Joel

Hey, everybody, and welcome to the Senior Reset podcast. We are talking about resources, education solutions, entertainment, and training for the senior community and their families. We have a great setup for you today. I’ve got my amazing co-host, Nicole Farmer, and I have Joan Ward is the director of nursing for Signal Health Group. She’s a registered nurse and certified in hospice and palliative care, which is a pretty big deal. That’s a hard certification to get.

And so, she is going to educate us today about hospice. This and everything we need to know and the myths that are out there surrounding this kind of scary word are important because, I think, by the time we get done today, we’re going to find that it’s not so scary and there are a lot of benefits to be had for people who are in certain situations. Thanks for joining us, Joan.

Nicole

Yeah. Thank you, Joan.

Joan

Thanks for having me.

Joel

So, I guess I want to throw you a softball to start because some people might not even know what hospice is. Now, can you just talk to us a little bit about what is Hospice, and why people need to know about it?

Joan

Hospice is a service that’s provided to those who have a terminal condition. They have decided not to pursue any more treatment for that condition that they have, and they just want to live out the rest of their lives comfortably. 

And so, it’s a team of people. There’s a physician, a nurse, a social worker, a chaplain, and a certified nursing assistant on the team. There are other types of therapies available if needed, but that’s the core team. And they come out to your home, wherever you live, to help provide you with comfort and care. If you have symptoms, they’re going to be managed, and you’re going to not have to run to the doctor every time there’s a problem; we come to you in the home and provide the care and it includes physical care but also emotional and mental care—all the things you go through knowing that you’re coming to the end of your life provides you with The spiritual, social, and physical It’s not just physical; it’s everything. It’s up to the whole person and the family to help them. Understand what’s going on and what’s happening and help them to get through the process as well.

Joel

So, I suppose the first myth question I want to ask you here is because it sounds like you already started talking about and this just kind of came to me, but in my family, the people that have used hospice have always been in a facility. You know, it seems like once people get to a certain point, they get put into a senior care facility, and then hospice is administered at the facility. It sounds like what you’re talking about is that hospice can happen in your own home. You don’t have to be separated from your family. In a facility.

Joan

Exactly. Hospice can be wherever you live; if you live at home or in your regular house, we come to you there. If you live in a facility for assisted living or independent living, we can come to you there. If you live in a skilled nursing facility. The hospice can come and care for you there. If it’s wherever you live, whatever your home is, it can be provided.

Joel

And how does the determination get made that somebody is ready for hospice?

Joan

The physician reviews the medical records and looks at the diagnosis, and there may be multiple diagnoses that all kind of create the prognosis, but there has to be a decision that if this disease progresses as expected, this person could have six months or less. I’m not saying that they’re going to go in six months. Some people live longer, but the main thing is that the problem that they have is not curable, and they’re not going to get better from it. They can feel better because their symptoms are managed, and they are comfortable. But the disease is still going to progress and cause them to become worse. That just has to be decided that this is where you’re at and in this disease process and that you’re not pursuing any treatment.

So, if it’s something like cancer, as soon as you’re done pursuing chemo or anything aggressive, you can qualify for hospice. If you still have the cancer and it’s not going to go away, then you can qualify for hospice. You just have to be done with aggressive treatment at that point.

Nicole

Now they can. Still, can I ask a question that comes up? Sometimes they can still take medication for certain things. It doesn’t mean that if they decide they’re ready to go hospice, they’re just taking them off everything and they’re done. There are still medications they can take for ongoing illnesses. To manage, correct it.

Joan

Because there are so many medications that are no longer helping anything, the only medications that are being reviewed are medications like Alzheimer’s medications for memory, now people don’t know any family members. They don’t remember anything. So those medications are likely not of any help, and you’re just giving them pills that could cause side effects that they don’t need. So, you’re just looking at what’s not helping and keeping the things that are. 

Nicole

If they get sick, are they still given antibiotics and things like that? They get a cold or a Symptom nut because that was, that’s.

Joan

Yes, that’s it.

Nicole

Just one of the concerns and one of the questions: I mean, I work in-home care, and we refer people to hospice all the time. And one of the concerns is that they won’t be able to have anything; they’ll, you know, kind of suffer I guess through illnesses. But they wouldn’t have been allowed. To have anything. That would make them Better, I guess, because we’re told. That they have to stop progressive treatment, right? So, I guess the thing that comes up sometimes comes up. They’re afraid of that.

