in dying folks in DC as I’m eight miles from the border in Virginia to DC. I believe that doulas are perfectly positioned to be at the bedside with someone who’s doing medical aid in dying. There’s one physician in DC who basically is doing the prescriptions. I’ve got connected with her and we have a really nice partnership. She refers her patients to me when a family believes that they would want a support partner, a doula, in this process. Usually, there’s a couple of meetings beforehand and then the day of their support. It’s gone extraordinarily well. It’s actually transformational for me to be there and to do that with someone. A son didn’t want to be there in the room when she took the drink and I was there. I’ve really supported a lot of awesome people. The people that have chosen to do this, I respect autonomy and dignity at end-of-life, and I’m a full supporter in medical aid in dying. That’s my experience, but I think doulas are perfectly positioned to be a support in that area.

Eric: Okay. We’re wrapping up in the last couple of minutes. I just want to hear as… When you think about doulas, end-of-life doulas, where we are, the nation around this, what are you hoping for? What’s next? I’m going to turn to John first. If you had a magic wand, John, anything around end-of-life doulas, what would you be using it on?

John: I have three things. One is I think they should be included and paid for in IDT teams. I think they have enough differentiation that will be over time that I think they should be part of ID teams and recognizes that. Two, I think doula training should be built into every professional school, medical school, nursing school, wherever people are taking care of folks. I think there should be some aspect of that. In the end, I don’t think you should be worth certifying palliative hospice unless you’ve had doula training, but I’m a little bit on the edge on that. And then lastly, I really do want to find a way to incorporate and get folks who have traditionally not seen hospice as a viable path forward to have those folks they really trust, understand the benefits of Goodwin Hospice and others in a way. I think doulas can lead that effort.

Eric: John, I’m going to push you out a little bit, too, because I am wondering if we think about payment structure for this. If anybody currently can just say, “Hey, I’m an end-of-life doula,” or you take a couple hour course and you call yourself an end-of-life doula, I worry that that may open things up to fraud. We’re even seeing that, obviously, in structured programs like hospice, but if anybody can hang up that shingle, do you worry about that?

John: I do not. I think the market and others will determine those individuals and who they work with. I have faith in the system of the hospices and the individuals to say they’re bringing worth or not. Again, I think it’s one of those issues that… I mean, Goodwin Hospice is not going to bring in people to be hospices in their IDT teams unless they’ve proven their structure and they can follow that. I think there’s that aspect of it. The reality is that there’s someone who hangs up their shingles is not a great doula, but it helps that individual. That works.

Eric: You’re okay with that?

John: I’m okay… Again, this is human-based care.

Eric: All right. Beth, I’m going to turn to you. The magic wand, running out a little steam, just use three times, but it’s got some energy left in.

Beth: I personally think it would be great if we could find creative ways to be able to meet the needs of people who are at end-of-life. That’s, obviously, where my focus is, but people who are faced with serious illness or at end-of-life and really to have more support going through that process that’s not just based on creative thinking, because we’re just not going to have enough staff. I think being realistic about how many people are going to need care and how many people are going to be here to provide care, I think we need to be creative and to realize that there are people with appropriate training that can help meet needs.

Eric: I love the creativity you’re showing, too, Beth. Amazing job. Amazing job at Goodwin Hospice, too. Okay. Jane, you’re the last one. A little sparks left from the magic wand. Yeah. One thing.

Jane: We need to look outside the box. We need to find untraditional workforce to fill in the needs of folks getting older as we age. We need more help, as Beth said. The system needs more help.

Eric: Well, I want to thank all three of you, but before we end, maybe we can get a little bit more Jimmy Buffett.

Alex: (singing)

Eric: Wonderful. John, how did he do as a Parrot Head?

John: Fantastic. He’s going to have his own Parrot Head following.

Eric: Jane, Beth, John, thank you for joining on the GeriPal podcast.

John: Thank you.

Jane: Thank you so much.

Beth: Thank you.

Eric: To all of our listeners, thank you for your support of the podcast.