Cultural Competency at End-of-Life

As a collection of hundreds of funeral providers throughout the country, we know from many years of experience serving our communities that every family is different. Among these differences are a family’s preferences for end-of-life care influenced by their cultural heritage, race, religion, geographic region, and family traditions.

Treating these families and their loved ones with appropriate respect for their traditions is an important part of their care while in hospice and through their transition into funeral care.

An awareness of these needs before the final moments is crucial in providing them with the smoothest transition to their funeral provider.

Religious Beliefs and Traditions

For those hospice patients who follow a particular religious or cultural tradition, hospice staff should begin early to connect them with chaplains or social workers who can then bring in local religious leaders when necessary. For example, in the Catholic tradition, the dying are given Last Rites. In the Muslim faith and the more traditional branches of Judaism, burials must take place right away. Some faiths call for a ritual washing of the body or someone to sit and watch over the deceased until burial.

Some religions allow organ donation, euthanasia, and cremation, while others do not. Our article on religious differences and this page from the National Institute of Health are good resources for understanding the wide variety of religious practices and beliefs you may encounter. According to the American Medical Association, “Culturally competent caregivers put aside assumptions and predispositions and make individual assessments of each patient and situation.”

Rituals Before, During, and After Death

According to Duke Health, these three steps by hospice or hospital staff can provide families with a culturally competent goodbye that honors their loved one’s religious or cultural background.

• Hospital Chaplains can assist with prayer and ritual preparations, or can involve appropriate community religious or spiritual leaders to meet the family’s needs.
• Ask patients and families in advance what traditions and practices will be meaningful to them; contact a hospital Chaplain for support & guidance.
• Determine the appropriate care of the body after death, and whether family members wish to help with this care and preparation.

Awareness of Disparities and Differences

According to the American Psychological Association, understanding the needs of diverse populations is important because:

• Our population is aging. The number of Americans over 65 by 2060 is expected to be 98 million.
• More than 2.4 million Americans identify as LGBQT+.
• Our country is becoming more racially and ethnically diverse.

Historic racial disparities have also impacted trust in hospice and funeral care, according to Joél Simone Maldonado, writing for the California Funeral Directors Association.

How to Help Diverse Families 

According to the APA, these three guidelines can help you provide appropriate help no matter what someone’s religious or cultural background is. We’re here to help guide you and your patients and families to the next steps.

• Treat all people with dignity, and respect each individual’s rich cultural traditions, rather than viewing those traditions as barriers to overcome. 
• Consider cultural values when providing care for all individuals, and understand how those values may influence decision-making about palliative and end-of-life care. 
• Be aware of your own attitudes about palliative and end-of-life issues.

As your partners through the end-of-life experience, we’ll continue to work with your patients and families to provide them with the appropriate care throughout their end-of-life journey.

Resources for Hospice Professionals

You can find resources on diversity and cultural sensitivity on these websites.

The National Hospice and Palliative Care Organization: Diversity

National Resource Center on LGBQT+ Aging

Washington State Medical Home Partnerships Project

American Psychological Association: Trauma and Grief Toolkit