Signs that death is near

Saying goodbye, preparing for time of death and your next steps.

Each person is unique and it is hard to predict exactly what may be encountered as our loved ones approach the end of life. Often, there are physical, mental, and spiritual signs that death is near. On the physical level, the body literally begins to shut down. These changes are normal and to be expected. They are not considered a medical emergency at this time of life. Your HopeWest team can provide additional information about what to expect.

 The following are things that may be observed and comfort measures that can be provided.

Refusal of Food and/or Fluids

This means the body is reserving energy for other essential functions. The person will not experience pain or other discomfort, such as feeling thirsty, as this is a natural process. Often, as people become dehydrated, their discomfort lessens. It is important not to try to force a person to eat or drink. Doing this generally makes a patient more uncomfortable and will not improve their condition.

Changes in Skin Temperature or Color

You may notice a coolness, paleness or mottling of skin on the arms, legs and back. This occurs as circulation is conserved for vital organs. Blankets can increase the patient’s comfort. We avoid using electric blankets or heating pads as they can cause burns without the patient feeling it due to the lack of circulation.

Loss of Urine or Bowel Control

As muscles relax, the patient may lose control of these functions. There is often a decrease in urine output. Patients should be kept clean and dry. Turning the patient frequently is important to assure good skin care and to prevent bed sores. A catheter may be considered for urinary incontinence.

Altered Breathing or Congestion

Gurgling or gasping may occur as the muscles in the throat tend to relax. At times, the patient may appear to stop breathing for a moment and then gasp. This is called Cheyne Stokes breathing. Elevating the head may decrease the sounds. To help with secretions, gently turn the patient’s head to the side and wipe out the mouth with a damp cloth or mouth sponge. Suctioning is not helpful and can make secretions worse.

Mental, Emotional and Spiritual States

While death remains one of the universe’s mysteries, many believe the spirit of the dying person actually begins a process of release from the body, its environment and all emotional attachments. This release tends to follow its own priorities, including the resolution of unfinished business, and it will always relate to a person’s lifestyle, values and beliefs. It is often said that, “people die consistent with the way they lived.”


Sometimes a person may become restless, try to get up or make repetitive motions. Try to avoid restraining these motions. Speak in a quiet, natural way. Try reading to the person, playing soothing music and keeping lighting slightly dimmed.


The person may become confused about time, place and/or the identity of people. Many people at this time speak of going home. It is important to speak softly and clearly remind the person of where they are and any care that is being given (ie: “I am going to give you this medicine to keep you from hurting.”) Try to keep as many things the same and in routine as possible.

Unusual Communication

A surprising number of people make out of character statements. They may speak in metaphors, speak to other loved ones who have previously died or talk about being somewhere they’ve never seen before. Research suggests these may not be hallucinations, but rather a form of communication.

Withdrawal and Increased Sleeping

As death approaches, people may begin to withdraw. They may close their eyes often or seem to have a decreased desire to communicate. This is often hard for loved ones. Try not to take it personally. It is a normal process of letting go that has to happen. The person may actually become unresponsive at some point. Know that hearing remains even when a patient appears to be in a coma. Be cautious in what you say during this time. Speak to the person in a normal tone of voice, identifying yourself by name. Hold their hand. You may want to touch their neck as this is a place where sensation seems to stay. This can be a good time to let the person know what they have meant to you.

Other Physical Signs
  • Decrease in blood pressure
  • Increase in pulse rate and difficulty finding it
  • Increase in perspiration
  • Elevation in body temperature

Saying Goodbye

Not everyone gets to say goodbye to the people they love before they die. Seize the chance if one seems to present, so you never have to wish you had told them something. Tell the person you love them and what you have loved about them. You might share special memories, activities or places you remember. Consider saying these things:

  • I love you
  • I am sorry for any difficulties I contributed to
  • I forgive you for any hurt I perceive you have caused me
  • Thank you

Sometimes it is appropriate to give the person permission to go. Often, people are so worried about how their loved ones will cope when they are gone that they hold on despite prolonged discomfort. You may provide the key for the person to release and let go by giving your permission. Tears are a natural part of saying good-bye. There is no need to hide them if they come. These will be your final gifts. Don’t worry if you say something when the person is not responsive or has their eyes closed. They will hear you.

When you lose someone, a period of grief usually follows and it may be difficult for you to concentrate or focus on your responsibilities. The HopeWest team understands this and will help you manage both your personal and financial responsibilities.

Preparing for Time of Death and Your Next Steps

What happens at the time of death?
  • Breathing stops
  • Heartbeat stops
  • Control of bladder and bowel ceases
  • Responses to verbal commands or shaking cease
  • Eyelids may be partially open with eyes in a fixed stare
  • Mouth may slightly open as the jaw relaxes
What should you do?

Call us at (866) 310-8900 and ask to have the HopeWest nurse paged. Do not call 911 or the emergency number for your area. You may call the secondary backup number at (970) 241-2212, if necessary. Spend time alone with the patient if you would like and wait for the nurse to arrive.

What will the nurse do?
  • Verify absence of heartbeat and breathing
  • Contact the doctor who verifies the death
  • Assist in contacting family members, if desired
  • Contact the coroner/medical examiner, if necessary
  • Contact the mortuary
  • Clean the patient’s body, if necessary
  • Help dispose of the patient’s medications and notifies the medical supply company to pick up any medical equipment, if applicable
  • Complete the patient’s discharge paperwork
  • Call or visits the family
  • May attend the funeral or memorial service
What will the social worker do?
  • Call or visit family
  • Assist in contacting family members, if desired
  • Provide counseling as needed
  • May make referrals to appropriate resources for the family
  • May attend the funeral or memorial service
What will the chaplain do?
  • Assist in contacting family members, if desired
  • Assist in choosing a mortuary if previous arrangements have not been made
  • Inform family about HopeWest grief recovery and support groups
  • Provide counseling or prayer as needed
  • May call or visit family
  • May conduct the funeral or memorial service, if requested
  • May attend the funeral or memorial service
What other decisions must you make?

If you or other family members would like additional time, the patient’s body may stay at home for up to 24 hours. A HopeWest team member will call the mortuary when the family is ready and the mortuary will pick up the body when requested to do so. If a decision has been made to donate organs or tissues, the nurse or funeral director can answer any questions you may have and assist you in signing the required consent forms.

What will the funeral home do?

At the appropriate time, contact the funeral home of your choice. They will help you with any specific questions and clarification of their services, which may include:

  • Pre-need planning
  • Exploring funeral/memorial service options; including viewings, cremation, burial and graveside option
  • Finding a minister or pastor to conduct the service
  • Contacting Social Security Administration and/or Veterans
  • Administration for death benefit, if applicable
  • Life insurance benefits
  • Death certificates
  • Cemetery arrangements – pricing and location
  • Anatomical donation of a body for science