Pearls

	•	While most Americans would like to die at home, most die in institutions due to a chronic illness where death was the expected outcome.
	•	Laws on DNR orders vary from state to state. State medical boards are the best sources for each state.
	•	Medicare reimburses for in home physician visits.
	•	However, sadly, physician house call to sick and dying patients are rare events these days. Many patients admitted to hospice never see their physician again.
	•	Dying peacefully at home — without being whisked away by paramedics while resuscitation is attempted — is difficult to do without the assistance of a home hospice program.
	•	It is to be remembered that the paramedics report to the local ER physician. Thus even the presence of a medical doctor at the scene of the code will not stop the paramedics from attempting resuscitation on a terminally ill patient without proper documentation about resuscitation preferences.
	•	A patient dying at home needs to be pronounced by one of the following: An RN/Hospice Nurse A physician A police officer A paramedic A medical examiner from the coroner’s office
	•	At the time of death, the family is instructed to call the on-call hospice nurse, who makes a visit and pronounces the patient (24 hours a day, seven days a week).
	•	Families of patients must be offered up to one year of bereavement support by the hospice.

Palliative Care