Resources for families
Signs that death is near, and when to call us
In the last weeks of life, most people sleep more, eat and drink less and pull inward. In the last days, breathing changes, the hands and feet cool, and there is less urine. These are normal parts of the body shutting down, not signs that something is being done wrong. The hospice team treats each one for comfort. No one can predict the exact timing, but you can call a hospice nurse at any hour.
Medically reviewed by Oscar Chien, MD, Medical Director, October 27, 2026
On this page (9 sections)
- Can anyone predict when death will come?
- What changes from weeks to days to hours
- What are the signs that death is near?
- What is "transitioning" and what is "active dying"?
- How long can someone live after they stop eating and drinking?
- What is the "death rattle" and how long does it last?
- What can you do in the last hours?
- Common questions
- More guides
Can anyone predict when death will come?
No. Doctors and nurses can describe a general range, such as weeks, days or hours, based on the changes they see. They cannot give a date. Some people decline slowly over weeks. Others change quickly over a day or two. Some rally for a short time and then decline again. The signs below often come in the order shown, but not always, and not every person shows all of them.
What the team can promise is attention. A hospice nurse answers the phone 24 hours a day, 7 days a week, and can visit when needed. Visits usually become more frequent as the end approaches.
What changes from weeks to days to hours
| When | What you may notice | What the hospice team does |
|---|---|---|
| Weeks before | More sleep, less interest in food and drink, less talking, less interest in visitors and the news, weight loss, more weakness | Adjusts medicines, teaches mouth and skin care, adds aide visits, talks with the family about what is ahead |
| Days before | Sleeping most of the time, very little eating or drinking, trouble swallowing, cool hands and feet, changes in breathing, restlessness or confusion, less urine | Visits more often, places comfort medicines in the home, stops medicines that no longer help, shows the family how to position the person |
| Hours before | Long pauses in breathing, noisy breathing from secretions, mottled skin on the knees, hands and feet, eyes half open, little or no response, very little urine | Stays in close contact, treats breathing changes and restlessness, and comes after the death |
The ranges are general. Some people move faster or slower, and some changes never appear.
What are the signs that death is near?
Each change below is a normal part of the body slowing down. Here is what it looks like, and what helps.
Sleeping more
The person sleeps most of the day and is hard to wake. This is the body saving energy. Sit with them when they are awake. Do not try to keep them awake for meals or visitors.
Eating and drinking less
Appetite fades, then thirst. The body no longer needs or can use much food. Forcing food or fluids can cause choking or discomfort. Offer sips or ice chips if the person wants them, and keep the mouth and lips moist. The nurse will show you how.
Withdrawal
The person talks less, keeps their eyes closed and seems far away. It is not rejection. Short visits, a familiar voice and a hand to hold are often enough.
Changes in breathing
Breathing may become fast, then slow, with pauses that can last many seconds. Near the very end, breathing can sound wet or rattling because the person can no longer clear saliva from the throat. People sometimes call this the death rattle. It usually does not distress the person. The nurse can turn the person on their side, raise the head of the bed and give a medicine that dries secretions.
Cool or mottled hands and feet
The hands, feet and knees feel cool and may look blue, purple or blotchy. Blood is moving to the center of the body. A light blanket is enough. Avoid heating pads, which can burn skin that no longer feels heat.
Restlessness and confusion
The person may pick at the sheets, try to get up, call out or talk to people who are not there. Some of this is normal near death. Some has a cause the nurse can treat, such as pain, a full bladder or a medicine. Keep the room calm, the lights low and the voices soft. Call the nurse if restlessness is new or hard to settle. Read what terminal agitation is and what hospice does.
Less urine
Urine becomes dark and there is less of it, then very little. The kidneys are slowing down. The nurse may suggest absorbent pads or a catheter if the person is uncomfortable.
What is "transitioning" and what is "active dying"?
Hospice nurses use two everyday words for the last stretch. Transitioning is the last days to a week or two: the person sleeps most of the time, eats and drinks very little, pulls inward and stops taking part in what is around them. Active dying is the last hours to a day or two: breathing changes its rhythm and pauses, the skin of the hands, feet and knees cools and mottles, and the person no longer responds.
