Očekávaná smrt doma: komu zavolat jako prvnímu a co bude dál¶

Pokud někdo, koho milujete, žil s vážnou nemocí a nyní zemřel doma, můžete cítit mnoho věcí najednou: smutek, úlevu, prázdnotu, vyčerpání, dokonce i otupělost. To vše je normální a žádný z nich neznamená, že to děláte špatně. Prošli jste dlouhou a únavnou dobou a můžete být unavení.

Tato příručka je určena pro úmrtí, která byla očekávána, obvykle v době, kdy byla osoba v domácím hospici, paliativní péči nebo péči na konci života. Nejdůležitější je vědět, že nemusíte spěchat. V příštích několika minutách se kromě jednoho klidného telefonátu nemusí nic stát, a to obvykle sestře nebo pečovatelskému týmu, kteří již vaši rodinu znají. Než zvednete telefon, můžete si sednout, nadechnout se a strávit s danou osobou, jak dlouho chcete.

Udělejte to teď¶

1. Zůstaňte chvíli tam, kde jste. Posaďte se s danou osobou. Držte je za ruku, chcete-li. Neexistuje žádná nouze ve smyslu závodu s časem.
2. Najděte plán péče nebo číslo hospice. Často je na lednici, ve složce u postele nebo je uloženo v telefonu pod „hospic“ nebo „paliativní péče“. Pokud jej nemůžete najít, požádejte někoho jiného v domácnosti, aby se podíval.
3. **Pokud máte plán, který vám to nařizuje, zavolejte nejprve do hospice, paliativní péče nebo linky zdravotní sestry na konci života. Řekněte: "Můj milovaný zemřel. Můžete poslat zdravotní sestru." Většina služeb odpovídá 24 hodin denně.
4. Pokud nemáte žádný plán, žádné číslo nebo nikdo neodpovídá, zavolejte na místní tísňové číslo (911 ve Spojených státech a Kanadě, 112 v celé Evropské unii, 999 ve Spojeném království) nebo lékaři dané osoby. Viz tísňová čísla stránka pro jiné země. Řekněte jasně, že to byla očekávaná smrt.
5. Papírování s neresuscitací uschovejte tam, kde je lze vidět, pokud nějaké existují, a ukažte je každému, kdo přijede. Nezačínejte KPR, pokud existuje platný příkaz a pečovatelský tým vám řekl, že osoba nemá být resuscitována.
6. Požádejte jednu osobu, aby si k vám přisedla. Přítel, příbuzný nebo soused vám může uvařit čaj, přijímat hovory a být tu pro vás.

Všechno ostatní, včetně pohřebního ředitele, rodinných hovorů a papírování, může následovat mírným tempem.

Neděláte nic špatného¶

Když se očekává smrt, lidé často cítí, že by měli být klidní a organizovaní. Někteří se stejně cítí šokováni, protože být připraven ve své hlavě je něco jiného než být připraven ve svém srdci. Někteří necítí vůbec nic.

Někteří cítí úlevu, že utrpení skončilo, a pak se cítí provinile za úlevu. Uvědomte si prosím, že všechny tyto jsou běžné.

Také se můžete ptát, zda jste propásli přesný okamžik, nebo zda jste měli udělat něco jinak. Pokud jste spali, v jiné místnosti nebo venku a dali si šálek čaje, když se to stalo, je to velmi běžné. Mnoho lidí zemře, když v místnosti nikdo není, a zdá se, že někteří čekají, dokud rodina neodejde. Není to selhání lásky nebo péče.

Není třeba nic dělat rychle, kromě zavolání správného servisu. Můžete si s danou osobou sednout tak dlouho, jak dlouho chcete, a sestře můžete říct, až budete připraveni, aby přišla.

Komu zavolat jako prvnímu: zkrácená verze¶

Správné první volání závisí na tom, zda existuje plán. Tato tabulka vám může pomoci v rozhodování.

If you are not sure which row fits, call the emergency number. It is always better to make that call than to wait and worry.

Why the hospice line comes first when there is a plan¶

Hospice and palliative care teams plan ahead with families. They know the person's wishes, medicines, and paperwork. They can send a nurse who is trained to confirm death, support you, and arrange the next steps.

If you call the emergency number instead, a crew may arrive who does not know the person and who is required to start resuscitation unless they see valid paperwork. This can be upsetting for everyone. That is why hospice teams ask families to call them first.

Why the emergency number is sometimes still right¶

There are times when the emergency number is the right call, even in a planned death. If there is no plan or the plan is not clear, if you cannot reach the hospice team, or if something unexpected has happened, call without delay. The call taker will ask questions and send the right help.

If the person was only recently ill and nobody had talked about end of life care, treat it as a sudden death. The guide on člena rodiny, který nečekaně zemřel přes noc doma explains what happens in that case.

