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When my mom died under Hospice care, the nurse came out and declared/called it, so I could then contact the cremation service. Since my mom's death last December, my dad's health is declining fast. He isn't in Hospice care and I don't know who I'd call if he gets his wish and dies at home in his sleep. Seems like calling 911, with all the folks they send out, isn't warranted if he's already gone. As an aside, he does have a DNR. Even with Google, I can't figure it out. Please advise and thanks.

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Hello Friends,
Thanks to all of your great advice, I signed my dad up for Hospice today.
I appreciate the benefit of your collective wisdom, and the time you took to share it with me. Grateful and humbled,
R27
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NeedHelpWithMom Feb 2020
I am very glad that you signed your dad up for hospice. Both of you will benefit from their services. Hospice will bring your dad and you comfort. If you or your dad wish to speak to the nurses, social worker or clergy, please do so. They were tremendously to our family when my brother was under their care in an end of life hospice facility.
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Frame all pertinent info and put it on the wall..DNR, POLST, ETC.

DOC'S phone number, your phone number, No reason for anyone needing to dig around for it.. It's on the wall.

GET HOSPICE ON BOARD, THERE IS NO REASON NOT TO. THEY WILL EVALUATE HIM AFTER 30 DAYS, BUT USUALLY THEY WILL FIND A GOOD REASON TO KEEP HIM ON HOSPICE... HECK MY MOM GRADUATED OUT OF HOSPICE 2 TIMES, THE THIRD TIME SHE DID GO "HOME". I miss her dearly.. :(
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Register him with your local funeral home or crematory place, with all the information. Actually, I did this with my relative, all pertinent information was on the form, kind of like Neptune Society... They have all the records, and when it is time, they will take him.

So, talk to his doctor and have him evaluated for palliative care and/or hospice. He can still be living at home while on hospice.. they just need to know your needs...

It will work out for you and dad.
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He's absolutely a candidate for hospice. He'd have the benefit of home visits from a nurse rather than you having to take him to medical appointments. That alone is worth it in my opinion.

In addition to the DNR, fill out a POLST form and have it next to his bed. It's kind of the "DNR and I'm not kidding" form. I think they're more universally recognized by emergency personnel (it's all about the wording), and both the nursing homes my mom's been in have required them.

You can download one, and they recommend you print it on bright-colored paper and keep it on the bedside table so it's easily seen.
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MAYDAY Feb 2020
TAPE IT ON THE WALL! BIG PINK PAPER. NObody can say that they cannot locate it. Yup, that happened to me. My aunt has hers taped on the wall, and another one with all her doctors info and my contact info on it. Nobody cannot say to me that they cannot find my number anymore. It's on the wall.
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Maybe im out of line but If im not mistaken when a person dies at home without hospice police will consider foul play.

you may want to have hospice just for yourself to not fall under criminal investigation.
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worriedinCali Feb 2020
Nope. It’s not considered foul play when someone dies at home. Especially when it’s an elder with multiple health issues.
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I would consult hospice and speak with his primary care physician. He can be signed on to hospice within hours and they can also help with navigating a conversation with the physician. An out of hospital DNR is a good thing to have on board. If he should pass before you initiate anything, your first call should be to his physician because someone needs to sign the death certificate.
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HOspice will allow him to die at home, if that is what he wants... call his doctor, get evaluated, and talk to social worker.. palliative care to other option...

talk to his doctor and insurance... call armstrong cremations, and get him set up with them if you are in the area, otherwise they will tell you who to call.
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ARmstrong Cremations.... is a good place to ask.. Los angeles.. .the oldest crematory in the city.... They will answer your questions.
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Call 9-1-1 and they will handle it, e.g. pronounce (time of death) and call the coroner's office.
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yep, 911. They know what to do. Will take care of calling coroner and get him moved on to the funeral home. If you have any medical records pertaining to his health, print them off to have current info. Will make their jobs easier.
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As others stated, call 911, they will send police and paramedics (just to be sure) coroner will remove the body and hold till funeral home can retrieve your father. Getting him enrolled in hospice care would make things easier when the time comes, the will send a nurse out to call time of death, if you have a funeral home or crematorium that you plan on using in advance of this situation hospice will also contact them for you. I am sorry you are going through this so close to losing your mom. Prayers and hugs sent your way.
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I live in CA. Been through a LO passing at home. Call 911. Tell them he has passed away at home. They send paramedics and police. Either will pronounce the death. Then call mortuary. Police will stay outside until mortuary arrives. Let your father's doctors office know he passed. A doctor has to sign the death certificate.
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anonymous951699 Feb 2020
This advice puzzles me. In this day and age, few of us have a doctor who will come to the house at a moment's notice. My dad's doctor most certainly would not.
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Call 911 if he's not on hospice and go from there. Even if he already died. EMS deals with dead people in their homes all the time.
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As long as doctor will initiate and hospice agrees he has the "need", it can be started. My understanding is that you can take or leave any care they offer, but still remain on it. They offer a lot of services, including any medications needed for current conditions (I think they'd also cover simple medical things like flu shots, antibiotics, medical equipment that might make him more comfortable, etc if needed, but if he developed another serious condition, they won't treat that - if treatment is desired, you have to contact them first and get him off hospice, then go for the ER/treatment. Cetude mentioned doing this for her mother. Then once he is stabilized, he can go back on hospice at home. Medicare does cover this.)

