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Finding a way through

Our opinion piece last Friday ignited a debate that has continued throughout the week.

It was picked up by Sky News on Friday evening, then over the weekend, articles appeared in The Telegraph, Newsweek, The Express, The Church Times, and Sputnik News all referencing our blog post, and it was referred to in a letter to The Yorkshire Post.

An article in The Guardian on Saturday by Good Funeral Guild member Rebecca Lee-Wale detailed how difficult the situation is for celebrants, another member of the Guild, funeral director Jenny Uzzell, discussed funerals under the current restrictions on BBC Radio 4 on Sunday morning (around 35 minutes in) and a third Guild member, Lucy Coulbert, spoke on Talk Radio on Monday afternoon about our blog post and her thoughts about it as a funeral director facing this crisis head on.

We have spoken to a number of journalists since last week and been interviewed live on LBC and Radio 5 Live, while in online forums many people have voiced their opinions, both in support of – and strongly against – our suggestion that funerals as they are now are neither safe nor adequate. 

The Jewish Chronicle revealed last weekend that Britain’s Liberal and Reform Jewish Movements had announced no mourners would be permitted at burials- see here, while a number of crematoria around the country have now moved to only accepting bookings for unattended cremations. Bradford, Aberdeen, Yeovil and Leeds have all already suspended ceremonies with mourners attending, while others are set to follow in the coming weeks.

The discussion continues, as more and more people experience just how difficult a socially distanced ceremony actually is. We have heard from numerous people who have found their own personal situation almost impossible to bear, and others who argued compellingly that an unwitnessed burial or cremation would have been even worse for them. There is no easy answer to any of these messages. There is no good solution to what we are facing.

But in response to our request for ideas for how to find ways of commemorating the lives of those who have died without risking the lives and wellbeing of those who survive, we had a message from a celebrant, Helen Wearmouth, who had a ‘somewhat left-field idea’ (her own words).

We invited her to write a guest blog for us. Here it is.

 

Funerals During COVID-19 – A Crazy Idea.

In her latest article Fran Hall extended an open invite for solutions to a problem; a problem which concerns more than just our industry. A problem which concerns our entire society:

How do we continue commemorating lives without placing mourners in jeopardy?

My idea is further down. It’s far from conventional, but these are desperate, unconventional times:

  • If you see a problem with my solution, please share it.
  • If you think of a better idea, please share it.

In the article below, I’ve tried to describe:

  • The problems posed by the current situation.
  • The problems other solutions cannot address.
  • My proposed solution.

Why can’t funerals continue as they are?

Before even considering the problem, it’s important to have a grasp on what the problems are. In this case, recent government safeguards implemented to protect us all from coronavirus present problems of their own. Any solution must solve these problems in addition to those caused by the virus.

The problems are:

  • Risk of infection between mourners.
  • Only ‘immediate family’ may attend.

This is vague and open to interpretation. Do unmarried partners count? How about step-siblings and foster children? Who gets to decide?

  • People showing symptoms are excluded.
  • Entire households of those showing symptoms can’t attend.
  • Over 70s will be less able to attend.
  • Those concerned about contracting the virus won’t attend.
  • With good reason, travel (whether essential or otherwise) is discouraged.

Other factors we need to consider.

Religious beliefs:

Here in the UK, land is a valuable commodity. Burials are more expensive than cremations and the remains take up more space. For several years now, this situation has been approaching a crisis point even without this strain of coronavirus as a catalyst.

For followers of the Muslim faith or Judaism, cremation is not an option, and people of these faiths represent a sizeable proportion of our population.

The problems with solutions I’ve heard so far.

So far, I’ve heard two main contenders for a solution to these problems. Both options only offer a partial remedy to each problem, and each creates its own problems:

Solution 1: Memorials at a later date

With this solution, the deceased would be cremated/buried immediately, allowing their service to be held at a later date.

Problem 1: When?

Will the end of this pandemic be easy to define? Pandemics often return in waves.

Problem 2: How many services could there be?

Once the pandemic is over, could we expect an explosion in the number of such services? How many services will people be able to attend?

Problem 3: Why are memorials not our ‘go to’ ceremony already?

Memorials have a great deal going for them. They’re cheaper, you have more time to organise; and can be held anywhere, and at any time.

