Funeral Consumers Alliance of Maryland and Environs

FCAME Guide to After Death in MD, DC, and DE

Updated 7.28.2022

The Funeral Consumers Alliance of Maryland and Environs (FCAME) is an all-volunteer-run 501(c)(3) non-profit information and advocacy organization that is entirely supported by donations from the public. Donations are tax-deductible and can be made on our website, <mdfunerals.org>.


Contents:

Planning for Care After Death

  • Benefits of advance planning
  • Resources for planning in advance and at the time of need
  • Contact information for regulatory agencies for questions or resolving complaints

Regulations Regarding Who Has Authority to Plan Final Disposition

General Information About Funerals

  • Burial
  • Cremation
  • Caring for your own dead
  • Green burials

Is Prepayment a Good Idea?

  • Things to consider before prepaying
  • Alternatives to prepayment

Financial Resources

  • Veteran’s benefits
  • Other government benefits
  • Options for those with little or no financial resources
  • Crime victims
  • Jewish resources

What to Do After Someone Dies

Death Certificates

  • Procedures regarding death certificates
  • How many death certificates are needed?
  • How to obtain death certificates

Autopsies

Organ and Tissue Donation for Transplantation

Donating the Body to Medical Science

  • Maryland State Anatomy Board
  • Local medical schools
  • Commercial organizations that accept bodies for donation

Planning for Care After Death

Unless you are of an advanced age or have a potentially life-threatening illness, you may not consider it necessary to do any thinking about your own after-death care. But it would be helpful to your family if you shared your ideas about whether you would prefer to be buried or cremated, or to donate your organs or body after your death in the event of something unforeseen.

You might want to have a candid discussion about whether you think elaborate funerals and caskets are worthwhile. You might want to investigate unusual options such as green burials and inform your family about the possibilities just in case. Or you might be of the mindset that you really don’t care and ask your family to do whatever makes them feel most comfortable in their grieving. But even in that case, it’s generally a good idea to talk about your preferences with your family even if only to give them permission to do what they think best without being overly influenced by the expectations of others.

These wishes can be part of your advance directive for health care – there is a space for expressing them in the optional Maryland form available from the Maryland Attorney General’s office, for example. As you get older or develop medical problems, revisiting this with your family is a good idea, as both your ideas and the options available to you may change. In addition, of course, it is prudent to have your affairs organized to make it as easy as possible for your survivors to take care of the arrangements and your estate in general.

An article on the website of the Funeral Consumers Alliance makes this important point:

“Your designated agent is not obligated to carry your wishes out if they’re highly impractical, illegal, or financially burdensome. It’s very important for you and your agent to understand how much your wishes will cost, and to plan accordingly. You should not expect your designated agent to pay for a costly funeral if you don’t set money aside for that expense.”

If the death of a loved one is expected, it is prudent to explore the specific options available locally ahead of time. There is little time to “shop around” after a death has occurred. At that time, the survivors are likely to be emotionally distressed. Having to make arrangements without having gathered information and considered the options in advance adds to the stress and often results in greater expenditures than is necessary, as the cost of funeral services vary widely even within the same community. 

Good places to start in gathering information, both in general and with regard to local options:

  • The Washington DC Metro Area Consumers’ Checkbook has in-depth information for consumers including ratings and articles on a variety of topics related to funerals which can be accessed from its website. The ratings information requires a subscription, although many libraries have a copy of the publication.

Funeral establishments must, by law, provide you with their list of costs in accordance with the FTC’s Funeral Rule, either over the phone or in person even if you are not in immediate need of services.  You may ask for the GPL, or General Price List, which should provide a menu of available services and their costs.

In case there are problems with a local funeral establishment or cemetery, or for questions about regulations, it may be helpful to consult the local regulatory agency or consumer protection service:

Regulations Regarding Who Has Authority to Plan Final Disposition

Maryland:   The Maryland Department of Health, Code Section 4-306 states that a person may designate someone to make arrangements on their behalf in an advance directive. Absent such a designation, this right falls to the following person(s) in order of priority:  A) spouse; B) adult child; C) either parent; D) adult brother or sister; E) guardian at the time of death; or F) any other person or agency authorized to or under obligation to dispose of the body. If the person has registered with the State Anatomy Board as a body donor, the Anatomy Board has jurisdiction.

Delaware: Delaware Code, Title 12, Ch. 2, § 264 states this right falls to: A) any person the deceased gave this right in a written disposition prior to death; B) surviving spouse; C) personal representative or administrator of the estate; D) adult child or majority of children if more than one; E) parents; F) siblings; G) next of kin; H) any person willing to take on the responsibility; I) a person appointed by the probate court.

