End-of-Life Signs Timeline

Hospice is a unique and different experience for everyone. You or your loved one may feel emotional, fearful, at peace, spiritual, or unsure of your feelings. The goal of hospice is to treat the person, not the disease, and to focus on providing the greatest quality of life possible for the patient. The Crossroads team works to achieve this by making the patient physically and mentally comfortable, and one of the ways we do this is by providing patients and their loved ones with a detailed understanding of the end-of-life stages timeline. This timeline helps people to assess where they are in their journey as well as what to expect next. 

If a patient loses their appetite or sleeps more, seems to withdrawal from others or becomes restless, this is not a cause for panic. It is part of the natural process. Since end of life is such a unique experience, individual patients may move through the symptoms below more quickly or slowly than expected. It’s possible that this timeline does not exactly match what you or your loved one is experiencing, but it should be useful as a guide to know what to expect, and to know that you are no alone.  

End-of-life Timeline Stages:

One to three months prior to end of life. 

• Decreased appetite, showing a lack of interest in eating
• Increased sleepiness, showing a growing desire for sleep
• Increased sense of ambivalence to people or the environment around them 
• Increased pain and nausea
• Increased risk of infections
• Noticeable loss in weight 

Patients may become more withdrawn, less active, less communicative, and possibly even more introspective during this time. 

One to two weeks prior to end of life. 

• An even greater desire to sleep
• Perhaps stopping all eating 
• Increased restlessness
• Increased congestion
• Increased levels of confusion
• Increased hallucinations or visions, often involving loved ones who have passed
• Changes in vitas such as temperature, respiration, pulse, and blood pressure

It is not uncommon for patients at this stage of the hospice end-of-life timeline to experience difficulty in taking oral medications or hydration. Patients may also lack the will or energy to get out of bed. 

Days or hours before end of life. 

• May experience a sudden and brief surge of energy
• Blood pressure may continue to decline
• Breathing may become erratic 
• Hands and feet may become cold, purple, and/or blotchy
• Pulse will weaken
• Eyes may become glassy or teary, or only be half open
• Urine output may decrease 

During this time it, you may also notice a Death Rattle or that their skin, particularly on their hands and feet, has become increasingly mottled and blotchy. 

Minutes until end of life. 

• Expect eyes and mouth to remain open
• Expect gasping breathing
• You may be unable to wake your loved one

It is impossible to predict the time of death, it may take hours or even days. The final stages of the end-of-life timeline can be difficult. Patients should be made as comfortable as possible and the environment should be peaceful and well lit. Individuals can range anywhere from unresponsive to lucid and clearheaded to confused and may be prone to hallucinations. These are all normal end-of-life responses. 

Understanding the Four Stages of Hospice Care

Hospice care is designed to provide comfort, dignity, and compassionate support to individuals nearing the end of life. It’s tailored to meet the changing physical, emotional, and spiritual needs of patients and their families. There can be considered four levels of hospice care, each serving a specific purpose depending on the patient’s condition and circumstances.

1. Routine home care.

This is the most common level of hospice care. Services are provided wherever the patient calls home—whether that’s a private residence, nursing facility, etc. A hospice team, including nurses, aides, social workers, chaplains, and volunteers, makes regular visits to manage symptoms and offer emotional and practical support.

2. Continuous home care.

This level is offered during times of crisis, such as severe pain or acute symptoms. Hospice staff may remain bedside for several hours or around the clock to stabilize the patient and avoid hospitalization.

3. General inpatient care.

When symptoms become too difficult to manage at home, patients may be temporarily moved to a hospice facility, hospital, or nursing home for more intensive care. Once symptoms are under control, the patient can return to their previous setting.

4. Respite care.

Caring for a loved one at the end of life can be emotionally and physically exhausting. Respite care allows primary caregivers to rest while their loved one is cared for in a hospice facility for up to five consecutive days.

How hospice helps in the final stages of life.

Hospice plays a vital role in supporting both patients and families as the end of life approaches:

• Pain and symptom management is a top priority.
• Emotional and spiritual support is offered through counseling, chaplain visits, and bereavement services.
• Family education and guidance help caregivers understand what to expect and how to provide comfort.

How do you know when a hospice patient is transitioning?

When a patient begins to "transition," it means they are entering the final days or hours of life. Signs may include:

• Increased sleep or unresponsiveness.
• Changes in breathing patterns (Cheyne-Stokes breathing).
• Cold or mottled extremities.
• Minimal intake of food or fluids.
• A sudden surge of alertness followed by rapid decline.

Hospice staff are specially trained to recognize these signs and provide additional support to ensure comfort and peace during this final phase.

What happens when hospice comes in?

When hospice care begins, a team works collaboratively to create a personalized care plan. This plan may include:

• Medication to manage pain and symptoms
• Equipment like hospital beds or oxygen, delivered to the home
• Regular visits from nurses and aides
• 24/7 on-call support

Hospice care is not about giving up—it’s about shifting the focus from cure to comfort, ensuring the patient lives as fully and comfortably as possible in the time they have left.

How will you know death has occurred? 

The final stages can be the most difficult as well as the most emotionally taxing. It is also possible that you will not be able to tell if your loved one has passed – this is why it is best to have an expert present. 

We recommend you discuss with the patient and loved ones how the final moments should take place. Consider a type of music that should be playing, spiritual rituals you would like included, items like flowers or pictures that should be in the space, and try to take a moment to say goodbye. 

Accepting hospice and preparing for the moment of death are two different things and many people are not prepared for the latter. Read through the end-of-life stages timeline above and ask your physician or a Crossroads team member if you have any questions. Beyond physical care, we provide resources for patients and their families when preparing as well as accepting death.