Hospice First Call Procedures After Death: Notification Protocol and Response Checklist

The Call That Starts the Clock

A family calls the hospice at 3:17 a.m. Their father has stopped breathing. Everything that happens in the next several hours follows a specific protocol — a chain of notifications, clinical assessments, and administrative handoffs that must be executed in order and documented in real time.

The first-call protocol is not complicated, but it is unforgiving. A missed notification, an undocumented step, or a handoff that falls between two team members creates exactly the kind of gap that surfaces in audits months later. And the on-call nurse receiving the call is operating under time pressure, emotional weight, and the family's need for both clinical competence and human presence.

Step-by-Step First-Call Response Protocol

Step 1: Receive the call and assess the situation. The on-call nurse (or triage team) receives the call from the family, caregiver, or facility staff. Before dispatching, gather basic information: the patient's name, location, who is present, and a brief description of what happened. Confirm hospice enrollment and review the current orders or plan of care, including any DNR if present.

If the caller reports signs of life — however faint — do not treat this as a post-death call. Follow your agency's active assessment protocol.

Step 2: Dispatch the on-call RN to the location. In most agencies, the on-call registered nurse responds in person. Document the time the call was received and the time the nurse was dispatched. If the death occurred in a skilled nursing facility (SNF), coordinate with the facility's charge nurse — they may have their own notification requirements under the SNF-hospice agreement.

Step 3: Pronounce death. Upon arrival, an RN or other practitioner authorized under state law and agency policy assesses the patient and performs the pronouncement. Use the assessment steps required by applicable rules and agency protocol, and document objective findings and the time of pronouncement. If the time of death is unknown, record that and follow the applicable death-record procedure.

Step 4: Notify the attending physician or hospice medical director. The pronouncing clinician contacts the physician responsible for the patient's care in the time and manner specified by applicable law and agency policy. Document the time of notification, who was contacted, and their response.

Step 5: Notify the funeral home. Contact the funeral home selected by the family, if one has been selected, and follow agency procedure for the handoff. Document the funeral home name, the person contacted, and the time of the call.

If the family has not yet selected a funeral home, provide them with options but do not make the selection for them. This is their decision, and it should not be rushed.

Step 6: Provide immediate family support. The nurse's clinical obligations are now met, but the human work begins. Sit with the family if they need it. Answer their immediate questions: What happens next? When will the funeral home arrive? What should they do with medications? Who should they call?

Offer practical guidance: they do not need to do anything immediately. They have time to call family members, to spend time with the deceased, and to process the initial shock. Some families want the nurse to stay. Others prefer privacy. Follow their lead.

Step 7: Manage controlled substances. Document the remaining supply of controlled medications in the home and follow agency policy, pharmacist guidance, and applicable law for secure disposal or return. Do not assume that flushing, mixing with an inactivating agent, or a family-member witness signature is required. Record the medication disposition and any required witnesses.

Step 8: Complete post-mortem documentation. Before leaving the location, the nurse should complete or initiate:

• The clinical note documenting the pronouncement (time, assessment findings, who was present)
• The physician notification log
• The funeral home coordination note
• The controlled substance disposition record
• The notification to the hospice office, bereavement coordinator, and clinical manager

The Handoff to the Bereavement Team

The first-call protocol ends with a notification to the bereavement coordinator, but the transition is not just administrative. The on-call nurse is often the last hospice team member the family sees in person during the acute crisis. Before leaving, the nurse should:

• Inform the family that the bereavement team will be in contact within the next week
• Provide the family with the bereavement coordinator's name and direct contact information
• Note any immediate observations about the family's emotional state — acute distress, conflict between family members, someone who seems especially isolated — that the bereavement coordinator should know before making the initial outreach

This handoff note is clinically valuable. The bereavement coordinator's first call to the family is significantly more effective when it is informed by the on-call nurse's in-person observations, rather than starting cold from the chart.

When the Protocol Changes

Unattended deaths. If the patient was alone and the body was discovered by a caregiver or family member, the clinician documents that the time of death is unknown and records the assessment and pronouncement time separately, following applicable state and agency procedure. Some states require coroner notification for unattended deaths, even expected ones in hospice. Check your state law and agency policy.

Deaths in facilities with their own protocols. SNFs and assisted living facilities have their own post-death procedures. The hospice's responsibility is defined by the written agreement between the hospice and the facility (42 CFR § 418.112). Coordinate with facility staff so the notifications do not overlap or conflict.

Suspicious circumstances. If anything at the scene is inconsistent with an expected death — unexplained injuries, missing medications, signs of environmental neglect — the nurse must stop the standard protocol and escalate. Notify the clinical supervisor, and depending on state law, the coroner or medical examiner. Document objective observations only.

The Hospice Worker's Family Bereavement Support Toolkit includes a first-call response checklist and post-mortem documentation templates designed for the on-call nurse who arrives at 3 a.m. — every step and every required entry, structured so nothing falls through the gap between the bedside and the chart.