Introduction

Understanding Hospice General Inpatient (GIP) Care is crucial for Hospice RN Case Managers to ensure proper patient care and regulatory compliance.

Understanding Hospice General Inpatient (GIP) Care

Let’s break down the critical aspects of GIP care:

Definition and Purpose of GIP

General Inpatient Care (GIP) is a specialized level of hospice care designed for patients with acute symptoms that cannot be managed effectively in their usual care setting. The primary goals of GIP are:

• To provide intensive, short-term pain control
• To manage acute or chronic symptoms that are uncontrollable in other settings
• To stabilize the patient’s condition and return them to a lower level of care when appropriate

GIP is not meant for long-term or custodial care. It’s a temporary intervention to address severe symptoms or crises.

Common reasons for initiating GIP include:

• Uncontrolled pain requiring frequent medication adjustments
• Severe nausea and vomiting
• Acute respiratory distress
• Wounds requiring complex care
• Severe agitation or delirium related to end-stage disease

Medicare Requirements for GIP Care

Medicare has guidelines for GIP care to ensure it’s used appropriately and effectively. Here are the key requirements:

Eligibility: The patient must be enrolled in hospice care and have symptoms that cannot be managed in their current setting.

Setting: GIP must be provided in a Medicare-certified facility, such as:

• A hospice inpatient unit
• A hospital
• A skilled nursing facility (SNF)

Documentation: Thorough documentation is crucial to support the need for GIP. This includes:

• Daily assessments of the patient’s condition
• Detailed descriptions of interventions and their effectiveness
• Clear evidence of working towards symptom control and discharge planning

Duration: While there’s no set limit on GIP stays, they are intended to be short-term. More extended stays may face increased scrutiny from Medicare.

Interdisciplinary Approach: The hospice team, including the medical director, must collaborate to determine the need for GIP and develop a care plan.

Here’s a table summarizing the key differences between routine hospice care and GIP:

Aspect	Routine Hospice Care	General Inpatient Care (GIP)
Setting	Patient’s residence	Medicare-certified inpatient facility
Symptom Intensity	Manageable at home	Severe, requiring intensive intervention
Duration	Ongoing	Short-term, focused on symptom management
Nursing Care	Intermittent visits	24/7 skilled nursing care
Goal	Comfort maintenance	Acute symptom control and stabilization

Remember, as a Hospice RN Case Manager, your role is crucial in ensuring that GIP is used appropriately and documented thoroughly. By understanding these requirements and guidelines, you can provide the best possible care for your patients while maintaining compliance with Medicare regulations.

The Growing Concern of Inappropriate GIP Billing

As a Hospice RN Case Manager, you ensure proper billing and documentation for General Inpatient (GIP) care. Let’s explore the growing concerns around inappropriate GIP billing and its implications:

Common Billing Errors

Hospices often make several mistakes when billing for GIP care. Being aware of these can help you prevent them:

1. Incorrect level of care: Billing for GIP when the patient’s symptoms don’t meet this intensive level of care criteria.
2. Inadequate documentation: Failing to provide sufficient evidence of the need for GIP in the patient’s medical records.
3. Extended GIP stays: Billing for GIP beyond the period of acute symptom management without proper justification.
4. Location-based billing: Mistakenly assuming a patient’s location (e.g., in a hospice inpatient unit) automatically qualifies for GIP billing.
5. Billing for routine care as GIP: Incorrectly coding routine hospice care as GIP, leading to overpayment.

Financial Impact on Medicare

Inappropriate GIP billing has significant financial consequences for the Medicare program:

• Overpayments: GIP is reimbursed much more than routine hospice care. In FY 2022, the daily rate for GIP was $1,068, compared to $203 for routine home care.
• Increased scrutiny: The high cost of GIP has led to increased audits and oversight by Medicare.
• Potential fraud: In severe cases, inappropriate GIP billing can be considered fraudulent, leading to legal and financial penalties for hospices.

Recent OIG Audits and Findings

The Office of Inspector General (OIG) has been actively investigating hospice GIP billing. Here are some key findings:

Audit Finding	Details
Error rate	Approximately one-third of Medicare GIP claims are submitted in error
Focus areas	Longer GIP stays and high-cost cases are under particular scrutiny
New audit	OIG launched a nationwide audit in 2023 focusing on GIP claims following acute hospitalizations
Audit timeline	Results of the new audit are expected in fiscal year 2025

Key takeaways for Hospice RN Case Managers:

• Be vigilant: Carefully assess and document the need for GIP care, ensuring it meets Medicare criteria.
• Collaborate: Work closely with your interdisciplinary team to ensure consistent documentation across all team members.
• Stay informed: Keep up-to-date with Medicare requirements and OIG findings to ensure compliance.
• Regular reviews: Participate in regular internal audits of GIP claims to identify and correct potential issues before they become problems.