Joan

Yeah. No, the treatment would be for the disease that’s eventually going to take their life. You will be in command of the situation symptoms, but if somebody has a urinary tract infection or respiratory infection, they’re going to get antibiotics. They’re going to get whatever they need to be comfortable and help that infection go away.

Nicole

Right, right. Away. Right. Makes sense.

Joan

We’re not likely to go full bore with IV antibiotics or, you know, IV fluids. Things like that are a little more aggressive, but even that’s on a case-by-case basis.

Nicole

Yeah. Thank you. I was wondering.

Joel

So, if somebody I guess the next question is, you know, you mentioned that a doctor can make that determination, but you know if a senior is getting older or if their health is deteriorating. They may not want to talk to their doctor. They may not think that they’re as bad as they are, you know? Can the family do something to try to initiate an evaluation? Does the doctor have to make that call?

Joan

No. Anyone can ask for a hospice evaluation. Family can be the one to Call the hospice and say, hey, we think we’re at that point. We feel like we might need hospice. Can you come out and, you know, do an evaluation? If the patient can self-refer, then we just go to our medical director to get permission and get the orders to complete the evaluation, and then they’re the ones who determine if the patient is appropriate or not. And then you know. We just need medical records to back it up. But no. Anyone can call and say, I think I need hospice.

Joel

And then, just to go over, if somebody has a deteriorating medical condition, it’s not getting better. My doctor says they have six months or less to live, and they’re not aggressively seeking treatment for that condition no matter what. It’s like cancer is a great illustration; you know that, but it could be a lot of other medical conditions When they enter hospice, they’re Going to be seeing, especially doing. It’s at home, you know. It’s the home-based thing we’re talking about. They’re going to have nurses check on their physical condition. They’re going to have people coming in and, you know, possibly working with spiritual counselors or volunteers to come to the house. Do you know what kind of things you do during those hospice months to try to make someone’s life better? You know, you’re not trying to make them physically better. But the whole goal is to make their lives better for those last couple of months.

Joan

Well, we start with the nurse, who will be out weekly at a minimum and more often if needed per patient’s needs, so will all be determined by the care plan. How often do you get with the patient and the family? You find out what their goals are for those months that they have and what they would like to be able to do or what would make them happy.

So, say you have somebody who says, I just want to go to church. Every Sunday, but I’m so short of breath I can’t make it. OK, so one of our goals would be to manage that shortness of breath so that they can get to church every Sunday and do what they want. Do it even if it’s something simple. So that’s just one example. There are a lot of different things people would like to be able to do, or maybe they’re just so exhausted they haven’t. They can’t enjoy their day at all.

So, we’re going to gather all that information and find out. What is that’s important to them is that they want to improve because we can make people more comfortable physically, we can’t stop the disease, but we can manage those symptoms along the way.

And so that’s where the nurse comes in, and she communicates with the physician. The physician doesn’t come out, but if they do, they need a face-to-face and that’s another whole area. We do that by phone with the physician, but the nurse is constantly in contact with the physician, and we’ll get the orders from the medical director. Make sure that the patient’s needs are met and that the symptoms are managed.

And then you have spiritual counselors and social workers for other needs like maybe they just want someone to talk to about the spiritual side of things. And then the social worker has helped with, like, things like funeral arrangements so that you have that stuff. Would figure it out and set it aside so you’re not trying to decide that at the end. And then the certified nursing assistant—I mean, there’s a lot more that a social worker does besides that, but that’s just one. For example, the certified nursing assistant comes out and provides personal care, such as bathing, and helps teach the family how to do some of those things because they have to be the primary caregivers. And we’re not there.

So, we do a lot of educating, a lot of listening, and we try to put ourselves. In their shoes and see where they’re coming from because not everybody has gone through having someone you know at the end of their life and they don’t know what’s ahead for them, we try to get into their world and help them see what they need for each one. It’s not a cookie-cutter thing for everyone. The services are all there for everyone, but everybody’s needs are going to be different.

