The first hours after a death: who to call, by where it happened
Who to call first depends on where and how the person died. This chapter sorts the six common situations, the donation calls that cannot wait, and what can wait until morning.
- Start here: the essentials
- 1. Which situation is this: the first call for each
- 2. A death at home, with or without hospice
- 3. In a facility, or sudden and unexpected
- 4. Away from home, or abroad
- 5. Donation calls that cannot wait
- 6. The paperwork path and investigations
- 7. See it: two first nights
- 8. Practice: your first-call plan
- 9. Your arrangements
- 10. Check your work
- 11. Knowledge check and scenario
Start here Essentials
At minimum, make the one call that fits where and how the person died, and write it down. Everything else in this chapter can wait until the call is made.
- Find your situation in the table. Hospice at home, at home without hospice, a facility, sudden or unexpected, another state, or abroad (the six situations).
- Make the call that fits it. Hospice at home: the hospice 24-hour line, not 911. Not sure the person has died, or the death was sudden: 911 (a death at home).
- Say so if the person registered as a donor. Tell whoever answers, and call a whole-body program at once (donation calls).
- Ask one person to come and be with you. A friend, a neighbor, a relative (see it).
- Write each call on the contacts sheet with the time (contacts sheet).
Minimum time: about 10 minutes for the calls. Done when: the death has been pronounced, or the call that leads to it has been made, and the contacts sheet lists who was called and when.
1. Which situation is this: the first call for each Understand
If you are not sure the person has died, or the death was sudden or unexpected, call 911. If the person was in hospice care at home and the death was expected, call the hospice's 24-hour number instead. If you or someone with you is in crisis, call or text 988, any time.
A death has to be pronounced: declared by someone with the authority to do it. The National Institute on Aging names a doctor in a hospital or nursing facility, or a hospice nurse, as examples. That person fills out forms giving the cause, time and place of death, and those forms are what let the official death certificate be prepared (NIA, What To Do After Someone Dies). Terms in this chapter are in the glossary.
Who pronounces the death, and so who you call first, depends on where the person died and whether the death was expected. Find your row; the sections below give the detail.
| Situation | First call | Who confirms or pronounces the death | What happens next | What can wait |
|---|---|---|---|---|
| At home, under hospice, death expected | The hospice's 24-hour number, not 911 | The hospice nurse | The nurse comes, confirms the death, completes the paperwork, and can call a funeral home for you | The funeral home call, until you are ready, within your state's rules |
| At home, no hospice | 911 | Emergency responders, then a doctor or the medical examiner or coroner | Responders come; police may come; the case may go to the medical examiner or coroner | Everything except the call and any donation call |
| In a hospital, nursing home or care facility | The staff are already there; ask the nurse in charge what happens next | A doctor or the facility's staff | Staff ask about donation and which funeral home will collect the body | Most decisions; ask how long the body can stay |
| Sudden, unexpected, violent or unattended (the medical examiner or coroner may be involved) | 911 | Responders; the medical examiner or coroner decides whether to take the case | Ask the dispatcher or police before moving the person or anything near them | The funeral provider, until the body is released |
| Away from home, in another US state | The call for the row above that fits where and how the person died | As in that row | A funeral home where the death happened, and perhaps one at home | Burial or cremation, and where, for a day or two |
| Outside the US | The local emergency number, then the US embassy or consulate | Local authorities, under that country's law | Consular staff explain local rules, documents and the choice between return and local burial or cremation | Return or local arrangements, while the consulate explains the options |
Reading this ahead of time? Write the number for your row on the contacts sheet now.
If you are not sure which row
- You are not sure the person has died. Call 911. The hospice row applies only when the hospice is already caring for the person and the death was expected.
- The person was in hospice, but the death was sudden in a way that worries you (a fall, an injury, something that does not fit the illness). Call 911, and tell the dispatcher the person is under hospice care. The sudden and unexpected section explains why.