The big difference between a funeral and a memorial is the presence of the body. Being able to say goodbye to someone you cared about when their body is present means more to many.

Problem 4: Will families be able to afford them?

After what is likely months of financial strain, will families be able to afford a memorial service?

Problem 5: What about prepaid funerals?

Will prepaid funeral contracts cover the change from a funeral to a memorial? If not, will this shake public faith in these investments?      

Solution 2: Internet streaming

 There’s been a great deal of discussion about web-streamed services.

The pros:
  • Allows unlimited virtual-attendees.
  • No-one needs to leave their home.
  • Independent of distance.
Problem:

If the crematorium even has this facility, there are so many ways this could go wrong. This solution relies on the sound working order of:

  • The crematorium internet connection.
  • The webcam(s), sound equipment.
  • Staff with sufficient technical knowledge to ensure the service is streamed.
  • Virtual-attendees having access to a computer.

Here in the UK, 12% of us still don’t.

  • Virtual-attendees having a fast enough connection to stream a service.

The minimum upload speed is about 1.5 mbps.

  • Virtual-attendees having the technical knowledge to ‘tune in’ to the service.

 

My Solution.

The vast majority of mourners arrive by vehicle. My idea is they simply remain in these vehicles. Much like American ‘Drive-In’ movie theatres, we apply the same idea to funerals.

Benefits of this idea.
  • Everyone assembles in the usual location.
  • No obstructions to reverting back to usual services once the pandemic is over.
  • All currently excluded groups (over 70s, non-immediate family and friends, estranged relatives, those showing symptoms); could still attend.
  • The body is present for people to say their goodbyes to.
  • No risk of contamination between cars.
  • Elderly and/or disabled mourners don’t need to walk anywhere.
  • Service could be held regardless of weather.
  • Whole households could attend together.
  • Allows those in the same vehicle the possibility of physical comfort (from members of the same household).
  • It requires little change.

Everything would continue to work in much the conventional way, except mourners would remain in their vehicles throughout the ceremony.

How it could work?
  • The service could be conducted in the crematorium car park.
  • Sound can be delivered via an amp, Bluetooth to mobile phones, or we could use a short-range FM transmitter to transmit to nearby car stereos tuned to a given frequency (the latest method used by drive-in theatres).
 
A request?

I believe this idea, crazy as it may be, offers the potential to address most of the problems we face.

Should you agree or disagree, I ask that you let us know. This problem will soon affect everyone in the UK, and only with our combined knowledge and experience can we can find a solution.

 

Helen Wearmouth

www.helencelebrantne.com

 

Please, stop now

Someone needs to say it.

With the heaviest of hearts, today we are going against everything that the Good Funeral Guide has become known for over the years, and calling for funerals to be stopped completely.

Now. Today. Just stop.

The decision to exempt funerals from the current ban on social gatherings was undoubtedly made for compassionate reasons, but the current lack of clear instruction and direction is leading to anguish and suffering beyond imagination.

By allowing funeral ceremonies to continue in some form or other, bereaved people – and all those supporting them – are genuinely risking their health and even their lives by gathering together to try and have a funeral like the ones we are used to, yet in most cases, grieving people are ending up with a funeral that has been pared down to something almost unrecognisable. Almost everything we are familiar with in a funeral ceremony has been stripped away by the attempt to slow the spread of Covid-19. What we are left with is worse than nothing. 

This cannot continue. It’s breaking people’s hearts, hurting family members and friends. It’s confusing everyone. It’s putting lives at risk. It’s making everything impossible for people who are already reeling from shock and grief. Heart-breaking decisions are being asked of people – decisions which are too much to bear. The current situation is not compassionate or kind, it’s devastating and destructive.

We will probably never know the damage that is being done daily to people’s hearts and souls, their emotional and mental wellbeing, their ability to grieve and survive in a newly empty, frightening world. Confusion and uncertainty casts a heavy weight that is doing untold damage to individual people everywhere. Families are being made to choose who can attend and who must stay away. Friends and lifelong companions are being excluded from being present for a ceremony through multiple individual interpretations of the phrase ‘immediate family’. If numbers are drastically limited, someone has to decide who has the most right to be there. It’s unbearable.

