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She is 93, has dementia and is in assisted living. At time she is comatose and a day or two later she is up, but this happens several times a week.

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Palliative care is just a description, rather than a specific service. It means care and treatment that are given to people with the aim of keeping them as comfortable as possible, as distinct from attempting to cure their disease or prolong their lives. Pain relief is the most important aspect of this, but it would also include help with symptoms like nausea and anxiety for example.

If your mother's doctors agree that she is approaching the end of life, they may recommend that she is referred to a hospice service. Hospice provides palliative care, but hospice trained professionals specialise in recognising and helping with the particular needs of people who are approaching the end of life or actively dying.
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It sounds as though Mom would be appropriate for Hospice care, becoming comatose certainly is not normal. It certainly sounds as though she should have 24 hour care in a skilled nursing facility.
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