Bariatric? Oversize? Now Supersize!

A person who is classed as being obese may be referred to as a bariatric patient when they have a body mass index (BMI) that is equal to or greater than 30. The term is also used in the medical field as somewhat of a euphemism to refer to people of larger sizes when requiring specific medical supplies such as larger hospital gowns, hospital beds or health care equipment.

The Funeral Industry generally uses the term “Oversize”

We have all seen the “Spaghetti Western” films where the town undertaker wanders out in the street with his tape measure after a shoot out. In the past, this was not too far from the truth, as the undertaker was also the carpenter that had to make the coffin. Getting the right size was important. Up until the 1970s, funeral directors may have carried a range of adult size coffins, in 2-inch increments from  5’6 to 6 Foot.

As coffin production moved into more automated volume-based production methods, the standard size soon became 6 foot (in the old language) and this is still the case today. Any person that is wider or longer than these standard coffins will require an oversize coffin. These are generally custom made and that is why there may be additional fees charged by the funeral director.

In recent decades the use of oversize coffins and caskets (coffin is wide at the shoulder, narrow at the feet, a casket is generally rectangular in shape) has increased exponentially as diets and other factors have resulted in a proliferation of obese and oversized people. Indeed in an increasing amount of instance, we are now dealing with super-sized people. It is not uncommon for the funeral now to be dealing with people between 200 – 400kg in body weight. This has bought a plethora of new problems for funeral service as indeed health and emergency services at large.

Deaths can occur anywhere, hospitals, aged care, residential homes, public places and funeral directors and coronial transfer crews have equipment and techniques designed to assist in the removal and transfer of the deceased from these locations into mortuary care. The equipment and techniques involved usually relate to standard size people or oversize.

“Supersize” the transfer of the deceased and nothing is normal. In some instances, removing the deceased from their home may entail removing walls to provide egress from the property. While some modern oversize mortuary stretchers have now been designed to hold the weight they simply cannot be used to hold the size of some in a safe way for transfer staff. With “Supersize” people large numbers of additional staff are often required to move them, this can often entail emergency service to assist.

“The weight of some clients is almost industrial and provides significant Occupational and Saftey Risks across the board”

Once transferred to mortuary things don’t remain simple, mortuary trolleys, preparation tables, lifting equipment are often not rated to these extreme weights, and fear of equipment failure is a real concern. For mortuary staff dressing, some of these deceased people can be quite hazardous.

Special Coffins are made and the deceased carefully placed in them, but many are not able to be cremated as cremation units have limited size entry requirements. Burial does not remain unscathed as families may be required to purchase 2 graves due to the width restraints of a single grave.

Burial requires a whole new set of procedures and regular coffin lowering devices just cannot deal with large loads. Hand Lowering is normally not an option due to potential gear failure and the safety of those about an open grave. In some recent cases specialist lifting cranes, capable of maneuvering the narrow paths between graves have been used to good effect. From an aesthetic point of view, it tends to make these graveside services very industrial but necessary.

Superize Burial
Big People, Big Equipment

Whatever word you choose to use bariatric, oversize, and or supersize, the problem in the funeral industry relating to manual handling continues to albeit “grow”.

Robert Nelson Funerals Partners with The Grief Centre

Grief and bereavement support at Robert nelson Funerals
As funeral directors, we know when someone close to you dies your life can change in many ways. Grieving is our way of adjusting to some of these changes. Grief is a natural response in our lives. There is no right or wrong way and men and women will grieve in different ways often finding it difficult to understand or support each other. People of different ages and cultures also have different ways of grieving. Some things you might feel when grieving:

shocked or numb

angry

relived

depressed or lonely

resentful

guilty

confused and forgetful

overwhelmed

frightened and panicky

Many people feel grief in their bodies as well, especially in the first few weeks following a death.  You may feel exhausted, cold tense and shaky. You might even find it hard to sleep or feel sick and have trouble eating. These things are common reactions to grief and may require a chat with your local doctor At Robert Nelson Funerals we recognise people deal with grief in different ways and after loss people will take their own time to deal with that loss.  There will be good days and bad days. While there are no hard or fast rules that you must follow there are things that you can do that may help you. That is why Robert Nelson and the Grief Centre provides you with a support person that can assist you at this time, a listening ear perhaps, or information, support or resources that could prove useful. Bereavement support is a complimentary service offered to families cared for by Robert Nelson Funerals and provided on our behalf by The Grief Centre. One complimentary counselling session is provided for all of our clients.   partnering with Robert Nelson Funerals

Professional Funeral Director What Does it mean? Part 2

Students must start in the classroom

With more than 4,000 deaths each month in Victoria, there are only a small number of funeral professionals with embalming qualifications and diverse industry training working within it. You would be forgiven to ask the question who is looking after your loved one?