By understanding these concerns and taking proactive steps, you can help ensure that your hospice provides appropriate care while maintaining compliance with Medicare regulations. Remember, your documentation and care coordination role support proper GIP billing and avoid potential audits or penalties.

Fraud Risks in Hospice GIP Care

Hospice GIP care fraud can take various forms, all of which can harm patients and undermine the integrity of the hospice system. Awareness of these risks helps you stay vigilant and ensure proper care delivery.

Examples of GIP-Related Fraud Cases

1. Unnecessary GIP Billing: In 2014, an Illinois hospice executive was charged with fraudulent billing for GIP when patients didn’t require this level of care.
2. Extended GIP Stays: A hospice billed for 46 consecutive days of GIP for a patient with a circulatory disease with no unmanaged symptoms, resulting in an overpayment of about $31,000.
3. Kickback Schemes: Some hospices have been caught paying nursing facilities $250 per day for every patient on GIP, violating anti-kickback laws.
4. Falsifying Patient Conditions: In 2012, a former hospice owner was sentenced to prison for billing GIP while providing lower levels of care, defrauding Medicare of over $3 million.

Red Flags for Potential Fraud

As a Hospice RN Case Manager, be alert to these warning signs:

• Unusually Long GIP Stays: GIP is meant for short-term symptom management.
• Lack of Physician Involvement: GIP should always involve a physician’s decision.
• Inconsistent Documentation: Care plans and daily assessments should align with GIP-level care.
• High Percentage of GIP Patients: An unusually high proportion of patients on GIP may indicate fraud.
• Pressure to Upgrade Care: This is a red flag if you feel pressured to elevate care levels unnecessarily.

Here’s a table summarizing key red flags:

Red Flag	What to Look For
Length of Stay	GIP stays exceeding 5-7 days without clear justification
Documentation	Lack of daily assessments or inconsistent symptom reporting
Patient Condition	Stable patients without acute symptoms receiving GIP
Facility Relationships	Unusual arrangements with nursing homes or hospitals
Billing Patterns	Sudden increases in GIP billing or consistently high GIP usage

What You Can Do

1. Document Thoroughly: Ensure your assessments justify the need for GIP.
2. Communicate Openly: Discuss concerns with your team and supervisors.
3. Know the Rules: Stay updated on Medicare GIP requirements.
4. Trust Your Instincts: If something feels wrong, it probably is. Don’t hesitate to speak up.
5. Protect Yourself: Familiarize yourself with whistleblower protections if you need to report fraud.

Remember, as a Hospice RN Case Manager, you play a crucial role in preventing fraud. Your diligence protects your patients and organization and preserves the integrity of the hospice care system. By staying informed and vigilant, you ensure that hospice care remains a vital and trusted service for those who genuinely need it.

The Critical Role of Hospice RN Case Managers

Your role as a Hospice RN Case Manager is multifaceted and essential. You are the linchpin that connects patients, families, and the interdisciplinary team, ensuring seamless, compassionate care.

Responsibilities from Admission to Discharge

Your duties span the entire patient journey:

Initial Assessment:

• Conduct comprehensive evaluations of patients’ physical, emotional, and spiritual needs
• Develop individualized care plans

Ongoing Care Coordination:

• Manage the implementation of care plans
• Collaborate with the interdisciplinary team
• Provide direct nursing care as needed

Symptom Management:

• Assess and address pain and other symptoms
• Adjust care plans as patients’ conditions change

Family Support:

• Educate patients and families about the dying process
• Offer emotional support and resources

Documentation:

• Maintain accurate, detailed records of patient care
• Ensure compliance with Medicare regulations

Discharge Planning:

• Prepare for transitions in care, including to GIP if necessary
• Coordinate services for patients returning home or moving to other care settings

Ensuring Appropriate GIP Utilization

As a Case Manager, you play a crucial role in determining when GIP is necessary and ensuring its appropriate use:

• Assess Need: Carefully evaluate if symptoms truly require inpatient management
• Document Thoroughly: Justify the need for GIP in patient records
• Monitor Progress: Continuously assess if GIP is still required or if the patient can return to routine care
• Collaborate: Work closely with the hospice physician and team to make GIP decisions
• Educate: Help patients and families understand the purpose and limitations of GIP

