Home health, comfort care, and crisis care exist to promote quality of life. Though each serves different ends (treating causes vs. treating symptoms), they exist on a continuum, providing patients with vital support at each phase of life’s journey.
Due to advances in medical science, services once available only in hospitals can now be provided in the safety and comfort of home. They are overseen by licensed professionals – nurses and therapists who work with patients one-on-one to help them regain their strength, monitor their health, and manage chronic conditions. Consequently, home health care has developed into a practical alternative to hospitalization. It also has the benefit of being more convenient and generally more affordable.
Home health agency staff are overseen by the patient’s primary physician. Together, they develop a plan of care, which determines what type of treatment is required, the frequency of visits, and whether the patient needs any special food or equipment.
Home health provides access to an incredible range of services, including:
Because home health is not open-ended (every care plan has a cut-off date) home health care workers also educate for independence. This may include teaching the patient new exercises to continue their recovery or new skills, such as how to clean and bandage a wound. Workers might even help organize the patient’s medication or diet. By the time the plan ends, the hope is every patient will be self-sufficient or require only minimal help to continue living on their own.
Home health is usually prescribed to patients who have been discharged from the hospital or a skilled nursing facility. Besides offering greater comfort, recovering at home enables patients to remain close to their loved ones and build practical skills in the environment where they will be most useful.
Patients living with a long-term disability may also benefit from home health care. Memory issues and medical problems can impose a heavy burden on travel, especially if the patient cannot drive themselves. Medication changes might also make it wise to opt for in-home health care, at least until potential side effects have been resolved.
Unlike home health, comfort care is not intended to improve health, but ease suffering. Instead of targeting the underlying cause of an illness, it treats symptoms.
Comfort care and hospice care are interchangeable. They are similar to palliative medicine, except that while palliative medicine is given alongside aggressive treatment, comfort care is only given at the end of life.
The decision to start comfort care is never easy. Patients are eligible once they have received a six-month diagnosis, but few take full advantage of the service. Over half of them spend 30 days or less on the program. More than a quarter are on it for less than seven.
Comfort care unlocks enormous resources. Besides pain medication, it also provides access to medical equipment such as hospital beds, oxygen, wheelchairs, and overbed tables. Not to mention a dedicated team of physicians, nurses, and other caregivers who help look after the patient’s physical, emotional, and spiritual well-being.
In light of this, it is not surprising comfort care has such a huge impact on quality of life. Managing pain frees patients to reflect and make peace with their loved ones before they go. Families benefit too. They are spared the pain of watching their loved one suffer, get immediate help with medical issues, and receive assistance with funeral and financial matters. The hospice team also provides counseling before and after the patient dies, to help family members work through their grief.
Like home health, comfort care requires that patients talk regularly with their doctor about the goals of care. Because of their training, doctors are sometimes too optimistic. Committed to saving lives, they occasionally pursue aggressive treatment even when it is unlikely to change the outcome.
With this in mind, patients struggling with an advanced disease should ask about other options besides treatment. If they feel the hardships are becoming too great, there are questions they can ask to help broaden the discussion.
Other signs it may be time to consider comfort care:
Patients wrestling with these issues should ask what they want their life to be like six months from now. Do they want to be undergoing invasive tests and procedures? Do they want to be dealing with the side effects of treatment? Would they like to be in a hospital or someplace nearer their family?
As is the case with home health, comfort care is not given in a hospital. Though professional hospice centers exist, most patients receive comfort care in their home. Hospice in home care is not only convenient, but also less stressful. Patients are treated in a safe and familiar environment, close to their loved ones. Supplies are delivered to their doorstep and a nurse is on call 24-hours a day. When the team visits, they can give the patient and family their full attention. There are even home health aides to assist with bathing, dressing, housekeeping, and the other activities of daily living.
Above all, home is where most patients prefer to spend their final days. They want to be close to their loved ones, surrounded by their memories. It puts them at ease, making the final transition easier to bear.
Sadly, death is not always peaceful. It is not uncommon for patients to become anxious, delirious, or even hostile as they approach the end. In such an event, hospice nurses work in shifts, remaining by the patient’s bedside administering and changing medications every hour until the crisis is resolved. Regardless of day or night, crisis care teams work round the clock, doing everything in their power to calm the patient and keep them comfortable.
For seniors, the transition between home health, comfort care, and crisis care preserves quality of life. Each stage focuses on their unique and specific needs, allowing them to age with grace, dignity, and comfort.
Jose Escobar is the Hospice Executive for Parentis Health. He works with patients and families across Southern California, providing support and education, in order to alleviate the pain and suffering of chronic and terminal illness.