Providing physical care

Download this quick checklist (PDF)  on what you can do to practically care for someone who is in their last days and hours of life.

The following also provides information about how you might provide physical care to the person:

The person you care for may be in pain for a number of reasons:

1. pressure ulcers
2. urinary tract infection (UTI)
3. constipation
4. heart failure
5. cancer
6. arthritis

If the person’s mental capacity is impaired, for example, because of a UTI or dementia, it will become increasingly difficult for them to tell others that they are in pain or experiencing discomfort. Staff may also assume that challenging behaviour, such as shouting out, is part of the diagnosis, so it is important that you as a family carer, who knows the person well, look out for signs or indicators that the person is in pain as if not recognised and treated the person may become even more agitated.

Watching someone you love be in pain is highly distressing. It will be draining for the person and it can affect their mood. They may be angry and irritable making it hard for them to talk and share their feelings which in turn makes it difficult for you as a carer.

Not all people who are terminally ill experience pain but if they are then pain relief should be prescribed by their doctor. Sometimes morphine is given to treat serious pain. Although many people are concerned that morphine may hasten death, this is not the case. The person you care for may take morphine as an oral medication. However, if they are no longer able to swallow or tolerate oral medications morphine may be given by injection. See Managing medication. In this case, the dose is carefully measured and adjusted. Morphine can also be administered to help with breathing difficulties’. Successful pain relief will bring much needed comfort to the person who is near to dying. 

1. Don’t be worried about giving the person as much pain medication as prescribed by the doctor. It’s important the level of pain is managed so make sure the level of pain is not overtaking the pain relieving medication.
2. If you are worried the level of pain is not controlled, tell the person’s doctor or nurse as the medicine can be changed or increased. It may be that a palliative care specialist is needed to help manage pain for a seriously ill person who is in a lot of pain.
3. Breathing
4. Difficulties with breathing are a common experience as the person approaches the end of life. The doctor may refer to this as dyspnoea. Breathing difficulties may make conversation with the person much harder. Very near death, the person might have very noisy breathing but this is not usually upsetting to them even though it might be to yourself and other family members. This is caused by fluids collecting at the back of the throat or by the throat muscles relaxing.
5. Try raising the head of the bed, opening a window, and using a humidifier or fan to circulate air. Painkillers can also help to relieve the sense of breathlessness. Try turning the person to rest on one side. 
6. Ask the doctor about any medicine they can prescribe that might help noisy breathing.

Skin irritation can be very uncomfortable and with age, the skin will naturally become drier and more fragile so it is very important to take extra care with an older person’s skin. 

The face can become very dry as well as the lips and eyes and can cause discomfort. The inside of the mouth can also become dry.

Sitting or lying in one position puts pressure on dry and sensitive skin and this can lead to painful pressure ulcers. Look out for any discoloured or darker skin as this is the first sign of a pressure ulcer, especially on heels, hips, lower back, and back of the head. Contact the person’s GP (or district nurse if known to them) for a pressure care assessment so that appropriate information and equipment can be given.

1. Apply alcohol-free lotion to soothe dry skin. Use a lip balm for dry lips and place a damp cloth over closed eyes to relieve dryness.
2. If the inside of the mouth is dry give ice chips (if the person is conscious) or wipe the inside of their mouth with a damp cloth or cotton ball or a treated swab might help.
3. Watch out for pressure ulcers. Turning the person side to back and to the side every few hours may help prevent pressure ulcers. Contact the person’s GP (or district nurse if known to them) for a pressure care assessment so that appropriate information and equipment can be given. Ask if a special mattress or chair cushion might help.

Nausea, vomiting, constipation, and loss of appetite are common issues at the end of life. The causes and treatments for these symptoms are varied, so talk to a doctor or nurse right away. There are medicines that can control nausea or relieve constipation, a common side effect of strong pain medications or taking iron for anaemia.

It can be upsetting as a carer when the person doesn’t want to eat or is too tired and weak to eat, particularly if the person has previously enjoyed their food and you have enjoyed preparing food and eating with them. Although you may be concerned about keeping the person eating and drinking, it’s important to remember the priority is to keep the person comfortable. As death approaches the person may not want to eat and going without food and/or water is generally not painful.

Swallowing may also become a problem. It may be helpful for medication to be given in liquid form rather than tablet. You may find the person makes a conscious decision not to eat which can be part of the person’s acceptance that death is near.

Drinking is more important than eating. But you may find the person even stops drinking and this may be a further indication of the end of life approaching.

