This is a guide for Care / Nursing Homes and other establishments who may be in care of a person who is dying or has recently died. It takes into account the challenges and concerns posed by the coronavirus pandemic and offers guidance on how to provide people with a caring, respectful and sensitive experience as they approach the end of their life.
The strict infection control measures imposed during the coronavirus pandemic limit close contact with people who are dying or have recently died. Where restrictions on visitors are in place, it may not be possible for faith representatives to perform some or all usual rituals. There may also be issues with allowing family members at the bedside particularly if, for example, they are having to self-isolate, they are in the high risk vulnerable group, or they are unable to acquire Personal Protective Equipment (PPE).
It may be useful for families to consider alternatives to their usual rituals, thus keeping them safe and also keeping the dignity and sanctity of their faith or belief system.
This guide has been developed with the help of Devon Faith and Belief Forum. It also takes into account the latest Government guidance [22nd April 2020] and will be updated as new guidance emerges.
This guide is intended to:
- Look at ways in which we can make the end of life experience more comfortable for people who are dying alone or in the absence of those who would, in normal circumstances, give them comfort. For example, exploring what can be delivered remotely (such as prayers over the telephone), or played from a device, or carried out by staff.
- Raise awareness of potential needs at end of life. It is not a definitive guide and for many religions there are different customs and interpretations.
- Not replace the need to discuss end of life care with the individual, or their next of kin if they cannot speak for themselves, but provide ideas on how barriers may be overcome. In the absence of a next of kin, the faith community representative could be contacted.
- Cover the stages from when death is imminent to when the body lays in rest prior to burial or cremation (it therefore includes rituals which may take place at the Funeral Directors’ prior to the funeral such as washing and shrouding, but does not include rituals/customs that form part of a funeral service. Guidance on funerals is available under Further Information below).
Healthcare Chaplains are allowed into wards and ICUs based on particular needs. When considering access, the following questions need to be asked:
- Is an intervention or visit urgent / timely? Is the patient approaching death but still alive at present? Note that in Catholicism, the Sacrament of the Sick is only offered for those still alive.
- Would it be significant for the patient? Would they otherwise be in distress?
- Is sufficient PPE available?
- Is it safe for the religious leader or family members to join – or are they at risk themselves for other reasons (self-isolating/high risk vulnerable group)?
Government and Public Health England guidelines are regularly under review, therefore please check the government website for the latest information on infection control.
Blessings, rituals and last rites
Washing and Shrouding - Baha'i, Jewish, Muslim and Sikh
The ritual of washing and shrouding which applies to some faiths usually takes place at the Funeral Director’s establishment (or other agreed community venue, such as a Mosque) by a team of community volunteers of the same faith and gender, or family members.
The ability to carry this out will be dependent upon availability of PPE and suitable facilities for the community, and the capacity of Funeral Directors. For Covid-19 deaths, facilities will need to be thoroughly disinfected in line with Public Health guidance. Should it be suspected that a person may have been infected or died of Covid-19, and in the absence of any testing, it would be advisable to use PPE and follow Public Health guidance.
Faith communities are allowed to exclude Covid-19 related deaths from ritual washing. Further information on washing/shrouding for each community is included below.
As death approaches
There are no specific rituals to be followed before death.
Baha’i law requires that the body should be buried (not cremated) within one hour’s journey from the place of death. The body would normally be washed and wrapped in a shroud of silk or cotton and buried wearing a Baha’i burial ring (although these are not compulsory for all in the West).
However, Baha’i law also requires that, in the case of serious and contagious diseases, the advice of health authorities must be followed, and it is accepted that this may preclude the washing and shrouding of the body, and even require cremation.
Further guidance is available by emailing the National Spiritual Assembly of the Baha’is of the UK
There are no universally agreed death or funeral rites prescribed in Buddhism. There are many variations relating to the culture and climate of the country where the practice was developed. Not all Buddhists believe in Reincarnation, but many do. However, the time of transition from this life is very important for all Buddhists.
As death approaches
It is important to maintain a relaxed and peaceful atmosphere in the person’s room and assume that if unconscious they may still be able to hear. So don’t talk over them about medical procedures etc. Adjust pain relief so that the person is relatively comfortable but as conscious as possible in the process of letting go.
It is said that it is best if someone is weeping or distressed that they leave the room, so that they do not distress or disturb the person. Rather to remind them of happy times and generosity.
