An elderly woman dies in her sleep, found in the morning by her husband. A man is found on the kitchen floor when his family comes home from the grocery store, a probable heart attack. A child takes a bad fall or an elderly grandmother is finally defeated by cancer.
Death — expected or not — sometimes reaches our doorsteps. Do you know what to do? I am of an age when death, while not expected, wouldn’t raise many eyebrows. I now fit the high-risk category for COVID-19, for pneumonia and serious effects from mosquito-borne illnesses like West Nile virus. So my husband and I are talking about what we’d do. Then the recent death of a friend sent me online to verify my instinct, which is to call 911.
Googling who to call can be confusing. For instance, the National Institute on Aging assures people there’s no need to move the body right away, but offers unexpected advice on who to call. In hospice, a plan is likely in place, the website says. Otherwise, “talk with the doctor, local medical examiner, local health department or a funeral home representative about how to proceed.”
When Deseret News talked to each of those, the advice was “please don’t.” Instead, call the police. Most recommended calling 911 and, if it’s clear someone has been dead a while, explaining it’s urgent, but not life-saving urgent.
Leaving-Well.org says not to call 911 or ambulance services “unless you want the paramedics to perform CPR and other life-sustaining treatment. If the paramedics are called, the law requires them to attempt to resuscitate the patient unless the patient has a special bracelet showing that he does not want resuscitation.”
That post, too, notes that if a loved one has not been cared for by a doctor or a nurse working under a doctor’s direction within the last 30 days, you have to call local law enforcement. “Failure to report such a death is a crime.”
Per that National Institute on Aging post, “You might want to have someone make sure the body is lying flat before the joints become stiff. This rigor mortis begins sometime during the first few hours after death.” Again, experts I consulted say please don’t unless you’re attempting CPR. Moving the body can interfere with a death investigation.
But who should you call? What do you say?
Here, according to experts, are best practices to handle a death at home — and what you can expect in the hours and days that follow.
The first thing to do when someone dies
The big question is whether the person was under a doctor’s recent care when they died at home. That’s an “attended death.” The alternative — an “unattended death” — calls for an investigation of varying depth, said Nick Larkin, vice president and funeral director at Larkin Memorial Corporation.
There’s broad agreement that if someone had hospice care, the hospice provider should be called first. The organization will send a doctor or nurse to verify death and will typically call the family’s preferred funeral home once they have completed what they need to do before the funeral home can remove the body, he said.
Joel Macey, president and CEO of Community Nursing Services in Utah, agreed. “Usually hospice won’t need to involve police unless something seems off. That’s very rare,” he said. In the case of an expected death in hospice care, the agency will see that the death certificate is signed, usually by the hospice medical director, at the mortuary’s request.
A declaration of death must be made by medical personnel, not law enforcement or family or someone else.
That death declaration is the first of many steps.
Why you must call the police
Unless the death occurs under hospice care or in a facility like a hospital or nursing home, it’s a crime not to notify police. So the advice to call the mortuary first is misguided, Larkin said. The first call goes to law enforcement.
That raises discussion, too: 911 or the nonemergency number? While some suggest a nonemergency line, Sgt. Aymee Race, of the Unified Police Department, said 911 is easy to remember and no one’s going to fault you for calling it in this time of high stress. Brent Weisberg, communications director for the Salt Lake City Police Department, agrees. Dispatchers, they say, are trained to get needed information, including whether it’s an emergency or if the person appears to have been dead a while. Weisberg said the more the dispatcher is told about circumstances, the better.
Race mentioned people are not required to attempt CPR. Unless they are shown a “do not resuscitate,” or DNR, form, the dispatched firefighter and emergency medical service team will determine whether they try CPR.
Anything that might be suspicious or an unattended death, which means no treatment by a doctor within 30 days, will launch an investigation, which could be somewhat cursory or extraordinarily thorough.
Officers will determine certain things, such as who the signing doctor would be for the death certificate (typically a doctor caring for the individual), or if the body should be taken to the medical examiner, who could sign the document. Once police are involved, they notify the mortuary of the death and when the body can be picked up, Larkin said.
There’s another reason to call 911, per Race: A responding officer will help with those next steps, even calling a cleric or friend or relative to come. “It’s good to have the officers handle the rest of that so the family can kind of sit back and start their process of mourning, right?”
