When a loved one is diagnosed with a serious or life-limiting illness, one of the most important things a family can do is understand what the palliative care journey actually looks like. Many people assume palliative care is a single event, something that happens near the end. In reality, it is a carefully structured process that begins at diagnosis and continues long after a loved one has passed.
The five stages of palliative care provide a framework that helps families, care teams, and individuals living with illness plan for what lies ahead. Each stage focuses on a different dimension of need: from building an initial care plan, to managing physical symptoms, to supporting the family through bereavement. Together, they ensure that every aspect of a person’s comfort, dignity, and wellbeing is addressed throughout the journey.
At Merling Care, our palliative care is guided by these same principles. Across Glebe House in Staines and Moorland House in Barton-on-Sea, our teams are experienced in supporting residents and their families through every stage, with the understanding, calmness, and kindness that define our approach.
The five stages of palliative care are: (1) care planning and assessment, (2) emotional and psychological support, (3) physical symptom management, (4) end-of-life care, and (5) bereavement support. These stages are not rigid steps but a flexible framework that evolves with the individual’s changing needs.
It is worth noting that the NHS does not publish a single official “five stages” model, but healthcare professionals and palliative care specialists across the UK widely use this five-part structure to organise support around comfort, dignity, and quality of life. The framework aligns with NHS England’s Ambitions for Palliative and End of Life Care, the national framework for local action through 2021 to 2026.
The first stage of palliative care begins at or shortly after a diagnosis of a serious or life-limiting condition. Its purpose is to establish a comprehensive, personalised care plan that reflects the individual’s needs, preferences, and wishes.
At this stage, a multidisciplinary team, typically including the person’s GP, specialist nurses, and other healthcare professionals such as occupational therapists or physiotherapists, works together with the individual and their family to understand:
This stage also provides a natural opportunity to consider Lasting Power of Attorney (LPA). An LPA for health and welfare allows a trusted person to make decisions on behalf of the individual should they lose mental capacity. Setting this up early, while the person is able to record their own preferences clearly, can prevent unnecessary distress for families later.
Care plans created at this stage are living documents. They are reviewed regularly and updated as the person’s condition and wishes evolve. At Merling Care, care plans are transparent and accessible to staff and family members at all times, so everyone involved in a resident’s care is working from the same understanding.
A serious illness diagnosis affects far more than the body. The emotional impact on both the individual and their family can be profound and sustained. Stage two of palliative care focuses specifically on psychological wellbeing and emotional resilience.
Support at this stage may include:
This stage is ongoing. Emotional needs do not follow a neat schedule, and the best palliative care teams check in regularly rather than treating psychological support as a one-off referral.
Families often tell us that the hardest part is not knowing what to say. One of the most valuable things our team can do is help relatives feel more confident in those conversations, and to remind them that presence matters as much as words.
Merling Care staff are trained to support residents emotionally as well as physically, and to maintain open, honest communication with families throughout the care journey.
Once emotional support frameworks are in place, the third stage of palliative care addresses the physical realities of living with a serious illness. For many people, this is the stage they feel most prepared for, but it often requires more specialist input than families anticipate.
Effective symptom management at this stage typically involves:
At this stage, the palliative care team works in close coordination with the person’s GP, specialist consultants, and community nursing services. The goal is not to eliminate all symptoms, which may not be possible, but to manage them effectively enough that the individual can live with as much comfort, independence, and quality of life as possible.
At Glebe House, which is registered for nursing, specialist nursing needs are part of everyday care. Our team is experienced in supporting residents with complex, progressive conditions alongside general residential and palliative care needs.
Stage four is what most people think of when they hear the phrase “palliative care,” though as this guide has shown, it is only one part of a much broader journey. End-of-life care begins when a person is approaching the final months, weeks, or days of life, and the primary focus becomes ensuring that time is as peaceful, comfortable, and meaningful as possible.
At this stage, the care team’s priorities include:
A person may wish to spend the end of their life at home, in a hospice, or in a care home. Where a resident has already settled into life at Merling Care, familiar surroundings and a trusted team can be a real comfort during this time.
We believe every person deserves to reach the end of their life with dignity, surrounded by kindness. Our small home environments mean that by this stage, our staff truly know the residents in their care. That familiarity, we think, matters enormously.
The advance care plan created in Stage 1 plays a crucial role here. It guides the team’s decisions and ensures that care reflects what the person would have wanted, even if they are no longer able to communicate their wishes directly.
Palliative care does not end at the point of death. The fifth and final stage recognises that families and close friends need continued support in the weeks and months that follow.
Bereavement affects people differently and follows no predictable pattern. Good palliative care services acknowledge this and provide:
Grief is not a problem to be solved. The role of bereavement support is to provide a safe, caring presence during a period of significant loss. Charities such as Marie Curie, Cruse Bereavement Support, and the National Bereavement Alliance offer specialist services across England that families can access at no cost.
At Merling Care, we remain a point of contact for families after a resident passes. Our open-door approach does not end with the care journey.
There is no fixed timeline for any stage of palliative care. Some individuals move through the early stages over several years. Others experience a more rapid progression. The framework exists to ensure that the right support is in place at the right time, not to impose a schedule on a deeply personal journey.
What matters is that care planning begins early, is reviewed regularly, and is always guided by what the individual wants.
Palliative care can be provided in several settings:
For many families, a care home provides important advantages in the palliative stage. Residents benefit from consistent staffing, a familiar routine, established relationships with carers, and 24-hour availability without the clinical feel of a hospital environment.
At Merling Care, our intentionally small homes mean that care is never impersonal. Both Glebe House and Moorland House accommodate fewer than 25 residents, and both hold CQC ratings of Good. Our staff know our residents and their families well before the palliative stages begin, which means the transition to more intensive care is supported by trust that has already been built.
At Merling Care, palliative care is one of a range of care types we provide alongside nursing, residential, dementia, and respite care. We believe that excellent palliative care is not a separate service added at the end of someone’s life. It is an expression of the same values we bring to every resident, every day.
Care plans are personalised, transparent, and kept updated. Our teams are trained and experienced. Our homes are small enough for every resident to feel genuinely known.
If you would like to discuss palliative care for a loved one, or arrange a visit to one of our homes, we would be very glad to hear from you.
You can also learn more about life at Merling Care and the care we provide at merlingcarehomes.co.uk.
The NHS does not publish a single official five-stage model, but healthcare professionals across the UK widely use this framework to structure palliative support. It aligns with the principles set out in NHS England’s Ambitions for Palliative and End of Life Care national framework.
The stages are a framework, not a rigid sequence. A person with a rapidly progressing illness may move quickly through some stages, or several stages may overlap simultaneously. The care team adapts the approach to what the individual needs at any given time.
A hospice is a setting where palliative care is delivered, typically for people in the later stages of a life-limiting illness. Palliative care itself is an approach that can be delivered in care homes, hospitals, people’s own homes, or hospices. The two terms are not interchangeable.
As early as possible after a serious diagnosis. Research consistently shows that early palliative care improves quality of life, reduces unnecessary hospital admissions, and helps individuals and families make better-informed decisions. It is far better to have plans in place and not need them urgently than to face difficult decisions without preparation.
This depends on the specific home and its registration. Glebe House at Merling Care is registered for nursing, meaning it can provide specialist nursing care as part of the palliative care package. Moorland House provides residential palliative care. Our teams work closely with community nursing and specialist services to ensure every resident receives the level of clinical support they need.
New to the subject? Read our introductory guide: What is Palliative Care? A Simple Guide for Families.