How to Make a Loved One Comfortable at End of Life: A Caregiver’s Guide to Comfort

If you’re caring for someone approaching the end of their life, you’re likely feeling a mix of grief, exhaustion, and a deep desire to do something meaningful. This guide is built from clinical research and palliative care guidelines to give you practical, evidence-based ways to make your loved one comfortable at end of life, covering physical comfort, emotional presence, environmental optimization, and your own wellbeing as a caregiver. And as always, a SonderCare bed expert stands ready to speak to you about your bedroom comfort questions and concerns.

Understanding Comfort Care: What It Means and What It Doesn’t

Choosing comfort-focused care is one of the most misunderstood decisions families face. Many assume it means “doing nothing.” The opposite is true.

The World Health Organization defines palliative care as an approach that “improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering.”¹ Comfort care doesn’t abandon medical intervention. It redirects it. Medications like opioids for pain and breathlessness, anticholinergics for noisy secretions, and benzodiazepines for anxiety are actively used, carefully titrated, and adjusted as symptoms change.²

What changes is the goal. Instead of fighting the disease, every intervention asks a single question: does this reduce suffering or increase it?

The UK’s National Institute for Health and Care Excellence (NICE) recommends “anticipatory prescribing,” where medications for the five most common symptoms at end of life (pain, breathlessness, nausea, agitation, and secretions) are prescribed in advance so nurses can administer relief immediately when symptoms emerge, rather than waiting for a doctor’s order.³ Ask your hospice team whether anticipatory medications are in place. If they aren’t, request them.

Understanding this framework matters because it empowers you. You aren’t a passive observer. You are an active partner in a care plan designed around your loved one’s comfort and dignity.

Physical Comfort: Positioning, Breathing, and Pain Relief

Physical discomfort at end of life often stems from a handful of manageable symptoms: pain, breathlessness, skin sensitivity, dry mouth, and difficulty finding a restful position. You can address each of these directly.

Positioning for Easier Breathing

Breathlessness (dyspnea) is one of the most distressing symptoms for both the person experiencing it and the family watching. Positioning is a first-line, non-pharmacological intervention recommended by multiple clinical guidelines.⁴

Semi-Fowler position (30-45 degrees): Elevating the head and torso reduces the pressure of abdominal organs on the diaphragm, allowing the lungs to expand more fully. A 2026 study in patients with acute heart failure found that a 45-degree semi-Fowler position increased mean oxygen saturation from 85.6% to 96.0%.⁵ While that study focused on heart failure, the physiological principle applies broadly: gravity helps the lungs work more efficiently.

An adjustable bed makes this straightforward. The SonderCare Aura Platinum home hospital bed offers Zero Gravity and Cardiac Chair positions at the touch of a button, allowing you to find the exact angle where your loved one breathes most easily without the struggle of stacking and restacking pillows throughout the night.

Side-lying position: For someone with fluid in one lung or an enlarged heart compressing the left lung, lying on the right side can improve oxygenation. A 2025 study found that right lateral positioning in patients with cardiomegaly improved oxygen levels from 68.2 to 78.9 mmHg and comfort scores from 2.1 to 4.3 on a 5-point scale.⁶ Place a pillow between the knees, another behind the back, and one in front for the arms to hug.

Forward-leaning (tripod) position: If your loved one can sit, leaning forward with arms resting on a pillow or overbed table stabilizes the shoulder muscles and allows them to assist with breathing more efficiently. This is a cornerstone technique in pulmonary rehabilitation.

With any position change, reassess comfort within five minutes. And remember: to protect the skin, reposition at least every two to four hours, balancing pressure relief with the person’s comfort and tolerance for movement.

The Fan Trick That Actually Works

This may surprise you: a small fan directed at your loved one’s cheek is one of the most evidence-supported, non-drug interventions for breathlessness. The 2021 American Society of Clinical Oncology (ASCO) guideline recommends airflow interventions with a moderate strength of evidence, which is actually stronger than the evidence for positioning alone.⁴

A 2019 meta-analysis of three randomized controlled trials found that a fan directed at the face at rest reduced breathlessness intensity by 11.17 points on a 100-point scale.⁷ The mechanism involves stimulating temperature and pressure receptors in the trigeminal nerve along the cheek, which sends signals to the brain that reduce the sensation of air hunger. A 2026 meta-analysis further confirmed that face-directed fan therapy provides significant immediate relief across various advanced diseases.⁷

The fan doesn’t need to be powerful. A gentle, handheld fan on a low setting is enough. Keep one at the bedside.

