When a loved one receives hospice care, it often means they are nearing the end of life. Hospice provides comfort care and support for those with terminal illnesses and their families. So when hospice staff say your loved one is “transitioning,” it is their way of letting you know death is approaching soon. This can be an incredibly difficult time filled with complex emotions. Understanding what to expect and how to support your loved one can provide some guidance during this profound process.
What does “transitioning” mean in hospice care?
In the context of hospice care, “transitioning” is a euphemism referring to the process of actively dying. It indicates your loved one’s health is declining more rapidly and death is likely to occur within days or weeks. Some key signs that point to this transition process include:
– Severe fatigue, spending most or all time sleeping
– Minimal interest in food/fluids
– Difficulty swallowing medications or frequent coughing/choking when eating or drinking
– Confusion or delirium
– Increasing difficulty communicating
– Limited ability to move around or sit up without assistance
As the body begins shutting down, your loved one may also experience changes in breathing patterns, mottled skin from poor circulation, a buildup of secretions in the throat, and loss of bladder/bowel control. Your hospice team tracks these kinds of changes closely to help guide you through the final stretch of your loved one’s life journey.
Why do hospices use the term “transitioning?”
The language around death and dying can be challenging. “Transitioning” is one of several euphemisms hospices may use, along with:
– Passing
– Expiring
– Slipping away
– Moving on
– Letting go
– Entering rest
This gentler terminology aims to ease some of the pain and discomfort around facing mortality. It provides a bit of distance from the harsh finality of “death” and “dying.” For some, these softer phrases feel more hopeful or spiritual. Others may find them confusing or vague. It’s okay to ask your hospice team to clarify what they mean if their language doesn’t make sense to you. They will likely appreciate the opportunity to communicate in whatever way brings you and your loved one the most comfort.
What should you do when your loved one is transitioning?
Learning that a loved one is transitioning to the end of life is painful, so be gentle with yourself. There is no one right way to navigate this profound experience. Focus on what feels meaningful and doable for you. For most people, priorities include:
– Making your loved one as comfortable as possible
– Finding closure and saying goodbye in your own way
– Seeking support from hospice staff, family, friends, faith communities, counselors, etc.
– Attending to your own self-care by resting, eating well, exercising, journaling, etc.
– Adjusting expectations and responsibilities with family, employers, etc.
– Appreciating the time you have left with your loved one
You may feel pushed into crisis mode and want to spend as much time as possible at their bedside. Or you may need breaks from the intensity of the situation. Balance engaging and detaching in whatever way allows you to be present. Know that just being nearby offers support.
What are typical signs that death is approaching?
In the final days and hours of life, you may notice your loved one going through significant physical, emotional, spiritual and social changes. Understanding common end-of-life signs can prepare you for what is coming. Some examples include:
Physical signs
– Minimal or no appetite/thirst
– Difficulty swallowing
– Fewer and smaller bowel/bladder movements
– Labored, irregular breathing
– Skin losing color, becoming cool to the touch
– Drop in blood pressure
– Changes in heart rate e.g. slower or irregular
– Long pauses between breaths
– Congestion/gurgling in lungs or throat
Mental & emotional signs
– Increased fatigue, sleeping most of the time
– Confusion about time, place, identity
– Restlessness, agitation
– Lack of interest in socializing or activities
– Withdrawal from surroundings
– Vision-like experiences or seeing people/places not visible to others
Social & spiritual signs
– Less talking, quieter
– Tendency to want fewer visitors
– Desire to have photos, objects, music nearby
– Interest in reminiscing about life events
– Expressing goodbyes and giving away possessions
– Seeking forgiveness or reconciliation
– Discussion about afterlife, meanings, legacy
These changes result from the body shutting down as systems fail. Decline progresses at varying paces unique to each person. Your hospice team closely monitors symptoms and provides comfort measures so the process feels as peaceful as possible.
How long can the active dying process take?
