Expected death at home: who to call first and what happens next¶

If someone you love has been living with a serious illness and has now died at home, you may feel many things at once: sadness, relief, emptiness, exhaustion, even numbness. All of these are normal, and none of them mean you are doing it wrong. You have been through a long and tiring time, and you are allowed to be tired.

This guide is for deaths that were expected, usually when a person was receiving hospice, palliative care, or end of life care at home. The most important thing to know is that you do not need to rush. Nothing has to happen in the next few minutes except one calm phone call, and that call is usually to the nurse or care team who already know your family. You can sit down, take a breath, and spend as long as you like with the person before you pick up the phone.

Lakukan ini sekarang¶

1. Stay where you are for a moment. Sit with the person. Hold their hand if you wish. There is no emergency in the sense of a race against time.
2. Find the care plan or the hospice number. It is often on the refrigerator, in a folder near the bed, or saved in your phone under "hospice" or "palliative care". If you cannot find it, ask someone else in the home to look.
3. Call the hospice, palliative care, or end of life nurse line first, if you have a plan that tells you to. Say, "My loved one has died. Can you send a nurse." Most services answer 24 hours a day.
4. If you have no plan, no number, or nobody answers, call your local emergency number (911 in the United States and Canada, 112 across the European Union, 999 in the United Kingdom) or the person's doctor. See the nomor darurat page for other countries. Say clearly that this was an expected death.
5. Keep the do-not-resuscitate paperwork where it can be seen if there is any, and show it to anyone who arrives. Do not start CPR if there is a valid order and the care team has told you the person is not to be resuscitated.
6. Ask one person to come and sit with you. A friend, relative, or neighbour can make tea, take calls, and be there for you.

Everything else, including the funeral director, family calls, and paperwork, can follow at a gentle pace.

Anda tidak melakukan kesalahan apa pun¶

When a death has been expected, people often feel they should be calm and organised. Some feel shocked anyway, because being ready in your head is different from being ready in your heart. Some feel nothing at all.

Some feel relief that suffering has ended, then feel guilty about the relief. Please know that all of these are common.

Anda juga mungkin bertanya-tanya apakah Anda melewatkan momen yang tepat, atau apakah Anda seharusnya melakukan sesuatu yang berbeda. Jika Anda sedang tidur, di ruangan lain, atau sedang minum teh saat hal itu terjadi, hal ini sangat umum terjadi. Banyak orang meninggal ketika tidak ada orang di dalam ruangan, dan beberapa tampaknya menunggu sampai keluarga mereka pergi. Ini bukan kegagalan cinta atau perhatian.

Tidak ada yang perlu dilakukan dengan cepat kecuali menghubungi layanan yang tepat. Anda dapat mengambil waktu selama Anda ingin duduk bersama orang tersebut, dan Anda dapat memberi tahu perawat kapan Anda siap untuk kedatangannya.

Siapa yang harus dihubungi terlebih dahulu: versi singkat¶

Panggilan pertama yang tepat bergantung pada apakah ada rencana. Tabel ini dapat membantu Anda memutuskan.

Jika Anda tidak yakin baris mana yang cocok, hubungi nomor darurat. Selalu lebih baik menelepon daripada menunggu dan khawatir.

Mengapa jalur rumah sakit didahulukan ketika ada rencana¶

Tim rumah sakit dan perawatan paliatif membuat rencana ke depan bersama keluarga. Mereka mengetahui keinginan, obat-obatan, dan dokumen orang tersebut. Mereka dapat mengirimkan perawat yang terlatih untuk memastikan kematian, mendukung Anda, dan mengatur langkah selanjutnya.

Jika Anda menghubungi nomor darurat, mungkin ada kru yang tidak mengenal orang tersebut dan harus memulai resusitasi kecuali mereka melihat dokumen yang sah. Hal ini dapat membuat kesal semua orang. Itu sebabnya tim rumah sakit meminta keluarga untuk menelepon mereka terlebih dahulu.

