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COVID-19 Changes Funerals and How Families Grieve

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April 20, 2020 -- Families whose loved ones die during the COVID-19 pandemic face unprecedented restrictions and challenges. To not say goodbye to loved ones, to not have loved ones attend funeral services, or to not even find a permanent resting place for a loved one is changing how people grieve.

“Everything's touched by COVID-19. The virus has altered the procedures entailed with any death of any cause,” Amy Cunningham, funeral director and owner of Fitting Tribute Funeral Services in Brooklyn, NY, says in an email.

To add to the stress and confusion, some state directives appeared to ban funerals outright and later were clarified to allow immediate family members to take part, throwing funeral arrangements into chaos. “It was 2 weeks of hell in March with continual changes in direction from the [Washington] governor’s and state licensing offices,” says Char Barrett, funeral director and founder of A Sacred Moment, a pioneer in home and green funerals in Everett, WA. In addition, cemeteries that are privately owned can have their own rules -- at least one privately owned cemetery in Washington is limiting graveside burials to five family members, Barrett says.

Most families are having graveside funerals and postponing memorial services until the stay-at-home orders and restrictions on group gatherings are lifted, according to funeral directors.

Overwhelmed Funeral Industry

Some families, especially in coronavirus hot spots, are having to postpone funerals as the funeral industry struggles to keep up with the sheer volume of COVID-19 deaths.

“A funeral director in the Detroit area summed it up -- in 40 years, he’s never seen anything like it. There’s such a high volume of deaths, it’s hard to keep up with it. There is little time to have any sort of service, because they’re just trying to take care of the dead,” says Christopher Robinson, a board member of the National Funeral Directors Association (NFDA) and vice president and general manager of Robinson Funeral Homes in Easley, SC. The NFDA’s 20,000 members represent nearly 11,000 funeral homes in the U.S. and 49 other countries.

Michigan has the fourth highest number of cases in the nation, behind New York, New Jersey, and Massachusetts, with the state's total deaths reaching 2,093 and total cases reaching 29,263 on April 16. The hardest-hit areas -- Detroit and surrounding Wayne, Macomb, and Oakland counties -- have disrupted cremations.

“The crematory that we use in Livonia, which normally picks up remains daily, has told us they can’t take more remains and to try them in the next day or two. We know cremation workers are working around the clock. Fortunately, we have climate controls at funeral homes so we can hold the remains for extended periods of time,” says Douglas "Dutch" R. Nie II, an NFDA board member and president and CEO of Nie Family Funeral Home & Cremation Services in Ann Arbor, MI.

Families in New York City face delays in holding funerals of any type due to shortages of funeral workers and space.

“Funeral directors normally see 40 families in a month. Now we’re seeing that number in the course of a few days. Families are constantly calling funeral homes to see if they can care for the deceased, and they’re doing their best to accommodate them,” says Mike Lanotte, JD, executive director of the New York State Funeral Directors Association in Albany.

Funeral directors in New York City have to schedule burials and cremations with cemeteries and crematoriums at least 2 to 3 weeks out, he says. In the meantime, most funeral homes have reached capacity and can’t take new remains, so many are being stored in temporary morgues, says Lanotte. But they can remain there for only 15 days, according to the New York City Chief Medical Examiner’s Office. If the remains are not picked up in time, they may be sent for temporary burial in the city’s potter’s field on Hart Island, Lanotte says.

Funeral directors are exhausted from working long hours, some are getting sick from COVID-19, and others are in quarantine. “Most funeral homes are small outfits with four or less employees, so if they lose even one or two workers, half of their staff is out,” he explains.

Help has started to arrive from volunteer members of the NFDA, including funeral directors licensed in New York and mortuary science residents and students, according to Lanotte. On April 9, New York Gov. Andrew Cuomo granted temporary licenses to out-of-state funeral directors, paving the way for the NFDA to send the names of 100 additional volunteers to the New York area in the coming days.

In addition, the Department of Homeland Security last month designated mortuary workers as critical infrastructure workers, which enables these “last responders” to have priority access to personal protection equipment and to be exempt from “shelter-in-place” mandates.

