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It could be days, it could be months, but she has very little muscles left from wasting. I feed her one little bite at a time, she has no pain, and through her dementia she loves me still. I need to know the right thing to do so when the time comes I can grieve and make the right decisions.

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Mimsy,

Have you looked into Hospice?
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I am so sorry and what pain for you to go through, but you are there for her even to the end and I am sure she knows that. Both my parents were aware too and I just lost dad a few weeks ago. Hospice is such a blessing and will help you as you get closer to the end of her life. Please reach out for help so you are not alone. I had home health and hospice for my dad, and mom also had hospice. I am a nurse so I knew I could care for them, but it was not easy. My prayers and heart are with you as you do this most loving act. God bless you sweet one as you continue in this journey.
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Find out the policy where you live for how the authorities handle it when someone dies at home. In our state, when someone dies without hospice involved there is an investigation. Three of my friends experienced that when their loved ones died. After the deceased had been taken out, they were questioned thoroughly along with walking through the inside and around the outside to look for signs of foul play. If you consider a hospice company, include these questions in your interview because I am sure each company has their own policy as to their involvement and how they handle it when the time comes.
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For us, it wasn't as clear cut as I've read here and elsewhere. Wanting to avoid a police investigation and the spectacle of flashing lights in front of the house, we opted to get on hospice. Handling the death easily was the sole reason we got on hospice.

In the end, it didn't work out that way. When the time came, I called hospice. Hospice told me to call 911. That led to the flashing light and sirens response. In fact, the first unit to show up was the police. Then the paramedics a couple of minutes later. Shortly after the paramedics arrived, hospice called us back and asked if the paramedics were here yet. I said they were, they asked me to ask the paramedics to declare a time of death. They did. Shortly thereafter they left. The police stayed around another 15 minutes to confirm identity and then they left. A few hours later a hospice nurse came over to call the funeral home and help me prep the body for transport. TBH, I could have called the funeral home myself and I declined the help in prepping the body. A few hours after that, the funeral home came and took the body.

In the end, I don't see how it helped to be on hospice for handling the death. I had to call 911 anyways. There was no police investigation and no coroner. For the $6,000 hospice billed medicare each month, the only real benefit we got was a box of diapers and wipes a week. I took care of everything else. We didn't even need any of the equipment since I bought all that, like the hospital bed, 3 years earlier out of pocket. I know other people have ongoing conditions that require the hospice medical team to be hands on, we did not. Next time, I'll forego hospice unless there is a medical condition that needs a high level of support. Since for the actual death, I don't see a benefit. Our GP could have issued the death certificate and he already did issue us the POLST form. Looking back, he tried to tell us all that when we asked for a hospice referral.
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Call your mom's doctor's office. Either her primary or whichever doctor she sees the most frequently/ is taking care of whichever illness she is most likely to die from ( for me, it was mom's cardiologist).

Ask them about this very scenario.

In NY -where I live- if a doctor will "sign off" on a death certificate, you can contact their office once she's passed, and just contact whichever funeral home you wish to use. You will likely need a DNR to show the EMT's if they are called to the scene. But your mom's doctor's will be able to give you instructions on what to do.

However, as already posted here, if you enroll mom in hospice, they will make it as easy as it can be for you; plus you will be able to avail yourself of their grief counseling services should you need them.

My deepest sympathies. A parent's death is never an easy thing to deal with, regardless of individual circumstances. (((Hugs)))
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I have had an ex die in his home and a friend. Yes, 911 was called but the bodies were not removed until a coroner came into examine them. My ex was actually taken back to the coroners office and examined. As his Ex (man who found him was a former friend) and no family, I got the call. Our coroner comes from another county, so it takes an hour to get here. We had a man get hit by a truck right outside where I worked. That man laid there, covered, until the coroner showed up.

