Patient Referral
Two hospice nurses caring for a patient in bed holding hands

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Patients may become more withdrawn, less active, less communicative, and possibly even more introspective during this time.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

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.