Fast forward to today, people are starting in the funeral business with no, or limited experience or expertise. Staff are subsequently instructed by the same inexperienced people. It would seem incredulous that your dog or cat needs to be medically attended to by a veterinarian who has carried out years of tertiary education yet those taking care of your nearest and dearest at death do not! With the advent of COVID19, many funeral homes and body transfer services were caught short with either no appropriate PPE or lack of it and certainly no formal training of how staff or employees were to use it! It would seem more out of luck than good planning that there appeared to be no funeral staff contracted COVID19 in the course of their duties in Victoria. During COVID19 some qualified mortuary staff prepared and allowed families to view COVID19 positive cases without incident. It is staggering to note that most funeral homes have staff working in their mortuary conducting invasive procedures on infectious and non-infectious remains with no qualifications and no formal training, let alone any infectious control education. Some staff are required to provide their own PPE or scrubs in the mortuary, yet others are preparing bodies in clothing that hours earlier or later they may wear while meeting a family.

Perhaps the reason for the lack of regulation lies with the industry itself. More often than not, funeral associations have tried to obtain regulation through minimum equipment, vehicles and premises guidelines. Despite the best of intentions, these guidelines are often grounded in the placement of barriers to entry for new entrants. By way of example, it is easy to spell out what equipment funeral director should have, but if they neither have the skill, expertise nor training to use it, it becomes a supercilious argument. Indeed, many have argued these minimum equipment guidelines should be mandatory requirements for health and saftey purposes.

On the surface, this would seem a genuine and rational argument. However, there is no evidence worldwide that the lack of these minimum equipment and vehicle standards has resulted in any public health and safety outbreak. So am I arguing that there should be no standards? Absolutely not! There are funeral directors in Melbourne today storing unrefrigerated bodies in garages, cupboards, and other unknown locations, that would be regarded by most in the general public as unacceptable and shocking

Local councils generally require a funeral home, of all persuasions, to have a town planning permit. Many are operating in Melbourne without the appropriate town planning permissions. Furthermore, the use of mains water-based aspiration devices within the mortuary are bound by Melbourne water regulations, requiring backflow preventers to be fitted and annually tested. Many funeral homes do not have these fitted, with the potential to ingest infectious waste back into our mains water system.

So are there any other permits required by a funeral director? Yes, the Department of Justice requires that all funeral directors are registered on their consumer affairs site, a free process without any checking at all!

What does all this really mean? For decades I have listened to the debate on licensing of funeral directors, but I’ve come to the conclusion it is not a matter of licensing as much as the lack of training and knowledge required. Until we can make training and education mandatory, we cannot begin to regulate an otherwise uneducated industry. So what training is currently available and how can I learn?

Embalming

MFE (Mortuary and Funeral Educators) and FIDA (Funeral Industry Development Australia) both based in Melbourne and both teach Certificate IV in Embalming. Qualified embalmers are usually members of either the BIE (British Institute of Embalmers) or AIE (Australian Institute of Embalmers) and often have annual training programs and conferences.

Infection control

MFE (Mortuary and Funeral Educators are about to release an online course in Infection Control. This would appear opportune given the ongoing Corona Virus pandemic.

And, sadly, that’s where it ends. It is hard to find an industry with so little training and so little interest in the ongoing development of its own people.

The United States has a variety of training options depending on your state. From University Business degrees majoring in Mortuary Science to TAFE-style courses and specialist colleges that all lead to state-based regulations, based on your training and qualifications. The United Kingdom through the National Association of Funeral Directors has a strong pedigree in ongoing training. Their Diploma of Funeral Directing is currently being replaced with the new NAFA Funeral Directing DipFD.

Clearly, we are nowhere near running a Diploma structured course, so what should be key training criteria for new entrants in Victoria. There are plenty examples of other local industries that have entry level courses that can be developed and built on.

The construction industry in Victoria requires all persons entering a construction site to hold a “White Card”, a one-day mandatory attendance course, in OH&S, some manual handling, and various other industry-specific training. Of course, for construction there are other specialist courses, such as riggers, doggers, traffic management, scaffolders, and so on, that can be added. In many ways, this style of learning can provide a basic framework to funeral based education.

What are some of the basic minimum subjects that need to be addressed for any new entrant or someone considering working in our industry:

Ethics

Infection Control

Basic Manual Handling – Coffins, Transfers, equipment

An Introduction to Death Grief and Bereavement

Coronial & Donor Tissue Bank Induction

Funeral Industry, Certificate, Forms and Documentation

Cemetery/Crematorium Induction

Grave Types and OHS practices and Manual Handling at Cemeteries

OH&S rights and obligations

Perhaps we are seemingly a long way off getting any considerable change in our industry it is apparent that many now focus on profitability rather than tangible quality and true professionalism.

One thing is for certain, if we are not talking about it, nothing will change.

Robert Nelson is a fifth generation funeral director, and past President of the Australian Funeral Directors Association (Vic Division), Past Deputy Chairman of the Australian Institute of Embalmers, Member of The British Institute of Embalmers

Professional Funeral Director What Does it mean? Part 1

Proper Structured Funeral Training a key to

In an age where almost everything is regulated, it would appear at odds that the Victorian funeral industry is almost devoid of any significant regulation, licensing or training. 

