What is Hospice Care? Feat. Silverado Hospice Guest – Nick
Monica Flynn: Hi everybody, welcome back to the right place for seniors. San Diego, it’s Monica Flynn. And I would like to introduce Eileen Piersa. Eileen’s our associate up in the North County of San Diego. And we have a guest speaker today, [chuckle] or shall I say, a guest interviewer, somebody that we’re gonna be asking a lot of questions of today, and that’s Nick, and I’m gonna say your last name wrong, Nick, Delgadillo. Did I get it?
Nick Delgadillo: You got it, you got it. That was excellent.
MF: Nick is from a Hospice organisation called Silverado Hospice here in San Diego, and Silverado is one that we use frequently as a referral source, because we have oftentimes, a lot of people that ask us about Hospice. And so we thought today we’d start with Nick and talk a little bit about hospice and the right times to be contacting hospice organisations, etcetera. And so, Nick, do you wanna tell us a little bit first about yourself and your company?
ND: Yes, most definitely. So, I’ve been in hospice for a little over 10 years, and I was part of taking care of my own family, I took care of all four of my grandparents on hospice, and so I’ve experienced it first-hand as far as what hospice entails, and I’ve had multiple experiences with hospice, good, bad. And so I really take that into what I do in my career is my empathy when I’m meeting with families. I’ve been with Silverado for a significant amount of time through the bulk of my career, and it’s a great agency. And overall, I value hospice in general as just the service that we provide, and I wouldn’t change it for anything.
MF: Well, and that’s exactly why we wanted to have you on today, Nick, because I personally have the same experience that you did with my mother. I had a Hospice agency that I used for my mom, and she actually graduated, she got kicked off ’cause she got better. And at her end of life experience, I actually used Silverado Hospice, had a very great experience with it. So, Eileen, can you touch a little bit on why you thought it was important that we invite Nick here today and some of the things that maybe we want him to cover for us?
Eileen Piersa: Absolutely. So, one of the things is, we get a lot of these questions, which is why we love partnering with people like Nick, but it’s like, when do you go on hospice? How do I make that decision? Are they all the same? What are my benefits? There’s so many questions that people have, and our goal is to be proactive and to give people as much information as we can before hand, so that they’re… When you’re in the thick of the crisis, if you will, it’s really hard to sort all of that. So, just to have some awareness about options and resources such as a placement agency, such as interviewing hospices, I think people will be more prepared to make better decisions.
MF: What do you think is, Eileen, the main one that we run into all time? I know what I think it is, I’d be curious to see what you think it is when we talk to people about hospice.
EP: I think people freaking out when they hear the word hospice from a medical provider, and this happened to my mom too, it’s like, “I’m not dying. Why are you calling the hospice?” And people just not having an understanding about the value and the benefit that this provides, and it doesn’t mean you’re actively dying.
MF: That’s right. And I say that all the time too, and I’m like, “Have you thought about hospice?” And people will say, “Oh, we’re not there yet.” So, Nick, can you address just really simply, when is the best time for somebody to look into or consider hospice?
ND: Yeah, these are all really excellent questions, what I like to say is, if you’re asking yourself that question, and as a family, if you’re even having the discussion, it’s the right time to bring up the potential referral or the time to interview a potential hospice agency. Because if you’re asking the question, there are certain things that are happening that are triggering those types of thoughts, or those concerns, whether that’s general decline or whether that’s frequent hospitalizations, whatever that may be. So, that’s where I like to start is if we’re asking ourselves the question, then it’s the time to invite some resources and some people who are comfortable having this discussion.
ND: And at that time, we can kind of make the segue into having a conversation, a constructive conversation, to analyze what is going on and bring the pieces and bring in the players, I like to say. I love working with Eileen and you, Monica, but it’s plugging in the different pieces to bring resources in for that family, but I always like to say, it is… If you’re asking that question, it’s the right time to bring up the hospice referral.
MF: And it’s not necessarily gonna be that they’re gonna be going on hospice and there’s nothing wrong with having a conversation and preparing yourself for what it looks like when the time is right to go on hospice.
ND: Yes. And I think one of the biggest things is, you are asking that question as far as, we’ve exhausted all efforts, we’ve gone to the doctor multiple times, we have frequent hospitalizations, and the initial reaction is that fear comes about that, does this mean that mom or dad or grandma or grandpa, or even in these times, sometimes we’re getting younger ages, but does it mean that we’re dying and does it mean that it’s end of life? And I think at that time, it’s best to get that informational visit, is because we make so many assumptions to what hospice is and what it is not. So, we like to do, I recommend a informational visit and whether you do an informational visit with one hospice, two hospices, three hospices, but each informational visit that you do.
