Three years ago, Margo Lalich co-founded the North Coast End of Life Collective. She’s a nurse and public health professional who says the COVID-19 pandemic was a “wake-up call” that helped her identify a lack of intentional, communal grieving and gaps in infrastructure surrounding end-of-life care in rural areas. She began hosting educational workshops via Zoom for people who wanted to learn more and be involved in facilitating end-of-life conversations and initiatives for their communities’ aging residents. One of the attendees was Kevin Shluka, a sculptor and landscaper located in Tillamook County who’s been volunteering in community hospice since 2024.
We’ll hear more from Lalich and Shluka about the role the End of Life Collective has filled in these coastal communities, and more on what it looks like to facilitate this unique model of care.
Note: The following transcript was transcribed using AI and validated for accuracy, readability and formatting by an OPB volunteer.
Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. Margo Lalich is a nurse and a public health professional. The COVID-19 pandemic was, in her words, “a wake-up call.” It helped her identify the gaps in quality end-of-life care on Oregon’s North Coast. That led her to co-found the North Coast End of Life [EOL] Collective three years ago. She hosted educational workshops on Zoom for people who wanted, to put it really plainly, to make dying better.
Kevin Shluka was one of those attendees. He is a sculptor and landscaper in Tillamook County who’s now been volunteering in hospice since 2023. Margo and Kevin both join me now. It’s great to have both of you on Think Out Loud.
Margo Lalich: Thanks for inviting us.
Kevin Shluka: Thank you.
Miller: Margo, first – I mentioned that the pandemic played a big role in your decision to create this, but you’ve had a long and varied career that death has always been a part of. Why did you start the North Coast End of Life [EOL] Collective in 2023?
Lalich: Yeah, thanks for the question. It’s the North Coast EOL Collective. EOL, an acronym for End of Life, of course.
I was on the front lines of the pandemic while I was the director of a program in Hawaii. I’d been director of public health in Clatsop County for many years, and then came back again in that role as the public health director. And what I saw – and again, I bring a global perspective to this because I’ve worked on many public health, global health projects – is that we responded to it with such shock and uncertainty, even though in Oregon, across the country, we’ve been planning for something like this for a long time. Many parts of the world live like this every day because of poor sanitation, contaminated water, malaria [and] a number of other public health threats.
Being on the front line and receiving calls; witnessing, daily, the fears of people in vaccination clinics, the uncertainty; getting reports of people I knew in the community who had died from the pandemic; and then [seeing] how profoundly impacted the elderly were affected by the pandemic, not only in our community, but across the country … I just sat back and I went, we are so ill-prepared as communities to confront the one thing we all share in common: We will all die, we are mortal beings.
In the last century or so, we’ve moved away from death being part of the community – and that is changing across the country. There was a time when it was outsourced to essentially three sectors. And I said, more things will come in the future and we have to return many parts of this back to the community. So that was really the catalyst for launching the collective.
Miller: And when you say the community, I’m curious what you see as the specific pieces on the North Coast, in Tillamook County, say? Because a lot of what you’re talking about, I think, is true nationally, that you’re talking broadly about national trends of 100 years ago, say, people being more likely to die at home around friends and family than now, where hospitals and a kind of medicalized end-of-life is, I think, the norm. But those are national trends. So I’m curious what you see specifically as the needs in rural parts of Oregon’s coast.
Lalich: Yeah, correct. So, in rural communities, the fact is that we are just more resource poor. And as we look at what’s happening in the landscape of health care and funding for particular services, we are more threatened by losing services than getting more services. And the three sectors that have really serviced end-of-life and death and dying have been hospitals, as you mentioned, it’s been medicalized; funeral homes, [which] is a very profitable, large industry; and fortunately, our hospices on the North Coast. We have one in Clatsop County and one in Tillamook County. Even though they’re affiliated with hospitals, they are not-for-profit. Many, many hospices are for-profit across the country.
So, it’s this idea that many people who access care, particularly tertiary care, specialized care, have to go to Portland for so many different things. And transportation then becomes a barrier, particularly for the elderly population, even though we’re interested in the whole population. So this idea that yes, we have these resources available to us, and we also have community.
When we look at the demographics of the North Coast, the reality is that many people move here and some have lived their whole lifetimes here because this is where they want to live. This is where they want to live the remainder of their life. But in order to do so, because there are limited or less services than would be available in an urban setting, we have to look at how we care for one another, neighbor to neighbor, or, as I like to use the term, stranger-friend, which I got from Maya Angelou in a children’s book she wrote.
So that was really kind of part of, again, the impetus, not only of the work we do, but also of the series that we recently facilitated with the development and incredible support from the Peaceful Presence Project from Bend, Oregon.
Miller: Kevin, why did you want to get involved in this collective, this movement?
Shluka: Well, I’ve always been oddly comfortable around death. And I just find it an incredible honor and incredibly inspiring to be able to participate in someone’s peaceful transition out of life. So, I kind of arrived at a point in my life where I had the opportunity in terms of free time to begin to focus a little bit more on developing my skills around that. It just happened to sort of coincide with the time when Margo was launching the North Coast EOL Collective.
Miller: Why do you think that you have, in your words, always been oddly comfortable around death?
Shluka: Strangely, I think it has to do a bit with detachment, but it also has to do with sort of … And I think the detachment comes into play because I can be excited and happy for somebody on their new adventure. Margo stated so wisely that we are so fortunate in our world not to be faced with death on a daily basis. So it’s really a privilege, an incredible privilege to be able to face death peacefully and surrounded by friends, family and neighbors. So to get to participate in that is just so meaningful.
Miller: Can you give us a sense for what that participation has looked like for you?
