Wednesday, May 5, 2021

What does an eol doula do?

I still don't know...

The website of the national office of the specialty nursing organization that I pay annual dues to has a new feature - a gated  community for discussing topics - kind of like a bulletin board listerv chat function AIM type thing that you can also read with your email, but you need to sign in if you want to respond, plus there's the dues.

Anyway, someone who is a practicing EOL doula and also a member of the org/community recently hosted a Zoom for anyone interested in meeting up and talking further. It's good to connect with people who share a commitment to serving patients and families facing serious illness and end of life.

I obviously can't share what others have said, but this is what I posted as my takeaway:

My questions about doulas remain, especially in the form of "what's the difference between a doula and a … ?"

  • Geriatric Case Manager, Aging Life Care Specialist, other non-physician referral source 
  • Source of support prior to hospice (psychotherapist, etc.) 
  • Source of support during hospice (adult day health program, etc.) 
  • Hospice volunteer 
  • Hospice medical social worker 
  • Hospice spiritual care (chaplain) 
  • Hospice aide 
  • Hospice nurse 
  • Adult child 
  • Primary caregiver 
  • Etc

I still find it hard to come up with a financially sustainable practice model of independent doula for hire, though that's part of the pitch in the online doula training programs

I also don't understand the reasoning for the claim that hospices will hire doulas - staffing is the highest cost and worst bottleneck in hospice, and I haven't heard anything about what a doula can/will do that addresses that problem.

If clinical staff can't spend adequate time with patients and families, to effectively teach, reinforce, and support them, it's probably because their case loads are too high, and/or they're not competent or adequately supported.

I understand there's a tradition of birth doulas, and have begun to learn more about the role as a complement to midwife and others in the larger context of reproductive justice.

Someone also guided me to this piece about doulas in Yes! Magazine, to help me understand more about the sacred tradition of doulas at end of life - I find there are important differences between what's described here and how the role is being promoted by the likes of NHPCO etc

My questions and skepticism (and alarm) remain - I think the current focus on end of life doulas is a distraction from what's too common in our field, namely crappy hospice resulting from understaffing and the ongoing chaos of frenzied mergers and acquisitions by corporate players buying their way to greater market share with junk bonds and private equity.

Important to acknowledge that two-thirds (2/3) of hospices operating today are for-profit (pdf 'Facts & Figures: Hospice Care in America (August 20, 2020) page 21, figure 22 "Tax Status")****

  1. People are dying
  2. ????
  3. Profit!!

NHPCO is their industry trade group with two goals - less regulation, more money.

Also too online doula training reminds me online yoga - white women appropriating the surface aspects of an indigenous tradition to make money.


*** "Tax Status" is both accurate and misleading - misleading because the operative concept here isn't taxes it's "PROFIT."

"Profit is the money a business pulls in after accounting for all expenses. Whether it's a lemonade stand or a publicly-traded multinational company, the primary goal of any business is to earn money, therefore a business performance is based on profitability, in its various forms."


Thanks for reading, see you next time.