14829 NHSCT someone dies cover.qxd:when someone dies 5
10/7/12
12:38
Page 1
When
someone dies
Information, guidance and
support for
Family and Friends
NT/MED/6179 07/12 4k
14829 NHSCT someone dies cover.qxd:when someone dies 5
10/7/12
Published November 2011
12:38
Page 2
We acknowledge the pain and distress that are felt after the death of a loved
one and offer our sincere sympathy to you, your family and friends who are
affected by this sad loss.
This booklet outlines practical information and guidance following both
expected and sudden death. We have included information on coping with
grief, which we hope will help you in the weeks and months ahead. If you need
further guidance and help, you will find contact details of local bereavement
support at the end of the booklet.
We hope that you find this information useful and that it will, in some small
way, reduce the anxiety and distress you feel at this difficult time.
We can make this document available in other formats on request. These
include:
•
•
•
•
•
•
•
•
large font
audiocassette
Braille
computer disc
main minority ethnic languages
DAISY
easy-read
electronic version.
Please let us know if you require information in an alternative format.
Contents
Practical information and guidance ................................................ 3
Certifying death .............................................................................. 3
Cremation ....................................................................................... 4
Organ and tissue donation ............................................................. 4
Consented (hospital) post-mortem examinations ........................... 5
The Coroner ................................................................................... 6
Property .......................................................................................... 7
Spiritual support.............................................................................. 7
The funeral director ........................................................................ 8
Arranging the funeral ...................................................................... 9
Meeting funeral costs ..................................................................... 9
Returning equipment .................................................................... 10
Registering a death ...................................................................... 10
People/Organisations to contact................................................... 12
Coping with grief ........................................................................... 13
Caring for children ........................................................................ 16
Support organisations................................................................... 18
Coroners Service for Northern Ireland.......................................... 21
Practical information and guidance
When someone dies, many decisions and arrangements need to be made.
Dealing with the practicalities can feel overwhelming. It is important to take
some time to gather your thoughts, to cry, or to talk. You might find it helpful
to seek support from another family member or someone outside the family
whom you trust. Your minister, priest or faith representative and your funeral
director will help you plan the funeral.
If healthcare staff or your funeral director need to be aware of any special
religious or cultural requirements in caring for your loved one after death, let
them know as soon as possible.
Certifying death
When your loved one died, a GP, hospital doctor or nurse trained in verifying
death will have confirmed that death occurred. If a doctor had examined the
person in the previous 28 days, knows the cause of death and knows that it
was a natural cause, they can issue a Medical Certificate of Cause of Death
(often called a ‘Death Certificate’).
Sometimes the issue of the Death Certificate is delayed, for example if:
• the death occurred at the weekend, overnight or on a bank holiday,
and the doctor on duty was not directly involved in caring for your
loved one
• the duty doctor needs to discuss the cause of death with the doctor
responsible for your loved one’s care
• the doctor needs to contact the Coroner for advice.
You should only make provisional funeral arrangements until you receive the
Death Certificate.
You will need the Death Certificate to register the death (see page 10), so
you must keep it safe. Check that the details on it – the name, date of birth,
address, etc. – are correct. This will help to avoid delays at the Registrar’s
Office.
3
Sometimes there are circumstances concerning a death which require the
involvement of the Coroner. See page 6 for more information.
Cremation
If you are planning to have your loved one cremated, you must inform
medical staff and your funeral director. A second doctor will need to confirm
the cause of death and complete a cremation form. There is an additional
cost for completing cremation forms. All cremations in Northern Ireland take
place at Roselawn Crematorium in Belfast.
Organ and tissue donation
Your loved one may have expressed a wish to donate their organs or tissues
by joining the organ donor register, carrying a donor card or speaking to a
family member to request that their organs be donated after death. You may
also have the option of considering donation after your loved one has died.
Sometimes a medical condition, cause of death or the place in which the
death occurred means that a person cannot be a donor.