Paperwork that matters: do not resuscitate and similar orders¶

Different countries use different names and forms for a person's choice not to be resuscitated. They are not interchangeable, and they do not work the same way everywhere. This is one of the biggest differences between countries, so please read the part that matches where you live and then check with the care team.

In some places an order must be a particular signed form to be accepted by paramedics. In others, a conversation or a note in the person's records may not be enough on its own. Ask the hospice team early which form your area uses and where it should be kept, ideally well before the day comes.

If paperwork cannot be found¶

If you cannot find the form, do not panic. Tell the call taker or the nurse straight away. Say, "My loved one was under hospice care and this was expected."

They will tell you what to do, which may include starting CPR. Follow their instruction. The most important thing is to be honest and calm.

If paramedics arrive and start trying to help¶

If paramedics arrive and there is no visible form, they may begin resuscitation. It can feel distressing to watch, but it is their legal duty. Tell them clearly and quickly what you know, and show any paperwork you can find. If the hospice nurse is on the way, tell them so.

If the paperwork is found while they are working, hand it to them at once. They are trained to follow valid orders and will stop when it is right to do so.

What happens after you make the call¶

Once you call the hospice or care team, a nurse will usually come to the home. They may talk to you by phone first and ask whether the person has stopped breathing and whether you are safe. They will tell you not to worry and that you can stay with the person.

When the nurse arrives, they will gently check the person and confirm that death has occurred. They will note the time. They are kind, quiet, and used to helping families. You can ask questions at any time.

What the nurse may do¶

Depending on the country and service, the nurse may:

• Confirm and record the death.
• Contact the person's doctor or the coroner if needed.
• Help wash and prepare the person if you wish, or leave that to a funeral director.
• Remove medical devices such as syringe drivers, patches, or catheters.
• Give you written information on what to do next.
• Help you deal with medicines left in the home.
• Offer to call a funeral director with you or for you.
• Offer to sit with you or call a family member.

Na cokoli z toho můžete říct ano nebo ne. Pokud chcete umýt a obléknout svého blízkého sami, mnoho služeb to podpoří. Pokud to raději necháte na profesionálech, je to také v pořádku.

Verification of death¶

Verification, sometimes called pronouncement, is when an authorised person confirms that someone has died. Who can do this differs by country:

• In the United States, a hospice nurse, doctor, or in some states a coroner can pronounce death. A physician or the medical examiner then signs the death certificate.
• In the United Kingdom, a doctor or trained nurse can verify an expected death. A doctor, usually the GP or hospital doctor, completes the medical certificate of cause of death, and the family then registers the death.
• In Canada, a physician, nurse practitioner, or in some provinces a registered nurse can confirm and pronounce death. The rules depend on the province or territory.
• In Australia, a doctor or in some states a trained nurse can verify death. A doctor completes the certificate, and the funeral director helps with registration.

You do not need to know these details in advance. The nurse who comes will explain what applies to you.

While you wait for the nurse¶

The nurse may take an hour or two to arrive. This time is yours. It does not have to be used for anything practical.

Some families light a candle, play favourite music, say a prayer, or share memories. Others simply sit quietly. Some people open a window as part of a custom or belief. You can do whatever feels right, as long as it is safe.

What to leave as it is¶

For an expected death, there is usually less to leave untouched than in a sudden death, but a few things should still wait:

• Do not throw away any medicines. The nurse will tell you what to do with them.
• Do not remove the person's ID bracelet or medical alert items yet.
• Keep the care plan and paperwork where the nurse can find them.
• Leave the bed and room mostly as they are until the nurse has finished.

You can gently close the person's eyes, straighten their blanket, and place their hands comfortably. Many nurses encourage this. If you are not sure, ask when you call.

Who to tell¶

You may want to tell family and friends. You do not need to do this before the nurse arrives, and you can ask someone else to make the calls for you. If you want to send a short message, you can write, "I am so sorry to tell you that [name] died peacefully at home today. I will call you when I can."

Keep a simple list of who has been told. When many people are grieving at once, it is easy to lose track.

Medicines and equipment left in the home¶

After a hospice death there are often medicines, oxygen cylinders, syringe drivers, and other equipment at home. This can feel upsetting, and you do not have to deal with it right away.

Medicines¶

Hospice and palliative care teams often have a clear process for medicines. In some places, the nurse can help you dispose of them according to local rules. In others, you should keep them secure until a pharmacist, nurse, or take-back scheme collects them.

Official guidance in many countries asks that you not flush medicines down the toilet or throw them in household waste unless the label says so. Use a pharmacy take-back scheme, community take-back day, or the hospice's own disposal arrangement. Do not give leftover medicines to anyone else. If there are strong painkillers or controlled drugs, keep them out of sight and locked away until they are collected.

