At-Home Death on Hospice Care

Sep 3, 2009 | 0 comments

If a loved one dies at home on hospice care, the first call goes to the hospice organization. All hospice programs have registered nurses on call 24/7, and in most states specially certified nurses may officially pronounce the deaths of home hospice patients. Check with a local provider to make sure this is the case in your state.

It helps to have a funeral home already selected to call after pronouncement, even if you haven’t made funeral plans. The hospice nurse will call the funeral home of choice to take the body to their facility. Most mortuaries handle transportation of a body from the home in unmarked vans, not in a hearse.

While waiting for the mortuary, the nurse will offer to wash the body to the extent necessary or desired by the family, and remove catheters, IVs or medicated patches. The family can help with the washing if they wish.

Most state Board of Pharmacy rules prohibit hospice nurses from taking back leftover narcotics. The current procedure is for the nurse to tally up and destroy, with a family member as witness, any controlled substances the patient was taking, such as narcotics and sedatives. This is done by pouring the pills and liquids into a sealable plastic baggie, pouring cooking oil, vinegar, or bleach over them, and discarding the bag in the trash. “Flushing medications down the toilet is ‘out’ these days, to protect groundwater and river quality,” said Nancy Costea, a hospice nurse.

If a patient has had a recent fall with an injury that might have contributed to the death, such as a hip fracture, the nurse will have to call the Office of the Medical Investigator (OMI) or the coroner’s office. The investigator on duty will determine over the phone if they need to take the case. If so, OMI’s removal team will take the body to their facility. OMI is also called if there’s suspicion of abuse or neglect, or if circumstances point toward a drug overdose.

A word about Do Not Resuscitate (DNR) orders: People who go on hospice acknowledge that they are going to die. Under current Medicare regulations, hospice providers cannot require that a DNR document be signed and in place. However, most hospice programs strongly encourage taking that step. This means that no heroic measures will be taken to restart heartbeat or breathing when the patient starts to fail.

Family members should not call 911 when the end seems near. Even with a DNR order, once emergency medical services are called, a home death gets needlessly complicated. Keep the hospice phone number posted by or programmed into the phone, and make sure anyone staying with the patient is aware of the importance of calling for the hospice nurse, not 911.

Anyone have an experience with an at-home hospice death they’d like to share?

A Good Goodbye