- The person was away from home. Use the row for how they died, wherever that was. Distance changes the transport and the funeral homes involved, not the first call.
2. A death at home, with or without hospice
At home under hospice care
Hospice is care for a person whose illness is expected to end in death, aimed at comfort rather than cure, and often given at home. When a hospice patient dies at home, the Hospice Foundation of America says family and caregivers should not call 911 or emergency services. Call the hospice provider's 24-hour number instead (HFA, When Death Happens at Home).
The reason is what each call sets in motion. 911 starts an emergency response. A hospice nurse comes to confirm a death the care team expected, and the hospice already has a plan for it. NIA says the same: if the person was in hospice, a plan for after death will likely already exist.
Per HFA, a hospice team member who comes after a death at home can:
- confirm the death and complete the legal paperwork, which the hospice sends to vital records so a death certificate can be issued;
- call a funeral home, or help you find one;
- prepare the body for transport and, if possible, stay until the funeral home staff arrive;
- help with calls to relatives;
- arrange removal of the equipment the hospice supplied, such as a hospital bed or oxygen;
- dispose of the person's medicines, which HFA describes as a federal requirement.
That is one organization's description; ask the nurse which of these your hospice does. One provider's rule
At home without hospice
When the person was not in hospice, call 911. Kansas State University's after-death checklist says so for a death at home without supports in place (K-State Research and Extension, Checklist for After a Death, MF3699), and AARP's checklist gives the same instruction for a death at home (AARP, What to Do When a Loved One Dies).
Expect responders, possibly police, and questions about the person's health and their doctor. A death at home without a doctor's recent care can be one the medical examiner or coroner reviews, depending on the state (next section).
If the death was expected but no hospice was involved, NIA suggests asking the doctor, the medical examiner or coroner, the health department or a funeral home how to proceed. In the first hour, 911 is still the call.
Time with the person, and when the funeral home call becomes necessary
NIA says there is no need to move the body right away after a death at home. Families may stay with the person, and this is the time for religious, ethnic or cultural customs. Family's choice If a faith or family practice sets what happens in the first hours, tell the nurse and the funeral home when they arrive.
Calling a funeral home is not required in the first hour after an expected death at home. The call becomes necessary when one of these is true:
- The place needs the body moved. A facility will ask (next section). At home, HFA notes that state laws vary on how quickly the body must be retrieved. Varies by state Ask the hospice nurse what your state and the hospice expect.
- A time limit set by the state or the provider is running. Some states set limits after which a body has to be refrigerated, embalmed or buried. Who decides gives the examples and who they bind.
- A faith tradition asks for burial soon. Who decides covers timing set by faith.
- You are ready. NIA says the body is picked up when the family is ready and according to local laws.
Burial or cremation need not be chosen before the body is collected: the transfer of remains to the funeral home is its own line on a funeral home's price list (16 CFR Part 453, the Funeral Rule). If the nurse offers to call a funeral home and you have not chosen one, you can ask for time to make one or two price calls in the morning. Funeral homes and your rights covers choosing.
Hospice ended before the death. If the person left hospice care before dying, the hospice row may no longer apply. Call the hospice line if you still have it and ask; if you cannot reach anyone and are not sure what to do, call 911.
3. In a facility, or sudden and unexpected
In a hospital, nursing home or care facility
When the person dies in a hospital or nursing home, the staff handle the pronouncement. AARP and NIA both say so. Staff will usually ask two things soon after: whether the person was a donor, and which funeral home will collect the body. A hospital that has a patient near death or who has died tells the local organ procurement organization under federal rules, whether or not you raise it (donation calls).
Four questions to ask the nurse in charge:
- How long can the body stay here? The answer tells you how soon you need a provider.
- What happens if we have not chosen a funeral home by then?
- Can we have time with the person, and can our customs be followed here? NIA advises discussing customs with facility staff early.
- Has anyone talked about an autopsy or the medical examiner? If the death was unexpected, the answer may change the timing.
