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When Michelle Acciavatti of Ending Well gets dressed for work, she has a few go-to outfits: bright, feminine clothing in solid colors and layered cardigans full of texture. The Vermont native swears by Bogs footwear, practical shoes perfect for sleet, snow, ice, and mud. And on her way out the door she’ll grab her trademark bag, handwoven in a bright turquoise with a magenta strap and tassels. Today’s outfit, perhaps a light pink blouse and royal blue skirt if it’s warm, passes muster — and that’s important. For Acciavatti, clothing isn’t just about self-expression. As an end-of-life specialist working with both the dying and their families, Acciavatti understands that colors, textures, and patterns can be fraught with meaning.
“The first big lesson I learned is to never wear all white,” she says. She tried it once: While working as a hospice volunteer, Acciavatti once wore a flowing linen dress and loose cardigan to visit a woman with mild dementia and advanced Parkinson’s disease. When her patient became agitated, Acciavatti realized it was because her billowy frock made her look like an angel coming to take the woman to heaven. As she remembered who Acciavatti was, “she sounded almost disappointed. I’ve never worn the dress to visit a patient again.”
In addition to unearthly associations — Acciavatti also retired red from her repertoire after being mistaken for a demon — clothing can have other significance to the elderly and ill. “I can’t think of a time when a patient has not been thrilled by bright colors,” Acciavatti says. “Patients really light up when I wear something bright, and they like to touch my clothes, so I usually try to wear a scarf or a cardigan — something they can grab and run through their hands and fingers.” For patients with dementia, Acciavatti explains, texture can be particularly important. “If I was just dressing for patients, I would definitely channel a bit of my inner ’80s kid and try to forget any of the rules about matching.”
But of course it’s not just about the patients. Working with families is integral to deathcare, and Acciavatti is always aware that the bright clothes she and her patients love may not appear “professional.” And when families don’t see Acciavatti as professional, it can actually be dangerous to the patient.
“I’ve been described as ‘that hippie girl that comes to visit,’” Acciavatti says, recalling an instance when a family’s primary caregiver took longer than most to trust her with the information she needed to effectively care for her patient. “She just didn’t want to share information about sleeping, eating, reactions to medication with someone she perceived as being flighty, ungrounded, and probably a drug user.” Acciavatti also tends to cover up her tattoos — but once she forgot and rolled up her sleeve, displaying a forearm illustrated with a naked woman turning into birds to her 96-year-old client. He grinned, winked, and said it was the best-looking woman he’d seen in years. “We became fast friends,” Acciavatti laughs.
Patricia Lundy, a writer and hospice volunteer, was advised to wear “business casual” clothing during her training, which also guided her away from both black and “garish” colors. As soon as she began volunteering, however, she realized the practical needs of the job didn’t line up with high-waisted skirts and prim blazers. She needed breathable, athletic clothing. “I transitioned to a uniform of ‘professional’-looking pants, sneakers, and a colorful athletic polo shirt,” she says. “I needed clothing I could sweat in and do heavy lifting in — from helping to reposition patients to taking out the linens to dealing with bodily fluids — while still being appropriate.”
“I don’t own anything ‘business casual,’” agrees Amber Carvaly, mortician and service director at nonprofit funeral home Undertaking LA. Carvaly, whose style runs more charming than corporate, prefers items like her deep purple ankle-length skirt from Eileen Fisher and a dusty ivory knee-length dress from Anthropologie that she pairs with a black cardigan. “Lots of soft colors that are still bold and bright,” she says. Like Lundy and Acciavatti, she also avoids all white or black — and tries to never show her shoulders. “An old Victorian throwback,” she explains.
For Carvaly, the funeral setting makes self-imposed modesty feel like a sign of respect rather than censorship. “The funeral isn’t about me, my adorable outfits, or anything me-related,” she says. “It is about my family and me just being there if they need me.” She tries to strike a balance of colors that feel joyful, like purple, but wears them in muted tones “so that it isn’t, like, ‘Oh, if you need to find the funeral director, just look for the flash of bright purple!” she jokes.
For death doula Evi Numen, learning about color perception in dementia patients changed the way she dressed. “Dementia patients can see a black mat on the floor as a hole because of loss of their visual acuity, so it follows that someone dressed in black might appear too jarring to them,” she said in a 2016 interview. I followed up with Numen, who told me that her patients tend to prefer blue, red, and green, in that order. “While these things may sound trivial, when someone is dying, color choices in clothing and environment can make a big difference.”
Other preferences are religious in nature. According to a Metaheret, or someone who washes and prepares the dead according to Jewish traditions, people found it “weirdly comforting” when she maintained Orthodox dress codes. The Metaheret, who preferred to remain anonymous, would cover her head, collarbone, elbows, and knees, wear a floor-length or under-the-knee skirt with opaque tights, and ensure that clothing wasn’t tight and figure-showing. “If Grandma wanted a Jewish burial, you wanted the people taking care of her to look like they just popped out of Fiddler on the Roof,” she explains. “So now even though I am no longer Orthodox or even practicing, I still have to put on what is basically a costume of religious observance to bury the dead in my community, including wearing a wig and putting makeup over tattoos.”
Tattoos are a common thread for many of the women working with the dead and dying. Whatever the “official” take, though, the patient response is often positive. “I get a lot of questions about my tattoos,” says Lashanna Williams, who works as a massage therapist and palliative doula at Antares Wellness. “What do they mean? People will start telling me old tattoo stories. You know, sometimes it's a nice bridge in conversation.” Williams alternately works alone and with another woman who owns a death midwifery organization in the Seattle area.
When she’s working for herself, Williams wears, well, whatever she happened to throw on that morning. “I don’t tend to work with clients who don’t take me for me,” she explains. “I think it is important for people to be able to to represent their true self while still taking into account that they are there for someone else. If we all come in in uniforms, it takes exactly what we’re trying to bring out. We’re not trying to bring a hospital home.” Williams believes the purpose of having a death doula or death midwife, or even a home funeral, is to bring death back home and make it a personal, family experience — like it used to be before dying in hospitals surrounded by strangers became the norm. Deathcare is inherently, unflinchingly intimate, and as with any kind of intimacy, appearance plays a huge role. “When you have someone who’s coming over in a doula role in a uniform, it feels very medicinal and very clinical, very sterile,” Williams says. “While if we come over in our everyday wear, it’s more personal. There is an immediate bond.”
Whether creating that personal bond, adding a touch of individual character, or encouraging patients to talk about their own past, clothing is an integral part of the deathcare profession. “Some of the older women will tell me about how they used to dress,” Acciavatti says of her patients. “Quite a few have been dismayed by the old-lady clothes they have to wear now. And it’s quite true for the men as well — many of them have taken great pride in their appearance. Whether it’s something dapper or flannel, it symbolizes how they want to be perceived.” Acciavatti works to ensure that her patients get to wear at least a top of their choosing for as long as feasible, just as she works to wear clothes that comfort and inspire. It’s a reminder that self-expression isn’t about vanity, but human connection.