The last three years of the 1880s formed a difficult period for Alice James. She lived alone in Leamington Spa: although Katharine Loring made extended visits, Alice had to do without the comfort of her uninterrupted presence. In August 1890 Alice's physical and emotional health deteriorated dramatically, and Katharine returned to her from the United States; Katharine now committed herself to her friend for the indefinite future. Henry wrote to William that Katharine had undertaken not to leave Alice while she remained in her ‘present condition’; no one expected Alice's condition to improve. Katharine arranged for the couple to move into a small house in Kensington, where they established themselves in serene domestic contentment. Alice's happiness was only consolidated by the diagnosis, in May 1891, of cancer in her breast and liver. At last, Alice had secure possession of the two enduring desires of her adult life: Katharine's undivided devotion, and the guarantee of imminent death.

Alice died on 6th March 1892; she was unconscious during this last day of her life.