Funeral venues and funeral companies are interpreting the new rules in different ways, meaning that, depending on whereabouts you are, you may only be allowed to have 25 – or 20 or 10 or 6 or 4 – people attending a ceremony. Crematorium staff in some places are being required to monitor the numbers of people arriving and restrict entry – one crematorium has stated that the chapel doors will be locked and the police called if more than a certain number of people gather for a funeral. Yet in other crematoria, no restrictions have been imposed. Everywhere is doing things differently.

You may have travelled in a limousine, or the cars you wanted may have been cancelled. You may be asked stay two metres apart outside the chapel while you wait. Or maybe nobody is willing to step in and tell you to stay away from other people gathering there. You may be asked to sit separately inside, or the seating might have been re-arranged to make sure you don’t come into contact with anyone. The coffin may be wheeled into the chapel, not carried. The curtains may have to close around the coffin to prevent anyone from touching the surface. Hymn singing may be discouraged – hymnbooks have been removed from many crematoria. Video-links may or may not work, leaving excluded mourners at home without a connection to those who are attending, unable to see or hear what is happening even remotely. There are licensing issues with music choices being broadcast, even where video links are available. It’s impossible for everyone who is trying to make things work right now.

Funeral ceremonies are where our deepest humanity is called for, to steady and support the faltering broken hearts of people whose worlds have been shattered by the death of a person they love. We show up to be silently present, to demonstrate our love by being there for the final time in the presence of the physical body of the person whose life has ended.

We come together to grieve as a family, a community, a society who stands together to bear witness to the loss of one of our own. We reach out our hands and our arms to comfort and hold each other, we lean on each other for support and safety. We weep together, we rest our heads against familiar loving shoulders and feel the warmth of strong arms holding us upright.

This is what a funeral is.

Now, none of this is possible.

The current confused and confusing situation is dangerous. It’s frightening. It’s unfair on everyone. It has to stop.

If a clear directive came from government that funeral ceremonies must stop now, we are certain that the incredible people who dedicate themselves to supporting bereaved and grieving communities will quickly find new ways of creating ritual and meaning in a safe way. Over the coming weeks we will share thoughts and ideas and ways of commemorating the lives of those who have died without risking the lives and wellbeing of those who survive. We welcome guest posts from anyone who would like us to share their ideas.

But for now, for today, for the foreseeable future, for your sake, for our sake, for the sake of all of us, please, please think the unthinkable.

Unattended burial or cremations are the safest, kindest, simplest way to deal with our dead right now.

Funerals, as we know them, cannot go on.

Dark times

Guest post by Jo Williamson from Albany Funerals

BBC Breakfast today (2:22:02)

“I wanted to share this, mainly because it’s the first time I’ve heard or seen anything about funerals on TV since the beginning of the outbreak.

Nothing so far addressing the sheer devastation we face having to explain to recently bereaved people that we can not offer them our usual warmth, our safe and tranquil space to plan something together that would have been exactly what their friend or relative would have loved, the choice of spending time with the person who died at our cosy premises, or the comfort of coming together in sadness and smiles to remember and celebrate their lives. I understand why – it’s too heartbreaking.

However! I wanted to pick up on something the GP says in the clip, about the fact that she understands the dilemma for people with pre-existing medical conditions on whether to attend a funeral because it would be ‘their only chance to say goodbye’… I would like to challenge this!

As funeral directors it has been almost impossible to adapt to this necessary change in the way we do things which goes against every bone in our body – no face to face meetings, social distancing, only 10 people allowed at a service, immediate family only, no contact, no hugs, stripped back ceremonies, unattended cremations and burials.

But we have adapted and so have our amazing customers and this is what I wanted to say – please do not despair. I truly believe that we can still do things properly, we just need to change our perception of what a funeral should be.

Up until now, a funeral was two things together – the laying to rest of the body by cremation or burial, and the memorial aspect – the part where we mourn and come together to honour and celebrate the person, to laugh, to cry, to comfort one another. This virus has forced us to change this but I do believe we can adapt to this situation by understanding that it is maybe not so wrong to separate these two parts. Having had heartbreaking phone conversations with our families about this, their first reaction is total horror, utter devastation and the feeling that they are letting down their loved one in some way. These phone calls have been the most horrific thing we’ve had to do in this job so far. However, and this is really important, talking to them daily, we have realised that actually, in most cases this wears off very quickly.