Shluka: Well, there’s been times where I’ve been at the bedside, holding the person’s hand. But oftentimes it’s on the periphery. And I think my best role is as a gardener. When you asked about what the community looks like, it’s Lindsay, who’s the retired nurse practitioner who can come and sort of tell you what to expect and help navigate the technical steps. And then it’s Tom down the street who can come and walk the dog, and it’s Kevin who can come and pull the weeds.
Miller: And you’re not speaking metaphorically here. You’re saying that when you’ve been volunteering at a community member’s death, you’ve been in a garden while that person was actively dying.
Shluka: I mean, it’s a great place to be. I think the hardest part about sort of participating in that moment in a person’s life is trying to figure out how to place yourself in a way where you can be the greatest support, without being an additional concern or burden. Oftentimes, when people are dying, they’re still anxious about hosting. So if you can kind of find a place where you can be, at least initially, on the periphery, and just let it be known that you’re available to participate in other ways if help is needed, that’s kind of the trickiest way to initiate participation.
Miller: Margo, that does make me wonder, because I think when people hear the phrase “end-of-life care,” their minds may go to things like hospice or palliative care – things that you were talking about earlier. But what else falls under the broad category for you?
Lalich: Well, I kind of go back to sort of the fundamentals, which is one of my primary focuses with the collective, and that’s education. Most people don’t know how much agency is actually available to them when they contemplate and think about their mortality, long before they’re ever confronted with the reality of death or dying. Or maybe more connected, not with their own lives, but with a friend, a neighbor, a family member or a loved one.
We’ve offered a lot of education, and partnered and collaborated with many entities across the country to bring that knowledge, to bring that information to the North Coast. Virtual makes it more accessible, and we also offer it at two different times. And it’s live, so people can ask questions. The single most common response we hear is, “I had no idea. I had no idea.” So for me, it really…
Miller: “I had no idea.” What are they saying they had no idea about?
Lalich: I had no idea this information was available. I had no idea that this was legally possible. I had no idea this was available. I had no idea there was someone I could go to who would have this information. Because it hasn’t been provided by the traditional sectors that we rely on in the past, and so I start with the education.
Miller: I imagine that there’s something self-selecting about the people who are choosing to be a part of your collective or choosing, for example, to take part in these Zoom tutorials. These are people who, by virtue of electing to take part, they’re showing some level of interest in or being comfortable enough to engage in this. How do you reach people who aren’t there yet, who are afraid?
Lalich: That’s a great question. So one would think, especially if you look at the demographics of our counties, that it’s primarily the aging population. And we tend to think about death and dying chronologically, even though if we look at data, everyday lives are exposed to death and dying on a daily basis for a variety of reasons. We do have people of all ages participate.
I can give you a couple examples of some initiatives that have launched in communities because of the collective, because of education. We do a lot of one-to-one consultation. One of the co-founders has a career in palliative care, oncology, is a clinical social worker, so she kind of focuses on grief and bereavement. I’ve been part of death cafes for a very long time, and I launched a death cafe here on the North Coast and then assisted the cafe in launching in Astoria. And at that cafe, we have people of all adult ages come and participate. Some are just death curious, others are actively navigating a new diagnosis, or a spouse who has a terminal illness, or they don’t have children. There are many, what are called, orphan adults. They don’t have children, their spouse has passed away, they don’t have parents, they don’t have family members who live nearby. And they’re wondering how it is they’re going to navigate the end of their life because they’re lonely – which we know is an epidemic – and they are alone.
There are many examples [of initiatives] that I have, but one in particular that might be of interest and answer your question is, because of the educational series, a very small and isolated community in Tillamook reached out and said, “We’ve chosen to live where we live. We want to age in place and prepare for the end of life. How can we go about doing this?” And there’s many ways this connects to public health, as was mentioned in your last segment. But I started meeting with them and they asked me to help them develop a community initiative so that they could be self-supporting and tend to themselves so they could age in place and know how to support one another.
That was two years ago, and it became an initiative within their community association. They had different speakers come and talk. They had a leadership team. We did a SWOT analysis. They delegated teams to work on certain projects within their community, and it’s ongoing today. And that’s a community where everyone showed up when we launched it, because it started with a community assessment. Not only as a community, but then as an individual, how do you evaluate your situation? It was really interesting.
Miller: Kevin, has thinking more consciously about death affected the way you think about life?
Shluka: Oh yeah. Yeah, absolutely. I think part of the reason why I feel strengthened in that moment, in that time when somebody’s passing, is because it gives you a greater appreciation for life, and for mortality and immortality. Yeah, absolutely.
Miller: You’re an artist, too, I mentioned. Has doing this volunteer work affected your day job?
Shluka: Yeah, for sure. I think a lot of my art has always been about emergence. And this is just another example of emerging, disappearing and movement into another realm.
Miller: Margo, what do you see as the biggest barriers standing in the way of your vision?
Lalich: Yeah, the vision – a collective approach to death and dying, this idea that the community is the collective – makes me think about who is engaged and who is not engaged. I receive calls and contacts from people in Washington and across the country who want to collaborate. But who I don’t hear from are the sectors that have really housed death and dying for decades now. And I think there’s a variety of reasons for that and certainly not enough time in this conversation to delve into it.
I think we are moving towards achieving that vision. I don’t think there’s an end goal because this is always evolving based upon all the influences that impact living well, aging well and ending well. But I think we are achieving that vision. It started with three of us and we were the collective, and now I think of the community as the whole North Coast, even though I live in Cannon Beach. And Kevin is here and Kevin is part of that collective. So I think we are manifesting the vision every day.
Miller: Margo and Kevin, thanks very much.
Lalich: Thank you.
Shluka: Thank you so much.
Miller: Margo Lalich is a nurse and founder of the North Coast EOL, or End of Life, Collective. Kevin Shluka is a sculptor, landscaper and community hospice volunteer.
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