Losing a loved one

The topic of death and losing a loved one, for many, is a difficult topic to address and understand. Every individual will go through a different process and each caregiver will experience different emotions. There is no right or wrong way to feel when the one you love is reaching the final act of living.

“I truly believe it’s all about the living. We are born and we die and everything in between is living, clear until our last breath.” – Diana Cazier

For our in-service for the month of February, Aspen Senior Care had the wonderful opportunity to have Diana Cazier from Elevation Home Health and Hospice teach our team about the sensitive topic of recognizing the signs to look for when your loved one is in the final act of living. She referred to the booklet by Barbara Karnes, RN, titled, “The Final Act of Living: Reflections of a Long-Time Hospice Nurse”.  

The final act of living is a challenge.  This is a flexible guideline for what caregivers can watch for because no one knows the exact date that someone will pass.

Signs to look for in the Final Act of Living

One to three months before death:

  • Withdrawal from world and people
  • Decreased food intake
  • Increase in sleep
  • Going inside self
  • Less communication

One to two weeks before death:

Mental Changes

  • Disorientation
  • Agitation
  • Talking with the unseen
  • Confusion
  • Picking at clothes

Physical Changes

  • Decreased blood pressure
  • Pulse increase or decrease
  • Skin color changes; pale, bluish
  • Increased perspiration
  • Respiration irregularities
  • Congestion
  • Sleeping but responding
  • Complaints of body tired and heavy
  • Not eating, taking little fluids
  • Body temperature: hot, cold



Days or hours before death:

  • Intensification of one to two week’s signs
  • Surge of energy
  • Decrease in blood pressure
  • Eyes glassy, tearing, half open
  • Irregular breathing: stop, start
  • Restlessness or no activity
  • Purplish, blotchy knees, feet, hands
  • Pulse weak and hard to find
  • Decreased urine outlet
  • May wet or stool the bed
  • Acetone breath

Minutes before death:

  • “Fish out of water” breathing
  • Cannot be awakened

Through this presentation, we were taught how to be more aware and understanding of the different signs we may observe as one approaches death from disease or old age. We are so grateful to Diana for her presentation as it will continue to help us be more supportive and observant as professional in-home caregivers.

“At Aspen Senior Care, we like to align ourselves with the finest Home Health and Hospice agencies in Utah. We appreciate their willingness to present at our in-service training and reach us about important topics.  We are better because of it.”

Gary Staples, Owner and Administrator


If you have any questions, or if you need further support, contact us today at 801-224-5910. You can also refer to “The Final Act of Living: Reflections of a Long-Time Hospice Nurse” by Barbara Karnes, RN.

For more information and topics about in-home care, visit aspenseniorcare.com