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The last days: what families can expect

Residents & families Aged care staff 6 min read

By Dr Josh Hatch, FRACGP

In the last days of life the body slowly shuts down. The changes can be hard to watch, and knowing what to expect can make this time less frightening. The changes below are those described by state health guidance for families 29.

Numbers in the text link to the 5 sources listed at the foot of this page.

Changes you may notice

  • Sleep. The person becomes sleepier and may stop responding 29.

  • Food and drink. They will likely not want or need food and drink 29.

  • Breathing. Breathing may become loud and fast, or there may be gaps of several seconds between breaths 29.

  • Noisy breathing. A rattling sound can come from mucus in the throat that the person can no longer clear. In a Dutch hospice trial it occurred in about a quarter of people who did not receive medicine to prevent it 22.

  • Skin. Skin may feel cool or clammy, and may look pale, blotchy, or have a blue or yellow tinge 29.

  • Restlessness. The person may pull at the bedclothes, try to get out of bed, seem muddled or cry out 29.

  • Bladder and bowels. Urine becomes concentrated as the kidneys slow down, and most people lose control of their bladder and bowels 29.

Signs that death may be very near

A study of 357 people with advanced cancer in two acute palliative care units recorded physical signs every 12 hours. Some signs appeared mostly in the last three days of life: pauses in breathing, breathing that waxes and wanes, a rattle, bluish fingers and toes, no pulse at the wrist, breathing with movement of the jaw, and passing less urine 30.

These signs came from people with cancer in hospital palliative care units, so they are a guide, not a timetable, for older people in aged care 30.

What helps

The person may still be able to hear familiar voices and respond to touch, which many families find reassuring 28. It is fine to hold their hand, talk to them in a calm voice, and tell them what they mean to you 29.

You do not have to be there every minute. If the person dies while you are out of the room, that is not a failure on anyone’s part.

Cultural, spiritual and religious practices matter at this time, and the Standards require palliative care to support spiritual, cultural and psychosocial needs. Tell the staff what is important 3.

What the facility should be doing

In the last days of life, the Standards require providers to have processes in place for each of these 3.

  • Recognising that the person is in the last days of life and responding as their needs change quickly 3.

  • Having medicines for pain and symptoms, including anticipatory medicines, prescribed, given, reviewed and available 24 hours a day 3.

  • Pressure care, mouth care, eye care and bowel and bladder care 3.

  • Recognising and responding to delirium 3.

  • Avoiding unnecessary transfer to hospital where that matches the person’s wishes 3.

  • Giving families information about the dying process and about loss and bereavement 3.

Related pages on this site

Sources cited on this page

  1. 3 Australian Government Department of Health, Disability and Ageing. Strengthened Aged Care Quality Standards (November 2025; implemented 1 November 2025). Outcome 5.7 Palliative care and end-of-life care, Actions 5.7.1 to 5.7.4. View source
  2. 22 van Esch HJ, van Zuylen L, Geijteman ECT, et al. Effect of prophylactic subcutaneous scopolamine butylbromide on death rattle in patients at the end of life: the SILENCE randomized clinical trial. JAMA. 2021;326:1268–76. (157 patients analysed, six Dutch hospices. Scopolamine butylbromide is called hyoscine butylbromide in Australia.) View source
  3. 28 Queensland Health. Care plan for the dying person: family and carer distress in the last days of life (fact sheet). (Undated; cites 2024 guidance.) View source
  4. 29 ACT Government. When someone is dying. (Last updated 16 December 2025.) View source
  5. 30 Hui D, dos Santos R, Chisholm G, et al. Clinical signs of impending death in cancer patients. Oncologist. 2014;19:681–7. (Prospective cohort; 357 patients with advanced cancer in two acute palliative care units.) View source

See every source cited across the palliative and end-of-life care section →

Written by Dr Josh Hatch, FRACGP. General information only, reflecting his reading of the published evidence as at October 2026. It is not individual medical advice, does not create a doctor–patient relationship, and must not be used to start, stop or change any treatment. It is not legal advice. Evidence, Australian regulatory requirements and state laws on advance care planning, substitute decision-making and voluntary assisted dying change — always confirm current advice with the treating GP, the state health department or a lawyer.

This is general education, not a clinical protocol. The doctors who practise with Umbrella Aged Care are independent general practitioners, and each makes their own clinical decisions with the resident and family. Your GP’s advice for an individual may differ from what is written here. If it does, please ask them to talk it through with you.

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