Let's break this down into a few different groups.

1. Timing - Hospice is designed for those patients with an estimated 6 months or less remaining.  As a Deathwalker, I work with anyone.  For me, an ideal client is young, perfectly healthy, very happy, and simply planning ahead.  We work to get things organized and on-track for when circumstances change, whether that's 2 hours or 80 years.  Now, obviously in our Western culture, it is still an uphill struggle to get healthy 20- or 30-somethings to start getting organized for end-of-life.  That being said, accidents, illness, and sudden death do, unfortunately occur.  Age has never been a good indicator of how much time we have left.  By starting before a terminal diagnosis (whether that happens at 20 years old or 95 years old), we can organize a solid (though flexible) plan for when hospice is eventually appropriate.  Any pre-work we get done will only help the hospice team to be able to best provide care that is in-line with our priorities and wishes.

2. Purpose - I am not a medical professional, but hospice has doctors and nurses specially trained to provide comfort care at end-of-life.  The hospice teams I have worked with are absolutely INCREDIBLE at helping patients and local caregivers to maintain this level of comfort.  The hospice chaplain can help to provide or supplement spiritual comfort.  Hospice volunteers are available to provide comfort, help, and company.   Social workers are actively available to help with grief and anxiety.  Where the Deathwalker/Doula comes in is to fill in the gaps.  Ideally, we'll have already worked with your doctors and legal advisors to have your advance directives, healthcare proxy, will, and anything else needed complete.  We'll have defined your spiritual priorities (or whether you have no spiritual tradition) so your faith leader and/or the hospice chaplain can hit the ground running in a way that is meaningful and helpful to you.  We'll have identified who you would like to be around at your end-of-life, and what roles they should play (if any).  We'll figure out how to make the environment you are in (home, skilled nursing, hospital, etc) most personal and comfortable to you, so the hospice team can work most effectively at your comfort.

3. Scope - The last act of hospice is usually to prepare us, after we die, for pickup by the funeral home, and certify our death.  By working with a Deathwalker/Doula beforehand, the hospice nurse will know if there are any special steps or requirements that are important to you immediately after you die.  Is there a certain person who should clean the body, other than the hospice nurse?  Are there certain songs or prayers you would like just after your final breath?  Is there a special item or outfit that you would like to accompany you to the funeral home?  Do you even want to go to a funeral home, or have you and your loved ones taken the appropriate steps to have a couple of days for an at-home wake?  Will a funeral home transport you to the crematory or cemetery, or have you and your loved ones made special arrangements?  These are all tasks that are typically outside the scope of hospice care, but would be helpful for the hospice team to be aware of.