What drugs are used in comfort care?

Comfort care, or palliative care, uses medications like opioids (morphine, fentanyl) for pain/shortness of breath, benzodiazepines (lorazepam) for anxiety/agitation, antipsychotics (haloperidol) for confusion/nausea, and anticholinergics (atropine) for excessive secretions (death rattle), often kept in a "comfort kit" for quick relief of distressing end-of-life symptoms. Other drugs address constipation, nausea, and fever, tailored to the patient's specific needs.

What are the three end of life drugs?

Other studies, too, found that morphine, midazolam and haloperidol were the most prescribed drugs in the palliative setting [30–33]. These drugs are given to relieve symptoms such as pain, restlessness and agitation, which are frequently seen in advanced cancer [2].

How long does someone last on comfort care?

Comfort care duration varies widely, from days to months or longer, depending on the underlying illness and whether it's standard "comfort care" (often days/weeks) or the Medicare hospice benefit (typically for < 6 months prognosis, but renewable). Many hospice patients die within weeks, but some live much longer; the average stay is around 90 days, though many enroll very late in their illness. 

What is the end of life drug called?

End-of-life medications aren't one specific drug; they are a group of medicines, often called "Anticipatory Medications," "Just in Case" medications, or "Palliative Care Drugs," used for symptom relief (pain, anxiety, breathlessness) or to facilitate a peaceful death, with specific types like Palliative Sedation for severe suffering or prescriptions under Medical Aid in Dying laws for self-administration. Key examples include morphine, lorazepam (Ativan), and midazolam. 

What is the hospice cocktail?

ALSO KNOWN AS: Brompton's mixture, hospice mix. DEFINITION: Brompton cocktail is a palliative elixir containing morphine, cocaine, ethanol, and other ingredients to lessen or prevent the pain and distress associated with terminal illness, especially advanced cancer.

Medication in Hospice; Comfort Medication

What hospice does not tell you?

Hospice doesn't always fully prepare families for the intense emotional toll (anticipatory grief, spiritual struggles), the variability in visit frequency and caregiver burden, the complexities of medication decisions (even comfort meds), or that while it's comfort-focused, some discomfort can still occur; they also might not mention specific costs or deep cultural nuances, and it's a type of care, not just a place. 

Can people come back from comfort care?

It's often used to mean the same thing as hospice care. However, comfort care is not always for the end of life. It does not necessarily mean impending death for the patient, even if it is being used as part of hospice care.

What are signs of nearing the end?

Physical signs that death is near include:

• mottled and blotchy skin, especially on the hands, feet and knees.
• blood pressure decreases.
• they can't swallow.
• less urine (wee) and loss of bladder control.
• restlessness.
• difficult breathing.
• congested lungs.

Do hospice nurses change diapers?

Yes, hospice caregivers, including nurses and aides, assist with personal hygiene tasks, such as changing diapers for patients who are bedridden or incontinent. This ensures the patient's comfort and dignity.

What is the injection given at the end of life?

Midazolam SC 10mg–20mg over 24 hours in a syringe pump + midazolam SC 2mg–5mg hourly as required. Levomepromazine may need to be used in addition to midazolam under specialist advice. Use lower doses if not used previously and in frail elderly for example: levomepromazine SC 2.5mg-5mg as required 2 hourly.

What is the 80/20 rule in hospice?

The 80/20 rule is part of the Medicare hospice rule that ensures most hospice services are delivered where patients feel most comfortable — at home. Under this guideline, at least 80% of all hospice care must be provided in a patient's home setting, such as a private residence, assisted living, or nursing facility.

Why is dilaudid used for end of life?

Here's where Dilaudid steps in as a suitable alternative. Dilaudid undergoes a different metabolic pathway, making it less dependent on kidney function for elimination. This characteristic allows healthcare providers to choose Dilaudid for patients experiencing severe pain or for those with renal insufficiency.

Why is lorazepam given at the end of life?