District of Columbia: DC Code, Division 1, Subsection 3-413 states that unless other directions have been given by the deceased, the right to make arrangements falls to: A) competent surviving spouse or domestic partner (as defined by DC law); B) surviving child or, if more than one, the majority of children: C) parents; D) surviving competent adult relatives in the next degree of kindred, or if more than one in the same degree of kinship, the majority of them; E) an adult friend or volunteer.

General Information About Funerals

Burial:

  • Funeral costs vary widely but according to one source, in 2021 the average cost of a funeral with in-ground burial not including cemetery costs was $8,605. Purchase of a cemetery plot, cemetery fees, and a vault or grave liner (typically required by the cemetery) can easily cost an additional $5,000- $10,000 or more, easily resulting in a total cost of $14,000 or more.
  • The cost of the basic services fee, which is the non-declinable portion charged by a funeral home for any service, to cover overhead and staff services, is about 25% higher in our area than the national average.
  • The least expensive burial option without any services, embalming, or viewing is called an immediate burial, and the FTC requires funeral establishments to offer this as an option which must be published int its General Price List. It does not include the cost of a casket or vault or cemetery plot. Although such a minimum service may not be what is planned or desired, comparing the charges for this bare-bones option among different funeral establishments may indicate which ones are more cost-efficient.
  • There are no state or federal laws about embalming though a funeral establishment may have its own requirements requiring embalming for viewing. Funeral homes can refrigerate bodies up to several days without embalming them.
  • Caskets may cost from $500 (for a very basic pine casket) to $20,000 and up, with the average cost approximately $1500 – $5,000.  An inexpensive models could be covered with a drape, flag, or quilt during a funeral or visitation if desired.  

Cremation:

  • Cremation costs vary widely and depend In part upon whether they are associated with a traditional funeral and/or interment of the ashes in a cemetery plot or mausoleum. A direct cremation alone without any traditional service may be obtained for as little as around $1000 from certain providers that specialize in simple cremations in the DC metropolitan area. In that case, a memorial service that does not involve the services of a funeral establishment may be held at a later date, incurring little cost. On the other hand, a traditional funeral followed by cremation at an upscale funeral establishment may cost as much as a traditional burial, particularly if there is interment in a cemetery plot.  
  • A casket may be purchased for viewing prior to cremation, if desired.  Casket outer boxes can be rented for such a purpose, and the inside fabric and soft lining is cremated with the body, and then replaced. Typical caskets themselves cannot be re-used. Caskets designed to be cremated with the body must be wood or cardboard or some other combustible material.
  • In Maryland, the body must be identified and held for 12 hours prior to cremation. The identification must be done by the person authorized to direct disposition of the body, or that person’s designee.
  • In DC, the medical examiner must review the case before the body can be cremated, which may delay cremation for several days.
  • In general, ashes may officially be scattered on one’s own property or that of another with permission, placed in a cemetery, retained by the loved ones, or scattered over a body of water at least three miles from land.

Caring for your own dead:

  • In Maryland, Delaware, and the District, individuals may care for their own dead, which means they may serve as their own funeral director. In the District, however, if the death was due to a contagious or infectious disease, disposition of the body must be by a licensed funeral director.
  • Carrying out a home funeral requires significant preparation in advance.
  • No state requires routine embalming of all bodies. In general, unembalmed bodies may be safely kept for two or three days if conditions are not overly warm. Dry ice should be used beyond 24 hours.
  • A simple covered box may be purchased from a funeral home or crematory, over the internet, or built at home. Many sources for anything from a cardboard box suitable for cremation (less than $200), to a wide selection of tasteful and sometimes handmade wood coffins, willow baskets, and caskets, some in the $400 to $700 range, can be found online, as well as sources for instructions to build your own wood coffin.
  • Here are some resources available to those planning or thinking about a home funeral:
  • Crossings is an organization based in Takoma Park, MD that offers local assistance with home vigils and alternative after-death care.   Now run by Jane Ellen Johnson.
  • The National Home Funeral Alliance is an organization committed to supporting home funeral education that lists resources local to any area throughout the country.
  • Final Passages is an institute dedicated to conscious dying, home funeral and green burial education.  

Green Burials:

  • Some traditional cemeteries now allow burials without caskets or with plain wood coffins (because some religious cultures demand it) although they typically do require a liner or vault, In addition, there is a growing movement for green burial cemeteries.
  • The Green Burial Council is a source of information about environmentally sustainable and natural death care across the US that lists cemeteries and funeral establishments that are certified by that organization.
  • Green Burial Association of Maryland provides an updated list of cemeteries and funeral homes offering green burial options in Maryland and the District of Columbia, as well as some nearby states.
  • The Jewish Funeral Practices Committee of Greater Washington offers a thorough source of information regarding Jewish funerals and death practices.  It also maintains lists of Jewish cemeteries in the Washington area, some of which offer green burial options.

