How to Meaningfully Say Goodbye

If your loved one in hospice care becomes nonverbal and unresponsive, it’s easy to believe the misconception that they can’t hear you. A recent study, however, reveals that hearing is the last sense that remains for dying patients. With this in mind, Heart to Heart Hospice can help guide you to provide meaningful moments during their final days even when they can’t respond.

The study, released by the University of British Columbia, measured electrical activity in the brain via EEGs of healthy control patients, hospice patients when conscious, and the same hospice patients when they became unresponsive. The important findings, along with observations of long-time palliative care doctors and nurses, show:

  • Brain activity supports that a dying patient most likely can hear.
  • Even if awareness of sound cannot be communicated due to loss of motor responses, the value of verbal interactions is measurable and positive.
  • Patients appear comforted by the sounds of their loved ones (in person and by phone).

“In the last hours before an expected natural death, many people enter a period of unresponsiveness,” says study lead author Elizabeth Blundon, who was a psychology PhD student at the time of the study. “Our data shows that a dying brain can respond to sound, even in an unconscious state, up to the last hours of life.”

Hearing at End of Life: What to Say When a Loved One’s Unresponsive

When a patient chooses to die comfortably at home under hospice care, how can you, as the primary caregiver, use this knowledge to provide meaningful final days? Trained to assist you, the experts at Heart to Heart Hospice help guide your interactions to feel respectful and compassionate, not awkward or forced.

One Heart to Heart family shares this experience: “The hospice nurse told us to keep talking to my brother even though he was not responsive. When his daughter in Australia called, we put the call on speaker. She told him she loved him and then sang a little song they shared when she was a child. He raised his eyebrow and twitched his lip, ever so slightly,” he said. “We all cried — he had heard her! This tiny act gave us all so much joy; he knew we loved him right until the end.”

Tips for Communicating When a Patient Can’t Respond:

  • Continue talking to them in a conversational way. Express your love for them. Share favorite memories.
  • Touch them when you talk to them. Speak clearly and with enough volume, yet use a gentle tone.
  • Read to them. Consider reading notes from loved ones, religious texts, poems, or passages from their favorite books.
  • Sing or play comforting music that is familiar and meaningful to them.
  • Accept phone calls from far-away loved ones and let them briefly talk to them via speaker phone.
  • Be willing to say goodbye and give them permission to do the same, releasing them from the guilt of “leaving you behind.” Say things like, “We love you and want you to know it’s okay to go when you are ready. You can be free of pain. We have had a wonderful life together.” 
  • It’s normal and healthy to let your tears and emotions show; it communicates your love for them.
  • Never say things that you do not intend for the dying person to hear, including scary health updates or stressful news. Talk about those topics outside of their room. Instruct and redirect others to do the same.
  • Eliminate background noise, like TVs or side conversations.

While it’s difficult to watch loved ones lose their motor skills and verbal abilities, knowing they can hear you helps bring closure and meaning. If you want guidance caregiving for your loved one in their final months of life, discover if Heart to Heart Hospice is available in your area, serving regions of Michigan, Indiana, and Texas. Read through our Patient and Family Handbook for the vast resources provided to our hospice families. 


Hearing persists at end of life, Science Daily (July 2020)