Mouth Care: A Small Act With Outsized Impact

As someone nears the end of life, they often stop eating and drinking. The mouth becomes dry, lips crack, and this can be a significant source of discomfort. Mouth care is one of the most meaningful things you can do:

• Use a damp sponge swab (available at any pharmacy) to gently moisten the inside of the mouth every one to two hours
• Apply a thin layer of petroleum jelly, coconut oil, or lip balm to the lips to prevent cracking
• If your loved one is conscious and can safely swallow, offer small ice chips or sips of water
• Avoid lemon-glycerin swabs, which can dry the mouth further over time

This is a gesture of tenderness that also provides real physical relief.

Skin Care and Pressure Relief

Skin becomes increasingly fragile during the final days. Even gentle friction can cause breakdown. A pressure-redistributing mattress helps distribute weight evenly and reduces the shearing forces that damage vulnerable tissue. For someone at higher risk, an alternating pressure air mattress uses cycling air bladders to continuously shift pressure points.

Keep skin clean and dry. Use gentle, pH-balanced cleansers rather than soap. Apply barrier cream to areas exposed to moisture. When repositioning, lift rather than drag to avoid shearing the skin. Soft bedding, like SonderCare’s organic cotton sheets, reduces friction against sensitive skin.

Working With the Hospice Team on Pain Management

Pain management at end of life is a medical responsibility, but you play a critical role as the person who knows your loved one best. Institutional protocols from leading hospitals recommend frequent assessment and rapid titration of pain medications until comfort is achieved.² If your loved one appears uncomfortable, wincing, restless, or tensing, communicate this to the hospice nurse immediately.

Ask about:
– Around-the-clock dosing rather than “as needed” scheduling, which can leave gaps where pain breaks through
– Anticipatory prescribing so medications are available in the home before a symptom crisis
– Route adjustments if swallowing becomes difficult (sublingual, rectal, or transdermal options exist)

You are the eyes and ears between nursing visits. Your observations matter.

Emotional Comfort: Presence, Words, and Connection

Research consistently confirms what caregivers instinctively feel: your presence matters. A landmark 2024 meta-analysis examining over 100 studies found that touch interventions produce medium-sized reductions in pain (Hedges’ g = 0.69), anxiety (Hedges’ g = 0.64), and depression (Hedges’ g = 0.59).⁸ Simply holding your loved one’s hand is not just emotionally meaningful, it is measurably therapeutic.

Touch as Medicine

The research suggests that repeated, short sessions of five to twenty minutes are more effective than single long sessions.⁸ You don’t need massage training. Light, gentle contact is enough:

• Hold their hand. Rest your hand on their forearm or shoulder.
• If they enjoy it, gently massage their hands, feet, or temples with light pressure.
• Even for someone who appears unresponsive, touch receptors in the skin remain active. Your hand on theirs still registers.

Avoid areas with IV lines, fragile skin, open wounds, or significant swelling. And always follow your loved one’s lead. If they pull away or show signs of discomfort, ease back.

Speaking to Someone Who Seems Unresponsive

Hearing is widely believed to be one of the last senses to fade. While definitive proof is difficult to establish in clinical settings, palliative care experts consistently recommend continuing to speak to your loved one, even when they can no longer respond.

Speak naturally. Tell them you love them. Share a memory. Read aloud from a favorite book. Narrate who’s in the room. Avoid discussing difficult topics or decisions near the bedside, people who appear unconscious may still process auditory information.

What matters most isn’t what you say. It’s the familiar warmth of your voice filling the room.

Music and Familiar Sounds

Personalized music has measurable effects on comfort. A study in nursing home residents found that individualized audio interventions reduced total agitated behaviors by 63.4%, physically aggressive behaviors by 56.3%, and verbally agitated behaviors by 74.5%.⁹ A 2024 multicenter randomized trial confirmed that both environmental music therapy and prerecorded music reduced pain levels and increased psychological wellbeing.¹⁰

Create a playlist of songs your loved one has always loved. Aim for calm, familiar tracks rather than anything new or stimulating. Sessions of about 20 minutes work well.¹⁰ Use earphones or a small speaker at a gentle volume.

If music isn’t their thing, consider audiobooks, nature sounds, or simply the ambient sounds of a home: a clock ticking, birds outside the window, family conversation in the next room.

