Most families prepare for the dying. Very few prepare for the minutes right after. When the breathing finally stops, the house goes quiet, and a question lands that nobody rehearsed: what do I do now?
The honest answer is that very little has to happen quickly. The next hour is less a checklist than a sequence, and the person who matters most is a nurse you can call. This guide walks through it in order, including the parts people tend to get wrong.
The short answer
If your loved one is receiving hospice care and you believe they have died, call the hospice’s 24-hour number for instructions. The nurse can explain what to do next and arrange an appropriate visit. If the death was unexpected, there are signs of an emergency unrelated to the expected dying process, or you cannot reach the hospice and need urgent help, contact emergency services and explain the situation. Follow any specific emergency instructions in the hospice care plan.
Three Things Worth Settling Before It Happens
The families who find the first hour manageable are usually the ones who did a little quiet preparation days earlier.
- Put the hospice number somewhere everyone can see it. At 3 a.m., nobody remembers a phone number.
- Agree on who is called, and in what order. Decide whether you want a call in the middle of the night or would rather it wait until morning. Decide in advance so nobody is making that call in tears.
- Make sure the right paperwork is easy to find. In Michigan, an out-of-hospital do-not-resuscitate (DNR) order is a specific legal document. If your loved one has one, ask the hospice team to confirm that the paperwork is properly completed and explain where it should be kept. Make sure family members and anyone providing care know how to find it. A DNR order does not replace the hospice emergency plan or decide what to do in every unexpected situation, so ask your hospice team exactly when to call hospice and when emergency services are needed. See Michigan's Do-Not-Resuscitate Procedure Act.
Also worth a conversation: do you want a chaplain, a priest, an imam or a family elder present? If there’s a prayer or ritual that matters to your family, tell the team now. Our spiritual care and chaplain services can help arrange it, and it’s far easier to do before than during.
The First Hour, Step by Step
1. Pause and note the time
Sit down if you can. Note the time. Death at the end of a long illness is usually quiet: the breathing slows, pauses grow longer, and then it simply doesn’t start again. You don’t have to confirm anything yourself. If death was expected, there is usually no need to rush. If you’re unsure whether your loved one has died, that uncertainty is itself a reason to call the hospice line right away and follow the nurse’s instructions. For what the final hours often look like, see our guide to end-of-life signs and timeline.
2. Call the hospice 24-hour line
Say it plainly: “My mother has died,” or “I think my husband has died.” The nurse can explain what to do next, often by phone, and arrange an appropriate visit according to the hospice’s procedures and the circumstances. You don’t need to remember anything. See 24/7 on-call nursing.
3. Call family, in whatever order feels right
There’s no rule that says everyone must be told immediately. In many real cases, families choose to sit together quietly for a while before making a single call, and that is completely fine.
4. The hospice team arranges a visit
The hospice team will explain what happens next and arrange an appropriate visit according to its procedures and the circumstances. A qualified clinician may determine or pronounce death as permitted by Michigan law, which allows a physician or a registered nurse to do so. The team can also guide you through immediate care, medication handling, and arrangements for the funeral home. Ask the nurse before removing medical equipment or changing anything you are unsure about. What happens next also depends on what you want. Many families ask for help washing and dressing their loved one, and some prefer to do it themselves with guidance. Others choose to do neither. Tell the nurse what feels right.
5. Call the funeral home when you're ready, not before
This is the step families rush most. Once the funeral home arrives, your loved one leaves the house, and for many people that is a significant moment. Take the time you need. Many families sit with the person for an hour or two, let relatives arrive and say goodbye, or wait for a priest or imam. How long is possible depends on the circumstances and arrangements, so tell the nurse and the funeral home what you need and ask what’s possible. If you haven’t chosen a funeral home yet, ask the nurse or social worker how the team can help. Our social work team can also walk you through the options.
6. The funeral home takes over
The funeral home arranges transport and generally coordinates the death certificate process (more on that below). You can be present when your loved one is taken from the home, or step into another room. Neither choice is wrong.
What You May Notice, and Why It's Normal
After death, the body may gradually cool, and the skin may become pale or change color. The eyes or mouth may remain partly open, and urine or stool may be released. These changes can occur naturally after death and do not, by themselves, mean that something went wrong. If anything is unexpected or worries you, call the hospice nurse for guidance.