If possible, let the body stay in place for up to 24 hours.
Helping the Dying – Hayagriva Buddhist Centre provides useful information.
- Ms Jude Taylorson, Devon Faith and Belief Forum – Buddhist representative, email: email@example.com
- Theravada, email: firstname.lastname@example.org
- Chinese Zen, email: email@example.com
- Tibetan, email: firstname.lastname@example.org
- New Kadampa, email: email@example.com
- Gaia House retreat centre, email: firstname.lastname@example.org
Chinese philosophy is based on three main strands: Confucianism, Taoism and Buddhism.
The family may request to keep a vigil with the deceased, and may wish to burn incense. The family may wish a coin to be placed under the tongue of the deceased. This should be left there and recorded as appropriate in the client records.
Church of England
Devon clergy and ministers can lead prayers, read bible verses and psalms over the telephone. Suggested prayers, including those for end of life situations can also be found here. These prayers can also be used by care staff, if necessary.
The Diocese can offer pastoral care and support to those in care homes and their wider family across Devon, through their network of parish clergy.
Contact the Diocese of Exeter for further local contacts and advice.
Or for more details contact (in Devon) The Venerable Andrew Beane by phone: 01392 425577 or mobile: 07898 932654.
No last rites performed.
Free Churches, sometimes referred to as Non-Conformist Churches, include Methodist, Baptist, United Reformed Church, Salvation Army, Pentecostalist Churches, and a number of others, all of which may have slightly different practices. A list of Free Churches is available from the Free Churches Directory. There are also many other independent Christian Churches and congregations not necessarily linked to any formal group, but having similar ethos.
Free Church members would not necessarily require that final prayers were said by a Church leader or ordained minister. Some Free Church patients may ask for a Minister or Pastor, and in those cases wherever possible a PPE visit or a phone call should be offered. But many Free Church patients would be happy if prayers were said by a sympathetic care worker. The important thing here is the wish of the patient or their next of kin, rather than the requirement of the Church.
United Reformed Church: Prayers from the Worship Book of the United Reformed Church are available to download. Devon contact: Revd Rob Weston, phone: 01566 784990 mobile: 07982 62249 email: email@example.com.
No last rites performed.
There are not normally specific rituals for the dying, but spiritual contact is important and active members of the church may want to contact their Bishop (contact local Church of Jesus Christ of Latter Day Saints).
Orthodox priests offer confession, prayer, advice, support and memorial prayers for those who have died, over the phone. Daily services are streamed on the Facebook pages for Torquay and Plymouth churches and messages come back through Facebook. Holy Communion, Anointing and physical visits are not currently possible.
Devon contact for further support: Fr Gregory Palamas, email: firstname.lastname@example.org or mobile: 07971 316416.
Quaker (Society of Friends)
Quakers local to the care home will be able to uphold the resident. They may be able to hold a dedicated Meeting for Worship, so that the person knows that they are being supported prayerfully. An individual Quaker may be available to speak to the resident on the phone and might choose a brief text to share if it was felt helpful. Hopefully the resident will still be in touch with Quakers in the locality and have a contact. If not, one of the Devon clerks will find a nearby Quaker meeting to help you. If the resident has moved a distance to be in the care home, we may be able to contact the Quaker Meeting where they last worshipped.
Devon contact: Gerald Conyngham, Clerking Team, Devon Quakers, email: email@example.com, phone: 020 7663 1163 mobile: 07422 973089.
The Sacrament of the Sick (which some may refer to as their last rites) can only be offered by a Catholic priest in person. In hospitals, there are priests who are being trained up for PPE who can be called in extremis. Although not ideal, in the event of not being able to secure permission to enter into a care/nursing home, the priest / deacon / layperson could offer prayers over the telephone.
Contact the local priest or contact the Diocese
When death is imminent, the head is normally positioned facing east or north. S/he is urged to concentrate on a mantra (a religious syllable or poem, sometimes in Sanskrit). Loved ones, if present, will often sing hymns, recite prayers and read scripture. A few drops of Ganga water or a Tulsi leaf may be placed in the mouth.
Choice of Mantras, Hymns and Slokas are available on YouTube. Recorded prayers/last rite services are also available from Vishwa Hindu Parishad UK.
