What to Expect When Your Loved One is Dying

During the dying process, often the most loving care you can offer is to sit quietly and listen.

The dying process

Even after months and years of loving and caring for a frail spouse or family member, the end of the dying process can still seem so surprising, so sudden.

It is never easy. But, the way we care for our family members during their final weeks and days can help make the transition more peaceful. To do that, we often need to change the way we think and talk about death.

While we all have our own ideas, fears, and beliefs about death and dying, it’s important to know how your loved one feels about the process. And how they would like to experience it. It’s important to be open if they want to talk about it.

Kim Mooney, a certified thanatologist and owner of Practically Dying, an educational source for support and information on dying, death, and grief often works with families and organizations to help them understand the dying process and better support those who are at the end of their lives.

“Often what those who are dying want and need, most of all, is to be listened to,” Mooney says. “To be attended to and supported in a way where they feel that they can bring anything up.”

For family caregivers who have taken on the daily tasks and responsibilities of their loved one’s care, this can be a difficult shift. Instead of focusing purely on the physical care, family members must slow down and tend to their loved one’s emotional needs.

This is done by being present with your loved one. By sitting with them quietly, listening well, and, when appropriate, sharing important conversations.

This is the kind of approach HomeCare of the Rockies teaches their professional caregivers through the HomeCare 100 Caregiver Training Curriculum.

Through this innovative training HomeCare of the Rockies caregivers receive 100 hours of classroom and practical, hands-on training that covers dozens of topics impacting older adults.

Caregivers learn about the aging process, approaches to dementia care, safe transfers and fall prevention, caregiver wellness, and what to expect and how to help an older adult in the dying process.

Knowing how to care and support an older adult at the end of life is essential to helping them transition in a meaningful, more comfortable way, says Sandi McCann, president of HomeCare of the Rockies, which provides in-home caregivers to older adults and families living in Boulder, Longmont, Louisville, Lafayette, Broomfield, Loveland, and all surrounding areas.

“Death is a natural part of life, and something we all face,” McCann says. “Yet we all deal with death so differently. When we begin to talk about grief and dying then we are better able to understand and help our loved ones be emotionally and physically supported at the end of their lives.”

Your End of Life Attitudes

Each of us has unique ideas and views about death and dying that are shaped early on by how we are raised, our personal experiences, and attitudes, and beliefs. Many of us grew up in households where death was rarely discussed and there were strict rules about how to grieve, Mooney says.

Often people were told not to cry, and urged to “move on” and get over their grief and because their “loved one was in a better place.” Yet, these approaches are not helpful to older adults who are nearing the end of life, nor to those of us who go on living without them.

It’s important to consider your own beliefs and experiences with death and grief when you are supporting your loved one. You may share different beliefs or opinions about death and what happens after and it’s important that you understand your own feelings better so you don’t impose your beliefs on the family member who is dying.

When we understand why we respond to death and talk of dying as we do, we can be more responsive – rather than reactive — and provide the kind of care support the older adult needs, even when it’s different than what you want or believe.

In some cases, you may have to put your own beliefs aside to best help your family member. Your father, for example, may be a Christian who believes in Heaven or an afterlife while you are agnostic. Yet, his final days are not the time to argue or influence or otherwise try to “get him to understand” your perspective. He’s entitled to his own beliefs and process and as a family caregiver, you can care for him best by supporting his emotional and spiritual needs in the way that is right for him.

Sometimes, the older adult may have little to say and you can help maintain a quiet, peaceful, comfortable environment. Other times your loved one may need and want to reminisce, tell stories, share regrets, or express love, sadness, anger, fear, and other emotions.

You can help by listening well, without judgment and being present and open. It might be difficult, or unfamiliar at first – especially if your loved one never shared much emotion previously – but recognize that this is part of their transition and honor their need to share.

You can encourage them by saying the simple phrase “Tell me more about that,” to let the older adult know, it’s OK to express his feelings and experience and make it safe for them to share whatever emotion they are experiencing.

“Don’t react and try to fix,” Mooney says. “Instead, help them to be comfortable with anything they are feeling. Many times, people just need to be listened to.”

For family members, this is also the time for you to share your feelings of love, or to say what you need to “clear the air” of past regrets with love and acceptance, not blame or condemnation.

Be sure to intersperse your own feelings and stories with quiet. Talk no more than 60 seconds at a time to leave room for your loved one to share.

Sometimes, the older adult will come up with a seemingly, out-of-character statement. This could be an indication that your loved one is preparing to say “goodbye” and is trying to see whether you are able and ready to let him go.

