When Someone Dies at Home on Hospice, Do You Call 911?

No — call the hospice, not 911. When someone on hospice dies at home, the right call is to the hospice's 24/7 on-call line, which is on your admission paperwork. Medicare requires hospices to have nursing and physician services available 24 hours a day, 7 days a week. A nurse comes to the home, confirms the death, and walks you through what happens next. Calling 911 instead starts an emergency response built to attempt resuscitation, which is not what an expected hospice death needs.

How do you know they have died?

The National Cancer Institute lists these signs that a person has died:

• No breathing and no pulse.
• The eyes don't move or blink and the pupils are enlarged; the eyelids may be slightly open.
• The jaw is relaxed and the mouth slightly open.
• The bowel and bladder may release.
• No response to touch or voice.
• The skin is very pale and cool to the touch.

Not sure? Still call the hospice, not 911. In the last days, breathing can stop for a while and then start again with several quick, deep breaths (MedlinePlus describes this pattern), so a long pause is not always death. The hospice nurse can help you check over the phone and come to verify it. NCI notes that families on hospice can ask a hospice nurse to verify the death. See breathing changes at the end of life.

Why not 911

911 sends emergency responders whose job is to try to restart breathing and the heartbeat. For a patient whose death was expected on hospice, that can mean CPR or other interventions the patient chose to avoid, and a crowded, stressful scene at the bedside. None of it is necessary: the death was anticipated, a plan is already in place, and the hospice is set up to handle this moment at home.

Will paramedics do CPR on a hospice patient if we call 911?

They may, unless they are shown a valid out-of-hospital DNR or POLST form. Being enrolled in hospice is not the same as having a DNR order; a DNR is not required to get hospice care. The National Institute on Aging explains that an out-of-hospital DNR is the document that tells emergency personnel your wishes outside a hospital, and that POLST or MOLST forms give orders professionals can act on immediately in an emergency. Which forms responders honor is set by each state, so ask your hospice which one applies where you live and keep it where responders would see it. See DNR orders explained and POLST forms and hospice care.

What the on-call hospice nurse does

When you call the hospice line, a nurse is sent to the home (or guides you by phone first). Once there, the nurse will:

• Confirm the death and, where state law allows, pronounce it. A hospice nurse is one of the people who can make the legal pronouncement; the rules vary by state, and the hospice knows the local process. See who pronounces death at home on hospice.
• Notify the attending physician and start the paperwork that leads to the death certificate, explained in who signs the death certificate on hospice.
• Help with the next steps, including the funeral home or cremation provider you've chosen. Ask the hospice in advance whether the nurse will call the funeral home or you should; the National Institute on Aging says that after a death at home you may need to contact it yourself or ask a friend or family member to. There is no need to move the body right away.
• Dispose of controlled medications such as opioids. Federal law lets a trained, licensed hospice clinician, such as the nurse, destroy a patient's controlled drugs in the home after death, following the hospice's written disposal policy and state law. The hospice must give you that policy when the drugs are first ordered.
• Support the family. The nurse is there to help you, not to hurry you.

A simple sequence to follow

1. Call the hospice 24/7 line. This is the single most important step.
2. Stay with your loved one. There is nothing urgent to do; you can sit, talk, or pray.
3. Let the nurse confirm the death and help with next steps.
4. Call the funeral home when you're ready, or have the person you agreed on in advance call; the timing is yours, within local law.
5. Let the nurse handle controlled medications under the hospice's disposal policy.

For the full after-death walkthrough, see what to do immediately after a hospice death.

When 911 is still the right call

• The person is not on hospice (or has revoked it) and you find them unresponsive. That is an emergency; call 911. For a death at home without hospice, the National Institute on Aging suggests talking in advance with the doctor, the local medical examiner (coroner), the health department, or a funeral home about how to proceed.
• Someone else is hurt or in danger, such as a caregiver who collapses, or a fire.
• The patient has said they want resuscitation attempted. Federal rules bar a hospice from making care conditional on whether the patient has an advance directive, so ask the hospice team in advance what to do in that case.
• The patient is alive and in crisis. Call the hospice first. The hospice may tell you to go to the emergency department if the situation can't be managed at home. Emergency care outside the hospice plan of care may be billed to you.

