Is Mouth Care Considered Medical or Comfort Care at End of Life?

Just like hospice regulations were created decades ago, end of life doulas functions are now being formalized. Hospice performs the medical, doulas do not. During a Question and Answer session with a group of end of life doulas I was presented with the question“Is mouth care at end of life considered medical or comfort care?"

It had never occurred to me that someone would think taking care of someone's dry mouth would be considered medical. I was startled by the question. Upon further thinking I realized in today’s litigious, medicalized, bureaucratic society we can take actions to extremes and that something as simple as mouth care can be questioned. SO —— here are my thoughts on comfort care vs. medical mouth care.

There is nothing medical about brushing your teeth, rinsing your mouth or moistening the inside of your mouth. We do it all the time. Why would it be suddenly considered a medical procedure just because the body is dying?

The answer --- it wouldn’t, at least it shouldn’t. Providing mouth care as end of life approaches is keeping a person comfortable, is comfort care, and anyone, no matter if there are letters after their name or not, whether they are paid or not, should be able to provide it.

Is there a right or wrong way to provide mouth care at end of life? Maybe. The biggest “danger” would be choking on the water put in the mouth. If the person is responsive, help and support them in brushing their teeth and rinsing their mouth. There should be no problem here although it may be a bit messy.

If the person is confused or non responsive, they are probably breathing with their mouth open so the tongue and inside of their mouth will become dry. Also, anyone getting oxygen will have dry mouth from the additional air flow into the mouth and throat area. 

Use moist or glycerin swabs from the drug store (if swabs have mouthwash in them you may want to dilute with a bit of water as the mouthwash can be too strong) or even a wet toothbrush to gently wipe the inside of the mouth and tongue. You don’t want any real quantity of fluid in the mouth because if they aren’t aware to swallow there can be a situation for choking.

Other comfort things to think about: A bit of vaseline spread on the lips can ease dry lips. If the person is alert, popsicles made from fruit juice can help.

Dying is not a medical event. It is a social, communal event AND, most importantly, it is a natural event. It is the body doing what it is naturally programmed to do. We can ease its transition by keeping it as comfortable as we can. Sometimes our natural body functions need a bit of an assist. Mouth care is one of those things.

Something More... about Is Mouth Care Considered Medical or Comfort Care at End of Life?

My booklet, The Eleventh Hour: A Caring Guideline for the Hours to Minutes Before Deathoffers information, ideas and support for caregivers in the weeks, days, and hours before death and just after. Having this information inspires and empowers the caregiver while reducing fear. Mouth care is part of this booklet.  It is also part of the dvd kit for NEW RULES for End of Life Care and is one of the booklets in the End of Life Guideline Series. 

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Interesting! I consider it comfort care. A moistened swab or glycerin swab wouldn’t be a Hazzard. I would consider this to be bare bones Nursing comfort care 101. Ask the family member if it’s all right first.
BK Books replied:
Thank you, Maureen.


Thank you, Barbara. We can never have enough conversations about what care to provide when we are wearing the doula hat, no matter what our background. And also what we can do as a hospice volunteer, no matter if we also are an EOL doula! I so appreciate that you are including ‘doula’ regularly in your blog posts. I recommend your writings to ALL my students, top of the list!
BK Books replied:
Hi Merilynne, haven’t touched base with you in awhile. Good to hear from
you. Thanks for the kind words. Blessings to you in the work you are doing.

Judy Judd

I worked in LTC for 28 years and we had a “recipe” for mouthwash that called for 30cc peroxide, 30cc soda pop (lemon-lime or ginger ale), and 5cc of mineral oil. We kept the mixture at the patient’s bedside where their family members could use a sponge toothette to clean/moisten the mouth. It was a small gesture, but one where it helped with the patient’s comfort and the family felt a little less helpless during that difficult time.
BK Books replied:
Judy, thanks for sharing the recipe. Blessings! Barbara

Lynn Jenkins

This issue is so timely for me. As a new Doula I was volunteering at our local Hospice. After completing my orientation with them I was assigned to a retired Hospice nurse with no family and in her last weeks with lung cancer. When we met, I found her to be gentle and grateful for anything I did to make her comfortable. One thing I noticed was that she apparently had partial upper false teeth and that no one had realized she had this in her mouth. I searched high and low for a toothbrush so that I could take out this partial and clean it (with gloved hands of course). The thing was dreadful and clearly had not been removed and cleaned since she had been in her facility. She was so so grateful to me and told me how she appreciated my cleaning her partial. But alas my Hospice “manager” was very displeased with me that I had crossed a line in terms of patient care that was out of my scope as a volunteer. Hospice decided to let me go as they were concerned I could not affectively volunteer and follow their rules with my nursing background. Sadly this Hospice is very threatened by Doulas.

As an aside I did get to spend last hours with this special patient. We held hands and she stared into my eyes for what seemed like hours. I prayed her rosary with her and she was peaceful. I would not have missed that special time with her for anything. We connected and I was honored to be with her at the end. Tho I am no longer welcome at Hospice as a volunteer, I would not have done anything different when it came to making this good woman feel some self respect in her last days.
BK Books replied:
Hi Lynn, thank you for sharing. Good for you for addressing an important
need that was overlooked by the professionals. I suppose you could have
reached out for assistance from the facility, I’m sure that is what the
hospice volunteer rules say. I wonder if the hospice would have reacted in
the same way if this had occurred in a private home—probably. I think it
was very harsh to discharge you for a “first offense”. What happened to
“three strikes” policies. I hope you find work as a doula. The end of life
movement will certainly benefit from your heart driven work. Blessings!

Paula Schneider

Barbara, this was a good piece of information. I wonder if family members are sometimes afraid to ask for mouth care or to ask how to do mouth care themselves. I’m thinking of my friend who told me after her husband died that he was in desperate need of mouth care and I assume it was not being done by staff. So sad that she carries that memory with her now. Apparently his tongue had just dried out completely and was like a hard rock in his mouth. Thanks for addressing this topic.

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