Here’s a table to help you quickly assess GIP appropriateness:

Appropriate for GIP	Not Appropriate for GIP
Uncontrolled pain requiring frequent medication adjustments	A general decline in condition
Severe respiratory distress	Caregiver breakdown
Unmanageable nausea/vomiting	Routine end-of-life care
Acute symptom crisis needing 24/7 nursing	Fall risk requiring supervision
Complex wound care	Lack of a caregiver at home

Remember, your role is crucial in ensuring that patients receive the right level of care at the right time. By carefully assessing needs, documenting thoroughly, and collaborating effectively, you help maintain the integrity of the hospice program while providing the best possible care for your patients.

Your compassion, clinical skills, and care coordination are invaluable to patients and families during this sensitive time. By understanding and fulfilling your critical role, you make a profound difference in the lives of those you serve.

Documentation Best Practices for GIP Care

Quality documentation is essential for providing excellent patient care, maintaining compliance, and supporting appropriate billing. Here are some key elements and best practices to keep in mind:

Key Elements of Quality Documentation

1. Clarity and Specificity: Be clear and specific about the patient’s condition, interventions, and responses.
2. Timeliness: Document in real-time or as soon as possible after care is provided.
3. Completeness: Include all relevant information about the patient’s care and condition.
4. Objectivity: Use factual, observable information rather than subjective opinions.
5. Consistency: Ensure your documentation aligns with the care plan and other team members’ notes.

Here’s a table summarizing these key elements:

Element	Description	Example
Clarity	Use precise, unambiguous language	“Patient reports pain level 8/10 in lower back.”
Timeliness	Document promptly	“Morphine 5mg IV administered at 14:30.”
Completeness	Include all relevant details	“Patient’s pain decreased to 3/10 after 30 minutes.”
Objectivity	Focus on observable facts	“Patient grimacing and holding lower back.”
Consistency	Align with care plan and team notes	“Continuing with pain management plan as outlined.”

Daily Assessments and Care Plan Updates

Daily assessments are crucial in GIP care to justify the continued need for this level of care and to track the patient’s progress. Here’s what to include:

• Symptom Assessment:
  • Detailed evaluation of pain and other symptoms
  • Use of standardized scales (e.g., 0-10 pain scale)
  • Patient’s response to interventions
• Medication Review:
  • Current medications and dosages
  • Effectiveness of medications
  • Any side effects or adverse reactions
• Physical Assessment:
  • Vital signs
  • Relevant physical findings
  • Changes from previous assessments
• Psychosocial and Spiritual Status:
  • Patient’s emotional state
  • Family coping and support
  • Spiritual needs or concerns
• Care Plan Updates:
  • Progress towards goals
  • Any new issues or concerns
  • Changes in interventions or approach

Best Practices for Daily Documentation:

1. Use the SOAP format:
   • Subjective (patient’s reported symptoms)
   • Objective (your observations and measurements)
   • Assessment (your analysis of the situation)
   • Plan (your care plan going forward)
2. Focus on GIP Criteria: Document why the patient still requires GIP-level care.
3. Highlight Changes: Emphasize changes in the patient’s condition or care plan.
4. Include Interdisciplinary Input: Document contributions from all team members.
5. Address Discharge Planning: Note progress towards transitioning to a lower level of care.

Remember, each day’s documentation should be able to justify the need for GIP care alone. Be thorough and precise, and always keep the patient’s best interests at the forefront of your documentation.

By following these best practices, you’ll ensure compliance and proper billing and contribute to better patient care through clear communication and thorough record-keeping. Your diligence in documentation plays a vital role in the overall quality of hospice care provided to your patients.

Regulatory Compliance and Audits

RAC audits are becoming more frequent in the hospice industry, with the federal government allocating significant resources to identify and recover improper payments. Here’s what you need to know:

• RACs can review claims going back up to three years
• Audits focus on areas like General Inpatient Care (GIP) and Continuous Home Care (CHC)
• In 2019, RACs recovered over $162 million in overpayments across healthcare providers

Preparing for RAC Audits

To be ready for a potential RAC audit, consider these strategies:

1. Maintain Thorough Documentation
   • Ensure all services are documented with justifications
   • Use standardized formats like SOAP notes for consistency
2. Stay Updated on Medicare Rules
   • Regularly review CMS guidelines and updates
   • Attend training sessions on billing and coding changes
3. Conduct Internal Audits
   • Regularly review your claims and documentation
   • Identify and correct issues before external auditors do
4. Develop an Audit Response Plan
   • Designate team members responsible for managing audits
   • Create a process for gathering and submitting requested documentation
5. Focus on High-Risk Areas
   • Pay special attention to GIP and CHC documentation
   • Ensure all GIP stays are justified as “reasonable and necessary.”

