Clinical Applications
Palliative and comfort care: what a surface can and cannot do
When the goal of care changes from healing to comfort, the questions about equipment change with it. Whether a wound will close stops being the measure. Whether someone can be turned without it hurting, whether they can be left to sleep, whether the hours between medication doses are bearable — those become the measure, and a support surface is judged against them instead.
This page is written for the person doing the caring. It covers what changes when the goal changes, why turning becomes the central question in palliative care, what a therapy surface actually contributes and what it does not, and the practical things that are easier settled early than late. It also covers the question most families do not think to ask until after they have spent money, which is what the hospice or palliative service already provides.
We will be direct about one thing throughout. A mattress is not pain relief. Symptom control belongs to the palliative team, and a surface that makes a person easier to care for is not a substitute for a conversation about whether their pain is being managed well. Dolphin® FIS® and Fluid Immersion Simulation® are registered trademarks of Joerns Healthcare LLC; we are an authorized Joerns dealer, and the claims attributed to Joerns here are Joerns' own.
- Joerns' relevant indication
- Where the condition precludes turning, or turning may be contraindicated
- What a surface is not
- Not analgesia. Symptom control belongs to the palliative team
- Ask first
- What equipment the hospice or palliative service already provides
- Battery backup
- Approximately 12 hours of alternate power, per Joerns
Working out whether a different surface is the right change
- 1
Name the goal out loud
Ask the team what the plan is now: is anyone still working towards healing this wound, or is the aim comfort and dignity. Families often discover that the clinicians have moved and nobody said so, and every equipment decision that follows depends on the answer.
- 2
Ask the hospice or palliative service what they supply
Ask, in plain terms, what equipment the service provides, what is on its list, and whether a specialty surface can be requested. Equipment related to the terminal condition is commonly supplied through the hospice rather than bought by the family, and this question is regularly asked a fortnight after somebody has already rented something.
- 3
Work out what is actually causing the distress
Pain on being turned, pain at rest, a dressing that pulls, a frame that is the wrong height, a wound that needs different management, or a medication schedule that is not holding. These need different answers, and only one of them is a mattress. Ask the nurse to help you separate them before changing equipment.
- 4
Treat the surface as one change among several
If the team agrees a different surface may help, ask what else is changing at the same time — the repositioning plan, the dressing regimen, the analgesia, the position the person is nursed in. Changing one thing tells you whether it helped. Changing five tells you nothing.
- 5
Choose rental over purchase, almost always
In palliative care the need is real and the duration is unknown, which is exactly the situation rentals exist for. A monthly rental can be ended when the situation changes. We will say plainly: we would rather rent you a surface than sell you one here.
- 6
Agree now what happens at the end
Ask us, before delivery, what collection involves and how much notice we need. Families should not be arranging equipment logistics in the first days after a death, and the whole thing can be settled in two sentences in advance.
What changes when the goal changes
In curative care, a wound is a problem to be closed, and the plan is built backwards from that. Surfaces are chosen for their contribution to healing, turning schedules are maintained because they protect tissue, nutrition is optimized because tissue needs it, and discomfort along the way is tolerated as the price of progress.
In palliative care, the calculation is different. If a person has weeks, an intervention that might improve a wound over months is not obviously worth what it costs them today. Turning every two hours, through the night, might be exactly the wrong thing for someone in pain. The team weighs burden against benefit, and the answer can legitimately be less intervention rather than more.
That shift confuses families, and it should be named rather than left to be inferred. If the nursing routine has changed and nobody explained why, ask. There is usually a clear reason, and hearing it directly is easier than watching it happen and wondering whether something has been given up on.
Turning, and why it becomes the central question
Repositioning is the foundation of pressure injury prevention, and at the end of life it can also become one of the most distressing things that happens to someone. Movement can hurt. Handling can hurt. Being woken can matter more than the schedule being kept. So palliative teams sometimes reduce, extend or modify a turning routine deliberately, as a clinical decision made for that person, weighing the skin against everything else.
This is the situation Joerns' own indications describe. Joerns states that the system "may also be used for patients whose medical condition precludes turning and repositioning, or where these interventions may be contraindicated". That is a description of a clinical circumstance, written by the manufacturer, and it is the closest thing to a palliative indication in the published material.
What it is not is permission. A mattress does not authorize a change to a repositioning plan, and no supplier should imply that buying one lets a family stop turning someone. The decision to modify turning belongs to the palliative or hospice team, for that person, at that time. Ask them what the plan is and ask them to write it down, so that everyone who comes into the house is doing the same thing.
What a surface contributes, and what it does not
A therapy surface changes how load is distributed and how the skin experiences friction, shear and moisture. Joerns describes its technology as reducing soft tissue distortion and promoting blood flow, and describes the therapy pad fabric as smooth nylon with low friction and low shear properties, breathable and moisture vapour permeable. Those are surface properties. For someone who is in bed all day, they are not nothing.
