Explained Simply · A Free Family Guide
Comfort Care and the Final Days, Explained Simply
Written and reviewed by Halston Juracka, RN-BSN, Certified Brain Injury Specialist and Kayla Juracka, RN-BSN · Updated August 2026
If you are reading this at two in the morning next to someone you love, you are not alone, and you are not doing it wrong. This guide explains what actually happens in the last days, why the body does what it does, what the comfort medications are for, and what genuinely helps. It is honest, because families deserve honesty more than they deserve comfort at this point, and because knowing what is coming takes away most of the fear.
A free two-page version, set in larger type, for reading in a dim room.
Written by Two Registered Nurses · Plain Words, Real Sources · Free to Print & Share
What is comfort care?
Comfort care means every decision is now made to reduce suffering rather than to extend life. Blood draws, blood pressure checks, and treatments that no longer help are stopped, not because anyone is giving up, but because they have become burdens without benefit.
What continues, and often increases, is attention: pain control, easing breathing, mouth care, clean sheets, repositioning, a quiet room, and people who love them nearby. If you are earlier than this and still deciding, our guide to hospice explains how the benefit works.
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What actually happens in the last days?
The body shuts down in a fairly predictable pattern. Knowing it helps, because almost everything on this list frightens families who were not told.
Sleeping more, then not waking
Days of increasing sleep, then long stretches unresponsive. Hearing appears to persist even then, which is why we tell families to keep talking to them.
Eating and drinking stop
This one causes the most anguish, so it has its own section below.
Breathing changes
It becomes irregular, sometimes fast then slow, sometimes with long pauses of ten to thirty seconds. This is called Cheyne-Stokes breathing, it is expected, and it does not mean they are struggling.
A rattling or gurgling sound
Secretions pool in the throat because swallowing has stopped. It sounds distressing and, as best anyone can tell, it does not distress the person. Repositioning and medication help.
Skin changes
Hands, feet, and knees become cool, pale, or mottled with purple blotches as circulation pulls toward the core. This is one of the clearest signs that time is short.
Confusion or restlessness
Some people become agitated, pick at bedding, or see and speak to people who are not there, often people who have died. This is common enough that hospice nurses hardly blink at it.
Less urine, darker in color
The kidneys are slowing down.
A surge of energy
Some people become suddenly clear, alert, and hungry a day or two before death. Families think they are improving. Sit with them, enjoy it, and know what it usually means.
Picture It This Way
For years, the medical system has been fighting the disease, and the person has been the battlefield. Hospice does not surrender the fight. It changes who the medical team is fighting for. Every resource turns toward the person instead of the illness: their pain, their breathing, their dignity, their time with the people they love. Nothing is withdrawn from them. What stops are the treatments that were costing them more than they were giving back.
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Why do they stop eating and drinking?
Because the body no longer processes food and fluid, not because they are being starved.
This is the hardest thing for families to accept, and it is the one where doing what feels loving can cause harm. Pushing food or fluids at this stage leads to choking, aspiration into the lungs, swelling, and fluid backing up in the lungs, which causes real breathlessness. Feeding tubes and IV fluids at the very end have been shown not to extend life or improve comfort, and often make things worse.
The body has its own mercy here. Dehydration at the end of life releases chemicals that dull pain and produce a calm, sleepy state. Hunger disappears. Thirst is felt as dry mouth, and dry mouth is treated with mouth swabs, ice chips if they can manage them, and lip balm, not with forced fluids.
Offer, never force. Feeding them is not how you love them now. Mouth care is.
If they want a sip, give a sip. If they turn away, that is the answer.
What are the comfort medications, and what do they actually do?
Most hospice patients have a small kit in the refrigerator. Families are often frightened of it. Here is what is in it and what it is for.
Medication
What it treats, in plain words
Morphine, or a similar opioid
Pain, and just as importantly air hunger. Small doses ease the feeling of not being able to breathe, and they do it better than oxygen does.
Lorazepam, or similar
Anxiety, restlessness, and agitation. It also eases breathing that has become panicked.
Glycopyrrolate or atropine
Dries the secretions causing the rattling sound.
Haloperidol
Nausea, and severe agitation or hallucinations.
Acetaminophen suppositories
Fever and discomfort, when swallowing is gone.
Giving these on a schedule rather than waiting for suffering to appear is standard, correct practice. Symptoms at the end of life are far easier to prevent than to chase.
Think of hospice as one chapter that palliative care may eventually lead to, if things reach that point. Many people receive palliative care and never enter hospice, because their disease stabilizes or is cured.
Does morphine hasten death?
No, and this fear causes real suffering, so it deserves a direct answer.