Implementing Effective Compliance Programs

A robust compliance program is your best defense against audit issues. Here’s how to create one:

1. Establish Clear Policies and Procedures
   • Develop written guidelines for all aspects of patient care and billing
   • Ensure all staff members understand and follow these policies
2. Provide Regular Training
   • Conduct ongoing education on compliance issues
   • Include training on documentation best practices and Medicare regulations
3. Designate a Compliance Officer
   • Appoint someone to oversee your compliance efforts
   • Ensure they have the authority to implement and enforce policies
4. Conduct Regular Risk Assessments
   • Identify areas of potential vulnerability in your operations
   • Develop strategies to address these risks
5. Implement a Reporting System
   • Create a confidential way for staff to report compliance concerns
   • Ensure all reports are thoroughly investigated and addressed
6. Monitor and Audit Regularly
   • Conduct ongoing internal audits of your claims and documentation
   • Use results to improve processes and address issues proactively

Here’s a table summarizing the key elements of an effective compliance program:

Element	Description
Leadership Commitment	Active involvement from top management in compliance efforts
Written Standards	Clear policies and procedures for all aspects of operations
Training and Education	Ongoing staff education on compliance issues and best practices
Monitoring and Auditing	Regular internal reviews to identify and address potential issues
Reporting Mechanisms	Confidential systems for staff to report compliance concerns
Enforcement and Discipline	Consistent application of disciplinary policies for non-compliance
Response and Prevention	Prompt response to detected issues and implementation of corrective actions

Remember, a compliance program is not just about avoiding audits – it’s about providing the best possible care to your patients while ensuring your organization operates ethically and efficiently.

By implementing these strategies and maintaining a strong focus on compliance, you can help protect your hospice from audit-related issues and contribute to the overall quality of care provided to your patients. Your role as a Hospice RN Case Manager is crucial in this process, as your documentation and care coordination form the foundation of your organization’s compliance efforts.

Strategies for Improving GIP Care Quality and Compliance

Staff Education and Training

Ongoing education is vital for maintaining high-quality GIP care. Consider implementing the following:

1. Regular In-Service Training
   • Schedule monthly or quarterly sessions
   • Focus on GIP-specific topics like symptom management and documentation
2. Case Studies and Simulations
   • Use real-world scenarios to practice decision-making
   • Simulate GIP admissions and discharges
3. Interdisciplinary Team (IDT) Education
   • Ensure all team members understand their roles in GIP care
   • Promote collaboration and communication across disciplines
4. Compliance Updates
   • Keep staff informed about regulatory changes
   • Review audit findings and areas for improvement

Here’s a table outlining key areas for GIP-focused staff education:

Topic	Description	Frequency
GIP Criteria	Review Medicare requirements for GIP care	Quarterly
Symptom Management	Advanced pain control and crisis intervention	Monthly
Documentation	Best practices for justifying GIP need	Bi-monthly
Discharge Planning	Strategies for timely transitions from GIP	Quarterly
Regulatory Updates	Changes in hospice regulations affecting GIP	As needed

Utilizing Technology for Better Documentation

Leveraging technology can significantly improve GIP documentation quality and efficiency:

• Electronic Health Records (EHR)
  • Implement GIP-specific templates
  • Use built-in reminders for required documentation elements
• Mobile Documentation
  • Provide tablets or smartphones for real-time charting
  • Ensure secure, HIPAA-compliant access to patient records
• Automated Alerts
  • Set up notifications for missing or incomplete GIP documentation
  • Use alerts to flag potential compliance issues
• Data Analytics
  • Utilize reporting tools to track GIP utilization and outcomes
  • Identify trends and areas for improvement

Regular Internal Audits and Quality Assurance

Implementing a robust audit and quality assurance program is essential for maintaining GIP compliance:

1. Scheduled Audits
   • Conduct monthly reviews of GIP cases
   • Use a standardized audit tool focused on GIP criteria
2. Random Chart Reviews
   • Perform surprise audits on active GIP cases
   • Ensure ongoing compliance, not just during scheduled reviews
3. Peer Review Process
   • Implement a system for nurses to review each other’s GIP documentation
   • Promote a culture of continuous improvement
4. Quality Metrics Tracking
   • Monitor key performance indicators for GIP care
   • Examples: length of stay, symptom management effectiveness, discharge outcomes
5. Corrective Action Plans
   • Develop and implement plans to address identified issues
   • Follow up to ensure improvements are sustained

