While most Americans would like to die at home, most die in institutions due to a chronic illness where death was the expected outcome.
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Laws on DNR orders vary from state to state. State medical boards are the best sources for each state.
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Medicare reimburses for in home physician visits.
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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.
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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.
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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.
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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
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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).
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Families of patients must be offered up to one year of bereavement support by the hospice.
