The First Hours After a Death at Home: A Gentle Guide for Hospice Families

The breathing you've been listening to for days has gone quiet. Maybe it's the middle of the night and the house is asleep. Maybe everyone is gathered around the bed. Either way, the room feels very still, and one question rises up fast: What do I do now?

My own loss didn't happen at home in hospice. But I know that stillness, and I know how loud the questions get when the person you love is suddenly gone. Families deserve to know what's coming before they're in the middle of it. That's why I make these guides.

So here is what the first hours really hold, in the order you'll meet them: the one call that matters, what you may see, the time you're allowed to take, and what can wait until morning. Start with this: if your loved one was in hospice care, this is not an emergency, and you do not have to rush.

Call the Hospice First, Not 911

Call your hospice's 24-hour number. The Hospice Foundation of America tells families not to call 911 when a hospice patient dies at home. Someone from your hospice will come to confirm the death and help with what comes next. If you want a few minutes with your loved one before you pick up the phone, that's okay.

Keep the DNR or POLST form close. If 911 does get called in a scary moment, hand the paramedics your loved one's signed out-of-hospital DNR or POLST form so they know what your loved one wanted, as MJHS Hospice advises. Keep the hospice number and those papers where everyone in the house can find them. Our free Call Hospice First fridge sheet (also in Spanish: Llame primero al hospicio) has room for all of it.

If they died while you were asleep or out of the room, it's still a hospice call when they were in hospice care. And please don't carry it as a failure. The Canadian Virtual Hospice notes that it's common for someone to die in the few minutes when family has stepped away.

When 911 is the right call: if your loved one was not in hospice care, or the death was sudden or unexpected. Our guide When Someone Dies Unexpectedly walks through what happens then.

How You'll Know

Death at home is usually quiet. Breathing and heartbeat stop, and your loved one no longer responds to your voice or touch. The eyes or mouth may stay partly open, and the bladder or bowels may let go as the muscles relax. Over the next hours, the body cools, the skin color changes, and the muscles slowly stiffen. These changes can be startling, but nothing has gone wrong.

Not sure? Call the hospice and tell them what you see. That's exactly what the 24-hour line is for.

You Don't Have to Do Anything Right Away

There is no rush to let the nurse or the funeral home take over. The Canadian Virtual Hospice says spending an hour, or even a few hours, with your loved one is realistic, and the Hospice Foundation of America says the funeral home will come when your family is ready. (State laws differ on how soon a body must be picked up, so your hospice will tell you if there's a limit where you live.)

If you'd like to, here are a few gentle things you can do yourself, or leave for the nurse:

• Lay them on their back. This is easier to do within the first hour or so, before the body begins to stiffen.
• Close their eyes gently with your hand. If the mouth stays open, a rolled towel tucked under the chin can help.
• Wash and change them, if that feels right. You can wash their face and hands, brush their hair, or dress them in something they loved.
• Keep keepsakes safe. If you want a photo, letter or rosary to go with them, the Canadian Virtual Hospice suggests bringing it to the funeral home later, so nothing gets lost when they're moved.

What the Hospice Nurse Does

When the nurse arrives, they'll confirm the death and start the paperwork the state needs for the death certificate. Who is allowed to pronounce a death depends on your state. In Virginia, for example, state law lets hospice nurses do it when the death was expected. In South Carolina, the Board of Nursing says nurses can assess that a death has happened, but a doctor, medical examiner or coroner certifies it. Either way, your hospice knows its rules and handles it.

The nurse may also:

• Remove tubes and lines, and get your loved one ready to be moved.
• Call the funeral home for you, or help you find one if you haven't chosen yet, and stay with you until they arrive when possible.
• Help with phone calls to family and friends.
• Set up pickup of the hospital bed, oxygen and other equipment. It doesn't have to go tonight.

A hospice social worker or chaplain may be able to come and sit with you too. Just ask.

Ask about the medicines. When strong pain medicines were first ordered, your hospice had to give you its written plan for getting rid of them and talk it through with you in a language you understand. A 2018 federal law lets hospice staff help destroy leftover controlled medicines in the home after a death, but the Government Accountability Office found that state and federal rules don't always match. So simply ask, "What should we do with the medicines?"

Unopened supplies. Hospices usually can't take back things like incontinence pads, but the Hospice Foundation of America says charities such as Goodwill or the Salvation Army may accept unopened packages.

Saying Goodbye in Your Own Way

Some people want to hold a hand, talk, or lie close. Others need to step out of the room. Some cry loudly, and some go very quiet. The Canadian Virtual Hospice says there's no right or wrong way, and everyone deserves the time and space they need.

• Say what's in your heart, out loud or in a whisper.
• Invite family and close friends to come before the funeral home arrives.
• If family is far away, a phone or video call can let them say goodbye too.
• If your loved one will be cremated, make sure anyone who wants to see them has the chance before they're moved.