Actually in most cases there is an element of RELIEF. Relief that at this horrific time of sadness and grief they do not have to rush around organising something they are dreading, that they have a little more time to process what has happened before catapulting themselves into trying, for the most part, to second guess the wishes of that person and make it all happen. The realisation that actually they are probably not in any fit state to even take in the ceremony, remember who was there, what was said, what the flowers or coffin even looked like.

We have been taking to local venues who have wonderful spaces little used during the week that cost less than a crematorium chapel. This is what we need to do, offer the second part of the ‘funeral’ in a few months – each one totally personal, more time, beautiful surroundings. Those families affected will be able to come together in a few months to say goodbye to those they have lost and they may possibly also be a little stronger and more able to cope, finding greater comfort and solace with the passage of time.”

Time to think the unthinkable

These are unprecedented times. Across the world, the Covid-19 pandemic sweeps everything before it, heralded by fear and confusion at conflicting government advice, with daily updates of the tens of thousands of people who have become ill, and rising numbers of deaths.

 And while much concern is rightly directed towards the wellbeing of the frontline medical staff battling to support and save the lives of people who are most severely ill, those in the funeral sector are waiting for consistent and clear advice about how to deal with people who have died – who may or may not be carrying the virus.

Currently, there are conflicting official documents relating to handling the bodies of people who have died who have been identified as testing positive for Covid-19, which is now a notifiable disease. (Details of the varying official advice as to levels of PPE required are at the end of this post.)

The guidance we shared from Public Health England in our blog post of March 2nd has now completely changed – something which we find inexplicable given the vast increase in numbers of people who have tested positive in the last two weeks, and the steady increase in the number of deaths.

14 days ago, Public Health England recommended full PPE, the use of a body-bag and disinfecting all external surfaces prior to moving the body of someone who has died who had tested positive for Covid-19.

Now, the official advice is now that ‘there is no requirement for a body-bag and viewing, hygienic preparation, post-mortem and embalming are all permitted’.

At the time of writing, Public Health England are prioritising testing and not testing either people who are symptomatic at home, or those related to a person who has tested positive.

It is, therefore, entirely possible that people who have died at home may have contracted Covid-19 prior to death but not been tested for it. Equally, it is entirely possible that funeral staff will come into close contact with bereaved people who may be carrying the virus when making arrangements for or carrying out a funeral. None of us know whether the virus is spreading among people as yet asymptomatic in our communities. Logic indicates that we should therefore assume that it is.

Until such time as there is consistent official advice to the funeral sector, and given the acceptance by the government that there are likely to be significant numbers of people in the community currently carrying the virus, potentially without displaying symptoms, we feel that we should be erring on the side of caution, particularly given the close exposure funeral staff can have to those in their care.

The Good Funeral Guide would therefore like to make the following suggestions to funeral directors and staff.

  • Assume that everyone in your company, all those in your care, all of the clients you are working with and everyone you encounter during daily activities could be carrying the Covid-19 virus. Put in place as many mitigating procedures as you possibly can.
  • Risk assess your daily operations in the light of this fast-developing situation: Have you got adequate handwashing facilities for staff and visitors? What guidance are you giving staff about handwashing throughout the day? Are they following it? Have you got paper towels? How are they being disposed of? Are you ensuring that all surfaces and handles in your premises are disinfected? What about pens? Cups? Kettles? Have you implemented screening questions when taking a first call to ascertain the level of risk to your collection team? Do you have adequate PPE for staff collecting or handling people who have died? How about body bags? Disinfectant? Hand sanitiser? Are any of your staff members in the potentially most vulnerable groups who are likely to be at most risk from contracting the virus? Or do any staff members have vulnerable family members? How are you minimising their exposure to potential infection? Are you minimising physical contact between staff members and between staff and clients? Are you offering clients the opportunity to make funeral arrangements remotely using email and telephone or video calls rather than physical meetings? What about at funerals? Have you advised staff not to shake hands or physically contact mourners? Are all staff members carrying and using hand sanitiser during the course of the day if they are unable to wash their hands? Are you working closely and communicating clearly with your colleagues to ensure everyone is ok, both physically and mentally? What more can you do?
  • Stay as up to date and informed as possible. The situation is changing minute by minute.
  • Connect with other local funeral companies. Louise Winter, of Poetic Endings, one of the GFG Recommended funeral directors, has set up a support network for London based companies to offer support and resources to each other and to enable a co-ordinated and efficient response to any crisis. Do the same in your area.
  • Plan ahead for the possibility that public gatherings may be prohibited. This move could potentially involve gatherings for funerals – either those where there are large numbers of people, or, in the worst-case scenario, completely. Client expectations will need to be managed sensitively and honestly.
  • Consider recommending that clients use their own cars to travel to funerals rather than offering limousines. Requiring a staff member to drive up to six people in close proximity in a limousine could be seen as asking individuals to undertake an unnecessary risk.
  • Stay in contact with your local crematoria and cemeteries. Some crematoria are already putting restrictions in place such as removing hymn books, prohibiting the carrying of coffins on shoulders and not permitting those who are self-isolating to attend funerals.

