Providing care after death

Providing care after someone dies involves treating their body with dignity, respecting their wishes, and supporting those important to them. This can be an upsetting topic to read about, so it's important to take care of yourself.

On this page:

When someone dies

There are legal requirements for what should be done when someone dies. There are different requirements depending on:

• where the patient died
• whether the death was natural (either expected or unexpected) or suspicious.

This page is an overview of what to do when someone dies at home and the death is expected. Each organisation will have its own policies and procedures, and it's important to follow local and national guidelines.

Verification of death

Verifying a death is the process of formally confirming a person has died. This may be carried out by a doctor or someone else specially trained to do this, for example a registered nurse. In the community, this will ideally be done within four hours of the patient's death.

Verification of death might be called different things. You might come across the terms 'confirmation of death', 'verification of life extinct' or 'recognition of life extinct'.

Things to do if you think a patient has died:

• Explain to those present that the person is understood to have died, but this will need to be formally verified. The time the death is verified, will be the official time of death.
• Call the patient's GP, out-of-hours service or district nurse promptly, so they can verify the death.
• If the patient dies on their own, respect their wishes regarding who to contact. Remember to offer people emotional and practical support.
• Be guided by the wishes of those close to the patient. For example, if the death happened out of hours, they may want to wait until morning when their usual GP is available to verify the death.

When a doctor or nurse verifies a death, there are certain things they'll do, including:

• checking there are no signs of life – this is done by checking for a pulse, listening to the patient's chest and looking at their pupils
• recording the time
• confirming the patient's identity
• checking if the patient has any infection risks
• checking if the patient has any implantable medical devices, like a pacemaker or radioactive implants. These could be a risk to funeral home and mortuary staff.

When there's a delay in verifying the death for example during coronavirus, keep the patient's environment cool. You can do this by switching off the heating in that room or opening a window. It's important not to use fans as they can spread infection. The person verifying the death will follow personal protective equipment (PPE) guidelines.

Certification of death

A doctor will certify the death. They will complete a Medical Certificate of Cause of Death (MCCD), and record the cause of death and any other illnesses the patient had. The doctor may also talk to you as part of their standard checks. This may happen if you were present when the patient died, and if they wished to be cremated.

The doctor who has cared for the patient recently or during their last illness will usually certify the death. Find each nation's rules for certification of death below:

England & Wales  
Scotland  
Northern Ireland  

The British Medical Association (BMA) has information about certification during the coronavirus pandemic and resources for each nation.   If you have any questions about certification of the death, contact the patient's GP.

If the death is unexplained or the cause of death is unknown, the doctor cannot issue a MCCD until they've contacted:

• the coroner if they're in England, Wales or Northern Ireland
• the procurator fiscal if they're in Scotland
• the police if there are suspicious circumstances.

Organ and tissue donation

Organ donation is not usually possible when someone dies at home. It typically needs to happen in a hospital intensive care unit or emergency ward, equipped to manage organ donations.

But some tissues can be donated if the person doesn't die in hospital. This includes the cornea (the clear tissue at the front of your eye). Cornea donation can happen up to 24 hours after death, and can take place in hospitals, hospices and funeral homes.

It's important to find out what the patient's wishes were and whether any plans are in place for donation.

Contact the NHS Blood and Transplant service for more information.  

Caring for the patient after they have died

Personal care should be provided after the death has been verified. Ideally this should be carried out within four hours of the patient dying. This will preserve their appearance, condition and dignity. It's recommended that two people provide personal care for the patient. One of these should be a registered nurse or another healthcare professional with the relevant training.

Treat the patient with respect to maintain their dignity. Check their Advance Care Plan or speak to those close to the patient about any personal wishes relating to care after death. If known, respect their wishes and any spiritual, religious or cultural practices.

Those close to the patient might want to help with personal care. If this is possible, it's important to sensitively prepare them for changes to the body after death. They will also need to be made aware of moving, handling and infection control procedures.

Each organisation will have their own policy and procedures for care after death – remember to check yours or ask your manager for information about this. It's also important to follow local and national guidelines.

The following steps can be used as a guide for providing personal care after death:

Infection control

• Be aware of any infections the patient had and follow infection control measures like wearing the appropriate PPE.

