[00:00:03] Speaker A: When you see.
Many one's love.
But to be the university, and you are only going to be.
[00:00:35] Speaker B: Hello, everyone.
Welcome back to if It's Not One Thing, It's Joanna. Today we are rounding out the third part of our series about services that may not be widely known but are extremely valuable when caring for a loved one. So specifically someone with dementia or Alzheimer's. And our guest today is Hope Dudek, who is basically. How would you describe her, Andrew? All things hospice care, Essentially.
[00:01:06] Speaker C: Yeah. She's had a lot of experience, both on the medical side and the social work side. She helps manage institutions that deliver the actual physical care of someone who's in hospice. But she also has a lot of experience focusing on delivering emotional support to the families and to the seniors themselves to help them deal with all things hospice, which is a huge transition. It obviously can be heavy stuff. And she's expert at helping families deal with that.
[00:01:34] Speaker B: Yeah. It's incredible what she provides and really what all of our guests in this series have talked about that could make a huge difference in the lives of.
In the lives of people who are really struggling to figure out how to provide the right amount of care and what that care should be. But before we dive into our interview with Hope, I want to talk about Thanksgiving.
[00:01:57] Speaker C: Let's hear it.
[00:01:58] Speaker B: Okay, so I know that this episode will be coming out after Thanksgiving, but we are recording a couple days after we had a delightful. I think it was a delightful Thanksgiving at Mom's house. At your house? Yes. Did you think it was delightful? It was delightful.
[00:02:12] Speaker C: I lasted a little bit longer this time before I went to my cave upstairs. My routine on Thanksgiving is to hang out as long as I can. And then the tryptophan wine thing hits. And at some point I go upstairs, assuming that I'm just. I'm just gonna take 10, 20 minutes while everybody hangs out, and it ends up being, you know, the end of the night for me. So, I mean, I apologize for that to everyone who was involved, but I know it's a little rude, but I just. I tried to pay for that by doing some heavy dishwashing before.
[00:02:43] Speaker B: I'll take it.
[00:02:44] Speaker C: So hopefully that wasn't.
Okay, trade off.
[00:02:46] Speaker B: It was. Listen, your Irish goodbye is like none I've ever seen. And I. I do think you've mastered it, but I'll take it because all of a sudden you were doing dishes, which I thoroughly appreciated because I do all the prep so. Well, I shouldn't say that. Let's give full credit to Julie. I did a turkey and Stuffing Julie did everything else. Anyway, I want to explain one of the reasons I'm bringing up Thanksgiving. Two reasons. One is we usually are delighted to have Thanksgiving with really about 30 people.
Am divorced. And shortly after I divorced, my ex husband passed away. But his family and our family were deeply, deeply connected throughout the course of our marriage and then still continue to be deeply connected afterward. And so we always have Thanksgiving together. A huge group. I shouldn't say always, but for many, many years. It's just beyond lovely that we still share this wonderful relationship and that everybody wants to be together for major holidays and Thanksgivings to be the one that we can do the best we do Thanksgiving at mom's house because there are so many of us and she has the biggest house. But this year we didn't. And one of the reasons why is because Mom's having a hard time really being connected when there's so many people there. And we talked about this ahead of time. Right. Agreed that 30 people is a lot for her to have in her house. And so for that reason, this year we ended up splitting our families up. And it was just nine of us, just our immediate family. Our lovely cousin Gary.
[00:04:20] Speaker C: Yeah, if I can jump in. I mean, it was. We noticed last couple years we've had this big thing and we would also celebrate mom's birthday, which is always a couple days before Thanksgiving, and deliver her a cake and have a wonderful little moment there that she really enjoys. And even her, you know, hanging around and seeing people is joy for her. But it really was true that she wasn't really able to participate and hang out with everybody. Even if someone comes over to talk to her, it's loud, it's a party atmosphere, and she really can't interact that much. So we thought it'd be better to have a more intimate setting where some interaction can happen. Of course, we still celebrate her birthday. And if I may say, it's also kind of nice to have something smaller and not to have the big production. And I love seeing everybody, but it's a lot of work. And so I didn't mind myself that it was a bit smaller.
[00:05:08] Speaker B: I agree that it was easier that it was smaller. But I'm just going to say, for the record, I missed our big group and I hope we can find a way back to that in some way because I love, love our family dynamics together. I think they're so. And I know that. I'm sure that you don't mean, oh, I didn't miss the family. I know you did.
[00:05:27] Speaker C: No, I Love all those guys. I really do. Even though I don't show it when I kind of like Irish goodbye upstairs. But this was this year.
[00:05:35] Speaker B: Yes.
[00:05:35] Speaker C: Next year we can do it absolutely differently. And of course at their place and we can just bring food.
[00:05:41] Speaker A: No, but we tried it this way.
[00:05:43] Speaker C: We can do it differently next year. Nothing's set in stone.
