Comfort and hospice care are often used interchangeably because they both address the physical, emotional, and spiritual needs of a person with a serious illness. However, comfort care and hospice are two completely different medical treatments with varying philosophies for end of life care. 

Comfort care may be given alongside the treatment intended to cure serious illness, whereas hospice care is given to people with less than six months to live, focusing on care and comfort rather than cure. 

In this comfort care vs. hospice comparison guide, we break down the similarities and differences to help family caregivers decide which suits you or your loved one best. 

Comfort Care vs Hospice: Similarities and Differences In a Nutshell 

Comfort CareHospice Care
EligibilityAnyone with a serious, life-debilitating illnessPeople who have less than six months to live
Pain ManagementAs much as possible but with long-term side effects in mindAs much as possible, without long-term side effects in mind
TreatmentOriginal treatment may continue if the patient desires itOriginal treatment stops and instead focuses on quality of life
InsuranceCovered by Medicaid, Medicare, and some private insurance. Coverage depends on the benefits and plansCovered by Medicaid, Medicare, and some private insurance. Mostly 100% covered
Treatment LocationHome, assisted living facilities, hospital, palliative care clinic, nursing homeHome, assisted living facility, nursing homes, hospital, hospice facility, nursing home
Period of CareFor as long as the patient desires itSix months or less

Comfort Care – Is it the same as Palliative Care? 

Comfort care, also known as palliative care, is specialized medical care for those living with a serious or life-limiting illness, like heart disease, cancer, and AIDS. It can be given at diagnosis, during curative treatment, and end of life care. 

Perhaps the biggest difference between comfort care and hospice is that comfort care doesn’t replace an existing treatment program (i.e., surgery, OT/PT, chemo/radiation, etc.). It’s instead given as an extra layer of care to enhance the patient’s quality of life further.

Comfort care may include the administration of pain relievers, anti-anxiety medications, antidepressants, sleeping pills, and other medications that may help ease discomfort or pain.  

In a nutshell, comfort care focuses on what the patient can do, rather than what they can no longer do. It follows through all stages of the illness, meaning that there’s no certain length of time a person can be cared for during it. 

Comfort care helps seriously ill people live for as long as possible, as comfortably as possible.  

Hospice Care Defined

Similar to comfort care, hospice care provides physical, emotional, and spiritual support to both the patient and the patient’s family. But unlike comfort care, which can be provided at any stage of a serious illness, hospice care is given to people with less than six months to live. 

Hospice doesn’t postpone death but rather accepts it as a final stage of life. Instead of treating the disease, it involves managing symptoms and side effects so the patient can live as pain-free and comfortably as possible in their last stages of life.

Hospice care is given when a disease reaches a point where treatment can no longer control or cure it.

This type of care often includes therapeutic support to help the patient cope with grief, illness, dying, and death. It may also address the spiritual aspects of the illness to overcome the fear of death. Family members may attend the sessions with them if the patient desires it.

Comfort Care vs. Hospice Care: How Are They Different?

Comfort care and hospice care are two different applications of care. Although they both provide emotional, physical, and spiritual care, the prognosis and goals differ. Here are the differences between the two: 

Eligibility 

As opposed to hospice care, comfort care doesn’t have time limitations. 

People can sign up for comfort care at any point after the diagnosis, whether it’s terminal or not. It’s not only for dying people; it’s also for those with lung disease, heart disease, neurological disorder, dementia, and any other chronic illness that has a negative impact on quality of life. 

Conversely, hospice care is given to people with at least six months to live if the disease runs its usual course.

Comfort care improves the patient’s quality of life for as long as possible, while hospice care improves the patient’s quality of life for as long as necessary. 

Treatment 

In palliative comfort care, people can opt for extensive, life-prolonging treatment to increase their chances of living a long life. 

Hospice, on the other hand, focuses on end-of-life comfort rather than disease treatment. It helps dying patients cope with their symptoms through pain management without the adverse side effects associated with chemotherapy, immunotherapy, and other extensive treatment. 

