When someone you love dies at home, the room can suddenly feel very still, and your mind may go blank. Even families who knew the end was near often find themselves asking, "What do I do now?"
This guide walks through the first hours, gently and step by step. It is based on guidance from hospice organizations and on research with bereaved families, explained in everyday words. The most important thing to know comes first: if your loved one was in hospice care, this is not an emergency, and you do not have to rush.
Free printable: The First Hours, A Gentle Guide for Families
A 23-page guide to fill in ahead of time and keep by the phone: important numbers, how you'll know, what the nurse does, saying goodbye, your rights with the funeral home, a first-24-hours checklist, a call list for helpers, and lined notes pages.
Call the hospice first, not 911
When a person dies at home in hospice care, the first call goes to your hospice's 24-hour number. The Hospice Foundation of America advises families not to call 911, because a hospice team member will come to confirm the death and help with the next steps.
Why it matters: if 911 is called, paramedics are trained to try to restart the heart. Unless a signed out-of-hospital DNR or POLST form is shown to them, they may begin CPR, which is not what your loved one chose. Keep the hospice number and those forms somewhere everyone in the house can find them, and make sure anyone sitting with your loved one knows who to call.
One exception: if a death is sudden or unexpected, or the person was not in hospice care, call 911.
How you will know
Death at home is usually quiet. Breathing stops, and there is no pulse or response to your voice or touch. The eyes may stay partly open, the jaw may relax so the mouth falls open, and the bladder or bowels may release. Over the next hours, the skin grows pale, the body cools, and the muscles slowly stiffen. Sometimes there are one or two long, spaced-out breaths after what seemed like the last one. If you aren't sure, simply call the hospice and describe what you see.
You do not have to do anything right away
Hospice and palliative care guides from around the world say the same thing: there is no rush. You can sit with them, hold their hand, pray, cry, or call someone to come be with you before you call anyone else. If they died in the night, ask your hospice what they'd like you to do. Many families feel better knowing they may wait until the house wakes up.
If you'd like to, there are a few gentle things you can do, or leave for the nurse:
- Turn off the oxygen and any electric blanket or heating pad.
- Within the first hour or so, lay them flat with one pillow under the head, while the body is still easy to move.
- Gently close the eyes. A rolled towel under the chin can help the mouth stay closed.
- Put dentures back in, and cover them with a light sheet or favorite blanket.
What the hospice nurse does
When the nurse arrives, they will confirm the death and record the time. In many states a hospice nurse can do this; in others a doctor signs later, and the hospice handles it either way. The nurse will usually remove tubes and patches, offer to wash and dress your loved one (you're welcome to help or to step out), and call the funeral home when you are ready. Medical equipment is usually picked up in a day or two, not that night.
Ask about the medicines. Leftover pain medicines shouldn't stay in the house. Rules differ by state. A federal review of hospice practices found that who is allowed to destroy medicines at home varies between state and federal rules, so your nurse may do it or may give you a disposal kit. Just ask, "What should we do with the medicines?"
Taking time to say goodbye
Many families worry about whether it's "okay" to stay with the body, or whether it will be too upsetting. Research offers some comfort here. In a study of 80 bereaved relatives published in the BMJ, seeing their loved one's body brought home the reality of the death, and although it could be distressing, few who did so regretted it. A later study of 64 families in Death Studies found that what helped most was having a real choice and being prepared for what they would see. Some who didn't see their loved one later regretted it.
Those studies were about sudden deaths, but the lesson carries over gently to home hospice: the choice is yours, and it helps to know what to expect. Some ways families say goodbye:
- Washing their face and hands, brushing their hair, or dressing them in a favorite outfit.
- Placing a photo, letter, rosary, flower, or family quilt with them.
- Playing their favorite music, reading a psalm or poem, or lighting a candle.
- Opening a window, a quiet tradition in many cultures.
- Inviting family and friends to come before the funeral home arrives.
- Asking a chaplain or faith leader to pray or perform your faith's rites.
Children can say goodbye too, if they want to. Tell them simply and honestly what they will see first, let them choose, and never force it. Our free children's memory pages and hospice guide for kids are on the Free Printables page.
When the funeral home comes
You decide when to call them. An hour, a few hours, or longer is fine. Most funeral homes come in a plain van, move quietly, and will let you stay in the room or step out. Some families walk out with their loved one to the door.
It also helps to know your rights. Under the FTC Funeral Rule, funeral homes must give you prices over the phone and an itemized price list, you may choose only the items you want, and you can use any funeral home you like. Embalming is not required by law in most situations.
What can wait
In the first 24 hours, the only things that truly need doing are calling the hospice, choosing a time for the funeral home, telling a few close people, and making sure anyone who depended on your loved one (a spouse, children, pets) is cared for. Death certificates, Social Security, banks, the obituary, and sorting belongings can all wait a few days. Let a friend make the other phone calls for you.
What you might feel
You may feel numb, shaky, calm, or exhausted, sometimes all within an hour. You may also feel relief. In a study of 217 family caregivers in the New England Journal of Medicine, 72% said the death was a relief to them, and more than 90% believed it was a relief to their loved one. Relief is not a lack of love. Often it means you loved them through something very hard.
For the rest of tonight, drink some water, eat something small, and let others help. You don't have to make big decisions yet. If you'd like to understand what often comes next in grief, our guide to anticipatory grief and what to expect in the final days may help, and your hospice's bereavement team will stay in touch for at least 13 months.
When to reach out for help right away
If you feel you can't cope, or you have thoughts of hurting yourself, call or text 988 (Suicide & Crisis Lifeline) at any hour. In an emergency, call 911. Your hospice bereavement team is also there for you. You can call them any time, not just when they call you.
Sources
- Hospice Foundation of America. When death happens at home (2024).
- Canadian Virtual Hospice. The Moments After a Death.
- Clinical Excellence Commission, NSW Health. Last Days of Life: When Someone Dies at Home.
- Chapple A, Ziebland S. Viewing the body after bereavement due to a traumatic death. BMJ, 2010.
- Mowll J, Lobb E, Wearing M. The transformative meanings of viewing or not viewing the body after sudden death. Death Studies, 2016.
- Schulz R, et al. End-of-life care and the effects of bereavement on family caregivers of persons with dementia. NEJM, 2003.
- U.S. GAO review of hospice medication disposal (2020), summary.
- Federal Trade Commission. The FTC Funeral Rule.
Keep this guide by the phone: download The First Hours (free PDF).