[00:05:45] Speaker B: Yeah. But I am going to say that another reason I'm bringing up Thanksgiving is even when mom was living in the assisted living home and you were staying at her house, we hosted Thanksgiving at her house and we brought her home for that Thanksgiving. We had brought her home a couple other times just to kind of see, like, is she able to come and hang out in her home, have a piano lesson, do some things? And so we brought her home for that Thanksgiving and then we had to bring her back to her assisted living apartment at the end of the night. And it was gut wrenching. And I remember that with such an intense feeling of sadness that here we were having this lovely celebration and taking her back to this place that was still confusing to her and she didn't really enjoy it. And you, in fairness, that was the goodbye for you that night. You had to actually physically take her back.
Do you remember what that was like?
[00:06:41] Speaker C: I don't remember that. Seems like 10 years ago now. My God, we've gone through so much stuff.
[00:06:46] Speaker B: It was two, by the way.
[00:06:48] Speaker C: Yeah. And, you know, I think we got into a groove. I remember we had that first long phase when she was in the home where we were like, militant about not bringing her back home because everyone advised us it would be too emotionally damaging for her and it'd be a traumatic experience. And then we slowly kind of have little dips. Like we go home to like, play the piano and hang out for a little bit for a meal and then go right to your house for dinner and then back to the home. And there was a couple of those, and one of them was very emotional and she was crying a little bit on the way back home. And then a couple other times it was no big deal because she kind of quickly forgot that she was sad that she was leaving home. And then when the redirect happens, she is always very amenable. Like, she doesn't fight at all or argue. We just like, hey, this is where you have to go and you have meds that you have to take and we'll go back there as soon as we can. And she's always overall okay. But generally, yeah, it was tough to. To extract her from that lovely situation. That she was in.
[00:07:49] Speaker B: Yeah. I also think that you are better at being a little less deeply emotionally involved in it than I am.
[00:07:55] Speaker C: Yes.
[00:07:56] Speaker B: But I just felt crushed and sad when we shook her back. So to have her home at Thanksgiving and to have her granddaughters there and to be together as a family, whether it's eight or nine of us or whether it's 30 of us is lovely. And I'm glad that we were able to do that. She seemed to have a good time, and let's, I guess we hope for many more. So that kind of brings us to our next point, which is what do we do when we feel like we might be ready for hospice care? An odd transition there, but we know that this person may not necessarily be right at the very end of life. And so that's why we wanted to talk to Hope today, because she's got some incredible resources but also some really good information on that topic that we really didn't know. And I assume many of our listeners don't know that I think they'll feel might be invaluable to them. It was to us.
[00:08:49] Speaker C: Absolutely. Let's get into it.
[00:08:51] Speaker B: Okay, we are going to leave you with the dulcet tones of Joanna. I got you.
[00:08:57] Speaker C: You told me to stop saying dulcet tones. All you do is say dulcet tones. I think we can say it every time. I don't mind. But, you know, we have to shake it up. I'm fine with that, too.
[00:09:06] Speaker B: All right, Well, I like it for now, so we will leave it with that and we will be right back.
[00:09:15] Speaker A: Someone to watch over me.
[00:09:23] Speaker C: And the.
[00:09:23] Speaker A: Words that all I'm thinking about always about always to be that's how the music is here and when you see the fountains.
[00:09:45] Speaker C: Welcome back.
We are here with Hope to talk about the medical side of hospice. Of course, we talked to Leslie Katz, who was talking about some more of the social services aspect of hospice and beyond hospice and how to support those with dementia or getting into dementia that need assistance. And today we want to ask a little bit about some of the more specific medical aspects of hospice and whatever else comes up. I know. Hope you do stuff beyond that as well. So, Hope Dudak, welcome. Can you just introduce yourself a little bit, like what you do, what's your title and where your focus is?
[00:10:24] Speaker A: Sure. My name is Hope Dudek, and I'm a master's level social worker for Michigan Palliative and Hospice Care.
I have been working in the field of Hospice for 25 years, and in that time, I've Worked with, I don't know, for me, countless. But I'm not very good at numbers.
Countless families and patients. I've worked in different roles.
I've been, of course, hospice social worker.
I work with our palliative patients as well. Those are patients who are focusing on symptom management, most of whom have chronic diseases. Then I've also been a community educ.
So I've educated community groups, dementia support groups, grief support groups, caregiver groups, patients themselves, as well as medical residents, nurses, social workers, case managers.
[00:11:26] Speaker B: Wow, you run the gamut. That's a long career in this field. It's very impressive.
So in our last episode, we talked to Leslie Katz at Jewish Hospice, and we talked specifically about the social side of the services that hospice provides, which are incredible. Your focus for specifically for us today is really about the medical side. Can you just explain a little bit about what that difference is?
[00:11:53] Speaker A: Really, we don't see that much of a difference because hospice. And what I love about hospice is that it approaches a person as a whole person.
You know, when we're in the hospital, we have as many specialists as we have body parts or systems sometimes, oftentimes a lot more.
[00:12:11] Speaker B: True. Yes.