If your faith has its own customs, tell the hospice and the funeral home as early as you can. Hospices must offer spiritual support and make reasonable efforts to bring in your own clergy. A University of Arizona guide for care teams gives a few examples. In many Jewish families, someone stays with the body until burial, which often happens within 24 hours. Muslim families often wash the body themselves and hope to bury within a day. Some Buddhist families ask that the body not be touched for several hours. Many Hindu families prefer to wash and dress the body themselves. The same guide says staff shouldn't wash a body without the family's consent. And if your family has no faith tradition, you don't need any ritual at all. Sitting quietly together is enough.

Children can say goodbye too, if they want to. The children's grief charity Winston's Wish says seeing the body can help a child understand that death is final, as long as they're prepared first. Tell them plainly that the person has died, and what they'll see: pale skin, cool to the touch, eyes closed but not sleeping. Let them choose whether to stand by the door or come close, and let them know they can change their mind at any moment. A child who would rather not go in can leave a drawing or a note. Our post Helping Children Understand Hospice and Death has more.

When the Funeral Home Comes

You decide when to call. If you haven't chosen a funeral home yet, your hospice can help you find one. The FTC Funeral Rule protects you in every state:

• Funeral homes must give you prices over the phone, and you don't have to give your name first.
• They must give you an itemized price list to keep.
• You can buy only what you want. You don't have to take a package.
• No state requires embalming for every death. You can ask about a private family viewing without it.
• For cremation, you can use a simple container instead of a casket.

These rights matter most when money is tight. A friend can call two or three places and compare for you.

If you'd like to keep them home longer, for a vigil or a home funeral, that's possible in many places. The Funeral Consumers Alliance says nine states require a funeral director for parts of the process, and some states have cooling or refrigeration rules. The National Home Funeral Alliance keeps a state-by-state guide.

If they wanted to be a donor, tell the nurse right away. The Hospice Foundation of America explains that organ donation isn't possible for hospice patients, but donating tissue such as corneas, skin or bone may be. The hospice calls your local donation organization once the death has happened, so the sooner they know, the better.

If they arranged to donate their body to science, call the program's number as soon as the death is confirmed, and follow its steps. They differ: UC Davis has families call its 24-hour line once hospice has pronounced the death, while Duke asks families to call a funeral home for transport first. Programs confirm each donation only at the time of death, so it helps to have a backup plan.

If they were a veteran, find the DD-214 or other discharge papers. Heart to Heart Hospice notes they're needed for military burial benefits. Our guide for veteran families has the rest.

What Can Wait (and the Little That Can't)

Tonight, only a few things truly need doing:

• Call the hospice.
• Choose a time for the funeral home to come.
• Tell a few close people. A friend can make the other calls.
• Make sure anyone who depended on your loved one, like a spouse, children or pets, is cared for.
• Lock up the house.

Everything else can wait a few days: death certificates (they can take several days or longer), telling Social Security (the funeral home often does this), banks and bills, the obituary, and sorting belongings. There is no deadline on their closet.

Every Family Is Different

• If you're alone, tell the hospice when you call. Ask whether a social worker or chaplain can come sit with you.
• If you aren't the legal next of kin, such as an unmarried partner, chosen family, or the friend who did the caring, tell the hospice who should be called and who will make decisions, so no one is left out. Our post on planning a funeral in hospice explains naming someone ahead of time.
• If you're Deaf, hard of hearing or have a speech disability, you can reach the hospice line through a free relay service by dialing 711.
• If English isn't your first language, ask for an interpreter when you call.
• If family is far away, it's okay to wait a little while for someone to arrive, if your hospice and funeral home agree.

What You Might Feel

Even when you knew it was coming, the death can feel unreal. You may feel numb, shaky, calm or exhausted, sometimes all within an hour. Not crying doesn't mean you didn't love them.

You may also feel relief, and then guilt about the relief. The Canadian Virtual Hospice says this is common. 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 people help. Big decisions can wait.

Your hospice doesn't disappear tomorrow. Medicare rules require hospices to offer grief support to the family for up to a year after the death, and many, like MJHS, offer up to 13 months. You can call them. You don't have to wait for them to call you. When you're ready, When the Caring Ends is written for caregivers in the months after.

For Hospice Teams

Hospices are welcome to print The First Hours for every family and leave it at the bedside. Nurses and aides may also like our one-page After a Death at Home visit checklist. More free staff tools are on our For Hospice & Care Teams page.

More Help

• What to Expect in the Final Days
• Sitting Vigil: A Gentle Guide for Hospice Volunteers and Families
• Helping Children Understand Hospice and Death
• When the Caring Ends: A Grief Companion for Former Caregivers
• When a Veteran Is in Hospice
• All our free printables

Please note: This is general information, not medical or legal advice. Hospice practices and state laws differ, so your own hospice team and funeral home are your best guides. If you are in crisis, call or text 988. In an emergency, call 911. Veterans: dial 988, then press 1.

Download The First Hours free (PDF) · See all our free printables

With care,
C. Lindorfer, Noted & Charmed