Pearls

Pearls Road Sign
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.
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