What to Do Immediately After a Hospice Death: A Checklist

When someone dies at home on hospice, call the hospice's 24/7 number, not 911. A death on hospice is expected, so there is no medical emergency and no need for paramedics. A hospice nurse can come, confirm the death, and guide you through the next steps. Nothing has to happen in the first minutes, and your loved one does not have to be moved right away. Here is the checklist for the first hours, in order.

The first-hours checklist

1. Take a moment. There is no emergency. You do not have to do anything in the first minutes except be present. The National Cancer Institute's signs that a person has died include no breathing and no pulse, eyes that do not move or blink, and no response to touch or voice. Breathing can also pause and then restart near the end, so if you are not sure, call anyway. A hospice nurse can verify the death.
2. Call the hospice's 24/7 number. This is the single most important step, at any hour. Say that your loved one has died, or that you think so, and ask when a nurse will get there. Keep this number visible near the phone.
3. Do NOT call 911. 911 starts an emergency response built to attempt resuscitation and transport, which an expected hospice death does not need. 911 is still right if someone else is hurt or in danger. Our guide explains why, and what to do if your loved one wanted CPR: do you call 911 when someone dies at home on hospice?
4. Mention any donation plans on your call to the hospice, and call the donation program too, if there is one. The time window is short. The National Institute on Aging says a registered brain donor's point of contact should reach the donation coordinator within two hours of death, and organdonor.gov says tissue must be recovered within 24 hours. See donating organs or your body after a hospice death.
5. Wait for the hospice nurse. The nurse confirms the death, notes the time, and contacts the doctor who will certify the cause, so the death certificate can be completed. State law decides who can make the legal pronouncement; see who pronounces death at home on hospice. You don't arrange any of this yourself.
6. Spend time with your loved one if you wish. Many families sit, pray, invite close relatives, or carry out religious or cultural customs. The National Institute on Aging says there is no need to move the body right away, but suggests making sure it is lying flat, because stiffening begins during the first few hours. The National Cancer Institute suggests placing the person on their back with one pillow under the head, with dentures in place if needed.
7. Call the funeral home or crematory when you're ready. If you already chose one, tell the hospice nurse and ask whether the nurse will make the call or you should. If your faith calls for prompt burial, say so. If you haven't chosen, see our guide on whether hospice helps with funeral or cremation arrangements. The social worker can point you to options, though the contract and costs are between you and the funeral provider. Funeral homes must give you prices over the phone if you ask, so you can compare before you commit.
8. Let the hospice guide medications and equipment. Don't flush or discard medications on your own unless instructed. Where state law allows, a trained hospice nurse can destroy leftover controlled drugs, such as morphine, right there in the home and record it. Otherwise the nurse directs you, under the written disposal policy the hospice must give you when controlled drugs are first ordered (42 CFR 418.106(e)). See what happens to medications after a hospice death. Ask when the bed, oxygen, and supplies will be picked up.
9. Notify immediate family and a few key people. Reach out only to those who need to know right away. Broader notifications can wait.
10. Gather a few details when you're ready. The funeral director will ask for the personal facts on the death certificate, such as full legal name, date and place of birth, parents' names, and Social Security number. For a Veteran, look for the DD214 discharge papers too. Any will, insurance policies, and account information can wait; none of this is required in the first hours.
11. Accept the bereavement support. Medicare requires hospices to make bereavement services available to the family for up to 1 year after the death (42 CFR 418.64(d)); some hospices run longer programs of their own, such as 13 months. Ask the social worker how to reach it; you don't have to navigate grief alone.

Who does what in the first hours

Most of the official steps are not yours to carry out. They belong to the hospice and the funeral provider.

Task	Who handles it
Confirming the death and noting the time	The hospice nurse; state law decides who can make the legal pronouncement
Signing the medical part of the death certificate	A doctor who cared for the patient, usually the attending or hospice physician, or, where state law allows, a nurse practitioner or physician assistant; see who signs the death certificate
Filing the death certificate and getting permits	The funeral director
Moving the body	The funeral home or crematory you choose
Leftover medications	The hospice nurse on-site, where state law allows; otherwise you, at the nurse's direction
Picking up equipment	The hospice and its equipment supplier; ask the nurse when
Ordering certified death-certificate copies	Usually the funeral home, on your behalf
Reporting the death to Social Security	Usually the funeral home, if you give it the Social Security number
Notifying family and arranging the service	You, on your own timeline

