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The most important thing is to make sure there is a DNR. Have the patient or their representative sign it well ahead of time. Make several copies and post them in prominent places around the home.
The next step is do not panic or allow anyone else to. A death in the home that is expected and has a DNR in place is not an emergency. Having Hospice in place will ease the burden. I can only speak for my part of NYS but a hospice RN can pronounce a death in the home and call the funeral home when the family is ready and I do stress when the family is ready as many times they will want to wait several hours for a distant relative to arrive. The hospice RN will notify the patient's MD and the funeral director will take care of obtaining the death certificate.
Having friends who may have to deal with an at home death without hospice I have suggested that they wait an hour before calling 911 and when the ambulance arrives inform the EMTs the actual time of death and show them the DNR and hopefully they will respect the family's wishes. Unfortunately the police will be called and the medical examiner will have to confirm death before the funeral home can be involved.
How do you know when someone is actually dead and not just in a deep coma. all I can tell you for sure is you just know. Check for a pulse in the neck, listen to the heart, if you don't have a stethoscope just put your ear on the chest and do the same with the belly. People who are sensitive to psychic or spiritual matters may just feel the life, soul or however you want to describe it leave the room. Some people even open a window so the soul can leave. Most home deaths are very peaceful and quiet but I can't guarantee that. Even in an unconscious state some loved ones want to die alone and wait till everyone has left the room. If that happens please don't feel guilty and wish that you had stayed a few more minutes. Others will stay alive against all odds for special reasons, like waiting for the birth of a new grandchild or a son to get home from the military. Death is a part of life and we leave this earth in different ways just as we come into it. death itself does not seem to be frightening it is the events leading up to it that makes people fearful so try not to do it alone and you will be doing the most loving thing you can do for an elder to let them die at home with dignity.
I am so sorry you are going through this, my heart aches for you both..
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