Departures intentionally connects end-of-life planning and funeral planning. They are the two sides of life’s transition, though served by different kinds of professionals. But medical providers, including palliative and hospice care, rarely interact meaningfully with funeral care providers. The idea is to create an intentional bridge between the two stages — a continuum of caring.

Usually yes, depending on what you want and what you prioritize. I’ll ask you some questions to think about that will help to guide your plan. We will identify the lowest-cost options that are compatible with your values. Some people just want to know the range of options, have agency in their choices, and feel assured no one is taking advantage of a vulnerable situation.

One of the goals of Departures is to provide space for more expansive — and even creative — thinking, about both the end of life and funerals. At the end of your life, how do you want to be cared for? How can you address situations that may be difficult to foresee? In funeral planning, you may want to consider alternatives that are often not presented, such as green burial, a home funeral, or a service in a place you care about rather than at a funeral home.

Talking about the end of life is a hard topic. It’s helpful just to recognize that truth when a parent or a loved one is resistant. It usually involves more than one conversation and you will probably have greater success by easing into it. You can ask easier questions to begin, such as how your parents’ perspectives on life have evolved as they’ve gotten older. Or you might recall a good friend your parents have lost and what their ending was like, and how your parents felt about it.

You’re not alone; most Americans have become less religiously affiliated. At the same time, at the end of life, and particularly at funerals, many people return to the religious tradition in which they were raised. These traditions can be comforting because they provide a familiar framework and set of rituals. You are also free to move outside of that framework and create a unique setting for people to remember, honor, reflect on, and celebrate the person they’ve lost.

Funerals cost more than they should and prices seem to defy logic or to be taking advantage of a vulnerable situation.

A “funeral” is often a group of related purchases: There is the funeral itself and the associated merchandise (e.g., casket), transportation, and service charges. There is the grave (if you are being buried), the grave liner, and the monument. Cemeteries charge a fee for opening (digging) and closing a grave. There are death certificate fees, obituary fees, officiant fees, flowers, and other expenses. Only a portion of these expenses is paid to the funeral home itself.

There are a few systemic reasons for the high costs of the services provided by funeral homes and these are in part due to inefficiencies that are built into the business. Funeral homes are like firehouses: They need to be staffed all the time, even though some days are busy while other days are, well, dead. Staff not working at capacity (because, at times, there is no work to do) is one example of inefficiency. (Funeral director salaries are more modest than you might think.)

Real estate, the most expensive asset for most funeral homes, is also used inefficiently. A chapel, for example, may be operated for only a few hours each week, but it is a fixed cost along with all the other space in the funeral home, such as the preparation facilities and meeting rooms.

One of the large funeral homes where I worked has a dedicated staff to make transfers of decedents. These men (they are all men) are in the funeral home from 8 AM to midnight every day, and they are on-call overnight. While on-site and dressed in suits, most days they spend a lot of time scrolling on their phones and, often, napping. But when a call comes in, they are dispatched immediately and are almost always able to get to the decedent within an hour. The families who use this funeral home expect that level of service.

There are many other inefficiencies. A hearse, which is a specially-modified sedan or SUV, can cost $150,000. (Commonly misunderstood is that the hearse is a ceremonial vehicle used to transport the casket to the church or synagogue and then to the cemetery; for initial transfers of a deceased from the place of death, most funeral homes use a nondescript van.) A hearse is a large fixed-cost asset that typically sits unused most of the time. Some funeral homes manage this inefficiency through fleet service arrangements, where hearses and limousines (and drivers) are hired on an as-needed basis. But many funeral homes like to have their own vehicles so they are assured of availability.

Corporations like SCI, which have bought up many independent funeral homes around the country, have tried to achieve efficiencies by sharing staff, vehicles, and preparation facilities across multiple funeral homes. But they, too, struggle with real estate inefficiency.