The facility's need to clear a room is a reason to choose soon, not to sign with the first provider named (Funeral homes and your rights).
A sudden, unexpected, violent or unattended death
A medical examiner or coroner is the official who investigates deaths that the law says need a closer look. In most states a coroner does not have to be a physician or a forensic pathologist, per CDC's Public Health Law Program (CDC, Coroner and Medical Examiner Laws). Which system a county has, and which deaths it reviews, is set by each state. Varies by state
CDC's handbook for medical examiners and coroners lists the deaths that typically require investigation, while noting that state laws vary (CDC NCHS, Medical Examiners' and Coroners' Handbook):
- deaths from violence: an accident, a suicide or a homicide;
- deaths in unusual or suspicious circumstances;
- a death from natural disease that was sudden and without warning;
- a death when the person was not being treated by a physician;
- a death that was unattended.
CDC's physician handbook lists falls, fractures, overdoses, choking, burns and exposure to heat or cold among the conditions to refer to the medical examiner or coroner whatever the time since the injury (CDC NCHS, Physician's Handbook on Medical Certification of Death).
When the medical examiner or coroner takes jurisdiction (takes the case), the office decides whether to examine the body and when to release it to a funeral provider. Until then, a funeral home can be chosen but cannot collect the body.
We do not say whether a death has to be reported, or whether the medical examiner or coroner will take a case. The police, the medical examiner or coroner, or the attending doctor decide that. After a sudden, violent or unexplained death, ask the 911 dispatcher or the police before moving the person or anything near them. The release date and any autopsy are the office's decisions; ask the office, not the funeral home, how long they will take.
While you wait, you can tell family (Sharing the work), find papers (Information and papers) and call providers for prices (Funeral homes and your rights). Write the medical examiner's or coroner's office, the case number they give you and the name of the person you spoke with on the contacts sheet. The funeral home you choose will need that number.
4. Away from home, or abroad
In another US state
Make the first call for how the person died, where they died: hospice line, 911, or the facility's staff. Distance changes what comes after. A body can be moved home, or cremated where the death happened and the ashes carried or sent home. Funeral Consumers Alliance's pamphlet on a death away from home lays out both (FCA, Death Away from Home):
- Cremation where the death happened. If no viewing is needed, FCA calls this usually the easiest. Compare all-inclusive prices, including crematory and permit fees.
- Burial at home. Two funeral homes take part, as AARP's checklist also notes: one where the person died, which handles forwarding remains, and one at home, which handles receiving remains. Both are separate lines that the Funeral Rule requires on a General Price List when a home offers them (16 CFR 453.2(b)(4)). Federal rule Airfare is extra in both.
FCA's 2020 pamphlet gave ranges of about $500 to $3,000 or more for receiving remains and $1,000 to $3,000 or more for forwarding. Those are FCA's 2020 figures, not what any provider charges now; the price lists do that (Goods, prices and the statement).
The first decision is which funeral home takes the body into its care where the person died. If the family needs a day to agree on forwarding or cremation, ask that home how long it can keep the body under refrigeration and at what price. Who has the right to make the call when the family disagrees is Who decides.
Outside the US
CDC's page on bringing remains into the US says the first step is to notify US consular officials, and that consular staff are available 24 hours a day, seven days a week (CDC, Importation of Human Remains). Next of kin in a different country from the death can call the State Department's Office of Overseas Citizens Services:
- 888-407-4747 from the US (toll-free);
- 202-501-4444 from abroad;
- after hours, weekends and holidays, CDC gives 202-647-4000; ask for the Overseas Citizens Services duty officer.
CDC gives the lines' hours as 8 a.m. to 5 p.m. Eastern, Monday to Friday. If you are in the country where the death happened, call that country's emergency number first, then the US embassy or consulate there.
USAGov says the embassy can communicate with local authorities, explain how to send funds, help with returning the remains or with local burial, and help complete documents, including the Consular Report of Death Abroad, the US record of a citizen's death in another country (USAGov, What to do if a US citizen dies abroad).