Nicole

And before coming into home care. I thought hospice was a very scary thing. I didn’t know much about it, but then I learned a lot more about it, and I think it’s great for the patients. But on the family side of it, there’s so much support there that I think it’s overlooked and underappreciated. Probably in the hospice field, they’re there for the family too.

Joan

Yes, because you never want someone to walk away from the situation at the end when the patient passes. Oh, I feel like they didn’t do enough, or they should have done this, or they should have done that. You want them to feel good about the whole experience, that everything went the way it should, and that they did all they could. Their grief process will be a whole lot easier knowing that they did everything they could do, and so we do our best to try to help them understand that that’s what they’re doing and not to have any ill feelings or any guilt because we can’t control it.

Nicole

And to have a medical professional in there telling them that, I’m sure, has to make a world of difference.

Joan

Very important.

Joel

So, you know, trying to figure out where that six-month line is because we’ve gone over a lot of the different benefits someone can get from getting into hospice. You know, there’s actual extra funding that comes in to try to make their lives comfortable in a lot of different ways. But you know, figuring out where that six-week line can be very difficult. Is there, you know, a reason someone should feel nervous about trying to nail that down, or are there benefits to trying to get an early evaluation? Maybe get evaluated earlier rather than later.

Joan

Well, there are benefits to knowing a little bit sooner because it’s OK. I guess that’s one myth. I’ve had people recently ask me if this hospice will just discharge at the six-month point. And I was like, no, hospice does not; that’s just a guide for the physicians, and with each diagnosis, there are so many different things we look at that give us indicators of how much time they might have.

So, we have what we call LCD guidelines that, for each disease process, tell us what to watch for, what to look at, and what’s happening with this patient, and that kind of gives us an idea that we’re in those six months. Some people might be on for a year or a year and a half, but as long as they’re continuing to decline and their condition is worsening, they’re still going to qualify for re-certification.

So, we just keep recertifying because they’re continuing to get worse. We’re just doing a good job of keeping them comfortable and managing their symptoms, and so sometimes people live longer because they are being so well managed. But then, at some point, you know the disease is going to take over.

Joel

So, what happens? I mean, if you want to get evaluated, is there a cost involved? Like, is there anything negative to try to get evaluated, and maybe you’re not there yet?

Joan

No, I’ve gone on many evaluations for people who either weren’t quite ready medically or were still pursuing. Or they feel like it’s too soon, and they’re probably appropriate. They’re just nervous about taking that step because of the stigma … that must mean I’m dying. Some people just need more time. Sometimes I’ll go out and visit people three times within a few months just to check in on them until they feel more comfortable. And then they say, okay, I think we’re ready now. I mean, it’s not something you can rush anyone into. They have to feel good about the decision they’re making. But definitely, I think if people have more information and realize that, just because you’re coming to hospice doesn’t mean you only have a few days. A few weeks, I mean it just means that you get to get comfortable. And have a better quality of life for the next 6 months or longer.

Nicole

Hunger, that is the biggest stigma with hospice is that it equals death, and it’s just for most people. That’s what they hear when you say hospice.” Well, I’m not ready to die. OK, well, you don’t have to. We had a lady in hospice for two years. We worked with her on our non-skilled Side, and she had hospice come in, which we supplemented with waiver services. She was on it for two years. Yeah. And she was. Comfortable for those two years? Yeah, yeah.

Joan

Yes. And that’s not uncommon.

Nicole

Medicine was taken care of, and families were given breaks when they needed them. They knew who to call when they needed that support. And you just don’t have that with your regular doctors. You can’t just call up a doctor’s office and they’re going to come hold your family’s hand while your loved ones are passing in hospice. I’ve known several. Hospice nurses over the years, and you know. My hat is completely off to you, Joan, because you have to have a special heart to do hospice like you do. And I’ve known amazing hospice nurses who go out in the middle of the night and hold family members’ hands while they’re there. To take their last breath, our most recent administrator, who has since moved on, was a hospice nurse forever. And these stories are amazing.

Joan

Right. She didn’t have to go to the doctor. She didn’t have to run out for anything. 

Nicole

And it’s probably one of those bittersweets, heartwarming experiences that’s so hard to carry around with you, but it’s such an honor to be able to be there in someone’s last moments.

Joel

Well, you still might someday.