What varies by setting

• At home: the on-call nurse comes to you; you call the hospice, not 911.
• In a nursing home or assisted living: facility staff and the hospice coordinate; the expected death is handled by the care team, not emergency services.
• State rules on pronouncement differ, so who formally pronounces can vary; your hospice knows the local process.

What to have ready

• The hospice 24/7 phone number, saved in every caregiver's phone and posted somewhere visible.
• The out-of-hospital DNR or POLST form, if the patient has one, kept where you and any responder can find it.
• The name and number of the funeral home or cremation provider if you've chosen one. If you haven't, the hospice social worker can help; see does hospice help with funeral or cremation arrangements.
• Any advance directive or hospice paperwork kept where you can find it.

One more thing about that night

Hospice does not station a caregiver in the home overnight to be present at the moment of death; aide visits are intermittent, not around the clock. If you want to understand why and what your options are, see does hospice pay for 24-hour care or caregivers at home. But the on-call line is staffed 24 hours a day, and a nurse will come when you call.

Plan so no one dials 911 by reflex

The urge to call 911 is strong, so make the right call automatic before the moment comes. Decide as a family that the hospice line is "our 911" for this. Tell anyone who might be in the house, such as a visiting relative, neighbor, or paid night helper, the same thing, and show them where the number and any DNR or POLST form are kept.

Frequently asked questions

What if I already called 911 out of instinct?

Tell the dispatcher and the responders right away that the person is a hospice patient, and show them the out-of-hospital DNR or POLST form if there is one. Then call the hospice line so the hospice knows emergency services are involved. Hospice enrollment alone may not stop resuscitation; the signed form is what responders look for.

Will the police or the coroner come?

It depends on local rules, but when the hospice handles an expected death, the hospice nurse can pronounce it where state law allows, and the National Institute on Aging notes that a plan for what happens after death will already be in place. It also points families to the medical examiner when a death at home happens without hospice. If 911 is called, who responds is decided by local agencies, so calling the hospice first is the way to keep the response to the hospice team.

Is the body taken away immediately?

No. There is no need to move the body right away. Many families spend time at the bedside before the funeral home arrives, and the pickup can be arranged when the family is ready and in line with local law.

What if the hospice doesn't answer or the nurse is delayed?

Hospices must have nursing services available 24 hours a day, 7 days a week. If you can't get through, call again and stay on the line or ask for a callback. Before that night, ask the hospice how quickly a nurse can reach you after hours, so you know what to expect. Nothing about an expected death has to be done in the first minutes.

What if my loved one dies in a nursing home or assisted living?

Tell facility staff and the hospice. They follow the coordinated plan of care, and an expected death there is handled by the care team rather than emergency services.

Do we need a DNR for the hospice to handle the death at home?

No. A DNR is not required to get hospice care, and you call the hospice either way. A DNR or POLST matters if emergency responders become involved. See DNR orders explained for hospice families.

Should we move or clean the body before the nurse arrives?

You don't have to. Ask the nurse on the phone what, if anything, to do. NCI says that once the family is ready, the body can be placed on its back with one pillow under the head, and dentures can be put in place if needed.

Does someone have to be there at the exact moment of death?

No. Aide visits are intermittent, so it's common for death to occur between visits or overnight. Whenever it happens, call the 24/7 line and a nurse responds. You have done nothing wrong if you stepped away.

What happens to leftover medications?

The hospice nurse handles controlled substances such as opioids under the hospice's written disposal policy, which federal law requires the hospice to share with you when those drugs are first ordered. Ask the nurse before throwing anything away.

Questions to ask your hospice in advance

• What exact number do we call at the time of death, day or night?
• How soon can a nurse reach us after hours?
• Does the patient have an out-of-hospital DNR or POLST form, and where should we keep it?
• Who will pronounce the death, and how does that work in our state?
• Will you contact the funeral home, or should we?
• What support do we have afterward, and for how long?

Bottom line: keep the hospice number where you can see it, and when the time comes, call hospice, not 911. If you're still choosing a provider, you can compare hospices near you and ask each how they handle the moment of death.