Redefining Aging: A New Perspective on Hospice

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And I always say that there's maybe one percent of our population, maybe less,

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that are what I call the true caregivers, much like yourself. I mean, this is a gift that was

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given to you. You were bred with it. But it's also, it's even beyond that. It's a true gift.

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Yeah, and you, I think, you're an operator as well. You know the people that intuitively have it,

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and the ones that try really hard and just don't, but I think at the heart of it, it's looking at

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people as people, not as tasks, and really somebody that wants to impact another's life.

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Those are the people that show up today when it snows, right? There are people that look at the

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weather and call in on Friday before storm on Monday. Yeah. And then because I can't, because I can,

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I can call in and still have an excuse not to show up. And yet, I'm calling in because it might

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snow and I'm forecasting I'm not going to be able to be there. And there are people that would take

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a cab and Uber, you know, have a brother pick them up, have a brother pick them and their co-workers

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up that will get there. Those are the people I want to surround myself with. Those are the people

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I want to create a business model around because those are the people that get it.

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And now the podcast we're together, we discuss proactive aging on your terms, connecting to the

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professional advice of our special guests while creating better days throughout the aging process.

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Now here's your host, Mark Turnbull. Hello everyone and welcome back to another lively discussion on

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aging today. We are the podcast where together we're exploring the many options to aging on your

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terms. You can find aging today and our past eight years of programming on our website. All you

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got to do is dial into aging today.us and I just want to say thank you all of you that have been

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following us and if you haven't started following us, please click the follow button and begin

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following us because we have so many great guests and conversations on aging today and the whole

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process to what it means to age and that is no different for today. In fact, I do know one thing is

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for certain they used to tell us that two things were for certain and that is death and taxes.

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I know that there are people that avoid taxes but I don't know anybody that has avoided death.

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So there's only one thing that you cannot avoid and that is death and that's what we're going to be

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talking about today. We're going to be talking about the type of life that you want to live

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as you approach the last chapter of your lives and here to join us in the conversation

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and to lead us into that is Stacy's servant and she is the vice president of health services

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at the friendship village and Stacy, I'm delighted that you're on and especially today because

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it sounds like you guys are snowed in. Yes, we are snowed in but if you're in health care,

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you're never snowed in, right? So you know, the show must go on and so we're here. It's a little

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colder than when I left work on Friday but nonetheless, we're here and excited about the conversation.

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Yeah, me too and it's near and dear to my heart. I know that you've been doing this for a number of

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years. We have as well. We own an in-home care agency and a hospice agency. So I am delighted to have

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a conversation with a fellow sojourner along the road and today we're not going to just talk about

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hospice but we're going to talk about the new vision, the new way of looking at hospice and the way

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that hospice really is meant to be. That's where I hope that we can go and not a traditional conversation.

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Are you in? I'm all in. All right. Sounds good. But before we do that, we always like to hear from you

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what's in your story and what, how did you, where were you brought up? What did you want to do with

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your life and then how did you end up where you are today? Yeah, sure. For me, I was raised in long-term

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care buildings. My mother was a registered nurse for 50 years. The majority of that time she spent

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being a director of nursing for several nursing homes in the St. Louis area. So when most of my friends

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were going to the beach on spring break, I was alongside my mom, volunteering in activities,

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calling Bingo, and really just felt automatically in tune with the elderly. You very young that I

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have to do something with the senior population. And so I went to school and studied, graduated with

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a communication disorder degree. And back before Medicare was what it is today, I was told that you

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really are going to only work with kids with a speech therapy degree. And quite frankly, at that

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age, kids scared me. They still scare me to some degree, but it wasn't the space in which I envisioned

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my career degree. So started right out of college as an activity director, just kind of getting my

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foot in the door in a small facility in Springfield, Missouri. And then slowly started to take advantage

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of other opportunities that came my way. I was a nursing home administrator for 20 years,

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six of that at Friendship Village. And then later became the vice president of Health Services

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for Friendship Village. So that always-- I'm sorry for family business, I guess.

