On an Instagram Live I recently did there was talk of a ten minute death call. Go to the home, pronounce the person dead, and leave to make the rest of your daily visits. Here is my idea of a death call. I have to warn you, it may take more than 10 minutes.
You arrive at the home, never having met the family. Shake hands and say, “Hi, my name is . . . and I’m from hospice. May I come in?” Go into the living room. “Can we sit here and talk for a minute? Tell me about what happened.” Listen to them tell their story. They are sad, scared, and need to verbalize their experience. It is the beginning of their grieving process.
After you have listened you will be able to say, “From what you have described John did a really good job of leaving his body.” Hopefully someone has explained before the death what happens and why but you again reassure those present that from what they have described nothing pathological or bad happened, that John did a good job.
Now it is time to see the body and pronounce. Ask if you can see John. Use his name, that is important. Explain to those present that while you are in the room you are going to tidy and want to give everyone the opportunity to say goodbye one more time. You might ask if they have another set of bed sheets that you could use and a washcloth and towel.
In the room arrange the body into a natural position with the head of the hospital bed up slightly. You may need to change the sheets (or not, depending on their condition as well as wash the person’s face and other areas that may have become soiled). Arrange a sheet over the body with the head uncovered and in a natural position. Tidy the room, leave a light on but not necessarily the overhead light.
Invite each person present to go in to say goodbye alone, unless they are frightened, then you can accompany them. Tell them to say everything they ever wanted to tell this person, speak from the heart and just have a talk with them. When everyone has said goodbye, call the funeral home.
Stay until the funeral home arrives. During that time you can talk about funerals, why a visitation and open casket are so helpful, how to make it personal, find meaning, gather pictures for an easel, write John a letter and put in the casket with him, have the kids draw pictures for grandpa and put in the casket with him.
This is a teaching opportunity. In the vulnerability of the family, you are bonding. You are their guide, their resource. It is a great teaching, comforting time. You have entered this house as a stranger but by your words and your actions, the comfort you bring, you can leave their friend.
When the funeral home arrives, go in the room with them. As they remove the body from the bed, you make the bed (even if it is a hospital bed) with clean sheets and find something to put on the pillow, a flower, a picture, a rosary, some memento found in the room. Leave the room with a small light on.
This room has become a memorial and will hold the memory of what happened here. You have helped create a sacred space rather than the family returning to a messy room and bed to trigger the sad, scary memories of what occurred there. You are creating a sacred experience that will become their sacred memory.
With the body gone, now your work is done. Ask the family if they have any questions they want to ask you. Did they understand everything that has happened? Is there anything they need you to do? This may be the time a hug goodbye feels right.
Now your ten minute death call is finished.
Something More about... Can a Death Call Take 10 Minutes?
In my book, The Final Act of Living: Reflections of a Long-Time Hospice Nurse I share my insights and experiences gathered over decades of working with people during their final act of living. For both professionals and laypeople, this book weaves personal stories with practical care guidelines, including: living with a life-threatening illness, signs of the dying process, the stages of grief, living wills, and other end of life issues.
14 comments
Having had opportunity to serve as a Crises Team and as a Hospice volunteer I always felt blessed to be with the person who was dying or had died and “being there” for the family. After death pronounced either by LE or Hospice and while waiting for body pick up, many, many acts of kindness can be done – for the deceased and for the family…always being sensitive to and following the lead of the grieved. For one person it was combing the beloved’s hair one last time!
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BK Books replied:
Hi Agnes, blessings to you for the important work you are doing. Barbara
Thank you how nice this should be done. Our mother died last month. We had wonderful Hospice nurses. However, she died early morning 6:00 am. We called the Hospice number and they sent a covering nurse over. We had never met her. She seemed anxious and in a hurry. She called the funeral home, asked us for the med’s that needed to be disposed of. She covered her with just the sheet up to her neck and took the pillows and blanket off the bed. She then left. I waited for the funeral home to come. I watched them move her from the hospital bed to the gurney and zip her up in two bags. Then proceeded to go out the front door down the sidewalk. That was a horrible site. Your piece is just beautiful.
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BK Books replied:
Oh Kim, I’m so sorry you are left with a memory created by thoughtlessness. Hospice and funeral attendants have the opportunity to create comforting memories unfortunately not all use it. Blessings! Barbara
Barbara, as a hospice social worker for almost 19 years, your guidance and educational resources for families and hospice staff are invaluable. I agree that the death visit should be as long as the family needs it to be, not based on hospice agencies running their nurses ragged. I wish you had mentioned how the nurse could tag in other disciplines to support the family and the nurse if they do not have the luxury of staying indefinitely with the family through the funeral home taking the deceased into their care. On our team we support each other and the family by joining the nurse if possible at the death visit and then once the nurse has pronounced and provided post-mortem care, sometimes with assistance from the CNA, the social worker or chaplain may stay with the family and arrange the room as you describe and support the family once the funeral home arrives and afterward. One of our local funeral homes will make the bed and leave a red rose on the pillow, which the family really appreciates. Thanks again for your resources, just please don’t forget that there is a whole team to support the family and each other. Warmly, Ginnie
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BK Books replied:
Hi Ginnie, you are so right about team work. I am impressed with how your team comes together to provide guidance for the family on a death call. Beautiful! That is what end of life care is about. Blessings to your agency in the good work you all are doing. Barbara
You make us feel like we’re sitting on your sunny patio, listening to you talk about the small moments that make the most difference.
Thank you for describing how to talk about the loved one who has just died, how to create a memorial environment in that now empty room, and the simple gesture of inviting loved ones to finish saying goodbye before making the funeral home call.
I sat in on a Daughterhood Circle online zoom. One of the women was so excited to recommend her new discovery: BK Books. She had purchased five of your publications. She talked about them to another woman who had just heard the word “hospice” spoken over her parent and was, of course, at a loss.
I quickly placed your site in the chat. They all scooped it up. Of the 11 others, only the leader had heard of you. Every generation must re-learn that resources exist.
I’ve got YOU in my Link to Links on my agingbetternetwork.com/home as I do what I can to give more to more. Hello and thank you from hired in-home caregiver and #AgingEnthusiast down here in the Willamette Valley!
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BK Books replied:
Hi Christine (Willlamette Valley Neighbor), thanks for the kind words and for sharing my materials. People need guidance and support and we can give it to them. Blessings! Barbara
I am so refreshed to hear that I am not alone in feeling that a death call should never be rushed. Many times I inwardly cringe when other hospice nurses describe their “I came – I saw – I pronounced and left” death visits. Feeling they have no responsibility to clean, position and definitely not wait for the funeral home to arrive.
Well…I firmly believe that attitude of quick get it done has no place in hospice!
Unfortunately- as many hospice organizations move to using productivity points with a certain number of required daily visits, and of course high unmanageable caseloads…it is not acceptable or possible to take time when it is needed. And when those rebels buck the system and actually spend time when needed, they get labeled as having time management and/or boundary issues during employment evals. (Ummmm- do I sound like I’m speaking from experience?)
Well- Many Thanks Barbara for sharing how a death visit experience should unfold gracefully. With compassion!
Not driven by efficiency and productivity monitoring!!!
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BK Books replied:
Oh Tammy, you are not the first hospice person to describe number of visits taking precedence over interactive time spent with patients and families. Medicare regs and high census has robbed us of time and time is part of the healing we offer. SO sad!! Blessings to you in the work you are doing. Let don’t them take away the gift you are giving your patients and families. Barbara
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