What’s the Difference? Palliative, Comfort and Hospice Care.

Many misunderstand the differences between Palliative, Comfort, and Hospice Care. November is National Hospice and Palliative Care Month.

So, hopefully, this information provided by CaringInfo.com, in association with the 2022 National Hospice and Palliative Care Organization, will be helpful to you and your family. 

What is Palliative Care?

Palliative care focuses on easing pain and discomfort, reducing stress, and helping people have the highest quality of life possible. It is appropriate at any age and an stage of a serious illness, not just end-of-life. It is an 'extra layer of support' — treating the symptoms of an illness and supporting the entire family.

What are the goals of palliative care?

Palliative care is a resource for anyone living with a serious illness, such as congestive heart failure (CHF), chronic obstructive lung disease (COPD), cancer, dementia, chronic kidney disease, Parkinson's disease, and many others. It is specialized medical care focused on providing relief from the symptoms and stress of the illness. Patients can continue to receive curative and therapeutic care such as chemotherapy, radiation, dialysis , and surgery while receiving palliative care.

The goal is to improve quality of life for both the patient and those who care for the patient. Symptoms that may be treated include pain, depression, shortness of breath, fatigue, constipation, nausea, loss of appetite, difficulty sleeping, and anxiety, among others. The organized services available through palliative care may be helpful to any person having a lot of discomfort, disability, or distress.

Palliative care services may include:

• Pain and symptom management
• Care coordination with your current physicians and anyone else who is part of your healthcare team
• Assistance with the development of your plan care
• Practical help with the completion of insurance forms and with making decisions abut options for your care and/or housing
• Help with advance directives and POLST's (https://www.caringinfo.org/planning/advance-directives/).
• Spiritual care, if desired

Both palliative care and hospice care (https://www.caringinfo.org/types-of-care/hospice-care/) are focused o the needs of the patient and their quality of life, but hospice is specifically focused on the period closest to death. Learn more about their differences. (https://www.cringinfo.org/types-of-care/what-is-the-difference-between-palliative-care-and-hospice-care/).

How and where is palliative care delivered?

Palliative care is provided by a specially trained team of doctors, nurses, and other specialists who work together with a patient's other doctors. Palliative care is based on the needs of the patient, not the likely course of the illness. The palliative care team works together with the patient, their caregivers, family and inner circle, and the patient's other doctors and communicates with all so that everyone is on the same page.

Palliative care can be provided in any setting, such as hospitals, nursing homes, outpatient palliative care clinics, specialized clinics such as oncology, and at home. Hospices are a leading provider of community-based palliative care.

Who pays for palliative care?

Medicare (https://www.caringinfo.org/planning/financial-matter/medicare/), Medicaid (https://www.caringinfo.org/planning/financial-matters/medicaid/), many insurers, and healthcare plans will cover the medical portions—physician and nurse services-of palliative care. Veterans ay be eligible for palliative care through the Department of Veterans Affairs (https://www.va.gov/). Check with your doctor and healthcare plan to see what insurance will cover in your particular situation. Unlike the comprehensive hospice benefit, there is no comprehensive palliative care benefit.

© 2022 National Hospice and Palliative Care Organization / Privacy (?privacy-policy).

What is Comfort Care?

Comfort care is a term very commonly used between doctors themselves and between doctors and family to mean end-of-life care. When doctors are talking to patients about moving away from life-prolonging or curative therapies, they often discuss the alternative as comfort-focused therapies, hence the term, "comfort care."

How is comfort care different from palliative care?

Comfort care is similar to palliative care (https://www.caringinfo.org/types-of-care/palliative-care/), in that it focuses on quality of life; however, palliative care is often accompanied by curative or therapeutic care (https://www.caringinfo.org/types-of-care/curative-care/) and comfort care is not.

How is comfort care different from hospice care?

Comfort care is a part of hospice care, but hospice care is much more. Hospice care (https:??www.caringinfo.org/types-of-care/hospice-care/), is an interdisciplinary team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient's and family/inner circle's wishes and needs. It can be provided in any setting. Hospice provides all medications, services, and equipment necessary. Hospice also offers bereavement care (https://www.caringinfo.org/types-of-care/bereavement-care/), (grief support) to caregivers (https://www.caringinfo.org/planning/caregiving/)

for up to 13 months after death. If your doctor suggests comfort care, it is important to ask if they are referring to hospice care (https://www.caringinfo.org/types-of-care/hospice-care/).

Does comfort care mean no medical therapy?

Comfort care still involves medical therapy, and sometimes lots of medical therapy, but the goals of the therapy are different. Comfort care often implies that the person is reducing the intensity of medical care because the burden is outweighing the benefits. It also commonly means the individual recognizes that they are nearing the end of their life.

One way to think about it is to imagine where and how someone is spending their time and energy. Someone with heart failure may regularly spend time taking medications, taking their vital signs, having their blood drawn for testing, taking other tests, and visiting their doctor. Someone focusing on comfort care will spend the majority of their time at home with friends and family. They may call the important people home and take the opportunity to say goodbye without a lot of medical-related distractions.

How do I ask my doctor what they mean when they suggest comfort care?

Doctors, or anyone, can rarely forecast exactly how long someone will live, so they often don't want to answer the question, "How long do I have (or they have)?" By asking it the other way around, the question becomes easier to answer.