As suggested, maybe you should call the non-emergency number in your County and find out their procedures. If you want no hassle, get Hospice in.
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Call EMS. They can pronounce her dead. They can transport her to a hospital to keep the body fresh while you make arrangements for her funeral. If you are Ok with a cremation, consider contacting several funeral services in your area about prepaid mortuary services - which cost much less.
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Mimsy1: A call to EMS should be made. Prayers sent.
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I am currently making arrangements for myself when I die. All of these are done for my adult children. In addition to providing the information about access to my assets - financial and property - completing preparations for my body is vital. While my hope is to donate my body to our local medical school, I’m aware that many potential donors are rejected. That leads to backup plans. Dealing with competing cremation providers was more time consuming that I expected, but I’d encourage you to be an informed consumer of these services. In our case I spent lots of time comparing these companies. I want very simple. No service (my family is planning a party based on my wishes and theirs). But even when clear that all we want is 1) pick up the body, 2) cremate the body, 3) return ashes to my adult children.
There were three cremation providers with whom a talked. One offered a very low price, but a background check raised too many questions. The second was the most expensive but insisted on including in their “standard basic package” many items that we didn’t want or need. This company insisted that I would need to purchase a “travel policy” for $569 in case I died more than 75 miles from my home. The second company also gave me incorrect information about the costs of the third company.
The 3rd company’s price was less expensive than the 2nd company and did not charge for cost of moving my body if I die away from home. (it helps to work with a company that has crematoriums all over the country. They also didn’t throw into the price things we don’t want or need. (Planning guide, special urns, etc.) The 3rd company would sell us all the extras, but respected our choice about we don’t want or need.
When this planning is done “pre-need” it is less expensive and gives the family needed time to assess the options. It is not free - depending on where you live and what you want you can figure it will cost more than $2200. The 1st company stated it would cost $1600, but I was unable to verify their legitimacy.
One more thing. Double check what the refund policy is. If, for example, should my body be accepted by our local medical school some companies will say, “oh sure. Your loved ones will get the money pre-paid for the cremation back. One of the companies with whom I was negotiating admitted that less than half of what was prepaid would be refunded.
Finally, I hope you enjoy these negotiations as much as I have. I enjoy being able to keep my children from the expense and hassle these arrangements involve.
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My father died at home, not unexpectedly, 3 days after he refused hospice care. So, I had to call the police, who called the coroner. The coroner couldn't come for several hours. so, he released the body to the ems who took him to the funeral home.
Luckily he had seen his doctor 3 days before death. and was recorded as needing hospice but refusing.
There was no suspicion of foul play but they were required to ask questions due to my Dad not being on hospice.
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Have her be evaluated by hospice and get her in their system. If she is not eligible now they can re-val when there is a significant change in condition or from time to time. Once they step in, they handle everything. I had cremation plans in place. When Grand pa died during the night, I discovered at 6am. The hospice RN came right away, took care of all the paperwork. The funeral home was picking up at 8am. I wrote them a check. Similar for Grand mom, except she passed during the day. Hospice called me several times for my support and came after she passed. This was my choice. Again hospice took care of the paperwork and the funeral home came promptly.
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Have you considered the support of in home Hospice?
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You should check with your Mother's doctor. Who to call and procedures vary state to state and county to county in so far as who needs notification and what the procedure is. Your Mom will have to be pronounced by a medical entity. If she is currently DNR there is no reason to call 911, ambulance services and etc. The latter, without a POLST posted, is required, without DNR papers, to attempt resuscitation in some areas.
You need to know the procedure for YOUR AREA.
Do you yet have hospice help? You should avail yourself of that because their grief counselors, social workers, etc. can guide you to a good undertaker in your area easily and let you know/help you in notifications. They have information that is a great help for someone who understands they are now dealing with end of life issues. Please call your Mom's medical services today. Hospice care is 100% covered by medicare.
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I would get Hospice in. Then its cut and dry. They will require a DNR (do not resuscitate) order. She will be kept comfortable and given morphine if in any pain. Which they can tell buy a B/P reading. You will provide them info on the Funeral Home u want. When Mom passes, you call the Nurse who should be available 24/7. She will pronounce time of death and do what needs to be done. She will then call the Funeral Director who will come for the person.

If you call 911, it will mean Police and a Coroner.
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I know someone who had an unexpected death in the home and on top of the shock and grief they had to deal with being investigated by the police, being enrolled in hospice eliminates all that.
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Mimsy, you need to follow the rules your state which is California.

If your mom is under hospice when she dies, your first call is to the hospice nurse. Hospice will help you take it from there.

