Death in Care Home Procedures

Understanding Care Home Death Procedures

When someone dies in a care home (residential or nursing home), specific procedures are followed. Understanding what happens, the care home's responsibilities, when the coroner gets involved, and your rights as family can help you navigate this difficult time.

October 2025 Update:

All care home deaths now go through the Medical Examiner system before registration. This has improved scrutiny and reduced inappropriate deaths going uninvestigated, though it adds 1-2 days to the process.

Important: Most care home deaths are from natural causes and proceed smoothly through registration to funeral. However, care homes are required to follow strict procedures to ensure proper oversight.

Immediate Actions When Death Occurs

What the care home should do immediately after a death:

1. Verify the Death

A registered nurse (in nursing homes) or doctor must verify that death has occurred. They check for signs of life and record the time of death. In residential homes without nurses, a doctor is called.

2. Notify the Family

The care home should contact the next of kin immediately, usually by phone. They should inform you sensitively and offer the opportunity to come to the care home if you wish.

3. Contact the GP

The resident's GP is contacted to attend and certify the death by issuing a Medical Certificate of Cause of Death (MCCD), if appropriate.

4. Secure Personal Property

The care home secures the deceased's personal belongings and valuables, creating an inventory for the family.

5. Prepare the Body

Staff prepare the body with dignity and respect, usually moving it to a designated quiet room. Religious or cultural practices should be respected.

Medical Certification in Care Homes

How the death is certified depends on the circumstances:

Expected Deaths from Known Conditions

If the resident was terminally ill or had known life-limiting conditions:

GP can issue MCCD if they attended in the last 28 days
GP will visit the care home (or may certify remotely in some circumstances)
MCCD states the natural cause of death
Certificate goes to Medical Examiner for review
If ME approves, family can register the death

Unexpected or Unexplained Deaths

If death was unexpected or cause is unclear:

GP may decline to issue MCCD
Death is referred to the Medical Examiner
ME reviews and may refer to the coroner
Coroner may order post-mortem examination
Registration is delayed until investigation complete

When Coroner Involvement is Likely

Certain circumstances trigger automatic coroner referral:

Death within 24 hours of admission to care home
Fall resulting in serious injury within 30 days before death
Unexpected death of someone not known to be terminally ill
Concerns about care quality
Suspicious circumstances
Death possibly related to medication error
Pressure sores or malnutrition concerns

Care Home Responsibilities

What good care homes should do:

Family Notification and Support

Contact family immediately (within 1 hour typically)
Provide clear information about what happened
Offer opportunity to visit and spend time with the deceased
Explain next steps and procedures
Provide bereavement support information

Documentation

Complete internal death notification paperwork
Prepare detailed care notes leading up to death
Create inventory of personal belongings
Document any incidents or concerns prior to death
Notify relevant bodies (CQC, local authority, CCG)

Coordination with Medical Professionals

Arrange GP visit for certification
Provide medical records to certifying doctor
Liaise with Medical Examiner
Facilitate coroner investigation if required
Coordinate with funeral director chosen by family

Personal Property

Secure all belongings immediately
Create detailed inventory with witness
Arrange for family to collect items
Handle valuables with appropriate security
Deal sensitively with disposal of items family doesn't want

Room and Billing

Explain when room must be cleared
Provide final account and billing information
Return any advance payments or deposits
Handle resident's mail appropriately

Family Rights and Involvement

What you can expect and request as family:

Right to Visit and Spend Time

You have the right to visit the care home and spend private time with your loved one. Good care homes accommodate this at any reasonable hour and provide a private, dignified space.

Right to Information

You're entitled to:

Clear explanation of circumstances surrounding the death
Access to care records (with appropriate legal authority)
Information about next steps in certification and registration
Contact details for relevant professionals
Explanation of any regulatory notifications made

Right to Choose Funeral Director

The care home cannot require you to use a particular funeral director. You choose your own, though the home may make recommendations. Beware of commission arrangements that may inflate costs.

Right to Raise Concerns

If you have concerns about the care provided or circumstances of death:

Raise concerns with care home manager immediately
Request explanation and access to care records
Contact CQC (Care Quality Commission) if concerns remain
Request Medical Examiner review if suspicious
Consider complaint or legal advice for serious concerns

Registration Process for Care Home Deaths

How death registration works after a care home death:

Obtaining the MCCD

The care home will receive the Medical Certificate from the GP (or coroner if involved). They should give it to you or your chosen funeral director promptly.

Medical Examiner Review

Before registration:

ME reviews the MCCD and care records
ME may contact you to discuss circumstances
ME confirms cause of death or refers to coroner
Process usually takes 1-3 days

Who Registers

Qualified informants for care home deaths:

Relative (preferred – spouse, child, sibling, etc.)
Person present at death (could be care home staff)
Care home manager (as occupier of premises)
Person arranging funeral

Care homes may offer to register on your behalf, but most families prefer to register themselves.