There is no precise timeline for when death will occur once a loved one enters this final transition. The process is highly individual and depends on the person’s specific condition. However, hospice professionals identify several general timeframes:
When death is imminent (hours to days)
For those clearly nearing the very end of life, death tends to occur within hours to a couple days. Your loved one likely appears extremely frail and weak, sleeping deeply most of the time. Breathing may become strained or irregular, with periods of no breathing for 10 seconds or longer. Loss of bladder/bowel control and decreased urination are also common.
When death is near (days to weeks)
If the decline seems more gradual, death may happen within days to a few weeks. Increased sleeping is still typical but your loved one may have brief periods of wakefulness and responsiveness. Limited ability to swallow remains, causing decreased eating and drinking. Breathing may sound congested due to fluid accumulation.
When the disease is running its course (weeks to months)
For some terminal illnesses like dementia, the dying process spans weeks to months. Your loved one may still have some clear moments in earlier stages, becoming less responsive and more fragile as death nears. Hospice teams guide families through these extended transitions.
While estimation can be difficult, asking your hospice team what they expect based on experience and your loved one’s condition may provide some sense of when death is likely to occur. But the timing remains uncertain, so being adaptable and patient offers the best mindset.
What happens to the body after death?
When your loved one dies, you may notice several common physical changes in their body over the following hours. These include:
Loss of vital functions
– No pulse or breathing
– Loss of control over bowel and bladder
– No response to stimuli
Changes in appearance
– Eyes fixed in one direction or open
– Mottled and discolored skin
– Cooling of the body’s extremities and surface
– Relaxation of the muscles, appearing sunken
Other post-death phenomena
– Opening of the mouth or sagging of the jaw
– Release of air from the lungs
– Partial erection in men
– Increase in any wounds oozing fluid
– Eyes tearing up
The person’s spirit is gone even though their body remains. What helps many people is remembering that your loved one no longer occupies their body. Over the hours, the physical processes slowly come to a halt. Understanding common after-death changes may ease any worry or sadness around your loved one’s appearance and condition during this sacred time.
What should you do when your loved one dies?
Losing someone you deeply care for turns your world upside down. Be extra compassionate with yourself in the aftermath of their death. There is no need to rush any next steps. Overwhelming emotions are normal. Begin by:
Grieving
– Make space for your own mourning through crying, shouting, laughing, or however feelings emerge.
– Let others provide support through listening, food, childcare help, etc.
– Avoid major decisions or life changes for now. Healing takes time.
Making arrangements
– Call hospice staff so they can officially pronounce death and initiate next procedures.
– Follow any cultural or religious rituals that bring comfort. These may include closing the eyes/mouth, praying, placing flowers, ringing bells, etc.
– When ready, contact the funeral home to move your loved one’s body.
Notifying others
– Reach out to family and close friends about the death. Involve them as feels appropriate and delegate tasks.
– Inform your loved one’s doctors, lawyer, financial/insurance providers, and any other key contacts.
– Announce the funeral service time/location as you arrange it.
Planning the funeral/memorial
– Decide on burial versus cremation preferences. A funeral home can explain options.
– Select casket/urn, gravesite, flowers, music, photos, readings, speakers, and other service elements.
– Create and distribute an obituary, program memorial cards if desired.
Honoring your grief, caring for yourself, and cherishing your loved one’s memory help sustain you through bereavement. Reach out if the loss leaves you struggling to function. Your loved one transitions on, while you embark on a new transition in life without their physical presence.
Saying goodbye when you can’t be there in-person
Sometimes circumstances prevent you from being physically present as your loved one dies. Illness, travel, or other obligations may separate you. This lack of closure adds another layer of pain. You can still say goodbye in meaningful ways by:
– Sharing a loving phone, video, or text message. Hearing your voice can be very comforting.
– Sending a card, flowers, music playlist, photo album or other tangible items to surround your loved one.
– Writing a letter to be read aloud to your loved one if possible.
– Asking hospice staff or another loved one to hold their hand and relay a message of love from you.
– Listening to your loved one’s favorite songs, looking through cherished photos, or praying together from a distance.
– Participating remotely in memorial events through video conferencing.
– Planning an in-person memorial service for a later date after the death.
