6) Dying at Home: What to Expect

Choosing to spend one’s final days at home is a profound and deeply personal decision. This page offers clear, transparent guidance to help families demystify the natural physical stages of the end-of-life process. Knowing what to expect reduces panic, ensures physical comfort, and allows you to create a peaceful environment for your loved one on Salt Spring Island or across the wider Island Health region.

Understanding Physical Signs:

Direct information on the natural physical changes, skin variations, breathing patterns, and shifts in consciousness that occur as the body slows down.

Managing Comfort at Home:

Techniques for non-verbal pain assessments, mouth care for dry lips, positioning to ease breathing, and ambient environmental adjustments.

The "No CPR" (DNR) Protocol:

Crucial legal and medical frameworks ensuring emergency medical personnel honor your loved one's choice for a natural, peaceful progression.

Immediate Next Steps:

A step-by-step checklist of exactly what to do and who to call, the moment death occurs, preventing unnecessary emergency interventions.

Core Legal & Clinical Frameworks for BC At-Home Deaths

1. Medical Orders for Scope of Treatment (MOST) & DNAR

To ensure emergency medical services (like BC Ambulance paratransit) do not perform invasive resuscitation efforts, specific legal forms must be actively signed and visible in the home.

The MOST Form: Review the Island Health Medical Orders for Scope of Treatment (MOST) Guide to understand how medical boundaries are established with your physician or nurse practitioner.

No CPR Directive: Download the BC Ministry of Health No CPR Form. This form must be signed by the physician or nurse practitioner and placed in a highly visible location (such as on the refrigerator or by the bedside).

Disclaimer: The following information is for general knowledge and should not be taken as medical advice. Consult with a healthcare provider for any health-related concerns.

2. Expected At-Home Death (EAHD) Registry

If a death is actively anticipated, your clinical team will file an Expected Death in the Home form.

System Enrollment: Read the provincial guidelines on BC Expected At-Home Death Protocols. Once this is registered, family members are legally permitted to bypass calling emergency services when death occurs, allowing for a quiet, paced process.

Step-by-Step Logistics Checklist

When death occurs at home under an active Expected At-Home Death (EAHD) protocol, follow these sequential steps to maintain order and tranquility:

Do Not Call Emergency Services: Calling emergency services triggers a standard police and sirens emergency response, which can cause intense distress and disrupt a peaceful passing.

2. Note the Time: Write down the exact time you believe your loved one passed away.

3. Contact Your Home Care Team: Call your designated palliative nurse or your physician/nurse practitioner to notify them of the passing.

4. Pronouncement and Registration: A physician, nurse practitioner, or an actively authorized registered nurse will come to the home to formally pronounce the death and complete the medical certification documentation.

5. Contact the Funeral Provider: Once pronouncement is complete, call your pre-arranged funeral provider or transfer service to schedule the sensitive transportation of your loved one.

Critical Local Support & Emergency Contacts

Salt Spring Island Local Assistance

Palliative Nursing & Nurse Advice: Call the South Island Community Access Line at 250-388-2273 to reach the on-call palliative home care nurses.

Local Compassionate Presence: Contact the community volunteers at Salt Spring Hospice at 250-537-2770. They can provide rapid bedside vigil support to sit with the family and offer quiet, non-medical stabilization during the active hours of transition.

Wider Island Regional Support

BC HealthLink (24/7): Call 811 at any time of day or night to speak directly to a registered nurse if you notice new physical symptoms or breathing patterns and need clinical guidance.

Central Island Palliative Hub: Call 250-739-5749 for communities from Mill Bay up to Deep Bay.

North Island Palliative Hub: Call 250-331-8570 for communities north of Deep Bay.