Return is not the only choice. FCA's pamphlet says local burial is often the cheapest option, although a few countries do not allow burial of foreigners, and cremation is available in most countries but limited in some. The consular officer can say what the country allows. A US funeral home is still needed to receive remains or ashes at home if there will be a burial or service there. Ask the authority
5. Donation calls that cannot wait
Donation is the one decision besides the first call that is lost if it waits. If the person registered, tell whoever answers the first call, then make the donation call yourself if no one else will.
| Kind | Who makes the call | Timing, per the source | Source |
|---|---|---|---|
| Organ donation | The hospital calls the organ procurement organization | Organs stay usable only a short time | HRSA |
| Brain donation (a registered brain donor) | The family calls the program's contact | Within two hours after death | NIA |
| Whole-body donation to a medical school | The family, the funeral director or the hospital calls the program | At once; one program asks for delivery within 24 hours | KU Medical Center, UT Southwestern |
Organ donation
When a patient is near death or has died, the hospital tells the local organ procurement organization (OPO), the federally designated group that coordinates donation in that area. The OPO decides whether the person could be a donor. A registry entry is legal consent; otherwise the OPO may ask the next of kin. Donation is considered only after death is declared, and the transplant team is not the team that treated the patient (HRSA, Donation After Life; HRSA, How To Sign Up). Federal rule
HRSA says registering does not mean donation will be possible, and that donation does not prevent an open-casket funeral. If you know the person registered, tell the nurse; the OPO will check. HRSA describes organ donation as arranged through the hospital, so after a death at home, ask the hospice nurse or the 911 responders whether any donation is still possible.
Brain donation
Brain donation for research is separate from organ donor registration. NIA says a registered brain donor's point of contact must be notified within two hours after death. If the person signed up with a brain bank or a research study, look for its card or letter now for the contact number.
Whole-body donation
Whole-body donation gives the body to a medical school or a body donation program for teaching or research. Each program sets its own rules. Two academic programs, as examples: One program's rule
- The University of Kansas Medical Center's program says the time between death and delivery should not exceed 24 hours, that the funeral director or hospital should call immediately, that the body should not be embalmed before delivery, and that it does not accept autopsied bodies (KU Medical Center, Willed Body Program FAQ).
- UT Southwestern's program asks to be notified immediately at death, since delay may make the body unsuitable, and says next of kin may arrange donation even without pre-registration (UT Southwestern, Willed Body Program).
Both programs can decline a body, for reasons such as distance, disease, the condition of the body, or an autopsy. If a program declines, the family arranges and pays for another disposition. Write a backup provider on the contacts sheet before you call the program, so a refusal does not start the search from nothing. Burial, cremation and other choices covers donation as a choice for the body.
The tables and steps above are for the first call. They do not settle how long a body may stay at home, whether a state requires a funeral director for any step, or whether an investigation or autopsy will happen. The hospice nurse, the facility, the medical examiner or coroner, and your state's funeral board answer those.
6. The paperwork path and investigations Go deeper
How the death certificate gets made
CDC's Funeral Director's Handbook describes the model most states follow, with the warning that state laws vary (CDC NCHS, Funeral Director's Handbook, 2019):
- The funeral director files the certificate with the registration official, within the state's time limit.
- The medical certifier (the attending doctor, or the medical examiner or coroner) completes the cause of death. Depending on the state, physician assistants and nurse practitioners can certify too, per the physician handbook.
- The informant, usually a close relative, supplies the personal facts. Information and papers covers that list.
- An authorization for disposition, often called a burial-transit permit, is needed in most states before the body is buried, cremated, released for study or moved out of the state. A completed certificate is usually required first. Several states require none, or only when the body leaves the state.
- Many states require a further authorization before cremation, so that evidence is not destroyed and the person is correctly identified. Who decides gives a state example.
So the funeral director is the person to ask about delays with the certificate.
