Q. What are end-of-life doulas?
A. End-of-life doulas (EOLDs) provide a broad range of non-medical, holistic support and comfort to those preparing for or experiencing end of life. EOLDs come from a variety of backgrounds and experiences with a shared desire to educate, guide, companion, and assist the dying and their families/carers in myriad ways. People who desire such support may engage with EOLDs as early as initial diagnosis, or as late as the beginning of the active dying phase or even after death, if bereavement care is what they are seeking. Although there is no difinitive list of services offered by EOLDs, they generally include several of the following: education and guidance; practical/logistical assistance; emotional, social, and spiritual care--before, during, and after a death. EOLDs may provide informational resources, hands-on comfort measures, respite, facilitation, advocacy, and many other services. Not all EOLDs offer the same modalities or expertise; if an individual or family desires services that they cannot or do not provide, the EOLD endeavors to make referrals and help locate needed resources. Above all, EOLDs seek to help those dying and their loved ones achieve an end-of-life experience that is as meaningful, peaceful, and well-prepared as possible for all involved. Learn more about the EOLD Scope of Practice and Codes of Ethics.

Q. How are they paid?
A. EOLDs are compensated for their services is varying ways. Some are paid by the hour, some offer a sliding scale, and some make other arrangements depending on types of services provided, whether they are on-call, staying overnight, traveling great distance, or other concerns. Some EOLDs don't charge any fees for their services, but instead provide support in a volunteer or pro-bono capacity. In most cases, the individual or family contracts directly with the EOLD; however, as more and more hospice and palliative care organizations are utilizing doulas, this may vary. At this time, we know of no third-party reimbursement for EOL doula care.

Q. How do EOLDs train?
A. Many EOLDs obtain their training through an EOLD training program, of which there are many in the US and elsewhere. Some training programs are offered on-line, some are solely in-person, and some are a hybrid of both approaches. In addition, there are EOLDs who have obtained their training through other end-of-life related educational offerings, hospice volunteer training, or through practical experience by serving in their community for years or by working in other related professions. An individual EOLD may choose to obtain the NEDA Proficiency Badge, based on NEDA Core Competencies, to assess whether his or her knowledge and skill is comparable to other EOLDs that meets an agreed upon standard. However, this is voluntary. Please note: NEDA does not accredit or evaluate any individual EOLD training program. Some training programs fully prepare EOLDs to take the assessment and obtain a proficiency badge, while others may not address all of the core competencies established by NEDA. Please inquire about this before taking training.

Q. If I am a birth doula, can I be an EOL doula?
A. Certainly. Those experienced in the Doula Model of Care, as developed by birth and postpartum doulas, are very well-equipped to become EOLDs, and many have made this career change. However, even though there are similarities, families at the end of life have very different needs that the doula should become familiar with. We recommend additional training and experience for those birth doulas who wish to become EOLDs. 

Q. What do students learn in the average training?
A. Trainings vary widely. The general categories of doula training include knowledge of: scope of practice, HIPAA requirements, hospice conditions of participation; communication skills, personal and professional boundaries, needs assessments; the doula model of care, hands-on, non-medical comfort care modalities, self-care; the dying process, legacy and life review; developing community resources; multicultural awareness/diversity, equity, inclusivity, and justice, vigiling; respite care, immediate after-death care; and bereavement. Throughout, doulas learn how to recognize and address the physical, emotional, and spiritual needs and desires of both the patient and the caregivers within the end-of-life doula's scope of practice. Look here for more on how to choose a training program; what training entails; and for a listing of training opportunities.

Q. Is licensing or certification available for EOLDs?
A. Licensure refers to being granted permission to legally practice or work in a profession that is tied to legislation on a state-by-state basis. There is no national, regional or state governing body that oversees EOLDs, and standards of practice. In the current field of EOLD practice, licensure is not available and therefore not required for end-of-life doulas to practice in any state. In other words, the practice of end-of-life doula is unregulated. This means that anyone can call themselves an end-of-life doula. The term "certified" generally means that one has obtained a certificate of completion from one of many trainig programs available. It is up to the individual or family to discern whether a doula is right for them or not. Look here for more information about how to select an end-of-life doula.

However, because there is no overseeing or accrediting body that licenses or certifies EOLDs. NEDA has developed and advocates for practical standards and practices as outlined in a doula model of care, scope of practice, code of ethics, as well as a carefully constructed Proficiency Assesssment Process for EOLDs who wish to obtain a NEDA proficiency badge. This "micro-credential" helps families, hospice agencies, and doulas know that a certain standard has been met. Look here for more on certification and proficiency badges.

Q. What is the Doula Model of Care?
A. According to Patty Brennan, one of NEDA's founding members and author of The Doula Business Guide: How to Succeed as a Birth, Postpartum or End-of-Life Doula, 3rd Edition, any model of care "broadly defines the way services are delivered. It outlines best practices for a person, population group or patient cohort as they progress through the stages of a condition or event. It aims to ensure people get the right care, at the right time, by the right team and in the right place." The Doula Model of Care defines appropriate end-of-life doula practice in service to the dying, their families, and others in their ambit.