Creating a Comfortable Environment

The space surrounding your loved one directly influences their comfort and calm. Research in this area is more robust than many families realize.

Temperature

A study of nursing home residents with dementia found that agitation scores were significantly higher at both 20.0 degrees C and 25.0 degrees C compared to the optimal temperature of 22.6 degrees C (approximately 72-73 degrees F).¹¹ The effect of optimizing room temperature was comparable to or greater than some pharmacological interventions.

Keep the room at 72-73 degrees F. Have light blankets available so you can add or remove layers based on your loved one’s cues. Cool, damp cloths on the forehead can help if they feel warm. Warm socks or a heated blanket at the feet can ease chill.

Lighting

Natural daylight during the day and soft, dim lighting in the evening supports the body’s circadian rhythm. A 2023 systematic review found that light therapy reduced sleep disturbances in people with dementia, specifically the number of nighttime awakenings.¹²

Open curtains during the day. In the evening, switch to bedside lamps or low-wattage bulbs. Avoid overhead fluorescent lighting, which can feel harsh and clinical. Nightlights provide orientation without disrupting rest. The SonderCare Underbed Auto-Nightlight activates with motion for safer nighttime navigation without flipping on bright lights.

Sound

Reduce unnecessary noise. Close doors to buffer hallway conversations. Silence phone notifications in the room. If you’re in a hospital or facility, ask whether alarm volumes can be reduced. The ECRI Institute has identified alarm and notification overload as a top health technology hazard, with clinicians and patients both suffering from the constant noise.¹³

At home, a white noise machine or gentle fan can mask intermittent disruptions and create a consistent, soothing backdrop.

Making the Room Feel Like Home, Not a Hospital

This is where small choices carry emotional weight. The room where someone spends their final days shapes how everyone in the family experiences this time. Familiar objects (photographs, a favorite quilt, a beloved plant) transform a functional space into a personal one.

Reduce visible medical clutter where possible. Organize supplies in covered bins. If medical equipment is necessary, choose options that blend into a residential setting. The Aura Platinum hospital bed was designed specifically for this: fully upholstered side panels in Crypton fabric and a furniture-grade headboard that looks like it belongs in a bedroom, not a ward. It offers hospital-grade positioning (Zero Gravity, Trendelenburg, Cardiac Chair) for symptom management while preserving the dignity of the space.

Keeping the room feeling like their room matters. For the person in the bed. And for every family member who will carry the memory of this time.

When Comfort and Medical Protocols Seem to Conflict

One of the hardest moments for families comes when comfort measures appear to contradict medical advice. Your father wants a sip of water, but his swallowing has deteriorated. Your mother is in pain when she’s repositioned, but she needs to be turned to prevent skin breakdown. These conflicts are real, and they’re normal.

The guiding principle in comfort-focused care is that the person’s experience takes precedence over the protocol. The Clinical Practice Guidelines for Quality Palliative Care explicitly state that treatment goals should be aligned with the patient’s values and preferences through shared decision-making.¹⁴

Here’s how to navigate common conflicts:

Eating and drinking restrictions: When swallowing becomes unsafe, the risk of aspiration pneumonia is real. But for someone in their final days, the goal has shifted. Small sips of water, ice chips, or a moistened sponge swab may provide comfort that outweighs the aspiration risk. Discuss this explicitly with your hospice team. Many palliative care physicians support “comfort feeding” when the focus is on quality of life rather than prolonging it.

Repositioning when movement causes pain: If turning your loved one causes distress, work with the nursing team to pre-medicate with a small dose of pain medication 15-30 minutes before repositioning. Use a pressure-redistributing mattress to extend the safe interval between turns. In the final hours, when comfort is the sole priority, the team may recommend reducing repositioning frequency.

Oxygen and breathing: Some people find nasal cannula oxygen uncomfortable or restrictive. If your loved one is pulling at the tubing, a fan directed at the face may provide equal or better relief of the breathlessness sensation without the physical intrusion.⁷

In every case, the answer is the same: talk to your hospice team. These are not decisions you should make alone, and a good palliative care team navigates these tensions every day.

What to Expect in the Final Days: Normal Signs vs. Concerning Signs

Understanding what’s normal in the dying process reduces fear. Many of the changes that alarm families are actually predictable parts of the body’s natural progression.

