What is the difference between palliative care, comfort care and hospice care?

June 29, 2009 by  
Filed under Ask Viki


Dear Viki,

I’m kind of confused because I don’t understand the difference between hospice care, palliative care and comfort care. Is there a difference between these and if so, why do each of the doctors say different things? What are they trying to tell me?

Great question. I think sometimes even doctors and nurses get confused by these different words to describe pain management and end-of-life care. The words do mean different things but many times they are used to describe the same thing, the support your loved one will get during the dying process. In practice, doctors may be saying the same things even though they are using different terms. Let me try to explain.

Let’s start with palliative care. This is the most misused term because it describes both pain management when you’re healthy and the support you receive during the dying process. Palliative care is the global word to describe all of the care that is related to relieving suffering. Let me say it in a different way. To palliate means to relieve or lessen without curing, to mitigate or to alleviate. So sometimes the patient may go to a palliative care specialist, even though they’re not dying, to help them get their pain under control or to alleviate their physical symptoms. They’re not dying, they are just asking for good pain management. It frustrates palliative care specialists when people think that all they do is take care of the dying. This isn’t true. They take care of the suffering of all patients. And one group of these patients happens to be the dying.

Hospice care is for people in the dying process. A patient can get palliative care without dying but you can’t get hospice without being a dying patient. There are also different kinds of hospices, both volunteer hospices and medical hospices. I volunteer at a volunteer hospice and we provide respite care and support for the patient and family. We are like a good friend who stops by to help out. A medical hospice will provide volunteers as well as visits from nurses, doctors, social workers, chaplains and nursing aids as well as providing the patient at no cost, symptom management medications, medical equipment and oxygen etc.

Hospice care can also be found in different locations. It doesn’t always happen in the patient’s home. It can also be found in an outpatient hospice, an inpatient designated bed in the hospital, in a skilled nursing facility, a board and care or assisted living facility. Your location shouldn’t determine your eligibility for hospice, although there are a few facilities who are not accredited to have hospice patients in their facility.

Now let’s talk about comfort care. This is a word that is most often used inside of a hospital. At some point, the doctor may come in and talk to the patient or the loved one about putting the patient on comfort care. Here is what they’re trying to say. They are saying that, at this point they have nothing else they can do to cure your loved one’s disease. But what they can offer you is to keep them comfortable and to help them have a good death. It may not mean that your loved one is dying immediately but that the aggressive treatments that they have been trying are not working to get them better. And now they want to focus on relieving the suffering and keeping your loved one comfortable. They are not abandoning the patient but they are changing the focus from curing to caring.

Now maybe you’re saying to yourself, isn’t the relieving of suffering like palliative care? Isn’t comfort care, palliative care? This is where it gets confusing again. Remember that palliative care is for both when someone is fighting their disease and when a person is in the dying process. In reality, the patient should be getting palliative care throughout their medical treatment experience. But sometimes palliative care is brought in very late and only as part of the comfort care (dying) plan. So you will want to speak up and ask for good palliative support while your loved one is healing and later on when they are dying. Patients should not be suffering or be in pain. Doctors now know how to take care of these symptoms, but if your doctor doesn’t or won’t help, then ask for a referral to someone who does. But be careful because some doctors will think you mean palliative care as in dying support. Make sure you explain what you are asking for, recovery support or dying support.

So, back to your question: If the doctor in the hospital says comfort care, they mean dying care. If they say palliative care in the hospital, they probably mean dying but they might just mean suffering care. You will need to clarify this with them. If they say hospice, then that means you will probably be discharged from the hospital to go home to die.

If a doctor wants to make the patient comfort care in the hospital, the patient can probably go home on hospice or perhaps to a facility that can handle their medical situation with hospice support. If your loved one wants to die at home, you need to advocate for them and say, “They would like to go home on hospice.” You need to speak up about where and how your loved one would like to die. They are entitled to a good death and so are you.

Have a kind and respectful day.

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11 Comments on "What is the difference between palliative care, comfort care and hospice care?"

