Their breathing sounds noisy and rattly — are they choking or suffering?

Usually not. The rattle is saliva pooling because they are too weak to clear it, and it is generally not distressing or painful for them. Turning them onto their side or raising the head can help; tell the care team, who can offer measures.

They are sleeping all the time and will not wake — can they still hear me?

Very likely yes. Hearing and touch are thought to remain even when someone cannot respond. Keep speaking gently, hold their hand, and say what is in your heart.

Should I call an ambulance when they die at home?

If the death is expected and you have a plan, no — it is not an emergency. Call your home-care or hospice team or the doctor as arranged, and they will guide certification and next steps. Save 995 for genuine emergencies.

How do I cope — I am exhausted and frightened?

This is one of the hardest things anyone does, and you should not do it alone. Rest, share the caring, and use respite and support via AIC (1800-650-6060) and your hospice team. For distress, SOS 1767 and mindline.sg are always available.

They seem restless and confused near the end — what should I do?

Some restlessness is common in the last days. Keep the room calm and quiet, use familiar voices and gentle touch, and tell the team — they can check for simple causes like discomfort or a full bladder and help settle it.

Caring for a Dying Loved One: A Caregiver Guide

Written & reviewed by the BestDoctors.sg editorial team · Last updated 25 Aug 2026 · General information, not medical advice

Caring for someone in the last days of life — at home, in a nursing home or a hospice — is one of the hardest and most loving things anyone does. The changes you will see as death approaches are natural, expected, and usually not distressing to the dying person, even when they look distressing to you. You do not need to be a medical expert: your presence, gentleness and simple comfort care are exactly what is needed, and the care team is a phone call away. And, importantly, an expected death is not an emergency — there is no need to call an ambulance if a plan is in place.

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In a medical emergency, or for severe or sudden symptoms such as breathing difficulty, chest pain, fainting or stroke signs, call 995 immediately.

Keep the palliative or home-care team’s after-hours number by the phone and call them for changes or questions. Call 995 only for a genuine emergency, not for an expected death with a plan in place. For your own distress, SOS is on 1767 and mindline.sg offers support.

Recognising the changes as death approaches

These changes are normal and usually peaceful for the person. There is increasing sleepiness and reduced consciousness — more time asleep, harder to wake, eventually a deep sleep — and hearing and touch are thought to remain, so keep talking gently and holding a hand. Eating and drinking reduce, as our appetite guide explains. Breathing often becomes irregular, with fast and slow phases and long pauses, and secretions can cause a rattling sound that is usually not a sign of choking, pain or distress for the person. The skin may become cool and mottled, and some people become restless or confused.

How to provide comfort

Simply being there — sitting with them — is one of the most valuable things you can do. Hold their hand, use gentle touch, and speak calmly and warmly, assuming they may still hear you even when they cannot respond; say the things you want to say. Keep the lips and mouth moist with good mouth care, gently change position for comfort and to ease noisy breathing and pressure areas (ask the nurses to show you how), and create a calm environment with soft lighting, quiet, and familiar people or music. Follow the person’s lead rather than a routine — there is no need to wake them to eat or wash.

Restlessness and noisy breathing

Two changes worry families most. Restlessness or agitation near the end — plucking at bedding, confusion, or seeming out of character — often settles with a calm, quiet room, familiar voices and reassurance, and the team can check for treatable causes such as discomfort or a full bladder. The rattling sound of secretions is usually not distressing to the person; turning them onto their side or raising the head can help, and the team can offer measures. Naming these in advance makes them far less frightening when they happen.

Looking after yourself

Caring for a dying person is physically and emotionally exhausting, and you matter too. Rest, eat and take breaks; share the caring across family and friends; and use respite options through the Agency for Integrated Care (AIC, 1800-650-6060) and hospice teams. Accept help — let others cook, clean, sit in or run errands — and lean on the team, your GP, faith or community support, a counsellor, or other carers for emotional support. Grieving before the death (anticipatory grief) is normal, and our caregiver burnout guide may help; if you feel overwhelmed or unable to cope, SOS 1767 and mindline.sg are there.

Knowing who to call

Have the palliative, home hospice or home-care team’s contact and after-hours line written down and by the phone, and know who to call at any hour — most home-care services have a 24-hour advice line. AIC (1800-650-6060) helps with caregiver support, respite and navigating services, and the Singapore Hospice Council (helpline 6277 8222) helps you find home, inpatient and day hospice care. Discuss in advance whether the plan is to remain at home, so an expected death does not trigger a reflex 995 call; 995 is for a genuine emergency, not an expected death with a plan in place.

What to do at the time of death

If death is expected and a plan is in place, it is not a medical emergency — there is no need to rush or call an ambulance, and you can take your time. Signs that death has occurred include no breathing, no pulse, and unresponsiveness, with the eyes perhaps open and the jaw relaxed. You can stay with your loved one for as long as you wish, and involve family or faith and cultural practices. When you are ready, contact the home-care or hospice team, the after-hours line, or the doctor as arranged, and they will guide the next steps, including verifying and certifying the death; in a facility, staff handle this.

Grief afterwards

Grief is individual, with no right way or timetable — waves of sadness, guilt, relief, anger and numbness are all normal, even after an expected death. Bereavement support is available through hospice and palliative services, community and faith groups, and counsellors, and our grief and bereavement guide goes further. For acute distress, SOS 1767 and mindline.sg are always available, and AIC can point you to services. Above all, remember that the changes you saw were the natural process of dying, and that your presence and care were exactly what your loved one needed.

Related palliative & supportive-care topics

Sources

NHS — Changes in the last hours and days: nhs.uk
Marie Curie — Final moments of life: mariecurie.org.uk
Hospice UK — Guide to hospice and end of life care: hospiceuk.org
Agency for Integrated Care (AIC): aic.sg

General information only. This guide is general information about palliative and end-of-life care and is not personalised medical, legal or financial advice. Palliative care is not “giving up” — it can be provided alongside active treatment to improve comfort and quality of life. Discuss a care plan with your palliative or medical team, and put questions about an Advance Medical Directive or Lasting Power of Attorney to a doctor or the relevant authority. For distressing or uncontrolled symptoms, follow the plan your team has given you or seek urgent help; call 995 for a medical emergency. For emotional distress, the Samaritans of Singapore (SOS) are on 1767 and mindline.sg offers support.

Caring for a Dying Loved One in Singapore