We will do our best to relay official advice for the funeral sector on this blog as we access it, however for the time being, common sense dictates that we recommend everyone takes the utmost care to minimise their potential exposure to Covid-19. Vulnerable members of our society need the rest of us to take as much care as we can.

NB Until such time as we consider it safe to do so, the GFG will be carrying out all our business remotely. Accreditation visits will be done using video calls rather than in person, and we will not be attending any conferences or mass gatherings for the foreseeable future.

As everyone should be, we are following the official guidance on hand hygiene, and, because we have highly vulnerable close family members, we are avoiding all unnecessary social contact.

Unprecedented, unknown, unknowable – this is our new normal for now.

 

The current official guidance regarding people who have died who tested positive for Covid-19 can be found in various documents – links below.

(It is worth noting that some local coroners are issuing guidance requiring that all those who die in the community MUST be brought into a mortuary in a body bag, regardless of whether or not funeral directors suspect the person has had Coronavirus. We have seen copies of these communications.)

The Health & Safety Executive document ‘Managing infection risks when handling the deceased’ advises that body-bags should be used for transporting people who have died from similar notifiable diseases (SARS & MERS) – see pages 48 & 49.

Public Health England’s ‘Interim guidance for first responders and others in contact with symptomatic people with potential Covid-19’ states that personnel handling bodies of those who have died at home where Covid-19 may be suspected should wear gloves and perform hand hygiene – see section 11.

Their ‘Infection prevention and control guidance for pandemic coronavirus’ document is far, far more proscriptive for those caring for people who are alive, recommending that  droplet precautions should be used for patients known or suspected to be infected with COVID-19 in all healthcare settings, and that ‘In all healthcare settings: A FRSM (fluid resistant surgical mask) must be worn when working in close contact (within 2 metres) of a patient with COVID-19 symptoms.’and that ‘Filtering face piece (class 3) (FFP3) respirators should be worn whenever there is a risk of airborne transmission of pandemic COVID-19 i.e. during aerosol generating procedures (AGPs)’

Recommended Personal Protection Equipment for the care of patients with Covid-19 is shown in the table below (page 24 of Public Health England’s ‘Infection prevention and control guidance for pandemic coronavirus’)

 

Covid-19 – official advice

After today’s COBRA meeting, the prime minister warned that the spread of coronavirus Covid-19 is likely to become more significant, with government sources warning that it could be “months rather than weeks” before the outbreak peaks.

In the absence of any new information or guidance, and while we await the revealing of the government’s ‘major UK-wide action plan’  we have heard from many funeral directors who are concerned about their potential involvement with caring for people who have tested positive for the virus and subsequently died.

We thought it worth putting the official government advice for those handling the bodies of people who have died from Covid-19 here on the blog in an easy to find place – full details can be found here.

