Difficulty on getting an authorized person to come home:
It may be hard to get someone out to pronounce the patient if hospice is not involved. Most doctors will not make house calls for pronouncement and very few nurses do so outside of hospice.
Family may call 911 and the paramedics will arrive with the police and the fire department and pronounce the patient. But this will be intrusive as they will have their sirens on. It is possible to call the police department at their regular, non-emergency number and request a policeman come out without lights and sirens. This strategy meets with variable success.
The family calls 911
In California, once the paramedics have been launched via 911, there are only two things that will stop them from attempting resuscitation:
- Grossly obvious death (rigor mortis).
- (The California Medical Association (CMA) out-of-hospital do not resuscitate (DNR) form in the state of California.
Other states have somewhat different rules but most have similar outpatient DNR forms. No amount of pleading by family members or even doctors, if present, can deter them from attempting resuscitation and transfer to the ER if the patient appears to have recently died.
Funeral Home Issues
Even if the family has successfully had the patient pronounced and (if needed) received a coroner ‘s release number, a funeral home must still accept the patient. This can be difficult, especially on weekends and late at night if arrangements have not been made in advance.