What Happens When Someone Dies at Home Without Hospice?

Take a breath. If you are not sure the person has died, call 911 now.

If the death was expected, you have time. The National Institute on Aging says that when someone dies at home, "there is no need to move the body right away." The American Cancer Society says it is okay to sit with your loved one for a while. "There's no rush to get anything done right away."

If the person was not in hospice, NIA suggests you talk with the doctor or the local medical examiner (coroner). You can also ask the local health department or a funeral home what to do. Follow any plan the care team gave you.

That depends on whether the death was expected and on the rules where you live. Much of this page varies by state, including who may pronounce and certify a death and which out-of-hospital order forms are used. Treat what follows as the general shape of it. The American Cancer Society says to talk with the care team ahead of time so you know exactly what to do. If you do not have a plan, ask for one now. When in doubt, or when anything about the death is unexpected, call 911 and do what the dispatcher tells you.

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 plan from the medical team.

You may have another number to call if:

• The death was expected from a known illness.
• The care team gave you a plan that says who to call.
• You were told to call the doctor's office or a funeral home directly.

The American Cancer Society says to make sure family and friends know exactly who to call, so they do not dial 911 in confusion or panic. If hospice or a home care agency is involved, call them first.

Here is the part families are rarely warned about. ACS says what happens if you call 911 after an expected death at home. Crews are required to try to revive your loved one or take them to a hospital. They must do this unless there is an out-of-hospital DNR order or POLST form in place.

A DNR order says not to try to restart the heart or breathing. NIA says an out-of-hospital DNR "alerts emergency medical personnel" to these wishes when you are not in a hospital. NIA calls POLST and MOLST forms medical orders that "health care professionals can act on immediately in an emergency." NIA says care at home needs an out-of-hospital order, signed by a doctor, for crews to respect the person's wishes.

ACS says the DNR order must be valid and visible. Keep the original somewhere you can hand it over at the door.

These forms vary by state. If a dispatcher or nurse gives you an instruction, follow it. This page cannot tell you your local rule.

The reason is legal, not personal. A death has to be pronounced and certified by someone with authority. StatPearls is a clinical reference hosted by the National Library of Medicine. It says the declaration "can be made by a clinician, medical examiner, or coroner." It says the medical examiner or coroner takes charge when a crime is suspected.

NIA lists the local medical examiner (coroner) among the people to talk with in advance when a death at home is expected without hospice. Having the doctor's name and phone number to hand can help.

Exactly who can pronounce death, 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 clinician, 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 was caring for the person, ask in advance whether they will sign the death certificate, and what your state requires. This is one of the most useful things to ask about ahead of time.

There is no need to move the body right away. NIA suggests having someone make sure the body is lying flat before the joints become stiff. NIA says this begins sometime in the first few hours after death.

NIA says the body can be picked up when the family is ready, following local laws. In most states a funeral home or the family can do this. After a home death, NIA says you will need to call the funeral home yourself, or ask a friend or family member to do it.

If the person wanted to donate organs or tissue, raise it as soon as you can. NIA notes that before death or right after it, a doctor may ask about donating organs such as the heart, lungs, pancreas, kidneys, cornea, liver, and skin.

NCI says families may have customs or rituals that matter at this time, such as ways of handling the body. It says to let the care team know about them. ACS says many families use this time to be together and say goodbye.

Two people usually complete it. StatPearls explains that the funeral director fills in the non-medical part, covering demographics and what happens to the body. A licensed health care practitioner who is allowed to certify deaths 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 copies of the death certificate. NIA says you will need one to claim life insurance, and to send to the three major credit agencies to help prevent identity theft. CDC's directory, Where to Write for Vital Records, links to the right office for each state and territory. CDC says the federal government does not give out these certificates.

Without hospice, you may be the one who deals with leftover medicines. Opioids and other strong medicines are worth dealing with soon.

The FDA says "the best way to dispose of most types of expired, unwanted or unused medicines is through 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." Put the mix in a sealed container, then in the household trash. Scratch out personal details on empty bottles.

A short list of medicines may be flushed instead when take-back is not available. FDA says these are sought after for misuse and 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 lists notifying the Social Security Administration, life insurance companies, credit agencies, and banks over the next few weeks.

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 keep it where the family can find it.

Also ask about hospice, because it changes all of this. NCI reports that people who receive hospice care seem to have better relief of symptoms, more days spent at home, and a less stressful death. Hospice services include a visiting nurse, and NIA names a hospice nurse among those who can pronounce death. NIA says that if the person is in hospice, a plan for what happens after death will likely already be in place. For Medicare to cover hospice, NCI says doctors must certify two things. The person is not expected to live more than 6 months, and is not being treated to be cured.

• 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
• What to Expect When a Person With Cancer Is Nearing Death — American Cancer Society
• Types of Advance Health Care Directives — American Cancer Society
• Making Decisions for Someone at the End of Life — National Institute on Aging
• 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