What to Do When Someone Dies at Home

Hospice Death vs Unexpected Death — the First Call Is Different

The most important thing to get right in the first minutes is who you call, and it depends entirely on whether the death was expected.

If the person was under hospice care: Call the hospice nurse, not 911. The nurse has the authority to pronounce the death, begin the medical certification process, and guide you through the next steps. Calling 911 during an expected hospice death triggers an automatic dispatch of paramedics and sometimes police, which can lead to an unnecessary and invasive scene — attempted resuscitation, forensic investigation, or even an involuntary transport to the medical examiner's office.

If the death was unexpected: Call 911 or your local emergency number. Do not move, clean, or adjust the body until law enforcement or the coroner has arrived, assessed the scene, and formally authorized the release. For non-natural or uncertified deaths, the remains may be transported to the county medical examiner for autopsy before being released to the family.

The First Two Hours

Once the death has been formally acknowledged (by the hospice nurse or by emergency responders), rigor mortis can begin as soon as two hours after death. This window matters if you plan to keep the body at home for a vigil or home funeral.

Position the eyes and jaw. Gently close the eyelids. If they don't stay closed, place small fabric weights — bags of dry rice or salt wrapped in cloth — over the lids. Close the jaw by wrapping a soft scarf under the chin and tying it at the crown of the head. These can be removed after one to four hours once the facial muscles set.

Clean the mouth. Use disinfecting swabs to gently clean the teeth and mouth. Insert small cotton rolls in the nasal passages if there's any drainage.

Place absorbent padding. Put an adult diaper or high-absorbency pad under the body. Gently press the lower abdomen to empty the bladder. This prevents soiling later.

Lower the room temperature. Turn down the thermostat, open windows if it's cool outside, and turn on fans. The goal is to slow the body's natural processes while you organize next steps.

Who to Notify

After the immediate care steps, work through this notification list:

1. Close family members who need to know immediately
2. The attending physician (if not the hospice nurse) to complete the medical certificate of death
3. Your religious leader or community if you want cultural rituals performed
4. A death doula, if you've arranged one, for hands-on guidance through body care and vigil setup
5. A funeral director, if you're in one of the nine states that require one (CT, IL, IN, IA, LA, MI, NE, NJ, NY) or if you want professional help with specific tasks

There is no legal requirement to notify a funeral home immediately. In the 41 states that permit family-directed care, you have the right to keep the body at home, care for it yourself, and make arrangements at your own pace.

Starting Cooling

If you plan to keep the body at home for more than a few hours, start cooling within four to six hours of death. The body needs to reach and stay between 33°F and 40°F to prevent decomposition.

Dry ice is the most effective option. Place 30 pounds initially — wrapped in towels or paper bags, never directly on skin — under the torso and over the abdomen. Replenish with 10 to 20 pounds daily. Keep windows cracked or a fan running since dry ice releases carbon dioxide as it sublimes.

Frozen polymer sheets (like Techni-Ice) are safer for households with children or pets. They require more frequent rotation — every three to four hours — but carry no gas buildup risk.

Frozen gel packs work for short-term cooling but may not maintain temperature in warm climates or beyond eight hours.

What Not to Do

Don't call 911 for a hospice death. This is the single most common mistake, and it can derail everything.

Don't rush. There is no legal deadline to call a funeral home. In most states you have 24 to 72 hours before any preservation requirements kick in (some states have no time-based requirements at all).

Don't assume you need a funeral home. In 41 states, families can handle the entire process — body care, vigil, transport, and delivery to a crematory or cemetery — without a funeral director.

Don't move the body unnecessarily. Care for the person in the room where they died. Moving a body is physically demanding and logistically complicated. If the bed needs protection, roll the person gently from side to side while sliding waterproof sheeting underneath.

Filing the Death Certificate

The attending physician completes the medical section of the death certificate. A hospice nurse may pronounce an expected hospice death and initiate the certification process. In most states, the family or funeral director then files it with the local registrar, who issues a burial-transit permit authorizing final disposition.

In practice, this process is smoother with a licensed funeral director because many states restrict electronic death registration (EDRS) access to licensed professionals. Families filing on their own typically need to use paper forms and visit the registrar's office in person, which can take one to two business days.

The Home Funeral / Family-Directed Guide walks through the complete filing process state by state, including which states allow family filing, which require a funeral director, and the exact forms you'll need.