When people think about end-of-life care, they often think of hospitals or hospice.
But for a growing number of Virginians, support begins much earlier — with a death doula.
Like birth doulas who guide families through the beginning of life, death doulas focus on the other end. They provide non-medical support, helping people and their families navigate advance-care planning, understand medical choices, talk through fears about dying and, in some cases, sit with loved ones during their final days.
The work often starts long before hospice.
“About 80% of the people I serve are months, if not a year, out from death,” said Shelby Kirillin, a Richmond-based death doula. “They’re still seeking treatment, but they want to understand what comes next.”
Many death doulas come from medical backgrounds, including work in emergency rooms, intensive care units or nursing.
Death doula services are typically booked by the hour or through monthly packages, with rates varying by provider. Hourly fees generally range from $50 to $175, with packages offered for clients who need ongoing support, particularly as health declines.
Cryst’l Scheer, a Williamsburg-based end-of-life doula and former hospice worker, said she began the work after seeing many people reach the final stage of life without a plan or a clear understanding of what was happening.
Scheer now works directly with terminally ill clients and leads community workshops, presentations and adult-education classes focused on end-of-life preparation.
“Death is not a clinical experience,” she said. “It’s a very communal experience — except the community is not talking about death and dying.”
Beyond planning, death doulas may help families organize practical details, guide legacy projects or provide emotional support for people anxious about death — roles Scheer said are often difficult to fit into clinical care models.
But despite growing interest, death doulas said their work remains largely invisible.
Jessica Sadler moved to Hampton Roads six years ago and now works as a death doula. She said many people don’t realize the profession exists or assume doulas are only called in during the final days of life.
“So, it kind of became like a secretive, reclusive type of care that makes it out of touch with reality,” Sadler said. “No one knows how to talk about it, or to talk about it or what people need, because it's not around us all the time.”
Cost can also be a barrier. End-of-life doula services are typically paid out of pocket and are not covered by insurance, making the support inaccessible for some families and difficult for doulas to provide full-time services.
“It’s so hard to sustain a full-time practice when the work isn’t reimbursed and you’re relying on private pay,” Sadler said.
Some death doulas have begun contracting with hospice agencies, but they said those arrangements are often funded through local philanthropy rather than insurance and rarely provide enough income to support full-time work.
“It's not owned by any big affiliates. It's not enough to make this a full-time job where someone could live on it,” said Jane Euler, a death doula based in Northern Virginia. “So this is more of a passion project. It's a heart-led service and care-support system.”
Death doulas across the state have begun organizing to expand access and awareness. They formed the Virginia End of Life Doula Collective, a nonprofit group focused on public education, professional support and long-term policy change.
Scheer, director and co-chair of the collective, said they are working to educate health care providers, hospices and lawmakers about how death doulas complement existing care. The group also plans to push for state policies that could allow end-of-life doula services to be reimbursed through public or private insurance, similar to coverage Virginia already offers for birth doulas.
“Everyone is going to face this,” Scheer said. “The difference is whether people have the time and support to prepare.”
