Having a loved one in a nursing home means they need round-the-clock care that a less restrictive environment can’t provide. Nursing homes are for people with complex medical needs and or cognitive problems requiring 24-hour access to nurses, aides, and medical treatment. You may have considered or used other long-term care options, and have decided that nursing home care is the only place that can provide the level of care your loved one requires.
Jump ahead to these sections:
- What Does the Staff Do When a Loved One Dies in a Nursing Home?
- What Is Family or Next of Kin Responsible for After Their Loved One Dies in a Nursing Home?
The majority of people who live in nursing homes are between the ages of 85 to 94 years old, followed by 74 to 84-year-olds. Chances are your loved one is near the end of their life if they are in a nursing home, but younger people live in nursing homes as well.
Preparing for the death of a loved one is complicated by many factors, including family wishes, and the emotional impact of losing someone close to you. Knowing what happens when someone dies in a nursing home is valuable, but what may be more important is how you and your family prepare. Ensuring that there are advance directives, a mortuary, healthcare and financial power of attorney in place will help the process go much more smoothly.
What Does the Staff Do When a Loved One Dies in a Nursing Home?
Staff in a nursing home experience death all of the time. Especially during COVID when deaths disproportionately affected nursing home residents. An environment that takes care of frail and medically complex individuals expects people to die under their care. If death appears to be imminent, the nursing home may recommend hospice care. Some facilities have special rooms or designated units that provide hospice.
Each nursing home may have a slightly different procedure following the death of your loved one, but these are the things you can expect to happen. Each state also has protocols to follow as well.
Notification of death
When your loved one dies, several different scenarios could occur:
- You are with your loved one when they die. If this happens, you notify the staff at the facility. A healthcare provider (a nurse in some cases) must verify that the person is deceased.
- A staff person is with your loved one when they die. In this case, the staff person notifies the doctor on call, the mortuary, and the family after verification of death.
- There is no one with your loved one when they die. At some point, when a staff person comes to take care of your loved one they notice they have likely died. They will contact the doctor or nurse to verify death and then the mortuary and family.
- The family decides to withdraw life-sustaining interventions and allow the person to die.
Death is generally accepted as being, according to the Uniform Determination of Death Act, “either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem is dead. A determination of death must be made in accordance with accepted medical standards.”
In all of these cases, someone has to certify and pronounce that their loved one has died under the medical definition of death. In some states, this can be a nurse, and in others, it could be a doctor.
If the death is suspicious
If the death is suspicious, the family or the nursing home may request an investigation by a medical examiner or coroner. This step should happen before the medical cause of death is automatically filled out by the doctor. The nursing home or family notifies the proper authorities of a suspicious death.
Nursing home staff prepare the body
The nursing home staff will disconnect all medical equipment such as IVs, catheters, and oxygen. An aide will bathe the body and change the gown to prepare for the family and mortuary.
The mortuary is called
The mortuary is called to come to collect the body. How long a family can remain with the body of a loved one tends to vary by facility and the state where they live. Some facilities may prefer that the body be removed quickly and quietly, so as not to upset other residents.
Filling out the medical cause of death certificate
An authorized person fills out the medical cause of death certificate, which includes the time and cause of death. This step is necessary to obtain death certificates later for the family.
What Is Family or Next of Kin Responsible for After Their Loved One Dies in a Nursing Home?
Unless you have experienced the death of someone before, you may be unprepared for what happens when someone dies. There are the duties of family or next of kin after someone dies, and then there is the emotional impact of the death itself. How prepared you are for death will make a significant difference in what follows next. Doing as much planning in advance can also give you time to grieve and make all of the other duties less stressful.
Selecting a mortuary
Suppose you have already taken this step, then great. If you haven’t, you will be responsible for contacting someone to collect the body for burial or cremation. Mortuaries are generally accustomed to families not having made this decision, and they have personnel on call 24/7 to respond. If you have already made plans, make sure to call the mortuary you have chosen.
