What Happens When Someone Dies at Home Without Hospice?

Take a breath. In almost every case, nothing has to happen in the next five minutes.

If the death was expected from a known illness, there is no emergency to manage. The National Institute on Aging says plainly that when someone dies at home, "there is no need to move the body right away." You can sit with them. You can call the people you need to call.

Two things do need deciding soon: who you call first, and what you say.

Medical-review hold: This draft discusses urgent or high-risk decisions. It is excluded from public search until a qualified clinician reviews the wording. Follow the patient's own care plan now.

That depends on whether the death was expected and on the rules where you live. Almost everything on this page varies by state and sometimes by county: which ambulance service attends and what its crews are obliged to do, who may pronounce and certify a death, whether police attend, and which out-of-hospital order forms are recognised. Treat what follows as the general shape of it. The version that binds you is the written plan the treating team gave you, and if you do not have one, ask for it now rather than later. When in doubt, or when anything about the death is unexpected, call 911 and do what the dispatcher tells you. Say the plain truth to whoever answers.

Call 911 if:

• you are not certain the person has died
• the death was sudden, or the cause is unclear
• you want resuscitation attempted
• you have no other number to call and no plan from the medical team

You may not need 911 if:

• the death was expected from a known illness
• a doctor has already agreed to sign the death certificate
• the treating team gave you a written procedure to follow
• you were told to call the doctor's office or a funeral home directly

Here is the part families are rarely warned about. If you call 911, emergency crews normally have to attempt resuscitation. They stop only when they can see an order that tells them not to. The National Institute on Aging describes an out-of-hospital do-not-resuscitate order as the document that "alerts emergency medical personnel to your wishes regarding measures to restore your heartbeat or breathing if you are not in a hospital." A POLST or MOLST form does the same job. NIA calls these medical orders that "health care professionals can act on immediately in an emergency."

Those forms only work if responders can find them. Keep the original somewhere you can hand it over at the door.

Rules differ by state, and sometimes by county. If a dispatcher, nurse, or officer gives you an instruction, follow it. This page cannot tell you your local rule.

If you call 911 after a death, police often arrive too. This shocks families and can feel like suspicion. It usually is not.

The reason is legal, not personal. A death has to be certified by someone with authority. StatPearls, the clinical reference hosted by the National Library of Medicine, notes that the declaration "can be made by a physician, medical examiner, or coroner," and that the medical examiner or coroner takes responsibility where foul play is suspected. When no doctor was present and none has agreed to certify the death, the case may go to the medical examiner or coroner. Law enforcement often attends while that is settled.

You may be asked when you last saw the person alive, what illness they had, what medicines they took, and who their doctor was. Answer plainly. Having the pill bottles and the doctor's phone number to hand makes this much shorter.

A family member cannot pronounce death. Neither can a funeral home. Exactly who can, and who signs the certificate, is set by state law and differs.

NIA states that the death "must be officially pronounced by someone in authority like a doctor in a hospital or nursing facility or a hospice nurse." StatPearls lists a physician, medical examiner, or coroner, and notes that in rare cases a nurse practitioner may complete the certificate when no physician is available.

If an oncologist or primary care doctor knew the person was dying, that doctor may be able to certify the death without anyone coming to the house. Whether that is allowed depends on your state. It is the single most useful thing to ask about in advance.

There is no rush. NIA suggests having someone make sure the body is lying flat before the joints become stiff.

Do not move the person out of the house yourself. A funeral home or cremation provider does that, and most answer the phone at any hour. NIA notes that after a home death "you will need to contact the funeral home directly, make arrangements yourself, or ask a friend or family member to do that for you."

If the person wanted to donate organs or tissue, raise it immediately rather than later. NIA notes a doctor may ask about donating the heart, lungs, pancreas, kidneys, cornea, liver, and skin. What is actually possible depends on how and where the person died.

Many families wash the body, sit with it, or say prayers before anyone is called. NCI encourages families to tell the care team about customs or rituals that matter to them. There is time for this.

Two people usually complete it. StatPearls explains that the funeral director can fill in the non-medical part after pronouncement, covering demographics and what happens to the body. A doctor, medical examiner, or coroner completes the medical part, which states the cause of death.

Filing deadlines are set by each state. StatPearls gives Wisconsin as an example, where the medical portion must be completed within six days of death, and notes the rule varies.

You will need certified copies, not photocopies. Banks, insurers, and pension offices usually insist on them. Order several at once. CDC's directory, Where to Write for Vital Records, lists the correct office for every state and territory. The federal government does not issue the certificates itself.

Without hospice, nobody else will clear the medicine cabinet. Opioids and other controlled medicines should not stay in the house.

The FDA says the best route is a drug take-back program. Look for a DEA-authorized collector, a pharmacy drop-off box, or National Prescription Drug Take Back Day.

If no take-back is available, FDA advises mixing most medicines "with something undesirable, such as used coffee grounds, dirt or cat litter," then putting that in the household trash.

A short list of medicines should be flushed instead, because FDA says they can "result in death from one dose if inappropriately taken." FDA's flush list names fentanyl, morphine, oxycodone, hydromorphone, methadone, hydrocodone, benzhydrocodone, oxymorphone, buprenorphine, tapentadol and meperidine, and also three non-opioids: sodium oxybate, diazepam rectal gel and the methylphenidate patch. FDA is firm about the limit: "don't flush your medicine unless it is on the flush list."

Almost everything. NIA advises notifying the Social Security Administration, life insurance companies, credit agencies, and banks in the weeks that follow. None of it is urgent tonight.

This is the conversation worth having now, while there is time. Ask the oncologist or primary care doctor:

• If he dies at home, who do I call first, and on what number?
• Will you sign the death certificate?
• Do we need an out-of-hospital DNR or a POLST form, and where should I keep it?
• Does our county require anything extra?
• What am I supposed to do at three in the morning on a Sunday?

Write the answers on one page and tape it inside a kitchen cupboard.

Also ask about hospice, because it changes all of this. NCI reports that hospice care is linked to better relief of symptoms, more days spent at home, and a less stressful death. A hospice nurse can come out at night, and in many states can pronounce the death. Medicare hospice requires a doctor to certify that the person is not expected to live beyond six months.

• What To Do After Someone Dies — National Institute on Aging
• Advance Care Planning: Advance Directives for Health Care — National Institute on Aging
• Death Certification — StatPearls, National Library of Medicine
• Last Days of Life (PDQ) — Patient Version — National Cancer Institute
• Where and How to Dispose of Unused Medicines — U.S. Food and Drug Administration
• Drug Disposal: FDA's Flush List for Certain Medicines — U.S. Food and Drug Administration
• Where to Write for Vital Records — CDC National Center for Health Statistics