Medical examiner and coroner systems
CDC's Public Health Law Program says each state sets its own standards for which deaths need investigation and its own training requirements, that coroners in most states do not have to be physicians or forensic pathologists, and that 20 states and DC require autopsies to be done only by pathologists. Its state profile map dates from 2015, so check the state's own law for anything since. To find the office for a county, CDC's National Vital Statistics System page links a directory of medical examiner and coroner offices (CDC NCHS, Medical Examiners and Coroners).
Autopsy
An autopsy is an examination of the body by a specially trained physician to learn more about the cause of death. NIA says the doctor may ask the family about one, that its signs are usually hidden by clothing and preparation of the body, and that a family whose religion or culture objects should talk to the doctor. When the medical examiner or coroner has the case, take any objection to the office.
Documents for remains coming back from abroad
CDC lists what consular officials help with: the death country's export papers, the US import documents (which can include a Consular Mortuary Certificate and a transit permit), and packaging. CDC does not require an autopsy, though some countries do before export. Remains that are not cremated have to be in a leak-proof container. CDC says no import permit is needed for remains already cremated or embalmed; unembalmed remains of a person who died of an infectious disease may need one.
Where sources differ: KU Medical Center's FAQ says airlines will not carry unembalmed bodies, while CDC's import rule asks only for a leak-proof container and a death certificate for unembalmed remains. Airline policy is the variable; ask the funeral homes handling the transfer.
Flying home with ashes
TSA allows cremated remains in carry-on bags, with special instructions, and in checked bags, though some airlines do not allow them in checked bags. TSA suggests a container of a lighter material such as wood or plastic, because officers have to be able to see into it on the X-ray; TSA says officers will not open a container even if asked, and a container they cannot see into will not be allowed through (TSA, Cremated Remains). Check the airline's own rule as well.
7. See it: two first nights See it
Sam Okoro and Ellen Okoro. Names, times and results are invented for this manual. Ellen Okoro, 71, a retired school librarian, widowed, was under home hospice care for heart failure in Spokane, Washington. She died at home at 4:10 a.m. on a Tuesday. Sam, 34, her only child, lives twenty minutes away and was staying the night that week.
Known. Ellen was in hospice and the death was expected, so this is the first row of the table. Sam calls the hospice's 24-hour line at 4:15, not 911; the number is on the front of the hospice folder. The nurse arrives within the hour, at 4:55, confirms the death and starts the paperwork. Sam calls their partner, Dev Raman, at 4:20, and Dev comes over. Ellen registered for no donation, so there is no donation call. At 7:30 Sam calls Ellen's neighbor, Carol Peck. Each call goes on the contacts sheet with its time.
Assumed. That Ellen can stay at home for the morning while Sam calls two cremation providers for prices after 8 a.m. That is Sam's assumption, made because NIA says there is no need to move the body right away.
Open, and who settles it. How long Ellen can stay at home under Washington's rules and the hospice's practice: the hospice nurse, and the funeral home Sam calls. Which funeral home collects her: Sam, after the price calls (Funeral homes and your rights). Whether Ellen left written wishes: the search in Who decides.
The Marsh family. Names, places and results are invented for this manual. Teodoro "Teo" Marsh, 66, an Army veteran who lived in Albuquerque, New Mexico, died suddenly while visiting his brother in Phoenix, Arizona. He had not seen a doctor for a year. His wife June, 64, and their adult children Lena, 38, and Carlos, 35, are in Albuquerque.
Known. The death was sudden and Teo was not under a doctor's care, so two rows apply: sudden or unexpected, and away from home. His brother calls 911. Before anyone moves Teo or anything near him, the brother asks the dispatcher what to do, and follows the responders' instructions when they arrive. The death is reported to the county medical examiner, who takes the case. June asks the medical examiner's office for the case number and a contact, and writes both on the contacts sheet. The body is released two days later.
Assumed. That the family has two days to choose a Phoenix funeral home. That is June's working assumption; the office has not given a release date on the first night.