The price for cremation at the full-service funeral home where I worked is about $4,000 and that is more or less the price at other full-service funeral homes, plus or minus a few hundred dollars. There are cremation services in the region which charge as little as $995.

Why is there such a large price difference?

The cremation service that charges $995 is, essentially, a “transfer service” where a driver transfers the deceased directly to the crematory. The remains wait at the crematory for the death certificate to be signed and filed with the State, and for the family to sign the cremation authorization.

The price of $995 is for someone who dies in a hospital, not at home. Why? Because hospitals make certain things easier for the funeral director: they will hold the remains (refrigerated) until the next business day so the funeral director doesn’t need to go out in the middle of the night. And hospitals are designed with wheeled cots in mind (there are large elevators and ramps), so the transfer can be handled by one person.

The same cremation service charges more (around $2,000) if you die at home or in a nursing facility. That’s because they usually need to send two people to a residence (in order to navigate stairs and tight spaces), and because the remains need to be picked up within a couple of hours — even if it is the middle of the night. (Nursing homes and other non-hospital healthcare facilities do not have morgues where a body can be stored until the next business day.)

Cremations handled by a full-service funeral home are different in a few ways, and also more expensive. Usually, it is the staff of the funeral home who come to pick up the deceased. The remains are typically sheltered at the funeral home while awaiting cremation. (Ultimately, the funeral home may likely bring the deceased to the same crematory as the less expensive cremation service.) If the family wishes to see their loved one before cremation, the funeral home will typically wash and dress the deceased for a private viewing. And there is typically more personal contact between the family and the funeral director. The funeral home can also arrange a funeral service (with the body present) prior to cremation, or a memorial service after cremation.

There actually is, more or less, pricing transparency in funeral service. But it hasn’t kept up with the times.

In 1984, the Federal Trade Commission established the “Funeral Rule”. It requires that funeral homes publish a General Price List (GPL) and that the price list be given to anyone who requests it. If you call a funeral home during their regular business hours, they must tell you their prices over the phone. If you go into the funeral home, they must give you a copy of the GPL to keep and you do not need to provide a reason for requesting it.

If you go to a funeral home to make arrangements, the funeral director is required to hand you a copy of the GPL before (or at the moment) you begin to discuss anything related to engaging their services.

The Funeral Rule was last amended in 1994 and therefore it does not address whether prices must be published online. After years of consumer pressure, the FTC has proposed updating the Funeral Rule to require that funeral homes post their GPL on their websites. But the change has not yet been adopted. A few states, including California, require that funeral homes post their prices online.

Cremation has a carbon footprint, of course. I’ve done some basic calculations, but the actual carbon emissions depend on a few factors.

A typical cremation emits 535 pounds of CO2, which is the approximate equivalent of burning 27 gallons of gasoline (though most crematories use natural gas). If you own a car, you have a sense of how much gasoline you consume. A cremation consumes the equivalent of one to two tankfuls.

For another comparison, a one-way flight from New York to Los Angeles on a 737 generates 127,000 lbs of CO2, which translates to about 1,200 lbs per person, or the CO2 equivalent of 2.2 cremations per person per flight.

Burial is not carbon-free, either. Digging the grave with a backhoe, producing and installing the grave liner, and quarrying and transporting the headstone all require fuel resources. Many headstones are quarried in Asia and other continents and shipped to the U.S. In addition to some fossil fuel use, burial also “consumes” land.

You know you want to be cremated. What else is there to do?

First, you should make sure you have communicated your intentions to family members or to the individual(s) who will take care of your final arrangements. If you think there might be any disagreement about following your wishes (sometimes family members have different beliefs or concerns about cremation), you should put your wishes in writing. You can make a prearrangement with a funeral home, or you can sign a funeral directive form, making sure you use a form valid in your state.

There are a few other questions to consider, including what you would like done with your cremated remains, or ashes: Should they be buried? Scattered someplace special? Inurned in a cremation niche at a cemetery? It is good practice (and considerate) to let your wishes be known. Too often cremated remains end up on a closet shelf, left to find a disposition on moving day years hence.

