Death in nursing home - is this normal - a bit shocked.

[MistressoftheDarkSide]

I'm posting here because I have no-one I can really contact at this time of night.

My MIL has been on palliative care for the last couple of weeks - end stage dementia and possible bowel cancer which wasn't investigated fully after long conversations with her GP. She stopped recognising anyone over 5 years ago. I saw her on Tuesday and it was heartbreaking.

I had a call just after midnight to say she had passed away, and basically the nurse who called immediately asked me to arrange for her to be removed immediately. I am two hours away and my father died in the middle of April, so I am in the middle of organising his funeral. I had mentioned at a meeting with tge funeral director on Tuesday afternoon that my MIL would likely be their next customer but hadn't formally engaged them in respect of her because from experience of several deathbeds one can never be sure how long these things will take and it felt disrespectful. To be frank I'm struggling emotionally with losing my Dad and my MIL became my sole responsibility when my DP died three years ago.

I'm posting because I'm so taken aback by the almost indecent haste of all this. The nurse said she had passed literally ten minutes before they called me.

Nobody explained to me any sort of procedure when I was there on Tuesday. I was asked if anything was in place and said I would make arrangements, but nobody said that if she passed in the night I would be expected to organise everything then and there. They were most insistent that they couldn't keep her till morning even.

Fortunately the funeral directors have a 24 hour line so the nursing home contacted them, but because they are out if area it's all being done through another firm in the interim until all paperwork is completed.

I don't want to over react if this is standard procedure and this is all my fault, so has anyone else had a similar experience? I was left feeling as though I've just done everything wrong, and I'm in bits to be honest. I can't contact anyone for support till the morning, so if anyone can talk me down I'd be really grateful.

Of course she would be qualified to verify death, or one of her colleagues would be. Doctors do not typically get called out to do that in nursing homes, they just fill in the form.

That’s helpful isn’t it.

OP I’m sorry for your losses it’s a shocking thing to wake up to in the middle of the night 💐

That sounds like fairly brutal policy from the nursing home. How shocking to be rushed like that
Please be very kind to yourself today.

It's not your fault but I think it is normal. When my mum died in hospital they insisted we had to get the funeral directors to move her straight away. No idea why they couldn't keep her until the morning
Luckily where my parents live there is a fantastic funeral directors (I know that sounds weird) with a 24 hour line and they did come quickly which suggests it's normal. I guess with nursing homes and hospitals they don't want other patients to see someone has died so it's easier (for them) to do it at night.
I'm really sorry you've been hit with two losses close together.

Bit of an aside but there's relatively few nurses who can formally/legally recognise death. It's not a standard part of their role. Absolutely they can do the practical - and realise a person has died but its generally someone else that has to visit and see them - paramedic or Dr.

I'm my area even the community palliative nurses cannot legally recognise death which seems mad but it is what it is. They could be with an end of life patient supporting them in their last hours with pink card medications, note the time they stopped breathing informing family etc, but they'd generally need to then ask either paramedic or Dr to visit. Out of hours this is generally a paramedic from the ambulance service - we aim to visit in the hour, recognise death, phone the oogp and pass the details of what's happened for the medical notes /confirm that we're agreed it's an expected death (death that is medical in nature and that we can be quite certain of the cause + has seen by a Dr recently).

I understand there is additional training available/some local or patient specific pathways that enable a nurse to legally recognise that a patient has died so it's not impossible just not usual. Only a Dr can issue a death certificate but they don't have to see the patient after they've died. They can do so from notes.