Physicians working with hospice patients are less concerned about the long-term side effects of pain relievers. Their primary objective is managing severe levels of pain until the patient’s last breath. 

Timeline

Comfort care teams don’t follow a treatment timeline. People can use curative treatments alongside comfort measures to manage their symptoms and treat their illnesses to live their best lives. 

Conversely, the hospice care team follows a timeline of six or so months, with no focus on curative treatment.

Myths about hospice vs. reality

Payment Options and Insurance 

Health insurance companies have strict regulations when applying for comfort care and hospice care treatments. 

Comfort Care 

Most comfort care services are covered by Medicaid, Medicare, and private insurance. Services covered by insurance vary from company to company, as well as where the care may be received. Coverage may also be dependent on the patient’s medical situation. 

The Medicare hospice benefit, for example, covers at-home palliative care, which covers the cost of hospital beds, medical equipment, and wheelchairs for palliative support and treatment.

It also covers prescription anti-nausea medication and pain relievers related to the diagnosis of the palliative care treatment plan.  

Hospice Care

Hospice coverage is far stricter than palliative care. To qualify, a medical professional, usually a physician, must certify that the patient is terminally ill with a life expectancy of six months or less. 

Medicare and Medicaid both cover costs for hospice care, but Medicare doesn’t cover the room and boarding costs of a nursing home or hospice inpatient facility. The patient may also need to pay a copayment for outpatient pain and symptom management prescriptions. 

Other than that, everything else is covered: doctors’ services, medical supplies, inpatient respite carespiritual and grief counseling, and any other services to manage pain and symptoms related to the terminal illness. It’s the only Medicare/Medicaid benefit that includes pharmaceuticals, 24/7 access to care, chaplain visits, and grief support following a death. 

Veterans may be eligible for both types of care through the Department of Veterans Affairs.   

Hospice insurance doesn’t cover treatment and prescription drugs intended to cure terminal illnesses. The care provided must be arranged by a hospice team. 

Regardless of the type of care you choose, it’s important that you get in touch with your doctor to ensure your loved one receives the best possible care with their chosen insurance.  

Who Qualifies For Hospice? 

People who qualify for hospice care have a limited ability to care for themselves, have received curative treatment but are no longer benefiting from it, or don’t qualify for appropriate clinical trials. 

On the other hand, people qualify for comfort care no matter the disease stage and whether curative treatment is ongoing.

Heart patients, for example, can receive palliative care at the time of diagnosis, even if they have years to live. 

Comfort care is applicable as long as pain management and ongoing care is required.

Can You Change Your Mind About Hospice?

Yes, you can change your mind about hospice. If the patient changes their mind or improves during hospice, they can opt out of hospice services and come back at a later date if they so desire. Hospice respects the patients’ choices: they choose what to do, and the hospice team makes it happen. 

Some of the reasons a patient may choose to opt out of hospice care include: 

  • The patient gets better, and their doctor(s) believe that more aggressive treatment can cure the illness or at least lengthen their lifespan 
  • The patient wants to try a new treatment 
  • The patient’s family situation changes
  • The patient wants to go back to the hospital for certain types of treatment
  • The patient wants to stop hospice out of their own desire

What Happens During Hospice Care? 

According to a report published by the National Hospice and Palliative Care Organization, most people enroll in hospice close to their time of death. 

In the report, approximately half of the people in comfort care died within three weeks, while roughly 35% died within a week.  Around 9% of these patients were referred to hospice three days or less before their death. 

A common misconception about hospice care is that you don’t need it until you are actively dying. In the opinion of many health care experts, especially those who work with older adults, is the sooner a person chooses to utilize hospice services, the better.

“When people wait until the very end of life to embrace the hospice journey, they may lose control of decision making and the support and guidance to participate in the decisions involved in the end of life process. Waiting too long can also impact the ability of both the person with a terminal illness and their loved ones from actively participating in the process of comfort, peace, and acceptance.”CYNTHIA COELHO, RN – NURSECYNTHIA.COM

These figures shouldn’t be the reality. People diagnosed with a terminal disease should discuss hospice care as soon as a terminal diagnosis is confirmed. Consider that both the individual who is ill and their whole family could benefit from the support offered by palliative care and hospice.