What a surface does not do is relieve pain. There is no analgesic claim in any Joerns source we have read, there are no comfort scores, no outcome figures and no patient accounts, and we are not going to supply any. If someone is in pain, the answer is a conversation with the palliative team about symptom control — and if that conversation has not gone well, ask for it again, or ask for a specialist palliative review. Families are often more reluctant to push on this than they should be.
The honest framing is this: a surface can make a person easier and gentler to care for, and it can change what the skin is subjected to between cares. It does not manage symptoms, it does not replace the team, and it will not be the thing that makes the difference on a bad night. Anyone selling it as though it might is selling to your fear.
Skin at the end of life
Hospice and palliative clinicians will tell you that skin can break down at the end of life even when the care has been meticulous. Circulation changes, perfusion to the skin falls, nutrition and hydration change, and the body's priorities shift. It is not a verdict on the family, the nursing or the equipment, and families who have been turning someone faithfully for weeks should hear that from somebody.
What that means practically is that the measure of success changes too. A wound that is not closing is not necessarily a failure of the plan; the plan may not be aimed at closing it. Ask the nurse what they are watching for and what would change the approach, so that you are looking at the same things they are rather than at a wound that is not going to behave the way you want it to.
If a new area appears, or an existing one changes, that is still worth reporting — not because everything must be fixed, but because it may change dressings, positioning or symptom control. Report it and let the team weigh it.
Ask the hospice before you rent anything
This is the most useful paragraph on the page and it costs us money to write. Where someone is under a hospice service, equipment related to their terminal condition is commonly supplied by the hospice as part of the service, at no separate cost to the family. Families frequently do not know this, and rent or buy privately in the middle of a crisis, and find out afterwards.
So ask the hospice: what equipment do you provide, what is on your list, what happens if we need something that is not on it, and how quickly can it arrive. Ask the same of a palliative service that is not formally hospice. Then, if a specialty surface has been specifically recommended and is genuinely not available through that route, come back to us and we will tell you what we can do.
We would rather be the second call than the first one here. A family that spends a five-figure sum on equipment they were entitled to receive has been let down by somebody, and we do not want it to be us.
Practical things, settled early
A powered therapy surface in a house is a machine, and the ordinary questions matter. It needs an outlet it can keep. It has a rechargeable battery that Joerns states provides alternate power to the control unit for approximately 12 hours if the system is disconnected or the power fails, and which recharges when power comes back. If outages are common where you live, tell the care team that rather than discovering it during one.
It has to fit the frame. Joerns is explicit that entrapment risk arises when gaps of even a few inches are left between the surface and the head panel, foot panel or side rails, and that the equipment is not to be used where such gaps are present. If the bed came from one place and the surface from another, somebody has to measure before anything is ordered.
And there are two things every caregiver should be shown at handover rather than left to find in a manual. Autofirm, which Joerns describes as desirable for transfers and care procedures and which returns to the previous setting automatically after approximately 15 minutes — useful for a dressing change or a pad change, when a firmer surface is easier and gentler to work on. And the hand check: Joerns instructs that after a comfort adjustment, the caregiver should confirm by hand that the person is not touching the mattress support platform underneath. Ask whoever delivers to demonstrate both, and to watch you do them once.
- A working outlet the equipment can keep, near where the bed will stand
- The frame make and measurements, before anything is ordered
- Autofirm demonstrated to everyone who provides care, not just to one person
- The hand check demonstrated, and performed once by you
- A note of who to call if the equipment alarms or fails, and when they answer
- Agreement, in advance, on how collection works and how much notice it needs
When it is over
Nobody should be on the phone arranging equipment collection in the days after a death, and it happens constantly because it was never discussed. Settle it in advance: tell us at delivery who the second contact is, and agree then how collection is arranged and what notice we need. Then it is a single call at a time when a single call is all anyone can manage.
A rental simply stops. There is no negotiation to have and nothing to argue about, and that is the reason we steer families here towards renting rather than buying. If a purchase has already happened and the equipment is no longer needed, tell us and we will tell you honestly what your options are, including the ones that do not involve us.
Questions for the hospice or palliative team
- What is the goal of care now — and has it changed recently?
- What equipment do you provide, and what is on your list?
- Can a specialty surface be requested through you, and how long does it take?
- What is the repositioning plan, and has it been modified deliberately?
- Is the pain being managed adequately, and who reviews that?
- What are you watching for on the skin, and what would change the approach?
- What should we report, and who do we call out of hours?
- Who is coordinating between the hospice, the GP or physician, and any other service?
- If we arrange a rental privately, does anything about that affect your care?
- Who do we tell, and in what order, when things change?
Questions people ask us
Will a therapy mattress reduce pain?
Is it normal for the team to reduce turning at the end of life?
Should we ask hospice before renting?
Is it better to rent or to buy in this situation?
The wound is getting worse even though we are doing everything. Have we failed?
What is the hand check we keep being told about?
How do we arrange collection afterwards?
If the team has recommended a surface and hospice cannot supply it
Tell us what was recommended, what frame it has to fit and roughly when it is needed. We will tell you what is available to rent, what collection involves, and what we need from you — and if the hospice route has not been asked yet, we will ask you to try that first.