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.
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”.
Ring a-ring o’ roses, A pocketful of posies. A-tishoo! A-tishoo! We all fall down!
Although now believed to be unlikely, this verse was thought to have alluded to the great plague of 1665.
I began writing this article months ago before any restrictions had been bought into place in Australia. Originally I was researching what to expect and how to prepare our funeral home and what was occurring throughout the world in funeral service. Eventually, I shelved the article as we seemed to be swamped with COVID overload. Although the COVID19 pandemic is by no means over I finally, decided to finish what I started to see where we have come from and what effects it has had on our industry.
On 30 January 2020, the World Health Organization declared the coronavirus outbreak a Public Health Emergency of International Concern.
The Australian Government issued a health alert as a precaution, based on the latest and best medical advice.
Across the world
“Across the world, there have been about 82,704 confirmed cases of coronavirus (COVID-19) and 2,814 reported deaths. Of confirmed cases reported globally, the case fatality rate is approximately 3.4%. The case fatality rate in countries and regions outside mainland China is 1.4% (To put it in some perspective typical Australian Death rate is 7.3 deaths /1000 population (2018 est) or 0.0073%)
The majority of cases of COVID-19 have been reported from mainland China. 4,207 cases have been reported from 49 countries and regions outside mainland China. Since 27 February there have been 623 new cases and 14 deaths reported outside of mainland China.”
As at 06:30 hrs on 28 February 2020, we have 23 confirmed cases of coronavirus (COVID-19) in Australia:
8 in Queensland
4 in New South Wales
7 in Victoria
3 in South Australia
1 in Western Australia
15 of these cases are reported to have recovered. The remaining cases are in stable condition. 8 cases are passengers who were on the Diamond Princess repatriation flight from Japan. They were in quarantine at the Manigurr-ma Village Howard Springs facility in Darwin when they tested positive to coronavirus (COVID-19). All of these people have returned to their home states for medical treatment.
(Australian Government Department of HealthCoronavirus (COVID-19) health alert, 28/02/2020)
As the world struggles with the implications of the Coronavirus what are the implications for the Funeral Industry in Australia and Worldwide?
Hong Kong –Coronavirus outbreak leaves Hong Kong funeral homes facing coffin shortage. City’s industry supplied by factories in Guangdong
(South Chine Post, 23/02/2020)
City’s industry supplied by factories in Guangdong that were ordered to close to stop the spread of the virus
Hong Kong government had to step in but only enough coffins left to last until the end of the month
The coronavirus crisis has led to a coffin shortage in Hong Kong after the outbreak stopped production over the border. Factories in Guangdong province were ordered to close until February 10 to contain the spread of the highly contagious virus, which causes the disease Covid-19.
The shortfall has triggered a warning from Hong Kong funeral parlours that stocks could dry up within days. Kwok Hoi-pong, chairman of the Funeral Business Association in Hong Kong, told the Post the temporary ban also covered the delivery of finished coffins to Hong Kong. According to Kwok, Guangdong accounts for 99 per cent of the coffins used in the city, and demand for them ranged from 120 to 140 per day. (MSN News.com)
Sichuan, China – Orders issued by China’s top health authority for the swift cremation of the remains of coronavirus victims at facilities near the hospitals where they died appear to be an overreaction and unnecessary to curb the transmission of the disease, top epidemiologists have said. The February 2 notice from the country’s National Health Commission requires hospitals to notify funeral parlours of the death along with family members but also states the procedure can be completed even if the family of the deceased does not agree.
(Al Jazeera, 09/02/2020)
The USA- In the United States States, National Funeral Directors Association (NFDA) has consulted with federal officials and embalming experts. At this time, they recommend that should an individual die from coronavirus, funeral home personnel who will come into contact with the body should use universal precautions. For more information, please see the CDC website with recommendations for healthcare providers – specifically, see section two, “Adherence to Standard, Contact, and Airborne Precautions, Including the Use of Eye Protection”
(National Funeral Directors Association, USA 26/02/2020)
24th May 2020
Move forward to today, worldwide there are now over 5.28 million confirmed cases of COVID 19 and 340,000 deaths. Australia 7,106 Confirmed cases and 102 deaths.
The economic effects of COVID19 have been well documented. But, what effect has this had on the funeral industry?
Some have suggested that the industry has benefited from COVID deaths? Let me put this in perspective, Victoria has had 19 COVID19 related deaths, yet during the period January – March 2020 there have been 10,111 deaths (not related to COVID19) – Births Deaths and Marriages, Victoria. While still very sad for each of those families, the overall COVID19 figure has been very low, in relation to any effect on funeral service throughout the state.
When restrictions were bought into Australia the most significant changes to funeral service have been the restrictions on the number of mourners attending a funeral, originally only 10 persons this has now increased to 20 in our state. For many families, this has been extremely difficult in deciding who does and who does not attend the funeral service. There has been much said about live streaming and how this is the panacea to helping families. While it has assisted many families, the act of being there in person to support families is not lost on many.
During this time of restriction, many families have made comments on how personal and private their funerals were and something they would consider in the future. Sadly, extended families and friends have not had this opportunity of saying farewell in the traditional way we know.
Many families have chosen not to have a service at all, with direct, or unattended cremation services on the increase. It is important to understand this type of cremation service has been on the increase for some time. Chosen for either cost or more commonly simplicity I think we can expect to see this continue to increase in popularity.