Joan

Yeah, I could probably write a book with a lot of stories.

Nicole

Yeah. Constant perspective. Yeah. Yeah. Amazing.

Joan

Yeah, I can. I can say I’ve learned more about life through the process of death and about what’s important in life and what matters. It seems crazy that we’re at the end of life, but it does bring up what’s important in life when you’re looking at the end.

Joel

Yeah, it’s not something I’ve experienced. Yeah, but I can imagine. Even though I don’t quite relate. You know, but going back to the evaluation process, if somebody gets evaluated and it turns out that you know they’re not ready for hospice, are there other benefits to the evaluation? Do you find that maybe they’re eligible for other services that could make their life better while you’re doing the evaluation? 

Joan

Yes, yes, you know us. With our company having home health, hospice, and PCA services, we often have PCA hospice needs. At the same time, maybe they’re not quite ready for hospice, but they still need some help. And so, you know, we can explain to them that there’s a PCA. Services that can help them in the meantime, and maybe later down the road, things change, and they do need hospice or home health care for other skilled problems.

So yeah, it’s the evaluation isn’t going to hurt you one way or another. It doesn’t cost anything. It’s just going to educate you more. I mean, I’ve had patients. I’ve had to say no. She’s not appropriate for it; you know, the disease has not progressed much yet, so maybe in another year or so six months have another evaluation, and then there have been times when other hospices come along and bring that patient on. But. I know in my heart they were not ready; they were not appropriate, and that’s not doing justice to somebody who Isn’t there yet, and they’re being treated like they are, so you know that’s why you have the evaluation to say yes or no. Well, you’re not. But we’re going to take you anyway because then you’re doing justice to that person.

Joel

Now, what’s the drawback of, say, a hospice company accepting you to hospice when you’re not ready? You’re in pretty bad shape, but you maybe have a year and a half or two years left. But they take you on anyway. What’s the drawback to doing something like that?

Joan

Well, if you get someone like that, that’s probably a hospice that’s not strong in what they do, and they’re not going to treat that person. I mean, they may need treatment for something or medications that hospice doesn’t cover, and they’ll be treated differently. They’ll be treated like they are in their last six months and maybe these things that you probably wouldn’t need for somebody who has three to six months. You may require someone who has been on medications for a longer period to soon is not a good thing. And you know, we’re very careful about that. 

With hospice, we, like Nicole was asking, are you just going to not give him the antibiotics? Are you not going to give him the if they still have high blood pressure? Have other issues that are not the ones that are going to take their place. We’re going to keep giving them the high blood pressure medication, we’re Not going to stop. You know them from getting everything that’s managing their symptoms. But if you get hospice care, Is going to bring somebody on regardless of whether or not they’re appropriate, which should not be happening, but it does. They’re not going to be treating them properly, and so they may end up on medications they shouldn’t be on yet. And it’s just dangerous. 

Nicole

Yeah, the thing I see with it is just sitting back from not even being in hospice and just listening to you talk is unethical. So that’s a whole concern in itself. And then two, you’re saying they’re going to treat them like they have six months left to live.

So maybe they will cut off some of their progressive treatments or more aggressive treatments that they could still be having. Also declined sooner, where they maybe had a year and a half left, and now, they’ve cut down their doses and they’ve treated them like they have six months, maybe they do.

Joan

Right. So, you just have to make sure that when you’re looking for a hospice, you ask them what’s making my mother appropriate and make them tell you why they think you’re appropriate. Find out what is the reason that she’s, you know, and what is the benefit of it? Of us, of us signing her on to hospice, you know, see if they can tell you; if they can’t tell you, then you probably have the wrong people. 

Nicole

Honestly, Joan. I love that I learn something new every time we do these podcasts, so I’ve been doing home care for 15 years. In this medical field, I learned something new every time. I honestly had no idea there were hospice agencies out there that would admit someone who wasn’t appropriate. Now I know about home care. Sometimes we’ll admit when they can’t stop, or, you know, maybe make them. They’re not appropriate for home care. But I didn’t know that someone would just come along to pick up a number and be like, Cool. I’ll take you on and maybe completely change the course of someone’s life. That’s scary.

