The longer you work as a live-in carer, the more likely it is that one day you will be working with a client who is approaching the end of their life.

For clients with family close by this can be easier than for clients who have family living far away or even in other countries. Understandably they may want to be close to their loved one at the end of life, but this may not always be instantly possible to achieve.

Travel arrangements will need to be made, work commitments need to be considered and even pets may have to be handed over to someone else while they travel to be with their loved one.

It becomes important then that we recognize the signs of approaching death and notify family in time for them to be with their loved one.

There is a fine dividing line between calling them too soon and leaving that call until it is too late. For families who are in other countries or very far away it simply may not be possible for them to make arrangements once, only to find that in three weeks’ time they are doing the same thing.

How do we recognize when death is near?

Although this can never, ever be guaranteed, there are some signs that we can look out for which are true indications that the end is close. These may indicate the last days or hours.

• Increase in sleep or drowsiness
• Loss of appetite, disinterest in food of any type
• Excess confusion
• Restlessness and extreme agitation
• Irregular breathing
• Pauses in breathing
• Cold hands and feet
• Swelling or blue coloring of hands or feet
• Hallucination and seeing people who are already dead
• Crackling sounds or gurgling when breathing

So, when do we call?

Each client you are placed with is different and has different family circumstances, and this needs to be taken into account when considering when to call the family.

If the family live abroad they will need time to make arrangements, and this can easily take up to a week. It is important that we are constantly in touch with them and that we know how long it realistically can take them to arrive.

Even family who live in the same country still need time to make arrangements. They may have work and school commitments which need to be covered. Travel time may be fraught with issues during the winter months.

Know the family’s schedule

Once you realize that your client is approaching the end of their life you should be in constant contact with family or next of kin. A daily phone call or email will keep them up to date.

The ideal person to ask about an estimated time frame is your client’s doctor. He is more likely to be honest with you regarding time frames and may even suggest that you notify family before you think about it.

What if they don’t get there?

Unfortunately, not every person has the privilege of being with a loved one when they pass away. You will be the person who keeps vigil at that time.

This is not the time to clean the house or do the ironing. It is the time for you to sit quietly with your client and show them love and support.

Holding hands and talking quietly are ways to show that you are with your client and can comfort them even though their family may not be there.

Final thoughts

If you have kept the family or next-of-kin in the loop as much as possible, whether they get there or not is finally up to them. This is not your problem – as long as you have given them as much notice as possible. The choice to come on a certain day is theirs, and not yours. However, you need to give them as much notice as you can so that they can be there at the end of life.

Once your client has finally passed away, you should be able to say with a clear conscience that you kept the family well informed to the best of your ability and helped them to make an informed decision.

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