When you hear the word “doula,” many people think of a person who guides a woman through childbirth. In recent years, however, a growing number of families have turned to death doulas, also known as end-of-life doulas or death midwives, for support during another one of life’s most profound and challenging experiences: dying.

Death doulas offer emotional, spiritual, and logistical guidance for the dying and their loved ones. While their role may overlap in some ways with hospice care, death doulas bring a unique, holistic perspective to the end-of-life journey.

Let us explore what death doulas do, how they compare to hospice workers, and other details about the services they provide to clients and their loved ones.

What is a death doula?

A death doula is a non-medical professional who provides comfort, education, and support to individuals nearing the end of life, as well as to their loved ones. Their work can span weeks, months, or even years, depending on the client’s unique situation and when the death doula is brought into the process.

Typical core services of a death doula may include:

  • Emotional support: Helping the client and their loved ones process fears, regrets, and hopes.
  • Legacy projects: Assisting in creating memory books, audio recordings, letters, or art for loved ones.
  • Practical guidance: Facilitating logistical conversations about advanced directives, funeral planning, or final wishes.
  • Presence and advocacy: Being physically present to hold space during the dying process, ensuring the client’s preferences are honored.
  • Education: Explaining to the client and their loved ones what to expect physically and emotionally during the final stages of life.

It’s important to note that death doulas do not replace medical professionals. More specifically, they do not administer medication, diagnose conditions, or provide hands-on medical care. Instead, they focus on the more emotional, human side of dying, creating an atmosphere of peace, meaning, and dignity.

>> Related: Saying Goodbye: How a CCRC Helps Residents Grieving the Loss of a Spouse

Death doulas vs. hospice workers

While both death doulas and hospice workers are dedicated to supporting people at the end of life, they often approach their roles quite differently. They also can differ in training, focus, and scope.

Death doulas are often trained through independent certification programs, though there is no nationwide standard for their education. Hospice workers, on the other hand, are usually licensed healthcare professionals, such as nurses, social workers, or chaplains, who have formal medical and psychosocial end-of-life training.

The focus of a death doula is primarily emotional, spiritual, and logistical. They may help with logistical planning, facilitate difficult conversations, and offer continuous presence and companionship. Hospice workers, on the other hand, concentrate on medical comfort care, including pain management and symptom relief, while also providing psychosocial support to both the client and their loved ones.

Timing also varies between the two roles. Death doulas can become involved months or even years before death, providing long-term guidance and relationship-building. By contrast, hospice care typically begins when a patient has been diagnosed with six months or less to live.

Payment structures are another distinction between a death doula and a hospice worker. Death doulas are usually paid privately by the family, and their services are rarely covered by insurance. Hospice services, however, are covered by Medicare and Medicaid, as well as by most private insurance plans.

Finally, there are differences in limitations. Death doulas cannot provide medical treatment or prescribe medication, focusing instead on non-medical support. Hospice workers are typically medically trained, but with their primary focus on clinical needs, it may leave them with less time for extended presence or personalized legacy work.

In short, hospice ensures physical comfort and symptom management, while a death doula ensures emotional comfort, continuity, and personalized planning. Some families may choose to work with both types of providers for a fuller circle of end-of-life care.

>> Related: Should We Scrap the Phrase, Hospice Has Been Called In?

Potential benefits of working with a death doula

Some clients and their loved ones see a great benefit from working with a death doula.  Indeed, many find that death doulas bring a deeply human and individualized touch to the dying process.

One of the primary benefits people may gain by working with a death doula is the amount of time and attention they can offer. Hospice workers often manage large caseloads, limiting the length of their visits, whereas a death doula may spend hours or even entire days with a client. This time allows for highly personalized care tailored to a person’s beliefs, values, and personality, whether that means curating a special playlist for a peaceful passing or arranging a quiet bedside vigil for loved ones.

Death doulas also can provide emotional safety for difficult conversations. They are trained to help people speak openly about death, easing fears and allowing clients and loved ones to express their feelings without judgment. In addition, their role may extend to guiding grieving relatives through the practical and emotional challenges that often follow a loss.