Given what everyone has said about avoiding the hoopla involved with an at home death, I would definitely look into it and sign up if possible! My mother is in a MC facility. Don't know what they do, but it won't impact me (no fire, emt, police, ambulance at my house!)
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Put him on hospice. Services can be minimal if pain management not needed
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cak2135 Feb 2020
I hope that I go in my sleep; it is the only way to go
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911, in any state
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I would start hospice immediately! I recently started it with my 86 y/o father. They have been wonderful! They drop his meds off at the door, a nurse comes once a week to check on him, and they are available 24/7. When he passes, I call them, and they handle it. No sirens or firetrucks. My cousin went through this with his older sister, and she said the one thing she would have done differently, was to start Hospice sooner!
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blueberrybelle Feb 2020
You can't just "start hospice." Hospice must approve the patient. You can apply and see what happens.
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Call 911. They can declare deaths and fill out certificates. They will probably take him to a hospital for storage until funeral services can arrive.

My gram died in the car on her way to a doctor's appointment. My mom drove her to her doctor. The doctor said, "Yes, she passed." Mom had to take Gram to a hospital to get a death certificate completed and store the body until the funeral service could arrive.
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disgustedtoo Feb 2020
OMG how awful for your mom! I don't think I would be able to drive, at least for a while, and not with someone who might pass like that!
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we had a friend die at home. We called 911. the ambulance came and then the coroner. They coroner pronounced her dead. Then the funeral home picked up her body.
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Call his doctor. Call your funeral director if you have chosen one. Call the police. If you explain that he has died they won't send all the bells and whistles.
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Just call 911 & tell them you need to report a natural death of a family member. In most rural areas, the sheriff's dept. is also he coroner. The 911 dispatch operater will send a couple of deputies to confirm death. They may or may not send firefighter / emt.
When my father-in-law passed, only a deputy came out & then the funeral home was contacted ( it was the middle of the night) & they sent a couple of people to get the body. When my good friend passed, dispatch sent the EMTs ( in our area the firefighters are trained EMTs) & 2 deputies. One of the deputies called the morgue to come for her body.
In one of the larger cities I imagine it is still handled pretty much the same.
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When my mom was living with me I thought about this situation constantly, Ricky.

I can see how this is weighing heavily on your mind. I called up Council on Aging in my area to ask this very question. They informed me to call 911 and explain that my mother had died. They take care of it from there.

Many years my grandma died while visiting at my parent’s home. Her heart just gave out. Daddy called grandma’s doctor. An ambulance came and took her body to the morgue. Arrangements were then made for grandma’s wake, funeral Mass and burial.
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anonymous951699 Feb 2020
Thanks.
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In California you can call 911, if he’s non responsive, they’ll ask you all that (and about a DNR) if he’s full DNR they will send a sheriff to deem him “passed of natural causes or illness” normally the coroner comes next to take him and you’ll be able to ask the coroner where he’s going and what the protocol is, assumably a morgue. Then any arrangements made or needing made will be with a funeral home if you’d like a service. But if I’m not mistaken the morgue handles cremation or holds him till funeral arrangements are made. We have a company called Neptune Society so when that happens they handle every detail that he’s established and I handle real property/assets only. I make 1 call and they carry out his preset decisions then send me 2 death certificates. It’s a burial insurance costing approx 4 grand with a rider policy for any dependents also covered till they’re 26 (god forbid) but it’s there.
I hope he remains not in pain, but hospice handles much more than pain meds so I would implement that to assist you and him... in my opinion.
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worriedinCali Feb 2020
What you say will happen is factually incorrect. It is not the sheriff that comes out to pronounce death. The paramedics and their doctor on staff will pronounce the death. The responding law enforcement agency will be whoever has jurisdiction, it won’t be the sheriff unless you live in their jurisdiction.
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My mom was on hospice for 2 years and I used them as a home clinic. They were useful continuing mom's regular home meds and I got labs done. I took her to the Emergency Room a lot which is your right while on hospice. When mom forgot how to eat and drink I revoked her hospice, took her to the hospital, they put a permanent feeding tube in her, then I restored her hospice on discharge. No problem! She was very comfortable after the feeding tube was put in and she lasted a long time with it. Ironcially she died of liver cancer and liver failure, and not Alzheimer's. But she died at home and she was really comfortable. yes old age and Alzheimer's disease is incurable--BUT I still continued to treat mom for dehydration, UTIs, and her regular meds under hospice!

