Tips from a Death Doula: 10 Ways to Keep Your Dying Person Comfortable

Caring for a loved one in their final days can be an emotionally taxing experience, leaving many caretakers feeling helpless and uncertain about how to alleviate the suffering of the dying person.

There are practical, simple, and compassionate ways that death doulas use to ease this journey so that your person remains as comfortable as possible. This time of transition is a profound and delicate period when even small actions matter. If you don't know how to help a dying person be more comfortable, this blog is for you. These comfort measures can happen at home, in the hospital, or at a care home—and anyone can do them.

This blog outlines ten essential areas of comfort care—from maintaining mouth moisture to managing temperature and sensory stimulation—that can significantly enhance the comfort of someone nearing the end of life. By attending to these needs, caretakers can provide physical relief and emotional support, making the final days more bearable for everyone involved.

Mouth Care

When someone is actively dying, they often breathe through their mouth and at a certain point, can't close their mouths. This leads to dryness, which can be uncomfortable (think "cotton mouth"). To assist your loved one, use disposable mouth swabs dipped in glycerin (not the lemon kind) or minty water to moisten their mouth regularly. You can also use a little room-temperature coconut oil. This process will need frequent repetition throughout the day and night. Additionally, it’s important to keep their lips hydrated, so apply a soft balm to prevent dryness.

Eye Care

It’s common for individuals nearing the end of life to stop blinking and have their eyes remain partly open, causing their eyes to dry out. This may produce tears or watering as the body tries to compensate for the lack of blinking. When the individual can no longer produce tears, it’s essential to consult with their physician or hospice care team to determine suitable eye drops to maintain eye moisture. Opt for longer-lasting eye drops to minimize the frequency of application.

Skin Care

As a dying person may no longer be able to consume food or liquids, dehydration sets in, making skin care crucial. To keep your person comfortable, apply lotion to their skin, focusing on areas like the hands and feet, and consider using this as an opportunity to provide a gentle massage. You can also use a light spray bottle to mist the air. Tip: A dehydrated death is a more comfortable death. Calcium builds up in the blood and creates a pleasant feeling, so don't be concerned about your dying person being dehydrated—just keep them comfortable. This is a natural part of the dying process.

Joint Care

The bones in our hands are particularly delicate, and during the dying process, even minor pressure can cause discomfort. To mitigate this, you can roll up small hand towels (as illustrated below) and position the individual’s hands around them. This allows for a comfortable rest and it alleviates joint pressure. These towels can also be soothing because of their soft texture. Try this method with the legs and feet but use pillows, instead of towels, for additional comfort.

Temperature Control

A dying person’s ability to regulate body temperature can diminish, leading to fluctuations between fever and chills. Regularly check their temperature by touch, and be prepared with the necessary items, such as fans, cool (but not too cold) washcloths for the forehead and sternum, and warm blankets or a space heater to adjust their body temperature as needed.

Medications

While death doulas are not medical practitioners, they are familiar with the various medications found in hospice comfort packs. It is crucial that the dying individual, or their healthcare proxy, has previously discussed the advantages and disadvantages of different end-of-life medications to make informed decisions. If they seem to be in pain or have difficulty breathing, consult the care team about the appropriate morphine dosage. Both end-of-life doulas and hospice care teams can aid in identifying signs of pain in non-responsive individuals.

Moreover, it’s important to consider the specific illness when deciding on pain management strategies. Medications like Lorazepam can address terminal anxiety, while laxatives may relieve constipation caused by opioids, and Haldol can help with restlessness or hallucinations. Anti-emetics like ondansetron can reduce nausea. Be attentive to the need for adjusting medication dosages as the dying process advances, and maintain regular communication with the hospice team and doula. Consult with your hospice care team about dosage increases.

Positioning

Positioning is important for two reasons: preventing bed sores and managing terminal secretions. Bed sores are painful wounds that can become infected. They are caused by prolonged pressure on the skin when someone is immobile. To prevent these, reposition the dying person every few hours, alternating between sides. Adjust them between upright and lying down positions. A hospice care team member, particularly a CNA, can demonstrate effective positioning techniques. You usually need two people to do this without injuring yourself.

Additionally, you can manage terminal secretions (accumulations of unswallowed saliva and other fluids in the throat and lungs) by adjusting your person to a more upright and side-to-side position, reducing discomfort and distressing sounds. Medication to reduce these secretions is available, but the pros and cons of these medications (like Atropine or hyoscyamine) should be discussed with the care team.

Speaking to Them

Hearing is often the last sense to remain functional, so speaking to your dying loved one can be comforting. Depending on their condition, they might not only hear but also understand you. Providing reassurance, expressing love, sharing memorable moments, or simply talking about daily events can offer comfort. If it seems they are struggling to let go, express your love, acknowledge the difficulty of separation, and give permission to pass when they are ready. This can be profoundly impactful for both the dying person and the caregiver.

The Senses

The dying process is a sensory experience, and considering elements like sound, sight, smell, touch, and taste can significantly aid in comfort. Soft blankets, silky sheets, a d gentle touch (like hair brushing or hand holding) can be soothing. Enhance the environment with lightly scented candles, the aroma of a favorite meal, or natural scents like pine or rosemary. Background sounds, such as music, nature sounds, chanting, or movies, can also provide comfort. For taste, even if swallowing is difficult (but still possible), offering a small amount of a favorite drink on a mouth swab, lightly flavored water, or a small amount of sorbet can be soothing during the dying process.

Intake

We see food as something that brings enjoyment, comfort, and health—but when someone is dying, food will not offer any of these things. The body is shutting down and does not need food; it can't efficiently metabolize it. It is a natural part of the dying process to lose appetite, so coercing your loved one to eat will have the opposite effect you're going for.

Another natural part of the dying process is that people lose their ability to swallow, which can make drinking fluids an opportunity for choking and aspiration. IV fluids during active dying are also not the best route, and your death doula or care team can explain the science behind this as well.

By focusing on these practical aspects of care, you can significantly ease the journey of a dying person, ensuring their final days are as comfortable and dignified as possible.

Interested in working with a death doula in Durham, NC? Contact us for a free initial 30-minute consultation.

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