If the patient dies at home
It is impossible to predict how you will react to a loved one’s death, even when it is expected. You may go into shock or cry. You may carry on as though nothing has happened – or try to do so. You may go through many different feelings and emotions after a person has died, even in the first few minutes and hours. There is no right or wrong way to feel and react.
Customs or preferences at time of death
If a Marie Curie Nurse or other healthcare professional is present, they will check the care plan to see if there are any religious or other customs or preferences that need to be observed directly before or directly after death. Please do tell them if there is anything they should or should not do. They will respect the deceased’s and your wishes.
Back to the top
Last offices (laying out the body)
The Marie Curie Nurse will undertake last offices for the patient if appropriate and if you wish. This includes washing the patient, dressing them in clean night clothes if necessary and arranging their hair or putting on their wig.
During last offices the Marie Curie Nurse may need to leave equipment such as a syringe driver in place until formal verification of death has taken place.
Do tell them whether you wish them to help you with this, or whether you would like them to do it for you. Do also say whether you wish to be present while they carry out this care or whether you prefer not to be in the room. There is no right or wrong decision – do whatever you feel comfortable with.
Some religions – or your own preferences – may mean that you do not want the Marie Curie Nurse to lay out the body. This should be in the care plan but do let the nurse know about any specific requirements in case it isn’t. If you are alone when the patient dies, you may or may not wish to undertake last offices yourself – some people find it comforting to do so while others might find it distressing and are more comfortable leaving it to others.
Back to the top
Verifying and certifying the death
While it may be clear that the patient has died, at some point an appropriate healthcare professional must formally verify that life has ended, whether they are present when the patient dies or visit afterwards. The body should not be removed from the home before this has taken place.
In addition, a GP will need to certify the death. This is a separate step from formal verification and involves completing a medical certificate confirming cause of death.
Sometimes a GP will undertake both steps at the same time. Or another healthcare professional will verify death in the patient’s home while a GP certifies the death later (for instance, at a funeral director’s). Sometimes a GP will visit and formally verify the death, but may not be able to certify it (for instance, if they are not the patient’s regular GP).
If there is no Marie Curie Nurse or other healthcare professional present at the death, call your GP’s surgery. A GP or their deputising service will visit to verify and/or certify death unless other arrangements are made with you on the phone or have been made previously. For instance, arrangements may be made for another professional such as a nurse or emergency care practitioner to visit and verify the patient’s death and for the GP to certify the death later.
If a Marie Curie Nurse or other healthcare professional is present at the time of death, they will check the patient’s care plan to see who can verify death, and whether/when the GP needs to be called. The Marie Curie Nurse will ask for permission to call the appropriate person and will respect any arrangements you have made with the GP and/or District Nurse.
Some Marie Curie Nurses can formally verify death in a patient’s home if this has been agreed between the local NHS services and the charity, and if the nurse is appropriately trained. However, they will still respect any arrangements you have made with the GP or District Nurse.
Back to the top
If you need the GP’s support
If it has been agreed that a healthcare professional other than a GP will formally verify the death, the GP will not visit the patient’s home. But if you feel that you or your family need care and support from the GP at this time, do ask them if they would be prepared to visit you. Even if the patient’s GP is not your GP, they may agree to do so. GPs will not always agree or be able to visit, but some will.
Back to the top
Do you want the Marie Curie Nurse to stay?
If a Marie Curie Nurse is in the house when the patient dies, you may or may not want them to stay until someone arrives to verify the death formally. The relevant healthcare professional may not be able to come right away, though generally they will arrive within four hours. If you want the Marie Curie Nurse to stay until death is formally verified or until the scheduled end of their visit, do tell them. Equally, if you would prefer them to leave, do say so.
The Marie Curie Nurse is there for you as well as the patient, and your wishes will be respected where possible.
Back to the top
What next?
After the patient’s death has been formally verified, the next stage will depend on whether you have decided to use a funeral director or whether you are handling the arrangements yourself (please see the later sections Do I have to use a funeral director? and Selecting a funeral director for more information).
If you are using a funeral director, you can now go ahead and contact them. They will generally come within the hour. You may decide that you would like a little more time with the deceased. If so, tell the funeral director on the phone what your wishes are and when you would like them to take away the deceased. The funeral director may advise you on a suitable timeframe so that they can provide the appropriate quality of care.
If you are making your own arrangements, it is generally possible to keep the body at home for a couple of days as long as you keep the room as cool as possible. Alternatively, some hospital mortuaries or funeral directors may be prepared to keep the body for you, though do expect to pay a charge for this. We suggest you obtain a book beforehand which covers what to do in detail if you do not wish to use a funeral director – see the Further information section for further information.
Back to the top
Certification of death and medical certificate confirming cause of death
The GP who certifies the death will provide a medical certificate confirming the cause of death. This will allow you to register the death, obtain the death certificate and arrange the funeral.
It may be that the GP did not certify the death when they visited - for instance, a GP cannot certify a death if they are not the patient’s regular GP, but can only formally verify that the patient has died. If this is the case, the appropriate GP will need to certify the death as soon as practicable at the funeral director’s, or elsewhere as appropriate if you are dealing with the arrangements yourself.
(On occasion the GP may refer the death to the Coroner – or Procurator Fiscal in Scotland – instead of signing the medical certificate. This can happen for a number of reasons and is often just a formality. For instance, even if a death was expected, it will be necessary to report the death if a GP has not seen the patient during the previous two weeks. Try not to worry if this happens.)
Back to the top
If the patient dies in a Marie Curie Hospice, other local hospice or hospital
Hospices and hospitals will have their own local arrangements and policies regarding verification and certification of the death, and will issue the medical certificate confirming cause of death. They will offer advice on what arrangements need to be made, including contacting a funeral director if this is what you wish.