You have total control on the treatment plan while on hospice. I just could not take mom to the doctor anymore so this is how I dealt with this, even though old age and Alzheimer's are terminal conditions.
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igloo572 Feb 2020
Cetude, what an awesome plan & way to use mediCARE hospice benefit. Hospice as your partner to have a in home clinic. Really beyond awesome, you go girrrl! Out of curiosity & you don’t mind my asking, did you have a local, more small hospice or was this one of big nationwide players (Vitas, Compassus, Southern)? Did hospice nurse do the pulls for blood work or you did? How did you get vials processed... like you dropped off at a pick up site or you mailed them? Or could you still get her like to a Quest or other free standing labs co.?
Hospice as in home clinic, love it!
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We called sc creamator cost way less than to call a mortuary
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Eloise1943 Feb 2020
What is sc creamator
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When my dad died at home, the funeral home was called. They came and removed his body in a very quiet and dignified way. He was under Hospice Care. No lights and sirens--all done professionally and w/o drama.

My grandma died at home, alone, NOT on Hospice and when my uncle found her, he simply called her dr. He came out, pronounced her gone and called the mortuary. She had recently had hip surgery and was not doing well.

We've had deaths in our neighborhood and having the whole fire dept along with the police come--it's awful. Kind of terrifying for little kids who witness all this...Hospice does things so gently IMHO, just having them on board, even if they are NOT providing day to day care, would be a boon to you. Takes away that possible drama.


Dad's hospice team was catered to HIS needs, toward the end they did provide a lot of support, Your dad could easily go from not needing much help to being very needy in a few days. I'd look in to it, just checking it out cannot hurt.
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Medicare hospice status is meant to help elders for whom no further "active" treatment of their illness is wanted. For instance, if the elder has congestive heart failure, no further active interventions will be done, such as trials of different medications, possible surgery, etc. If a cancer patient who wishes no further interventions like chemo, radiation, surgery, hospice will provide comfort measures like pain management.

Medicare hospice status is granted after his MD determines that he likely has 6 months or less to live. That is a medical determination, not something a caregiver "decides." And hospice status can be renewed again and again.

When on Medicare hospice status, all medical support, including help with ADLs if needed, are 100% paid by Medicare. You and your dad will receive no bills. The hospice service determines what services the patient needs and then provides them. The service is seamless and very worthwhile (based on two cases in my immediate family.)

It's up to you and your dad to bring up hospice with his MD. That MD can explain what it means in his case. It sounds like, if your dad is "declining fast," hospice may be helpful to furnish some services, including nurse visits to the home, and they handle notification of the correct persons when a death occurs. For all these reasons, talk to the primary care MD about the advantages and disadvantages (seems like none in this case,) of Medicare hospice status.
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auntsally Feb 2020
Hello
Great post with lots of information. (2/5/20). You mentioned about M/care Hospice pays for all ADL's if needed. That is only if hospice is coming to the home, correct? My MIL is in a NH, and on private pay, we are working on Medicaid application with an attorney.
If she were moved back to a house, and stayed on Hospice, what type of care do you think she would get, paid for, if needs 24/7? She has Parkinsons, and can only eat pureed food now, and cannot do anything (transfer) without help, and also is incontinent.
Do you know if hospice would loan her a bed in the NH, just like they would at a house?

thank you
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Ricky, since you apparently have already contacted a cremation service for your mother, are you using the same one for your father?  If not, have you identified a funeral home?

They could probably offer suggestions on how best to approach the situation, since they're familiar with your particular area.  

None of my family died at home, so I have no recent experience in this aspect of caregiving.

This is a sad situation, having lost your mother so recently, and now facing your father's apparent imminently close passing as well.  

I respect your attempt to honor his wishes; my father also planned to die at home, but his last illness was too intense for home care.    I was fortunate to find a compassionate multi-level facility where he spent his last days, warm, cared for well beyond any level I could handle, even with the nominal assistance of hospice. 

I still regret that I couldn't honor that last wish but I know in my heart that he couldn't possibly have gotten the care he got with a group of people trained to provide various levels of care.   Had I kept him at home, I know that I would still be battling recriminations for not providing the level of care I thought best for him.

Still, this is his wish, and you're considerate to try to honor it.
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Before going on hospice, know what that means. People are saying he should go on hospice just to avoid a police investigation. While that's preferable, he would also be giving up any curative treatments. Hospice is all about making dying as painless as possible. Not curing any illness. So what is your dad's health? Is he actively getting any curative treatments?
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worriedinCali Feb 2020
That’s not what people are saying at all. Hospice is being suggested so that the family can avoid the emotional trauma of having first responders come out and then having to sit there waiting on the coroner. And there Most likely won’t be a police investigation unless there are signs Of foul play. For most elderly people under the care of a doctor, the police do not investigate and that is a fact.
The OPs dad is old and it doesn’t even sound like dad is interested in curative treatment at all. It sounds like palliative care is appropriate.
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I thought you had to qualify for hospice by having a 6 month-or-less life expectancy. It doesn't sound like Ricky's dad fits that requirement.
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worriedinCali Feb 2020
That is no longer true.
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