If you close your eyes and picture your life, you might picture yourself in your home. Our homes make up a significant portion of our identities. They are where we spend the bulk of our time, seek comfort, connect with loved ones, recharge, rest, take refuge in difficult times, make future plans, set goals and more. Isn’t the best part of a vacation or holiday, going home? It holds our comfort items and is where we experience life’s simple joys. It is also where we experience many of life’s challenges, including facing loss.

In society, death often occurs at home and the immediate who to call and what to do is an immediate source of heightened anxiety. Every death holds some commonalities (we’re all human) and each death (like every birth) is unique, so these will influence who to call. These are some of the parameters I use in determining who to call when death occurs: Expected Death in the Home, a Sudden/Expected Death and a Sudden/Unexpected Death.

There are different courses of action required depending on whether the death was unexpected or expected. In this post, I will share details about how to plan for death at home, as well as what you will need to do once loss of life occurs.

Reporting Sudden Death Occurred in the Home

This is a death that should immediately be reported to 911 who will initiate police response. Do not touch the decedent or move them, at this time. You can request that emergency response be without lights and sirens. This helps to quiet some of the anxiety. Sudden death in the home will also often have a Victim Services volunteer reach out to family to offer support. An example could include Mr. Samuels (76) having a cardiac arrest while making his spouse dinner.  

Reporting an Expected/Sudden Death in the Home

The road to death is often a long trajectory. Sometimes AHS is already involved in palliative home care, sometimes not. If someone is living with a terminal illness, such as cancer and they pass away suddenly, it is appropriate to make a 911 call first. This will result in the police service attending. Between law enforcement and the Alberta medical examiner, a decision will be made as to whether the decedent transfers into medical examiner care or is available directly to funeral home care.

The deceased should not be moved or touched at this time. There is a requirement to ensure there are no circumstances that require further investigation. This process sometimes takes several hours, and may involve questions of the family. It is protocol they’re required to follow, and may be uncomfortable, but it does not mean that they have suspicions. Often, the local Victim Services Volunteer may attend the scene to support the family.

Planning for Expected Death in the Home

When death is expected, or a natural outcome of a person’s illness, home is often the preferred location for death. In-home care of a family member is more common with the availability of home care, hospice and palliative care support. But caregiving through end of life is a big job and should not be taken on lightly.

Respite and supports can dramatically assist through this time. Alberta Health Services and a good funeral provider can support caregivers and the dying through this time. Making this decision early in the journey also helps to reduce chasing from facility to facility. No more waiting, driving, documents, testing and on and on. When a home-death plan is in place, the journey is experienced differently. It is not without its grief and worry. Of course, there is that but the outside influences and demands of our health and care systems are minimized. Letting go of these can have other benefits as nature takes its course. End of life is so much more than a medical experience.

Having said that, medical/health resources are critical. In addition to arranging home-care and palliative care supports, physicians and nurse practitioners can provide guidance around creating a home-care plan. An Expected Death in the Home (EDITH) form should be included as part of this plan. The EDITH form is the permission required for the funeral home to take the decedent into care before the Medical Certificate of Death is issued. In Alberta, we do not record “time of death.”

Reporting an Expected Death in the Home (Edith)

When Alberta Health Services has provided an EDITH form, there is no requirement to call 911 when death occurs. Funeral arrangements should be in place before death occurs. There is also no requirement to call the funeral home immediately. This is the transition from the vigil time (waiting for death) to wake time (spending some time processing, escorting death out and transferring over to funeral home care).

Leaving a message and waiting until morning is fine. You can take your time. Loved ones can spend time with the deceased. This might be a good time for rituals such as brushing their hair, holding their hand, and saying private goodbyes. The family may wish to gather to tell stories and share memories. Pine Box Funerals specializes in home death and care. If you would like other additional information, Alberta Health Services has a helpful brochure available on their website.

Managing Changing Conditions

Palliative passing at home can be daunting. What happens if things become too much? What if the patient is in pain? Or if things escalate beyond the care that the caregiver can provide? Alberta Health Services has an Assess, Treat and Refer (ATR) Program that offers support to families when their intention is to allow death to occur at home. ATR offers a team of paramedics who respond to calls in homes where palliative care is in place and the person has requested to die at home, but something is changing that has frightened or panicked the family or loved one. Remember that actively dying is hard work and isn’t always the journey we hoped for… but we can be prepared and the supports of ATR provide comfort and reassurance at an incredibly vulnerable time. 

Passing in comfort

With some forethought, passing away at home can be a deeply meaningful experience to family and the dying. The logistics of keeping a loved one at home after death don’t need to be overly complicated, just well thought through. A practical timeline for the deceased to remain at home is 12 to 36 hours. 

When your loved one passes, we – as end-of-life care providers – help you by being present for end of life care. We can assist with whatever level of involvement of decedent care you would like to participate in (tidy up, bathe, dressing or shrouding, placement). Shrouding our loved ones out can be as meaningful as tucking a loved one in.  

It’s appropriate, if you choose, to maintain a vigil in the comfort of home. The term wake can be used here, as it describes the time period before the deceased physically departs from home. This is a “not really here” and “not really there” time, a threshold. No need to rush. Readings, faith, ritual, prayer, music, song, story, art, nature – these are all elements of our cultural life commemorations. So they should be included at death. This period of time acknowledges that death has occurred and life has changed. 

This is a lot of information. Death at home does happen more often than we know. Whether unexpected or planned for, it is a life changing moment. Having some general knowledge about “what to do” or “who to call” can help guide our thinking, when death comes calling.