Equipment¶

Hospital beds, oxygen concentrators, commodes, and other items are often loaned by the hospice, a health service, or a charity. The team will usually tell you who to call to collect them. You do not have to do it today. Many families like to wait a few days or weeks.

Syringe drivers and devices¶

A nurse will often remove these themselves. Do not try to disconnect them unless you have been shown how. If a device is alarming, you can silence it and call the number on the device or the hospice.

Choosing and calling a funeral director¶

You can call a funeral director once the death has been confirmed, either with the nurse's help or afterwards. There is no need to choose anyone in a hurry. You can take your time, and you can make the call the next morning if you prefer.

If you already have a plan with a funeral home, call them. If not, ask a friend, a faith community, the hospice team, or a local bereavement service for suggestions. You are allowed to ask for prices and to choose a funeral director who feels right for you.

What to say on the call¶

You can say, "Our loved one died at home today. The nurse has confirmed the death. We would like to talk about the next steps." They will ask for the name, address, and a few other details, and they will explain how they can help.

Funeral directors in most countries can collect the person at any hour. Some will come within an hour or two, and others will arrange a time that suits you. You do not have to say yes to the first time offered.

Consumer rights¶

In many countries, funeral homes must give you a clear written price list on request. In the United States, the Funeral Rule from the Federal Trade Commission requires this. In the United Kingdom, funeral directors must display prices and give written quotes under rules from the Competition and Markets Authority. Ask for an itemised list if you feel unsure.

If something goes wrong with a funeral home, the guide on funeral home mix-ups, delays, or overcharging explains your rights.

If you are not sure the person has died¶

In the minutes after a long illness, it can be hard to tell. The person may look peaceful, as if sleeping. Breathing at the end of life can be very slow, with long pauses, and families sometimes wonder whether a pause is the last one.

You do not have to decide this by yourself. Call the hospice line and say, "I think she has died, but I am not sure." The nurse can talk you through what to look for, or come to check. If the nurse cannot be reached, call your local emergency number and explain that you are not sure.

Do not worry about calling too early. Nobody will mind. Waiting quietly and calling for guidance is always acceptable.

Common things families notice¶

Some things surprise families, and they are usually normal. The body may relax and the face may soften. The skin may become cooler and pale.

A small sound or movement may happen shortly afterwards as the body settles. If any of this worries you, tell the nurse, who has seen it many times and can explain it kindly.

When there are other people in the home¶

If children, older relatives, or visitors are in the house, ask someone to look after them while you make the call. Tell them calmly and truthfully that the person has died and that a nurse is on the way. The guide to telling children and teens about a death offers simple words for each age.

A flow for an expected death at home¶

flowchart TD
    A["Your loved one has died at home and it was expected"] --> B["Sit with them for as long as you like"]
    B --> C{"Do you have a hospice or palliative care plan"}
    C -->|"Ano"| D["Call the hospice or care team line"]
    C -->|"No or unsure"| E["Call your local emergency number or the doctor"]
    D --> F["Nurse comes and confirms the death"]
    E --> G["Crew attends and may need to follow their protocol"]
    F --> H["Doctor or coroner informed as needed"]
    G --> H
    H --> I["Call a funeral director when you are ready"]
    I --> J["Rest, eat something, and ask for support"]

After the nurse has gone¶

When the nurse and funeral director have left, the house may feel very quiet. This is often the hardest moment. You may feel flat, lost, or suddenly very tired. It is normal for the body to feel heavy after a long period of caring.

Try to eat something and drink water. If you have been caring for someone for weeks or months, your body is likely depleted. You do not have to do anything else tonight.

Sleep and the first night¶

You may not sleep, or you may sleep for many hours. Both are normal. If you have trouble sleeping, you can try a warm drink, a quiet room, or the company of a friend. Please avoid using alcohol to numb the feelings, since it often makes the following days harder.

If you have a sleeping medicine that your doctor prescribed, follow the instructions on the label. Do not take anyone else's medicines. If you are worried about your own health, call your doctor or a nurse line.

Feeling relief¶

After a long illness, relief is a common emotion. Many people feel guilty about it. Relief does not mean you loved the person less. It means you are glad that suffering has ended and that the long wait is over.

You can feel relief and sorrow at the same time. This mix is normal and usually softens over time.

The days that follow¶

Once the first day has passed, a few steps will need doing. The guide to the first hours and days after a death at home has a full checklist. In short:

• A death certificate or medical certificate will be completed by a doctor.
• The death will need to be registered with the appropriate office, which varies by country and region.
• A funeral or other farewell can be arranged at your own pace.
• Family and friends can be told, with help.
• Money, bank accounts, and legal matters can wait for a few days.

