What Does Comfort Care Mean? Facility FAQ and Best Practices

In spite of the growing demand for in-home hospice services, nearly 60% of all deaths still occur in hospitals. Comfort care measures are used in in-patient settings to direct care for patients in the time immediately surrounding death. These guidelines ensure that each patient experiences the most dignified end-of-life journey possible.

So, what does comfort care mean for patients and staff and how should it be put into practice? We’ll discuss what this type of care is and how it relates to palliative and hospice care services. Then, we’ll cover five best practices your facility can use to guide and support staff in providing the highest quality care possible during this challenging time.

Frequently Asked Questions About Comfort Care

Before we discuss best practices, it’s important to get a baseline understanding of what comfort care is, why it’s used, and when it’s incorporated into a patient’s plan of care. Below we’ll provide answers to some common questions on comfort care measures.

What is comfort care in the hospital?

In hospital-based settings, comfort, or end-of-life (EOL) care describes the interventions that reduce suffering, alleviate pain, and provide relief for the patient who is actively dying. It does not have to be provided by a hospice provider and often is not. For example, in the hospital setting the primary team might order EOL care measures for a dying patient, with or without additional hospice or palliative care consultation.

What is comfort care vs. hospice vs. palliative care?

So, what does comfort care mean in context to hospice and palliative care? Well, there’s no real difference between comfort care and hospice care as these terms are often used interchangeably. To be eligible for comfort care/hospice services, a patient usually has a prognosis of six months or less to live and must no longer be seeking treatments to cure or slow the disease process.

Although palliative and hospice care models share overlapping goals, there are differences in when and how they’re used. Palliative care also addresses a patient’s need for symptom management, but unlike comfort/hospice care, it can be used at any point during the course of a serious illness, including during active, curative treatment.

Can comfort care be done at home?

Patients who know they are approaching end-of-life will sometimes plan ahead so that they can receive comfort care at home. In these situations, patients and families consult staff to figure out what types of measures make the patient most comfortable. While a physician will still oversee the patient’s care plan, at-home comfort care is commonly provided by friends, family, and non-medical staff.

How long does comfort care last?

Generally, comfort care is offered to patients who are expected to live six months or less since this is also the length of time that Medicare will cover hospice benefits. However, the exact amount of time that comfort care lasts will depend on the prognosis of each individual patient. This may sometimes end up extending beyond six months, or last a few weeks.

Can someone recover from comfort care?

Patients typically only receive comfort care when they are not responding to curative treatments. Patients may see some improvements while on comfort care because it is focused on enhancing their overall quality of life. However, this does not mean that they are fully recovered from their illness.

On some occasions, a patient’s prognosis could unexpectedly change and they may live longer than expected. In these instances, patients and their doctors will discuss their care options and make plans for how to respond to a relapse in their condition.

Best Practices for Providing Comfort Care

Now that you know how to answer the question, What does comfort care mean? it’s important to learn how to properly put these measures into practice. The goal of EOL care is to meet the patient’s physical, mental, emotional, and spiritual needs. The processes and procedures at your facility should support staff in meeting these objectives. Here are five best practices that give your team the tools they need to provide exceptional comfort care.

1. Create an Order Set for Symptom-Based Care

Order sets help standardize care between providers and are effective for ensuring that every aspect of care and physical comfort has been specifically addressed. Many facilities base their order sets on symptom management categories, including:

• Pain
• Dyspnea
• Anxiety
• Delirium and agitation
• Nausea and vomiting
• Secretions
• Constipation
• Fever

Adequate pain control is one of the most important symptoms to manage. About 40% of patients experience moderate-to-severe pain during the last three days of life.

Other important categories of information outside of symptom management include code status (confirmed DNR/DNI), withdrawal from mechanical ventilation, and removal of invasive monitoring devices. Hydration, artificial nutrition, and oxygen administration can be controversial and opinions on their use can vary widely.

2. Develop a Nursing Order Set for Comfort Care

If your nursing staff ask you, What does comfort care mean in context to our care protocols? you should also have a nursing order set that you can easily refer them to. A nursing order set is an essential companion to the symptom management order set. These orders must also be detailed and address all aspects of nursing-related patient care, including:

• Frequency for assessing and reassessing symptom management categories.
• Vital signs frequency (or discontinuation).
• Oral care.
• Turning/repositioning.
• Room identification (signage).
• Silencing of alarms.
• Removal of monitoring devices (e.g., monitors, blood pressure cuff, sequential compression devices, etc.).
• Visitation and preparation of the room for loved ones.
• Assessment of family psychosocial needs like bereavement and funeral arrangements, social work, and spiritual support.

Many facilities support nursing orders by including them in a comprehensive EOL policy and protocol. It’s important to make sure that both order sets and related policies are all in alignment and that updates are made as needed.

3. Develop an Education Plan

Your team must have a solid understanding of EOL care practices, including training on any order sets, policies, or procedures that specifically guide care. Education efforts should be ongoing and are often incorporated into annual competencies.

For general EOL education, the End-of-Life Nursing Education Consortium (ELNEC) offers courses and resources for nurses who practice in critical care, geriatric, and pediatric care settings. Other programs offer training courses to improve communication between clinicians and patients during EOL care. A host of other educational materials are available through the Hospice and Palliative Care Nurses Association.

Finally, remember to engage the patient and their support systems in your education plan. You should ask yourself, What does comfort care mean to your patients? Be sure to assess their educational needs around EOL care to help set expectations and initiate those difficult — but essential — conversations about how the patient defines a “good death.”

4. Enlist a Multi-Disciplinary Team

The entire interdisciplinary team should be involved in the decision to transition care. Many of these patients are already receiving care from palliative and hospice care teams. Respiratory therapists, speech therapists, physical therapists, nurses, social workers, and other consulting specialists will likely be involved in the decision-making process. The patient and their loved ones are the focus of all discussions and should be involved (as much as possible and appropriate) every step of the way.

In addition, once EOL care is initiated, it’s important to clearly communicate this to everyone working in the facility, including dietary services, environmental services, and phlebotomy. The patient and their family should be given as much privacy and respect as possible. In addition to placing an order in the electronic health record (EHR), many facilities use signage on the door of the room to alert staff and prevent unwanted visitors. Disruptions should be avoided to maintain a peaceful, quiet environment for the dying patient.

5. Support and Care for Your Team

You should also be reflecting on the question, What does comfort care mean for your staff? Caring for the dying is emotionally difficult for healthcare providers. Moral distress and compassion fatigue set in when a nurse’s core values are strained. It’s common for staff to struggle with being patient advocates during this stressful time. Consider rotating staff assignments for patients who are receiving comfort care nursing so your team has time to recharge and focus on their own well-being.

Establish support systems to help staff process the intensity of working with dying patients and grieving loved ones. Conduct structured debriefs after a patient’s death to encourage staff to share their experiences and evaluate what worked well and what didn’t.

Many facilities make social workers and chaplaincy services available to staff to help with emotional and spiritual needs. Mindfulness and wellness programs have become increasingly popular, and many employee assistance programs (EAPs) offer free counseling sessions for staff during times of crisis. Caring for your team shows you value them as individuals and acknowledge that they’re affected, spiritually and mentally, by witnessing death and grief.

Looking for More Patient Care Resources?

Now that you know how to answer the question, What does comfort care mean and how is it used? you may be looking for extra resources to help your facility deliver patient-centered care. Don’t miss out on IntelyCare’s latest free nursing management insights to support your healthcare team.

IntelyCare writer Kerry Larkey, MSN, RN, contributed to the writing and research for this article.