Managing a serious or life-limiting illness takes more than just medical treatment, and no family should have to figure it out alone. Palliative care is there to support both the person who is unwell and the people around them. It may begin soon after diagnosis, even when the person is expected to live for weeks, months or years. Generally speaking, palliative care moves through five distinct stages, each offering a different type of support as needs change over time.
Palliative care commonly progresses through five stages: stable, unstable, deteriorating, terminal and bereavement. These stages give patients, families and care teams a shared framework for assessing need and planning ahead. Each stage reflects a shift in the person’s condition and a corresponding shift in the focus of care, but the goal across all five remains the same – to support the best possible quality of life, on the person’s own terms.
The stable stage is the starting point for many people entering palliative care. At this stage, the person has been diagnosed with a serious or life-limiting illness, but their symptoms are being managed, and their condition is not worsening day to day. Being stable does not mean being cured. It means current care is keeping things under control, whether through medication, lifestyle adjustments or other interventions, and many people at this stage continue with their normal daily activities.
During this phase, the palliative care team works with the person and their family to build a care plan. This covers current symptoms, the support required and how care will evolve if things change. It addresses physical, emotional, social and spiritual needs, not just medical ones. Family members are brought into the process early, receiving guidance on how to provide care and how to look after their own wellbeing alongside that role.
The unstable stage begins when something changes unexpectedly. A new symptom emerges, an existing problem worsens suddenly, or the person’s condition shifts in a way the current care plan does not cover. This stage requires an urgent review of the care plan and a prompt response from the care team. The change may be physical, such as increased pain or breathing difficulties, or it may involve a sudden shift in mood or cognitive function, amongst other things.
It is not uncommon for someone in palliative care to experience at least one unstable episode requiring urgent intervention. This is not a sign that something has gone wrong. It is a recognised part of the process, and palliative care teams are prepared for it. During this phase, emotional and psychological counselling may be introduced or increased.
The deteriorating stage is marked when there is a gradual, ongoing decline in an individual’s health. Unlike the unstable phase, where change is sudden, this stage is marked by a steady worsening that continues despite treatment and support. The individual needs more help with daily tasks, and fatigue and pain become harder to manage. The palliative care team will shift the focus from palliative care to end-of-life care at this stage.
Unfortunately, many individuals at this stage may have only weeks or months to live, causing significant distress for the affected individual and their families. The palliative care team can offer counselling, practical respite, and ongoing support to deal with the grief and anguish.
The terminal stage refers to the final weeks or days of a person’s life. The illness is advancing rapidly, death is expected soon, and the focus of care shifts completely to keeping the person comfortable, maintaining their dignity, and honouring their wishes. Physical signs that a person has entered this stage can include significant changes in breathing, reduced alertness, loss of appetite, and a gradual withdrawal from their surroundings.
Medical care continues through this stage, but its purpose changes. The priority is relieving pain and distress rather than managing the illness. Where possible, the person is cared for in the place of their choosing, whether that is at home, in a hospice or in a hospital. Emotional and spiritual support is provided to both the person and their family, and the care team is there to guide loved ones through what is happening and what to expect. This stage is deeply personal, shaped by who the person is, what they believe and the people around them.
Palliative care does not end when the person dies. The bereavement stage is a formal and important part of the palliative care framework, extending support to the family and loved ones who are now grieving.
A loved one’s death can be an enormous weight to carry, and grief looks different for every person. There is no correct way to experience it and no timeline to follow. Bereavement support can include counselling with a psychologist or social worker, access to grief support groups, follow-up contact from the care team in the weeks after the death, and practical guidance on what comes next. For carers who spent months or years providing intensive support, the loss of that caregiving role alongside the loss of the person can leave a significant void. Bereavement services acknowledge former carers as individuals in their own right, offering support that extends beyond their previous caregiving role.
If someone you love is receiving palliative care, you do not need to have all the answers. The palliative care team is there to guide you, and no question is too small to ask. Ask questions whenever something is unclear, and ask again when you need more information.
As a carer, your own wellbeing matters just as much as the care you are providing. Accepting support, taking breaks and talking to someone about what you are going through is not a sign of weakness or a distraction from your role. It is how you sustain the capacity to keep showing up.
There is no fixed answer. Each stage can last days, weeks, months or longer, depending on the illness, the person’s overall health and how they respond to care. Some people remain in the stable phase for years. Others move through the stages more quickly; no two people’s experiences are the same. What matters is not how long each stage lasts, but whether the right support is in place throughout.
The five stages of palliative care don’t always happen in order; a person can move from stable to unstable and back to stable again. The stages are a framework for understanding and planning care, not a fixed sequence that every person must follow. This flexibility is intentional. It allows care teams to respond to what is actually happening and adjust support as circumstances change.
As a person moves through the stages, the intensity and focus of care shifts. The symptom burden is likely to increase, and what was manageable in the stable phase may become more complex to manage as the illness progresses. The treatment focus changes too, moving from active management toward comfort in the later stages. Care planning becomes more detailed, and the support needs of the family grow alongside the person’s medical needs. The palliative care team works with the whole family, not just the patient.
In Australia, the five-stage framework is used across hospitals, hospices, aged care homes and community settings, aligned with national palliative care standards. It helps care teams communicate consistently about a person’s condition and ensures that support is scaled appropriately to their needs.
Most people can access palliative care through the public hospital system, with additional in-home support available through aged care or community care programs. A GP is usually the starting point and can refer to specialist services as needed.
Understanding the stages of palliative care helps you ask better questions, plan ahead and make sure care reflects what matters most to the person at the centre of it. If you would like to connect with others who have been through similar experiences, or if you are looking for information and support, I Am Living provides access to personal stories, practical resources and a community of people who understand what this time in life may feel like.
You do not have to navigate this alone.