Green burial is generally accepted to mean that the body is not embalmed and is buried in a biodegradable casket (such as one made of wood or wicker), or simply in a shroud. A burial like this can take place in a traditional cemetery, however many cemeteries require concrete grave liners. (For more about that, see the FAQ on Grave Liners.)

More often, green burial means being buried in a cemetery or on protected land that is designated and managed for the purpose of natural burials. Such cemeteries (or portions of traditional cemeteries) exist throughout the country. Typically, these natural burial grounds do not have traditional monuments or headstones, though they may have alternative ways of marking graves. Sometimes cemetery rules require any clothing on the body be biodegradable, with no plastic fibers or fasteners. And often the body is buried in a shallower grave than at a traditional cemetery, deep enough so as not to be disturbed by animals but close enough to the surface that the natural process of decomposition will proceed more rapidly than it does in a deeper grave.

Green burial also includes “natural organic reduction,” or “human composting,” which is currently only available in a few states. Some people consider cremation a relatively green option because it does not take up land.

Before there were casket (or coffin) manufacturers, caskets were made by local cabinetmakers. Things have changed, and continue to change as the casket industry has consolidated to a small number of manufacturers.

Until a few decades ago, the casket sale was the profit center for a funeral home. Prices were grossly inflated to cover a portion of the funeral home’s services. Funeral homes still make a substantial profit on casket sales, but not to the same degree as decades ago. Instead of folding overhead expenses into merchandise sales, today most funeral homes have a “Basic Services” charge which is intended to cover core operations. Still, caskets cost more than perhaps they should.

What are your options?

If you are being buried (as opposed to cremated), the first option is to choose a less expensive casket from the selection offered. (Jews are traditionally buried in a “plain pine box.”) It is worth remembering that this is something that will be placed in the ground (or entombed above-ground, if that is your preference). It will only be seen for a very short period of time. Its “durability” is of little value since all caskets (well, the wooden ones, at least) will begin to decay as soon as they are buried. Metal caskets will slowly rust and decay over a very long period of time. Despite claims to the contrary, no casket is permanently impervious. Ultimately, caskets are impermanent as life is impermanent.

You have at least one more option.

The Federal Trade Commission requires that a funeral home accept a third-party casket. That means you can purchase a casket from another vendor (e.g., Costco, Amazon, Walmart, OvernightCaskets.com, and others), or, even, from an artist, carpenter, or cabinetmaker and have it delivered to the funeral home. The funeral home must accept it and is not permitted to charge a handling fee, but they can require that the casket be delivered during normal business hours and that it be delivered on the day it is needed (so it doesn’t have to be stored). You are entirely within your rights to do this. There are a couple of caveats to consider: the funeral home will not be responsible if the casket arrives scratched or damaged, or if delivery of the casket is delayed.

A grave liner is a concrete box — like a large shoebox — that gets lowered into the excavated grave, into which the casket is placed. At the burial service, the grave liner is sometimes then filled with dirt (around the casket) before the concrete cover is lowered into position.

What is the purpose of this concrete box?

Liners (and their beefier and more expensive kin, “vaults”) are generally not required by law, but many cemeteries require them by policy. The main function of the liner is to preserve the level landscape above the grave by reducing the tendency of the ground to settle. When the earth settles into an excavated grave, in addition to poor appearances, it can cause headstones to topple. The grave liner serves the practical functions of keeping the ground level and making the landscape easier to maintain.

Older cemeteries and “burying grounds” may not require a liner. If you visit an old cemetery that did not use liners, you will typically see uneven ground and toppled or leaning headstones and markers.

Some cemeteries that require a liner by policy will make exceptions on religious grounds. The most common accommodation is to still require a liner but knock out the bottom so a wooden casket sits in direct contact with the earth.