Joan

Well, hopefully, there aren’t very many, but I have heard stories from people who have gone through that and in that one situation, I told the family she was not appropriate, and then I found out later that somebody else came along and swooped him up and brought him into service.

And so, I spoke with the son and told him what to watch for because I was appalled by that. They would do that. I hope it doesn’t happen very often, but it does. It does happen.

Nicole

No, but for our family members who are listening and who have loved ones for me, they could have to face that one day. Joal, we have you know, parents like that. It’s good to know that you do have to watch out for those things because I would never imagine that someone would make someone. Would take someone on a hospice case like that that wasn’t ready. That’s crazy to me.

Joan

Right. And you don’t want that. There are a lot of hospices out there in this part of the world where I am in Las Vegas. There are a lot of hospices, so there’s a lot of competition for the business, which is sad to say. So, there are a lot of choices, and people don’t always know they have choices. They can choose who they want. That’s what they need to do. They need to compare. They need to ask questions. Find out why are you here. 

Saying this, that this is the right thing for my loved one, and see if they know what they’re talking about, and you know, don’t just get somebody who says, oh, well, you’ll get more, you’ll get supplies, you’ll get this, you’ll get that. They’re not talking about the disease process. So, they don’t understand the process.

Nicole

Well, and that’s the truth. My aunt passed away last year, and she was at a place where she could have probably used hospice, but she was still fighting. She was actively dying in the hospital, and it was just a matter of time. But she was not ready. To accept that she wanted lifesaving measures, she didn’t want to be a DNR, but they brought hospice in any way. Well, my family waited. For me to get there. Because of my background, I asked questions, and I asked the regular nurse, and she told me I had to wait for the Hospice nurse.

So, the hospice nurse comes in, and I’m asking all these questions, and she has no answers for me. Like, what medications will you be stopping? What can we expect? What are you going to do for her? And she was, like, pretty much telling me she didn’t have any of the answers. And I’m like, But I’ve been waiting for, like, an hour. It was just a horrible experience we had. Not signing off on hospice. We just waited it out.

Joan

And that’s what makes me sad because I think there are probably more of those situations. And so, when somebody could have a good hospice experience with a different company, maybe, and then those are the examples that they think, Oh, gosh, they’re all that way. But we’re not.

Nicole

There was kind of a comparison made, like a euthanasia kind of thing about the end of life, and the way that it was worded in the way that it was said should have never been discussed, like about a family member. Was just an awful experience.

Joan

Yeah, and now that’s what makes me sad. That’s why I say people should not be afraid to ask questions. And if they don’t have the answers, then they’re probably the wrong company. And you want to try talking to some others.

Joel

So, I want to ask on the funding side. We talked about how someone can enroll in hospice, and the goal is 6 months. But they could roll out of hospice if a new treatment becomes available that they might want or if their conditions start to improve for whatever reason. Maybe they lose some weight and start feeling better. You know, whatever it is, they can roll it out after they’re involved. And they can roll back in at a future date. And you said that there are people who have been on for, you know, a year. Two years. How does the funding work for hospice?  When do you start extending past the six-month mark that it’s intended for?

Joan

Mainly Medicare. Most people have Medicare. If they’re under the age of Medicare, then they might have regular insurance that covers it, but it goes by certification periods, and there are 290-day periods, and then there are sixty-day periods indefinitely after that. 

At the end of each of those periods, you recertify for the next. As time goes by, the cost, or the payment, I should say, gets a little bit less. Or when someone’s on for a longer period, Medicare still pays, but it gets less. But the thing is, you can come off any time, you want. If you change your mind and say, OK, I want to revoke, this isn’t for me. I want to see I seek aggressive treatment, and you can sign a paper and be of service. Right then, right now. And then, say, two months later, you want to get back on again. And you’re still qualified. Then you go into the next class. Period. You, lose the rest of that certification period and go on to the next one. 

And then there are also times when patients improve because sometimes, we don’t have a crystal ball. We’re not perfect. We think they’re ready for hospice. And then we get them so managed that they start to improve. They can’t show that there’s any more decline.

And so, then we have to sign off service temporarily, and then usually eventually we get them back because the disease is progressing much slower than expected. So. Those are those other cases where Hospice has to sign them off, and then they’re available to come back later once they’re approved again.

