Comfort Care for End-Of-Life Patients

Comfort care, otherwise known as palliative care, is a form of medical care that focuses on relieving symptoms and improving the quality of life of someone with a serious illness. Palliative care is derived from the word "palliate" which means "to allay or moderate."

Comfort care can be administered as part of hospice care in which a person has less than six months to live, but can be used for people anyone who is suffering from a severe chronic illness, such as heart failure or COPD.

This article explains what comfort care means, what it involves, when is used, and the possible barriers to accessing care for yourself or a loved one.

What Is Comfort Care?

Comfort care does not involve the treatment of an illness or disease. Instead, it focuses on easing the symptoms of a disease to reduce suffering and improve the quality of life. Comfort care may also include providing emotional or spiritual support.

Comfort care involves a multidisciplinary team of providers who work together to ease symptoms of a serious, complex, or terminal illness. The care may be provided at one's home or in a hospital, specialized nursing facility, or long-term care facility (like a nursing home).

Comfort Care vs. Hospice Care

Comfort care may be a component of hospice care, but it is not the same thing as hospice care.

With hospice care, a physician needs to determine that you have less than six months to live, and you must declare that you no longer want curative treatments. If these conditions are met, hospice care benefits can be approved by Medicare, Medicaid, and most comprehensive health plans.

In contrast, comfort care can be delivered even if the condition isn't necessarily life-limiting. While it was initially intended for people with terminal cancer, comfort care is now afforded to many different diseases, including non-terminal ones.

With comfort care, insurance coverage can continue as long as the treatment is deemed medically necessary. With hospice care, the coverage period is six months (although it can be extended if you are recertified by a physician).

Symptoms or Conditions Treated With Comfort Care

Comfort care can be used for a wide range of medical conditions and can begin at any stage of an illness from the initial diagnosis to the end-stage disease. You may need comfort care if your illness causes severe and hard-to-treat symptoms like:

• Pain
• Nausea or vomiting
• Chronic diarrhea
• Severe constipation
• Difficulty breathing
• Difficulty swallowing
• Anxiety or depression
• Severe fatigue
• Chronic insomnia
• Severe skin conditions

Comfort care generally lasts for as long as you have a serious illness, until you enter hospice care, or until you no longer need comfort care.

Comfort care is not limited to a specific medical condition (although coverage and benefits can vary). Conditions for which comfort care may be needed include:

• Alzheimer's disease
  
• Amyotrophic lateral sclerosis (ALS) 
• Cancer
• Chronic obstructive pulmonary disease (COPD) 
• Cystic fibrosis (CF)
• End-stage kidney disease
• Heart failure
• Inflammatory bowel disease (IBD)
• Liver failure
• Multiple sclerosis (MS)
• Parkinson's disease
• Stroke

Examples of Comfort Care

The providers involved in delivering comfort care work in coordination to treat both physical and emotional symptoms. The care plan is individualized and may be delivered alongside curative treatments like chemotherapy and radiation.

Based on your needs, the comfort care team may consist of:

• Primary care physicians
• Medical specialists
• Nurses
• Occupational therapists
• Physical therapists
• Psychologists or counselors
• Social workers
• Dietitians
• Spiritual or religious advisors

Some practices and facilities specialize in coordinating or providing comfort care, including:

• Palliative care practices
• Licensed home health agencies
• Licensed hospice agencies
• Nursing facilities
• Healthcare clinics
• Hospitals

Barriers to Accessing Comfort Care

Arguably, the biggest barrier to comfort care is cost. While Medicare, Medicaid, and most private insurers offer coverage for palliative care services, co-pay costs can be prohibitive and certain treatments and medications may be excluded.

Moreover, if care is needed in an inpatient facility, the cost of room and board is often not covered unless you have supplemental insurance or a high-premium policy.

Even if you can afford the cost of comfort care, there is a serious shortage of palliative care specialists in the United States. According to a study in the American Journal of Medicine, there are only around 6,600 physicians practicing in the field, roughly a quarter of what is needed.

To this end, it's important to do your research. Start by doing a search of local providers using the online locator offered by the Center to Advance Palliative Care. You can also speak with your health insurers to find in-network providers near you.

Summary

Comfort care, also known as palliative care, is a specialized medical care aimed at easing suffering and improving the quality of life of people with severe medical conditions. It is delivered by a team of providers who work in coordination to relieve pain and symptoms and to provide emotional support.

While comfort care is commonly used in hospice care, you do not need to be dying to receive comfort care treatment. Medicare, Medicaid, and most private insurance plans offer coverage for comfort care services, although there may be co-pay costs and excluded treatments.