If your mom is not under hospice when she dies, your first call is to 911 to get the police and coroner to come out. They need to make sure there is no foul play when someone dies at home. Your second call is to mom's doctor, then the next call is to the funeral home to pick up the body.

If mom passes away at night, you can wait until morning to start calling.

I'm sorry for your impending loss.
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Clairesmum Jan 2022
good advice....
I'd add that arranging for funeral services now - contacting the mortuary you wish to use, and prepaying for what you want to do - relieves you of making those decisions at the time. A hospice SW can help with this task.
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This happened to me when my mother died at home with me. The first call was to her doctor, who knew her health issues, to obtain a death certificate. The next (with sisters' agreement) was to the funeral agency, to remove her body. That was all required in the short term.
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Hospice is free (well, paid for by Medicare). Get her signed up for it. When you sign up, they'll ask what funeral home you want to use, and when she dies, you call the hospice people. They handle everything. There's no need to call 911.

If there's anyone who might like to say goodbye in private first, be sure to notify them as well. The hospice nurse happened to be in the building when my mom died, and she called me before she called the funeral home so I was able to get there first and sit with her for a bit. I gave the OK to call the funeral home when I was ready.

Be ready for them to take her once you call, because as soon as the paramedics or police arrive, it's all business with them. They'll be kind, but they won't wait around for you to be ready.
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Call 911. Tell them the person has died, and no heroic measures will be necessary. Have on hand Mom's hospice documents and DNR attesting this should they want to see.

A paramedic can pronounce death, but in our state a doctor has to sign the death certificate. They'll transfer her remains to where this is done at the hospital. From there, the funeral home she and you have chosen will take them and proceed with the arrangements you have put into place.
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Sharon44 Jan 2022
I called 911 and had the paperwork for 'do not resuscitate' and the paramedics insisted of resuscitating anyway. I hate to think if they had brought the poor guy back, he wanted to go. I did wait a while in case it was just one of his collapses but they still heard his heart. Wonder if you have to wait hours before calling which I would hate to do.
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Call EMS. they will transport to ER to have county coroner to declare dead and process a death certificate.
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JoAnn29 Jan 2022
EMS will not touch her. The Coroner, in my State anyway, will be called to the place of death. It has to be determined that there has been no foul play.
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Mimsy
It sounds like your aunt could be on hospice. If she isn’t, you might want to call a hospice and ask for an evaluation. You could also ask her doctor to send a hospice out. These days those in decline seem to qualify easier than in the past. It is a service paid by Medicare and provides a lot of support and comfort for the patient and the family. From what you posted it seems that you have things well in hand. Hospice does provide supplies in addition to help with baths and a nurses support.
If she does have hospice, then you would call the hospice and they would make the arrangements to have your moms body removed.
If it should happen before she is placed on hospice, you could call your local law enforcement and they will send the appropriate person to manage her transition.
States, counties, communities can have different protocols. I think I would call your funeral home or local law enforcement and ask for their guidance.

It sounds like you are doing a wonderful job caring for your mom.
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Why not have your mom's doctor write her an order for a hospice evaluation? That way, when she does pass, you can call hospice who will arrange to have her body taken away by the funeral home that you have pre-arranged? The hospice nurse also cleans, dresses & preps your mom's body for removal by the funeral home. During times of grief and loss, it can be difficult to make these types of calls and to even know WHAT to do! When hospice is involved, the nurses come by a few times a week to help mom bathe and to bring by the necessary supplies she may need, like a hospital bed, adult briefs/wipes/pads/swabs to keep her mouth moist, etc. Medicare pays for the service which also includes a chaplain and support for YOU. Plus, in case your mother starts feeling pain or discomfort during her transition, hospice can help her with comfort care medications as well. The nurse will examine mom & update you on how she feels your mom is doing/progressing along her transition journey, what to expect in her final days, etc. You really shouldn't be totally alone at such a stressful time.

If you don't want to involve hospice, then when your mom passes, call up the funeral home or cremation service that she's signed up for to come take her body. Hopefully those arrangements have already been made........if not, now is the time to make them, not after she passes when you'll already be stressed out and upset.

Wishing you the best of luck with a difficult situation
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