Morphine given at appropriate doses to treat pain and breathlessness does not shorten life. What families see is that a person receives morphine and dies soon after, and the mind connects the two. The actual sequence is the reverse: pain and air hunger increase as death approaches, so morphine needs increase as death approaches.
The Thing to Hold Onto
The medication follows the dying. It does not cause it.
Untreated pain and air hunger are genuinely harmful, exhausting the body and terrifying the person. Withholding comfort medication out of fear does not buy time. It buys suffering.
If you are worried about a dose, ask the hospice nurse to explain it. That is exactly the sort of question we would rather answer ten times than have a family sit in fear once.
What actually helps in the room?
Very little of it is complicated, and none of it requires training.
What Helps
Talk to them. Hearing is thought to persist, so say the things you want said, and say them plainly. Introduce yourself when you arrive.
Keep the room calm and low. Soft light, few people at once, familiar music if they liked it.
Mouth care every hour or two while awake. Swabs, a little water, lip balm. This is the single most comforting physical thing you can do.
Reposition gently every few hours, with pillows for support. A cool cloth on the forehead. Warm blankets, though remember cool hands and feet are circulation, not a room that is too cold.
Touch them. Hold a hand, stroke hair, sit close. It is for both of you.
Take care of yourself. Eat something. Sleep in shifts if there are several of you.
Vigils are long, and people who love the dying often forget they are still living. Our guide to caregiver burnout is written for exactly that.
When should you call hospice?
Call the hospice nurse, any hour. Using them is not a bother, it is the entire point of the benefit.
Call Hospice, Any Hour
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Pain that is not controlled
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Breathing that looks like struggling
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Agitation you cannot settle
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A new symptom that frightens you
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Running low on any comfort medication
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When you simply do not know what you are looking at and need someone to tell you
Also call when death appears to be very close, and call after the death has occurred. There is no rush in that final call. Sit as long as you want first. Nothing needs to happen quickly.
When is it still 911?
For a person on hospice at home, the answer is almost never, and this matters.
Before You Call 911
Calling 911 typically brings resuscitation attempts, an ambulance, and an emergency department, which is precisely the death most families have chosen to avoid. If the do-not-resuscitate or POLST form is not physically present and visible, paramedics are obligated to attempt resuscitation.
Keep These Two Things Visible
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The do-not-resuscitate order, or the POLST form
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The hospice phone number
Call hospice first. They will come.
Where can Las Vegas families turn?
Your hospice team is the first call for everything, twenty-four hours a day, and using them is not a bother, it is the entire point of the benefit.
Hospice bereavement support continues for the family for a full year after a death, and it is free and underused.
When the hours become more than a family can hold, and vigils are exhausting in a way nothing else is, professional caregivers at home work alongside hospice so families can rest, sleep, and be present rather than being the entire staff. That is a large part of what our practice does, and it is often the difference between a family enduring the last weeks and a family being able to be in the room. If you are earlier in an illness, palliative care is the version of this that runs alongside treatment.
There is no way to do this perfectly. There is only being there, keeping them comfortable, and letting them hear your voice.
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More in This Series
ALS, Explained Simply · Dementia, Explained Simply · Heart Failure, Explained Simply · Stroke, Explained Simply · Falls, Explained Simply · Parkinson's, Explained Simply · Every "Explained Simply" guide is free, written by the same two nurses, and built to be shared.
HJ
About the owners
Halston Juracka, RN-BSN, CBIS and Kayla Juracka, RN-BSN are the registered-nurse owners of Apex Home Nursing Services, a premium private-pay home care agency serving Summerlin, Henderson, and the greater Las Vegas valley. Halston is a Certified Brain Injury Specialist and nurse educator. They founded Apex to give referral partners a clinically serious, reliable resource and to give families nurse-led care that actually keeps people safe at home.
Sources
National Institute on Aging. Providing Care and Comfort at the End of Life.
Hospice Foundation of America. Signs of Approaching Death.
Multi-society statement and clinical reviews on artificial nutrition and hydration at the end of life.
Portenoy RK, et al. Opioid use at the end of life and survival. Journal of Pain and Symptom Management.
References
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U.S. Centers for Disease Control and Prevention. Facts About Falls, Older Adult Fall Prevention, 2026. cdc.gov/falls
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Reducing Hospital Readmissions, StatPearls, NCBI, 2024; and 30-day readmission analyses among older adults. ncbi.nlm.nih.gov
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Genworth and CareScout 2024 Cost of Care Survey; Nevada cost data. payingforseniorcare.com/nevada
This guide is general educational information, not medical, legal, or financial advice. Apex Home Nursing Services is an RN-owned, private-pay personal care agency in Las Vegas, Nevada. Registered nursing services, where applicable, are provided by the RN owners under their own Nevada licenses, coordinated by, not provided by, the agency.