Caregiver for the Elderly: Why Is It So Challenging?

Stages of Death and Dying {and hospice care options}

Often when seniors are suffering from serious illness with no possible cure they may choose to forego any sort of medical treatment. Instead, they opt for hospice care on the strength of a doctor’s prognosis. The stages of death and dying and hospice care options are foreign to many people who have never had to deal with the death of a loved one.

Hopefully, this post will shed some light on the topic.


Once a senior realizes there is no medical treatment that will help them they have the option of choosing hospice care. In this situation, no effort is made to cure the patient. In effect, the illness is considered to be terminal. At the same time, symptom relief will be continued to ease pain and suffering.

In most situations, hospice care is for those who have been diagnosed with six months or fewer to live assuming the disease is left to run its course.


Stages of Death and Dying {and hospice care options}
Some people choose an assisted living facility for hospice care.

On the other hand, if doctors provide treatment to very ill patients in the hopes of curing them it is called Palliative care. Palliative care is configured to help with symptoms and improving quality of life. In this instance, death is not imminent and the disease is still curable.

There are several options when hospice care is chosen. The setting can be in the home, nursing home, inpatient hospital, or an assisted living facility.

Much like palliative care, patients in hospice care are provided with comfort care and family support. The biggest difference between the two is that all attempts to try to cure a patient are ended when they opt for hospice care.

It’s really a team effort. Social workers, doctors, nurses, spiritual advisors, and trained volunteers work together with the patient, primary caregiver, and family. Their focus is on providing medical, emotional, and spiritual support if needed. In most cases, there will be someone available by phone day or night.

Family and friends normally look after the day-to-day care of the patient with the help of the hospice team who will coach them on how to care for a dying person. They will also offer respite care in the event caregivers are in need of a break. This can be for a matter of hours or even as long as a few weeks depending on the situation.

Stages of Death and Dying {and hospice care options}

It’s seldom possible for doctors to predict exactly when a person will die. They may estimate six months or fewer which qualifies for hospice care, but in some cases, patients will live past the six-month threshold. So what happens then?

Most likely the doctor will still certify that the patient is near death and in that event, Medicare can continue to pay for hospice services.

This book on Hospice and Palliative Care might be very helpful to you.

Are children involved? Here is a book titled Lifetimes: The Beautiful Way to Explain Death to Children.

And this by McGraw-Hill Education: The Last Dance: Encountering Death and Dying

Although every patient is unique, there are six common stages of death that family and caregivers should be aware of.


Everyone has that favorite food they love. If a patient is near death they will lose their appetite for all food including their lifelong favorites. In other words, they simply lose interest in eating.

It makes sense when you think about it. All our lives we eat in order to keep our bodies running at optimum levels. I have always believed that our bodies are very intuitive.

For instance, if we lift weights we get stronger. Choose not to exercise and our heart gets weaker and muscles get soft. It’s almost like a series of checks and balances with our bodies trying to keep up with the demands that are placed on it.

Stages of Death and Dying {and hospice care options}

Normally the body requires us to eat to provide fuel, and in most cases, the body responds to the needs of the moment.

In the late stages of life, I believe our body knows when the end is near. This makes eating an exercise in futility and really unnecessary. At this stage, there is no point in trying to force someone to eat. Instead of eating, the patient would most likely much rather sleep.


It follows that if a person stops eating the body is running low on fuel. This, in turn, will lead to weakness and drowsiness. If you are around a patient and they appear to be sleeping, great care should be taken about what is said.

There have been many examples of patients seemingly being sound asleep, However, but can still hear what is being said by those around them.


Chances are you will notice mottled skin in the upper body of the patient. In most cases, this will go hand-in-hand with poor circulation.

The body will instinctively provide blood flow to the vital organs. The result is often cold extremities. In other words, cold fingers and toes are another sign that death is very near. In some cases, the same mottled skin might be present in hands and feet, although this might happen months earlier and in itself is not an indication of imminent death.


Even if a senior has never exhibited signs of confusion caused by dementia they often become confused as death nears. It’s almost as if they have suddenly developed dementia.

They become confused about the day, time, and even the place where they are. They might even become confused by the people in the room. It would make sense then to have family and friends who want to say their final goodbye to do it before the patient reaches this stage.

There is always the chance that the patient might not recognize them if they wait too long.

Stages of Death and Dying {and hospice care options}
Hospice care takes place all over the world.


This can be a bit scary. Sometimes it’s referred to as the death rattle. What is really taking place is a struggle by the patient to take in oxygen. Breaths can become loud and long and will often be followed by intervals of not breathing at all.

The secretion of bodily fluids might give the breathing a gurgling sound. In order to alleviate this one might try propping the patient’s head in an upright position until the labored breathing subsides.


Kidney failure at this stage is not necessarily a bad thing. Signs of kidney failure might be brownish-colored urine or swollen ankles and feet.

In almost all cases, this is a sign of a decline in the cycle of life. Kidney failure in the late stages of life can actually be a sign that the onset of a coma is very near. This actually might be desirable as a peaceful coma will often allow the patient to die quietly with no pain.


It makes sense that most people would choose to end their life in the comfort of their own homes if at all possible.

In some situations this will also reduce the cost involved in the event there is no medical coverage. Yes, seniors can receive hospice care in assisted living or in a hospital, but this isn’t the first choice of many seniors.

If they are in their own home they will be surrounded by family and friends pretty well all the time. Familiar surroundings might also ease their anxiety and allow them to live their final days in an environment they are used to and love.

It’s important that family members are aware of the various stages of death and dying and hospice care options available to them so they can make the best possible choice for the patient that allows them to die peacefully and with dignity.

Would you like to share your thoughts on this topic? Feel free to leave a comment at the bottom of this page.

2 comments / Add your comment below

  1. That’s interesting that the focus of hospice care would be to make the person as comfortable as possible, not to cure them. I feel like most people would get to that point at some point in their life. If my parents get to that point, I’ll have to make sure they get taken care of so they can be comfortable when they pass away.

    1. Yes, hospice care normally means that death is not that far away and all attempts to find a cure have basically failed. You are right. The whole idea is to make people as comfortable as possible during their final days, weeks, or months.

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