Managing an expected home death.

grows louder as it nears your home and you realize you’ve made a mistake. But it’s too late. In a moment of panic, you dialed those three digits — 911 — and triggered a system. Soon paramedics are rushing through the front door and into the bedroom where your grandfather lies beneath his favourite blanket, without breath, without pulse, finally at rest after a fight with cancer that lasted a year but seemed like a decade. The paramedics attempt to coax life back into the body, a futile effort, and yet, despite your pleas for them to stop, they persist. Then you hear more sirens. Seconds later, you are standing in your driveway, a police officer peppering you with questions, and neighbours, curious about the commotion, peering at you through slits in living room curtains. Your grandfather didn’t want this. You didn’t want this. Nobody wanted this. So much for a peaceful death at home. This is a scenario no family wishes to experience, which is why, according to experts in end-of-life care, people should have a plan in place for an expected death in the home. Otherwise, the family member present when the death occurs may be left wondering what to do and whom to call. For a planned death, there is no need to call anyone except the physician involved in the deceased’s care and the funeral home director. Some people don’t realize this, however, and inadvertently turn an expected event into a false emergency. “If a family member panics at the time of death and calls 911, paramedics will respond. A paramedic has to initiate full resuscitation, even if it is obviously not the right thing to do. Police have to be called and the coroner has to be called. If you call 911, it is recognized as an unexpected event and an emergency,” says Dr. Doris Barwich, program medical director of end-of-life care for Fraser Health in British Columbia. “People panic and think that calling 911 means they are just calling for help, but what they are doing is triggering a cascade of events.” To assist families caring for terminally ill relatives, some provinces have published guidelines on how to manage an expected home death, including Nova Scotia (www.gov.ns.ca/health /reports /pubs/PFEDH_brochure.pdf), Prince Edward Island (www.gov.pe.ca /photos /original/hss_homedeath.pdf) and Manitoba (www.cpsm.mb.ca /guidelines /gdl1600 .pdf). The instructions are similar, for the most part, informing families to complete forms indicating a death in the home is imminent (to be sent to parties involved in the care of the patient and the eventual transport of the body, including the home care services provider and the funeral home) and to notify the funeral home when death appears near, while cautioning against calling the police, a coroner or emergency services. Barwich prepared the protocol for British Columbia, which states that a “No Cardiopulmonary Resuscitation” form should be completed (www.health .gov .bc .ca/hcc/pdf/expected_home _death .pdf). Ideally, a physician or nurse should visit at the time of death, but if a family decides to contact the funeral home directly without consulting a health care professional, they must also possess a “Notification of Expected Death” form. This document, to be completed by a Managing an expected home death