Nicole

So, they discharge in the middle of a certain period, like in the middle of 45 days into 90 days. They lose 45 days that you’re Going to get paid for, right?

Joan

Yeah. Well, yeah, we’re not going to get paid anyway because they’re going to come off. But when they go to sign on again, they have to go into the Next cert period. So, for about 45 days.

Nicole

Just disappears, yeah.

Joan

It does

Joel

So, my question is, if you’re a hospice, say you mentioned that you evaluated somebody and thought they weren’t ready, and then another hospice got a second opinion and said yeah, we’ll take you on and give you services if they’re not ready, it sounds like the funding is … the first six months, you have the most funding for medications, social services, and all kinds of other things. Can make your life better. 

After that six months, you start getting less and less and less, so if somebody takes you on too early, say you’re like a year, two years, or three years too early, which it’s really hard to tell sometimes. They could end up when they need the most funding. Not there anymore. And that’s kind of the risk of getting into a hospice too early or taking somebody on, that’s one of the risks.

Joan

Well, that’s true. and I’ve seen that. I was approached to take a patient who had been in hospice for five years, which I’d never heard of. I’ve never heard of that. And then suddenly, they decided they were going to take them off service. Well, at that point, I think we probably weren’t getting paid. I don’t know exactly, but I’m probably not getting much if any, free service. They should have been obligated to if they kept them that long because now the patient was probably at a point where they were appropriate for hospice five years ago, they were not.

And so, it’s a disservice to that patient because now their benefit is used up. Other hospices can’t take them because, you know, it’s free care. But you know, a big hospice could do it because, you know, it doesn’t hurt to do pro bono once in a while and help somebody out. I mean, that’s what we all should do on occasion. 

You know it was a situation that could have been avoided had they not taken her on so soon. And you know, I don’t know the story behind it. I just know the situation was that they had been on for five years, and I’d never heard of anyone being on for that long.

Joel

So, I guess one of the myths out there is that you know, you kind of stuck with the hospice agency that reaches out. You know, if you’re in a hospital and the hospital says you need hospice and their hospice nurse comes down, one of these might be that you have to talk to that hospice nurse. 

You certainly can, but it sounds like you can also get a second opinion, ask questions, and decide if you’re comfortable. Because of this, it sounds like not all hospice agencies are created equal. So, what are some questions that people could ask to try to figure out if they are talking with a good hospice or whether they need another opinion?

Joan

They kind of had to go with their gut in the beginning and see if they felt like they could talk to this person. Are they rushing them? Are they trying to hurry up and get them to sign on the dotted line? Are they? Are they taking the time to explain everything that you’re asking them and, you know, most of the time you’re getting a marketer? It might be an RN. It could be a nurse or LPN. It could be a nurse liaison, but it might not be. It might be nobody medical, just a marketer that you know has been trained on. Hospice. But they’re not going to have the medical answers for you.

So, I think you should ask to speak to one of the nurses so that you have an idea of who’s going to be coming out and who’s going to be doing the care. Am I going to get the same nurse every time? Am I going to have someone different every time? Is somebody going to be available in the middle of the night when I need help? You know those are all important things because those are what the services are supposed to provide. The continuity of care is huge for a hospice patient. You want to be connected to them. They start to feel like we’re part of their family, so if they’re getting a different person every week, the care isn’t going to be what it should be.

Joel

Other places where people can find reviews for hospice organizations are if they go to Google and look them up, and they can also see reviews from family members.

Joan

Some of them, yeah. Some of them are reviews. That’s one way. But I think you just have to ask more questions and compare. I had to go out on an evaluation for a patient who was in an assisted living facility. That, the daughter said, I’m tired of speaking to marketers. I wanted to talk to the nurses, so they set her up with four of us from four different companies to talk with her to find out who she felt most comfortable with.

They did choose me, so I ended up getting that patient, and she still texts me. Oh, periodically. And that was 5–6 years ago. So, people don’t forget; you know, they remember those who took care of their loved ones. 

That was the way she went about it. And I said, Wow, that’s pretty cool. I’ve never had anyone do that where they, you know, talked to four different nurses from four different companies, and then they could make the decision who they wanted based on who you know is going to be coming out and taking care of the patient, you do have choices. And I think that gets It’s misconstrued when they’re in a hospital because the hospital has certain people that come in, and they’re supposed to give you at least three options. But you might live in an area where you have a whole lot more than that to pick from. You don’t have to choose from those three either. So, you just have to shop around and know that you have options.