At the moment of death
Holy ash or sandal paste is applied to the forehead, Vedic verses are chanted, and a few drops of milk (usually Panchamrut – made of milk, honey, sugar candy, ghee and yoghurt), Ganga or other holy water are trickled into the mouth.
After death, the head is positioned facing south or west. A single wick lamp is kept lit near the head and incense burned. The eyes and mouth are closed and hands brought over the chest or at the side of the body. Lighting of the lamp is important for Hindus and this need should be considered alongside a fire risk assessment and safety measures (for example, removing any oxygen equipment first). It can be extinguished if left unattended.
The day before the funeral the body is bathed, usually by the family members of the same gender or by the Funeral Directors, then the body is dressed and draped in white cloth or their normal clothes (but no leather or shoes) before being placed in the coffin. Other rituals include family members placing Khichadi (uncooked rice and mung dal in a white handkerchief) to the right of the coffin, and offerings of flowers.
If it is not possible to wash the person due to restrictions, then it may be possible to substitute this ritual by sprinkling Holi Water on the body and chanting the mantras.
All required items are available from local Indian Shops or from online marketplaces; in most cases families will get these.
Devon contact: Ravindra J.Nathwani, mobile: 07976 561140.
Over half of the UK population is non-religious but these people will have a variety of personal beliefs.
Some non-religious people will be Humanists, some will be atheists or agnostics but not necessarily Humanists, and others may have a belief in Nature or universal energy.
Most will not believe in an afterlife, but some may have a personal belief around continuing after death in some way, especially in the memories of those they love.
Because of this variety in beliefs, it would be vital to ask all non-religious patients (or family members if necessary) about their own personal beliefs and what they would like to happen.
As death approaches
People who are not religious may have particular personal rituals, artefacts, or needs for support when they die.
Humanists, and many other non-religious people, would object to the use of religious prayers, words, rituals or artefacts. Poetry, music, or stillness could be helpful. The following links might be helpful:
Wherever possible, a dying person will recite or repeat the Shema or declaration of faith as their last utterance. It can be played or heard on a device as long as a Jew is reciting the Shema (it does not have to be a Rabbi). The Shema is the single most important rite to perform either by the dying person or a Jew on his/her behalf.
The first line is the most important (this is the English translation): “Hear, O Israel, the Lord is our God, the Lord is One”.
The following are examples available on You Tube:
Upon death, the eyes are closed.
Normally, the body is never left alone as a sign of respect.
Tahara, or ritual washing, is also normally done by the Chevra Kadisha (Jewish burial society). It could occur in a care/nursing home by a trained Jewish person, but usually requires a named team to cleanse and say prayers. However, the Chief Rabbi of the United Kingdom of Great Britain, Northern Ireland And the Commonwealth has categorically stated that if there is any suspicion of this being a Covid-19 related death, then ritual washing must not be performed. For non-Covid deaths, ritual washing and shrouding would normally take place at the Funeral Directors where this is possible, bearing in mind it may be difficult to do this in the current situation.
Devon contact: phone 01392 411611 (RD&E Exeter) and ask for the ‘on call Chaplain’.
As death approaches
Where possible, a dying person will repeat the Shahada or declaration of faith as their last utterance.
One of the following videos could be played to assist this process if no-one is available:
In the absence of the family being with the person, gloves must be worn (also as part of PPE needs) and the head should be turned to the right shoulder.
The person who has died is usually washed (Ghusl) as quickly as possible after death and wrapped in a simple white shroud. For men, up to three pieces of cloth are used for this purpose, for women, five. This must be carried out by members of the same sex who are Muslim and trained in the practice. The local Mosque has a team of volunteers who carry this out.
People who have died from Covid-19 can be exempt from washing.
Cremation is prohibited.
Contact 1: Mr Abul Shahar Lashkor, mobile: 07971 885789.
Contact 2: Mrs Neomi Alam, mobile: 07725 866497, email: firstname.lastname@example.org. For all email correspondences please also copy in the Exeter Mosque email address: email@example.com.
There is no single agreed death or burial rite for Pagans, as Pagans are all individuals, but respect and kindness are important.
Most Pagans believe that this life is not the end, that they travel on to the summer lands where the God and Goddess live, from which they will be reborn again. Most pagans don’t see death as an end, only the next stage of life.