[00:12:13] Speaker A: So we don't look at a person as a set of lungs or as a heart contained in this, you know, fleshy vehicle. We look at a person and we look at the people who are around them, and our focus of support is on that entire unit.
We know that we can't manage symptoms like pain if everything else is going wrong around them, if their caregiver is hyperventilating, if a person is estranged from family or is stressed about their living situation. So those things tie in together, and it's important for. I mean, I think that always should be the case for all medical care throughout life. But we do focus on that in hospice, which is different than our current medical system in a lot of ways.
[00:13:08] Speaker B: So can you talk about the kinds of services that hospice provides specifically from your end relating to medical hospice?
[00:13:16] Speaker A: Sure.
Our focus is on symptom management and function. So just how is a person to, you know, within their current abilities? We're not looking to restore function or rehabilitate someone. We're not looking to diagnose, since we're not looking to diagnose, we're also not looking to do a lot of the testing, the pokes and the prods.
And to be honest with you, a lot of people who come to us say that they are relieved to be able to leave behind those pokes and prods just Some. For a lot of our patients, just getting in the car and going out is a huge thing. For folks with dementia, it's extremely upsetting for them to go to a hospital. For them to even just go to a doctor's appointment can throw them off, can be the source of safety concerns or arguments.
So we're coming, bringing care to them.
[00:14:17] Speaker C: And if I could just jump in there. That's one of the things. When we first were doing this transition to hospice for mom, she of course was like, what is this? What are you talking about? I don't know what this is. And the one thing that kind of turned her attitude about it was when I said, oh, well, you don't have to go to the doctor anymore. You're gonna have a nurse come in here every couple weeks and just chat with you and see how you're doing. And that's what your medical care is primarily gonna be about. She's like, oh, that sounds good. Yeah.
[00:14:47] Speaker B: It's been a game changer for us in that she literally sits in the exact same chair. And every time Rebecca, her hospice nurse, comes and it ends up being kind of a joyous visit as opposed to exactly what you said, you know, getting my mom. And I'm sure this must be true for so many people, getting her in and out of the car, especially in the dead of winter, and sitting in a waiting room and then sitting in another exam room waiting and, you know, for a very quick visit that could be over nothing at all.
This has been a huge game changer for us. We feel really fortunate to have those services in her home, which is exactly where she wants to be all the time.
[00:15:27] Speaker A: Right.
So the care from a, I guess, patient care perspective, like the medical. If we're honing in on the medical part, it may vary from between hospices because some people think that hospice is a government program. It is not.
It is.
Our guidelines are all the same. So CMS or Medicare Centers for Medicare Services set our rules. But then how every hospice does it is a little bit different.
The mandated disciplines are nurse, hospice aide, social worker, and chaplain.
Beyond that, other hospices have their own personalities. Also, visit frequencies do change just based on staffing for each different hospice or maybe for geography or, you know, different factors like that.
With our services, typically the nurse will visit one to two times a week as a routine visit.
And then we have 24 hour availability for someone to talk to a nurse. If there are symptoms that pop up, maybe someone is really agitated, maybe it's over the holiday and someone's Urine stinky and dark, and you have a lot of frequent, you know, urgency. Maybe we want to start treating them for urinary tract infection.
Something like maybe they fall.
[00:16:55] Speaker B: Yeah, you know, sure happens. So you can. I'm getting a little ahead of us. But you are able to treat for urinary tract infection because that's not in interfering with, I guess, end of life care. That's more of a comfort level piece.
[00:17:10] Speaker A: Right. And we could talk for a whole session about urinary tract infections or in the elderly.
And I think it is important to assess what is going on each time and not just be throwing antibiotics at people, because antibiotics can also have their own side effects.
[00:17:29] Speaker B: Yeah.
[00:17:30] Speaker A: So, you know, we do want to keep in mind that we're not just blindly treating each time. We suspect someone might have the tiniest infection because a lot of people are colonized, which means that they always are carrying this kind of bacterial load.
[00:17:50] Speaker B: Yeah, I think that was the case for our dad for sure. And we've noticed, you know, a little bit here and there for our mom. So the advantage, obviously, of bringing in hospice care is really one of the biggest advantages. Seems like the ease of it, the. The pure joy of being able to be in your home and having somebody coming, somebody, I would assume, a regular visitor, someone who you start to get to know. I would imagine that's the case.
[00:18:17] Speaker A: A lot of people do find that that continuity is. Is helpful. Of course, you don't have your case manager, your nurse, who's assigned visiting on the weekends or on the evenings usually, because we do have to let our nurses, you know, for sure, time off. And then the other people can. Part of the team can also become part of someone's fabric, like the hospice aide who can help with baths a couple times a week, or the chaplain or the social worker. We have a massage therapist. And I don't know if your mom takes advantage of that, but everyone loves our massage therapist.
Other hospices might have other services, like, well, we have volunteers as well, for companionship, where they might do other things. And then some hospices will have other services.
