Zion’s Way Hospice realizes this is a difficult time of life for you and your family. Our approach at Zion’s Way Hospice is to be honest and straightforward in all matters affecting you during this time.

Everyone approaches death in their own way. The final steps will be unique to each individual. The following information is to help you prepare and anticipate the signs and symptoms which are indicative of approaching death. These are only guidelines of how the body prepares itself for the final stages of life. For some, it is a long process; for others, it happens very quickly.

One To Three Months Prior To Death

The hospice patient spends increasingly more time sleeping during the day. At times, it will be difficult to arouse the patient from sleep.

Plan your time with your loved one for those occasions when he/she seems most alert. As the patient becomes aware of his/her approaching death, he/she may withdraw from the world around them, lose interest in TV, reading and other people. Sleeping is a way of withdrawing, a way of processing one’s own life.

Your loved one will lose interest in food, lose their appetite and not be able to eat. Offer fluids and small amounts of food to the patient. When a body is preparing to die, it is natural for eating to stop. Eating is living. It takes a great deal of energy to digest food and the body does not have this energy at this stage of life. It’s all right not to eat. A different kind of energy is needed, now, a spiritual energy, not a physical energy.

One To Two Weeks Prior To Death

The hospice patient may become increasingly confused about time, place and the identity of familiar people. Remind your family member what day it is, what time it is and who is in the room taking care of them.

Sleeping is almost constant now; the patient cannot seem to keep his/her eyes open. The patient can be awakened and is able to hear what is being said, even if there is no response. You may notice your loved one becoming restless, pulling at their bed linen, picking at the air, picking at their clothing or displaying agitated arm movements. These symptoms are a result of a decrease in the oxygen circulation to the brain and a change in the body’s metabolism.

- Talk calmly so as not to startle or frighten the patient.

- Music can be a great source of comfort.

- With the confusion and disorientation, you may notice the patient is talking to people about places and events unknown to others.

- The patient may see and talk with loved ones who have gone before them and is now focusing on changing from this world to the next.

The arms and legs of the body may become cool to the touch. The body temperature fluctuates between fever and cold. There may be an increase in perspiration, often accompanied with clamminess. These side effects result from the blood circulation slowing down.

- Keep a warm blanket on the patient to prevent him/her from feeling overly cold. Do not use an electric blanket.

You may notice a change in the breathing pattern. Respiration may change to a very rapid or a very slow pace. There may be ten to thirty seconds of no breathing known as “apnea”. Elevating the head of the bed often relieves this irregular breathing pattern. These patterns have a tendency to come and go. Breathing may be irregular one minute and normal the next. Oral secretions, or congestion, may become more profuse and collect in the throat. A rattle sound may occur in the lungs or throat. This symptom is a result of a decrease in the body’s intake of fluids and the inability to expel saliva.

- Use a cool mist humidifier to help alleviate these symptoms.

- Elevating the head of the bed may make breathing easier.

- Turning the patient on their side may promote comfort.

- Wiping the mouth with a wet cloth, or cleaning the mouth with wet swabs will relieve feelings of dehydration.

One To Two Days Prior To Death

Sometimes a surge of energy will appear and the patient may talk clearly and be alert and favorite foods may be eaten. The spiritual energy for the transition from this world to the next has arrived. Then, the signs and symptoms from the one to two weeks prior to death become more pronounced as death approaches.

- Restlessness becomes more intense.

- Breathing patterns become slower and shallower.

- Congestion becomes very loud.

- Eyes may be open, or semi-open, glassy and non-functional.

- Hands and feet may become purplish and the body’s skin appears blotchy.

- Non-responsiveness may occur.

- Loss of fluids may occur.

How will I know when death has occurred?

- No breathing.

- No heartbeat.

- Loss of bowel and bladder control.

- No response.

- Eyelids slightly open and eyes fixed.

- Jaw relaxed and mouth slightly open.

Consult with your Zion’s Way Hospice caregivers. You may call the office anytime. A nurse is on call 24 hours a day and seven days a week to assist you with any situations or concerns that you might have.