This happens not infrequently and funeral homes are experienced in dealing with situations where someone dies away from home. If you or a loved one were to die within the US but in another state, you or your family would contact the funeral home near where you live and they would make arrangements for the transfer of the deceased. If the body will be shipped by plane, it will need to be embalmed (with certain religious exemptions) and it will be placed in a sealed container required by the airlines. If your intention is to be cremated, it is simpler and much less expensive to be cremated at the location of the death and then have the cremated remains shipped home. If you die overseas, things become more complicated as rules vary by country. Still, you would contact a funeral home near you to coordinate the return of remains.

Embalming is a chemical process that temporarily preserves the body of the deceased. It was first used during the Civil War and allowed the war dead to be returned home for burial, rather than be buried in the battlefield. The practice is widely used in the U.S., though it is less commonly used in Europe and most other countries.

In addition to its preservative effect, embalming can make the deceased appear “more natural” in coloring and fullness if, for example, the deceased will be viewed. As is true of anyone practiced in their trade, an experienced embalmer and restorative artist can do beautiful work, even in the most difficult cases. The result is often a comfort to families as a last impression of their loved one.

In most circumstances, embalming is not necessary. Everything eventually decays and the preservative effect of embalming is temporary. Depending on many factors, including the chemicals used, the decomposition process may be delayed by months or a few years.

When a decedent is brought to a funeral home, the body is either refrigerated or embalmed. Both forestall decomposition, though refrigeration provides a shorter window. In some ways, embalming makes things easier for the funeral home, especially if the funeral or final disposition will not be immediate. There is often little difference in the charge for embalming versus refrigeration. (You should only be charged for one or the other.)

There are certain cases where embalming is recommended or even required:

• If the deceased will be entombed above ground, embalming is almost always required by the mausoleum’s policies.
• Refrigeration provides acceptable preservation for about a week to 10 days. If the funeral or disposition will take place after that timeframe, embalming is recommended and often required. Some state laws require embalming if a body will be held more than a certain number of days, though an exemption request can be filed for religious reasons.
• In circumstances where a body is partially decomposed (e.g., the deceased was not found immediately), embalming may be necessary.
• If the body is being shipped by plane, it must be embalmed. There are certain religious exemptions where a body can be shipped in a container packed with wet ice.

The following description of the embalming process is graphic and some people may find it disturbing.

Embalming uses chemicals in the formaldehyde family to preserve the body. The embalming fluid (a mixture of several chemical components) is pumped at pressure through the body’s circulatory system.

Typically, an incision is made around the collarbone to access the right carotid artery and the jugular vein. The artery is cut and a thin metal tube (cannula) is inserted into it. (Another tube is inserted into the cut jugular vein for drainage.) Embalming fluid is then pumped through the cannula into the carotid artery, pushing the blood through the body and replacing it with the preservative. The process mimics the heart’s pumping action and the blood naturally drains through the jugular vein as the embalming fluid makes its complete cycle through the circulatory system. The limbs may be massaged during the process to aid in distribution.

(If the carotid artery is inaccessible or circulation does not proceed naturally because of a break or blockage, the embalmer may access other arteries in the groin, legs, or arms.)

As the embalming fluid circulates, it moves from the arteries down to the capillaries and in this way it comes in contact with virtually every cell as it chemically transforms the body’s soft tissue. The entire process may take about an hour. At the end of the process, arteries and veins that have been accessed for embalming are tied and the incisions are sutured and hidden from view.

The final step in the embalming process, while necessary for preservation, is fairly violent. The embalming fluid reaches the soft tissue through the circulatory system, but it cannot directly reach the contents of the abdominal cavity, bowels, and intestines. As the final step, a long aspirating tool (trocar) is plunged into the abdomen and suction is applied to remove as much of the liquids and semi-solids as possible from the organs and cavities. During the aspiration process, the trocar is rigorously moved throughout the abdominal and chest cavities, and into each of the organs.

Finally, embalming fluid is poured into the abdominal cavity, by gravity, in order to reach areas not accessed during injection. The hole created in the abdomen by the trocar is sealed and the embalming process is complete.