When to Call Hospice and When to Call 911
Calling 911 is the instinct most people have, and for an expected hospice death it’s often not the right first call. Emergency responders follow applicable protocols and legal requirements, and the police may also become involved. A calm, expected death can then become a chaotic one, with strangers in the bedroom and the family pushed aside.
That’s why understanding your hospice plan and any DNR documentation before a crisis matters so much. If a family member calls 911 anyway, the hospice team can still help sort things out.
Call emergency services if the death was unexpected, if there are signs of an emergency unrelated to the expected dying process (for example, someone in the home has been injured), or if you cannot reach the hospice and need urgent help. Tell the dispatcher your loved one is on hospice, and follow any specific emergency instructions in the hospice care plan.
Medications and Equipment: What Happens
Hospice patients often have strong medications in the home, including some controlled substances. Federal rules require every hospice to have a written policy for managing and disposing of controlled drugs, and to give you a copy and explain it when those medications are first ordered (see 42 CFR 418.106). Please do not flush, discard, or otherwise dispose of hospice medications on your own unless the hospice’s instructions specifically direct you to. Contact the hospice nurse, who can explain the applicable disposal procedure. Depending on the medication, state requirements, and hospice policy, disposal may be handled by an authorized hospice employee or through another approved method. Keep medications secure while you wait for instructions.
Hospice provides equipment such as a hospital bed, oxygen concentrator, or commode while your loved one is on service, and the supplier usually collects it in the days that follow.
The Paperwork Nobody Warns You About
The funeral home will generally coordinate the death certificate process, including obtaining the required medical certification and filing the record. The appropriate physician or other authorized official completes the medical portion, depending on the circumstances. The funeral home can explain how to obtain certified copies and when they are available (see Michigan LARA: death certificates). Practical points:
- Order more certified copies than you think you'll need. Banks, insurers, pension offices, and the vehicle registry each tend to want an original.
- Don't rush to close accounts in the first few days; avoidable mistakes are common in grief.
- Ask the funeral home which agencies they notify for you, such as Social Security.
If you’re unsure about benefits or costs, see who pays for hospice care and the Medicare Hospice Benefit.
If There Is No Hospice Involved
When a person dies at home without hospice, there is often no nurse to call, no pronouncement process in place, and no one to take charge of medications. Depending on the circumstances, a physician, the police, or the medical examiner may need to be contacted, and that can add hours of stress to an already hard night.
Details vary by situation, but with hospice, someone is already there to lead you through it. If your loved one is nearing the end and you’re not yet receiving hospice, it’s worth asking about it sooner, not later. See signs it’s time for hospice.
Common Mistakes Families Make
- Calling 911 out of reflex in an expected hospice death, without first calling the hospice line.
- Calling the funeral home immediately, before relatives have arrived or the family has had a moment.
- Dealing with medications themselves, instead of asking the hospice for instructions.
- Having no plan for who’s called at night, so one exhausted person carries it all.
- Feeling they failed if they weren’t in the room. Many people die in the few minutes a relative steps out. It isn’t anyone’s fault.
After the First Day
The first day is logistics. The weeks after are often harder. At St. Marie’s, the care doesn’t end when the patient dies. Federal rules require hospices to make bereavement services available to the family and others in the bereavement plan for up to a year after a death. The services and how often they are offered depend on assessed needs and the hospice’s program. Our bereavement support is there for exactly that. You’re welcome to reach out whenever you need it.
Frequently Asked Questions
Michigan law allows a physician or a registered nurse to pronounce death, but the hospice's own procedures and the circumstances decide who does what in each case. Ask your hospice team how it works. You don't have to be certain yourself before calling.
There is no single answer. Many families take an hour or two to be together, but the time depends on the circumstances and arrangements. Tell the nurse and the funeral home what you need and ask what's possible.
Don't flush or discard anything yourself unless the hospice specifically tells you to. Call the nurse, who will explain the disposal procedure that applies. Keep the medications secure while you wait for instructions.
No. Many people die when family steps out, even after days of sitting at the bedside. It doesn't mean you did anything wrong.
Talk With Our Team
If someone you love is nearing the end and you’d like to understand what the final days could look like, call us. Our team can walk you through exactly what would happen at your home, before it’s needed, so the first hour is less frightening.
St. Marie’s Hospice is Medicare-certified and CHAP-accredited, serving Wayne, Oakland, and Macomb counties.
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