Hospice exists to manage a person’s symptoms so that they may spend their remaining time with dignity and quality. This means that it’s about providing care and curtailing invasive treatments that may create discomfort. 

Supportive Care and Symptom Control 

During hospice, specialists ensure that a patient’s last stages of life are as comfortable as possible. 

To do this, the hospice interdisciplinary team may cease medications or treatments with painful side effects, blood draws, and needle sticks, as well as diagnostic studies, medical therapies, lab work, and scheduled surgeries.

Specialists may also increase the dosage of painkillers and medications that can relieve discomfort, pain, and nausea. The medical team ensures that the patient lives pain-free yet alert enough to make important decisions and enjoy their time with loved ones. 

Home and Inpatient Care

Most hospice patients spend their remaining time at home, but certain situations may require admission to a hospital, an inpatient hospice center, or an extended-care facility. 

The hospice team informs and advocates for what’s best for the patient, depending on their family situation and the illness. 

Physical Therapy 

Physical therapy maximizes the patient’s functional ability and comfort to enhance their quality of life through exercise, patient education (i.e., breathing exercises, relaxation, etc.), and hands-on care. 

With a designated physical therapist, patients learn how to move freely, restore function, reduce pain, and prevent further disability. PTs guide patients on how to best utilize their remaining abilities despite the gradual decline of their mental and/or physical health. 

Services include:

  • Pain management and relief 
  • Therapeutic exercises 
  • Positioning to lessen pain, prevent pressure sores, and help with digestion and breathing
  • Home modifications, if necessary 
  • Energy-conservation training 
  • Endurance training 
  • Gait training

Emotional and Spiritual Care 

During hospice, emotional and spiritual advisors are present throughout the program. Patients may attend therapy to come to terms with their diagnoses, ease anxiety, and discuss unaddressed feelings. 

Romantic partners, family members, and friends may also attend the therapy to provide emotional support. 

Spiritual support is set up to meet the patient’s religious needs, which may make it easier to say goodbye or find comfort in death in the afterlife if the patient believes it.

Social workers also play a supportive role by making sure important documents like an advanced directive and funeral and burial preparations are in place.

Bereavement Care 

Bereavement is a term used to describe the period of mourning after a loss. Upon the death of a loved one, the hospice team works with surviving family members/friends to help them through the grieving process. Bereavement care is provided a year after the patient’s death. 

In Summary

Comfort care and hospice shouldn’t be used interchangeably as they’re two completely different types of specialized care. 

Comfort care is given to patients with more than six months to live and willing to continue long-term treatment to cure them of the disease. 

On the other hand, hospice care is provided to patients approaching the end of their lives, typically with less than six months to live. 

Both types of specialized care focus on the patient’s comfort and quality of life. 

Frequently Asked Questions

What are the key differences between comfort care and hospice care?

Comfort care includes medical treatments aimed at relieving symptoms of a serious illness at any stage, possibly alongside curative therapies. Hospice care, a specific type of comfort care, is for patients with a life expectancy of six months or less, focusing exclusively on comfort and quality of life, with curative treatments typically discontinued.

Can a patient receive both comfort care and hospice care simultaneously?

Patients generally do not receive comfort care and hospice care simultaneously. Comfort care can transition into hospice care as the patient’s condition progresses and the focus shifts from curative to purely palliative measures.

How does the decision for comfort care or hospice care affect medical treatment options?

Choosing comfort care may include ongoing curative treatments along with symptom management. In contrast, opting for hospice care usually means stopping curative treatments and focusing solely on symptom relief and comfort.

What are the insurance and cost implications for choosing comfort care or hospice care?

Most insurance plans, including Medicare and Medicaid, cover aspects of comfort care and hospice care. However, coverage details and potential out-of-pocket costs can vary, especially regarding room and board in senior housing, hospice facilities, and certain comfort care treatments.

An expert in senior care, Amie has professional and personal experience in senior housing, caregiving, end-of-life care, and more from her 24 years of working with older adults.