Nicole

That is the biggest, biggest, most important thing to educate on I believe across the board, Choice I mean, so many times they get put in a hospital and they just get all this paperwork thrown at them, and it’s happened so many times. The family members mine and Friends I was aware I had He’s a service coordinator here at one of the independent living facilities. I’ve worked with him for years. His mom wanted us; she wanted our home care agency at Signal and They said they came in and gave her paperwork, and they were like, OK, maybe it’s all set up with the hospital company. Have fun, you know. I sent her home. He’s like, Wait a minute. Like we want Signal.

And so, he was there and was able to advocate for her and speak up for her. But so many people, they just get discharged, and they’re like, well, I don’t know, they said Hot. Somebody’s coming out. I. Don’t know. I mean, they’re just They’re just told what to do. Do so, letting them know they have that choice. I try so hard to educate them before they get there. That point is on my side of things.

Joan

And if you get somebody and you’re not happy, you can transfer to another company. It’s that you’re never stuck. It’s always an option.

Nicole

Right.

Joel

So, how would someone do that? 

Man, I guess following up on that is, how do you know if you’re stuck with a bad hospice provider, and if you realize you are, how can you go about the process of changing a hospice? Is it as simple as, you know, interviewing another hospice and saying, you know what, I want to go with you guys. And then they handle the paperwork. How does that work?

Joan

Pretty much you. If you’re uncomfortable and feel like you’re not getting what you’re supposed to that or they’re not showing up or, you know, for whatever reason, when I, you know, say I call and I say I need help because something happened with my grandpa and they’re like, acting like, you know? Oh, they’re a bother, you know. And they’re feeling like nobody wants to follow through and be there for them. Or you know. They’re not getting consistent care from the same people. Whatever it is that makes them uncomfortable, then they have the right to look elsewhere, and you just call another hospice and say I’m getting hospice care right now with this company. I’m not happy. Would you come out and talk to us and see what you think? And then you, of course, do the same process. You still have to look at the medical records and make sure that they’re appropriate because just because someone else brought them on doesn’t mean they’re appropriate.

So, you still have to do your due diligence and make sure that they’re right for hospice. Because who knows? Maybe that’s why they’re complaining. Maybe they’re not really hospice patients, but that’s an easy thing to do, and then it’s just a matter of paperwork and having them sign. You notify each other. Hospice that they’re transferring and getting their records, and they just come together and switch over. 

It’s very easy for the patient. The equipment gets switched over because we provide hospital beds and different things, so then that would get switched over as well to the company that, you know, the new hospice is taking on. So, all of that can be coordinated. It’s not difficult.

Nicole

And a good hospice agency would be the one to coordinate those things. You correct.

Joan

Yeah, yeah. They will usually give you time. The other hospice won’t just pull it out from under you and leave you on the floor. You know, they’re going to give you time to get another bed in there and switch the patient over.

And so, you know you’re never stuck unless you live in a very, very small town and there’s no other company. Then, I guess, you don’t have as many options.

Joel

Did you have anything that you might want to say to family members out there who are looking, you know, and realizing maybe that their family member might need hospice? Do you have any words for them? Before we wrap up today.

Joan

You have to be comfortable with the decisions that you make and not be afraid to ask a lot of questions. There are no bad questions. You need to feel good about what you’re doing, and then once you make that decision, our goal is always to help everyone—not just the patient, but the family, the caregivers, the friends, whoever’s taking care of them—feel confident about their role and that we are in there providing that support for all of them. 

Even the neighbor across the street who comes in and checks in once in a while, anybody that’s involved and cares about that patient you want them to feel supported. That’s something you should be getting. We want the patient to ultimately have a dignified and peaceful passing, and we want the family to feel good about it because you can have a positive experience in the most difficult time. Of your life. And losing someone is so difficult.