  1. Ron Hochhauser on Wed, 7th Nov 2012 8:00 pm 

    My 44 y/o Daughter lives with my Wife & I. Divorced, w/6 y/o Son which is the main reason she has fought her stage 4 cancer for 17 months that has now progressed to several vital organs. Two Trails have slowed the process but now is progressing at a higher rate. Jolie has 50/50 custody of her Son. Jolie’s ex has given her a terrible time since their divorce, including extreme legal issues & attempting to control Jolie & her Son. The ex’s actions have added horrendously to Jolie’s failing health. Jolie’s Doctor is Dr Ena Sagota, Holy Cross Hospital, Fort Lauderdale. The Doctor’s nurse mentioned your organization & said it should be a good fit for us. We will be discussing Hospice/Palitive Care next week with the Doctor. I’ll attempt to talk to Jolie prior to that to find her desires for her future.
    THX for listening, Ron & Arlene Hochhauser

  2. Diane Baldi on Fri, 9th Nov 2012 11:17 am 

    Good morning Viki,
    I would like to clarify with you your definition and description
    of hospice care either by phone or via email.
    Your definition of hospice is not accurate in terms of ” for people in
    the dying process..”. The Medicare Hospice Benefit provides care
    to patients with a prognosis of 6 months or less.
    Please refer to our website, or http://www.nhpco.org for a clearer understanding
    of this invaluable and often underused care available to patients of all ages.
    Thank you, and again, would love to discuss with you!
    Diane Baldi RN. CHPN
    Chief Executive Officer
    Hospice of the Sacred Heart
    600 Baltimore Drive
    Wilkes Barre PA
    (570) 706-2400

  3. Denice Christian on Fri, 4th Apr 2014 6:37 pm 

    I read this article and it had just the right information I needed, my family is at this place and had so many questions but I know better understand. Thank you for posting this article.

  4. Delia Brennan on Mon, 13th Oct 2014 9:53 pm 

    Thank you so much for this article. I was confused by the term “comfort care”. My best friends mom is dying, and tonight they have begun comfort care. Thanks again. Peace.

  5. Linda on Wed, 16th Sep 2015 9:39 pm 

    My husband has many problems with his health and we have to use the V.A. He has to be tapped every 2 to 3 weeks. So each time we go to the hospital he see’s a different doctor and each one say’s something different from palliative Care, comfort care, to Hospice care. I know that he is in liver failure but what questions could I ask to get a better answer from his doctors. Thank You.

  6. Viki Kind on Thu, 17th Sep 2015 9:52 am 

    Linda, So sorry your husband is ill. Thank you for asking me this question. I think that what each of the doctors is saying is that your husband is moving into the last stage of his life. When lots of doctors are saying palliative care, comfort care or hospice, what they are all saying is your husband is dying. I am really sorry to be the person to have to say this to you so directly. I am not saying he is dying today or even soon, but his disease is taking his life. What you could ask the doctor is the “Surprise Question,” “Would you be surprised if my husband died in the next _______ (few months, few weeks, few days, etc.)? It is difficult for doctors to tell you exactly when someone is dying but they can usually answer the “Surprise Question.” This is a famous question that was designed so we can talk about prognosis. When my best friend used this question for her mom’s condition, it really helped because the doctor was able to give her the information that my friend needed to make the right decisions. Another question you could ask is, “When a person is having to get tapped every 2-3 weeks, what does this mean?” Or, “How long do people live when they are needing to get tapped every 2-3 weeks?” As a person who believes in hospice, I would encourage you to talk to the hospice team about starting hospice. I used hospice for my dad, my aunt and many other friends and family. They were able to provide the additional care, support, knowledge and caring that the patient and the whole family needed.

  7. Paul on Tue, 6th Oct 2015 11:32 am 


    As with a lot of folks commenting on this website, my family is also confused with this subject. My dad is 61 years old and had a subarachnoid hemorrhage (caused by a cerebral aneurysm). It was very severe. After about a week and half the doctors said there is possibility for recovery etc and they transferred him to a acute rehab hospital. He has been there for about 2 weeks now. The neurologist came to see him a few days ago (viewed his charts/reports previously as well) and said she doesn’t anticipate any recovery and the damage is too severe. In this case what is out best option? The reason is he is pretty much breathing on his own now and overall body is ok, but brain is extremely damaged according to the doctor. We are confused as we think he wouldn’t want to be in a nursing home just fading away. I view that as also comfort care but a very slow process, however, choosing so at the hospital he’s at now would just be faster. Sorry, not sure if I said that correctly. What should we expect if we choose comfort care? Will he starve to death? Would he even know he is hungry? Sorry, just trying to understand. Please advise. Thanks for all your help.