On the Front Lines in New York and New Orleans

We're all exhausted, physically, emotionally, mentally. I've gone days without seeing my kids and only sleeping a few hours. When I do sleep, I dream that I'm taking on yet another death. It's 9:30 at night and I've been in since 6 a.m.,” Sherry Bensimon, funeral director at Riverside Memorial Chapels in New York and New Jersey, says in an email.

“But what hurts the most are the stories of families grieving the fact that their loved one died alone. Because the pathogen is so virulent, patients can't have a family visit. My colleagues and I are crying on the phone with these families. Their stories haunt me,” she says.

She is performing only graveside funeral services. “Unfortunately, between cemeteries being overloaded and not enough funeral directors, there are delays. I am very open and honest with all of my families, and I explain the issues. Every single family is understanding. We are all in this together.”

Bensimon, an Orthodox Jew who serves mainly Jewish families, says the pandemic has affected every aspect of Jewish funerals. “Burying by sundown is almost impossible now as well as performing the traditional preparation of the deceased.” The ritual washing and dressing to prepare the deceased for burial is called “tahara” and is performed by a sacred society called the “chevra kadisha.”

“There are hardly any chevra kadishas who are willing to perform taharas on COVID-19 deceased. I am one of the few, but I just honestly don't have time because I am so busy trying to arrange removals and permits [required by most states to dispose of the remains] and burials,” says Bensimon.

She also said there was a shortage of PPE, bleach, and disinfectants. “I disinfect my morgue every morning and afternoon. I'm sitting in bleach-stained clothes as I type this. Again, I work for a wonderful company that's working round the clock to get us what we need, but there's just a global shortage. We're having to reuse masks and gowns (I spray them with bleach too).”

Funeral directors and their staff in New Orleans, another coronavirus hot spot, are also stretched to the limit. As of April 16, the Louisiana Health Department reported 22,532 cases across the state with 1,156 deaths. New Orleans and Jefferson parishes have more than 10,000 of the state's cases.

Louisiana Gov. John Bel Edwards signed an executive order March 31 that eases licensing restrictions on out-of-state mortuary workers and directs that funeral services be expedited.

“The goal is to take the pressure off hospitals, coroners offices, morgues, and funeral homes,” says Boyd Mothe Jr., president and CEO of Mothe Funeral Homes, which has three locations in Orleans and Jefferson parishes just outside New Orleans.

“Every funeral home is having storage problems -- people are calling, asking if we can hold a funeral this or next week or can we hold off until more family can gather. The answer unfortunately is a resounding no,” he says.

“We are using the expedite order as a tool to recommend to families that they need to get on with the work ahead of them regarding the deceased. Everything is in slow motion with families now because some are sick or in quarantine, or both, and they feel disconnected from family members. All this makes getting the authorization to make funeral arrangements challenging,” says Mothe.

In addition, people are dying without their families around them and are having funerals without family and friends. “The community support that we all need and desire is missing. My funeral director standing at a distance, many people wearing masks, it all feels very odd because we’re used to shaking hands, and in Louisiana we hug and kiss,” he says.

Another blow to the largely Catholic community in New Orleans is with churches closed, they can’t hold the traditional Mass for the deceased and receive Communion with family, relatives, and friends, says Mothe.

Home Funerals

The pandemic has created unintended opportunities for home funerals similar to vigils and wakes as other types of services have been disrupted and more people are dying at home.

In New York City, officials are recording more than 200 home deaths per day -- nearly six times the number held in recent years, according to ProPublica.

“I'm coaching people over the phone to seize the moment and, despite the COVID-19 chaos, take some sustenance from it. No matter the cause of death, it's likely going to take the funeral home or the medical examiner a good bit of time to arrive at the place of death,” Cunningham, the Brooklyn funeral director, says in an email.

She advises the family -- all gloved and masked as caretakers -- to “light the candle, make the necessary calls for help in the transfer in as calm a setting as you can create. This is your wake. This is your moment. Your loved one has crossed the threshold. If nobody else but you have entered the residence in 14 days, and you know it's colon cancer, and hospice is signing the death certificate, you are in a privileged spot. Maintain a safe social distance from any newcomers,” she advises.

If the death is due to COVID-19, it doesn’t preclude a home funeral, but one should take precautions, including wearing PPE and not moving the body onto its side, say Cunningham and Barrett.

