When death occurs at home  
  What to Expect:
A dying person will go through a number of physical changes as the body ‘slows down’ and prepares for the final stages of life.

If you are prepared for the possibility that these normal and expected changes may occur, your family’s situation will be more manageable.

Remember that each situation is different and these signs and symptoms may not necessarily occur in all dying persons.

The following changes usually appear in this order:
A dying person may...
Sleep longer
The patient may sleep longer periods and sometimes have difficulty waking.
• Plan conversations for times when the patient is more wakeful and alert
• Keep visiting times brief or encourage visitors to sit quietly at the bedside

Reduce Intake
The patient will have a decrease in appetite and ability to swallow.
• Offer small servings of light foods
• Decrease portions appropriately

Become Confused
The patient may become confused and unable to recognize familiar people or surroundings.
• Give reassurance
• Avoid physical restraint, if possible
• Calm and soothing music or gentle massage may ease a restless patient

Have Difficulty Swallowing
Swallowing, or ‘forgetting to swallow’, is common.
• Give only what the patient wants and can handle
• Forcing to eat and drink at this stage could cause vomiting or choking
• Remind the patient to swallow

Have Irregular or Shallow Breathing
It is quite common to have 10-30 second periods when breathing may stop.

Have Irregular Pulse or Heartbeat
Both of these are normal patterns and are signs of the ‘slowing down’ process.

Develop ‘Wet Sound’ Breathing
This may be caused by saliva collecting at the back of the throat that cannot be swallowed because of weak muscles.
• Turn patient to the side
• Raise the head of the bed or raise upper body with pillows
If this does not reduce the breathing sounds, it may also be caused by moisture in the lungs. Medication is available to relieve this.

Be Unresponsive
The patient may be unresponsive to voice or touch and may be in a coma or sleeping with eyes open.
• Continue to speak in a calm, natural way. Everything you say may be heard.

Lose Control of Bladder or Bowels
Your Home Care Nurse can give advice on appropriate protective padding or recommend whether a catheter may be necessary.

Have Cool Legs and Arms
The patient may develop cool legs and arms, with the skin acquiring a mottled blue/purple appearance.
• This is an expected process due to a slowing of blood circulation
• Use the usual amount of bed coverings to keep the patient comfortable
 


At time of death
• There will be no response
• There will be no breathing
• There will be no pulse
• Eyes will be fixed in one position, and may be open or closed.
• There may be a loss of control of bladder or bowels.

If you think death has occurred:
• DON’T call 911, Police or Ambulance. This would mean immediate resuscitation attempts and a transfer to the Emergency Department, regardless of your wishes at this point.
• DO call Victoria Hospice or the Palliative Response Team if you are already registered with Victoria Hospice.
• DO call your Family Physician to come to the home and pronounce death.
• DO call family members, friends or a spiritual advisor if you would like someone to be with you.
• DO call the Funeral Home when you are ready, and after the physician has come to pronounce death. There is no rush for this. Spend as much time with your loved one as you wish.

After the funeral home has been called:
• Before the funeral home attendants arrive, you may wish to bathe or dress the body.
• After the funeral home attendants arrive, discuss their procedures with them.
• You may want to assist with transferring the body to the stretcher.
• Funeral plans can be made by appointment on the following day.
 


Telephone numbers
 Print this page and keep a list of these numbers handy:

• Family Physician:
• Home Care Nurse:
• Funeral Home:
• Victoria Hospice or your local palliative care program: