Imagine caring for someone you love at home. Maybe they've been dealing with a serious illness for some time, and you know their health has been declining. Then one day, they die. You know what to do if there's a medical emergency. You know to call 911 if someone needs immediate help. But what happens when someone dies at home and hospice isn't involved? Who do you call? Does someone have to come pronounce the death? Can you contact the funeral home yourself? These are questions many families don't think about until they're facing the situation. And while we often talk about what happens when someone dies at home while receiving hospice care, not everyone is enrolled in hospice.
So, let's talk about what families should know.
First, Was the Death Expected or Unexpected?
This is an important distinction because the next steps may be different.
An expected death might involve someone who has been living with an advanced illness, whose health has been declining, and whose medical provider is aware that they're approaching the end of life.
An unexpected death might involve someone who was previously doing well, someone who dies suddenly without a known explanation, or a situation where there's uncertainty about what happened.
Here's where things can get confusing. Just because someone was elderly or had a serious medical condition doesn't automatically mean their death will be handled as an expected death. Whether they were under medical care, whether arrangements were made ahead of time, and the circumstances surrounding their death can all affect what happens next.
That's why planning ahead can make such a difference.
Who Do You Call First?
If someone collapses, becomes unresponsive, or you're unsure whether they're still alive, call 911 immediately. If someone has died unexpectedly, or there is no established plan for an expected death at home, calling 911 is generally the safest first step. Emergency responders can assess the situation and help determine what needs to happen next.
But what if your loved one was already nearing the end of life? If their death was expected, their healthcare provider was involved, and a clear plan was established beforehand, you may have been instructed to contact a specific physician, medical provider, or other designated professional when death occurs. In that situation, follow the instructions you've been given.
The important part is not to assume that every death at home follows the same process. If your loved one has a serious illness and wants to remain at home, ask their healthcare provider ahead of time:
“If they die at home and we're not using hospice, who exactly should we call?”
And don't stop at getting a name. Ask what happens after hours, on weekends, or if that person is unavailable. It's a simple question that can prevent a lot of confusion later.
Does Someone Have to Pronounce the Death?
This is another question families often have.
When someone dies at home, there is a process for confirming the death and completing the necessary documentation. Depending on the circumstances, this may involve emergency medical personnel, an authorized healthcare professional, or the medical examiner's office. In Florida, the person responsible for medically certifying the cause of death may be an authorized treating practitioner or the medical examiner, depending on the situation.
Something worth understanding is that pronouncing a death and certifying the cause of death are not necessarily the same thing. A death may be confirmed, but there is still documentation that needs to be completed before the death certificate can be finalized. Families generally aren't responsible for figuring out the legal paperwork themselves, but knowing who is involved can make the process less confusing.
Will the Police or Medical Examiner Be Involved?
Possibly.
I want to address something here because I think it can be frightening for families who aren't expecting it. The involvement of law enforcement or the medical examiner doesn't automatically mean anyone suspects something terrible happened.
In Florida, certain deaths must be referred to the medical examiner. These include sudden deaths in people who appeared to be in good health, deaths without appropriate medical attendance, and deaths involving accidents or suspicious circumstances. Sometimes the circumstances simply require additional review before a cause of death can be established. That may involve questions about medical history, recent symptoms, medications, or what happened before the death.
Depending on the situation, the medical examiner may determine that an investigation or examination is needed. If this happens, it's okay to ask questions about the process and what your family should expect next. If the death is being investigated, follow the instructions of the responding authorities before moving or changing anything at the scene.
When Does the Funeral Home Get Involved?
If your loved one has already chosen a funeral home, that information can be extremely helpful.
Once the appropriate authorities or healthcare professionals have completed the necessary steps and authorized release, the funeral home can coordinate transportation and begin discussing arrangements with the family. If the death falls under the medical examiner's jurisdiction, the funeral home may need to wait until the person is released into its care.
Families may also be asked for basic information about their loved one, including personal details needed for the death certificate. In Florida, funeral directors play an important role in preparing and filing death records, while the appropriate medical professional or medical examiner provides the medical certification. If no funeral home has been selected, the family will need to choose one.
That brings me to something I really encourage people to think about before a death happens…
What If Nobody Knows What Their Loved One Wanted?
Imagine trying to choose a funeral home, decide between burial and cremation, contact relatives, and make arrangements while you're still processing the fact that someone you love has died.
Now imagine doing all of that without knowing what they would have wanted. Unfortunately, this is a situation many families find themselves in. Some people have very specific wishes. Others have never really thought about it. Sometimes families assume they know what their loved one would prefer, only to realize they've never actually discussed it.
You don't have to plan every detail of your funeral years in advance… but having a few conversations can make a difference. Does your loved one have a funeral home preference? Would they want burial or cremation? Are there religious or cultural traditions that matter to them? Who should be contacted when they die? Even knowing where important documents are kept can be helpful.
These conversations might feel uncomfortable, but they're often much easier to have before a family is dealing with a death.
What If You Want Some Time With Your Loved One Before They Leave Home?
This is something I think deserves more attention. When someone dies, families may feel like everything has to happen immediately. Phone calls need to be made. People need to be notified. Arrangements need to begin. But it's also okay to want a moment. Maybe you want to sit beside your loved one. Maybe there are family members who want to say goodbye. Maybe you simply need a little time to process what's happened. When a death is expected and the appropriate arrangements are in place, families may be able to spend some time with their loved one before transportation occurs.
However, when a death is unexpected or requires an investigation, there may be restrictions on what can happen before the person is released. That's why I encourage families who are planning for a death at home to discuss these preferences ahead of time with their healthcare provider and funeral home. You can ask what is possible, what needs to happen first, and whether there are any time limitations. Having those answers beforehand can help families know what to expect.
Can an End-of-Life Doula Help if Someone Isn't on Hospice?
Absolutely.
While end-of-life doulas often work alongside hospice teams, doula support isn't limited to people receiving hospice care. An end-of-life doula provides non-medical support to individuals and families as they navigate serious illness, dying, and the time surrounding death. That might include helping someone explore their end-of-life wishes, discussing what they want their final days to look like, or helping caregivers prepare questions for their medical providers. A doula can also assist with vigil planning, provide companionship, offer emotional support, and help families understand what arrangements they may want to make ahead of time.
Following a death, a doula may offer emotional and practical support as the family begins navigating what comes next. However, an end-of-life doula does not replace medical care, pronounce death, certify the cause of death, or take over the responsibilities of a funeral director. The role is to provide another layer of support during an experience that can feel overwhelming.
A Little Preparation Can Make a Difficult Day Less Confusing
Not every death can be anticipated, and even when someone has been seriously ill for a long time, their death can still be difficult to process. No amount of planning takes away the grief. But knowing who to call, understanding what might happen next, and having some idea of your loved one's wishes can make those first few hours less confusing.
If someone you love has a serious illness and wants to remain at home, don't be afraid to ask their healthcare team about what happens when death occurs. Ask about after-hours arrangements. Ask whether a funeral home should be contacted ahead of time. Ask what steps your family should expect.
You don't have to wait until the final days to have these conversations. You don't have to know all the answers before you start asking questions.
At Blooming Transitions, I provide non-medical end-of-life support to individuals and families throughout the Tampa Bay area, with virtual support also available.
Whether you're planning ahead, caring for someone with a serious illness, or navigating the time surrounding a death, I'm here to help you feel more informed and supported through the process.
Because families deserve to understand their options before they're faced with making difficult decisions.