Tissue donation is the gift of tissue such as corneas (parts of the eye) and
heart valves to help others with certain medical conditions. Organs need to
be removed immediately, but it may be possible to donate tissue up to 24
hours after a person has died.
Specialist Nurses in Organ Donation are available in the Trust to speak to
families and to offer information and support. If you would like to speak to
a specialist nurse, you should inform the staff looking after your loved one.
They will arrange this for you. The specialist nurse will support you no matter
what decision you make.
4
Consented (hospital) post-mortem
examinations
A hospital doctor may ask you for permission to carry out a post-mortem
examination. This can help determine the nature and extent of the disease
your loved one died from and increase medical knowledge about it.
Occasionally, a person may give consent before their death for a hospital
post-mortem to be carried out after their death, but this is unusual.
It is normally the next-of-kin’s decision whether to give consent. Their
decision is recorded on a special consent form.
The hospital post-mortem is not a compulsory examination, and you can
refuse. If you are willing to consider it, the doctor will explain what is involved
and answer any questions you have. You will be given a booklet to read –
Information for Relatives: Hospital Post Mortems – to help you make your
decision.
If you give your consent, the examination will take place soon after the death.
Your loved one’s body will then be released for burial or cremation. You will
be told of any preliminary findings before the full post-mortem examination
report is finished – this can take 6–12 weeks.
5
5
The Coroner
For legal reasons, a death sometimes needs to be referred to the Coroner.
This includes when:
• a doctor did not see or treat the person in the 28 days before they died
• the cause of death was sudden, violent or unnatural, such as an
accident, assault or suicide
• the cause of death was an industrial disease of the lungs (for example
asbestosis)
• the death occurred in other circumstances that may require
investigation.
The Coroner will consider the information that the doctor provides and make
one of the following decisions:
• the doctor can issue a Medical Certificate of Cause of Death
• the doctor must complete a Coroner’s pro-forma and forward it to the
Coroner’s office
• a post-mortem examination is required to find out the cause of death.
If the Coroner orders a post-mortem examination, consent from the next-ofkin is not required. The Coroner’s decision has to be accepted. A Coroner’s
Liaison Officer will contact you to inform you of the initial post-mortem
findings and let you know when your loved one’s remains will be released.
You must not set the funeral date until you have the Coroner’s permission.
You will then be advised how to obtain the necessary form which permits
burial or cremation.
Your loved one’s doctor will receive a copy of the full post-mortem examination
report. This may take a few months. The family will be told when the report is
available and may wish to meet the doctor to discuss the findings.
6
Property
When someone dies in a place other than their own home, for example in a
hospital or nursing home, there may be personal clothing and property to be
collected.
Collecting personal belongings can be a difficult experience. You may choose
to take them with you right away following the death or return to collect them
later.
Ward/Care home staff will give you details of any valuables belonging to your
loved one that are held securely by the Trust. If applicable, they will also give
you the contact number of the cash office holding the items.
If your loved one had a will, money sent to the cash office is returned as
a cheque, usually through their solicitor. The return of valuables may be
delayed because of legal requirements. For example, a will may require you
to have a legal document called a grant of probate. If there is no will, a
number of other forms will need to be completed. Cash office staff will advise
you.
Spiritual support
Many people get support and comfort from their spiritual advisor after the
death of a loved one. If you would like a minister, priest or faith representative
to take the funeral service, contact them as soon as possible to discuss the
arrangements. If you are unsure who to contact, ask staff if you may speak
to a hospital chaplain for advice.
7
The funeral director
Most people use the services of a funeral director when arranging funerals.
Funeral directors are available seven days a week and provide a 24-hour
on-call service throughout the year. You or your loved one may have already
chosen a funeral director; if not, you will find details in Yellow Pages, under
‘Funeral Directors’.
The funeral director will help with many things that need to be done. Their
duties might include:
• arranging collection of the deceased from the place of death
• the preparation, care and dressing of the deceased
• contacting your spiritual advisor, place of worship, cemetery or
crematorium to arrange the funeral
• arranging for the completion of necessary medical certificates for the
crematorium (if required)
• assisting with the selection of a coffin
• arranging the purchase and/or opening of a grave
• inserting newspaper notices
• ordering flowers
• providing a hearse and additional cars for the funeral
• receiving and distributing donations to charity.