A note on deaths in a facility

If your loved one dies in a nursing home, assisted-living community, or inpatient hospice unit, tell the nurse or staff on duty. The steps are similar, but staff often start them, and an expected death is handled by the care team rather than 911. In a nursing home, Medicare requires the facility's written agreement with the hospice to say the facility will notify the hospice immediately when a patient dies (42 CFR 418.112). That rule does not cover assisted living, so if you are there, make sure someone has called the hospice. Being on hospice is not a DNR, so check ahead of time that any DNR or POLST form is in the facility's chart. If you have customs or rituals that must happen soon after death, the National Institute on Aging suggests raising them with staff early. You can still ask for time to be present, and you get the same bereavement support afterward.

Frequently asked questions

How soon will the nurse come?

Federal rules require hospices to keep nursing available 24 hours a day, 7 days a week (42 CFR 418.100(c)), but they do not set an arrival time. It depends on the hour and how far the nurse has to travel. Ask on the phone when to expect the nurse, and ask your hospice this before the death if you can. Nothing has to be done while you wait.

How long can my loved one stay at home before the funeral home comes?

There is no need to move the body right away. The National Institute on Aging says the pickup can be arranged when the family is ready, according to local laws, and those laws vary. The Federal Trade Commission says some states require embalming or refrigeration if the body is not buried or cremated within a certain time; Minnesota, for example, sets that point at 72 hours after death. If you want to keep your loved one at home for more than a few hours, tell the nurse and funeral director early so they can say what is practical and allowed where you live.

What if it happens overnight? Can we wait until morning to call?

Call when you are ready, at any hour. The hospice's on-call nurse responds at night; that is exactly what the 24/7 line is for. A short wait is fine: the National Cancer Institute says there is no need to hurry, and families may wish to sit with the person first. But the National Institute on Aging says the death should be officially pronounced as soon as possible, so don't hold the call until business hours to avoid bothering anyone.

What if I already called 911 by reflex?

It happens, and it is understandable. Tell the dispatcher and the responders right away that your loved one was on hospice, show them any out-of-hospital DNR or POLST form, and call your hospice's 24/7 line. Hospice enrollment alone may not stop a resuscitation attempt. Responders look for a signed form, and each state sets which forms they can honor.

Will the police or a coroner come?

Usually not for an expected death under hospice care, but local rules differ. CDC guidance says the deaths that typically need investigation involve an accident, violence, or suspicious circumstances, a sudden death without warning, or no treating physician. Some places still require a report: the Denver Office of the Medical Examiner requires hospice facilities and nursing homes to report deaths in their care, and Collin County, Texas, says hospice deaths in a residence or facility must be reported. A report helps the office decide whether anything further is needed. Your hospice should know the local rule. If your loved one had a recent fall or injury, or if anything about the death worries you, tell the nurse right away.

Can we wash or dress our loved one?

Yes, if that matters to you or your faith, but you don't have to. Ask the nurse first whether anything should wait, such as a planned donation or a required report. The nurse can also tell you what help the hospice offers; practices vary.

When does bereavement support begin?

The groundwork starts before the death. Medicare requires the hospice to assess the family's bereavement needs as part of the patient's care, and services can be offered before the death if needed. After the death, services are available for up to 1 year. The social worker or bereavement coordinator may reach out, and you can also ask the nurse how to connect. Medicare's hospice booklet lists grief and loss counseling for you and your family among the covered services.

What comes after the first hours

Once the nurse has come and the immediate steps are done, the practical focus shifts. None of this has to happen today.

• Burial or cremation. Read does hospice help with funeral or cremation arrangements for what your hospice can and cannot do, and where the funeral provider's role begins.
• Social Security. In most cases the funeral home reports the death if you give it the Social Security number. Any payment for the month of death must be returned. See does the funeral home notify Social Security.
• Certified copies of the death certificate. USA.gov says most agencies and programs require them. See who signs the death certificate on hospice.
• Other notifications. Over the next few weeks, the National Institute on Aging suggests notifying life insurance companies, banks and other financial institutions, and the three credit bureaus (Equifax, Experian, and TransUnion) to help prevent identity theft.

If you are arranging care for someone else and want to understand the team that supports families through this, you can also compare hospices near you.

Bottom line: call the hospice, not 911; let the nurse confirm the death and guide the paperwork; take your time; and lean on the bereavement support that comes with the benefit. You are not expected to manage this moment alone.