Patients facing terminal illnesses often experience heightened stress and restlessness. Benzodiazepines can provide relief, promoting a sense of calm and comfort in the final stages of life.

What are common symptoms in the last 48 hours of life?

In the last 48 hours of life, common symptoms include significant changes in breathing (irregular, pauses, gasps), decreased consciousness (drowsiness, unresponsiveness), cooling extremities with mottled skin, increased restlessness or agitation (terminal restlessness), and noisy respiratory secretions ("death rattle") as the body slows down, though hearing often remains intact. Appetite and fluid intake decrease, and the person may experience confusion or hallucinations.
 

How to help someone pass away peacefully?

What to do for someone who is dying

1. Hold their hand to reassure them.
2. Use pillows or cushions to support them.
3. Change the position they're lying, as this can sometimes help them feel more comfortable. ...
4. If they feel achy in a particular part of their body, you may be able to ease the pain using warm or cold pads.

What is the first organ to shut down when dying?

The digestive system often shows the earliest signs of shutting down as appetite and thirst fade, followed by the brain, which fails quickly from lack of oxygen once breathing and circulation slow, leading to unconsciousness. While the heart and lungs are vital and cease functioning close to the end, the digestive system's gradual slowdown (loss of hunger, bowel movements) is usually the first noticeable sign of the body preparing for death. 

Who pays for hospice care services?

Government programs. Medicare covers hospice care costs through the Medicare Hospice Benefit. See www.medicare.gov/coverage/hospice-care. Veterans' Administration (VA) benefits also cover hospice care.

What is the moaning sound at the end of life?

Moaning sounds at the end of life, often called the "death rattle," are usually from secretions (saliva/mucus) pooling in the throat as swallowing weakens, causing a gurgling noise with breath, not pain or drowning; it's a normal sign of the dying process where the brain doesn't signal to swallow, but it can be distressing for families, and hospice teams can help manage the sound and ensure comfort. Sometimes, rhythmic moaning or grunting can be a self-soothing sound from relaxed vocal cords as breathing becomes irregular, also not necessarily pain.
 

How long does it take for someone to pass away on comfort care?

For some people, the dying process may last weeks. For others, it may last a few days or hours. A dying person's experience may be influenced by their illness or medications, but certain signs and symptoms are common.

What medications are not allowed on hospice?

There isn't a strict "not allowed" list, but hospice stops medications that are curative (fighting the disease), preventive, or not related to comfort, focusing instead on symptom management for the terminal illness; this often includes statins, blood thinners, many blood pressure/sugar meds, chemo, and some dementia drugs, while continuing those for pain, nausea, or anxiety, with the hospice team making individualized decisions. 

Will Medicare pay for comfort care?

You pay nothing for hospice care if you get your care from a Medicare-approved hospice provider. How do I know if a hospice provider is Medicare-approved? An amount you may be required to pay as your share of the cost for benefits after you pay any deductibles.

Does hospice bathe patients?

Yes, hospice care includes bathing patients as a key part of personal care, with trained hospice aides or nurses providing sponge baths, bed baths, or assistance with showers to maintain hygiene, comfort, dignity, and prevent skin issues, and the cost is covered by Medicare. This crucial service supports both the patient and family caregivers, offering relief and ensuring the patient feels human and respected. 

How does a hospice nurse know when death is near?

Hospice nurses recognize impending death by observing a cluster of physical changes, including irregular/slowed breathing (like pauses or gasps), mottling (bluish/purplish skin) on extremities due to poor circulation, cold hands/feet, decreased urine output, a weak pulse, increased sleepiness or restlessness, and changes in consciousness (unresponsiveness or hallucinations). They look for these combined signs, which indicate the body is shutting down, to prepare patients and families for the final stages of life, often within days or hours. 

What is the negative side of hospice?

Unfortunately, hospices often have to turn away patients due to a lack of hospice beds. Since hospice is only covered when a medical prognosis gives a patient six months or less to live, it can be difficult to allocate hospice care on short notice. Families and caregivers often feel guilt for choosing hospice care.