Normal signs in the final days and hours:

• Changes in breathing: Irregular patterns, periods of no breathing for 10-30 seconds (Cheyne-Stokes breathing), and a rattling or gurgling sound from secretions pooling in the throat. This sound is often more distressing for family members than for the person, who is typically unaware of it.
• Decreased consciousness: Sleeping more, becoming unresponsive, or appearing to look past you. This is a natural withdrawing inward.
• Skin changes: Mottling (blotchy purple-blue coloring) on the knees, feet, and hands. Skin may feel cool to the touch despite normal body temperature.
• Decreased intake: Refusing food and water is the body naturally shutting down. This does not cause suffering the way hunger does in a healthy person. The body is releasing endorphins and ketones that actually suppress appetite and create a state of mild euphoria.
• Restlessness or agitation: Known as terminal restlessness, this can involve picking at bedsheets, attempting to get out of bed, or appearing confused. It can be managed with medication.
• Urine output decreases: Kidneys are slowing. This is expected.

Signs to contact your hospice nurse about:

• Uncontrolled pain or visible distress that isn’t responding to current medications
• Severe agitation or restlessness that escalates
• New onset of seizures
• Sudden, unexpected changes that feel different from the gradual progression your team prepared you for
• Bleeding that wasn’t anticipated

You do not need to manage these alone. Hospice teams typically have a 24-hour nurse line for exactly these situations.

Taking Care of Yourself: The Caregiver’s Wellbeing

The AARP’s 2025 Caregiving in the US report found that 63 million Americans are now providing unpaid care to family members, a nearly 50% increase since 2015. Over 40% are providing high-intensity care. One in five report their own health as poor. And only 22% have received any formal training for their caregiving role.¹⁵

You are likely tired. You may not be eating well. You might feel guilty stepping away for even an hour. These feelings are universal among caregivers, and they are also a signal that your own needs require attention.

Practical Self-Care During End-of-Life Caregiving

• Accept help. When someone asks “what can I do?”, have a list ready: bring a meal, sit with your loved one for two hours, pick up a prescription, walk the dog. Specific requests are easier for people to fulfill than open-ended offers.
• Sleep when you can. If nighttime care is disrupting your sleep, ask a family member, friend, or hospice volunteer to take a shift. A hospital bed with adjustable positioning, like the SonderCare Aura Premium, can reduce the number of times you need to wake up for manual repositioning.
• Step outside. Even ten minutes of fresh air and daylight can reset your nervous system.
• Eat and hydrate. Keep simple, ready-to-eat food nearby. Dehydration and low blood sugar compound emotional exhaustion.
• Talk to someone. A hospice social worker, a grief counselor, a trusted friend. Processing what you’re experiencing in real time is not a weakness. Ask your hospice provider if they have a formal caregiver support program, as evidence shows these programs benefit caregivers, patients, and outcomes.¹⁶
• Know that grief can begin before death. Anticipatory grief is real and common. You may already be mourning the loss of who your loved one was before this illness. That doesn’t mean you’ve given up. It means you’re human.

After: Be Gentle With Yourself

There is no correct timeline for grief. Some people feel relief, then guilt about the relief. Some feel numb. Some feel everything at once. All of these are normal responses to an abnormal situation. Hospice bereavement services are available to families for at least 13 months after a death, and they are included in the benefit at no additional cost.

Frequently Asked Questions

How do you comfort someone who is dying at home?

Focus on three areas: physical comfort (positioning for easier breathing, mouth care, skin protection, and working with hospice on pain management), emotional comfort (touch, familiar voices, music, and reassuring presence), and environmental comfort (stable temperature around 72-73 degrees F, soft lighting, reduced noise, and personal touches in the room). Even small actions like holding a hand or adjusting a pillow provide measurable relief.

Is it okay to talk to someone who is unresponsive?

Yes. Hearing is believed to be among the last senses to diminish. Palliative care professionals recommend continuing to speak to your loved one in a calm, natural tone. Share memories, express your feelings, or simply narrate who is in the room. Avoid discussing stressful decisions near the bedside.

Should I force someone at end of life to eat or drink?

No. Decreased appetite and thirst are natural parts of the dying process and do not cause the same suffering they would in a healthy person. The body releases endorphins and ketones that suppress hunger. Forcing food or fluid can increase the risk of aspiration and discomfort. Instead, offer small ice chips or sips if the person is conscious and interested, and keep the mouth and lips moistened with sponge swabs and lip balm.

What is the “death rattle” and does it cause suffering?

