At some point, the active part of the dying process will begin. This process is not the same for everyone, but there are certain things you can expect. You may feel that you are fully prepared for the death of your loved one until this process actually begins. To help you through this transition and to assist you in supporting your loved one, there are some things you can recognize as death approaches. Physical Signs of DeathThe ability to move and feel sensation are lost, beginning in the legs and then the arms. Pressure from tight fitting sheets can irritate the patient. Keep the bedclothes loose and help them change position often. The patient may start to perspire heavily, especially on the upper part of their body, and their temperature may rise. They may be too hot and seem restless. Provide a well ventilated atmosphere and keep the bedclothes light. You may find that although their temperature is higher, their body will feel cool to the touch. The skin color may be mottled and have a bluish color, especially in the feet and legs. Sight and hearing may begin to fail. Sit near the patient's head and talk to them directly. Don't assume the patient can't hear you. The patient may sleep more and communicate less. Continue to talk to, sit near and touch the patient. Touch is very comforting. The patient may be confused and think they are living in a past time of their life. They may think they are younger and that you or others are someone else. Try not to get upset if they don't recognize you at times. Keep talking to them and reorienting them to time and place. Don't whisper to others within hearing of the patient. They may think you are trying to hide something from them. Bowel and bladder control may be lost. The patient may sound very congested, like they have to clear their throat. The amount of oral secretions may increase. It helps to turn the head to the side, raise the head of the bed a little, place a towel under their head to catch the secretions and gently wipe out the mouth with a damp cloth. At this point suctioning may increase any discomfort. You may see meaningless, repetitive movements increase. Don't restrain the patient and avoid loud, sharp and sudden noise. Playing music is more soothing. Desire for food or fluid may decrease or stop altogether. Offer ice chips or sips of juice, and refresh their mouth frequently. Don't try to force them to eat or drink. The patient may begin to have 10-20 second periods of no breathing, called apnea; followed by short, shallow and rapid respirations. Keep the head of me bed raised and hold the patient's hand, talking gently. If you feel that death is near, you may want to have family and friends come to say goodbye to the patient and express their love for the patient. You can call the Hospice nurse at this time to tell her that changes have occurred. You will know death has occurred when there has been no breathing or heartbeat for several minutes. You do not need to do anything immediately. The eyes will look fixed at one spot and no blinking will occur. The mouth may be partly opened and the patient will be motionless. After death has occurred, if you haven't called the Hospice nurse, call her now at the number given at the end of this page. Tell the person who answers that there has been a death, tell them the patient's name, your name and your phone number. They will have a Hospice nurse call you, they will come to your home, confirm that death has occurred, and assist you with the details. They can call the funeral home of your choice and will also notify the doctor. Hospice care does not stop here. Hospice of Orange and Sullivan Counties continues to keep a supportive relationship with you and your family for as long as thirteen months after the death of your loved one. Counseling and bereavement support groups are available for you if you desire. Hospice of Orange and Sullivan Counties is on call 24 hours a day. If you need help or are having a problem, call; 845-561-6111 or 1-800-924-0157.
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