I’m so sorry for your loss. It does sound incredibly insensitive, the way it was dealt with in the care home. Like others have said, their are reason the way they have to do it.
We were treat so differently when my mum died in a care home. We got a call to say she had passed away, early hours of the morning. My sister got the call and called me. We immediately when to the care home.
We were greeted at the door, we went into my mums room, they had covered her with a lovely sheet and put some flowers by her bed. The nurse on duty, said we could stay and say our goodbye and stay as long as we needed. She then brought us cups of tea and left. No mention of funeral directors just kindness. After a while she came back and asked if we wanted anything. We then asked her, what do we do now? She said they would phone a funeral director of our choice, when we were ready, again no hurry. 🌺🌈

I'm so so sorry you are going through this - it sounds brutal and so frustrating that in a hospice they hid behind euphemism "are arrangements in place" rather than spell it out what was needed.
I don't know if it's any help but I and a lot of people of this thread had no idea that it was that fast. But now we do. You've probably saved hundreds from going through the same shock as you. Thank you - I hope that brings a little comfort that you've saved us from that.
💐

I’m sorry for your loss. My mum died at 4am and I was called asking if we wanted to see her, we said no so the undertakers arrived and took her to the funeral home shortly after. When my uncle died at a similar time, again the funeral directors were there promptly. I think it is normal for nursing homes as no one really wants a deceased person hanging around, it is much more dignified to be at the funeral home.

I dont.know if it's standard in a nursing home but my mum passed away at home a few months ago ,and her body was collected within a couple of hours after we phoned the funeral directors they were very professional and efficient.

It is quite a brutal process - I remember when my late Mum was in a CH under the contract you had to have arrangements for who would be the Undertakers. We paid out for a funeral plan to cover that eventually. We also had to clear her room within 24hrs of death.

I'm sorry you have had such a poor experience with the care home OP.

My mother died in a care home a few months ago. She died in the night and they rang me first thing in the morning. I had told them which local funeral director I wanted to use (but had made no arrangement with them).

The care home got the doctor in to certify death, and arranged for my mother to be taken to the funeral directors. The staff were very kind and rang me at each stage, I did not have to do anything.

I rang the funeral director the next day to make sure they had my contact details, and when I got the death certificate I made the arrangements for her cremation.

The care home did not give me a timescale for clearing her room, they said to go in whenever I was ready. But I knew that the room would (obviously) be charged for until I cleared it. Her fees were paid up for the next fortnight anyway so I did it a week later.

I think it’s usual , but obviously there are better ways of asking . We were asked if we wanted to see my mum first and we were not pressured to clear the room straight away .

Sorry for your loss.

I do think this is standard though. When my grandmother passed in a home I went straight to her and within a hour rang a funeral directors. We waited till they collected her. We were asked to collect her belongings as soon as we could do did the next day.

I know it may sound cold but I don't think they can hold bodies in the same way you may have the choice to do at home. They are probably keen to deal with on that shift rather than having more staff and residents impacted. Sadly it happens very regularly in homes.

Sorry for your loss. Sounds as though they delivered the conversation very insensitively but in my experience this is standard. As others have said, in a hospital they can take the body to a chilled morgue, but care homes don't have that facility so it's straight to the funeral directors.

I hope you manage to sort things out in the next few weeks and do look after yourself. x

This depends on the local area.

I'm sorry for your loss.

Care homes don't have morgues or proper places to hold a dead body. They likely start to smell within a certain amount of time and need to passed to the undertaker very quickly. They just can't sit out for hours, or days without proper preservation.

Experience of two elderly relatives dying in care homes and this is exactly what happened. Asked to arrange an undertaker to remove body asap and room to be cleared out within 24 hours.

It seems harsh but they're a business so they want the room available.

Sorry for your losses OP.
Normal practice I think. My relative died at night after 8 weeks of “any time now” the nursing home had asked in advance for the funeral directors details so it was all very quick once they had died. And I can understand why - those places are heated to ridiculous temperatures.
There was no hurry to clear the room though, but she had been there best part of 8 years at 6k a month so they’d probably had their moneys worth!

I know someone who works as a funeral director and the reason they have staff on call is for deaths out of hours.

Without going in to too much details, care homes don't have the facilities to look after bodies.

You just pick the phone up and contact the funeral director you have chosen, it only takes a few minutes.

Both my parents died in hospital but they both were in a home prior. We certainly were given longer to clear their room. A few days in my dad's case and with mum it was just over a week.
With mum they brought us tea while we sorted everything out and never felt rushed at all.
So sorry for your loss for your dad and your mil.