8
Arranging the funeral
If the death occurred at the weekend or over a bank holiday, or if the Coroner
is involved, there may be a delay in being able to proceed with the funeral.
You can only make provisional funeral arrangements until you have either
the Medical Certificate of Cause of Death or permission from the Coroner.
Before your loved one died, you may have had a chance to talk with them
about their wishes for burial or cremation and what type of funeral service
they would like, for example music, hymns and style. Alternatively, their
solicitor may have this information in a will, or they may have left written
instructions separately.
It can be helpful for some to see the body after death and, if possible, to
participate in the funeral. Children and young people who were close to the
person who died may like to be involved in planning and taking part in the
funeral. For example, young children could draw a picture or write a letter to
place in the coffin. (See also ‘Caring for children’ on page 16.)
If you have a minister, priest or faith representative, they will help you to
plan and prepare for the funeral and provide you with emotional and spiritual
support.
Meeting funeral costs
Funerals are expensive, and some people contribute to a payment plan to
cover the cost of their funeral. If you are on certain benefits, you might qualify
for financial help in the form of a burial grant.
You can ask your social worker, funeral director or the local Social Security
Office for information on burial grants.
You can also find more details at www.nidirect.gov.uk, under Government,
Citizens and Rights, in the section on Death and Bereavement.
9
Returning equipment
If your loved one was cared for at home before their death, you should contact
the district nurse, who will arrange for the removal of equipment such as
electric beds and hoists. The nurse will also remove the patient records and
advise you about the safe return of unused medicines to the local chemist.
You can arrange for removal of other equipment, such as wheelchairs,
commodes and bathing and walking aids, by contacting your local
occupational therapy department.
Registering a death
All deaths that occur in Northern Ireland must be registered at an office of the
Registrar of Births, Deaths and Marriages. This can be either in the district
where the person died or in the district where they normally lived, if within
Northern Ireland.
When a Medical Certificate of Cause of Death has been issued, the death
must be registered within five days to allow the funeral arrangements to be
made.
In cases referred to the Coroner, the death can only be registered after
the Registrar has received the necessary certificate from the Coroner. The
Registrar’s Office will then contact a relative of the deceased and ask them
to call and register the death.
Telephone numbers and contact details of local offices are listed in the Yellow
Pages, under ‘Registration of Births, Deaths & Marriages’.
10
Who can register a death?
If they have the necessary documents and information (see below), any of
these people can register a death:
• any relative of the deceased
• a person present at the death
• a person taking care of the funeral arrangements
• the executor or administrator of the deceased’s estate
• a person living in or responsible for a house, lodgings or apartments
where the death occurred
• a person finding, or a person taking charge of, the body.
Documents and information you will need
• the Medical Certificate of Cause of Death (Death Certificate) signed
by the doctor
• full name, surname and usual address of the deceased
• date and place of death
• date and place of birth
• marital status (single, married, widowed or divorced)
• occupation of the deceased (if the deceased was a wife or widow, the
full name and occupation of her husband or deceased husband)
• if the deceased was a child, the full name and occupation of the father
or, where the parents are not married, the full name and occupation of
the mother
• maiden name (if the deceased was a woman who had married and
changed her surname)
• the name and address of the deceased’s GP
• details of any pension apart from a state pension that the deceased
may have held.
What the Registrar will give you
• a Form GRO 21 giving permission for the body to be buried or for an
application for cremation to be made
• a certificate of Registration of Death (Form 36/BD8), issued for social
security purposes if the deceased received a state pension or benefits.
There is no cost for registering a death, but it is recommended that you buy a
number of certified copies of the certificate of Registration of Death that the
Registrar gives you. This is because insurance companies, etc., will require
one as proof of the death, and they do not accept a photocopy.
