Death is never easy. Each person’s journey is unique. Each survivor’s healing process is unique too.

Whether you’re a caregiver looking after a dying loved one or a person who knows your time on earth is coming to an end because of illness or age, learning what to expect as a natural death nears can help you be better prepared. It can also give you time to make decisions for comfort and relief.

Several months before the end of life, a dying person may begin to sleep more than usual. As you get closer to death, your body’s metabolism falls. Without a steady natural supply of energy, fatigue and tiredness easily win out.

How you can help

Let them sleep and help them find comfortable places to rest. Encourage them to get out of bed so they don’t develop sores.

Energy needs decrease as you get older. Because you don’t need as much energy to carry out daily tasks, food and drinks seem less necessary. People who are near death may not even be interested in some of their favorite foods. A few days before death, your loved one may stop eating or drinking entirely.

How you can help

Let them eat when they’re hungry. Hydration is important, so offer your loved one ice chips, ice pops, or ice cubes. Soak a washcloth with cool water and use it to pat their lips. When they stop drinking altogether, keep the delicate skin around their lips moisturized with a lip balm.

It’s not uncommon for people who are dying to slowly withdraw from the activities and people they love. This is a natural reflection of changes in energy, as well as a desire to protect their final days and hours.

How you can help

Withdrawing doesn’t mean your loved one doesn’t enjoy the company of people they love. Let friends and family visit when your loved one feels comfortable. If they aren’t interested in seeing people, don’t take it personally. This isn’t a reflection of how they feel about you. Some people don’t wish to let others see them dying, so they may isolate themselves in their last days.

Blood pressure dips near death. Changes in breathing become more obvious, and heartbeats become irregular and difficult to detect. As blood pressure falls, the kidneys will stop working, too. You may notice urine that is tan, brown, or rust-colored.

How you can help

These changes aren’t painful, so there’s no need to do anything for these signs.

As your loved one eats less food and drinks fewer fluids, bowel movements may become smaller and irregular. Likewise, urinating may become infrequent. After eating and drinking stops entirely, they may not need to use the restroom at all.

How you can help

This is a natural process, so don’t be alarmed if they stop taking trips to the bathroom. Changes in urine color are normal too. They reflect kidney function, and as the kidneys shut down, urine production may slow or stop.

In some healthcare settings, such as a hospice facility, healthcare providers will use a catheter to drain urine from the bladder.

Blood circulation draws inward toward your vital organs in the final days. That means blood circulation in places like your hands, feet, and legs is greatly reduced. That can lead to skin and limbs that feel cool to the touch. The skin may appear pale, too. Eventually, the reduced circulation may cause skin to take on a mottled blue-purple look.

How you can help

Even though the skin or limbs may feel cool to you, your loved one may not be cold. If they are, a blanket or light covering may help keep them warm.

In the final days before death, muscles can become very weak. Simple tasks, like lifting a cup of water or turning over in bed, may become difficult.

How you can help

Make your loved one as comfortable as possible. If they need to drink from a cup of water, position the cup near their mouth and insert a straw so they can more easily drink. If they need to flip or turn in bed, gently help them move until they reach a comfortable spot. If you can’t lift your loved one, ask for a hospice nurse to help.

This is an alarming sign for many people as they sit with a loved one who’s dying. These breathing fluctuations may include changes in breathing, sudden gasps for air, or long stretches of time between breaths.

How you can help

While labored breathing may seem painful or problematic to you, your loved one likely isn’t aware of what’s happening. Some pain medications can make breathing easier, so talk with your loved one’s doctors and palliative care providers about ways to ease breathing or coughing.

The brain remains very active during the dying phase. However, it’s not uncommon for a person who is dying to have moments of confusion or incoherence. Some people may become restless and aggressive if they don’t know where they are or what’s happening.

How you can help

Remain calm and speak quietly. Assure your loved one you’re there to take care of them. Make sure you tell your loved one who you are when you start talking, and introduce each new person who sits with them. Their brain is still working, even if it seems like they’re asleep.

The intensity of pain will likely increase as a person becomes nearer to death. It’s not uncommon for a person to show visible signs that they’re in pain. These signs include grimacing, wincing, groaning, or scowling.

How you can help

Most pain can be treated, but this may require people to be in a hospital or nursing care facility. Dying people may stop being able to swallow, so an intravenous (IV) line may be necessary to deliver pain medicine. This medication must be administered in a hospital.

You may have heard of dying people saying they see long-gone loved ones in their final days. Hallucinations and visions of other places or people aren’t uncommon either.

How you can help

While it may be upsetting, don’t try to correct your loved one. Arguing over what’s real and what isn’t will only cause confusion and frustration. Instead, ask them questions and help them understand what they’re seeing.

In a person’s final hours and minutes, their body is slowly shutting down. The organs stop working entirely.

The only thing you can do in these last minutes is help them be comfortable and feel loved. Surround yourself and your loved one with the friends and family they most care about.

Don’t stop talking with your loved one. Many dying people can still hear and understand what’s happening. Help them feel comfortable by letting them know they’re surrounded by people who care for them. For some individuals, knowing they have people around them who care helps them let go.

If you’re using a heart rate monitor, you can see visibly when the heart stops working. This is a clear indication your loved one has died.

If you’re not, look for other signs that death has occurred. These include:

  • no pulse
  • no breathing
  • relaxed muscles
  • fixed eyes
  • no response
  • a bowel or bladder release
  • partially shut eyelids

When your loved one has passed away, take your time. Spend a few minutes with the people who surround you. A person’s natural death isn’t an emergency, so you don’t have to call anyone right away. When you’re ready, call the funeral home that you’ve selected. They will remove the body and begin the burial process.

If your loved one is in a hospice facility or hospital, the staff will handle the final logistics for you. When you’ve said your final goodbyes, they will arrange for your loved one to be moved to the funeral home.

Losing a loved one is never easy. Even when you’ve known the death was coming and you’ve prepared yourself for it, it still hurts. In the first days and weeks after a loved one’s death, take your time to acknowledge, embrace, and experience each emotion.

When you’re ready, seek out a support group. This can be friends and family, or you may want to seek professional help. Grief groups are common, and many hospitals host groups for the grieving. Religious groups like churches or synagogues may offer individual or group counseling too.

Grief is different for every person, so don’t judge your progress by that of another person. Find a group that feels comfortable and welcoming. Over time, you’ll come to treasure the memories of your loved one and look forward to new memories with people you still have.

For more support, read a first-person account of the painful choices the end of life brings for the caregiver.