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A Guide to Comfort Care for the Elderly

Comfort care is part of end of life care (EoLC) and focuses on many aspects that individuals and families face as we approach the end stage of our life. This is part of every medical discipline but it does not have to wait until the last day or weeks we have left. It can start years in advance and help us to deal with death and dying and to enjoy the time that we have left.

What is Comfort Care?

Comfort care is a multi-discipline part of every aspect of healthcare. It includes doctors, nurses, caregivers, social workers, clergy, and so many other people. The goal of comfort care is to ease the physical sufferings and pressure, the emotional distress and worry while uplifting the spiritual needs of people who are in the last segment of their life. It is a type of care that helps with the practical tasks of living as we prepare for our death and is appropriate for both the patient and the patient's family.

In short, comfort care is about improving the quality of life for the patient at the end of their life while providing respect, dignity, and ethics.

Read more about what comfort care is and what to expect from the National Institute on Aging – Providing Comfort at the End of Life

What are Some Comfort Care Options?

Most health institutions have a comfort care program. Some of these are institutional and others work out of your home. They include:

Hospice – Hospice care focuses on providing comfort and end of life care for people with a terminal diagnosis and a doctor's recommendation that they have six or fewer months left to live. That is not to say that people must die within that six-month window and many patients on hospice are re-admitted at each six-month marker.

Hospice is provided primarily in the patients home though sometimes the team provides comfort care in a facility. Hospice also provides respite care so that family can recuperate and re-energize.

Palliative Care – Palliative care and hospice care are similar. Both provide relief from pain and suffering while addressing the social and economic difficulties that patients who are dying face. In the case of palliative care, the focus is more on helping people throughout a terminal illness. This means that you can still receive treatment for your illness rather than just for your symptoms. With hospice, the focus is not on providing treatment but on easing the symptoms as the disease progresses.

In-home Care – In-home care means care can occur within the home. In home care can be provided by a licensed or unlicensed nursing registry or company, hospice, or even a palliative care organization. The focus of in-home care changes based on the type of organization providing the care.

Palliative Care In-Home – Because home care companies, hospices, and other medical organizations all provide palliative care in one form or another it becomes important to evaluate each type of care provider to find the one the best suits your needs.

Nursing home – Sometimes home is a nursing home or skilled nursing facility. These providers also provide comfort care and often have contracts with hospice to provide end of life care. They may also work in conjunction with hospice to provide end of life care. Nursing homes provide skilled and allied health workers in a sub-acute hospital setting. Patients have access to professional and allied health, such as physical therapy and receive help with physical care, such as toileting and bathing.

Learn more about Choosing the Right Nursing Home from AARP.

How Much Does Comfort Care Cost?

The cost of comfort care varies by organization and by the type of organization. With hospice, there is no charge or very little cost. Hospice relies on donations and the standard payment from Medicare. Patients may incur some costs for items that are not covered by Medicare.

Palliative costs vary also, by organizational type and can be billed through insurance at which point the patient is often also liable for co-payments and deductibles. If palliative care is provided by a hospice then the charges are minimal.

Most in-home care companies provide a flat hourly rate which can be expensive and those rates vary from organization to organization and across geographic location.

How Does Someone Plan and Prepare for Comfort Care?

The time to make decisions about comfort care is long before that care is needed. Though not everyone has that opportunity to plan, planning is best.

Consider insurance for comfort care and EoLC. The reason for this is that not every type of insurance pays for in-home care. Start by:

  1. Making important decisions about how you want to die and where you want to die. Many people prefer to die at home. Thinking about this is difficult, but it allows you to put into place legal documents, such as a power of attorney to help protect your rights and to enforce your decisions.
  2. Discuss your plans and quality of life expectations with your family. It is important that everyone understand what your wishes are and what you expect. It can be difficult for families to accept your wishes as they face their own grief. You can ask your clergy to participate, sit down with a social worker, or even a counselor. Organizations such as hospice have both clergy and social workers available and hospice treats the entire family as the patient. This means that there is someone to talk to and ask questions of and someone who will stand up for your rights while making sure that your dignity is protected.
  3. Don't wait until the last moment to begin comfort care. Organizations that offer palliative care often treat people long before they are dying. With hospice, your doctor must guesstimate that you have six months or less left to live. Starting before it is a crisis allows you the opportunity to understand your options, and begin the process of meeting your care, spiritual, and emotional needs.
  4. Make sure your financial and estate affairs are in order. Part of this process is to ensure that you have all the financial resource you need and to make sure that everyone understands what your wishes are. This can end a lot of family drama before it begins. Also, have someone who is an executor of your affairs in place. Doing so helps take the burden off of you.

Learn more about Getting  your Affairs in Order from the National Institute on Aging

What Services are Offered in Comfort Care?

Comfort care encompasses all of the patients need. It includes physical care such as bathing and can include house cleaning and meal preparation when a family member is not available. It provides care and medications that help to manage pain. It provides access to professionals that can address spiritual and emotional support. In the case of hospice, grief support remains in place for six months after the patient dies. This helps the family recover from the loss. It also helps to enforce your dignity and rights as a patient.

How Does Comfort Care Differ from Other Senior Care Options?

In many situations, comfort care is part of another type of care, such as hospice or palliative care.

  • Comfort Care vs Hospice – both are similar and comfort care is part of hospice. With hospice, the goal is to provide comfort rather than life-sustaining treatments.
  • Comfort Care vs Palliative – This comparison is more difficult to show because palliative care can also be aggressive treatment. We often think of comfort care as the basic end of life care, but it is more. For example, a  younger person with a terminal illness may not want to stop fighting. They may want to try advanced treatment or even clinical trials. Those options are not part of hospice, but still, there is comfort care in the form of pain control, spiritual care, and emotional support.
  • In-Home Care vs. Comfort Care – Many in-home care companies can provide comfort care, though many may not be equipped to provide spiritual and emotional support. Comfort care goes beyond just physical care and needs to include spiritual and emotional care too.

When Should I Consider Comfort Care?

Comfort care should be part of our decision making long before we need it. Sometimes, that does not happen and comfort care can be initiated at any time with the consent of the patient and a provider. For the best outcome, plan now for comfort care and then adjust those plans as needed.

We all live and eventually we all pass on to a greater reward. How we die is something we should plan and discuss openly with everyone involved. Comfort care removes burdens such as spiritual angst, guilt, and helps us deal with the grieving process while we are still living. Our end of lifetime should be as freeing as possible and comfort care helps do just that.

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