Here’s a checklist for your internal GIP audit process:

•  Verify that GIP admission criteria are met and documented
•  Ensure daily assessments justify the ongoing GIP need
•  Check for interdisciplinary team involvement
•  Review medication administration records for appropriate interventions
•  Confirm that discharge planning is addressed throughout the stay
•  Evaluate the overall quality and completeness of documentation

Implementing these strategies can significantly improve the quality and compliance of your GIP care. Remember, as a Hospice RN Case Manager, your attention to detail and commitment to excellence make a real difference in the lives of your patients and their families.

Continuous improvement in GIP care ensures regulatory compliance and enhances patients’ care experience during critical periods. Your role in implementing and maintaining these strategies is invaluable to your hospice organization and the patients you serve.

Conclusion: Balancing Quality Care and Regulatory Compliance

As a Hospice RN Case Manager, you’re at the heart of a delicate balance between providing compassionate, high-quality care and meeting regulatory requirements. Let’s reflect on how to achieve this balance effectively:

The Dual Focus of Hospice Care

1. Patient-Centered Care
   • Prioritizing comfort and quality of life
   • Addressing physical, emotional, and spiritual needs
   • Supporting families through the end-of-life journey
2. Regulatory Compliance
   • Adhering to Medicare guidelines
   • Maintaining accurate and thorough documentation
   • Ensuring appropriate use of General Inpatient (GIP) care

Strategies for Achieving Balance

• Integrate Compliance into Daily Practice
  • View documentation as a tool for better patient care, not just a regulatory requirement
  • Use care plans to guide both patient care and compliance efforts
• Cultivate a Culture of Integrity
  • Encourage open communication about compliance concerns
  • Celebrate both quality care achievements and compliance successes
• Leverage Technology Wisely
  • Use EHR systems to streamline documentation while improving care coordination
  • Implement automated reminders for key compliance tasks
• Continuous Education and Training
  • Stay updated on both best practices in hospice care and regulatory changes
  • Participate in regular in-service training sessions

Here’s a table summarizing key aspects of balancing care and compliance:

Aspect	Patient Care Focus	Compliance Focus	Balanced Approach
Documentation	Record the patient’s comfort and symptoms	Meet Medicare requirements	Use detailed documentation to justify care decisions and meet regulations
GIP Utilization	Provide intensive care when needed	Ensure appropriate use of GIP	Carefully assess and document the need for GIP, focusing on patient benefit
Team Communication	Coordinate care for patient benefit	Ensure all team members are informed of compliance requirements	Integrate compliance discussions into regular care planning meetings
Family Interactions	Provide emotional support and education	Obtain necessary consent and explain Medicare rules	Use family meetings to address both care needs and program requirements

Remember Your “Why”

Amid regulatory pressures, never lose sight of why you became a hospice nurse:

• To provide comfort and dignity to those at the end of life
• To support families through one of life’s most challenging transitions
• To make a meaningful difference in people’s lives

By keeping this purpose at the forefront, you can navigate the complexities of compliance while still delivering the compassionate care that defines hospice.

Final Thoughts

Balancing quality care with regulatory compliance is an ongoing process. It requires vigilance, adaptability, and a commitment to excellence. As a Hospice RN Case Manager, you play a pivotal role in this balance:

• Your clinical skills ensure patients receive the best possible care
• Your documentation justifies the care provided and meets regulatory requirements
• Your leadership helps guide the entire team in maintaining this delicate balance

Remember, every time you document thoroughly, you’re not just meeting a regulation – you’re advocating for your patient and supporting the vital work of hospice care.

By embracing both the art of compassionate care and the science of regulatory compliance, you elevate the entire field of hospice nursing. Your dedication makes a profound difference in the lives of patients and families during their most vulnerable moments.

I appreciate your commitment to excellence in hospice care. Your work truly matters.

