When a person dies in a hospital or nursing home, a lot of the first steps are already in the staff's hands. A doctor or another authorized person pronounces the death, the medical side of the death certificate gets started, and the facility can help with the arrangements that follow.
What the staff will need from you is fairly short: the name of a funeral home, and any decisions about autopsy or donation if they come up. You can take a little time with both.
What do the staff do after a death?
The death is pronounced first. The National Institute on Aging says a death must be officially pronounced by someone in authority, like a doctor in a hospital or nursing facility, and that person fills out the forms recording the cause, time and place of death.
The CDC's handbook for funeral directors explains that a hospital or other institution may help the funeral director gather what's needed for the death certificate, sometimes handing over a certificate that's already partly filled in. In some states, if the person's own doctor isn't available, another doctor on duty can pronounce the death and, with the attending doctor's permission, release the body to the funeral director.
If you'd like time with the person, or there are religious or cultural customs to observe, tell the staff early. The National Institute on Aging suggests discussing important customs with staff ahead of time if you can, and asking a member of your religious community or a spiritual counselor to come. If family members want to see the person before they're moved, this is the time to call them.
Who does what
Facility staff
Pronounce the death, start the medical part of the death certificate, keep the person until the funeral home arrives
Funeral home
Pick up the person ("transfer of remains"), complete and file the death certificate, report the death to Social Security
You, or whoever is in charge
Choose the funeral home, answer questions about autopsy or donation, collect belongings
Choosing the funeral home
The facility will ask which funeral home to call. If the person made arrangements in advance, look for paperwork that names a funeral home. If not, the choice is yours to make, and it's fine to make a few phone calls first.
The FTC's Funeral Rule helps here:
- Funeral directors must give you price information over the phone if you ask.
- The FTC's business guidance says they can't require you to give your name, address or phone number before they answer.
- Every funeral home must give you a General Price List that's yours to keep. Picking the person up from the hospital shows on it as "transfer of remains to funeral home."
The FTC suggests comparing prices from at least two funeral homes. Our guide to comparing funeral home prices shows what to look for on a price list, and our questions to ask a funeral home can help on the phone.
Once you've decided, tell the facility. The National Institute on Aging notes that the hospital or nursing facility may help with the arrangements from there.
How long will the facility keep the body?
It varies from place to place, and there's no national rule. Ask the nurse or social worker how long they can hold the person and whether there's a charge after a certain point.
If you need a day to decide, say so. It's also fine to choose a funeral home just to bring the person into its care while the family talks about the rest. The FTC says no state law requires embalming for every death and that refrigeration is usually an acceptable alternative, and a funeral home generally can't charge you for embalming you didn't approve.
Autopsy and the medical examiner
There are two different situations here.
The first is an autopsy the family is offered. The National Institute on Aging says the doctor may ask whether you want an autopsy, an exam by a specially trained doctor to learn more about the cause of death. If your religion or culture objects, tell the doctor. The NIA also notes that an autopsy doesn't usually rule out a viewing, because the signs are generally hidden by clothing.
The second is a medical examiner case. Some deaths have to be reported to the medical examiner or coroner, even in a hospital. The CDC's handbook for medical examiners says all deaths from external causes (accidents, injuries, suicide or homicide) must be referred to them, along with sudden deaths and deaths where the cause isn't known.
- State law decides what happens, and the family's wishes are only part of it. In Minnesota, for example, the law lets the medical examiner order an autopsy when it serves the public interest, with protections for religious objections.
- If the medical examiner is involved, ask their office when the person can be released to the funeral home.
Organ and tissue donation
The doctor may ask about donation before or right after the death. According to the National Institute on Aging, some states show donor status on the driver's license, and if the person didn't record a choice, the family has to decide quickly. There's no cost to the donor's family. Brain donation is a separate process; if the person registered for it, their contact has to be told within two hours of the death.
Belongings and money held by the facility
Ask the staff where the person's belongings are and who can sign for them. In a nursing home, ask how long you have to clear the room.
A federal rule for nursing homes covers money the home was holding. If the home kept the resident's personal funds, it must hand over those funds and a final accounting within 30 days of the death, to the person or probate court handling the estate, following state law.
Frequently asked questions
Do we have to use the funeral home the hospital suggests?
The choice normally sits with the family, and specifically with whoever has the legal right to make funeral decisions. You can call any funeral home for prices first; the FTC's rule requires them to answer by phone. If the person prearranged a funeral, check that paperwork before you call around.
What if the person was in hospice at the nursing home?
Medicare says hospice care can be given in a nursing home. Call the hospice as well as letting the nursing staff know; the National Institute on Aging says hospice patients usually have a plan in place for what happens after death.
Who gets the death certificate?
The funeral home usually files it. The CDC's funeral director handbook says the funeral director completes it, gets the cause of death from the doctor or medical examiner, and files it within the state's time limit. Ask the funeral home how to order certified copies.
Sources
- National Institute on Aging: What To Do After Someone Dies
- CDC/NCHS: Funeral Directors' Handbook on Death Registration
- CDC/NCHS: Medical Examiners' and Coroners' Handbook on Death Registration
- Minnesota Statutes: 390.11, Investigations; reportable deaths
- FTC: The FTC Funeral Rule
- FTC: Shopping for Funeral Services
- FTC: Complying with the Funeral Rule
- Code of Federal Regulations: 42 CFR 483.10, Resident rights
- Medicare: Hospice care coverage
- Social Security Administration: What to do when someone dies