Neither word is a diagnosis or a promise of a timeline. They are the nurse's way of telling the family what stage she thinks the body is in. If you want to know, ask the nurse directly: "Do you think she is transitioning?" You will get an honest answer. Read more in transitioning and active dying.
How long can someone live after they stop eating and drinking?
When a person in the last stage of an illness stops eating and drinking, days to about two weeks is usual, with wide variation from person to person. The body's needs fall as it slows down, and hunger and thirst fade with them. This is the illness, not starvation: the person is not suffering for lack of food.
What helps is care of the mouth, which gets dry: sips, ice chips, a moist swab, lip balm. Fluids through a vein or a feeding tube at this stage do not add comfort and can add swelling, congestion and breathing trouble. Read do feeding tubes help in advanced dementia. Read more in how long someone can live after they stop eating and drinking.
What is the "death rattle" and how long does it last?
The death rattle is a moist, gurgling sound with each breath. It comes from saliva and secretions that collect in the throat when the person can no longer swallow or cough. It usually appears in the last hours to a day or two of life.
It is hard to hear, but it does not mean the person is choking or drowning, and most people at this stage are not aware of it. Turning the person on their side, raising the head of the bed and cleaning the mouth reduce it. If it continues, the comfort kit has a medicine that dries secretions, and the nurse will tell you when to give it. Read the comfort kit. Read more in the death rattle.
What can you do in the last hours?
Hearing is thought to be the last sense to fade. Talk to the person as you always have, even if they do not respond. Say what you want to say. Play music they loved. Read to them. Tell them who is in the room.
Touch helps too. Hold a hand, moisten the lips, stroke the hair. Keep the room quiet and the light soft. Take turns so that no one is exhausted, and eat and rest when you can. If you step out for a moment and the person dies while you are gone, that is not a failure. Some people seem to wait until they are alone.
Common questions
How long can a person live without eating or drinking?
There is no fixed number. Near the end of life, people often live days and sometimes a week or more with very little food or water, and most do not feel hunger or thirst the way a healthy person would. Moist lips and mouth care keep the person comfortable.
Is the noisy breathing painful?
It usually is not. The sound comes from a small amount of saliva in the throat that the person can no longer swallow or cough up. It is often harder on the family than on the person. The nurse can reposition the person and give a medicine that reduces secretions.
Should we keep giving regular medicines?
Ask the nurse. Near the end, pills for long-term problems such as cholesterol or blood pressure are usually stopped, since they no longer help and can be hard to swallow. Comfort medicines continue and can be given as liquid under the tongue or by other routes.
What if we are not sure the person has died?
Call the hospice. You do not need to be certain. The nurse will come, confirm the death and notify the doctor. There is no emergency and no need to call 911.
More guides
Read about the comfort kit that holds the medicines used in the last days, and what to do when your loved one dies at home. Grief support for the family continues for 13 months after a death. See bereavement support. Four shorter guides answer one question each: the death rattle, terminal agitation, how long someone can live after they stop eating and drinking and transitioning and active dying.
About this page
- Written by
- Beta Hospice care team
- Medically reviewed by
- Oscar Chien, MD, Medical Director
- Last reviewed
- October 27, 2026
- Next review
- April 27, 2027
How we write and review this site
Sources
- National Institute on Aging: Providing care and comfort at the end of life (opens in a new tab)
- National Institute on Aging: End of life (opens in a new tab)
- Medicare.gov: Hospice care coverage (opens in a new tab)
These sources support the general information on this page. For one person鈥檚 care and coverage, talk with the hospice team.
You do not have to decide alone.
Call (877) 258-7129 any time, or leave your number and someone from Beta's hospice team will call you. No decision is needed to call. Most families start with a question.
Only a hospice doctor, together with the person鈥檚 own doctor, can confirm hospice eligibility. A website cannot.
- A nurse answers 24 hours a day, 7 days a week
- You can stop hospice at any time
- You have the right to choose your hospice