Resources

General Inpatient (GIP) Level Of Care For Hospice Explained

Top Four Problems Hospice Agencies are Facing in Eligibility and Billing

OIG Launches Audit of Inappropriate GIP Billing

Illinois Hospice Executive Charged With Federal Health Care Fraud For Allegedly Falsely Elevating Level Of Patients’ Care

Two Men Sentenced for Role in $9M Hospice Fraud Scheme

Hospice Medical Director Sentenced for $150M Hospice Fraud Scheme

Hospices Inappropriately Billed Medicare Over $250 Million for General Inpatient Care (OEI-02-10-00491; 03/16) (PDF)

Hospices Likely to See ‘Uptick’ in RAC Audits

OIG’s Hospice GIP Audit Fueled by Inappropriate Billing; Nearly One-Third of Claims Have Errors

Medicare Claims Processing Manual: Chapter 11 – Processing Hospice Claims (PDF)

CMS Medicare Fee for Service Recovery Audit Program

RAC Audits: 10 Strategies to Ensure Compliance

Publication of the OIG Compliance Program, Guidance for Hospices (PDF)

Holistic Nurse: Skills for Excellence book series

• Compassionate Care in Conflict: A Nurse’s Guide to Managing Combative Patients
• Dementia Staging Mastery: A Nurse’s Guide to Dementia Assessment
• The Nurse’s Guide to Motivational Interviewing: Empowering Patients to Make Lasting Health Changes
• Clinical CBT Applications: Essential Strategies for Modern Nursing Practice

Empowering Excellence in Hospice: A Nurse’s Toolkit for Best Practices book series

• Art of Hospice Prognosis: Essential Skills for Clinical Assessment and Family Communication
• Beyond the Hospital: Navigating a Career in Hospice Nursing
• Breath of Life: Managing End-of-Life Respiratory Symptoms
• Care Plans for Hospice Patients: A Comprehensive Guide
• Clinical Pathophysiology: A Reference for Hospice and Palliative Nurses
• Compliance-based, Eligibility Driven Hospice Documentation: Tips for Hospice Nurses
• Conversations at the End: Guiding Families Through Final Days
• HOPE in Practice: Implementing Patient-Centered Outcomes in Hospice Care
• HOPE in Action: A Practical Guide to Hospice Assessments
• Hospice Clinical Pharmacology: Critical Thinking for Comfort-Centered Care
• Hospice Tools of the Trade: Essentials for Hospice Nurses
• Mastering Dementia Admissions: Essential Guidelines for Hospice Eligibility
• Mastering Hospice Eligibility: An Essential Guide for RNs and Clinical Managers
• Mastering Hospice Recertifications: A Comprehensive Guide for Nurses
• Mastering the Hospice Item Set: A Comprehensive Guide for Nurses and Managers
• Medication Reconciliation in Hospice Care: Maximizing Quality of Life
• The Art of Hospice Visit Planning: A Clinical Guide to Patient-Centered Care Frequency
• The Complete Hospice Visit: A Nurse’s Guide to Excellence
• The Hospice CoP Handbook: Meeting Federal Mandates from Admission to Audit
• Time Management for Hospice Nurses: Practical Strategies for Rural Practice
• Whispers of Time: Understanding the End-of-Life Timeline

Tips for Hospice Nurses – Numerous Articles

Bridges to Eternity: The Compassionate Death Doula Path book series:

• Becoming a Death Doula: Foundations and Practice
• Becoming a Death Doula: Business Growth
• Becoming a Death Doula: A Complete Guide to Starting Your End-of-Life Doula Practice (Foundations and Practice and Business Growth combined)
• Crafting Meaningful Legacies: A Guide for End-of-Life Professionals
• Vigil Planning Guide: Creating Sacred Space in Life’s Final Chapter
• Crucial End-of-Life Conversations: A Compassionate Guide for End-of-Life Professionals

Find an End-of-Life Doula

• Compassion Crossing, LLC – operates on-site through Madison County, Kentucky and virtually if you cannot find one local to you.
• The International Doula Life Movement (IDLM) – https://www.internationaldoulalifemovement.com/directory/
• The National End-of-Life Doula Alliance (NEDA) – https://www.nedalliance.org/end-of-life_doulas_a_through_m.html and https://www.nedalliance.org/doula_directory_n_through_z.html
• The International End-of-Life Doula Association (INDELA) – https://inelda.org/find-a-doula/
• EveryLoved – https://everloved.com/death-doulas/
• Death Doula Director – https://deathdoulas.com/deathdouladirectory/

Currently, there is no universal director of end-of-life doulas (EOLD). It’s essential to note that some EOLDs listed in directories may no longer be practicing. The author recommends starting with IDLM, as their training program is always current and thorough, followed by NEDA, which is the only independent organization not affiliated with any school.

End-of-Life-Doula Articles