If you can create a calm atmosphere for the dying person with sounds of nature. They may have a favourite CD to hand or you can play something from YouTube (here is a suggestion), or something similar. If they have pagan objects in the room, ask if they want them brought closer but otherwise don’t touch them. Lighting a candle that they can see burn (if it is safe to do so), sprinkling water lightly on the person, or touching drops to the palms, forehead and heart to cleanse them, slightly opening a window to allow a breeze and bringing a bit of nature in for them, a couple of leaves from a nearby tree for example might be appropriate. Ask them what they want if you can.
Depending on their particular path, beliefs and ideology, the soul can leave the body immediately and a window needs to be opened to allow the soul to fly free, or any time during the following three days.
Families and friends may want to offer readings, pray, sing, chant, dance or simply talk with the person’s spirit at this time. If it is not possible to be in the same room, alternatives such as telephone / online contact or an adjoining room could be considered.
Natural burial or cremation is preferred. Many Pagans do not wish their bodies to be embalmed, as this is seen as poisoning the Earth and would also mean that they could not be buried in a natural burial ground.
South west contacts:
Pagan Federation liaison for hospitals email: firstname.lastname@example.org or email@example.com.
Southwest Pagan Federation email: firstname.lastname@example.org.
Similar to Judaism, it is customary for the family to sit with those who are dying and after death, so this could pose challenges under social distancing/isolation rules – particularly for wider family members. The family may find it helpful to consider other ways of fulfilling this custom, such as sitting with a photograph or personal objects, or setting up an online vigil (using Zoom, for example) if this would help bring comfort.
After death, the family will request that the person be laid out in clothing of their choice.
When a Sikh seems near death, the Hymn of Peace (Sukhmani) is recited.
The following could be played: https://youtu.be/SIqag-x5gqI
The person who is dying will try to respond by saying the name of God (Waheguru).
The body is washed and dressed in their traditional Sikh clothing as soon as possible after death.
Clothing (for initiated Sikhs) include the ‘Five K’s’:
- Kesh is uncut hair on the head and body, symbolizing acceptance of God’s will. This gave rise to the distinctive Sikh turban, a way to keep the long hair clean and tidy.
- Kachh is a pair of white cotton shorts worn as an undergarment. It is practical in battle, and therefore symbolizes moral strength and chastity.
- Kara is a steel bracelet symbolizing responsibility and allegiance to God.
- Kangha is a wooden comb that represents personal care and cleanliness.
- Kirpan is a steel dagger, a symbol of resistance against evil and defence of truth.
The five K’s should not be removed at any time. These items also go with them to the cremation and are not returned.
Sources and further information (please note that there are many interpretations and consideration is needed on how to apply practices during a pandemic – therefore consultation with local faith groups has formed a key part of this guide):
Discovering through death – Beliefs and Practices ISBN 978-0-9568518-0-2
Public Health England has published guidance for care of the deceased with suspected or confirmed coronavirus (COVID-19). In summary it states (as at 31st March – please check for any updates):
There may be coronavirus on the body, which presents a small but real risk of transmission.
- Avoid all non-essential staff contact with the deceased person to minimise risk of exposure. If a member of staff does need to provide care for the deceased person, this should be kept to a minimum and correct PPE used as set out in the guidance on residential care provision (gloves, apron and fluid resistant surgical mask).
- People should not take part in any rituals or practices that bring them into close contact with the body of an individual who has died from, or with symptoms of, coronavirus (Covid-19) for the duration of the pandemic. This includes washing, preparing or dressing the body.
- Contact with the body should be restricted to those who are wearing PPE and have been trained in the appropriate use of PPE.
Government Guidance on managing a funeral (relevant sections)
- Bereaved people are treated with sensitivity, dignity and respect.
- Mourners and workers involved in the management of funerals are protected from infection.
- Mourners are advised not to take part in rituals or practices that bring them into close contact with the deceased. Where there are aspects of faith which include close contact with the deceased, that contact should be restricted to those who are wearing Personal Protective Equipment (PPE) under the supervision of someone who is trained in appropriate use of PPE. Detailed guidance on care of the deceased is available and should be followed, regardless of the setting in which personal care of the deceased is provided.
- Given the very significant risk for vulnerable and extremely vulnerable people who come into contact with coronavirus (COVID-19), it is strongly advised that they have no contact with the body of the deceased. This includes washing, preparing or dressing the body.
We recognise the extreme emotional difficulty this may place on families but these measures are in place to keep people safe.
The County Council has published information for families on what to do when someone dies.