Timeline

Typical timeline from death to registration:

Day 1: Death occurs, GP contacted
Day 1-2: GP issues MCCD
Day 2-4: Medical Examiner review
Day 3-5: Registration appointment
Day 5-14: Funeral can proceed

When Deaths Are Referred to the Coroner

Certain care home deaths must be reported to the coroner:

Mandatory Referrals

Death within 24 hours of care home admission
Fall resulting in fracture within 30 days of death
Death following choking incident
Unexpected death of person not known to be terminally ill
Death possibly related to medication error or adverse reaction
Concerns about neglect or abuse
Grade 3 or 4 pressure ulcers present

Discretionary Referrals

Medical Examiner or care home may also refer if:

Unexplained injuries present
Concerns about quality of care
Family raises safeguarding concerns
Death follows restraint or seclusion
Pattern of deaths suggests systemic issues

What Happens After Coroner Referral

Coroner reviews circumstances and care records
May order post-mortem examination
Body usually released within 1-2 weeks
Investigation continues (may include inquest)
Registration proceeds once coroner issues documentation

Financial Matters After Death in Care Home

Understanding your financial obligations:

Fees Owed

Care home fees are typically owed:

Up to and including the day of death
Plus notice period (usually 7-28 days depending on contract)
Check the care home contract for specific terms
Some homes waive notice period compassionately

Personal Allowance and Client Account

Many homes manage residents' personal spending money. The home should provide final accounting and return any balance to the estate promptly (within 7-14 days typically).

Funding Arrangements

Notify relevant parties about the death:

Local authority (if they funded care)
Continuing Healthcare team (if NHS-funded)
Pension providers (payments should cease)
Benefits agencies (stop benefit payments)

Room Clearance

You'll need to remove personal belongings by the date specified in the contract (often 7-14 days). Arrange collection promptly to avoid storage charges.

If You Have Concerns About Care

If you're worried about the care your relative received:

Immediate Actions

Raise concerns with care home manager – Give them opportunity to explain and address issues.
Request access to care records – You may need legal authority (executor status or court order).
Document your concerns – Make detailed notes while memory is fresh.
Speak to other residents' families – Are there patterns suggesting systemic issues?

Formal Complaints

If concerns aren't resolved:

Care Quality Commission (CQC): Regulator for care homes in England
Care Inspectorate Wales: For Welsh care homes
Local authority safeguarding team: For abuse or neglect concerns
Professional bodies: If specific professionals (nurses, doctors) were negligent

Legal Action

For serious cases:

Clinical negligence solicitor: For medical negligence claims
Inquest solicitor: If coroner investigation occurs
Police: If criminal neglect or abuse suspected

Note: Most concerns can be addressed through complaints processes without expensive legal action.

COVID-19 and Care Home Deaths

Special considerations that continue to apply:

Death Certification

COVID-19 can be certified as cause of death without post-mortem if clinically diagnosed. GPs can now certify remotely in some cases, though they should view the deceased where possible.

Family Visits

Current guidance prioritizes allowing families to visit dying residents and to spend time with deceased loved ones, even during outbreaks (with appropriate infection control).

Increased Scrutiny

Following pandemic experiences, care home deaths receive more regulatory scrutiny. Medical Examiner reviews are more thorough for care home deaths.

Supporting Other Residents

Good care homes recognize that death affects other residents:

Notification: Other residents should be told sensitively about the death, especially if the deceased was well-known in the home.

Memorial activities: Many homes hold small memorial events or moments of remembrance.

Bereavement support: Staff should monitor and support residents who may be grieving.

Checklist: After a Care Home Death

Visit care home to see your loved one if you wish
Choose a funeral director
Collect personal belongings (within timeframe specified)
Obtain Medical Certificate (from care home or GP)
Wait for Medical Examiner review (1-3 days typically)
Register the death (within 5 days if possible)
Arrange funeral (usually 1-2 weeks after death)
Settle final care home account
Notify funding bodies (local authority, CHC, DWP)
Cancel any ongoing services or subscriptions
Raise any concerns about care received

Questions to Ask the Care Home

• What were the circumstances surrounding the death?
• Who was present when death occurred?
• Has the death been referred to the coroner? If so, why?
• When can we collect personal belongings?
• What is the final account balance?
• Can you recommend a funeral director? (But remember you choose)
• How do we access care records if needed?
• What happens next with certification and registration?

Regional Variations

Scotland

Different registration timeline (8 days instead of 5) and Procurator Fiscal instead of coroner. Care homes in Scotland follow similar notification procedures but with Scottish regulatory oversight.

Wales

Care Inspectorate Wales regulates care homes. Medical Examiner system applies. Otherwise procedures similar to England.

Northern Ireland

Regulation of Care Northern Ireland oversees care homes. Coroner system similar to England. Registration procedures broadly comparable.

Getting Support and Advice

• Care Quality Commission: 03000 616161 / cqc.org.uk – For concerns about care
• Local authority safeguarding: Contact your council for abuse concerns
• Action on Elder Abuse: 080 8808 8141 – Helpline for abuse concerns
• Independent Age: 0800 319 6789 – Advice and support
• Age UK: 0800 678 1602 – General advice and support
• Cruse Bereavement Support: 0808 808 1677 – Bereavement counseling