Appearance and positioning

• Lay the patient flat on their back and if possible, straighten their legs and place their arms at their sides, with palms down and fingers straight.
• Leave one pillow under the head as this helps to keep the mouth closed. If the jaw needs more support, place a pillow or rolled up towel underneath the chin. Remove this before anyone views the patient. If their mouth won't close, it's important not to force it or use bandages as this can leave marks. Explain to the family or friends that a funeral director can help with this.
• Close the eyes by lightly pressing down on the eyelids for 30 seconds. If this does not work, do not apply tape to the eyelids. Explain to the family or friends that a funeral director can help.
• Clean the mouth and teeth or dentures. If the family or friends request the dentures are removed for cleaning, advise them it may be difficult to replace them. If this happens, do not use force. Instead place the dentures in a clearly labelled container to keep with the patient. Explain to the family or friends that the funeral director can help place them back in the mouth.
• Tidy the patient's hair and arrange it into their preferred style if known.
• Shaving someone who has recently died can cause bruising. A funeral director can do this later if the family or friends request it. If the family or friends request this earlier, sensitively discuss the possible consequences and document this in the patient's notes. Be aware that some faith groups do not allow shaving.
• Wash and dress the patient appropriately, unless requested not to do so for spiritual, religious or cultural reasons, or where the death is being referred to the coroner. Those close to the patient may wish to do this. Sensitively prepare them for the potential release of air that should not be mistaken for breathing. Prepare them also for potential soiling including from the mouth and nose.
• Explain to those close to the patient that the funeral director will dress them in their final outfit.

Medical equipment

• Where no catheter is in place, drain the bladder by gently pressing on the lower abdomen for 30 seconds and collect urine in a receiver. If a catheter is in use, either replace the drainage bag with a new one or remove the bag and spigot the catheter. This will depend on organisational and local procedure.
• Only remove medical devices such as syringe pumps if you're trained to do so. This should be done after the death has been verified, and when it's not being referred to the coroner or procurator fiscal. Gauze and tape may be applied to cannula sites. Follow your organisation's policy on the disposal of the cannula and line, and the safe storage of the syringe pump.
• Clamp drains, intravenous (IV) and subcutaneous lines.
• Cover stomas with a clean bag.
• Cover wounds with a clean absorbent dressing and secure with an occlusive dressing. Leave stitches and clips as they are.
• Avoid using strongly adhesive tape as this can be difficult to remove at the funeral directors and can leave marks.

Body fluids

• Use pads to absorb possible leaks from the urethra, vagina or rectum.
• If you're trained to do so, contain leakages from the mouth or tracheostomy by suctioning and positioning.

Personal belongings

• Remove jewellery in the presence of another person – unless requested not to do so by the family or friends – and document this in the patient's records. All jewellery removed should be wiped with a disinfectant wipe, placed in a valuable property envelope (if available) and sealed in a clear plastic bag. Secure any jewellery which hasn't been removed with minimal tape that is not strongly adhesive, and document this.
• Be aware of any spiritual, religious or cultural ornaments that need to remain with the patient, and make sure these are clearly documented.

What to do next

• Record all the personal care you have carried out in the patient's care plan.
• Inform the funeral director of any medical devices (such as a pacemaker), prostheses, dressings or jewellery that have been left in place.

Supporting people close to the patient who has died

Every death is unique and people react in different ways. It's important to be respectful of the needs of anyone close to the patient that's died. They might want you to take the lead or they might prefer that you're in the background.

You can support them in the following ways:

• Sensitively tell them about the death if they weren't with the patient when they died.
• Allow them time to begin to process what's happened, and be prepared to listen rather than speak.
• Guide them through next steps, and explain what to do after someone dies – for example how to register the death. You could share Marie Curie's information for bereaved family and friends on practical, legal and financial matters.
• Let them know about bereavement services they can access. You could tell them about Marie Curie's Telephone Bereavement Service, where they can access ongoing telephone support.
• Be aware of anyone in the household who may need additional support. This might include children under 18, adults with learning disabilities, adults with dementia, and other vulnerable adults. If you're concerned someone may need extra support, contact the GP or district nurse.
• Reassure them that everything has been done to care for the patient and to maintain their dignity. This is especially important during the coronavirus pandemic, when the people important to the patient may not have been able to spend time with them in the way they would like.

Share Marie Curie's information for family and friends about grief.

Taking care of yourself

Caring for a patient who has died and the people close to them, can be emotionally challenging. It's not uncommon to build a relationship with the person you're caring for, and you may feel a range of emotions when they die.

Sometimes, these emotions can be triggered a long time after the patient has died. Their death can also bring up memories of people you know who have died.

If your feelings are affecting your work or personal life, it might be a good idea to get some support.

This could include the following:

• Accessing clinical supervision – ask your manager if you're unsure how to access this.
• Talking to your manager about how you're feeling.
• Speaking to other colleagues about your experiences – they may have had similar experiences themselves.
• Seeing a counsellor or psychologist.
• Contacting Marie Curie's Telephone Bereavement Service, where you can have up to six telephone sessions with a trained volunteer. Volunteers cannot advise, offer counselling or clinical supervision, but they can offer a safe space to talk openly about your grief.

Find out more about Marie Curie's Telephone Bereavement Service.

Useful resources

E-learning for healthcare (e-LfH) – includes sessions on care after death  

Hospice UK guidance on providing care after death  

NHS Education for Scotland – Support around death  

BMA Guidance: COVID-19: death certification and cremation  

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