Recognizing when Death is Near: How to Plan and What to Expect

End of life signsIt can be just as difficult to predict the exact time that someone will die as it to predict exactly when a baby will be born. However, there are signs you can watch for that will help you prepare mentally, emotionally and physically for this big change in your family’s life.
As you care for your loved who may be near death, look for normal signs like these:

  • Losing interest in and becoming less responsive to what is going on around them
  • Sleeping or seeming drowsy most of the time
  • Eating and drinking less than usual or not at all
  • Irregular breathing, including noisy or gurgling sounds, sometimes called a “death rattle”
  • Talking to someone who has already died
  • A brief surge of energy and clarity of mind

The loved ones of a person who is dying want to know what they can do to make the person more comfortable. Even though a dying person may seem unconscious, many professional caregivers think hearing may still be functional. Continue talking to your loved one. Express your love, hold their hand and reassure them that they can go when they are ready. Take advantage of a brief period of consciousness to say final goodbyes. Even though my father couldn’t talk, we put the phone up to his ear to let out-of-town family members talk to him. He seemed to respond to hearing their voices.
Don’t try to force food or water. Going without food or water is not uncomfortable. Swallowing may also be a problem, especially for people with dementia. A conscious decision to give up food can be part of a person’s acceptance that death is near. If the person’s mouth seems dry, just swab it with water and apply lip balm. A “death rattle” may be helped by turning the person to one side. Pain killers often make breathing easier, as well.
Ask for help when you need it and graciously accept it when it’s offered. Some specific tasks that you could assign to others include picking up the mail or newspaper, writing down phone messages, doing a load of laundry, feeding the family pet, taking children to their activities, picking up medicine from the pharmacy, paying bills, walking the dog, babysitting or bringing in meals. Help with any of these tasks may provide welcome relief for caregivers.
Keeping close friends and family updated can be a big job. Setting up a family blog, a mass-email list, a private Facebook page, or even a group text can reduce the number of calls you have to make. Assigning a family member or friend to make the updates for you can help reduce the emotional burden of answering frequent questions.
If the patient or anyone in the family needs help with religious traditions, funeral plans or other spiritual issues, someone can also be assigned to call the family’s spiritual leader or advisor or even the funeral home that has been selected. Hospice services also provide spiritual counseling and support.
If the loved one or the family hasn’t already decided what is the preferred location for where death should take place, there are three options for patients who are on comfort measures only (CMO):

  1. If the loved one is in the hospital, the family may wish to stay there, either with or without hospice. Staying in the hospital for longer than one day may not be an option, because many hospitals have a 2-3 day time limit for in-hospital hospice or comfort care only.
  2. An inpatient hospice unit staffed by hospice nurses, social workers, and physicians can provide excellent comfort care as well as helping families with psychological and religious needs.
  3. Many people express a desire to die at home, and many families also prefer to bring their loved one home with hospice care. Hospice services provide roughly 2-4 hours of care a day, depending on the patient’s needs. The family will need to provide basic comfort care for their loved one with guidance from the hospice team. Additional in-home services are offered by Dakota Home Care and other in-home-care companies.

The available options will vary depending on the patient’s condition, the insurance, and the family’s situation.
A dying person may have some specific fears and concerns. He or she may fear the unknown or worry about those left behind. Some people are afraid of being alone at the very end, while others want to wait until their loved ones are not there before they let go. Remember that a dying person may still be able to hear you, so you can continue to express your love and give comfort until the last breath.
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