Carehome telling family patient has died.

[ginandnappies]

Hey everyone

Posting here for traffic.

My brothers partners family has a bit of an issue, and I just want to see if anyone has any advice.

Her grandad is in a care home and her mum (his daughter) got a phone call today saying he had passed away. It has been expected for a few days. She wasn't near the home, so an hour later she got another phone call saying they made a mistake and when they went to wash him he was breathing.

Surely this isn't right. They never got a doctor to confirm the death. She was in shock after the phone call so just said ok and put the phone down.

Anyone got any advice?

Xx

Were they really sat with him holding his hand? I'm dubious.

We are in Scotland too. The doctor came to sign the certificate at his usual round the next morning. The shift nurse who was sitting with my mother telephoned me. When I went round the next day she had been washed and changed. My father died at the village cottage hospital and I was sleeping in the same room. They woke me when they found he had died on one of their usual rounds, then brought me tea and sat with me while other nurses drew the curtains to wash and dress him, and take his ring off for me. The doctor came on his morning round (again the GP) and signed the certificate.

Nurses are not all qualified to verify death. They need to have special training in order to do so.
Sometimes someone can appear to be dead but actually isn’t. And as pp has said, it can take a while for an on call doctor to attend.
How distressing for the family though. Really the staff should have said he appears to be dead but we’re waiting for the dr to confirm it.

Just to add that residential homes don't have nurses - only care assistants, so it depends largely as well if the home was nursing or residential and if a nurse is present all the time. If not then again, it would be in the hands of the surgery or on call services the home called to verify death, they will send whoever is appropriate when they can.

as nurse in hospital when someone died we use to "lay" someone out - which entailed gently & respectively washing them etc. mostly to get them ready for family to view - when someone dies the breathing can become very slow (only a couple of breathes a minute) & intermittent - the pulse get harder & harder to find (you need to check with a stethoscope & the pulse probably wont to observable on extremities but only in the main arteries - the breathing can sound laboured -

@Henryismyfriend oh gosh, that's awful! Like you said though it's prioritising which is totally understandable. Thanks for your input it's very helpful. Xx

yearof I don’t know what it’s like in hospitals, but certainly in nursing homes every death I’ve witnessed has been with a nurse/ carer sitting with the patient. There would be the odd patient who would die in their sleep unexpectedly but most of the time it’s quite clear that someone’s condition has deteriorated. They wouldn’t be left on their own if it was clear they were dying.

pulse won't be easily observable just on the extremities

I think the bit I'm struggling with is even if it's very hard to spot, shallow breathing etc the family should not have been informed until it was 100%.

Community nurse here...have also worked in residential care.

Not all areas have nurses who can verify deaths.
Our practice would be to ring doctor but inform the family at the same time. The person shouldn't be washed or moved until the doctor has been to verify the death.
I would always as nurse or carer have someone else also check the pulse and breathing before calling the doctor and then sealing the room until the doctor had visited.

As PP have said, doctors will not visit at the moment you ring. I have had a 16 hour wait from someone passing to a doctor visiting at a weekend before. Weekday is usually up to four hours as the doctors will do their morning/afternoon surgery before making home visits.

Since you are in Scotland you need to folllow the following protocol:

Write an official complaint to the manager and ask to see a copy of their official complaints procedure (to determine time they have to respond).

If you are not happy with their response put in writing that you wish to escalate it to a stage 2 complaint.

If you are not happy with their second response then get in touch with the Care Inspectorate (telephone or email) and they will formally investigate the matter and send you a copy of their findings.

English law does not require a doctor to confirm death. Especially an expected death. As the certificate must be done by a doctor who cared for and saw the deceased in the last 14 days an out of hours doctor will not be able to do that anyway. There may be a long wait for a doctor to come and confirm death as they are obligated to safely fulfil their duties to the living first so can only attend once free to do so.

My Nana died alone.

I meant if someone was holding their hand wouldn't they know they were still alive therefore he was alone.

@Ginandnappies

You're welcome, and yes I can see why you'd struggle with the family being informed before it was certified, but you have the waiting issue to contend with and honestly in the years I worked in care and the friends I made that still do, I've never heard of this happening where the family is informed and it's not actually happened. I've had a few 'I think he's..... No, not yet' moments over the years, so I can see how it could happen though.
I think as a pp said (and I was trained in care the same way) we inform of a deterioration in the condition not death unless it's confirmed by someone qualified to do so. Or until the family arrive, then you gently explain the procedure.
And washing someone after death is expected practice, like I said in my case not until death is verified, but you would wash and change them, comb hair and make them look peaceful and change the bed so that they leave for the last time as dignified as possible.

In NHS settings it is protocol to wash and wrap the body before the funeral home collects.

I'm not sure where you all think a doctor will appear from to declare the death. Especially in the community, that can take some time. The home would want the family to know ASAP so they can come and see their relative.

It's hard when a person is dying, they can stop breathing and then start again, or be really shallow breathing and you can miss it. Although someone should have checked for a pulse before informing the family. Mistakes do happen but that doesn't make it any easier on the family. There's nothing that can be done now except maybe more training for next time.

Having had a parent die in hospital and the others 8na care no,e, I find this really horrible, red I personally wouldn't have told family members over the phone that someone had died (I never do, I always say "there's been a change in their or condition" or "there's been significant deterioration"). Seems shitty but that's how I was trained, and it does minimise the distress for families
It definitely wouldn’t decrease distress. Those sort of messages send people scrambling as fast as they can to try to see their loved one before they go - and you know that isn’t possible. Thank goodness both places phoned us and had the basic decency to tell us the truth.

Other in a care home. Sorry, iPad types nonsense 90% of the time.

A doctor always had to be called when I worked in a nursing home. Also the carers always washed the deceased and made sure they where clean and dry.

When my aunt died I had a phone call to say that they were fairly sure she was dead, but would check half an hour later. That seemed sensible to me as she was so ill that it was hard to tell. I actually thought she had died the day before when I was there.

I got to the care home just after their second check and they were just washing her and tucking her up comfortably in bed until the mortuary people got there. No doctor was needed, the nurse on duty was able to confirm the death.

I wasn't in the least offended or upset by the procedure, they seemed to know exactly what they were doing and treated my aunt and me with utmost respect.

Please contact adult social care in the local authority of the home. That's a safeguarding issue.

How is it a safeguarding issue???

Not sure I would like a call to tell me that they were "fairly sure" my family member was dead

I'd want to know either way.

@jomaIone they thought a resident had died. They didn't confirm this. It's lucky they went back after an hour to wash "the body" if it had been longer, due to workload, needs of other residents that person would have been left without care. Potentially left without food, fluids, end of life palliative medications (obviously which depends on the circumstances of their condition). If they were on palliative care and their care compromised, it could have resulted in them being in unnecessary pain and distress. All that needs investigation to stop it happening to other residents. Please tell me how that isnt a safeguarding issue?

@cardibach I can appreciate where you're coming from, and at times it is less than ideal that this is the way we have to communicate with families regarding the death of a loved one, especially when we know for sure that someone has passed away, but as pp has mentioned- we shouldn't really be saying they've passed until death has been verified. The favourable option for me personally is to monitor the condition of the person and if I feel there has been a marked deterioration I would call the family to make them aware that passing is likely to be imminent, in order to enable them to get there on time to be with their loved one.

It's also important to remember that a lot of passings occur overnight and not all family members wish to be contacted at 2 or 3 in the morning to inform them of death or deterioration.

I’m so sorry. I can see how this happens but I agree, it doesn’t make it any less painful for the family. The staff do need more training to ensure it is handled better in the future.