Is Prepayment a Good Idea?

Although preplanning for after-death care is a good idea, we do not generally recommend prepaying for one unless spending down for Medicaid or the death is expected within the not-too-distant future.

Things to consider before prepaying:

  • You might move or die in another state, and it would be expensive to have your body transported back to the funeral home you made the contract with. You might not receive a full refund including interest if you did not follow through with the original contract, so the total expenses would be higher than you had planned for.
  • You might change your mind about the kind of arrangements you want.
  • The money you pay today might not cover the cost of what you want in the distant future, necessitating substitution of cheaper merchandise or additional money from your survivors.
  • Or as competition from discount funeral homes heats up, some costs may go down, meaning either you might have paid too much at that particular establishment, or you might have been able to get the same services for less elsewhere.
  • The money you pay today might be needed in the interim for other expenses.
  • If payments are made in instalments and you do not complete the payments, your refund may be reduced by a significant sales charge.
  • The seller of the funeral services may not be in business when the need arises, or the business might be taken over by another one that refuses to honor the contract if the money was not kept in a protected trust.
  • Your survivors may not be aware of your prepayment contract. At the very least, they are not likely to have been present when you made the contract so may not be in a position to make sure that what you arranged for is what you get. All documents should be carefully kept and family members should be made aware of where to find them.
  • Some specific information about pre-need contracts in Maryland can be found on the website of the Maryland Board of Morticians and Funeral Directors here.
  • Regulations about pre-need contracts in the District of Columbia can be found here.

Alternatives to prepayment:

  • Create a pay-on-death account (sometimes referred to as a Totten Trust) with your bank. You control the account and can withdraw from it at any time. The money can be put in a CD, or savings or money market account and is payable to a beneficiary of your choice. You should have a backup beneficiary in case the primary one dies before you do. The funds are available immediately at the time of death without having to go through probate. Annual interest is subject to income tax.
  • Life insurance or an annuity contract may be structured to provide a death benefit, payable to a beneficiary and not a funeral home.

Financial Resources

Veteran’s benefits: 

VA burial benefits can help service members, Veterans, and their family members plan and pay for a burial or memorial service in a VA national cemetery. Family members can also order memorial items to honor the service of a Veteran. To find out how to apply for the burial benefits you’ve earned, and how to plan for a burial in advance or at time of need, contact the VA Benefits Hotline by calling: 800-827-1000 or visit their website to determine eligibility. Qualified veterans, service members or family members may receive benefits including:

  1. A gravesite in any of the 138 national cemeteries with available space;
  2. Opening and closing of the grave;
  3. A burial liner provided by the government;
  4. A headstone or marker provided by the government;
  5. Perpetual (ongoing) care of the gravesite.

Other government benefits:

  • There is a one-time $255 lump sum Social Security survivor’s benefit paid to an eligible spouse or to one child, if there is no surviving spouse, which may help with funeral expenses. Call 1-800-772-1213 to notify the SSA after the death. Review the Social Security website  for more information about survivor benefits. This is usually done by the funeral director.

Options for people with little or no financial resources

  • In DC, the Department of Human Services offers a Burial Assistance Program that provides modest financial assistance toward the funeral expenses of indigent residents whose income and assets qualify. The burial or cremation must be arranged through a contract funeral home.
  • In Maryland, the Department of Human Services offers a Maryland state burial assistance program which provides limited financial help with funeral expenses of deceased recipients of Public Assistance programs when their families cannot afford funeral costs.
  • In Delaware, the Delaware Division of Social Services offers limited assistance (the latest information available as of July 2022 is $400 to $1500) toward burial in a state pauper cemetery for the truly indigent whose families cannot afford burial

Contact:  Department of Health and Social Services

            1901 N. DuPont Highway

            New Castle, Delaware 19720

            302-255-9040

Crime victims:  

Every state has a crime victim compensation program which may provide substantial assistance to crime victims and their families.   Visit the state website to determine eligibility and benefits offered. 

Jewish resources: The Hebrew Free Burial Society The Hebrew Free Burial Society takes care of burial arrangements for indigent Jews who cannot afford a traditional Jewish funeral. They perform ritual washing of the body. The Jewish Chaplaincy Service of JSSA (the Jewish Social Service Agency) provides Rabbinic coverage for these funerals, which are conducted at the Chesed Shel Emes cemetery in Capitol Heights, Maryland. Phonet: 301-762-2825, as of July 2022.