[00:19:08] Speaker B: We definitely noticed that when we started to talk to Leslie about the list of activities that are involved or possible, we felt like, oh, yeah, we want every single one of those. But we like to share the wealth, literally, among other people, because there's so much. And I know that you have so many people you have to service, but we do. She does take advantage of, you know, certain regulars each week that have really enhanced her life and her in home care.
[00:19:35] Speaker C: Great and one of the big awakenings for us was figuring out that mom was even eligible for hospice. She's in pretty good physical shape. Dementia has advanced, but she can have quick, short bursts of conversations with people.
And we just assumed before we knew this that hospice was like an end of days situation.
When you hear that word, you assume it's the end. There's no point in getting any more care.
They're at most weeks away from passing away. And can you tell us a little bit about how incorrect that is and what really the definition of hospice is and who's available? Because I think a lot of people might not realize this is a great option.
[00:20:18] Speaker A: Oh, definitely. That's one of the greatest misconceptions about hospice. People hear that word and they freak out because they think, my loved one's not dying right now or I'm not dying right now.
And that isn't what's required for someone to qualify for hospice. And there's a difference between what qualifies someone for hospice and what makes someone ready for hospice.
So the qualifications for hospice vary depending on someone's disease.
They do have to have an identifiable life limiting disease. Dementia is a life limiting disease in and of itself. But hospice isn't necessarily appropriate throughout the entire disease process. Now someone starts to become eligible when they start meeting certain criteria.
We see decline in certain areas.
So almost across the board for any disability, we look for nutritional decline.
Maybe someone isn't eating what they as much as they used to.
They typically are showing unintentional weight loss.
Maybe their function has declined.
It could be with mobility.
Maybe they have a history of recent falls.
Maybe they've gone from being completely independent to needing assistance with what we call the activities of daily living.
So maybe they were able to prepare food for themselves and now they can't.
Maybe they were able to bathe before, but now they need assistance, those types of things.
[00:22:09] Speaker B: So the dementia diagnosis, or in fact an Alzheimer's diagnosis in itself, may not be a core qualifying diagnosis, so to speak. It's how the patient is responding as a result of that.
[00:22:25] Speaker A: It's their level of. So it's the nutritional status, the functional status, cognitive status.
So we see people who aren't maybe having difficulty with communication where they were able to hold a conversation before.
Now their conversational abilities are greatly impacted.
You know, inconsistent.
Because with some different types of dementia, we might see that someone can give a lecture like they used to when they were professors one day, but then the next day they were not able to do that. I'm Sorry.
[00:23:05] Speaker B: That's okay. We like that you have a real life going on besides this conversation.
[00:23:09] Speaker A: Right. So we. So we start to see the. The decline overall, this overall picture. Then at the same time, often are looking also for comorbidities. That means other diseases, other disease processes. You know, what else do they have going on? Do they have congestive heart failure? Do they have copd? You know, some. Sometimes people will come to us because they're 90 sick. Mom's had dementia. She's doing okay for a while. Then she had a hospitalization where she fell, and they found that there's a tumor in her lung. And they don't really want to pursue it. They suspect it might be a cancer. So at that point they say, okay, we're not going to pursue all of this.
This hospitalization was exhausting.
And we just want to focus on the time that we have with Mom. We want to keep her out of the. Out of the doctor's office. So that's where we start having the medical part meet up with the intention and the goals of life.
[00:24:06] Speaker B: Right.
[00:24:07] Speaker A: Together. Right. So, yeah, someone might qualify for hospice but not want hospice. And so those things need to come together, and that can be a process.
[00:24:20] Speaker C: And what's the. You know, while we're talking about this, this is always the gray area that we don't quite understand with mom because she's in hospice. And certain things, like you mentioned, if you had a tumor may not be treated at this stage, but she's, again, in pretty good physical health. When can she get, like, urgent care? When can we call the ambulance? Like, I assume if she, like, breaks her leg, we should call the ambulance or, like, what are those lines of where you, like, let something go versus oh, yeah, she needs to get some physical care now because it doesn't look like from a physical perspective she's going anytime soon. And so something might come up that needs help.
[00:25:00] Speaker A: Sure.
What we, in my company, what we recommend, and I think this is true across the board for hospices, is if something happens, immediately let the hospice team know.
The hospice team may recommend you calling 911 for someone to be transported.
But then we would have you sign revocation paper week.
Typically, unless it's just going to the emergency department to get stitches. Maybe someone falls and they need some stitches.
Maybe they. They just go get stitches, come home.
You know, that. That might not be the case. If it's something where you're going to want radiology, you know, like X rays, other things, then we are going to ask you to evoke from services just so it makes billing easier for Medicare. It is seeking more aggressive treatment. In my 25 years, I have had people who have come off of services because they broke something and have had surgery to stabilize a break or and even maybe afterwards done a little post hospital rehabilitation to restore some mobility, maybe.
But I've also had people who have had fractures, have really not been eligible for any sort of surgery.
