One of the primary areas of focus for an end-of-life guide is exploring life meaning through personal reflections that help a dying person and those close to them look at what has been important to that person over the course of their life. We’ll explore what they have learned, the values they have come to hold, their impact on the people they have lived among, and what they consider to be their legacy. I will support a dying person and loved ones in extracting from this activity/discussion the material they might want to use in creating a remembrance/legacy project. This project may reflect who the dying person has been and the impact they will leave behind on people and their community. Such a project could yield a video, a scrapbook, letters to loved ones, etc.

A dying person may be alone or without family and friends for a significant portion of their day. For these clients, I offer companionship and Comfort Touch (a type of gentle acupressure on the hands and feet, often used to help reduce anxiety, relieve pain, and offer a physical connection for a dying person). During these visits, the dying person may choose to discuss their end-of-life process, ask questions about what lies ahead, share fears or worries about their journey, or share how they think their loved ones will deal with their dying. Other times, the dying person may simply appreciate the company of a caring person who can address their needs, listen to their stories, or simply offer silent companionship. I also offer respite visits to allow primary caregivers to get a break, rest or address other needs or obligations unrelated to the care of their loved one.

I will help the dying patient and/or their loved ones plan for the care of the body after death. Some plans may include a ritual of gentle washing of the body with natural products, anointing with oils, and dressing of the deceased. Other plans may be structured to engage a natural funeral service or a traditional funeral home or mortuary to care for the body. Most plans will include specific details related to post-death body care, a memorial or remembrance ceremony, and burial or cremation intentions. I will help the dying patient and/or their loved ones understand their options, document their wishes, and assist in overseeing the execution of their intentions.

I will help the dying person and loved ones plan for the last days of life. This involves reviewing and explaining the choices they have regarding where they want to die, how the space is to be set up around them, the kinds of interaction they want with loved ones, caregivers, and others, as well as the kind of sounds, readings, smells, light, and touch they would find comforting and helpful as they go through the dying process. If there is conflict between the wishes of the dying person and their loved ones, I will advocate for the primacy of the dying person’s wishes while exploring ways to support their loved ones. Prior to and during The Vigil, I will inform loved ones and caregivers about the signs and symptoms of the active dying process and imminent death, discuss how and when to address these symptoms, and what to expect as the process unfolds.

When the dying person is in the last days of life – the time often referred to as the “vigil” or “active dying phase”, I will attend to them and those around them in ways that reflect their wishes. My primary focus at this stage is maintaining and advocating for the spirit of a plan they had worked out beforehand. If no such planning work occurred prior to my involvement, I will review the choices and options available with those involved as the vigil begins. I may use sound, readings, comfort touch, guided imagery, and ritual to deepen the sense of meaning and bring greater comfort to everyone involved. While I do not provide any medical care, I may assist in the physical care of the dying person such as assisting in repositioning, adjusting or changing bedding, providing basic oral care, and offering general comfort care. 24/7 support can usually be arranged if it is desired.

Following the death, I will be available to family and loved ones to discuss the nature of bereavement and encourage the processing of some of the emotions grief evokes. I will also refer loved ones to bereavement services offered through the organizations the dying person and family had been involved with or share community resources available to assist in bereavement.