When a patient can no longer benefit from curative treatment, comfort care allows them a better quality of life. Comfort care does not seek to cure or aggressively treat illness or disease. It focuses on relieving symptoms and optimizing comfort as patients near the end of life.
Comfort care can be given at home and nursing facilities. Most patients and family members prefer home to hospitals. Hospice care is one source of comfort care delivery. Comfort care is sometimes called palliative care, but the terms “palliative care” and “hospice care” cannot be used interchangeably. Hospice can be provided in the last six months of life. Palliative care can be offered anytime in the course of an illness.
Loved ones with a wide range of health conditions can benefit from comfort care. This includes cancer, heart disease, chronic obstructive pulmonary disease, and dementia or Alzheimer’s disease. Sometimes loved ones oppose stopping aggressive treatment for a condition and moving to comfort care. They may feel that there is still hope and not realize how much discomfort the treatment is causing their loved one. It to know and ensure the patient’s needs and wishes are honored. Many people approaching death make their own choice to stop treatments that cause significant side effects, preferring treatments that improve comfort. Your loved one also may prefer to die free from the life-support, such as ventilators and dialysis.
Choosing Where to Die In Comfort
Your loved one might have preferences for end-of-life care and where to receive it. Try to clarify which type of care your loved one wants. Options might include:
- Home care — Most people prefer to die at home or in the home of a family member. You can assume the role of caregiver or hire home care services for support.
- Hospice care — services that help ensure the highest quality of life for whatever time remains , can be provided at home as well.
- Inpatient care. Some people might prefer round-the-clock care at a nursing home, hospital or dedicated inpatient hospice facility.
Comfort Measures for Specific Types of Discomfort:
If your loved one:
- Feels tired and has little or no energy, keep activities simple. A bedside commode can be used instead of walking to the bathroom. A shower stool or switching to sponging off in bed can save a person’s energy.
- Is no longer eating or drinking but wants to eat, you can help with feeding. Try offering favorite foods in small amounts. Or, serve frequent, smaller meals rather than three big ones.
- Has shortness of breath or labored breathing, turn the head to the side and place pillows beneath it. Open a window or turn on a fan. Oxygen or a cool-mist humidifier also might help. Ask the medical team if medication is indicated. Sometimes, morphine or other pain medications can help relieve the sense of breathlessness.
- Is agitated or confused, try to be calm and reassuring. Remind the person where they are and who also in the room.
- Seems to be in pain, ask the medical team to adjust medication. Focus on relieving pain without worrying about possible long-term problems of drug dependence or abuse. Pain is easier to prevent than to relieve, and severe pain is hard to manage. Don’t wait too long to give medication. Try to make sure that the level of pain doesn’t get ahead of pain-relieving medicines.
- Has skin irritation, gently applying alcohol-free lotion can relieve dry skin. Dryness on parts of the face, such as the lips and eyes can be eased by a lip balm, a damp cloth placed over closed eyes, ice chips, or a specially treated swab. A heavy cream can be used on heels and elbows.
- Has bed sores or pressure ulcers, turning the person from side to back and to the other side every few hours may help prevent more sores or heal existing ones. Try putting a foam pad under an area like a heel or elbow to raise it off the bed and reduce pressure. Ask if a special mattress or chair cushion might help. Keep the skin clean and moisturized.
- Has cold hands and feet, make sure there isn’t a draft in the room. Turn up the heat and provide warm blankets .People who are dying may not be able to tell you that they are too hot or too cold, so watch for clues. Someone who is too warm might repeatedly try to remove a blanket. A person who is hunching their shoulders, pulling the covers up, or even shivering is giving signs of being cold. Avoid electric blankets because they can get too hot.
Mental and Emotional Needs
End-of-life comfort care also includes helping the dying person with mental and emotional distress. Depression and anxiety are common. Conversations about their feelings or medication may help. Holding hands, a touch, or a gentle massage can be soothing and make a person feel connected to those he or she loves. Just being present and listening can make a difference. Music at a low volume and soft lighting can improve mood, help with relaxation, and lessen pain. Listening to music might also bring back memories that the person can share with those who are there.
Many people nearing the end of life have spiritual needs as important as their physical concerns. Spiritual needs might include:
- Finding meaning in one’s life
- Ending disagreements with others and resolving unsettled issues with friends or family
- Struggles with their faith or spiritual beliefs
Praying together, talking with someone from one’s religious community (such as a minister, priest, rabbi, or imam), reading religious texts, or listening to religious music may bring comfort. Family and friends can talk about the importance of their relationship and share memories of good times. Those who can’t be present could send a recording of what they would like to say or a letter to be read out loud. Your loved one might also find it comforting to have help with leaving a legacy — such as creating a recording about his or her life or writing letters to loved ones, especially concerning important future events.
Comfort care isn’t just about tending to a patient’s physical needs but to a patient’s mental, emotional and spiritual needs as well. Successful comfort care providers find ways to offer emotional as well as physical support. They also know when to ask for help.
Every situation is different. Dakota Home Care assigns an experienced registered nurse to visit your home, to evaluate and assess the patient’s and family’s needs. We work with the patient, family and home care staff to draft and implement an individualized plan of comfort care, including hospice care, for your loved one. Call us today at 701.663.5373 to schedule an appointment.