What Hospice Really Means – Part 2
Monica Flynn: Hi, welcome back. It’s Monica Flynn with A Right Place for Seniors here in San Diego. And up in the corner is Eileen Piersa, my associate up there in the North County. And we have a guest speaker who we had earlier, a couple of weeks ago, Nick Del… Now, I always mess your last name up, I don’t know why, Delgadillo…
Nick Delgadillo: Delgadillo.
MF: From Silverado Hospice. And so the reason we’re having Nick on again today is because we work with a lot of hospice agencies here throughout San Diego County and Nick is one of our favourites. And we like to reach out to some different hospice organisations when we get into placement for our families, whether they’re calling us for resources because they wanna stay home or because they’re having to leave their home or the hospital, most likely it’s the hospital, and have to get into a board and care facility setting. And oftentimes, hospice is a part of that care piece as they’re being discharged. And so, somebody doesn’t have to be imminently dying and that death isn’t within days before they’re appropriate for hospice. And so that was one of the reasons we wanted to bring Nick back to maybe address that a little bit more because that’s a really important piece to not only the family, but obviously for the person who is at the end of their life. So Nick, can you just explain that a little bit for us?
ND: Yeah, no problem. So since the beginning of hospice, hospice started off, and there was four or five that was pretty much cancer and heart disease. And now in 2020, we have multiple diagnoses in hospice that are primary diagnoses, and from early onset to late onset. And I always like to have this discussion because sometimes when that hospice referral comes across or that family is notified that a hospice referral’s being made, we make an assumption based upon historical beliefs of hospice, that it means that your loved one is imminently dying. And it’s absolutely not true at all that there’s imminent passing.
ND: We have… Hospice is a… The election benefit period is a 90-day period, then another 90-day period, and 60 subsequent days after that. And as long as that physician identifies that patient to be hospice appropriate throughout that time and we continue to evaluate, the patient can… We have patients that stay on hospice for sometimes a year or two. So… And there’s times patients graduate from hospice and that’s fantastic. If the patient gets better and they no longer are appropriate for hospice, then patients come off of hospice. And sometimes we have patients that are on for a short time. But nonetheless, it is one of the biggest myths, I think, in hospice and in healthcare, that if you get a palliative care consult or if you get a hospice referral for your loved one, that it means that we’re dying, and it’s absolutely not true. So I’m glad we’re talking about this.
MF: The other thing that I have found with this myth is that… So when somebody’s coming out of the hospital, for instance, and they’re going back home and they need some extra support, sometimes, again, family members haven’t been through this a lot, so they don’t even know the right questions to ask. And so, and that’s the value, I think, of somebody like Monica and Mary and I, that we have the background and the knowledge so we could say, “Ask the doctor about, if they can go on hospice.” Because oftentimes, there’s… They can’t do those basic daily needs for themselves at that point in time, but they can get better. But that extra support can make such a difference. And I know, Monica, you went through and had your mom go on and then off hospice. And so there’s… It’s, again, not understanding that full benefit. And you’re so right, it doesn’t mean that they’re imminently dying and actively dying in this moment. It’s that support that’s gonna help them get stronger and better.
Eileen Piersa: Yeah.
MF: So again, it’s just posing the question. It may or may not be the appropriate thing at that moment in time, but it’s another way to educate and help people understand that this benefit is available to you.
ND: Most definitely. And I also wanna bring up a point here while we’re… The three of us are interacting here, is I love utilising A Right Place for Seniors for this purpose is: We always don’t have to… Hospice… The hospice conversation may eventually happen and we like to encourage that informational visit to happen. But when you have a quality placement agency who has three representatives throughout the county that is surveying land, especially in the time that we’re in right now with visitation restrictions that are happening, that partnership and that phone call to a well-known placement agency that has the relationships and the partnerships throughout the community, that you can develop that speed of trust with, to be able to get a understanding of where that quality board and care is or where that quality hospice agency is. And so in those early days when as a family, when you’re making those decisions, that you develop the members of your support team to make the appropriate decisions.