11
People/Organisations to contact
You need to inform a number of people and organisations when someone
dies. This list will help you determine who to notify – not all will apply in every
case. A family member or close friend could help.
Contacting these people and organisations early will help avoid the distress
of letters, telephone calls and supplies/equipment continuing in the weeks
and months ahead:
• GP, district nurse, social worker, home help, day-care centre
• other healthcare professionals (for example optician, dentist, podiatrist)
• provider of medical aids, equipment, supplies
• any hospital the person was attending
• solicitor – contact before the funeral to check if there is a will stating
the person’s wishes concerning burial or cremation
• Social Security Agency – regarding attendance, disability living,
incapacity, carers, industrial injuries and maternity allowances
• local Social Security Office – regarding income support
• Department for Work and Pensions – regarding state retirement
pension
• school, higher education institutions
• employer, trade union, pension company
• bank, building society, Post Office, Credit Union, credit card company,
financial advisor
• mortgage company, Housing Executive, landlord
• insurance company (personal, household, vehicle – if you are secondnamed driver on the policy, you will no longer be insured)
• Inland Revenue
• Driver and Vehicle Agency
• Translink – regarding travel pass
• Passport Office
• utilities – gas, electricity, telephone/mobile phone companies
• season ticket issuers
• catalogue companies.
12
Coping with grief
Adjusting to the loss of someone that we love can make us feel confused and
overwhelmed by sadness and other emotions. This is grieving.
This section describes some of the feelings that might affect how we think
and behave when we are grieving. Not everyone will experience all of these.
You may feel some more strongly than others, and they may come in any
order or be mixed up together.
Grieving is normal, and people react differently. There is no time limit for the
feelings associated with grief – for some people it is a matter of months, for
others years. You need to give yourself time to adjust and re-engage in life
without the person who died.
Thoughts and feelings associated
with grief
You may feel numb at first. You might experience feelings of shock and
disbelief, even if the death was expected. It may feel unreal – you cannot
accept that your loved one has died. This is a normal reaction that initially
comforts you against loss.
It is not uncommon to feel ashamed of your emotions. For example, you may
feel guilty for things you think you should have done, or relief that the person
has died and that their pain and suffering is over. You may experience a
feeling of disloyalty when you find yourself pursuing new or old interests.
You may be angry with yourself, for the things you said or always meant to
say and did not have the chance to. You may also feel angry at the person
who died, or you may blame other family members or the professionals
involved in the care of your loved one. Depending on your religious/spiritual
beliefs, you may question ‘why’ this was allowed to happen.
Part of grieving is trying to make sense of something that often seems
senseless. You may find yourself thinking ‘If only...’
13
If you have lost someone who has been a big part of your life, your home
may seem very empty. The feeling of isolation can be painfully strong. You
may feel sorry for yourself.
Longing can be a big part of grief. Some describe this feeling as similar to
‘losing your mind’. For instance, you may look for your loved one in a crowd;
you may think you have seen them on a bus or even heard their voice, even
though you know that they are dead.
It is common to have feelings of sadness and depression. These should
lessen with time. If, however, the feelings get stronger and you are unable
to carry out normal tasks or you experience suicidal thoughts, then it is
important for you to seek specialist help. The usual way to access this is
through your GP.
Physical and behavioural changes
You may feel tired, but you cannot sleep. You might feel hungry but unable to
eat. You may have difficulty concentrating and be easily distracted or forgetful.
You might find yourself in a state of panic or viewing simple problems out of
proportion.
You may feel run down and lethargic or have aches and pains that you do not
normally suffer. Although this can be a normal part of the grieving process,
seek advice from your doctor if you are concerned.
You may find that friends and neighbours sometimes avoid you. This is
because they do not know what to say and/or they are finding it difficult to
cope with their own feelings of loss. It may help if you take the first step by
letting them know that you would appreciate their friendship and support.
It might seem that life would be more bearable if you made drastic changes
to avoid painful memories, such as moving house or disposing of your loved
one’s belongings. Try to avoid doing this at an early stage in your loss. There
will come a time that is right for you to make such important decisions.