Wishing you well today @MistressoftheDarkSide
Myself and a friend both had ill parents and I made a point of telling her the things I found most bizarre which really helped me process it and consequently she was a bit more prepared.
My dad, expectedly died at home 2am, and they had shuffled him out by 4am. I think I was expecting something I'd only actually seen in movies - peacefully lying there while family visited.

Everything else is taken at a slower pace now. And it does get easier, you can take time to decide what and when.
I found telling the first person hard, then I got a bit of a script going. I also found all the professionals involved in death events - medical, carers, funeral arrangements even down to booking catering amazing. Death seems to bring out a patience and support in strangers acting for you.

Best wishes to you in these sad days.

I think it's normal, for hygiene and morale reasons. Care homes are very warm and don't have facilities for storing remains. It might also be upsetting for staff, other residents or their family members to know that their client/friend is lying in the next room/along the corridor. That being said, it doesn't sound as ithe home communicated well. They should have prepared your family for this.

My mum was in care and died 18 months ago . About two months before she died the manager told me (very kindly and tactfully) something I had already suspected, that although they couldn't make a prediction as to when, Mum didn't have long left to live and I should be 'putting things in order'.

I went straight from that meeting to a local funeral parlour and made arrangements and passed the details to the care home. When Mum eventually died I was 5000 miles and several time zones away but the plans kicked in and the home and the funeral directors handled things beautifully between them. I was very grateful to them.

I’m so sorry for your losses OP and that you have so much on your plate; it’s really hard and sad.

I’m sure the home could have handled it more sensitively and supported you more, possibly by asking the question about undertakers in advance. But I do think it makes sense for them to arrange collection of the body as soon as they can; it’s distressing for the staff and residents too and there is nowhere a body can be safely and respectfully kept, which there is at a funeral home. When a close relative of ours died at home we called the undertaker very quickly
for his body to be collected; anyone who wanted to see him again could do so there rather than at our house. So I don’t think it was wrong to ask you about this at the time they called to advise you that she had died; but I am really sorry they hadn’t prepared you for it or introduced it sensitively when they called you.

Please take care of yourself.

That’s the bit that was missing for the OP - the advanced discussion about arrangements in the event of death.

What the OP is describing may be “normal” for many but that doesn’t make it right or acceptable.

Having processes to discuss arrangements for the point of admission should be standard and it isn’t a shortage of money thing either, its just very poor organisation. Its completely unreasonable to expect a bereaved relative to find a funeral director in another area in the middle of the night which is exactly why it should all have been discussed with options on record at the point of admission.

I am sorry for both losses, not surprised you are bewildered.

I've no experience of this, many elderly people die in hospital so there is less rush, I do sort of understand that a nursing home does not have the facilities for keeping bodies too long which may explain it. It should have been said to you in a sensitive manner with explanation given.

However your mother in law has been collected so that bit is over.

Regarding her bowel cancer not being properly investigated, many elderly people have that or other forms of cancer and nobody knows about it until post mortem. Cancers grow slowly in old age and as long as there are no unpleasant symptoms, it is usually considered best to leave well alone. Sometimes investigations and treatment at that stage are more unpleasant than the illness and death is hastened. That happened to my cousin who had bowel cancer. An aunt of mine was found to have had lung cancer on post mortem but she hadn't experienced much in the way of symptoms so was not investigated and died of age related things. Please try and put that out of your mind now, your mother in law is at peace.

As far as her personal effects are concerned, I see no reason why they cannot all be put in a box and posted to you. It's unfair to expect you to go there if it's a long journey. Perhaps ask what the personal effects are, you are hardly likely to want nightclothes, cardigans and the like but bits of jewellery, watch, clock, letters etc could easily be parcelled. However they may not do that sort of thing but do ask.

It seems you are dealing with most of this on your own. It will pass and then you must look after yourself, build yourself up and pamper a bit for a while so you can move on and live your life well.

Good luck.