Sometimes, families are surprised by the process.
David Gessel, executive vice president of the Utah Hospital Association, tells the story of a relative’s death years ago from a heart condition. Police arrived and were unable to verify that the individual had been under a doctor’s care recently and that the death was not unexpected. He recalls an officer staying hours until that could be verified.
Investigating a death, removing the body
Even if someone is apparently beyond medical aid, said Weisberg, “we still need to have firefighters and (an ambulance crew) respond to the scene to confirm that individual has died.”
There are steps: Confirm the death. Investigate the circumstances and whether it’s a criminal matter. Officers look around the scene and gather information, then talk to their supervisor about next steps. They may call out the homicide squad — a detective to look into things or a full call out. That happens with a clear homicide, suicide, child, infant or juvenile death or any other suspicious circumstance.
Sometimes a death looks normal but the autopsy deems it suspicious; the reverse is also true. Death investigations may seem like they take a long time, Weisberg said, but officers must be thorough.
The officer and other first responders will ask about DNRs, recent doctor visits and medication the person was on. They’ll likely call the doctor: This person was under your care. Will you sign the death certificate? Race said some say yes, others no.
A medical examiner investigator may come out.
Some deaths, by law, trigger a call to the medical examiner’s office, said Cory Russo, chief medical examiner investigator, who notes that state laws are very clear. Utah Code says the medical examiner has jurisdiction if it appears that death was by violence, suicide or accident; if the circumstances were unusual or suspicious; if the person hadn’t seen a doctor recently; if an illness that poses a public health threat is suspected; if the death was work-related or involved a minor; if it was in an incident involving police; or if the person died in custody or in a medical substance use treatment facility, for instance. The list is quite long.
Weisberg said making sure a death is above board is an absolute priority,
Police often ask a law enforcement victim advocate to help families sort through next steps. The representative knows about end-of-life options, Race said. It’s about helping people in crisis — and an unexpected death is just that.
Weisberg said the help from calling police can include social workers, victim advocates and others. “These are very traumatic instances, even when someone’s health may be deteriorating, or that death is not necessarily a surprise. When that finally happens, it can be hard on so many people. While we have an investigative function, we also have a social service response. That includes helping people navigate through what they’ve just experienced.”
The crime lab may be called to photograph the scene, “because most of the time we only get one shot at these investigations,” Weisberg said.
Once a scene is released, potential evidence can be lost if later something seems suspicious, Weisberg said. Officers are under pressure to “make sure we get it right every single time. So there’s no huge urgency for us to ever speed through an investigation.”
In an attended death, the officers will notify the medical examiner’s office and work with the family to arrange transport of the body before releasing the scene. The officer generally stays until the body is removed, Weisberg said.
The medical examiner’s role
The Office of the Medical Examiner deals with thousands of cases a year. Its 2023 report, which was a final count for 2021, said more than a third of deaths in Utah were reported to the office, nearly 8,000. Medical examiners investigated more than 80% of those deaths, totaling 6,542 that year.
Russo said hospice nurses and hospital staff know to call about anything suspicious, like a possible drug overdose or signs the person fell before death. Funeral homes sometimes call and report something they observed, too.
Still, not all deaths are reported to the medical examiner. Someone who’s been seen recently by a primary care provider and has a significant medical history, where the scene of death seems natural and there’s no indication of trauma or drug use, may not be reported to the ME.
Russo said it would likely be pointless to first call a person’s doctor unless it was a hospice doctor.
Still, that happens in small towns where people know each other well. “It’s still not the proper channels, because law enforcement has to respond and contact us to rule out that it’s an ME case,” she said. Russo described a hypothetical case where a wife comes home and finds her husband dead on the kitchen floor. The police, she said, will interview the person on the scene and will look around. The officer(s) will call the medical examiner’s office and describe the circumstances. “We will ask a series of questions to determine if it falls under our jurisdiction.” If it does, a medical examiner investigator will be dispatched.
That person’s focus is the body. “We will do an external examination; we look for different signs of death and other things. We also photograph the body, the scene, anything that we feel is relevant to determining manner of death,” Russo said. “We talk to next of kin if they are there. We ask about medical history and any drug use, suicidal ideations, a list of questions — anything to help us determine cause.”