For further information on how to manage swallowing difficulties and guidance on mouth care. 

For details of what to expect when someone is approaching the end of their life (PDF). 

For further information on how to feed the person you care for. 

1. If the person is very weak, help them with feeding if they are wanting food.
2. To address loss of appetite, offer favourite foods in small amounts or try smaller meals offered more frequently. Tastes may also change, so that foods they once loved might be rejected. Whatever they fancy whenever they fancy is fine.
3. Talk to the doctor, nurse, or palliative care team about the use of nutrient supplements to keep up calorie intake.
4. Don’t force the person to eat as this may be adding to their discomfort. Similarly, small sips of water can be given but again this should not be forced.
5. Temperature
6. People who are dying may not be able to tell you that they are too hot or too cold. So it’s important to look out for clues such as the person repeatedly trying to remove a blanket. If cold they may be hunching their shoulders, pulling a blanket up, or even shivering. 
7. If the person appears to be hot take off the blanket and try a cool cloth on their head. Make sure there are no drafts.
8. If the person appears cold raise the heat in the room and add another blanket. Avoid electric blankets and hot water bottles.

Mobility and prevention of falls is key when providing care to a person with a terminal illness. Keeping the person you care for as mobile as possible for as long as possible can reduce the incidence of pressure sores and infection. A fall can also massively impact the person’s confidence, may increase anxiety, and reduce the quality of their last few months/weeks of life. 

It is common for people nearing the end of life to feel tired and have little or no energy so it’s important to keep activities simple. For example, a bedside commode can be used instead of walking to the bathroom. A shower stool can save a person’s energy, as can switching to a bed bath.

For more information on how to prevent falls.

Monitor the person’s mobility and if you are concerned about falls risk (near misses, unsteadiness, reduced confidence) encourage the person to seek further advice and support from GP, district nurse, physiotherapist/occupational therapist, or Community Falls Prevention Team. 

Helping the person you care for to use the toilet, commode or bedpan might cause one or both of you to feel embarrassed or awkward. Many family carers feel it changes the nature of the relationship with their loved one. A GP or district nurse can advise on what is available locally to help with their personal care. Training and support should be available when a family carer first helps the person to use the toilet.

The person’s district nurse or an Occupational Therapist can advise on equipment such as a raised toilet seat, bedpan or urinal, handrails near the toilet, mattress protectors and pads, or a commode/commode screen for privacy.

It is not unusual for people approaching end of life to experience bladder problems, including needing to urinate more often, not being able to urinate, not having control over when to urinate, bladder spasms, and urinary tract infections (UTI) which can affect any part of the urinary system including kidneys, ureters, bladder and urethra. Common signs of a UTI are a strong urge to urinate, cloudy/bloody urine, strong smell, pain and burning when passing urine, nausea/vomiting, muscle aches and pains, and new or deteriorating confusion. A sudden change in behaviour is the best indication of a UTI in an older person.

Lots of illnesses and treatments can also cause bladder problems such as a neurological condition that may have damaged the bladder nerves, surgery, or medications.

The person you care for may also require additional support and personal care due to bowel incontinence or they may have a stoma bag. Most people have a bowel movement more than three times a week and pass good textured faeces without straining. The colour of stools may vary but should not be too pale or very dark although colour may be affected by medication such as iron.   

For more information about how to help the person you care for use the toilet or commode. 

For information on how to help the person keep clean. 

In Surrey, there is a specialist NHS continence service with specially trained continence nurses offering advice and guidance. For example, they will provide free of charge two continence pads per day if the person you care for is incontinent. They also run incontinence clinics and provide a number you can call for advice.

1. Keep an eye out for any bladder changes including UTIs and speak to the doctor or nurse if you are concerned. Sometimes it might be necessary to insert a catheter and a district nurse can do this procedure at home. 
2. Unless the person is struggling to swallow or the person is advised by the GP not to do so, help the person to keep fluid intake up – based on NHS England advice we should all be drinking 6 to 8 glasses of fluid a day. The colour of urine can indicate dehydration however it is worth remembering that some foods and medicines can cause an unusual colour or darker. Monitor and seek advice if you have any concerns. For more information about preventing or managing UTIs, see Urinary tract infections (UTIs).
3. If there is a change in bowel habit or stools change texture or are very dark or very pale encourage the person to talk to their GP or nurse. If normal bowel habit is not occurring, that is they haven’t been for 2 to 3 days, speak to the person’s GP as constipation can be very painful and may well be the reason for no passing of urine.