What Happens in Your Final Months

Added: 2026-05-06

[00:00:00]what to expect at the end of life and how to prepare for it. I'm going to organize this video into 6 months prior to death, 3 months prior to death, one month prior to death. So, wherever your loved one lands, you'll know what to expect and what to do. A lot of my information comes from the fabulous famous book called Gone from My Sight by the Queen of Hospice, Barbara K. Please cue picture of the queen. This is something I learned when I first started hospice nursing and I think it's everything you really need to know if your loved one's at the end of life. So, six months out, the further you are from death, the harder it is to say how long you have. So, when we say someone has 6 months, that is very general and very gray. It is not black and white and it's hard to know because they are pretty far from death in in the hospice world anyway. The main thing you're going to see is less socialization, probably a little more sleeping, and a little less eating. So, eating less, sleeping more, dare I say isolating more. I don't like saying I don't like saying isolating because it sounds negative, but this person may just start cocooning a little bit, right? They may only want their close family and friends nearby. They don't want to be doing a bunch of parties and stuff. It depends on the personality, but you may notice that 6 months out. And I feel like I don't have to say this, but just in case I have some new followers here. I'm speaking about people at the end of life, okay?

[00:01:20]I'm not just talking about any Tom, Dick, or Harry over here. Talking about people who are likely on hospice or have lifelimiting illnesses, terminal illnesses. This is what you can expect.

[00:01:29]Okay? Side note, when I went viral on TikTok, which is the first place I ever went viral, this is the video that went viral. Me talking about the gone from my site book and about what to expect 6, three, and one month out. Just a little FYI. Okay. And actually, an even funnier thing is that Gen Z was the reason it went viral because they all started commenting, "I guess I'm dying. I'm guess I'm dying." Because I was talking about how you'd sleep more and be antisocial.

[00:01:55]Anyway, okay, I digress. So, 6 months, it's going to be great and you're not going to notice that much. You know, sleeping more, eating less, socializing less. Now, three months out, three months out, it gets a little more, I would say, obvious that things are changing and you're getting closer to the end of life. They're going to be sleeping a lot more. Probably sleeping more than they are awake. Definitely eating a lot lot less. Maybe one meal a day, maybe two meals a day, maybe softer food. They don't want like full like burgers, like anything hard to eat. It's going to be kind of a chore to eat.

[00:02:32]appetite will be low, very little eating and drinking, sleeping a lot more.

[00:02:36]Another thing you're going to start noticing is a functional decline.

[00:02:39]Before, maybe they needed a little help or they were getting kind of tired after, you know, walking around the house or taking a shower. Now, at 3 months, they're going to need help with those things. They're going to need help with the shower. They're going to need help going to the bathroom. They're not going to be able to prepare food, right?

[00:02:54]So, someone else is going to have to get them the food, and they won't need help eating it yet, but they're just going to need a little more help with daily living activities. And again, things will exhaust them a lot more. Maybe a little intermittent confusion here and there, maybe when they're waking up or going to sleep. All very normal. Both at six and 3 months, what can you do? Let their body be the guide. Do not force anything. Don't force them to get up.

[00:03:20]Don't force them to eat. Don't force them to drink. They don't need to do anything. Let their body be the guide.

[00:03:27]As long as they are clean, as long as they are safe and they're comfortable, they're good. So, as far as what to do, be with them. Don't force anything.

[00:03:36]Unless they are really not clean or something and you need to get them clean, then yes. But other than that, you let their body be the guide. Now, we're getting to about a month out. A month before death, you're going to notice, I think, significant changes.

[00:03:50]They may look different in the sense of like muscle wasting, maybe a lot thinner. A month before death, they might have days where they don't eat at all or days where they only take a spoonful or two of food. Now, you're going to be noticing that they're going to be sleeping, I don't know, maybe 18 hours a day. Sometimes, not all the time, sometimes they'll need a lot more help with daily living activities. Maybe not even not even going to be able to get out of bed. It does depend on the disease and the person's age and other coorbidities, things going on like that.

[00:04:23]But generally speaking, they're going to be in bed most of the time, needing help to get out of bed if they can. They may be incontinent at times, definitely ve very, very little food and water, which is normal. They're not starving to death. The body is purposely doing this to help them shut down and sleeping a lot more. And the way I describe this and the way Barbara describes this is the body is preparing itself. Our bodies are built to live and they are built to die. And this is one of the ways it helps do it. It basically helps you die by making you sleep more and not making you eat and drink. Making you sleep more and not like your body doesn't want food and water. This is also that very strange time where your loved one may start seeing dead relatives, dead loved ones, old pets who have died. Again, very, very normal. This is called visioning and it happens usually around the four to three weeks before death.

[00:05:17]They start, you know, visioning and seeing these things. They don't necessarily know why. It's usually very comforting to them. Nothing you need to do about it. They're not deprived of oxygen, which is many people think that it's not oxygen deprivation. It's not the meds. It's a part of death and dying. And we don't necessarily know why it happens, but we know it does. We know it's around this time. What do you need to do around this time? Mostly what you need to do is care for the person. And this is where it gets exhausting, the hospice company is not going to provide roundthe-clock care. No hospice company will do that unless the symptoms are unmanaged. Okay? But generally speaking, if the person is comfortable, the work falls on the family. And the work is usually cleaning them, changing them, giving them food and water if they want it, giving medications if they need it.