Kenapa nomor darurat terkadang masih tepat¶

Ada kalanya nomor darurat adalah panggilan yang tepat, bahkan dalam keadaan kematian yang direncanakan. Jika tidak ada rencana atau rencana tidak jelas, jika Anda tidak dapat menghubungi tim rumah sakit, atau jika terjadi sesuatu yang tidak terduga, segera hubungi. Penerima panggilan akan mengajukan pertanyaan dan mengirimkan bantuan yang tepat.

Jika orang tersebut baru saja sakit dan tidak ada seorang pun yang membicarakan tentang perawatan di akhir hayatnya, perlakukan hal tersebut sebagai kematian mendadak. Panduan tentang seorang anggota keluarga yang meninggal semalam di rumah secara tidak terduga menjelaskan apa yang terjadi dalam kasus itu.

Dokumen yang penting: jangan menyadarkan dan perintah serupa¶

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.

You can say yes or no to any of this. If you want to wash and dress your loved one yourself, many services will support that. If you prefer to leave it all to professionals, that is fine too.

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.

Apa yang harus dikatakan saat menelepon¶

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¶

Jika ada anak-anak, saudara lanjut usia, atau pengunjung di dalam rumah, mintalah seseorang untuk menjaga mereka saat Anda menelepon. Beritahukan kepada mereka dengan tenang dan jujur ​​bahwa orang tersebut telah meninggal dan ada perawat yang sedang dalam perjalanan. Panduan untuk memberi tahu anak-anak dan remaja tentang kematian 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 -->|"Ya"| 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 dan itu hospice home care guide describe what happens in the final hours, in case you want to understand what you saw.

Perbedaan menurut negara¶

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

Di Amerika Serikat¶

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.

Di Inggris¶

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.

Di Kanada¶

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 menjaga dirimu dalam kesedihan yang akut 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 nomor darurat 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.

Pertanyaan yang sering diajukan¶

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

Jika ada rencana perawatan hospice atau paliatif, hubungi saluran hospice atau tim perawatan terlebih dahulu, karena mereka mengenal orang tersebut dan dokumennya. Memanggil nomor darurat dapat menyebabkan kru harus mencoba melakukan resusitasi jika mereka tidak melihat dokumen yang valid. Jika Anda tidak dapat mencapai rumah sakit, atau tidak ada rencana, hubungi nomor darurat setempat dan katakan dengan jelas bahwa kematian telah diperkirakan terjadi.

Apakah saya harus menunggu perawat sebelum melakukan sesuatu?¶

Anda dapat duduk bersama orang yang Anda kasihi selama yang Anda suka sebelum dan sesudah menelepon. Usahakan untuk tidak melepas peralatan medis atau membuang obat-obatan sampai perawat selesai melakukannya, karena mereka akan memberi tahu Anda apa yang harus dilakukan. Anda dapat menutup matanya dengan lembut, meluruskan selimutnya, dan tetap berada di dekatnya. Jika Anda tidak yakin, tanyakan kepada perawat melalui telepon.

Seberapa cepat saya perlu menghubungi direktur pemakaman?¶

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.

Apa yang harus saya lakukan dengan sisa obat?¶

Jaga agar tetap aman dan tidak terlihat, dan jangan menyiramnya atau memberikannya kepada orang lain. Tanyakan kepada perawat rumah sakit, apoteker, atau layanan kesehatan setempat tentang skema pengambilan kembali atau pengaturan pembuangan. Obat pereda nyeri yang kuat dan obat-obatan yang dikontrol harus disimpan di tempat yang aman sampai dikumpulkan.

Sumber diperiksa¶

• NHS (Inggris): "Apa yang harus dilakukan setelah seseorang meninggal", "Verifikasi perkiraan kematian", dan panduan perawatan di akhir hayat.
• GOV.UK (United Kingdom): "Tell us once" and guidance on registering a death.
• Hospice UK: panduan untuk keluarga setelah kematian di rumah.
• 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.
• Pemerintah Kanada dan sumber daya perawatan paliatif provinsi mengenai perencanaan perawatan awal dan perintah DNR.
• 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.
• Palang Merah (Palang Merah Amerika, Palang Merah Inggris): dukungan setelah kehilangan.

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

Panduan terkait¶

• 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