The death rattle is a gurgling or rattling sound caused by secretions pooling in the throat as the swallowing reflex diminishes. It is typically more distressing for family members than for the dying person, who is usually unconscious or semi-conscious. Medications like glycopyrrolate can reduce the secretions. Repositioning to a slight side-lying position may also help secretions drain naturally.

How do I know when death is near?

Common signs include irregular breathing with pauses, mottling of the skin on extremities, decreased responsiveness, cool hands and feet, and very little urine output. These changes may unfold over hours or days. Your hospice care team can help you understand what to expect based on your loved one’s specific condition.

What if comfort measures conflict with medical protocols?

This is common and navigable. The guiding principle in comfort-focused care is that the person’s experience and stated wishes take precedence. Discuss specific conflicts (eating restrictions, repositioning pain, oxygen discomfort) directly with your palliative care team. They can adjust the care plan to prioritize comfort while managing risk appropriately.

You Are Already Doing Enough

If you’ve read this far, you care deeply about the person in that bed. That care is the most important thing you bring to this experience, more than any technique, any positioning protocol, any perfectly curated environment.

The median hospice stay in the United States is just 18 days. One in four patients are enrolled for five days or fewer.¹⁷ The time is short. But within that time, you have the ability to shape something that every family member will carry forward: the memory of how their loved one was cared for, how the room felt, how the final days unfolded.

You don’t need to be a nurse. You don’t need to get everything right. You need to be present, to pay attention, and to ask for help when you need it.

Your presence is the comfort. Everything else is a tool to support it.

References

1. World Health Organization. (2020). Palliative Care Fact Sheet. https://www.who.int/news-room/fact-sheets/detail/palliative-care

2. Penn Medicine. (2018). Comfort Care Guidelines. As summarized in palliative care research protocols for opioid, anticholinergic, and benzodiazepine administration at end of life.

3. National Institute for Health and Care Excellence (NICE). (2015, updated 2019). Care of dying adults in the last days of life. Guideline NG31. https://www.nice.org.uk/guidance/ng31

4. Hannon, B., et al. (2021). Management of Dyspnea in Advanced Cancer: ASCO Guideline. Journal of Clinical Oncology, 39(12), 1389-1411. https://ascopubs.org/doi/10.1200/JCO.20.03465

5. Semi-Fowler positioning study in patients with acute decompensated heart failure. (2026). International Journal of Health, Economics and Social Sciences (IJHESS).

6. Agussalim, A., et al. (2025). Effect of right lateral positioning on oxygenation and comfort in patients with dyspnea due to cardiomegaly. Science Frontier.

7. Swan, F., et al. (2019). Airflow relieves chronic breathlessness in people with advanced disease: An exploratory systematic review and meta-analyses. Palliative Medicine, 33(6), 618-633. Supplemented by Pereira, C., et al. (2026). Meta-analysis confirming face-directed fan therapy efficacy.

8. Packheiser, J., et al. (2024). Meta-analysis of touch interventions in adults: Effects on pain, anxiety, and depression across more than 100 studies.

9. Integrative review of environmental design interventions for end-of-life care. Study of individualized audio/white noise in nursing homes. PMC5856462.

10. Multicenter randomized clinical trial on music therapy and prerecorded music for pain and psychological wellbeing. (2024). Published in PubMed Central.

11. Mendes, A., et al. (2021). Study on indoor temperature and agitation in nursing home residents with dementia. Supported by WHO indoor temperature guidelines.

12. Fong, T., et al. (2023). Light therapy for people with dementia: Systematic review and meta-analysis of effects on sleep, agitation, and depression.

13. ECRI Institute. (2019). Top 10 Health Technology Hazards for 2020: Alarm, Alert, and Notification Overload. Executive Brief.

14. National Coalition for Hospice and Palliative Care. (2018). Clinical Practice Guidelines for Quality Palliative Care (4th ed.). https://www.nationalcoalitionhpc.org/wp-content/uploads/2020/07/NCHPC-NCPGuidelines_4thED_web_FINAL.pdf

15. AARP/National Alliance for Caregiving. (2025). Caregiving in the US 2025: Key Trends, Strains, and Policy Needs. https://www.aarp.org/pri/topics/ltss/family-caregiving/caregiving-in-the-us-2025/

16. Center to Advance Palliative Care. (n.d.). Caregiver Support Program Implementation Toolkit.

17. NHPCO Facts & Figures, 2024 Edition. Based on 2022 Medicare hospice data.