  8. Viki Kind on Tue, 6th Oct 2015 1:30 pm 

    So sorry your dad and family is going through this. It sounds like the right steps have been done so far. And that you are doing the right thing by thinking about what your father would say to do. Comfort care establishes the plan we will use to reach the goal of keeping him comfortable for however long he has. It isn’t that we are trying to hurry his dying along and we are not trying to keep him here. For many people, they may wish their dying would come sooner but we don’t hasten people’s death. The phrase we would use is to AND – allow a natural death. Which mean we are not giving treatments that will prolong his life, but only treatments that will comfort any symptoms he might be having. We are allowing nature to take its course.
    In general when people are dying, they naturally get less and less hungry and thirsty until they say, “No,” to everything. Depending on the amount of brain damage your dad has experienced, your dad probably don’t sense these needs at all. Based on how severe your dad’s brain injury is, over time, (I don’t know how long but you could ask the doctor for an estimate), his body will begin to die. There may be medications that are life-prolonging that your dad would want to have stopped. You can talk to the doctor. The doctor should be putting him on hospice now. Hospice can help wherever he ends up staying. Hospice will make sure he is well cared for for however long he has left. The way to look at all of this is that whatever choices are being made, they have to fit your dad’s life goals. The question to keep asking is, “What will ______ treatment/choice get dad and would he want it?” The medicine has to help the patient get to the patient’s desired goal. If it won’t work to achieve the person’s goal, then don’t do it.
    At this time, the goal is to feed him emotionally by saying words of love, telling him that he will be remembered and that he made a difference in the world. This can also be a time to hold his hand, hold him in your arms, stroke his hair, play music he loves, say prayers if that would be important to him, etc. The end of our lives are not about medicine, but about love and comfort and respect and dignity.

  9. shirley bernard on Tue, 13th Oct 2015 3:20 pm 

    My sister was diagnosed with dementia in 2010 and I did not find out ab out it until 2012 after her husband died. I took care of her after he died and found out she kept getting demoted on her job as a manager. I tried to take care of her but she could not stay alone at night and resented some of the care takers coming in. I am 78 and could not take care of her full time and put her in assistant living memory care at Brookdale in Northern Ky and I do not think they took good care of her letting her get UTIs and being abused by another patient. In one day she fell at facility and never regained any normalcy and could not walk. She had some hydrocyphulus but since she has begun tearing her hair out and agitated and medicines are not working they want to put her on comfort care at the nursing home. They do not think she could go underanthesetic to getMRI. They want to give her on haloperidol

  10. shirley bernard on Tue, 13th Oct 2015 3:38 pm 

    continuing- they want to put her on comfort care but still give her something for pain and something to sleep at night. Since she has had this for 5 yrs. do you think it is too soon for this? Also, if we decide to do this we have to agree to a do not recessitate. Is this the right decision as she seems so uncomfortable with her agitation

  11. Viki Kind on Tue, 13th Oct 2015 7:48 pm 

    So sorry that you and your sister are going through this. To answer the easy parts first. 1. Comfort care includes pain management and possibly medicine to help her sleep comfortably. 2. One doesn’t “have to” be a DNR, do not resuscitate, to be on hospice. Although, it is usually a good idea that when one starts comfort care – hospice, one should be a DNR. But there are a few people that choose to still be a full code. 3. Many of your other questions have to do with medications and I am not a physician so I can not address these. You might want to talk to the hospice doctor to get a second opinion about how to best manage your sister’s symptoms. I think talking to the doctor/s about her agitation etc. should be a high priority for you to address. People shouldn’t be suffering. 4. Dementia by itself is not usually a reason to be on hospice. There has to be physical symptoms as well. I can’t address whether it is “too soon” because I don’t know what her other health issues are and why the decision is being made “now” that it is time for hospice. One thing that might help you is to understand that hospice doesn’t have to start only a few days or weeks before someone dies, people can receive the benefits of hospice for months and even years before their deaths. The hospice team will determine if your sister qualifies for hospice which means that she is sick enough to die in the next 6 months. But that doesn’t mean she will absolutely die in the next six months. I know some hospice patients who have been on hospice for years. IF a patient continues to be “sick enough to qualify, the hospice team will submit information to the insurance company so she continue on hospice. So, even if it seems to be “too soon,” it might not be when we think about the long-term benefits of hospice. 5. Your main focus is to make sure she is “comfortable and comforted now.” Do what you can to make sure the medical team is doing right by her and then you an focus on making sure she feels loved and cared for by you.

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