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Yeah, absolutely. How did that impact your life? You mentioned that while everybody else was going

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to Disneyland and developing their own Disneyland and you were going to senior centers with your

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following your mom. What kind of an impact did that have on you? Well, I mean, she was the general.

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As far as I saw her, she really taught me at a young age where the bar needed to be as far as

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taking care of people. What can passion and empathy look like as a young person taking care and

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spending time with seniors? And I believe that's kind of a trade I've been able to pass on to both

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my children now, one's of freshmen in college and wants to go into the healthcare space. And

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the other one is the big teddy bear who loves to be around seniors. And so I feel like

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empathy and compassion is not something that people automatically have, but we have to actually have

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to kind of put them in landscapes in which they'll be exposed to different things because, you know,

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not everybody has grandparents, not everybody sees their grandparents, but, you know, in any given

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facility or senior living community, there's 500 potential grandmas and grandpas that you can

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show love to and the love you get back, I think is tenfold. But for me, it's always been a personal

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journey really holding my mom with the highest regard as far as keeping me on point, making sure I

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don't personally accept less than because she would not be happy. She would be looking down at me

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with that look and you don't want that look for my mom. So, you know, for me, it was very, it's been

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always a personal journey and really just working the way that I saw her personally work and the way

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I think she would expect me to work today. Do you see this as a calling for you? Yeah, for sure. I do. I

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think that not a job, not a job, not a place for a paycheck, but a calling. What does that mean

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to you? Yeah, I think it's what you just can't get away from, right? So, it's a calling is just what

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you think in your spare time. I mean, I think people that are really invested in their profession and

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in their callings never take a break about thinking how we can do something better. I mean,

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I'm always kind of challenging myself or talking about what about this? So, I don't like this.

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So, why is it like this? And just trying to continuously push that that bar higher. And I think

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I can't imagine doing anything else, you know, if I won the lottery, I would still want to do

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exactly what I'm doing. Maybe a little differently, but, you know, if you had money to impact a lot of

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things that might look different, but certainly I don't think I would ever do anything different with my

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career or my career path. Yeah. And you've probably come across a lot of people who consider themselves

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or have tried out being a caregiver and some get it, some don't. And I believe that all of us

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have that capacity to care for another human being, but to do it on a professional basis day after

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day after day after day to complete strangers. That's a whole other level of a caregiver.

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And I always say that there's maybe one percent of our population, maybe less, that are what I

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call the true caregivers much like yourself. I mean, this is a gift that was given to you.

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Yeah. It was, you were bred with it. And then, but it's also, it's even beyond that. It's a true gift.

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Yeah. And you, I think you're an operator as well. You know the people that intuitively have it and

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the ones that try really hard and just don't, but I think at the heart of it, it's looking at people as

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people, not as tasks, and really somebody that wants to impact another's life. Those are the people that

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show up today when it snows, right? There are people that look at the weather and call in on Friday before

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storm on Monday. Yeah. And then because I can't, because I can call in and still have an excuse not to show up.

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I'm not showing yet. I'm calling in because it might snow and I'm forecasting I'm not going to be

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able to be there. And there are people that would take a cab and Uber, you know, have a brother pick

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them up, have a brother pick them and their co-workers up that will get there. Those are the people I

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want to surround myself with. Those are the people I want to create a business model around,

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because those are the people that get it. And you're going to be successful when you surround yourself

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with people that get it and are like-minded. Yeah. And it creates a lot less stress in the long run

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when you have people like that. And my grandfather always told me he said he was a successful

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businessman and he said, I said, what was the reason for your success? And he said, oh, it's easy.

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And he pulled out his little tattered little saying and it said never be associated with failure. And

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what he meant by that was surround yourself with people that are better than you or that are gifted

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that that you don't have to, you know, spend a lot of time holding their hand. They just are driven.

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They get it. And that's what he did. And that's what we're attempting to do as well.

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Yeah. And that makes the job fun, right? And that makes doing things like this fun.