Hospice and palliative care teams usually offer bereavement support to families for many months after a death. Ask the team about counselling, support groups, or phone calls. Many families find these helpful.

If you were the main caregiver¶

Being a caregiver can be all consuming, and when it ends, there can be a sudden empty space. You may feel lost or unsure of your role. You may also feel exhausted and physically unwell.

Please be patient. Rest, eat regularly, and let others help. Consider seeing your own doctor in the coming weeks, because long periods of caring can take a toll. The guide to hospice and end of life emergencies a hospice home care guide describe what happens in the final hours, in case you want to understand what you saw.

Differences by country¶

Rules differ, so please check locally. These notes are general guidance only.

In the United States¶

Hospice agencies are required to offer a 24 hour phone line. Calling them rather than 911 is usually right if the person was enrolled in hospice. The hospice nurse can pronounce death in most states, and a funeral home collects the person. The hospice or doctor completes the medical part of the death certificate, and the funeral director usually files it with the state.

In the United Kingdom¶

Call the out of hours district nurse, the palliative care helpline in your care plan, or the GP out of hours service. If you are unsure, call NHS 111. A doctor must complete the medical certificate, and the death is normally registered within five days in England and Wales. If the death was not expected after all, call 999.

V Kanadě¶

Call the palliative care team, home care nurse, or after hours line listed in your plan. If you have none, call the person's doctor or your local emergency number. Procedures for who can pronounce death differ by province. Funeral homes and provincial civil registration offices handle registration.

In Australia¶

Call the community palliative care service, the GP, or the after hours line in your care plan. If none is reachable, call 000. A doctor or authorised nurse confirms the death, and the funeral director helps with registration in your state or territory.

Looking after yourself¶

Please see the guide to looking after yourself in acute grief for physical symptoms, sleep, food, and when to seek help. For now, remember the basics:

• Drink water and eat something small.
• Rest when you can.
• Stay close to people who care about you.
• Do not make big decisions.
• Tell someone if you feel very low or unsafe.

If you ever feel that you cannot go on, or you think about harming yourself, call your local emergency number or a crisis line right away. The tísňová čísla page lists crisis lines for many countries, including 988 in the United States and Canada.

A note on first aid training¶

If you would like to feel more prepared for future emergencies, a hands-on first aid course from the Red Cross, St John Ambulance, or a local provider is a good idea. There is no hurry, and many caregivers find that learning later helps them feel steadier. For today, you are allowed to rest.

Často kladené otázky¶

Should I call the emergency number or the hospice when someone dies at home under hospice care?¶

If a hospice or palliative care plan exists, call the hospice or care team line first, because they know the person and the paperwork. Calling the emergency number can lead to a crew who must try resuscitation if they do not see valid paperwork. If you cannot reach the hospice, or there is no plan, call your local emergency number and say clearly that the death was expected.

Do I have to wait for the nurse before I do anything?¶

You can sit with your loved one for as long as you like before and after you call. Try not to remove medical devices or throw away medicines until the nurse has been, because they will tell you what to do. You may gently close their eyes, straighten their blanket, and stay close. If you are unsure, ask the nurse on the phone.

How soon do I need to call a funeral director?¶

There is no set deadline in the first hours, and many families wait until the morning. The nurse or doctor will usually confirm the death first. You can then call a funeral director when you feel ready, and they can collect your loved one at a time that works for you.

What should I do with leftover medicines?¶

Keep them secure and out of sight, and do not flush them or give them to anyone else. Ask the hospice nurse, a pharmacist, or your local health service about take-back schemes or disposal arrangements. Strong painkillers and controlled drugs should be locked away until they are collected.

Zdroje zkontrolovány¶

• NHS (United Kingdom): "What to do after someone dies", "Verification of expected death", and end of life care guidance.
• GOV.UK (United Kingdom): "Tell us once" and guidance on registering a death.
• Hospice UK: guidance for families after a death at home.
• National Hospice and Palliative Care Organization (United States): "What to do when death occurs" and guidance on hospice and 911.
• Federal Trade Commission (United States): The Funeral Rule.
• Government of Canada and provincial palliative care resources on advance care planning and DNR orders.
• Australian Government Department of Health: palliative care at home and advance care directives; Services Australia: what to do when someone dies.
• ReSPECT process and DNACPR guidance from the Resuscitation Council UK.
• Red Cross (American Red Cross, British Red Cross): support after a bereavement.

Procedures differ by country, region, and care provider. Follow the instructions of your hospice team and local officials.

Související průvodci¶

• Family member died overnight at home unexpectedly
• First hours and days after a death at home
• Hospice and end of life crisis
• Looking after yourself in acute grief
• Death of a spouse or partner who handled everything