[00:06:04]Not everyone needs medications at the end of life, but some people do because they have pain or shortness of breath.

[00:06:09]you will be the one that has to give the medication. Now, the hospice company will provide all of that stuff, but you'll be the one that has to give it.

[00:06:16]And of course, you'll have a 24-hour number you can always call and nurses can visit and things like that, but you will be doing a lot. So, you're going to need a lot of help at this time because your loved one will be fully dependent most likely at this time. Probably bed bound, maybe not fully, but most of the time. Definitely incontinent intermittently. So, you're going to have to be changing them. Just a lot of work and it and it's hard. And it's hard.

[00:06:37]Now, this last phase, you know, after that month phase, right, and you're in the two weeks phase, right, two weeks before someone dies, they're not quite actively dying, which is the last phase of life, the last few days of life, but they're not like at the month, and they're in that in between. That is what we call transitioning. Transitioning is a very gray area. Again, we don't really know. It's a very like, are they actively dying? Are they not? Are they conscious? Are they not? And it's going to wax and wayne during this time.

[00:07:08]They're going to probably have days where they do make sense and they are awake and they can eat and they are saying they want breakfast and then they'll have days where they won't wake up at all at all. Sleep all day long and they won't eat at all and you're thinking this might be it, right? And then the next day maybe a little more energy. So during this transitional phase again a lot of work on you and you're going to want the let the body be the guide. talk to your hospice company.

[00:07:35]Let them know, hey, they slept all day, they haven't eaten. That's going to queue us into knowing this person's in the transitional phase and we should visit more. Okay, we as hospice nurses should visit more. So during this phase, just expect them to sleep maybe all the time, most of the time, maybe needing medications from the comfort pack just to help with shortness of breath or if they're having pain or confusion. This doesn't always happen, but sometimes.

[00:08:01]And of course, if they want food and water, yes, they can have food and water. If they don't want food and water or they're not waking up to tell you, let their body be the guide. Okay? Also very normal. Also, in this time, they may have they'll be in and out of consciousness. So, awake, not awake, conscious, not conscious. Okay? Very normal. Again, they may be seeing dead relatives and dead loved ones in this time. And you know what? Go with it.

[00:08:25]Especially if they're okay with it. Now, the actively dying phase, that's the last phase of life. usually around a few days, maybe a week. It depends. The longest I've seen someone actively dying is 3 weeks. That's very unheard of. So, don't expect that. But it's right after the transitional phase. And how it's noted, how you can tell they're not transitioning anymore is because they usually go fully unconscious. So, fully unconscious, no food and water for a day or so, and they are not waking up at all. Okay. Now, we know they're in the actively dying phase. They can still hear us. They're not fully cognizant, but we do think they can still hear. So, still be there and talk to them. But this is the phase where their consciousness is pretty much shut off and their body is just going into like the bodily function of like setting itself up to eventually die. So, no food and water because they're unconscious and that's how the body wants it because then it can go into ketosis, start releasing endorphins and make the person feel good. They're fully unconscious, their mouth may be gaping open, their eyes might be open, but they're not making eye contact. all very normal because their muscles are fully letting go and relaxing. They're going to start having changes in breathing because they're metabolic metabolically they're changing and it's going to change the way they breathe. You're going to start hearing the death rattle or terminal secretions. When you start hearing that sound, which I've done many videos about, that's when you know it's pretty close, right? Few hours, maybe a day.

[00:09:52]And what do you have to do during this time? You just have to be there. Just be there. You want to keep them clean, safe, and comfortable. If they need meds, you give meds. All the meds are sublingual in the mouth, so you don't have to worry about swallowing or anything like that. You take the hospice nurse's direction. You are they clean?

[00:10:09]Are they safe? Are they comfortable? If you can say yes, you're good. And you just be there. Between the transitional and active phase is when that surge of energy can happen. The rally we call it.

[00:10:20]It's actually called terminal lucidity, but it's like that phenomena that happens where someone suddenly perks up and has a really good day. It will usually happen before the actively dying phase. Sometimes it happens during the actively dying phase, and it really surprises people. The good and bad part of it all is that they usually die very shortly after. So, we don't know why it happens again, but it happens during that transitional to the active. They'll have a boom burst of energy, a really good day. Maybe they'll ask for a cheeseburger. They'll get up and walk around. their personality comes back.

[00:10:50]They're cracking jokes and you're thinking like, "What the hell? It's a miracle. They're they're they're coming back, but then they die shortly after or they go into the actively dying phase, usually about a day after." So, I like to talk about it so you know that it exists. It's a phenomena that happens in onethird of all of our patients. We don't know why it happens. Okay? Then, once you're at the actively dying phase, like I said, all you need to do is remember, keep them clean, safe, and comfortable, and have family there to support you. And it's just about being being there being there during the sacred time until they take their last breath.