By Thomas A. Parmalee
Lisa Pahl, a licensed clinical social worker, had no way of knowing that she was about to embark on an exciting business adventure when she met Lori LoCicero, whose husband was dying of pancreatic cancer at age 44.
While Pahl was accustomed to helping navigate the end of life in her role as hospice licensed clinical social worker, it was LoCicero’s first experience going through such a traumatic ordeal. She had lots of questions, and the two women had much to talk about.
After her husband, Joe, died in 2008, the two women continued to talk, and their conversations increasingly gravitated toward how it was so hard for people to talk about the taboo topic of death – until it was too late.
Eventually, the two women (pictured at top with Pahl on the left and LoCicero on the right) launched The Death Deck, which they describe as both a game and a tool that allows friends and family members to open up and share thoughts and preferences about death in a nonthreatening and even fun way.
The deck consists of 112 cards – 80 that have multiple choice questions and 32 open-ended questions that urge players to “dig deep” before responding.
Numerous funeral homes have used the game to help families spark conversations about death – and Pahl and her co-creator also offer an abbreviated version of the game that can be branded to market individual funeral homes, which can be used to encourage families to proactively think about preplanning, Pahl said.
Just recently, Pahl delivered a presentation at Darling & Fischer Funeral Homes in the Bay Area of California.
“They hosted a day of gratitude for hospice and health care professionals,” she explained. The funeral home gave attendees the Death Deck as well as a related game, called the EOL (which stands for End-of-Life) Deck.
“The Death Deck is for when death seems far away – it is meant to normalize conversations about death, and we weave a lot of humor into the cards,” Pahl said. “The End-of-Life Deck is for people suffering from a serious illness or older adults.”
She noted that the Death Deck is the more popular of the two games, perhaps because while talking about death in advance is hard, talking about it when it is imminent is even harder.
Pahl, who still works in hospice, uses the decks in her work. “There are lots of questions in both decks about disposition options and what people want for themselves,” she said. “People get the chance to talk about their end-of-life preferences.”
With the Death Deck, people will learn about cremation jewelry and new disposition options, such as composting. They will consider whether they want to be cremated or buried. About 20 of the 112 questions are disposition related, Pahl said.
Custom decks with 16 cards that can be branded with a funeral home’s logo are a favorite with end-of-life providers, Pahl said. “They leave those behind with pens and that kind of thing,” she said. “It is something with more intention to help families preplan.”
Creating the games, which are available through the Death Deck website and at online stores such as Amazon.com, was no easy task, Pahl said.
But the games have proved to be a wonderful success, with the biggest hurdle continuing to be getting people to actually have conversations about death.
“People tell me this seems like a great idea, but they still avoid it,” Pahl said. “They may purchase the deck, but they can’t figure out how to get the family to play it. So, I think that remains our largest issue to tackle – this is a topic people don’t want to talk about, and we have made it as fun as we can.”
But they are definitely making inroads toward accomplishing their mission. “Our sales are great, and have grown every year,” Pahl said.
Hospice care and end-of-life professionals as well of death doulas buy both the Death Deck and EOL deck regularly, but Pahl would still like to see the games in the hands of more “everyday people.”
Funeral homes use the decks regularly in their community engagement activities, and Pahl has spoken at death and dying classes and at various venues in her capacity as a social worker. She’s also been a podcast guest on numerous shows. “I worked as a hospice social worker for 17 years,” she explained.
Along the way, she’s met some incredible people.
“I was just the keynote speaker at a caregiver conference on how to have these important conversations,” she said. “I’ve met the coolest people … people who work in death and dying tend to be great, compassionate and creative people.”
All of her work advancing the games has helped her as a social worker, she said. “I get to introduce so many things to my team outside of the narrow hospice world because of the creativity in the death space,” she said.
As to how funeral homes can incorporate the Death Deck into what they do, she said, “Preplanning is the way to go.” An at-need situation is not the right time, she explained.
“We have had funeral homes that give families a Death Deck when doing their preneed arrangements, and we have gotten some great feedback on that,” she said.
Pahl’s goal remains to help people avoid complicating their grief by making final preparations ahead of time.
“Losing someone is hard, and it just gets harder when you haven’t prepared ahead of time,” Pahl said. “We are trying to help people prepare, so that the people left behind are not left with a mess.”
The Bridge Between Hospice and Funeral Homes
The hospice team has a “huge influence” on decisions that come at the end of life, Pahl said.
“Families look to us for guidance, and usually it is the social worker talking to the family about the arrangements they have in place,” she said.
In the area of California where she works, Pahl estimates that about 80% of families with a loved one in hospice opt for a direct cremation.
“Recently, I have been finding myself really sad about that because I will talk to families about what their plans are for how they are going to honor their family member,” she said. And many times, they don’t have any plans, she said.
“So often, families are now saying maybe they will go to dinner and just choosing direct cremation,” she said. “I think because so many are choosing cremation, it then become a race to see who can provide it cheapest – and we are losing the benefits of the funeral home and the collective grief experience.”
As to what funeral homes can be doing to serve families being served by hospice better, Pahl said educating hospice care providers about the value funeral homes can provide, including the specific services they offer, is key. Show them how you can improve the grief experience, she advised.
“Direct cremation is leaving it in the hands of a bereaved family,” she said. “I will reach out six months later, and they still haven’t done anything because it takes someone to organize it.”
More Ahead
If you thought that Pahl and LoCicero would be content with moving along the conversation about death with two games and that’s it, well, you’d be wrong.
The two have a Grief Deck in the works, which will be rolled out next year.
“It will have the same design – some multiple-choice questions and some open-ended questions,” Pahl said. “The idea is to give people an opportunity to share their grief. We designed it to be used as a tool for bereavement groups, as well as for grievers who want to find a way to express their grief with people.”
You can buy the Death Deck on Amazon.com or on via the Death Deck website. Bulk pricing for funeral homes who want to purchase a large quantity of decks is available, as well as the option for a smaller deck with a funeral home’s branding.
The Death Deck website has more than just a couple card games. On it, you can find some great blog posts about death and dying written by Pahl, as well as additional resources for families planning for the death of a loved one. You can also buy Death Deck merchandise, listen to podcasts about death and more.
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