Here’s the official guidance:

  1. Handling dead bodies
  • the act of moving a recently deceased patient onto a hospital trolley for transportation to the mortuary might be sufficient to expel small amounts of air from the lungs and thereby present a minor risk
  • a body bag should be used for transferring the body and those handling the body at this point should use full PPE
  • the outer surface of the body bag should be decontaminated (see environmental decontamination) immediately before the body bag leaves the anteroom area. This may require at least 2 individuals wearing such protective clothing, in order to manage this process
  • the trolley carrying the body must be disinfected prior to leaving the anteroom
  • prior to leaving the anteroom, the staff members must remove their protective clothing
  • once in the hospital mortuary, it would be acceptable to open the body bag for family viewing only (mortuary attendant to wear full PPE)
  • washing or preparing the body is acceptable if those carrying out the task wear PPE. Mortuary staff and funeral directors must be advised of the biohazard risk. Embalming is not recommended
  • if a post mortem is required safe working techniques (for example manual rather than power tools) should be used and full PPE worn, in the event that power tools are used. High security post mortem suites are available if needed and can be discussed with the PHE incident team
  • after use, empty body bags should be disposed of as category B waste
  1. Putting on and removing personal protective equipment

This PPE ensemble is more enhanced than pandemic flu requirements due to COVID-2019 being a novel coronavirus and the evidence base for transmission limited. Therefore, this is based on expert opinion to date and may be revised as the situation evolves.

Use safe work practices to protect yourself and limit the spread of infection:

  • keep hands away from face and PPE being worn
  • change gloves when torn or heavily contaminated
  • limit surfaces touched in the patient environment
  • regularly perform hand hygiene
  • always clean hands after removing gloves

Pre-donning instructions:

  • ensure healthcare worker hydrated
  • tie hair back
  • remove jewellery
  • check PPE in the correct size is available

21.1 Putting on (donning) PPE

The order for putting on is gown, respirator, eye protection and gloves. This is undertaken outside the patient’s room.

Perform hand hygiene before putting on PPE

  • put on the long-sleeved fluid repellent disposable gown, fasten neckties and waist ties
  • respirator. Note: this must be the respirator that you have been fit tested to use. Where goggles or safety spectacles are to be worn with the respirator, these must be worn during the fit test to ensure compatibility. Position the upper straps on the crown of your head, above the ears and the lower strap at the nape of the neck. Ensure that the respirator is flat against your cheeks. With both hands mould the nose piece from the bridge of the nose firmly pressing down both sides of the nose with your fingers until you have a good facial fit.

If a good fit cannot be achieved, do not proceed.

Perform a fit check. The technique for this will differ between different makes of respirator. Instructions for the correct technique are provided by manufacturers and should be followed for fit checking.

Eye protection: place over face and eyes and adjust the headband to fit.

Gloves: select according to hand size. Ensure cuff of gown covered is covered by the cuff of the glove.

21.2 Removal of (doffing) PPE

PPE should be removed in an order that minimises the potential for cross contamination. Unless there is a dedicated isolation room with anteroom, PPE is to be removed in as systematic way before leaving the patient’s room i.e. gloves, then gown and then eye protection.

The respirator must always be outside the patient’s room.

Where possible (dedicated isolation room with anteroom) the process should be supervised by a buddy at a distance of 2 metres to reduce the risk of the healthcare worker removing PPE and inadvertently contaminating themselves while doffing.

The FFP3 respirator should be removed in the anteroom or lobby. In the absence of an anteroom or lobby, remove FFP3 respirator in a safe area (for example, outside the isolation room).

All PPE must be disposed of as healthcare (including clinical) waste.

The order of removal of PPE is as follows:

Gloves: the outsides of the gloves are contaminated

  • grasp the outside of the glove with the opposite gloved hand; peel off
  • hold the removed glove in gloved hand
  • slide the fingers of the un-gloved hand under the remaining glove at the wrist
  • peel the remaining glove off over the first glove and discard
  • clean hands with alcohol hand rub

Gown: the front of the gown and sleeves will be contaminated

  • unfasten neck then waist ties
  • pull gown away from the neck and shoulders, touching the inside of the gown only using a peeling motion as the outside of the gown will be contaminated
  • turn the gown inside out, fold or roll into a bundle and discard into a lined waste bin

Eye protection (preferably a full-face visor): the outside will be contaminated

  • to remove, use both hands to handle the retraining straps by pulling away from behind and discard
  • clean hands with alcohol hand rub

Respirator: in the absence of an anteroom/lobby remove FFP3 respirators in a safe area (such as outside the isolation room)

  • do not touch the front of the respirator as it will be contaminated
  • lean forward slightly
  • reach to the back of the head with both hands to find the bottom retaining strap and bring it up to the top strap
  • lift straps over the top of the head
  • let the respirator fall away from your face and place in bin
  • wash hands with soap and water

ENDS