• One way to ask what they mean is to ask, "Do you mean hospice care?"
• Another useful approach is to ask, "Would you be surprised if (name) died in six months?" or some other time period.

© 2022 National Hospice and Palliative Care Organization / Privacy (/privacy-policy).

Hospice Care

The term hospice is frequently misunderstood and is equated in many persons minds with imminent death. On the contrary, hospice care focuses on quality of life, on the wishes of the patient and family, and on easing distress at the end of life and the months preceding death. CaringInfo will explain what hospice actually is and how it can help.

What is hospice?

Hospice is a type of health care (https://www.caringinfo.org/types-of-care/), that focuses on the relief of a terminally ill patient's distress and symptoms and attending to their emotional and spiritual needs during the final stages of life. Hospice care prioritizes comfort and quality of life by reducing pain and suffering. Hospice care provides an alternative to therapies focused on life-prolonging measures that may be difficult, be likely to cause more symptoms, or are not aligned with a person's goals.

Hospices care for people where they live. Although some hospice care is provided in hospitals, in-hospice facilities or nursing homes, most patients are cared for in the place they call home, which is where most people would prefer to be. Hospice provides all medications, services, and equipment necessary. Hospice also offers bereavement care (grief support) (https://caringinfo.org/types-of-care/bereavement-care/), for up to 13 months.

What is the philosophy of hospice?

Hospice care provides compassionate care for people in the last phases of incurable disease or simply aging so that they may live as fully and comfortably as possible. The hospice philosophy accepts death as the final stage of life: it affirms life but does not try to hasten or postpone death. It concerns itself with providing the individual and the family with support and choices so that everyone can be fully present.

To quote Dame Cicely Saunders, founder of the first modern hospice, "You matter because of who you are. You matter to the last moment of your life, and we will do all we can, not only to help you die peacefully, but also to live until you die."

Who can benefit from hospice care?

Given that we are all mortal, eventually most of us. Hospice wraps itself around a patient and family to pro-vide support during a difficult and confusing time. Most of us have never been in the presence of a person towards the end of their life, much less actually dying. Hospice staff can explain what is going on, how to take care of the person, what to expect. Medicare certified hospices must have a 24/7 telephone line to call when crises or questions arise, so no one is alone trying to figure out what to do or whether or not to call 911. Hos-pice can advise on and provide medications to make the patient more comfortable and instruct the caregivers in their use.

Is accepting hospice care giving up?

This seems to be the understanding of many people. However, there is another way to look at it.

In many ways choosing hospice is the opposite of giving up; choosing hospice is actively choosing to have a voice and some control during the last stages of one's life. Instead of being pushed around by the processes and procedures of the healthcare system, we can choose care that is aligned with our values and priorities. Those persons who want everything possible done, can and should receive that care, but many people would choose a less intrusive path.

What services does hospice offer?

Hospice care is provided by a team that works together focusing on the patient's needs whether physical, emotional, or spiritual. The goal is to keep the patient as pain-free as possible, with the loved ones nearby.

The team usually consists of:

• Clergy or other counselors
• Home health aides
• Hospice physician (or medical director0
• Nurses
• Social workers
• Trained volunteers
• Speech, physical, and occupational therapists, if needed
• The patient's personal physician may be included

Often, persons choose to have their primary doctor involved in medical care. Both the primary doctor and the hospice medical director may work together to coordinate the patient's medical care, especially when symptoms are difficult to manage.

Among its major responsibilities, the interdisciplinary hospice team:

• Manages the patient's pain and symptoms
• Provides emotional support
• Provides medications, medical supplies and equipment
• Coaches caregivers on how to care for the patient
• Delivers special services like speech and physical therapy when needed
• Makes short-term inpatient care available when pain or symptoms become too difficult to manage at home or when caregivers need respite time
• Provides grief support, also known as bereavement support.

Although hospice provides a lot of support, the day-to-day care of a person receiving hospice care is provided by family, friends, the inner circle, or paid home health aides. The hospice team coaches caregivers on how to care for the patient (https://www.caringinfo.org/planning/caregiving/caregiver-duties-and-activities/), and even provides respite care when caregivers need a break. Respite care can be for as short as a few hours or for as long as several days. Medicare covers up to 5 days of respite care at a time.

What does the hospice 6-month requirement mean?

Some people think that their doctor's suggestion to consider hospice means that death is very near. That is not always the case at all. People often don't begin hospice care soon enough to take full advantage of the help it offers.

In the U.S., people enrolled in Medicare can receive hospice care if their doctor thinks they have fewer than 6 months to live should their disease take its usual course. Doctors have a hard time predicting how long a per-son will live. Health often declines slowly, and some people might need a lot of help with daily living for more than six months before they die.

Talk with your doctor (https://www.caringinfo.org/planning/communicating/talking-with-doctors/), if you think a hospice program might be helpful. If they agree, but think it is too soon for Medicare to cover the services, then you can investigate other ways of paying for the services.

What happens if someone under hospice care lives longer than 6 months?

If the doctor continues to certify that the person is still eligible, Medicare can continue to pay for hospice services. It is also possible to leave hospice care for a while and later return if your doctor again thinks you are eligible.

Next, you can learn more about how to choose a hospice.

2022 National Hospice and Palliative Care Organization / Privacy (/privacy-policy).

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