What to Do After Someone Dies

The National Institute on Aging offers general guidance on what to do after someone dies.  AARP (American Association of Retired People) also offers guidance on what to do when someone dies, as does Consumer Reports

At the time of a death:

  • If a death at home is expected, call the hospice nurse or the doctor in charge of the case, who may come and pronounce the patient dead.
  • If the person was not a hospice patient and it is not possible to reach the treating doctor, call 911, but be prepared with a Do-Not-Resuscitate order if one exists, to avoid unwanted attempts at resuscitation.
  • If death is unexpected, call 911. The dispatcher will decide who will respond to the call – i.e., rescue squad, police, fire, and rescue.

Most hospitals have a place where a body may be stored in a cool environment or refrigeration facilities for several hours up to a day or two. Under Maryland law, families have 72 hours to claim a body before it is sent to the Maryland Sate Anatomy Board, which is where unclaimed bodies go. as unclaimed. However, bodies in a hospice or nursing home must be picked up soon as they do not have any storage facilities. Bodies should be picked up from a home within a few hours, unless they are preserved with dry ice, to avoid decomposition. For that reason, if a death is anticipated, it very helpful to select a funeral home in advance unless the plan is for body donation.  

The family may find it comforting to spend some time alone with the body after the death if possible.

Death Certificates

All deaths are recorded with a death certificate that lists, among other pieces of information, the cause and manner of death. When a person is under treatment by a doctor or other appropriate health care provider and dies from natural causes (i.e., the result of old age or disease), the health care provider can complete and sign the part of the death certificate that specifies the time, date, place, and cause of death. This must be done within 24 hours in Maryland, and 48 hours in Delaware and the District of Columbia.

If a person is not under the care of a physician, or if the death is unexpected or occurs under suspicious or unusual circumstances (i.e., the result of injury), then the medical examiner must be notified to begin an investigation and make sure the death certificate is completed

After the death certificate is signed by the appropriate medical practitioner, the body can be released to a funeral director, to the Maryland Anatomy Board or a medical school, or to the person acting as the funeral director for a home funeral.  Then the funeral director, or in the case of a body donation, the Maryland Anatomy Board or medical school that accepts the donation fills out the rest of the death certificate and files it with the appropriate government entity with information from the family.

Vital statistics needed for the death certificate include: the deceased person’s social security number, age, date and country of birth, address, citizenship, marital status, race, education completed, occupation, years served in the U.S. military (if any), as well as their father’s and mother’s full names. Once the death certificate is filled out and filed, it may take one to several days for it to be processed by the Office of Vital Statistics.

Multiple certified copies of the death certificate will be needed to take care of matters related to the deceased person’s affairs, as most financial entities do not accept photocopies.

Certified death certificates are needed for each: insurance policy (though multiple policies with the same insurance agency may require only one); annuity; brokerage account; stock transfer agent account (such as Computershares); retirement account; mortgage account; bank; and pension or employer death benefit claim. Probating a will, opening a safe deposit box belonging to the deceased, transferring title to a boat, car, or real estate property will also each require a certified death certificate. It may also be necessary to provide a death certificate to discontinue the deceased’s cell phone account or to remove a social media account. It is prudent to call credit card companies as soon as possible to avoid unauthorized charges, and most will then require documentation with a death certificate, once it is available, to close the account for any credit cards for which the deceased is the primary cardholder.

The funeral director usually takes care of notifying Social Security, and Social Security will in time notify the three credit bureaus but it is prudent to notify them proactively to avoid having someone apply for credit in the deceased person’s name during the period it may take for such notification to take place. The Equifax website states as of 7/24/22 that notifying just one of the three credit bureaus will suffice, but that one will require a certified death certificate. It is also prudent, though not required, to send the IRS a copy of the death certificate to protect against identity theft. Most states, including Maryland, require a death certificate with the final tax return. In some states, including Maryland, the Department of Motor Vehicles is automatically notified by the Department of Health and Mental Hygiene when a death certificate is filed for a state resident, but it is also prudent to notify the DMV proactively to avoid identity theft, which will require a dearth certificate.

Some banks may be willing to make a copy of a certified death certificate if presented in person, and then return the original. Only one copy of a certificate will likely suffice for multiple accounts and a safe deposit box with the same bank for accounts registered under the same name.

Death certificates are typically ordered through the funeral director at the time arrangements are made. Funeral directors may add a fee for obtaining certified death certificates from the county or state department of health and providing/mailing them to their clients.

