Exact difference between comfort measures & hospice?

What is the difference between Comfort Measures Only, Hospice, DNR...What is the exact difference? ( I know some, but I'll appreciate if someone can clearly explain it.) Thanks a lot in advance.
comfort measures only: this means no other intervention or medications which are not related to making the patient more comfortable. that's no antibiotics, no more lab work or diagnostic studies, therapies, or procedures; usually diet as desired (if the patient can take p.o), and oxygen, treatments, and medications to promote comfort are given. note that in the dying patient, iv hydration causes more distress by preventing the natural decrease of secretions and urine, so ivs are usually stopped and discontinued. thirst is not an issue with the actively dying, but nausea and vomiting and wet lungs with shortness of breath are.dnr: do not resuscitate. no cpr, no intubation (although sometimes this last has to be specified), no "code meds." sometimes notes specifics, like, "no intubation," "no pressors," "no external pacing," and the like. may or may not include "comfort measures only," so be sure the md knows what's wanted.hospice: hospice is a service which is most often paid by medicare but whose services are generally duplicated by non-medicare insurance if the patient isn't eligible for medicare.to be eligible for hospice, the person must be terminally ill with a condition that can reasonably be expected to cause death within six months if not treated, and treatment (beyond palliative care, symptom management for comfort) is not wanted. this is a really nice little site with pdf worksheets for different diagnoses (like alzheimer's, adult failure-to-thrive syndrome, cv, renal, hepatic, hiv, etc.) and functional performance scales to help you see how to determine whether death may be expected within six months and meeting hospice criteria. http://wecareho.startlogic.com/admissionb.html/here's the info for hepatic disease as an example:lcd for hospice – liver disease (311)patients will be considered to be in the terminal stage of liver disease (life expectancy of six months or less) if they meet the following criteria (1 and 2 must be present; factors from 3 will lend supporting documentation):1. the patient should show both a and b:a. prothrombin time prolonged more than 5 seconds over control, or internationalnormalized ratio (inr)> 1.5b. serum albumin <2.5 gm/d12. end stage liver disease is present and the patient shows at least one of the following:a. ascites, refractory to treatment or patient non-complaintb. spontaneous bacterial peritonitisc. hepatorenal syndrome (elevated creatinine and bun with oliguria (<400ml/day)and urine sodium concentration <10 meq/l)d. hepatic encephalopathy, refractory to treatment, or patient non-complainte. recurrent variceal bleeding, despite intensive therapy3. documentation of the following factors will support eligibility for hospice care:a. progressive malnutritionb. muscle wasting with reduced strength and endurancec. continued active alcoholism (> 80 gm ethanol/day)d. hepatocellular carcinomae. hbsag (hepatitis b) positivityf. hepatitis c refractory to interferon treatmentpatients awaiting liver transplant who otherwise fit the above criteria may be certified for the medicare hospice benefit, but if a donor organ is procured, the patient must be discharged from hospice. it is a very regulated insurance product, which includes very specific services for patient and family (defined as whoever the patient says they want included). hospice cases are audited q3months to see that the patient still meets criteria for services. people can be on hospice for as long as necessary, though, so long as they meet criteria. people can "flunk" hospice and get better; if they then decline and meet criteria again, they can go back in service with no wait period and no penalties. i like to say it's one of the best federal benefits ever put into place.

@GrnTea: WOW! Well explained...Txs a alot!

Quote from payang0722what is the difference between comfort measures only, hospice, dnr...what is the exact difference? ( i know some, but i'll appreciate if someone can clearly explain it.) thanks a lot in advance.

Basically the way i see it is that Comfort cares are kind of when death is going to happen soon. all medications are stopped (except antianxiety or pain medcations). nothing is done to prolong their life. For example, we had a patient come in with sepsis and was not responding to anything we were doing. It was difficult to even maintain oxygen sats in the 80's. She was a DNR-DNI so we couldnt intubate (normally we would in this situation). She did end up being comfort cares due to her code status and nothing else we could do. It had to be the families decision to put her on comfort cares because of the state she was in she was unable to make that decision.Hospice is the same concept, but more long-term. Like if someone was diagnosed to end stage renal failure and doesnt want treatment. They may be placed on hospice. Hospice can be the patient's decision.

My goodness gracious; after that what can I say but excellent work Esme12 and GrnTea. Outstanding!

Quote from tyvinMy goodness gracious; after that what can I say but excellent work Esme12 and GrnTea. Outstanding!

I admire all of you wonderful nurses with tons of experiences and knowledge. I bow my head.

@tyvin: Indeed Excellent Job from the 2!!!

I'm going to save this thread as it has invaluable information. I am finding more and more that my friends need this information for their aging relatives. Good Job!

Quote from payang0722@tyvin: Indeed Excellent Job from the 2!!!