ND: Even if we did it together, each informational visit that that family does, the anxiety levels come down and those fears come down of what hospice is, and even analyzing the clinical history and physical. There’s so many things that come in from the hospital. The history the physical, everything that’s happened throughout the hospitalizations, so assistance in analyzing and breaking down that H&P and then saying… In my case, I like to say, you know what, I would like to utilize, Monica and Eileen here as a resource because there’s been some caregiver breakdown and a boarding care may be needed so on that initial step, it’s making the referral, but and then setting up the informational visit.
EP: And one of the things that I’ve learned too, is that people not understanding What does it mean to be on Hospice, what’s the care that they get and where could be at home could be in a senior community that they’re living. It can be in all kinds of places. So Hospice comes to them wherever they are, and can you talk a little bit, Nick, about what do those visits consist of?
EP: Yes, so a hospice… Medicare and private insurance covers hospice, Medicare A covers the hospice benefit. So when the hospice referral comes over, whether it’s from a physician office or whether it’s a hospital, a large percentage of our referrals come from the hospital system, so what the process is, is the history and physical is sent over from the physician and a physician order is sent over as well. Now, that doesn’t necessarily mean that the hospice is stating that the patient is appropriate at that time, what that means is that a physician has stated that the patient has six months or less to live scientifically, but at the same time, the patient can be not appropriate for hospice, so we get that history and physical and we set up for the informational visit, and we assess for hospice appropriateness, and there are clinical guidelines that Medicare requires us to coincide with, and if the patient is found to be appropriate clinically, then we bring the patient on the hospice services and Medicare covers medication, medical equipment, and a medical team that provides care for the patient.
ND: I like to say this ’cause every hospice agency is different in how they have their team setup, but every hospice agency provides a physician, a medical director. The medical director works alongside a registered nurse, and the physician is gonna create a point of care that the case manager RN will help organize that plan of care one day at a time. The registered nurse also works alongside a Home Health aide. And the home health aide is kind of the eyes and ears for the RN, and the RN is the eyes and ears for the physician. So when we have good continuum of care and everyone is working together on that clinical level, there’s a good stream line of communication from the family to that home health aide to the RN, to the physician. That’s quality hospice care. Another thing I like to bring up is that hospice is for the patient due to a clinical diagnosis, but at the same time, there is, and we can go into this at another date as well, but there’s multiple levels of pain.
ND: There’s emotional pain, there’s physical pain, there’s clinical pain, so the hospice team under the Medicare benefit offers social workers and they offer spiritual counsel, so our spiritual counselors are part of our team and our social workers are part of the team to handle advanced directives with the social workers side. With the spiritual counsel side to handle those spiritual pains for the patient, but also the family so there could be caregiver breakdown, there could be family turmoil, there could be just understanding the diagnosis and there’s denial. So we like to encompass the care team that the Medicare benefit pays for to support the family on a clinical need, but also on emotional and a social need as well.
MF: Yeah, I think that’s super important. And not coming at this from a medical background, but coming at this from a caregiver background, having cared for my mother for many years at home and then having to place her… She didn’t go on in a hospice until after we did placement and boy, it made a big difference for me. And it was a huge benefit to me. One that I was not expecting, I didn’t know because I haven’t gone through it yet, that there was a spiritual counselor and they had a music therapy person, that came and played music and staying with my mother, and it was really lovely. So that’s great, thanks, Nick, we appreciate it. And I think for time constraints we’ll probably save some of this for another time Eileen do you have any closing questions or comments for Nick before we move on?
EP: No, just in general, for me closing comment is, you could tell that there’s a lot of parts to this, and we are all great resources for people, because how many times do you go through this in your lifetime, you’ve been through it four times Nick, not everybody gets four. Usually once or twice. And you just don’t know. So we are here to help. We are here to help you find answers. Find questions, if we don’t know, we have great resources like Nick and others that we can tap into, so just know that inquiry is a okay. Just call us and we will help you find the answers.
MF: That’s right. Hey Nick thanks so much for showing up today really appreciate it.
ND: My pleasure. It was a pleasure Interacting with y’all, and I love working with you guys and I look forward to continue working with you and you guys are a great outfit. I love the partnership.
MF: Thank you.
EP: Thanks we do too.
MF: See you next time.