14
Suggestions that may help
Allow yourself time to grieve. Accept that crying is a normal way to release
your feelings and that you may need to allow yourself to cry sometimes.
Try to accept help from others, and do not allow yourself to become isolated.
Remember that anniversaries, birthdays and Christmas can intensify feelings
of grief, so you may benefit from extra support at these times.
Take care of yourself, eat sensibly and exercise. Check with your GP if you
have any health worries.
Try to keep to routines – perhaps re-establish old routines or set new ones.
Sharing your feelings can be helpful. It is not always easy to do this with
family and friends, and you may prefer to speak with someone else you can
trust.
You might also consider contacting a local organisation that offers
bereavement support. (See the ‘Support organisations’ section at the back
of this booklet.)
Remember, you will have good days and bad days. Allow yourself to laugh,
cry and be angry – you have lost someone you love and it hurts. As time
passes, you will find that memories are perhaps less painful. You will be
able to remember without becoming so distressed. You may find yourself
pursuing new or old interests.
Keep in mind that specific things which may be too painful for you to do at
the beginning may provide comfort later on, for example visiting the grave,
listening to a special piece of music or looking at photographs. Starting a box
for mementos such as letters, pictures and items that had special significance
for your loved one can also be a helpful focus for your grief.
Keeping a journal can help you to process painful feelings that you may find
hard to share.
Try to avoid becoming dependent on substances such as alcohol or nonprescribed medications or drugs.
15
Caring for children
Adults often feel the need to protect children from death and their own grief,
as they think the children will find it too upsetting. However, children are often
more frightened when they are not sure what is going on around them than
when they are allowed to be a part of it.
When you tell children that a loved one has died, use simple language and
answer any questions as honestly as you can. Use words such as ‘dead’ and
‘death’ rather than ‘lost’ or ‘sleeping’, which can be confusing for them.
Pre-school children do not generally understand that death is permanent
and may repeatedly ask questions such as ‘When is granny coming back?’
Children of primary school age usually do have an understanding of the
finality of death and often ask direct questions about it.
Signs of grief
Children may display symptoms such as becoming quiet and withdrawn,
clinging towards a parent, bed-wetting, fearing the dark, or displaying sleep
or behavioural problems at home or school. These are all normal reactions
for young children, and for most they will pass in time.
Teenagers are already going through physical and emotional changes, and
communication can often be difficult for this age group. They often feel a
sense of injustice and question why their relative or friend had to die. They
may ‘test the boundaries’ by, for example, staying out late or losing interest
in school. It can help for them to talk about their feelings. It is important that
they feel someone is listening to them and acknowledging how they feel.
16
Helping children cope
Sometimes it helps to allow children to decide for themselves if they wish to
see the body or not. However, to enable them to make their decision, you will
need to prepare them by explaining what they will see. For young children
you may need to explain that the body no longer eats, talks, walks or sleeps
and that it may feel cold to touch.
It may be helpful to encourage the child to write a letter, draw a picture or
put a small gift in the coffin (take care that this does not include batteries or
electrical items if your loved one’s body is to be cremated). This can be a
positive way for the child to say goodbye.
You can also encourage children to remember the person who died by
sharing stories, looking at photographs or keeping mementos.
As with adults, sometimes individual children will benefit from specialist
bereavement support. If you think this is the case for a child in your care,
contact your GP or one of the organisations listed in the next section.