So they've stabilized the break and come home.
And we've helped them to be comfortable despite having that.
[00:26:44] Speaker B: So if somebody does, let's say, have a break and they have it, you know, operated on and they, they have to opt out of hospice, can they re qualify later and then you can come back? Got it. Okay.
Interesting.
[00:26:58] Speaker A: Yeah, that's definitely it. It coming on and off of hospice is definitely an option.
But if someone is doing that on the regular.
Right.
[00:27:09] Speaker C: Obviously you can't be hopping on and off all the time.
[00:27:12] Speaker A: Again, like you might qualify medically, but what is that intention? What are your goals? Because if you keep coming off of hospice to seek hospitalization or treatment, is your goal really for comfort, is your goal really hospice care?
[00:27:28] Speaker B: Right.
[00:27:28] Speaker A: Hospice isn't looking to limit someone's life or to tell someone what they have to do. But hospice is a choice.
And just like it's a choice, you also do need to get this wonderful career where you can talk to a nurse, not wait for a doctor's visit. Those things you're giving up, those diagnostics you're giving up. A lot of times you might be giving up certain medications.
You know, we always want to manage things that make you uncomfortable, like high blood pressure. We're not going to take someone's high blood pressure medication away if they're routinely running higher blood pressures.
[00:28:08] Speaker B: Right. And that. Actually I'm kind of jumping on your questions, Andrew, but we had that question about vaccines for my mom that, you know, we get our yearly call from CVS saying it's time for her flu shot or her Covid shot or even pneumonia. And then that was a question. Well, wait, vaccines are preventative. If you are in hospice, can you get a vaccine?
[00:28:30] Speaker A: Yeah, we've got plenty of patients. We just. They tell whoever's administering the vaccine that this is not related to hospice.
So they bill as a non related expense.
And it's just a little modifier. If someone is a biller out there, it's a GV or a GW modifier that indicates that it's not related to the hospice diagnosis.
And we do have people who still get podiatry oh, right.
You know, while being on hospice without having to revoke from care.
So like I said, that might be podiatry, psychiatry.
You know, other types of specializations where we typically don't have people seek specialty care would be those really high test kind of specialties. And also things that are related to the hospice diagnosis. If you are on, maybe on hospice because you have congestive heart failure, you're not going to see your cardiologist anymore. If you come on to hospice for cancer, you're not going to see your oncologist anymore.
But again, you still might be seeing your psychiatrist or a psychotherapist or podiatrist or. I don't.
Dentists, you know.
[00:29:59] Speaker B: Right.
And do you ever have patients who time out of hospice, I mean, who are in it for such a long period of time that they're no longer qualified?
[00:30:09] Speaker A: Well, it's not so much a timing out. It's based on someone's physical condition and wants.
So they might come off of hospice because they want to seek more aggressive treatment or I want to back up a little bit to the qualifications. Part of the qualifications is that there need to be two physicians who agree that someone is appropriate for hospice based on a six month prognosis. People, this is where people get confused.
[00:30:39] Speaker B: Yes, I agree this is a confusing part.
[00:30:41] Speaker A: The six months is just. These physicians are saying, I would not be surprised if this person's disease follows a natural course.
I wouldn't be surprised if this person died in the next six months.
However, some people are. We all have our own course of life, right?
[00:31:01] Speaker B: Right.
[00:31:02] Speaker A: Someone might be continuing to decline at a very low level and be on service for much longer than six months.
So there are times when someone really reaches a plateau or maybe even starts doing better because they. Maybe it's because they're benefiting from the increased support.
Maybe we've managed their symptoms and. Or maybe just something has happened within their body that they are doing better. You know, we might see some, a patient with dementia who really levels out.
Maybe they came onto services after a hospitalization where they were really debilitated and now they're back home and things are normal. They're eating well. They haven't had other hospitalizations that have harmed their ability to get out of bed and do those things.
So we sometimes do have to discharge them for what we call extended prognosis.
[00:32:08] Speaker B: Interesting.
[00:32:09] Speaker C: What's the longest you've ever heard of anybody staying at hospice? Is there a record out there?
[00:32:14] Speaker A: I don't know.
[00:32:14] Speaker B: We might beat it.
[00:32:16] Speaker A: I think on one of my previous, another hospice I was with, we had someone for about three and a half years.
[00:32:21] Speaker B: Oh, wow.
Right. And we do notice that that's been a factor. Rebecca, our nurse comes and does like a six month checkup with the doctor.
[00:32:31] Speaker A: So initially when someone comes onto services, Medicare does recognize that increasing support and symptom management might make someone do better.
So.
[00:32:42] Speaker B: Right.
[00:32:42] Speaker A: It gives us a little bit, a little extra time to before we reassess their hospice eligibility.
And that's called recertification. So initially there's a 90 day period, followed by another 90 day period and thereafter it's every 60 days.
[00:32:59] Speaker B: Okay.