Perhaps one of the most valued aspects of their work is the continuity they bring. While hospice staff members may rotate, a doula often remains a steady, familiar presence from the first meeting to the final moments and beyond, offering comfort through consistency.

>> Related: Do Your Loved Ones TRULY Understand Your End-of-Life Wishes?

Possible drawbacks to consider

While death doulas can provide deep comfort and support, there are some potential limitations to consider. For many people, cost is at the top of the list. Death doulas’ services are typically paid out-of-pocket, which can be prohibitive for some families.

Another common concern is the lack of regulation in the field. Since there is no national licensing system for death doulas, the quality of training and level of experience can vary widely from one provider to another.

The role of a death doula may even feel a bit redundant to some families. This may be especially true for families already receiving hospice care, or if their needs are already being met by existing medical providers and emotional support people.

Additionally, misunderstandings about the death doula’s scope of practice can occur in certain situations. For example, death doulas cannot legally provide medical services to the client (unless, of course they have obtained applicable healthcare certifications). For this reason, it’s important for families to have a clear understanding of what services the role does and does not include.

How to find a reputable death doula

Because the field is unregulated, careful research is essential when selecting a death doula for yourself or a loved one. Here are a few practical steps to take to ensure you are finding a reputable provider:

Check certification programs

Again, certification is not required in this field, however, many death doulas do complete training through trade organizations such as:

These association sites include search tools to find a provider in your area. Your local hospice organization may also be able to refer you to a provider.

Ask for references

It can be eye-opening to speak with a candidate’s previous clients. You’ll learn about their experience as well as their professional strengths and potential areas for improvement.

Interview multiple candidates

Remember that you are in the driver’s seat in this process. Interview multiple people and be sure to ask about their philosophy, services offered, pricing, and availability.

Look for hospice collaboration

If you plan to use hospice services as well, it’s important to choose a death doula who is comfortable coordinating with medical staff.

Trust your instincts

A doula’s role is highly personal. It is essential that you choose someone who feels like the right emotional fit for both the client and their loved ones.

>> Related: Planning for the Future After a Spouse’s Death

How much do death doulas cost?

Costs for a death doula can vary greatly based on location, experience, and services provided.

For those who charge an hourly rate, you can expect to pay anywhere from $50 to $150 or more per hour. Other providers may offer “package rates” for their comprehensive services, which might range from $1,500 to $5,000 or more for ongoing support until the client’s death. A flat fee may be charged for 24-hour vigils or multi-day bedside presence when the end of life is near.

At present, death doula services are not typically covered by Medicare, Medicaid, or private insurance in the United States since they provide non-medical care. As a result, the cost of their services must usually be paid out-of-pocket by the client and/or their loved ones. Some death doulas do offer sliding scales or pro bono work for those in financial hardship, however.

It’s also worth noting that some long-term care insurance policies may reimburse part of the cost of a death doula’s services. Additionally, some hospice programs have begun integrating death doula services into their offerings at no extra charge.

>> Related: Long Term Care: How Much Does Medicare Actually Cover?

A gentle bridge between life and death

The work of a death doula is rooted in both ancient tradition and contemporary practices. While our modern healthcare system focuses on treating disease, death doulas focus on tending to the human being in those final moments. They offer a continuity of presence, a listening ear, and a sense of dignity that many families find profoundly healing when a loved one passes.

Indeed, every life has meaning and every death is momentous, and choosing to hire a death doula is a deeply personal decision. For some, it’s a source of comfort, closure, and connection. For others, hospice care alone may feel sufficient.

Either way, the rise in utilization of death doulas marks a noteworthy cultural shift in the U.S. — one that may continue to grow as the baby boomers age. It represents a renewed openness to speaking about death and planning for it. And maybe most important, it is an avenue by which people are able to approach death with grace rather than fear.

FREE Detailed Profile Reports on CCRCs/Life Plan Communities
Search Communities