But you can walk away from it and know that it went well, they went peacefully, and you did your part, and then your grief process is going to be so much smoother, and things will also go the way they’re supposed to. You can’t control everything. I’ve had people wait in the room. For days, and I can’t leave them. I can’t leave them. And then I tell them, well, they might be waiting for you. To let you know. Then one day they get up, go in the kitchen for something to come back, and the patient’s gone. And they said, Oh. I’ve been waiting all this time, and … that’s how it was supposed to be. So, you know, we just don’t get to control everything.

And the patient might leave on their own because they feel like it’s too hard for them. The loved one to go through or, for whatever reason, they just felt like they needed to be by themselves when they exited the world. But just know that everything goes the way it’s supposed to, and we don’t have as much control over things as we think we do. And it’s OK for it not to be perfect. But as long as the patient goes peacefully and comfortably, however, that ends up being It’s alright. You don’t. You don’t have to feel like you did. Didn’t do something right. That’s the thing. And then, after hospice, there’s bereavement support.

So, you have a whole year of support, if needed, to help you through the grief process. And some people use it, and some people don’t. I would recommend that you at least use Look into it and see if there’s anything that would help because there are different ways they can help. So, I guess that’s about it. All I can say We just want people to feel good about the way it went and have no regrets.

Nicole

Well, I think you’re amazing, Joan.

Joan

Thanks!

Joel

So, if I were to I do too. It’s a special type of person that can help families with you. Yeah, I guess to try to summarize a lot of the things that we talked about today, you know when we first started talking about what hospice was, we said that it was that or that it was, you know, ideally helping someone in their estimated last six months of life. But it doesn’t have to be the last six months. I mean, that’s kind of what our goal is, and that’s where the most funding is. So that if you know make sure that you’re the most comfortable during that period.

But if a new treatment comes out for you or if you start to feel better now that you’ve better managed the pain and the care you’ve been getting, you can go off of hospice and get that treatment. And if it’s not working out, you can always come back later.

There are some benefits if you want to get evaluated early because it might give you a better idea of when that window might be coming up, but you might also find that you are eligible for other services or therapies. Personal care assistant. You know, there are different benefits that you might not have known were going to be available to you that might be available and that you might find out about during the evaluation.

We talked a little bit about how the funding works, about how you get the most in the beginning and, you know, it starts titrating down as time goes on, and that some hospice agencies may take you on early to try to get the most out of a client and how that may be a good disservice to you and that you should talk to someone if you get a second opinion or a third opinion if you need it, and make sure that you’re comfortable with the company that you go with and that you’re the majority and not just trying to access the funding, and that when you do get into hospice, there are some huge benefits as far as the care that you receive, the medications, and having nurses in there on at least a weekly basis taking care of you. And then we talked a bit about, you know, from the family side, how you know things kind of happen the way they’re going to happen. You know, don’t feel guilty about it. All you can do is do your best. That sounds like a pretty good overview of what we discussed.

Joan

It’s a huge subject. It’s a huge subject.

Joel

Yeah, it is. It is a huge subject, and maybe we’ll have you back on again with some data to delve a little deeper.

Joan

Yeah, yeah, it could go very in-depth, but I think overall that’s, you know, and then if people leave questions, we can always…

Joel

Yeah, so you’re located in Nevada. If somebody wanted to reach out to you to discuss So you’re in Las Vegas; how could somebody reach you if they were looking to talk with you a bit about hospice for their family and they’re in the Las Vegas, NV area?

Joan

Our website has our phone numbers and all our information to reach out to us.

Joel

We’ll make sure that gets put in the show notes, and people can reach out to you if they’re in that area.

Joan

Because I do, I do have often, people call me from out of town, and they’ll say my grandmother lives there in town. We’re not sure what she needs, and then I say, well, I’ll go out and talk to her, and, you know, I’ll just visit out just to pop in and see if they’re even somewhat close to needing hospice. But even if they don’t, it gives the family great relief to know that somebody poked their head in and checked on them. And now they have an idea of what they need to do to help them out.

And so, we’re happy to do things like that. We don’t, and we don’t have any problem making a trip over to somebody’s house. See if you know our services might help them, and if not, what? They need us. You know, we can help advise on what they might need. And then the family has a little bit of time to relax because a lot of people live in Vegas but don’t have family here.

Joel

You are a saint. All right. Well, thank you. For coming on and expressing appreciation.

Nicole

Joan, have a good day.

Joan

It. Thank you.