What to Do If Someone Dies At Home
What should you do if someone passes away at home? Does it make a difference whether the death was expected or unexpected? What if the person you are caring for appears to be dying, and you know they did not want any heroic measures? What do you do?
When we are caring for someone of an advanced age, death is always a possibility. Many caregivers worry about what they should do if they came home to find their loved one dying or expired. While we can't give legal or medical advice, here is what we have consistently recommended to personal clients over many years:
When Death is Expected
When someone is terminally ill and death is expected within six months or less, we recommend that families give very serious consideration to engaging Hospice care. Not only is their caregiving assistance extremely helpful, but the Hospice agency will make all arrangements to handle death at home when it comes.
The Hospice agency will follow local regulations about notifying the appropriate authorities in advance, so that there will be no legal or medical issues. The Hospice nurse will instruct the caregiving family about what to watch for as death approaches. When that time comes, the family has only to call their nurse. The Hospice nurse will come as soon as possible, legally pronounce the death, and assist the family to notify their choice of funeral provider to remove the body. The nurse will remain with the family as long as necessary.
When Hospice is involved in the care of a terminally ill patient, there is no need to call 911 or the doctor.
This is one of the reasons we strongly recommend Hospice care when it is appropriate.
If Death Was Expected, But There is No Hospice
If the death is not unexpected, but there was no Hospice agency involved, then it will be necessary to call 911. Both paramedics and police will probably respond. A "non-attended", or non-Hospice death that occurs at home without the presence of a physician, is normally treated as a patient at risk. Paramedics and other authorities do not expect citizens to be experts on whether a patient is truly deceased. They will initiate emergency procedures and, in most cases, transport the person to the emergency room. There, the emergency room doctor will legally pronounce the death.
In localities where paramedics may pronounce death, they may or may not skip the hospital.
IF the deceased had a properly prepared out-of-hospital do-not-resuscitate-order, and IF the family produced it immediately when paramedics arrived, paramedics should honor the deceased's wishes and not provide CPR. In this case they will either transport the deceased to the hospital or simply notify the police of the death.
Paramedics should and will disregard an Advanced Directive, which is the document used to instruct physicians about the kind of care desired in a terminal illness. They are not doctors and do not make the determination about whether an underlying illness is "terminal." In the case of an Advanced Directive, their job is to attempt to revive the patient so that the "terminal" status of the patient can be determined by a doctor in the emergency room. Having an Advanced Directive will never prevent emergency personnel from attempting CPR in the home.
If it is obvious to paramedics that death occurred far enough in the past that resuscitation will clearly be useless, they may withdraw and leave things to the police instead of taking the body to the emergency room. This procedure will vary by locality.
Once the police and the medical examiner are initially satisfied that no foul play was involved, the medical examiner will remove the body so that a legal cause of death can be determined.
In some cases, and depending on the municipality, where there is no question of foul play and the doctor has been available to answer any questions by telephone or in person, the body may be released directly from home to the funeral home.
If Death Was Unexpected
Call 911 immediately. Unlock the door, and then have any out-of-hospital-do-not-resuscitate documents in hand if the deceased made those arrangements. If you do not know whether or not the deceased wanted CPR, if you know how begin CPR and continue until instructed to stop by emergency rescue personnel.
The police and the coroner will undoubtedly be involved in an unexpected death. Be prepared to be questioned extensively by the police. It is their job to determine that no evidence of foul play exists.
When Hospice is involved and death occurs, one call to the Hospice nurse is all that is needed. The Hospice nurse and staff will handle all other official calls.
If there is no Hospice involvement -
1) call 911;
2) unlock the door;
3) if there is one have any out-of-hospital-do-not-resuscitate document in hand;
4) provide CPR if appropriate and there is no DNR document; and
5) await further instructions from emergency medical and law enforcement personnel.
Home page photo by "psd"