Open, and who settles it. The cause of death and the release time: the medical examiner. Whether to have the Phoenix home forward the body to an Albuquerque home that receives it, or to cremate in Phoenix: the person with the right to decide, which the family does not agree on yet (Who decides). What forwarding and receiving cost: the two homes' price lists (Funeral homes and your rights).
Free sources behind this chapter:
- NIA, What To Do After Someone Dies: pronouncement, time with the body, autopsy and brain donation, by where the death happened.
- Hospice Foundation of America, When Death Happens at Home: what to call and what the hospice team does after an expected death at home.
- Funeral Consumers Alliance, Death Away from Home: the choices and the price lines for a death in another state or abroad (prices from 2020).
- CDC, Importation of Human Remains: the consular steps, the Overseas Citizens Services numbers and the documents for return to the US.
8. Practice: your first-call plan Practice
Minimum: the first call for your situation written on the contacts sheet, with the number, plus the one person you will ask to come. Time: about 15 minutes, or the length of the calls if the death has happened. Materials: a phone, the contacts sheet, the hospice folder if there is one, and any donor card or program letter among the person's papers.
- Name the situation. Pick the row in the table. If two rows apply, as for the Marsh family, write both.
- Write the first call on the contacts sheet: who, the number, and what they will do.
- Look for a donation registration. Check the driver's license, a donor card, or a brain bank or medical school letter. If there is one, write its number on the sheet as the second call.
- Write the person who will come. A name and a number, and a second name in case the first cannot.
- Log each call as you make it, with the time and what was said. If a medical examiner or coroner is involved, add the case number.
- If the person is dying and you are planning ahead, fill the contacts sheet now: the hospice line, the person's doctor, one funeral home near the place of death and, if they live elsewhere, one near home.
- Find the medical examiner or coroner's office for the county through CDC's directory link, and write its number in case it is needed.
- If the person travels, write the Overseas Citizens Services numbers on the sheet.
9. Your arrangements Your arrangements
The box below reads your setup and shows the row of the table that fits it, with the calls to put on the contacts sheet.
10. Check your work Check your work
Criteria
- Did the first call match the situation: the hospice line for an expected death under hospice, 911 when unsure or after a sudden death, the staff in a facility, the consulate abroad?
- Has the death been pronounced, or is someone with the authority to pronounce it on the way?
- If the person registered for any donation, was the program or the hospital told, inside the program's time limit?
- Is one person with you or on the way?
- Does the contacts sheet list each call with the time, and a case number if there is one?
- Do you know who will tell you when the body has to be moved: the hospice nurse, the facility or the medical examiner?
Worked example
Sam's night (fictional example) meets each criterion. The hospice line, not 911, fits an expected death under hospice. The nurse confirmed the death at 4:55. There was no donation to report. Dev came at once. The contacts sheet shows the hospice call at 4:15, Dev at 4:20 and Carol at 7:30. The one criterion still open is the last: Sam has assumed there is time for price calls in the morning, and the nurse is the person to confirm it before the nurse leaves.
The Marsh family's night (fictional example) meets them as far as the family can; the medical examiner sets the release.
Common mistakes
- Calling 911 after an expected death under hospice. It starts an emergency response, and the hospice's plan is set aside. Use the number on the hospice folder.
- Calling the hospice when you are not sure the person has died. If you are not sure, call 911.
- Tidying the room or moving the person after a sudden death before asking the dispatcher or the police.
- Waiting until morning to call a whole-body donation program. One program asks for delivery within 24 hours.
- Choosing a funeral home because the facility asked for a name within the hour. Ask how long the body can stay, then make one or two price calls.
What is still unresolved
This chapter gets the death pronounced and the first calls made. It does not settle who has the right to make the decisions that follow, which decisions have a deadline, or how long the body can wait before it is collected; Who decides takes those up. Whether a death is investigated, and when the body is released, is the medical examiner's or coroner's decision. The choice of funeral provider is Funeral homes and your rights.