Additional copies may be ordered if needed through the funeral director or directly from the appropriate government entity. Application requires proof of the applicant’s eligibility to obtain  death certificate as explained on the web sites listed below.

  • In Maryland, death certificates may be obtained through the Division of Vital Records of the Maryland Department of Health on-line or by mail. Alternatively, they may be ordered in person at one of several local government sites throughout the state. Details about those locations and prices for death certificates (which vary according to several factors) can be found on the Division of Vital Records website.
  • In D.C., death certificates are obtained through the D.C. Department of Vital Records and may be ordered on-line, by mail, by phone, or in-person by appointment. As of July, 2022, DC charges $18 each, and there are additional processing fees if ordered by mail, phone, or online. 
  • In Delaware, death certificates are obtained through the Department of Health and Human Services and may be ordered on-line, by mail, or in-person by appointment. As of July, 2022, the fee is $25 each, plus processing fees when ordered through a third party. 

Autopsies

If the medical treatment team or the medical examiner determines that an autopsy is not required to determine the cause of death, the the family may obtain a private autopsy, if desired, at their own expense.  

  • Autopsies are not covered under Medicare, Medicaid or most insurance plans.  However, some hospitals — teaching hospitals in particular — may not charge for autopsies of individuals who passed away in the facility. This is rapidly becoming a rare situation, given the fact that extensive sophisticated testing prior to death means that usually the cause of death is not in question. A private autopsy by an outside expert can cost between $3,000 and $5,000. In some cases, there may be an additional charge for the transportation of the body to and from the autopsy facility.
  • Autopsies are best if performed within 24 hours of death, before organs deteriorate, and ideally before embalming, which can interfere with toxicology and blood cultures.
  • Autopsies usually take two to four hours to perform. Preliminary results can be released within 24 hours, but the full results of an autopsy may take up to six weeks to prepare.
  • The National Association of Medical Examiners has a published list of resources to help find private autopsies providers.
  • The College of American Pathologists also provides a list of board-certified pathologists by state who perform autopsies for a fee.
  • Individuals can also contact local medical examiners and medical schools to perform autopsies, or obtain word-of-mouth referrals from hospitals, funeral homes and attorneys.
  • Johns Hopkins University, Autopsy Pathology
  • University of Maryland Medical Center, Pathology Services
  • Howard University School of Medicine, Pathology

Organ and Tissue Donation for Transplantation

The Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services. HRSA oversees organ, bone marrow and cord blood donation. Their website offers a full and detailed explanation of the donation process, both before and after death.

A person can consent to be an organ donor while still alive and competent by registering in the state of residency.

The Washington Regional Transplant Community web site explains facts about organ and also tissue and whole-body donation.

In Maryland, you may designate yourself to be an organ donor on your driver’s license. Conversely, you may state in an advance directive that you do not wish to become an organ donor or stipulate limitations on donation.  

Donating the Body to Medical Science

  • Maryland State Board of Anatomy , 1-800-879-2728. The Board accepts bodies for all the medical schools in Maryland and also schools of dentistry, PT, mortuary sciences, the military, paramedics, etc. Anyone 18 or older of sound mind may sign up to donate his body. There are no restrictions based on infectious diseases, etc. Neither a family member or even an authorized health care agent may donate another person’s body to the state Anatomy Board. The only exception to the requirement for a person to have registered to donate in advance is if he stipulated in his advance directive to donate his body to the State Anatomy Board, not just to “donate his body to science.” So, if you want to donate your body to them, you must do it yourself in advance. 
  • Local medical schools. It is always best to pre-arrange, but it may be possible to donate without doing so, if there has been no recent surgery, organ donation, autopsy, extensive resuscitation, or infectious disease. Even if a pre-registration has been made, if the body is deemed unsuitable it may not be accepted, so a backup plan is advised. Cremation and local transportation, usually only within a 50-mile radius, is covered. Local medical schools include:
  • Howard University –Department of Anatomy – 202-806-9869 (but as of 7/2022, not accepting donations)
  • Georgetown University –Department of Cell Biology – 202-687-1219
  • George Washington University – stopped accepting bodies in 2016  
  • Uniformed Services University of the Health Sciences – Anatomy Dept.- 301-295-3334
  • Donating the brain to scientific research. It is possible to donate just the brain for research into neurological disease by registering in advance with the Brain Donor Project. The rest of the body is returned to the funeral home after the brain is removed in a manner that is non-disfiguring.

The Funeral Consumers Alliance of Maryland and Environs (FCAME) is an all-volunteer-run 501(c)(3) non-profit information and advocacy organization that is entirely supported by donations from the public. Donations are tax-deductible and can be made on our website, <mdfunerals.org>.