End of life: Caring for your dying loved one

Caring for a dying loved one isn't easy. Even when you know the end of life is approaching, you might not feel prepared. Understanding what to expect — and what you can do to increase your loved one's comfort — can help.  

Choosing where to die

Your loved one may have various choices for end-of-life care. Options may include:

• Home care. Many people choose to die at home or in the home of a family member. You can assume the role of caregiver or hire home care services for support. Hospice care can be provided at home as well.
• Inpatient care. Some people may prefer round-the-clock care at a nursing home, hospital or other facility. Hospice care can be provided in these facilities, too.

When you discuss the options with your loved one, consider his or her preferences and special physical, emotional and psychosocial needs. Evaluate how much support can be provided by family members and friends. For help determining the best option, talk with your loved one's health care team or a social worker.

Spirituality at the end of life

As your loved one approaches the end of life, he or she may talk about spirituality or the meaning of life. Don't force the subject — but if it comes up, encourage your loved one to explore and address his or her feelings. You might ask your loved one open-ended questions about his or her beliefs and experiences. You may want to invite a spiritual leader to visit your loved one as well.

Saying goodbye

You can help your loved one communicate his or her final wishes for family and friends. Encourage your loved one to share his or her feelings, including thanks or forgiveness, and give others a chance to say goodbye. This may stimulate discussion about important, unsaid thoughts, which can be meaningful for everyone. Your loved one might also find it comforting to leave a legacy — such as creating a recording about his or her life or writing letters to loved ones, especially concerning important future events.

Recognizing when death is near

It's difficult to predict exactly when someone will die. However, in the weeks before death, your loved one may show various signs and symptoms indicating that the end of life is near. Look for:

• Restlessness and agitation. Your loved one may insist on frequently changing positions.
• Withdrawal. Your loved one may no longer want to participate in social events or other favorite activities.
• Drowsiness. Your loved one may spend most of his or her time asleep.
• Loss of appetite. Your loved one may eat and drink less than usual.
• Pauses in breathing. This may happen when your loved one is asleep or awake.
• Difficulty healing. Wounds and infections may not heal.
• Swelling. This may happen in the hands, feet or other areas of the body.

When awake, your loved one may also begin to settle unfinished business or talk about seeing or feeling the presence of loved ones who have died. Your loved one may even say that he or she feels death is near.

Providing comfort

The active phase of dying usually begins several days before death. Signs may include changes in skin color, noisy or irregular breathing, inability to eat and drink, and limited ability to communicate. Although you can't change what's happening to your loved one, you can help him or her feel as comfortable as possible.

Your loved one also may experience a brief, final surge of energy. Though it can be confusing to see your loved one with renewed vitality, remember that this is a normal part of dying. Take advantage of the opportunity to enjoy him or her and say your final goodbyes.

Keeping vigil

For many families, keeping vigil near a dying loved one's bed is a way to show support and love. If you decide to keep vigil, continue talking to your loved one. If you think your loved one would want to share this time with others, invite family members or close friends to show their support as well. Express your love, but also let your loved one know that it's all right to let go.