Things could get complicated if your loved one has not designated what they want done with their body. If you have legal authority, such as a medical power of attorney, you can make that decision. Families can get very emotional around these decisions when someone dies, so it is strongly recommended that you and your loved one handle these details in advance.
Determine organ or tissue donation
If your loved one is an organ or tissue donor, there could be time and location constraints on the donation process. The organ donation team needs to be contacted immediately for organ donation.
Notify other family members
It can be helpful to have planned out this process in advance. Ask one person to notify other family members. Some may want to come to pay their respects in person, and others may be out of town. The courteous thing to do is let everyone know that your loved one has died.
Spending time with the body
Spending time with the body of your loved one is part of the grieving process. In a nursing home, the quality of that time could be affected by whether your loved one shared a room with someone else and the requirements of the home itself. You may have specific religious or spiritual customs to follow, and the nursing home should give you the time you need to complete those.
Remove all belongings from the room
It is important to remove all personal belongings from your loved one’s room. If there is furniture that you don’t want, the nursing home will often donate it to another resident. Take care to look in all of the drawers and other places for important items. If your loved one kept some personal or legal documents in the nursing home safe, make sure you collect those.
Meet with care staff
If you have specific staff you want to thank for taking care of your loved one, now is a good time to do it. Once you leave the nursing home, things will get very busy in a hurry. If staff is not available, make sure you send a card later. A social worker might be available to assist with any additional bereavement resources you need.
Death certificates
Most people don’t think about the importance of death certificates, but you will need one for each institution, bank, and other assets. You can obtain certified death certificates from the mortuary or your county health department. Ask for more than what you think you will need to expedite settling the estate. The nursing home can usually assist you with this process.
Notification of death
The “notification of death” process can be very time-consuming but must be done before the estate settlement. Virtually nothing can take place without the appropriate institutions receiving this notification. This is where you need the certified death certificates. Here is a partial list of companies and agencies to notify:
- Insurance companies. Notify all insurance companies to stop premium payments. Ask for any possible reimbursement of premiums.
- Social security. Check on any survivor’s benefits you may be entitled to as next of kin.
- Financial institutions. All financial institutions will require a certified death certificate and proof that you are the legal executor of the estate.
- Veterans affairs. If your loved one was a veteran, you could ask about possible survivor-death benefits.
- Residential home. If there is still a home, notify all utility companies unless you decide to keep those until the home’s sale. In other cases, there may be a family member living in your loved one’s home.
Bereavement
Sometimes grieving gets lost in all of the details following someone’s death. And this can be especially true in a nursing home setting where you may not have the privacy and time to grieve as a family. It is important to take the time to mourn the loss of a loved one, and funerals, graveside services, memorials, and celebrations of life are all the different ways that families come together to do this.
On occasion, a loss is so sudden and significant that you need additional time to process. Take the time you need and reach out for spiritual or other counsel if you think it would be beneficial.
Settling the estate
Once your loved one is at the mortuary, you will already have plans in place for a funeral, or if not, have the opportunity to arrange a service. When someone dies, there is significant work for the entire family, especially the executor or trustee of the estate. An attorney can be beneficial in walking you through this process which can take months.
Protocol for Death in a Nursing Home
No one wants to die in a nursing home, but sometimes it is inevitable. Planning for and anticipating your loved one’s death will make the transition easier for everyone. And don’t forget that your loved one would probably prefer to be at home, so do what you can to bring comfort and compassion to a challenging situation.
Sources:
- Davis, Charles. “Medical Definition of Death.” Medterms, MedicineNet, 29 March 2021, Medicinenet.com.
- “Facts and Statistics About U.S. Nursing Homes.” Nursing Home Abuse and Neglect, Nursing Home Abuse Center, 9 February 2021, Fightnursinghomeabuse.com.
- “What to do After Someone Dies.” End of Life, National Institute on Aging, 20 August 2020, Nia.nih.gov.