17
Support organisations
Cruse Bereavement Care
Bereavement support and counselling for adults, children and young people
Northern Area
• (028) 2766 6686
Youth Services
• 0808 808 1677 (freephone)
• www.rd4u.org.uk
Day-to-Day Helpline
• 0844 477 9400 (freephone, 9 am to 5 pm, Monday to Friday)
• www.cruseni.org
Samaritans
Confidential, non-judgemental emotional support for people experiencing
feelings of distress or despair
•
•
•
(028) 2565 0000 (Ballymena)
(028) 7032 0000 (Coleraine)
www.samaritans.org
24-Hour National Helpline
• 0845 790 9090
• 0845 790 9192 (hard of hearing, deaf and speech-impaired only)
Compassionate Friends
Support and friendship after the loss of a child, including adult children
•
•
•
(028) 8778 8016
0845 123 2304 (freephone, national helpline)
www.tcf.org.uk
18
Northern Trust Bereaved by Suicide Project
Bereavement support groups and counselling for those bereaved by suicide
in Northern Trust areas
•
•
(028) 2563 6607
email: [email protected]
Lifeline Helpline
24-hour support for those in distress or despair
•
•
0808 808 8000 (freephone)
www.lifelinehelpline.info
Barnardo’s Child Bereavement Service
Support for children following bereavement
•
•
(028) 9066 8333
www.barnardos.org.uk
NI Hospice
Bereavement support for families whose loved ones had contact with them
•
•
•
74 Somerton Road, Belfast, BT15 3LH
(028) 9078 1836
www.nihospicecare.com
Marie Curie Centre
Bereavement support for families whose loved ones had contact with them
•
•
•
Kensington Road, Belfast, BT5 6NF
(028) 9088 2000
www.mariecurie.org.uk
19
Age NI
Information, advice and support for older people
•
•
•
•
3 Lower Crescent, Belfast, BT7 1NR
(028) 9024 5729
0808 808 7575 (advice line, freephone)
www.ageuk.org.uk
Northern Ireland Council for Ethnic Minorities (NICEM)
Information, support and advice for people from ethnic minority groups
•
•
•
3rd Floor, Ascot House, 24–31 Shaftesbury Square, Belfast, BT2 7DB
(028) 9023 8645
www.nicem.org.uk
WAVE Trauma Centre Support
Befriending and counselling for people who are victims of violence or
bereaved due to the ‘Troubles’
•
•
(028) 2766 9900
www.wavetraumacentre.org.uk
20
Coroners Service for Northern
Ireland
Coroners are independent judicial officers. They deal with matters relating to
deaths that may require further investigation to establish the cause of death.
A Coroner will make whatever inquiries are necessary to seek to establish the
cause of death, for example ordering a post-mortem examination, obtaining
witness statements and medical records, or holding an inquest.
•
•
•
Mays Chambers, 73 May Street, Belfast, BT1 3JL
(028) 9044 6800
www.coronersni.gov.uk
21
Notes
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
..................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
22
Experience of Care at the End of
Life
We welcome comments from families and friends, which we can use to help
us to improve our services. Within the next few months, if you would like to
give us feedback on your experience, please complete this questionnaire
and return it to the address below.
Name (optional) .............................................................................................
Address (optional) ..........................................................................................
Hospital .......................................................... Ward/Dept ............................
For (a)–(f) below, please rate your experience by circling the number beside
each statement that best describes your view:
5 = excellent 4 = good 3 = satisfactory 2 = poor 1 = unacceptable
(a)
The level of information and
communication you received
before your loved one’s death
5
4
3
2
1
(b)
The quality of care your loved
one received before death
5
4
3
2
1
(c)
The attitude of the staff caring
for your loved one
5
4
3
2
1
(d)
The level of care and support
given at the time of death
5
4
3
2
1
(e)
The level of care and support
you received after the death
5
4
3
2
1
23
(f)
The usefulness of the information
in this booklet
5
4
3
2
1
Any other comments (for example suggestions as to how the care could
have been improved):
.................................................................................................................
.................................................................................................................
.................................................................................................................
Address:
Patient Experience Officer, Governance Department,
Bush House, Bush Road, Antrim, BT41 2QB
Thank you for taking the time to complete this questionnaire.
24
14829 NHSCT someone dies cover.qxd:when someone dies 5
10/7/12
Published November 2011
12:38
Page 2
14829 NHSCT someone dies cover.qxd:when someone dies 5
10/7/12
12:38
Page 1
When
someone dies
Information, guidance and
support for
Family and Friends
NT/MED/6179 07/12 4k