FREQUENTLY ASKED QUESTIONS ABOUT A DEATH AT HOME

Reaching the end of your caregiver journey is a very emotional time demanding much courage and compassion. You may want to "be there" for your loved one, providing support and making sure their wishes are carried out. Often we do foresee the death of our loved ones as we witness gradual declines in their health and functioning, but sometimes death comes suddenly.

How do we begin to prepare for this time?

The caregiver can begin preparing by gathering the facts:

• Learn about the diseases or conditions that affect your relative by talking
  with the health professionals providing care. Ask about symptoms,
  changes in health or behavior that may occur and the "normal" course of
  the disease and/or condition.
  
• Contact organizations and foundations that have information such as the Alzheimer's Association, Heart Association, Cancer Society and Parkinson's Association. Check the telephone book, library and Pima Council on Aging for listings.
• If your relative has a terminal illness, you may want to become familiar with the services and benefits offered by hospice care. Your relative should feel free to discuss hospice care with their physician at any time during a life limiting illness. The hospice approach to care focuses on comfort and dignity for the dying patient and their loved ones. All efforts are made to allow the person the comfort of dying at home.

Dying is a part of living, but sometimes endings come sooner than expected. Often we avoid the issues surrounding death - not because we do not care, but because we feel so helpless at the time of this final crisis.

My family member was sleeping so soundly that she didn’t hear me enter her room. For a moment I was frightened that she had died. She was fine, but what should we do if this really happens? It is frightening to face this situation without the resources you need. Knowing the information and your loved one's preferences will help you manage this difficult time. If your loved one is in the hospital, nursing home, hospice program or other healthcare facility when death occurs, the facility will take care of many details and help with arrangements, such as: declaring the person’s time of death, calling designated family members, the physician, and mortuary. If you want to spend time with your loved one, facility staff will often allow family members a few private moments with the deceased. In most cases, the facility's social worker or other trained health professional will be there to help and stay with the family until arrangements are made.

What if you don’t expect the death and it is not in the hospital or a medical setting? When someone dies at home, or other home care or non-medical setting, the details are more complicated. If your relative is enrolled in a Hospice program you will be instructed to call the Hospice emergency number instead of 911. Hospice staff are highly trained professionals and will know exactly what to do. Staff will come to the home, assist with details and offer support while you wait.

If your relative is not in a hospice program, and you or another person finds that your loved one has died, it will be necessary to call 911 immediately to report the situation. (If a paid caregiver from a health agency is present they may need to call their agency to report the situation as well). After you have called 911 or the hospice team, you should call a friend or support person to come and stay with you while you wait.

There will be a number of medical emergency responders that will arrive at the place of death to review the incident. When the 911 team responds, they will notify the appropriate law enforcement personnel (police or sheriff’s department). The primary physician of the deceased will be contacted to determine if the death is expected and to inquire whether the physician is willing to sign the death certificate. If the physician indicates that it is an expected event (such as a terminal illness) then arrangements will be made to take the deceased person to the designated mortuary or funeral home.

If the death does not seem reasonable, looks suspicious, or the physician doesn’t know their patient well enough to feel comfortable signing the death certificate or cannot be contacted, then the law enforcement team will call the office of the medical examiner. The medical examiner will transport the body to their office to determine the cause of death, which may include an autopsy. The body of the deceased person will not be released until a determination as to cause of death has been made, but this usually only creates a delay of a few days, often less, depending on the circumstances.

Is there always an autopsy? No, actually the office of the medical examiner often retains the body of a deceased person until a mortuary is designated, and only conducts an investigation or autopsy if there is enough information to indicate a crime may have been committed. They are well trained in cultural and religious differences and make every effort to honor beliefs that object to an autopsy. However when necessary, it is part of the procedure.

How long will the whole process take? The process can be very time consuming, and may span several hours. Losing a loved one is very difficult even when anticipated, and perhaps more so if the death is sudden. It is important that you try to stay calm, and that you not disturb the situation until the 911 team and law enforcement arrives. Again, it is important that your second call after calling 911 should be to a relative or close friend who is willing to be there and comfort you while waiting for the proceedings to be completed. Be aware that it may take several hours, and that even if you think you are prepared, you will probably be in distress.

What about the numbers of people, who will be coming into the home, such as, paramedics, police, and doctors? Generally, the 911-paramedic team may have two to three members. The law enforcement team may have one or two officers responding, unless you suspect something criminal has occurred, then one or more detectives may also be present. If there seems to be more about the scene that requires investigation or documentation, a number of law enforcement personnel from the Department of Forensics may arrive to take photographs, fingerprints and conduct other investigative procedures. Also present would be the physician or medical examiner, and/or mortuary personnel to transport the body.

End of Life Decisions: Death at Home

End of Life Decisions: Death at Home