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
Francoise Putting
Hello Barbara,
I was called on a Sunday evening, 9:30 PM, by someone at my sister’s nursing facility.
The person said, " I’m really bad at this. Your sister just died. You need to get the body out of here. We need the bed." WOW This person needs your guidance on how to deal with death. Your booklets should be part of everyone’s education. They are great and they have educated me a lot. Thank you for your wonderful insights and advice.
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BK Books replied:
Dear Francoise, I am so sorry someone was so unthinking, actually cruel, when they told you of your sister’s death. I hope you called the director of the facility and told them what happened. If you don’t tell someone in authority then it will happen again to someone else. Blessings to you! Barbara
Hello Barbara,
I was called on a Sunday evening, 9:30 PM, by someone at my sister’s nursing facility.
The person said, " I’m really bad at this. Your sister just died. You need to get the body out of here. We need the bed." WOW This person needs your guidance on how to deal with death. Your booklets should be part of everyone’s education. They are great and they have educated me a lot. Thank you for your wonderful insights and advice.
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BK Books replied:
Dear Francoise, I am so sorry someone was so unthinking, actually cruel, when they told you of your sister’s death. I hope you called the director of the facility and told them what happened. If you don’t tell someone in authority then it will happen again to someone else. Blessings to you! Barbara
Susie
Good morning Barbara,
Your work has meant so much to me over the years and a very fond memory of mine is the time I met you at a conference and I was able to hug you – years ago, of course. Not recently. Because my home care agency didn’t have extra copies of Gone From My Sight, I gave away my autographed copy to a physician with an ailing family member and I still miss it.
Last summer, I read your words to my best friend as he was moving through his last week or so on Mother Earth and this was such a comfort to both of us – for him to know what to expect and for me to know that he had less fear, because there would be fewer surprises in store for him.
Your affirming words are invaluable. When I was fortunate to be a hospice nurse, I went to many death calls, especially on the overnight shift, and I was so fortunate to have the flexibility to remain with the family and help them walk through their very first steps following their irrevocable life change. Most people were glad to be shepherded to another space while the funeral home staff came to take the deceased loved one into their care. Some wished to be present for all of it, and I supported that choice as well, as you described.
Despite the pressure on hospice clinicians to be quicker in so many ways, I always remembered that I was caring for people, not machines. When I wasn’t sure exactly what to do, I defaulted to the care that I hoped some caring person might offer to me in a similar situation. I called it “golden ruling” them.
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BK Books replied:
Hi Suzie, I really like your term “golden ruling them”. Going to add it to my tool box. Blessings! Barbara
Good morning Barbara,
Your work has meant so much to me over the years and a very fond memory of mine is the time I met you at a conference and I was able to hug you – years ago, of course. Not recently. Because my home care agency didn’t have extra copies of Gone From My Sight, I gave away my autographed copy to a physician with an ailing family member and I still miss it.
Last summer, I read your words to my best friend as he was moving through his last week or so on Mother Earth and this was such a comfort to both of us – for him to know what to expect and for me to know that he had less fear, because there would be fewer surprises in store for him.
Your affirming words are invaluable. When I was fortunate to be a hospice nurse, I went to many death calls, especially on the overnight shift, and I was so fortunate to have the flexibility to remain with the family and help them walk through their very first steps following their irrevocable life change. Most people were glad to be shepherded to another space while the funeral home staff came to take the deceased loved one into their care. Some wished to be present for all of it, and I supported that choice as well, as you described.
Despite the pressure on hospice clinicians to be quicker in so many ways, I always remembered that I was caring for people, not machines. When I wasn’t sure exactly what to do, I defaulted to the care that I hoped some caring person might offer to me in a similar situation. I called it “golden ruling” them.
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BK Books replied:
Hi Suzie, I really like your term “golden ruling them”. Going to add it to my tool box. Blessings! Barbara
Roger Cohn
Thank you. I think a checklist (mental or written) is a good thing for a newbie.
Thank you. I think a checklist (mental or written) is a good thing for a newbie.