ME investigators also offer resources, including a pamphlet with information likely to help families on some basic next steps. “We tell families, your loved one will be coming to the ME’s office for further examination.” It’s not always a full autopsy. Families are told to decide which funeral home and let it know the loved one is with the ME. The funeral home will contact the medical examiner to see when the body will be released.
“The family doesn’t have to do all this back and forth; it’s handled between the funeral home they choose and our office,” Russo said.
The medical examiner’s investigator in Utah provides a booklet prepared by Caring Connections at the University of Utah College of Health that helps families figure what to do next. There’s a lot, from obvious things like planning any memorial to letting Social Security know the individual is gone. Banks must be notified, credit cards canceled, insurance claims, if any, filed. It all requires a death certificate.
Families often think they can request an autopsy if they wonder how someone died. Legitimate concern about cause of death will be looked into. But if nothing looks off and the circumstances don’t require the ME, families would need to hire someone else to do a clinical autopsy, rather than the forensic one a medical examiner conducts.
Making end-of-life wishes known
Gessel, of the Utah Hospital Association, recommends family members not shy away from talking about death. They should know each other’s end-of-life wishes. Adult children or spouses should know where the paperwork is if someone doesn’t want CPR. They should know and honor someone’s wish to be an organ donor, if the death allows it. But “many don’t make decisions before they die.“
Most don’t fill out advanced directives. They don’t want to have hard conversations. “Just having the communication is so important — and also understanding the processes that happen,” Gessel said.
Rob Ence, executive director of the Utah Commission on Aging, believes families help each other when they do their own paperwork, including what’s called POLST in Utah, which stands for the Physician Orders for Life-Sustaining Treatment. But doing it and not telling loved ones the decisions you made and where to find the document defeats the purpose.
The advance directive is “basically the living will that dictates things while you’re alive; your testamentary will oftentimes will have instructions about which mortuary, the type of funeral preference, along with distribution of estate issues,” he said. But not everybody’s taking the time to put that in writing.
While you’re having those conversations, it’s a good idea to provide other information that could be helpful when you die, like whether you preplanned funeral services or purchased a gravesite and where your will can be found.
A registry for final wishes?
Ence is an avid proponent of creating a registry — something the Legislature could do — that would let people file their advanced directives, POLST, DNR wishes and other information that would help police, the ME, and others at the end. Many hospitals have that paperwork from patients, but that doesn’t mean first responders can access it, he said.
With a registry, they could. And people would be able to update their wishes in the registry he envisions; it’s not “one and done.”
Race would love to see Ence’s registry vision come to fruition. It would be great, she said, if people could file their wishes where police or care providers could look it up, rather than rely on people who don’t have the answer or don’t like the answer.
“The POLST cannot be effective if it’s not found. And so many EMTs who are first responders don’t have access to that information. So they resuscitate the best they can,” Ence said.
He pictures the state managing a registry like it manages vaccine records or death certificates, which are both in a central repository.
Everyone 18 and older should have an advanced directive “the minute they go off to college or on an LDS mission or to the Peace Corps,” said Ence. “When you are an adult, your parents or guardians no longer have authority to act on your behalf for medical decisions, so an advanced directive becomes an imperative if you have wishes you want followed.” Otherwise, the state’s “legal hierarchy” takes over. “It’s letting the state decide for you rather than deciding yourself.”
People can and do change their minds. He recommends revisiting a directive at least every 10 years or when you have a life change, like marriage or divorce. “It’s not static. It needs to be dynamically updated to make sure it’s current with your situation,” he said.
With no central repository, people need to know where to find your paperwork. Some attach theirs to an entryway. “But home’s not the only place you can die,” Ence said.
There are bracelets that alert a first responder to paperwork location. That’s not as efficient or all-encompassing as Ence and others would like.
Asked what he wants people to know, Ence doesn’t pause. “If they don’t make decisions about how they want to be handled, systems will act upon them — only because that’s the way we’re set up, like emergency care or additional medical treatments or medications or whatever it might be. If you leave it to the system, they will act. What they’re charged to do may not be your wishes.”
You have to make your wishes known.