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Signs of Approaching Death

End-of-Life Timeline: Know what to Expect


If you have a loved one who has recently entered into hospice care or is going to, you may have a few months, or even weeks to say goodbye. Death is something we all must face. Saying goodbye to a loved one is hard to do, but learning what to expect from the dying process came make it easier for you to care for them as they prepare to leave, it can help to say goodbye and better cope with the aftermath of your loss.


Dying is a natural process and is highly variable since signs vary substantially between individuals. Clinical signs present within an individual increases when the individual is transitioning from one stage to another.

Life Immortal poem

Goldencare Hospice and Palliative Care works hard to keep hospice patients physically and emotionally well as they improve their quality of life. Our experts can help patients and their families comprehend terminal illnesses. Call us at 855.655.0500 for support.


Hospice care allows you to share your loved one's most difficult journey with them, which can make it easier for you to obtain closure, properly care for them, maintain good communication, help cope during their final days, better appreciate the time you have together and provide them the medical care they need. Hospice helps you face this together with highest standard of care and professionalism.


Every death follows it's own course, but hospice patients generally exhibit several stages of symptoms before passing.


Dying is a natural process accompanied by decrements in neurocognitive, cardiovascular, respiratory, and muscular function. It's highly variable and can last up to several weeks in some instances.


End of Life Stages Timeline


Weeks Before Death:

There are many forewarning signs that death is near besides clinical indicators and symptoms. Analyzing emotional signs can shed light on a patient's end-of-life status. It's important to let your loved one set their own pace during this time, speak in a calm reasurring voice, while holding their hand, and keep them hydrated.


Some of the signs can include:

  • A prolonged state of excessive fatigue, sleep, perhaps being comatose-like

  • Confusion and/or disorientation

  • Hearing or seeing people and events not visible and not present to you

  • Social withdrawal and detachment, less communicative

  • The desire to conduct a life review or settle something unresolved, seeking forgiveness

  • The desire to focus on funeral planning


Common Symptoms include physicial changes such as:

  • Chronic Fatigue

  • Loss of appetite

  • Higher risk of infection

  • Fragile, easily-damaged skin

  • General pain

  • Prolonged, unexplained weightloss

  • Difficulty swallowing

  • Untreatable nausea

  • Swelling of the abdomen, such as edema or ascites


Critical indications include temperature, respiration rate, pulse, and blood pressure alteration. Temperature, respiration, vibration, and blood pressure are vital indicators.

Hospice patients may struggle to take oral medications or stay hydrated at this stage. This was expected. Patients may be too exhausted to get up.


Last for a few days or hours

  • A brief energy surge that slowly fades

  • Dropping blood pressure may continue

  • Breathing may be abnormal—numb, purple, and speckled hands and feet

  • Pulse weakens

  • Labored breathing

  • Increased restlesness, due to lack og oxygen to the limbs

  • Eyes may moisten or cloud

  • Cold hands

  • Inability to close eyelids

  • Urine output may decrease


You may also notice a Death Rattle or wrinkles and scars on their hands and feet. These are common in dying people.


  • Death Rattle is a "Gurgling" sound produced on inspiration and/or expiration related to airway secretion.


Momentary death

In the final hours, your loved one's body will begin to shut down, and may slowly become unresponsive. If you think your loved one is simply asleep or unconscious when in fact they died, call the hospice nurse to provide you with further instructions if you suspect this is the case.


Some tell-tale signs that indicate your loved one has passed away:

  • They begin to gasp, then slowly take several more breaths relatively far from one to another

  • Their eyes and mouth open

  • They cannot be awakened


End-of-life planning is complex. End-of-life preparation is elaborate. A calm, well-lit area prioritizes patient safety. They may sleep, wake up, and dream. This is typical of the dying.


Hospice Team Involvement During Stages of Dying

When clinical signs of dying emerge, the hospice interdisciplinary care team initiates a care plan update that includes:

  • Revisions to interdisciplinary visits

  • Education on the dying process

  • Adjustments / additions of necessary medications

  • Assurance that proper HME is in place to assist your patient and family


The hospice team provides support in a variety of ways, specific to each team member's discipline.


Physician, Nurse, Nurse practitioner:

  • May discuss the discontinuation of non-beneficial treatments

  • Ensure symptom medications and necessary equipment are available

  • Educate family on use of medications to manage symptoms and/ or pain, and describe physiological changes associated with the dying process.


Social Worker & Chaplain:

  • Help patients and families explore their feelings and relationships

  • Participate in life review, including search for meaning and contributions

  • Conduct life closure, including forgiving and facing regrets, being able to say goodbye, and coming to terms with the acceptance of ongoing losses and death


Hospice Aides:

  • Recognize the clinical signs of dying and communicate them to the team

  • Support patient and family through the dying process


Hospice Team Involvement Helping Families Cope after Loved One has Passed

End-of-life care is a journey shared with family. The duration of care involves providing ongoing support to family members, helping them navigate emotional challenges, understand the process, and make informed decisions about their loved one's care.


After a loved one dies, family members need time to process their feelings. They should not be subjected to additional stress with the logistics of legal forms or removal of the body.


It's important for family members and friends to stay in touch and rely on each other as their move through their grief.


GHPC is a Medicare-certified hospice and we do provide up to a year of grief and loss counseling for the family following their loved one's death.


At Goldencare Hospice and Palliative Care, we are committed to making this journey as peaceful and meaningful as possible, regardless of it's length. GHPC is your Partner in End-of-Life Care. Call GHPC at 855.655.0500 with any questions.

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