[00:33:00] Speaker A: We need to be documenting that there is some decline. Whether that's cognitive, whether that's, you know, we're looking at their weight or we're measuring their arm circumference.
And what that does is that gives us an idea of. Because sometimes people won't have significant noticeable weight loss, but maybe they're, they're losing muscle.
[00:33:22] Speaker B: Right. She did mention that was a conversation we had when I was there last time that I noticed my mom looks thinner and she said, oh, I'm going to bring the tape measure next time. So we're going to start doing some measurements for her, which I thought was fascinating. I hadn't really thought about that. Now you mention Medicare quite a bit. Medicare covers hospice. That's how it's paid for.
[00:33:44] Speaker A: Yeah, it goes, it doesn't go through currently.
Medicare or hospice does not go through. Like if you have a Medicare supplement, it does not go through that. It goes directly to Medicare.
[00:33:57] Speaker B: Okay.
[00:33:58] Speaker A: So hospice is covered at 100%. So there's not a co pay or deductible for hospice. Hospice also picks up the cost of comfort related medications or those medications someone might be continuing that are related to your hospice diagnosis.
So they cover some medications, but not all necessarily.
Okay.
[00:34:25] Speaker B: Yeah, that makes sense. We, that's what we've noticed with her, that there are certain medications that were discontinued when she entered hospice and that now I get it because it was potentially prolonging her life.
[00:34:44] Speaker A: Not even necessarily that. It's just remember that there's no medication that doesn't bear some sort of risk or some sort of side effect.
A lot of cardiac medications increase the possibility of falls.
Long term antibiotic can be difficult or hard on someone's kidneys.
A lot of medications actually have increased fall risk.
Or if someone has been maybe on blood thinners long term, we want to look at that also and say is the grade of stroke the risk of stroke greater than risk of falls at this point. Because if someone falls and they're on blood thinners, then we're really risking injury, you know, or hastening death. Right. If someone's on there and they fall and they get a bleed.
So those things are looked at with a very discerning eye. We don't just continue medications just to continue them, but that's what a lot of people are doing when we come to them. We have. I've had people come out with laundry baskets full of old medication.
[00:35:56] Speaker B: Wow.
[00:35:57] Speaker A: So the admitting nurse will do a medication reconciliation. That is.
Show me all your medications. What are you actually taking?
What are you not taking?
You know, maybe it's time to do a little clean out.
[00:36:12] Speaker C: Right, Right. Hope. Okay, let's get you out of here on these couple. And I know you also had a lot of the emotional side of hospice and helping families and patients themselves deal with everything that's going on. What's two parts? What is some of your advice about when it's ready to call hospice and then what advice you give families to kind of prepare for that emotional transition and then the process of going through it?
[00:36:43] Speaker A: Yeah. This could be really turbulent for families. Right. A turbulent decision.
Especially if there are members who are thinking that hospice needs to hasten death, that we're going to take things away from someone. They don't look at us. Adding value, adding comfort, adding support, helping with coping, adding services.
Right. Like all of those things are super important.
So I think it's always helpful if someone is having a lot of hospitalizations or if you are the caregiving child of a patient of a person, Are they starting to resist going back and forth to the hospital? Do they have an incurable disease like dementia, like congestive heart failure, copd, pulmonary fibrosis, some types of cancers?
And at that point, I think it's smart, it's often smart in a hospitalization to ask to speak with the palliative care team.
The palliative care team, our palliative care providers see people with advanced diseases at home, even if they're that's focused on comfort, like on symptom management, while someone is also pursuing diagnostics and cure just to make sure that their symptoms are managed so that maybe they can function the best and so that they can take a look their options of care.
Hospice falls under palliative care because it is palliative care, but it's palliative care that has a much tighter focus on comfort and support and is leaving behind the curative focus and leaving behind diagnostics and Rehabilitation.
So families and even doctors who aren't in hospice are very poor.
[00:38:59] Speaker B: Prognosis. Prognost. Yeah.
[00:39:01] Speaker C: Prognosticators.
[00:39:02] Speaker B: Is it a prognosticator?
[00:39:04] Speaker A: So instead of saying, do you think this person would be surprised if they died in the next six months? I would recommend asking, would you be surprised if this person died in the next year?
Okay.
[00:39:17] Speaker B: Interesting.
[00:39:19] Speaker A: And all those other conditions apply, that this person has an advanced disease, that they've been going to the hospital a lot, or they're not wanting more treatment, or they want to look at options beyond treatment.
Then talk to a hospice person about hospice. You know, they can take a look and see if your loved one, if you or your loved one qualifies for hospice.
And then from there, that's that one part. And then the other part is when you hear about what hospice is from a palliative care or hospice professional, does that sound like something you want to consider?
And sometimes we'll meet with a family before you meet with a patient.
[00:40:05] Speaker B: Yeah. My experience among my friends is that it's the families who really need more of the guidance than the patient themselves. Because, yes, you're right.
The connotation of hospice is my relative is days, if not weeks away.