Anne Gorman
When my Jim died our Hospice nurse did almost everything you described. I was very fortunate to have my Hospice Team for the weeks before Jim died. We were able to have him in my home. There was never any hurry that last day. And my Hospice nurse stayed until the funeral director left. Your books got me through so many things. It has been ten years and I continue to give people I know copies of your books. Thank you for all you do. Anne
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BK Books replied:
Hi Anne, thank you for sharing your hospice experience. I am very pleased to hear what a positive experience it was. Blessings! Barbara
When my Jim died our Hospice nurse did almost everything you described. I was very fortunate to have my Hospice Team for the weeks before Jim died. We were able to have him in my home. There was never any hurry that last day. And my Hospice nurse stayed until the funeral director left. Your books got me through so many things. It has been ten years and I continue to give people I know copies of your books. Thank you for all you do. Anne
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BK Books replied:
Hi Anne, thank you for sharing your hospice experience. I am very pleased to hear what a positive experience it was. Blessings! Barbara
Jeanine Journey
Dear Barbara, I am a hospice MSW and I’ve been using your books since 2008 with my patients and their families. I believe that only the first ten minutes of a death call should take ten minutes. I do death calls in my state and I can tell you that they take as long as they take and that’s it. We are in this field to serve and serve we must! Thank you for the years od support and guidance you have provided us all. Blessings to you each and everyday!
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BK Books replied:
Thank you Jeanine, You and I are on the same page. Blessings to you in the work you are doing. Barbara
Dear Barbara, I am a hospice MSW and I’ve been using your books since 2008 with my patients and their families. I believe that only the first ten minutes of a death call should take ten minutes. I do death calls in my state and I can tell you that they take as long as they take and that’s it. We are in this field to serve and serve we must! Thank you for the years od support and guidance you have provided us all. Blessings to you each and everyday!
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BK Books replied:
Thank you Jeanine, You and I are on the same page. Blessings to you in the work you are doing. Barbara
Agnes
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
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
kim
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
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
Ginnie
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
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
Christine A. Smith
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
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
Tammy CHPN
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
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!!!
———
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
Paisley Davis
THANK YOU FOR THIS!!!! Such an Important Lesson to Keep in Mind.
THANK YOU FOR THIS!!!! Such an Important Lesson to Keep in Mind.
Colleen
I just have one comment and that being I discourage family to be present when the funeral home comes for the body. I encourage them to say their good-byes before the funeral home gets there. In my experience, it can sometimes be very difficult to move a body who is not in a hospital bed, i.e. recliner chair or upright. It can be very upsetting to see that for a loved one.
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BK Books replied:
Hi Colleen, I agree it can be upsetting. I suggest they stay in the other room and I will be their representative BUT if they want to be there I will support them and be with them. Thank you for sharing. Blessings!! Barbara
I just have one comment and that being I discourage family to be present when the funeral home comes for the body. I encourage them to say their good-byes before the funeral home gets there. In my experience, it can sometimes be very difficult to move a body who is not in a hospital bed, i.e. recliner chair or upright. It can be very upsetting to see that for a loved one.
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BK Books replied:
Hi Colleen, I agree it can be upsetting. I suggest they stay in the other room and I will be their representative BUT if they want to be there I will support them and be with them. Thank you for sharing. Blessings!! Barbara
Robin Riddle
Yes! Just this morning we had hospice staff tell us that they will not remain in the family home beyond pronouncing. They will not prepare the body in any way. They will not wait for the funeral home to arrive. No wonder the family dreads having to ask this hospice agency to make the “death call”….
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BK Books replied:
Hi Robin, So sad to hear that. I’m thinking End of Life Doulas will stay. Blessings! Barbara
Yes! Just this morning we had hospice staff tell us that they will not remain in the family home beyond pronouncing. They will not prepare the body in any way. They will not wait for the funeral home to arrive. No wonder the family dreads having to ask this hospice agency to make the “death call”….
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BK Books replied:
Hi Robin, So sad to hear that. I’m thinking End of Life Doulas will stay. Blessings! Barbara
Laura Jenkins
Thank you. This is beautiful. Our experience wasn’t exactly like that, but our wonderful hospice nurse death call visit was definitely more than 10 minutes. What struck me most at the time was how gently the nurse explained that my daughter and I probably wanted to step out of the room while the funeral home staffer and she moved my husband’s body to the gurney. She was exactly right.
Thank you. This is beautiful. Our experience wasn’t exactly like that, but our wonderful hospice nurse death call visit was definitely more than 10 minutes. What struck me most at the time was how gently the nurse explained that my daughter and I probably wanted to step out of the room while the funeral home staffer and she moved my husband’s body to the gurney. She was exactly right.