Does comfort care happen only at end-of-life? This blog post explores comfort care vs. hospice, how these terms are used and what they mean for patients.
Comfort Care vs. Hospice
Hospice providers devote our efforts toward certain concepts that can seem somewhat abstract: quality of life, dignity, and most of all, comfort. A cynical observer might wonder how much comfort a person living through her final days might experience, but hospice workers know that adequate comfort care can make all the difference in the world to our patients and their families. But comfort care is not strictly synonymous with hospice, and it has applications outside of hospice. What follows is a brief overview of comfort care vs. hospice.
The two terms are often used interchangeably, but they are not strictly the same. Some people say the word “hospice” with hushed undertones as if uttering it would issue forth a dread curse; for them, “comfort care” is a euphemism to avoid the implication of death. Comfort is the primary component of hospice, but they are different things: hospice necessarily involves such care, but comfort care happens outside of hospice, too.
What Is Comfort Care?
As the name suggests, comfort care relieves discomfort and pain from patients. It is the primary medical intervention in end-of-life care, so we hospice workers are trained in minimizing our patients’ pain and discomfort. But it is not strictly limited to hospice, and it is also a major component of palliative care for patients.
Comfort care comes in many forms.
- Pain management is an obvious intervention, and doctors work with patients to find the medication that will best limit pain with a minimum of deleterious side effects. Physical therapy also helps to reduce pain.
- After pain, breathing difficulties are the most common complaint for hospice and palliative care patients. Dyspnea (shortness of breath), tightness in the chest, and uncontrollable coughing can seriously impact a patient’s physical and emotional state, so respiratory therapy is important in comfort care.
- For bed-bound people, pressure ulcers (bedsores) are a grievous complaint, but sadly, they are often impossible to prevent entirely. All comfort care providers must plan to help the patient turn and shift in bed—and keep in mind the possibility that manually moving the patient might become more painful than the pressure ulcers themselves.
- Trouble swallowing can of course impact a patient’s ability to nourish herself, but speech therapists can help with that.
But physical comfort is only part of what dedicated caregivers can provide. One cannot overstate just how badly a poor mental or emotional state can affect a patient. Patients who are cheerful and stable need less pain medication, make fewer complaints, and are more hopeful for the future.
- Loss of independence can weigh heavily on people requiring intensive care. But physical therapy can improve a patient’s range of motion, and occupational therapy can help the patient keep doing the things she loves.
- Don’t forget the social impact of a severe illness. Loss of speech can be mitigated with the efforts of a speech therapist. And all comfort care providers make an effort to be sociable and friendly, giving the patient a potential social outlet.
- And of course, severely ill people are often preoccupied with thoughts of mortality and the meaning of life. Sometimes they become embroiled in negative thoughts and emotions; others regret their choices; some worry about what might lie beyond. For these patients, comfort care providers employ social workers and chaplains to help people manage their emotional and spiritual needs.
In Hospice
To qualify for hospice, a patient must be expected to pass away within six months. The patient’s condition or illness does not respond to treatment, and recovery is no longer deemed possible by the physician. In such cases, no attempt to treat the illness is made: all medical intervention is geared towards making the patient as comfortable as possible. Knowing this, providers of hospice services dedicate their efforts totally to the comfort of the patient.
With the help of a conscientious hospice team, a patient’s final days can be spent with minimal pain and discomfort. All medications and therapies administered are to lessen the patient’s discomfort, allowing her to attend to her family and the considerations related to her death.
Comfort is provided, not just to the patient in hospice. Hospice workers know that family members of terminally ill patients suffer in their own way and often stand in dire need of help. In a home hospice, family caregivers are the people who provide most of the support to the terminally ill patient. Providing support to an ill family member, while also juggling jobs, children, bills … it comes as no surprise that family caregivers typically hit a wall and burn out. Professional caregivers know that family members require support, and they will work their hardest to ensure that families have the support they require.
Dying is a difficult process for even the most sanguine patient and her family, so hospice teams are trained to look after the family’s needs in addition to the patient’s. Each family is different, so hospice workers will delicately attune themselves to the family’s emotional rhythm, standing ready to offer whatever the family might need. This could be material and professional support, training to help family members care for the ill loved one, a sympathetic ear to vent to, or even just a cheerful presence to buoy the patient’s mood. Patients typically become attached to nurses and home health aides, who visit the home hospice often and provide plenty of hands-on care. It is not uncommon for patients and hospice workers to form friendships, and the arrival of a favorite hospice worker is an occasion for joy for many patients.
What about Outside of Hospice?
Comfort care is not unique to hospice. Consider palliative care, which shares many of the same goals as hospice, such as minimizing discomfort and maintaining the quality of life. However, unlike hospice, palliative care typically includes measures to treat the patient’s illness, with the long-term goal of mitigating or even eliminating the disease or condition that limits the patient’s life.
There are many palliative patients in hospitals, nursing homes, assisted living facilities, and private homes who need comfort care in addition to the curative treatments they are already receiving. Their troubles can be great: in addition to the troubles caused by illness or injury, palliative patients might undergo chemotherapy or radiotherapy, go through difficult surgeries, or take medicine with troubling side effects. For some, intensive treatments might just as difficult as the ravages of the disease itself, endured only because there is some hope of removing the disease from the patient’s life—if the disease is not treatable, the patient would probably qualify for hospice care and such difficult treatments would cease. It is no surprise then that palliative patients require a blanket of comfort care to cushion them from the double blow of disease and treatment.
Patients at any stage of a serious illness, starting from diagnosis, can qualify for palliative care. As in hospice, the focus is on the patient’s comfort and enabling the patient to be independent as possible. Ideally, the patient’s treatment will help the patient recover from her illness, and she will eventually leave from palliative care. If this is not possible, however, the patient might transfer to hospice, and all curative treatments stopped, allowing her care team to focus entirely on her comfort and quality of life.
Expert Care No Matter What
Comfort care, whether it comes in hospice or palliative care, is a necessary part of a patient’s well-being. We at UCLAH know the value of the help we bring to your patients’ lives, but hospice workers do not have an exclusive claim on providing comfort care. So when considering the differences between comfort care vs. hospice, keep in mind the many palliative patients who also benefit from comfort care.
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