The Stages of End-of-Life

There is no guaranteed timeline for the end of life. Hospice care workers and other medical providers often assess the number of clinical signs of impending death to determine a general timeline for each individual patient. Some may live longer than the expected timeline while others reach the end of their journey a little sooner. 

As a loved one, not knowing how much time you have left or what to expect from the stages of end-of-life may feel unsettling. Discussing estimated timelines with hospice care workers based on your loved one’s current clinical end-of-life signs and specific medical details can help. 

The following information about the most common end-of-life process should provide insight into what you may experience in the months, weeks, and days to come with your loved one. Not everyone will hit all of these stages in the process of dying, and each patient may move through the stages at a different pace. 

Pre-Active Stages of End-of-Life

The pre-active end-of-life stage can begin a month or more before a person displays multiple clinical signs of impending death. This early stage of the process starts when a person’s body begins the transition toward permanent rest. Your loved one may or may not realize when they enter this stage, but you may notice the following signs: 

• Increased time sleeping 
• Appetite reduction 
• Less interest in drinking water or other liquids 
• Weight loss 

Your loved one may continue to show some interest in food and drink, or they may show little to no interest. They may have a sudden interest to settle their affairs, reconnect with distant or disconnected loved ones, or review the highlights of their life. Some people will start to see loved ones who have already passed away. 

Active End-of-Life Stages

The active stages of end-of-life typically begin within one to two weeks of death. Your hospice care team will start to detect more and more clinical signs of dying. As the signs accumulate, the end of your loved one’s journey gets closer. 

Some of the most common signs noticed in the early period of active dying are often noticed within one week of death and may include: 

• Delusions and delirium 
• Difficulty swallowing 
• Difficulty speaking clearly
• Cold feet, hands, arms, and legs 
• Lowering blood pressure 
• Fluctuating or high heart rate

Within a few days of death, you may notice a worsening of those end-of-life signs plus one or more of the following: 

• Bluish coloration of extremities 
• Hyperextended neck 
• Non-reactive pupils 
• Decreased response to visual and verbal stimuli 
• Pauses between breaths 
• Inability to close eyelids 
• Grunting sounds 
• Fever 

It may feel like your loved one is pulling more inward, drawing away from you, as they get closer to the end of their journey. You may not understand everything they have to say as they get closer, and that’s okay. Sitting with them and providing comfort is more than enough. 

Eventually, your loved one may become completely unresponsive. They may still hear your words if you want to continue talking to them. 

Your hospice care team is with you until the process is complete. You’re never alone when Lucky Palliative Services is by your side.