While you may regret not being physically present, your loved one knows you care deeply. Express your love across the distance in whatever personalized ways you can. This helps start the healing process.
Finding meaning in your loss
The death of a loved one often challenges your fundamental assumptions and beliefs about the world. You may wonder: why did this happen, where did they go, how will we manage without them? Making meaning from the loss takes time and reflection. Ways to find purpose may include:
Continuing bonds through legacy and memory
– Share fond memories and stories to keep their spirit alive.
– Look for signs of their enduring energy in special places, objects, dreams, or happenings you associate with them.
– Create rituals like setting a place for them at holidays or lighting candles on their birthday.
– Support causes they cared about or continue meaningful projects they started.
Exploring spiritual beliefs
– Read texts from your religious or cultural tradition for comfort about the afterlife.
– Join in rituals like masses, prayer circles, meditation, or visiting graves.
– Reflect on spiritual questions around mortality, meaning, morality, and existence itself.
– Consider joining a grief support group through your faith community.
Appreciating personal growth
– Notice areas of emotional maturity or priorities shifting in positive ways.
– Express gratitude for what you learned from your loved one.
– Reflect on how you became wiser, stronger, or more compassionate through loss.
– Consider how to live a meaningful life honoring their memory.
The death of a loved one forever shapes you. Finding light within the darkness helps the meaning-making process evolve over a lifetime.
Taking care of yourself through loss and grief
Losing a loved one demands an immense amount of emotional and physical energy during an already fragile time. Exhaustion, confusion, stress or neglecting your needs can further deplete your reserves. Prioritize self-care practices like:
Getting adequate rest
– Follow your natural rhythms of sleeping more or difficulty sleeping
– Nap during the day as needed
– Seek medication if insomnia becomes frequent
Eating nutritious foods
– Have easy to prepare snacks and meals available
– Drink plenty of water and other fluids
– Take vitamins or nutritional supplements if appetite decreases
Getting light exercise
– Take short, gentle walks outdoors
– Do restorative yoga or stretches
– Receive massage for relaxation and body comfort
Trying stress-relieving practices
– Do breathing exercises, meditation, visualization
– Listen to soothing music
– Seek counseling or peer support groups
– Write in a journal to process complex emotions
Making time for enjoyment
– Read books, watch shows, or listen to podcasts you find uplifting
– Spend time outdoors connecting with nature
– Look at photo albums or old videos of your loved one
– Engage your creativity through crafts, cooking, art
During profound loss, nurture yourself as your loved one would want. You deserve care and comfort so you emerge whole on the other side.
When to seek help for complicated grief
Intense emotions and a sense of disorientation after a loved one’s death are normal. Typically, acute grief gradually improves over six months as you process the loss and adapt to a new reality. But for some, grief becomes complicated and leads to significant impairment in daily life. Contact your doctor or a counselor if you experience:
– Ongoing depression and extreme focus on the loss
– Inability to enjoy positive life experiences
– Hypervigilance about avoiding reminders of your loved one
– Withdrawing from social connections
– Obsessive rumination or fixation on circumstances of the death
– Extreme bitterness over the loss
– Feelings of meaninglessness about life
– Risky behaviors like substance abuse or recklessness
Unresolved trauma, lack of social support, sudden death, financial stressors, or mental health conditions can make grief overwhelming. While grief never disappears, it should not remain debilitating. With professional help, you can find healthy ways to integrate this loss into your life’s narrative.
Conclusion
Saying goodbye to a loved one nearing the end of life marks one of life’s most poignant transitions. Understanding the dying process and typical end-of-life symptoms helps demystify what is happening. While each person’s timeline is unique, common signs indicate death is fairly imminent or still some days to weeks away. Knowing what to expect provides some guidance amidst profound uncertainty. Staying focused on your loved one’s comfort, finding closure in your own way, and allowing difficult emotions to surface makes this rite of passage more meaningful. Your loved one’s essence lives on through you, shaping your days even after physical separation. Cherish this precious, painful time. And remain open to hope stirring once again when the moment is right.