Hospices can benefit from staying abreast of the latest innovations in end-of-life doula care delivery, particularly when it comes to seeing improved quality and bereavement outcomes.

Important for hospices to understand about recent evolutions in doula support is that training for these professionals varies vastly across the country, according to Anna Marie Adams, founder and CEO of the International Doula Life Movement (IDLM). The organization launched roughly five years ago and offers end-of-life doula education and support.

No standardized training or certification programs exist for doula professionals, leaving significant gaps in their expertise and skill sets, Adams said. The issue can create challenges for hospices seeking to collaborate with doulas to improve family support, she indicated.

“The way that doulas’ practice has been integrated into health care has changed over the years,” Adams told Hospice News. “One thing that’s needed is to raise the bar [on] how we are going to change the face of the end-of-life education and care that doulas are providing. Innovations with doulas in the hospice model are helping with community education and debunking misconceptions about these services.”

Doula training takes flight

IDLM’s doula education program includes 44 different training modules. Doulas can specialize in various services such as advance care planning, providing spiritual and emotional support or offering different therapeutic treatments such as Reiki or meditation, among others.

Among the most significant needs that doulas can help address is assisting families in navigating and understanding a fragmented health care system, Adams said. This involves training doulas on the different types of health care upstream of hospice and an overview of the regulatory and reimbursement systems involved, she added.

“The biggest need that I’ve seen is the complexity of understanding and working through the medical system,” Adams said. “Doulas need to know what hospices do and don’t provide, and that advocacy has been big and evolving over the years. There is more awareness taking place of how a doula can help a family manage more complex cases of care and needs, and really navigate and advocate for them.”

Benefits of doula investments

Hospices and other health care providers are increasingly recognizing the value proposition of end-of-life doulas. Doula services were identified as among the top main routes of diversification among hospices last year who responded to Hospice News’ annual Outlook Survey.

End-of-life doula programs have evolved in recent years to include a more diverse range of non-medical services. Some hospices that have layered doulas into their workforce are seeing a return on these investments in various forms – including quality outcomes, retention, care continuity and improving health equity among underserved patient populations.

Among the significant benefits of investing in doulas is that these professionals can help address unmet needs among terminally ill patients and their families, according to Elwood Hungarter, CEO of Center for the Heart. The organization provides end-of-life doula services and bereavement care in New Jersey, New York and Pennsylvania.

Center for the Heart partners with IDLM to provide end-of-life doula and bereavement services, education and training, as well as community outreach. Through the partnership, the organizations have created a training model for doula professionals that also offers employment opportunities at Center for the Heart.

The collaboration with IDLM has made a significant difference in terms of building a pipeline of trained doula professionals to support a growing population in need of grief support, Hungarter indicated. Collaborations with doula professionals can also help hospices reach patients earlier in their disease trajectories as they move across the care continuum, he stated.

“Our business model is where sustainability comes in as far as getting people onto palliative or hospice care services much earlier and building a continuum that increases length of stay, revenue and support,” Hungarter told Hospice News. “The quality scores go up, and we’ve seen this firsthand among hospices. But the field of end-of-life doulas is not fully developed, and so the potential is just huge to team up with them and get support moving upstream.”

Doula services can augment clinical support by reinforcing education and care planning, providing companionship and bedside presence, as well as assisting with memoriam and legacy projects. This is according to Beth Klint, executive director at Goodwin Hospice. The hospice is part of the nonprofit senior living and health care organization Goodwin Living, which serves northern Virginia and Washington, D.C.

Goodwin Hospice formed a collaboration with end-of-life doula provider Present for You LLC roughly five years ago. The hospice’s doula program recently reached a milestone of providing 2,000 visits to patients and families.

Goodwin Hospice’s service agreement with Present for You includes “on demand access” to EOLDs when a patient and family need arises, Klint previously told Hospice News. The program is supported through philanthropic donations and offered to patients and families as a complimentary service.

End-of-life doulas enhance hospices’ holistic approach by filling the gaps that often exist between clinical and non-clinical support, Klint indicated.

“Integrating non-clinical roles like doulas into care delivery can improve overall satisfaction and quality of life for patients and families [and] reduce stress on clinical teams by sharing the emotional and practical support workload,” Klint recently told Hospice News in an email. “[Doulas] offer companionship, help families navigate decisions without medical jargon, and create space for meaning-making. This non-clinical layer ensures that care is not only comprehensive, but also deeply human, honoring the whole person and their relationships.”