And the real truth of the matter is it doesn't really matter how close or how far that is. The services that hospice has provided, from our perspective, have been a game changer for us, and it's brought us a lot of comfort. And my experience with both of my parents is that we, as the caregivers, are the ones who almost sort of needed the comfort as much as the patients themselves. And that's one of the reasons that we wanted to talk to you today, because I think there are so many people out there who make this assumption. Rightly so. I understand that. But really what we've discovered is that hospice has been a game changer for us, and we feel so fortunate to have these services on board for our mom.
[00:41:08] Speaker A: I'm so glad. Glad to hear that. That's good. And I'm glad you guys are spreading the word as well.
[00:41:13] Speaker B: Thank you.
[00:41:13] Speaker C: We're trying.
[00:41:14] Speaker A: We're trying the scariness out of the H word.
[00:41:17] Speaker B: Yes, for sure. And I think that's.
[00:41:20] Speaker A: That's.
[00:41:20] Speaker C: It's. It's. It's a warm blanket. It's very welcoming.
[00:41:23] Speaker B: Ah, that's beautifully said. It is, for sure. Hope, thank you for joining us today. I hope your dog does not mind that we took you away from caregiving, but we really.
[00:41:37] Speaker C: He was very. He was very supportive.
[00:41:40] Speaker B: I wouldn't notice there, too. But I also, again, we really do feel that it's important for people to understand that the services that hospice provides really make life better. And that's our. Our purpose for sharing this information. And we're grateful that you spent your time with us today to do so as well.
[00:41:58] Speaker A: Absolutely. Thank you. And.
And you guys take care.
[00:42:02] Speaker B: Thank you so much.
[00:42:03] Speaker C: Thanks, Hope. Talk to you soon.
[00:42:04] Speaker A: All right.
[00:42:05] Speaker B: Bye.
[00:42:05] Speaker A: Bye.
The blue skies are with you today.
[00:42:18] Speaker B: And you're going to have a lot.
[00:42:19] Speaker A: Of fun because most of them are doing different days.
Somewhere over the rainbows. Eyes up.
[00:42:35] Speaker C: And we are back.
What a lovely chat with Hope. And again, just as someone else is doing some incredible work, and she has a really interesting wide range of experience within the hospice world. My main takeaway is that I thought we had. We're still. First of all, we're still learning a lot of stuff. It's not like we come at this with, like, hey, we figured it all out because we've been dealing with this for five years intensely. No, there's still discovery that we are encountering and doing this podcast is also helping us learn a lot of this stuff. A lot more details than we realized. And one of the things is, you know, when we had Leslie on and talking to her and getting into the details of hospice, I then I went from this like, oh, I thought it's all just one thing. And the medical and the social and spiritual and emotional support is all tied together, but it's not. It's separate. There's, like, emotional support services, palliative care, I think is how Leslie termed it. And then there's like, the medical side, which is treating the physical patient and dealing with those type of things in a different way. And then Hope comes on and she's like, well, there's also, even when you're doing that, the physical side, you can't just do that, only you're also dealing with some palliative stuff and trying to make sure that the family is okay and that the patient is psychologically okay.
And that's. I guess that's also part of physical care. We don't tie. When we say mental and emotional and psychological support. We don't normally associate that with physical care, but it is physical care. That's a huge part of it. And certainly one of the things that I think we're going to take advantage of that Hope mentioned is for just us to have a talk with her about what we're going through while I think we're dealing with it fabulously. You know as well as possibly can be dealt with. But of course there's probably stuff under the surface that we don't realize that we should be talking about to make sure we're keeping our sanity. And I actually had suggested in our pre chat with Hope, maybe we should have that session here on the podcast.
And she's like, nah, maybe not. Maybe not right away. Let's have our, let's first have our little general chat and then may. And then maybe we'll do that later on. We'll see.
[00:44:42] Speaker A: Interesting.
[00:44:43] Speaker C: But it is, there's like HIPAA stuff. It's like this private stuff and you're not, I don't think, allowed to do that, but I'm happy to sign a waiver if you are. It might be interesting.
[00:44:51] Speaker B: I waive my HIPAA rights.
[00:44:53] Speaker C: Yeah. But so it was great to hear her kind of 360 degree approach to hospice, which makes perfect sense.
[00:45:00] Speaker B: I also really appreciated the fact that so much of it is covered by Medicare. You know, I think that people, when you're looking at resources you're spending, if you are really what, regardless of what kind of care you have for your loved one, we know it's expensive. And so I think that it was really, I mean, you know, mom's hospice care comes with things that we aren't even utilizing. Like they'll bring free briefs. We don't use the briefs that they have because we're in love with the live dry ultimates. We'll talk about that another time. I know we've touched on that already, but I mean, when Rebecca, the hospice nurse comes over, she brings wipes and gloves and all the medication shows up on mom's doorstep and it's really taken some of that tedium out of our lives and also maybe reduce some expenses in that respect because so much of it is covered, which I think is pretty incredible.
[00:45:51] Speaker C: Absolutely.