For as long as I can ever remember, there have been industry calls for regulation., I have sat on boards that have called themselves professionals and in one case likened themselves to chartered accountants. The differences between the two could not be more startling. 

For most entering the funeral industry, there is no formal or structured training. On the job learning starts from day one. Some funeral directors believe that throwing prospective employees into the “deep end” will determine if they are a suitable candidate. This may include taking them on deceased collections transfers, introduction into a mortuary and potentially witnessing autopsies, often within their first few hours of stepping foot into their premises! It’s hardly surprising some don’t last until morning tea.

Historically funeral directors, or undertakers as we were known, were cabinet makers, they made their own coffins, collected and prepared the deceased and carried out the funeral. They were real family affairs where the men would perform the day-to-day functions in the funeral parlour, but when they went out their wives attended to “walk ins” (families coming into the funeral home to advise of a death without telephoning first). Funeral directors lived on their premises and it was 24 hours, 7 day a week affair. Children of the funeral directors also lived in the funeral home. Many would grow up to take the reins of their parents. Learning was from a young age and children were instructed in how to behave and where they could and could not go within the funeral home. As a fifth generation funeral director this is how it was for me and my father before me and his father as well. For each generation we were bought up with a clear understanding of care, compassion and respect. 

During the 1960s and 70s most funeral homes were no longer making their own coffins as these were being made by industry-specific manufacturers which continues to this day. Funeral Directors (as is now the preferred name) came to concentrate on the delivery of the funeral service itself. Many funeral homes up to this point had been regarded as either Catholic or Protestant funeral homes. Towns would typically have 2 funeral directors and they would generally look after one of the two major religions. This era also provided another fundamental change to this dynamic, ‘Immigration’. As with many other facets of Australian culture, the immigrants bought a wealth of new customs and traditions to our shores. Funeral directors had to adapt and learn these customs overnight. With it bought the obvious rationale that funeral homes were capable of dealing with all faiths, customs and traditions.

Throughout the 60s and 70s, we began to see many family-owned funeral homes that either had no children or indeed children that did not want to continue in the family business. Many of these small businesses began to be absorbed by larger families, sometimes the names were changed. Many of these old names still exist but may be under an ASX listed company ownership with no connection to its former owners.

Traditional funeral directors would train staff in traditional ways. A funeral crew would be made up of: 

1. Conductor

2. Hearse driver

3. Coach driver. 

The most experienced staff would be the conductor; typically, this person had many years of experience and on-the-job training and mentoring before reaching this role. The hearse driver, normally the newest person, would work alongside the conductor, receiving constant instruction and mentorship. They may be in this role for several years as they learnt all aspects of the funeral industry. The coach driver has already been through this mentorship and now had greater responsibilities in collecting families and getting them to the funeral venue on time and returning them home. The next step up for them will be to a conductor.

While training was on the job wasn’t quick, funeral staff had plenty of opportunities to practice and learn from experienced knowledgeable staff with many years of learning. These funeral crews would typically work together for many years and become adept at intuitively knowing how to work together.

Funeral staff were required to work their fair share of after-hours and on-call work. This may be funeral transfers (collection of deceased from aged care, private homes, hospitals, etc). Many funeral homes also had contracts to provide coronial transfers for reportable deaths, such as murder, suicide, road trauma etc. The work would be interesting as you would not know where your next job may take you. Some funeral director assistants would struggle with these often difficult tasks. There was no debriefing or counselling provided or available at this time.

Skilled and experienced staff may also be funeral arrangers; these were the staff that would meet with families to organise funerals. As well as a thorough understanding of the operational and practical aspects of organising a funeral, a funeral arranger is required to complete the statutory and required documentation for a funeral.

The only documented and structured training was reserved for embalmers. Although there have been numerous iterations of embalming training in Australia, early embalmers did their theory and exams via correspondence and their practical case studies with local mentors and examiners. Most would take about two years to complete their studies. In Melbourne, there were only a handful of funeral homes that placed a high priority on embalmer training and education. Most did not, and many did not have trained embalming staff, and this is still the case today.

With the advent of HIV/AIDS we saw a dramatic and cohesive interest and effort in training for Infection Control practices and procedures. In collaboration with the Health Department Victoria, The Australian Funeral Directors Association and the Union movement, the industry was finally able to construct structured guidelines that were both valuable and worthwhile for all those concerned. The early courses ran for two days, addressing the stigmas of HIV/AIDs and the practical considerations of universal barrier precautions and personal protective equipment.

While early courses were well attended, interest wained and it wasn’t long before funeral homes were calling for the course to be shortened, so staff didn’t have to be away so long (2 days). Indeed, the course is now non-existent. A travesty at best and irresponsible to say the least! This strikes at the heart of an industry trying to obtain potential regulation or licensing. The inability of funeral directors to place a high priority on training or education of their workforce in funeral service.

In the early 1980s, the Australian Funeral Directors Association ran a number of 2 week live-in Funeral Management Schools, for skilled professionals to upgrade their management skills in funeral service. These have also gone by the wayside.

To read more and look at some potential solutions please read part 2 in next months blog