Perhaps this greatest effect has been on the closure of many of the alternate funeral venues, golf, bowls, yacht clubs have all been forced to close their doors. These are the places where contemporary funerals are held, where the focus is on family, friends and celebration of life. Usually mixed with food, drinks imagery and contemporary music. Civil celebrants, who often lead these types of services have often not been engaged throughout this period and have been noticeably quiet.
Thankfully many will be able to have memorial services in these locations when some sense of normality returns.
Although much was made about the lack of PPE(Personal Protection Equipment), sanitisers, body bags etc, the industry has copped relatively well and there now appears to be sufficient stocks available. Oddly, there have been anecdotal stories of some directors not carrying any PPE going into the COVID19 crisis, when indeed this forms part of funeral directors regular kit.
While there has been much written about the health care staff, internationally those countries and places with significant COVID19 related deaths have personally taken its toll on some funeral directors. Having to deal with large caseloads, restrictions on family visitations and even no attendance burials, many in the industry have struggled to cope with the personal impact and rapid changes this has all bought about.
The risks to funeral staff in Australia are still high. As we often enter aged care facilities, hospital and the like, protocols are now in place to register and record those entering and staff are normally temperature checked. The same cannot be said when entering private homes.
COVID19 is by no means over and as we continue to deal with new restrictions, protocols and procedures, we should be forever mindful of the human toll this has had on mankind.
Continue to take care.
Robert Nelson is a 5th generation funeral director with more than 3 decades in the funeral industry. He is the owner and managing director of Robert Nelson Funerals, based in Melbourne, Australia
Interstate or overseas holiday travel can be such a fun and exciting time. New cultures, new experiences rest and relaxation for some some, exciting adrenalin fuelled activities for others. But what happens when fun turns to tragedy?
Australians are avid overseas travellers, with over 9 million Australian taking overseas trips each year. in 2016/17 1,600 Australians died overseas. These figures are only set to rise.
Organising repatriation or funeral services on your own overseas can be complex and expensive when you don’t know what you are doing. In some countries the law and bureaucracy can also complicate the expediency of handling an untimely death. Despite the deceased having an Australian passport we are bound by the laws of the country we are visiting and this can be a confronting situation when families are distressed in shock and or grieving.
Robert Nelson, of Robert Nelson Funerals said “in one case we handled a few years ago the person died on a remote Island in Greece in the middle of summer. There was no refrigeration and no chance to get the person off the island for days. A large fish tank was seconded from a restaurant and turned into an ice box until the body could be transferred to Athens before coming back to Australia.”
Should death occur overseas the first point of contact is your insurer. They will be able to advise you of your entitlements. You should be mindful that simply having travel insurance does not guarantee your claim will be accepted. Most travel policies have extensive terms and conditions. Illegal or some extreme activities, riding or driving while under the influence may also result in the insurer rejecting the claim.
Once the insurer has accepted the claim, they generally work with assistance companies that provide advise and assist with organising the funeral or repatriation services. These companies in turn work with specialist in house funeral companies to provide on ground services and expertise.
The family will need to make a choice of having a burial or cremation in the country of death or repatriate the body back to Australia.
Body Repatriation is a highly specialised field and is best handled by experienced competent professionals. Many countries do not have the type, style or standard of funeral service or body storage that many might be expected in Australia.
All bodies being repatriated by air back to Australia will need to be fully embalmed. In Australia this is generally performed by members of the Australian or British Institute of Embalmers. Overseas it may be performed by doctors or universities and is not a normal procedure in funeral service in those countries. The quality and standard of preparation can be less than satisfactory.
The despatching funeral service will organise , collection of the body, all necessary local documentation, a specialised and hermetically sealed coffin, suitable for air transfer. They will liaise with their own government authorities for death and health certificates and other formal documentation that may be required. In addition they will work with the Australian Consul within that country as well as Airlines and Customs brokers.
These processes cannot occur overnight and you would expect some delay before the body can be returned home. This can add to the distress of families back home.
Robert says, “in a case we dealt with in the North of England the Coroner only worked in that town once a week and we had to wait for more than week before the coroner could commence their investigation.”
Before arrival home the family will have needed to contract a local funeral service provider, who will arrange for the collection of the coffin from the airport on arrival and clearance from Australian Customs. The local funeral director will then organise local documentation for burial or cremation, this may also take a number days to organise.
So what happens when you are not insured or the insurer will not accept your claim?
You will be left to organise all of this on your own. Be mindful there are specialists in international repatriation in Australia that have strong connections throughout the world. you should use these resources in order to save you time and avoiding over payment.
When death occurs away from home but in Australia thing are a little different. When death occurred interstate most bodies used to be flown home. This entailed using a funeral director at the place of death and another in your home town. It can be quite costly. Whilst this still happens today, most bodies are road transported by specialist crews and vehicles. This mean they can collect the body from the hospital or coroner and transport directly to the home town funeral director. Generally this is seen as the most expedient and cost effective solution.
There is no doubt when death occurs away from home and often in sudden and unexpected ways it adds to the trauma of the situation. However, behind the scenes their are teams of dedicated, skilled, professionals working around the clock to ensure your loved ones are returned as quickly as possible.
Robert is a fifth generation funeral director and Managing Director of Robert Nelson Funerals in Melbourne, Australia. He is a member of the British Institute of Embalmers and skilled in International and Interstate repatriation service. he has strong connections in this field throughout the world