It’s OK to cry as you sit with your loved one, or offer a gentle, comforting touch and remind them that you’ll be OK or even give them “permission” to go so that they can transition when ready. You may also want to assure them that they have lived a meaningful life and that they are loved.

But, it’s important that the older adult be able to go through the dying process themselves and not feel like they have to “hang on” or be stronger or live longer to help you get through.

Dying is a natural and normal process and by being present and open to these conversations and experiences, you allow your loved one to go through the transition in the way they need.

At the same time, your loved one’s emotional, spiritual, and social needs are changing, the physical care they require will change too.

What to Expect During the Dying Process

As the body changes during the dying process, you’ll notice several things happen.

Changes in appetite. Your loved one may want to eat and drink a little, or not at all as the body begins to conserve energy.

What to do: Do not force the older adult to eat or drink. Instead, help them be comfortable. Ice chips, frozen Gatorade, or juice might feel good in their mouth. A cool, moist washcloth placed on the forehead may be a physical comfort.

Altered sleep patterns. As death nears, the older adult may spend more and more time sleeping and might be uncommunicative or difficult to wake. This is due in part to the body’s changing metabolism.

What to do: During this time, you can sit with the older adult, hold their hand, speak quietly. Do not shake them awake or speak loudly. Also, preserve your loved one’s dignity by talking directly to the person as you would if he was awake. Never talk about your family member or his condition to others, while in his presence.

Hearing is the last sense to go, and it’s possible the person can hear you and be comforted or even hurt by the conversations taking place around them, so it’s important to keep the environment calm and peaceful. Take family arguments out of the room. You can also use this time, even when your loved one appears unconscious, to express your love.

Changes in breathing patterns. Your loved one may also begin to breathe irregularly and take shallow breaths with periods, up to a minute long, with no breath at all. They may also appear to pant at times. This is common and a result of a decrease in circulation to the internal organs.

What to do: Elevate the senior’s head, or gently turn him onto his side to enhance comfort. Speak softly and lovingly.

Vision-like experiences. Many older adults speak or claim to have spoken to people who have already died. They may also appear to respond to people or experience places and things not visible to you. For some people, these vision-like experiences are a natural way to prepare to transition from this life.

What to do: Don’t be afraid, these visions are normal and common. And, do not argue, contradict, explain away, or deny what your loved one is sharing or experiencing. These visions are very real to them and a very natural part of the dying process. Simply affirm and support.

An increase in restlessness. The older adult you care for may begin tugging at the bed sheets or clothing or display other restless motion. This behavior can be a result of a decrease in oxygen in the brain and metabolism changes.

What to do: Do not interfere or try to restrain, but do try to calm by talking in a quiet and natural way. Reading to your family member, sharing happy stories, playing soothing music, or gently massaging the senior’s forehead can help.

During this emotional time, it can be hard to know just what to do, and how to help. A HomeCare of the Rockies caregiver trained in end of life care can help by supporting you and your loved one during this process. Our caregivers know what to expect and can ease stress by handling the care needs and basic household tasks so that you can be there through your loved one’s transition.

Help from Hospice during the Dying Process

Caregivers also work with hospice personnel to help the older adults and family members at the end of life.

You may already have had a palliative care program in place to manage pain and symptoms during treatment and these programs can also coordinate care between providers to help monitor interactions between patient medications and keep the patient and family educated about the medical conditions.

But, when your loved one is diagnosed as having six months or less to live and is no longer seeking curative medical treatment, medical providers may suggest hospice care. This is an important support to those who are nearing the end of life and their families.

Hospice care provides medical and non-medical care delivered by physicians, nurses, chaplains, and certified nursing assistants, as well as volunteers. Hospice providers will also help your family navigate the process after your loved one has died.

At the End

When your loved one dies, call in hospice personnel if they are not already in attendance. They will help you through the practical next steps such as making the declaration of death, signing paperwork, and calling the mortuary.

But you don’t need to rush this. In the moments or even the first hour after death, you can gather together, sit with the body, say your goodbyes, wash and clean the body, celebrate your loved one’s life, or conduct other sacred rituals and ceremonies that are important to your family.

If hospice is on hand, they will help support your desires at this time and then guide you through the next steps.

Death and the dying process is a natural part of living, yet it is complicated by our own personal views and experiences and influenced by the way we’ve been raised to think and talk about the process.

When we know what to expect near the end, we can do our best to support our loved ones in a way that helps honor their experience and can help them find comfort, peace, and meaning in a life already lived.

To learn more about what to expect when caring for a loved one during the dying process, call us 720-204-6083. Our HomeCare of the Rockies caregivers are trained specifically in how to care for older adults during this time and we are here to support you.

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