The recent statement from the Bush family about former First Lady Barbara Bush’s decision to receive comfort care instead of hospitalization has created a surge of interest and questions from the public about what “comfort care” actually means.
There are different forms of comfort care, but at its most basic, it’s a plan that focuses on symptom control, pain relief, and quality of life for a patient and ultimately to provide care and not a cure. “The other part of comfort care,” says Janet Burda, advanced practice nurse with Palos Community Hospital’s Home Health program in Palos Heights, “is helping relieve anxiety for the caregiver. Often caregivers don’t know what to expect at the end of a loved one’s life and they often don’t know how to recognize symptoms of discomfort in a patient who is not able to talk or otherwise communicate.
The two best-known categories of comfort care are palliative care and hospice care.
Palliative care is patient and family-centered care which focuses on quality of life by anticipating, preventing, and treating suffering during the course of the illness – for example, things like pain, anxiety, shortness of breath, nausea, vomiting or diarrhea for a cancer patient going through chemotherapy. This type of care addresses physical, intellectual, emotional, social, and spiritual needs and facilitates patient autonomy, access to information, and choice. This type of care is not for terminally-ill patients.
If a terminal diagnosis is made, then the patient would qualify for hospice care. Hospice is a model of compassionate, high-quality care for the patient and the patient’s family, where an interdisciplinary team of professionals, which include a physician, nurse, social worker, allied therapists, counselors, home health aides, spiritual and grief support and trained volunteers provide the patient with emotional, psycho-social, and spiritual care in addition to medical care. Each patient’s care plan is tailored to their needs. According to the National Hospice and Palliative Care Organization (NHCPO), hospice cares for more than 1.65 million Americans, and their families, every year—a number that continues to grow.
Comfort care reflects the fundamentals of hospice and palliative care while hospice care provides the most comprehensive array of covered services. In the U.S., hospice organizations are the primary providers of community-based palliative care and comfort care services.
The Medicare Hospice Benefit requires that a terminally-ill patient have a prognosis of six months or less left to live, but to clarify, there is not a six-month limit to hospice care services. Patients in hospice include those with cancer, dementia, heart disease, COPD, renal disease and other illnesses. The majority of hospice care is provided in the home, yet hospice care can also be provided in nursing homes, assisted living facilities, and inpatient settings.
Hospice eligibility requirements should not be confused with the length of service. A patient in the final phase of life may receive hospice care for as long as necessary when a physician certifies that he or she continues to meet eligibility requirements. Under the Medicare Hospice Benefit, two 90-day periods of care (a total of six months) are followed by an unlimited number of 60-day periods.
All end-of-life care should begin with a conversation, Burda said. With Barbara Bush’s death the day after National Healthcare Decisions Day, April 16, a national initiative to encourage adults of all ages to plan ahead of a health crisis, her passing evoked many timely conversations about end-of-life planning.
“People should take steps to educate themselves and family members about preferences and options,” she said. “Talk to your family. Have that critical conversation about what you want the end of your life to look like. That affords you the control.”
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