With expanding options of home care and palliative care services we can expect to see more deaths outside our hospitals and aged care facilities.
The latest research shows that 70 per cent of Australians now wish to die at home, surrounded by friends and family. However, only 14% of people are passing away in the comfort of their own home often because advanced care planning has not been put in place. (Source: Dying Well, Grattan Institute 2014)
Some of the benefits of dying at home are that it:
- Helps maintain emotional well-being by being cared for in a familiar environment surrounded by people they know well.
- Lets the individual spend more time with family and friends.
- May offer more opportunities to maximise quality of life.
- May feel more natural and less clinical, while still giving access to expert medical advice and symptom control.
- Allows a sense of control over the last part of the person’s life.
- Family and friends may find comfort in providing most of the care.
If a person chooses to die at home they do need to get their affairs in order. The loved one should discuss their personal preferences with their family and it is suggested that they:
- Document their wishes in writing.
- Make a will.
- Organise a Power of Attorney (PoA), Enduring Power of Attorney (EPoA) and Enduring Guardian.
- Develop an Advance Care Plan (also known as an Advance Health Directive).
If the death is expected
If you are the person’s medical practitioner it is best practice to ensure that the patient has finalised their Advance Care Plan and estate planning (Will and Power of Attorneys)
You also need to be aware of NSW Health Policy Directive, Death – Verification of Death and Medical Certificate of Cause of Death.
Verification of Death is a clinical assessment process undertaken to establish that a person has died. Using a standard regime of clinical assessment tools, a registered medical practitioner, registered nurse or qualified paramedic can establish and document that death has occurred. Verification of Death has previously been known as extinction of life in NSW Health policy.
Verification of Death (form SMR010530) is required to enable a person’s body to be transported by a funeral director or government contractor. In circumstances where there may be a delay in completing the Medical Certificate of Cause of Death (MCCD). A MCCD must be completed within 48 hours of the death. (Avant Fact Sheet, MCCD Order form)
A medical practitioner should only certify the cause of death if a diagnosis as to the cause of death can be made. If the medical practitioner is unable to ascertain the cause of death then the matter is required to be referred to the Coroner.
Death Certification Arrangements for Expected Home Death
Within regional and rural settings, there may be specific challenges in organising a medical practitioner to complete the Medical Certificate of Cause of Death (MCCD) due to greater distances involved and the limited medical workforce. Local Health Districts may elect to put in place local procedures to designate the medical practitioner responsible for completing the MCCD in advance of an expected death. This approach is encouraged by the State Coroner.
In many cases the patient’s GP will head the health care team for patients approaching and reaching the end of their lives who choose to be cared for and die at home. To assist with formalising this process, a Death Certification Arrangements for Expected Home Death form (SMR010.531) has been developed and endorsed by NSW Health. Use of this form is encouraged, but not mandated where Local Health Districts have elected to develop a process for managing expected deaths in this way. It has been enabled on the North Coast.
Once the death has occurred at home
The family/friend/carer/nurse of the deceased need to notify the deceased’s medical practitioner without delay. The medical practitioner will advise if they are able to complete the Medical Certificate Cause of Death (MCCD).
The Medical Practitioner may have already completed a Death Certification Arrangements for Expected Home Death form, which will be with the deceased, or alternatively there may be a Verification of Death form completed at the time of death by an attending registered nurse or qualified paramedic.
Once this is completed the family should contact the Funeral Director who will organise the transfer of the body to their mortuary. The Funeral Director will require either the completed (1) MCCD, (2) Verification of Death or (3) Death Certification Arrangements for Expected Home Death form before they can remove the deceased’s body.
If the medical practitioner is unable to ascertain the cause of death and is not prepared to complete a Medical Certificate Cause of Death, the family needs to contact the local police without delay. The police will attend the place of death of the deceased, inspect the body and complete a report for the Coroner.
Once the police have completed their initial investigation they will contact the Government Contractor to remove the body and deliver it to the nominated forensic institution for an autopsy in an attempt to ascertain the cause of death. The Coroner will notify the family when the deceased’s body can be released to the care of a nominated Funeral Director or delivered to a regional hospital in the area where the person died. Generally, the Coroner will hold the body for up to 7-10 days before release.
A death, whether it is in the hospital, nursing home or hospital is traumatic for all family members. It is important to have completed clear documentation by both the family and the GP so as not add to that burden.