A home funeral was not on Kate Merriwether’s radar when her 84-year-old mother, Sherry Lynch, passed away in hospice care in Mill Creek, WA, last month. Merriwether had planned a private cremation ceremony with a few relatives and a large memorial service for extended family and friends a few months later. But when the pandemic happened, the crematory near her home stopped allowing families to be involved, and the memorial service was put on hold indefinitely.

Barrett, who was taking care of the cremation, suggested Merriwether consider a home funeral instead.

Merriwether liked the idea, and her house was large enough to accommodate her mother in a biodegradable casket and a few family friends. The funeral home brought her mother to her house and gave her guidance on how to treat and manage the body and PPE to use.

Merriwether covered her mother’s face in a sheer cloth shroud so you could still see her lying there. She placed lit candles around the casket in a dark room, which gave it a “tomblike” ambience. As her mother was a liturgical artist, she covered the casket with images of her artwork.

Barrett also suggested using Zoom to stream the ceremony to those who could not attend in person. “We put the computer on a Lazy Susan chair so it could spin around the room to focus on the person talking.”

During the evening ceremony, Merriwether, the only family member in the Northwest, did most of the talking about her mother’s life and then took part in rituals with those present. They sang and ended the ceremony, laying hands on her mother and observing a few minutes of silence.

Merriwether undoubtedly found the ceremony meaningful. But she was particularly moved by the experience of sitting with her deceased mother. “It was similar to sitting with a newborn -- it was very still, and there’s a majesty that’s beyond you. I fell more in love with my mother as a person during that day than in the last 4 years of dementia care, which had many intimate times. That final moment was more healing than therapy,” she says.

Technology for Funerals

The pandemic has also pushed funeral homes into adopting technology perhaps sooner than planned. “I have gone from zero to 1,000 in less than 2 days -- essentially gone to Zoom meetings, so I am able to meet with families virtually and still engage with them. Zoom allows us to share documents and pictures of urns and caskets on the computer screen,” says Barrett, the Washington funeral director.

In addition to the popular FaceTime, Zoom, and Google Hangouts for virtual meetings, some companies have designed apps to help consumers plan funerals, store legal documents, and share messages.

“We have already more families wanting to do funeral arrangements online. Now we’re creating tools to make it easier for them to do that from a smartphone or computer. From talking to colleagues, I think this will fundamentally shift how we engage with families in the future,” says Barrett.

With social distancing requirements, several state governors have waived requirements for physical signatures on legal documents, allowing digital signatures instead.

But using technology can be daunting for older people, says Mothe, the Louisiana funeral home president. “Most of the people dying here are of the World War II generation, so they are not so tech savvy,” which adds to the challenges they already face with grieving.

But Nie, the Michigan funeral home president, doesn’t think technology will replace the desire families have to meet and comfort each other in person. He now has life celebrations and memorial services scheduled from July through September. “Most families are very thankful for our ability to find ways to communicate when we can’t be together, but they’re saying they can’t wait until they can hug each other again.”

Barrett also misses the direct physical contact with families. “I miss being able to hug people, miss being able to serve them warm chocolate chip cookies, and I miss having my therapy dog, Bindi, here to greet them.”

Correction: An earlier version of this story mistakenly said the hospice care where Sherry Lynch passed away was in Portland, OR. It was actually in Mill Creek, WA. 

WebMD Health News Reviewed by Arefa Cassoobhoy, MD, MPH on April 20, 2020

Sources

Kate Merriwether, Seattle.

Amy Cunningham, licensed funeral home director and owner, Fitting Tribute Funeral Services, Brooklyn, NY.

Char Barrett, funeral director and founder, A Sacred Moment, Everett, WA.

Douglas “Dutch” Nie, funeral director and owner, Nie Family Funeral Home & Cremation Services, Ann Arbor, MI.

Sherry Bensimon, funeral director, Riverside Chapel, Manhattan, NY. 

Boyd Mothe Jr., president and CEO, Mothe Funeral Homes, Orleans and Jefferson parishes, LA.

Christopher Robinson, board member, National Funeral Directors Association (NFDA); funeral director, Robinson Funeral Homes, Easley, SC.

Mike Lanotte, JD, executive director, New York State Funeral Directors Association, Albany.

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