We continue to learn about all this new stuff that is available and the supplies thing is really, is really a big one because these are things that we were buying before.
[00:46:01] Speaker A: Yes.
[00:46:02] Speaker C: I mean, some of the medications are covered. We should also note that some of the medications are not covered because if you're in that kind of degenerative disease, end of life, hospitality, hospice trajectory, some of the other maintenance medications are. Aren't included, but we, we are still able to get those if we wanted to.
[00:46:21] Speaker B: Yes.
[00:46:21] Speaker C: And our normal refill at CVS and her backup insurance still covers it. So it's not a completely all or nothing thing. They both work together and it was nice to hear Hope Say that a lot of that other stuff, especially in the emergency stuff, is still covered by insurance and that, yes, if mom breaks her leg, we can call the ambulance and take her to the hospital.
[00:46:43] Speaker B: We're not gonna say power through it.
[00:46:45] Speaker C: Sorry, dude, you're in hospice.
[00:46:46] Speaker B: You'll be okay.
I'll get you some morphine. Yeah, no, I mean, obviously. But it is an important piece to remember that even the part about, you know, having to instruct our caregivers about when they should call 911 and when they shouldn't call 91 1, they actually seemed very well versed in it. But it was all important information. It's interesting that I think that so many families, and we talked about this with Hope as well, you hear that word hospice and you immediately think, yeah, no, we're not ready for that. We're not there yet. I was saying to you that I have a really good friend whose father is well into his 90s. He's declining in such a huge way. They're living in, I guess, an independent living situation within what could be more assisted living, but he's declining rapidly. And there's constantly hospital visits or they're running over to help if there's a fall or, you know, this happens or that happens. And I have said to her over and over, you need to talk to hospice. You need to bring somebody in. One, you're going to start getting supplies that you need, but two, it makes your life easier. And also, it doesn't mean that his death is imminent. It means that services are going to be brought on that are going to help you, your family members, but most of all, him. And she's really ready to do it, but her siblings keep saying, no, no, no, no, no, we're not ready for hospice. So I think it's important for people to hear that, yes, we have a vision of what hospice is, but really there's so much more to it that while it may be thought of as sort of an end of life piece, it's kind of life saving in many ways for the people around you who are scrambling to provide the kind of care that you need, and also just the social, emotional resources that I think caregivers need. And that's one of the reasons that we're doing this pod.
[00:48:33] Speaker C: Well, I have a prediction for the healthcare market that I think is bound to happen, which is, you know, we have this trend of the senior population growing exponentially over the next couple decades. And as the word gets out more about what hospice is and what it can mean, that that emotional reaction of, no, we're not ready is going to shift the other direction. I predict that, like, more and more people are going to start using hospice earlier than later, and there's going to be this demand to get into hospice, and then people might be like, we can't take you yet because you're not ready. There's going to be a shift, and I think that's going to happen. So I don't know how to buy hospice stocks, but get on them right now.
[00:49:13] Speaker B: My God, I don't even know what to say to that. I think we should say goodbye.
[00:49:18] Speaker C: That's a great idea.
[00:49:19] Speaker B: That's a great ending. Indeed, Indeed. I'm using all your catchphrases today.
[00:49:24] Speaker C: All right, kids, well, thanks for listening.
[00:49:27] Speaker B: As a reminder, if you have a story to share, comments, suggestions, anything that you think will be helpful for our podcast community as caregivers who are always looking for advice, please feel free to email
[email protected] and just a reminder, I'm.
[00:49:47] Speaker C: Not a financial expert or planner, so all rights not reserved for any bad advice I just gave. But in the meantime, thanks. Here's mom to play us out.
[00:49:57] Speaker B: Yeah, it was bad advice.
[00:49:59] Speaker A: I disagree.
[00:49:59] Speaker C: I think that was good.
[00:50:01] Speaker B: But hospice isn't for profit.
[00:50:03] Speaker C: Well, I don't know how to do it. Just do some research and try to figure out what are the companies that are involved. And buy. Buy the glove company that serves hospice or the. The wipes company.
[00:50:14] Speaker B: I see the diaper company. I see what you're saying.
[00:50:17] Speaker C: The financial guys and ladies can figure that out.
[00:50:19] Speaker A: Okay.
[00:50:20] Speaker B: I wonder if they're listening to us.
[00:50:21] Speaker C: We're keeping this. We're keeping this. I haven't stopped pressing record yet. So for everyone who stayed on for this bloopers section.
[00:50:28] Speaker B: Yeah, we do like the blooper.
[00:50:29] Speaker A: Our blooper reel.
[00:50:30] Speaker C: We'll see you.
[00:50:31] Speaker B: Okay, bye.
I get a kick out of you.
[00:50:43] Speaker A: Always.
[00:50:44] Speaker B: You're all I want to be.
So somewhere over the rainbow skies are.
[00:50:58] Speaker C: Blue.
[00:51:01] Speaker B: And a quick out of you always believe in your day.
