Barbara Bush’s Final Decision Highlights Comfort and Palliative Care Options

At 92, Former First Lady Barbara Bush had been in failing health for several years, challenged by chronic obstructive pulmonary disease (COPD) and congestive heart failure. This past Sunday, a spokesman announced that Mrs. Bush had decided she had received enough medical interventions to extend her life. Instead, she wanted to focus her last days on spending time with family and receiving comfort care. Mrs. Bush died April 17, at her home in Houston, with her family around her.

What Is Comfort Care?

Comfort care is often misunderstood to mean an absence of medical care, but that’s not the case. Comfort care is used at the end of life, with the goal to alleviate suffering and decrease symptom burden. Medical professionals are involved in patient care, and the team might consist of the primary care physician, palliative care doctor, respiratory therapist, physical therapist, psychologists, nurses and social workers.

Comfort care doesn’t only focus on a person’s physical condition, but on their overall well-being. That could include massage therapy, pet or music therapy, as well as spiritual guidance.

Hospice care is a term often used interchangeably with comfort care. Hospice is comfort care, covered by Medicare, and is provided in the home — whether that is a private home, a nursing home or an assisted living home.

Comfort Care vs. Palliative Care

While comfort care is provided to patients who are at end of life, palliative care is a system of care that can benefit patients who are coping with a serious or life-threatening illness like cancer, heart disease, heart failure, advanced lung diseases, Alzheimer’s disease and dementia. Patients recovering from major surgery or complications from a hospitalization may also benefit from palliative care.

Like comfort care, palliative care is used in conjunction with ongoing medical care. As people continue to live longer — including those with chronic conditions — managing those conditions to help people have a higher quality of life is important. A palliative care team might consist of doctors, nurses, registered dietitians, pharmacists, psychologists, social workers and chaplains.

With palliative care, a patient can get support as soon as they are diagnosed and can continue to receive support throughout treatment.

Benefits of Care Options

In addition to providing support to the patient and their family, when patients select a care option, they begin an important, albeit difficult conversation. No one wants to think about their own death, but it may help to have some control surrounding the process. Questions to consider include:

• Have advanced directives been written?

• What about a living will?

• Is there a designee to make health decisions in case the patient isn’t able to?

• If someone is at end of life, would they prefer to continue medical treatments that would extend life, but not provide a cure, or is treatment that manages pain a preferred option?

There aren’t any right or wrong answers. The idea is to open up conversations so patients understand their options and can make choices that give them and their families the support they need during the most difficult time.