If you want to donate your body to science, it is best to look into the options in advance. Depending on several factors, human remains may be accepted for organ donation, anatomy instruction, disease study, and other purposes. Anatomical donations are dearly needed and can be a beautiful counterbalance to a tragic death.

That said, the circumstances of a death may limit certain options. For example, elderly people are typically not accepted for organ donation. Bodies that have had invasive cancers or extensive surgeries are generally not accepted for anatomy study. Some people find that making an anatomical donation is not as easy as it might sound.

If you are planning to pursue donation, it is important that you tell your family so they are aware of your wishes. You should carry a donor card in your wallet. It is important that the process be initiated immediately upon death, especially for organ donation.

Usually the institution accepting the gift will pick up the decedent at the place of death without cost to the family. A funeral home will still need to be involved to process the administrative paperwork of the death, and it will charge a fee for this. After the body has served its scientific purpose, the accepting medical institution will usually have the remains cremated and returned to you. The institution generally pays this expense.

Yes, you should preplan for your funeral. (It makes things easier for the people who come after you.) You can preplan by simply writing down your wishes and communicating them, or you can make a specific plan at a funeral home.

Whether you should prepay for your (or a loved one’s) funeral is a different question.

Prepayment locks in the price at the time you make and pay for the arrangements. If you are dealing with an established funeral home, there is almost no chance of financial malfeasance. Your prepayment will typically be placed into one of two types of funding vehicles: A bank account held in trust for you at a regular bank, or a specific type of life insurance product where the proceeds of the policy can only be used for the funeral of the policy owner. (Most funeral homes have moved to the insurance policy model.)

The basic idea of prepayment is that it locks in today’s prices “forever”. But your money would probably do just as well if you kept it invested in a fairly conservative mutual fund, for example. There is not likely to be a huge financial advantage in prepayment versus holding onto your money. Still, there are other reasons you might want to prepay (e.g., so your children don’t have to worry about it).

In cases where someone is trying to qualify for Medicaid and they need to spend down their cash assets, prepaying funeral expenses is a legal tool for doing so, subject to an established dollar limit that changes from year to year.

Certain “third party” funeral expenses can be prepaid but the future price is not guaranteed to be covered. (Your survivors would pay the incremental difference in cost at the time of your death.) Third-party expenses may include newspaper death notices, death certificates, officiant honorariums, flowers, catering, etc. Prepayment also may not guarantee crematory fees. Prepayment at a funeral home typically will not include cemetery fees for opening (digging) and closing a grave. (You can prepay those at the cemetery, if you wish.)

There are other factors to consider when deciding whether to prepay, such as if you think you might move out of state (e.g., to be near family). You will also want to pay close attention to the terms of the prepayment investment product: A funeral home, or the insurance policy they use to fund the funeral expenses, may allow up to a year to pay in full, but if you exceed the grace period the penalty fees can be substantial.

If you have a terminal illness, some state laws, with certain limitations, permit medical aid in dying (MAID). These include California, Colorado, Hawaii, Maine, Montana, New Jersey, New Mexico, Oregon, Vermont, Washington, and Washington DC. Most states require residency to receive MAID, and all require the individual to administer any drugs prescribed themselves, without assistance. Washington DC does not require residency; Oregon does not require residency if you receive medical care in the state.

Switzerland allows assisted suicide under certain, more permissive, conditions and there are a number of nonprofit organizations that help people who qualify. The patient must be able to exercise control over the act, including ingesting any medication.

Yes. Before funeral service became professionalized, many funeral rites took place in the home, with the deceased present. It is still possible to do this. It can be a comfortable and supportive setting. If this is an option you want to explore, for yourself or a loved one, we can discuss what is required by law, where you may need help, and what to expect. More broadly speaking, you have more options than you might think; they are just infrequently presented or considered. You are not limited to a funeral home, church, or synagogue.