ND: So sometimes making that phone call to A Right Place for Seniors, A Right Place for Seniors can kinda triage these things for you and kind of make those decisions to, “Whether we need… We may not need hospice, we may need home health, which board and care we may need to go to.” Home care may be needed. Home care with home health or home care with hospice. But nonetheless, when you have a great agency like A Right Place For Seniors, you place that phone call and you have an agency that’s going to triage these decisions for you. And at that… In those early stages, a lot of those anxieties and fears and that weight comes off your shoulders. And Monica, you’ve experienced firsthand kinda what that weight feels like. And I think if we can talk a little bit on that as far as those initial steps and when you guys get that first phone call, and then you help resource that family, I think is really huge during this time.
MF: Yeah. And one of the things that we oftentimes would run into as well, is people think that they… And I know I’m going back to people dying, but people often think they wanna die at home. And we will run into it when people are home and they’re going on hospice, they’ll come to us and say, “Can you help us with placement?” Because they’ve decided A] They don’t wanna die at home, or they just don’t have the resources at home to help facilitate a more peaceful passing. And so that’s where… And I appreciate your compliment on that, Nick. That’s where we come in and we know the best places that have hospice waivers, ’cause that’s a whole ‘nother topic, but they have to have a hospice waiver and be qualified to take hospice patients. And we’re intimately aware… Typically, it’s a board and care home that will take ’em of those facilities, or shall I say, communities that will take hospice patients. And they’ll have that 24-hour support then, where they wouldn’t maybe be able to manage that at home. And so that’s a good point, that it doesn’t have to be at home, and then hospice at home. It also can be placement with hospice following.
MF: So anyway, those are some good topics for us to think about. And so anyway, that’s what we have for today. We didn’t wanna go too far past our time. And Nick, thanks so much. We really appreciate your letting us pick your brain, we constantly bring you up into these conversations, but it’s really helpful for our families. And if it’s not a need for today, it could be a need for tomorrow. So we really appreciate the information.
ND: Most definitely.
EP: And again, just call and ask questions. Because a lot of this is trying to think through options, and that’s one of the things… Yeah, and thanks, Nick, for the compliment because we try to give people options and just some recommendations for them to consider. We don’t have all the answers and I certainly can’t make a decision for somebody, they know their loved one best. But Nick and I even worked on one where the person gave… A doc gave several months and was able to chat and say, “Do you… How do you wanna spend your last time with your mom? Do you wanna be arranging a schedule for everybody to be coming in and making sure there’s groceries in the house and blah blah blah blah, or do you wanna spend time with your mom?” And it was so precious that she really got to spend… We placed her mom in a beautiful board and care, took such a good care. And she got to spend those last weeks with her mom, not worrying about all that stuff. And again, she even said, “If I hadn’t had your help, Eileen, I would never… ” She would have thought that she… ‘Cause the relatives were putting pressure on her to leave her mom at home. But those last few weeks would have been so different.
ND: And that’s an excellent point, Monica, because if we emphasise… With everything that’s going on right now in our world and all that we’re dealing with, if we emphasise, “What do we need most?” We need community, we need love, we need family. And during this time right now, these early decisions that we’re making, if we can get a support team around us to make quality decisions to where we can’t play God, as I like to say, and we don’t know how much time, but what we can do is we can concentrate on the quality of time. And I always like to say that, “The best medicine is family and love and family togetherness.” And we can make that great choice for that board and care, if that home setting is overwhelming and there’s caregiver breakdown. And our whole goal is to have a smooth landing. And if the home isn’t the appropriate setting, and in that particular instance, it wasn’t. And so, that efficiency in the appropriate board and care placement to where we just do it once. And we go to that board and care, and that family can take a deep breath, and just be by the bedside, and have quality time and live one day at a time. And I like to say that’s what hospice is. And that’s why I love our partnership, is because you guys always nail it and we go right to that place. And it’s just smooth and it’s a great feeling when that family feels some chemistry between us, that we’re able to make the appropriate decisions, and then they’re able to have quality time.
EP: Yeah. Wonderful. Alright, so I guess it’s a wrap for this one.
MF: Yes it is.
MF: Thanks, Eileen. Thanks, Nick. And we’ll see you guys next time.
ND: Alrighty, you guys take care.