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Because you're around people that look at it is not hard, but it's a privilege and it's

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an honor to take care of people. And when you're around that every day, that's infectious.

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And so that's exciting.

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Truly is. Have you ever stopped and pondered about what is the definition of a caregiver?

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Because I believe it doesn't matter if you're an owner or if you're an RN, a doctor,

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CNA, you know, just a regular caregiver. I mean, you don't need a degree.

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Right. But what is a caregiver?

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What you ever thought about, what, you know, what are the traits, you know, that you've noticed about

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those people? And such a great question. I joke that I'm not a nurse all the time.

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So, but to your point, I'm a caregiver and all the important stuff I think I can do, you know, the

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the gifts of patients, kindness, human touch, you know, the gift of giving time, you know,

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where you're not always looking at your watches, you have to move on to the next thing. I think

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in really having the gift of being interested in who you're serving, because they all have a story,

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right? And so if you just are trying to figure out like, what, what, what,

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come, what is something deeper about Mary Smith that I can maybe connect with, that brings light

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joy to her life and makes my job, which the jobs are hard. We're asking people to do hard things.

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It can also bring joy to them. So, yeah, I would, I would think all those things are important.

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Yeah, yeah, I think curiosity is one of my favorite words and, and you have to be a curious person.

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What is it that makes Stacey tick? Who, who are you? And when you are a caregiver, you should be able

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to walk into a room and begin to take a special interest in that individual. I always tell my caregivers,

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think of yourself when you're a host of a party. What's your role at that party? Your role is to

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wander with your eyes all around the room to make sure everybody is comfortable. Yeah. And that's

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a true caregiver. And, and I came up with a definition and I want to throw this at you to see what

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you think. But a caregiver is someone that can spontaneously recognize the needs of another person

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and act upon it. I think that's spot on. I mean, it's just like, wow, spontaneously

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recognize that takes awareness, that takes a presence. And I think so many caregivers as I watch

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caregivers, some get it, like you said, some don't, those they get it are present. Yeah. And just being

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aware of your surroundings and connecting the dots, right? And so like when you enter a room and you're

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like taking care of somebody noticing things, noticing pictures, noticing books, maybe noticing that

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their water, they can't get to it. You know, it's all the little things, it's all that, like,

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just being aware of your surroundings and connecting the dots so that you can better

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pronounce. I think it's huge. Yeah. Yeah. Finding, finding ways to make their life more,

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you know, easier finding their ways to make their life more pleasurable, more comfortable.

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All of those things that go into that. And then I've noticed that there's different types of

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caregivers. There are the caregivers that are really good with companion care, but they may not

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be so good with personal care. And then there are, there are what I would say that there's many

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caregivers out there that are more transactional as opposed to relational. Have you noticed that as well?

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Yeah. For me, transactional caregivers, I'm not a fan of necessarily. Yeah. You really wouldn't

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want transactional caregivers orientating any of your new hires because you're just going to

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breed more transactional caregivers. Explain to our audience what we mean by a transactional caregiver.

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Sure. So, you know, what I would say that kind of goes in lines with is like just looking at a person

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at all the tasks that they have to do for them. Yeah. And so for instance, if you walk into a room,

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you're looking, oh, I have to, they marry, dress, marry, you know, change her clothes, clean her room,

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make her bed. Those are all the things that go with taken care of Mary that day. Yep. They're transactional.

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They're, they are. Every relationship has a transaction to it. But what is the motivation behind that

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transaction? Yeah. And I think it's just to get done, you know, and just to get done the quickest.

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And when you have a transactional, can you imagine being on the other end of that? Where, I mean,

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usually it's pretty obvious that you have a transactional caregiver. They don't talk as much. They

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don't engage as much. They don't make eye contact as much. All the fluff things you don't get.

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I would much rather have the slower relationship type of caregiver because that's what's going to be

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so much more impactful for the residents that we serve. You know, I, I had residents tell me when

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I was an administrator, you know, I had my aid walk in four times and she did all the things great,

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but she never once said hi. She never once asked how my day was. She never once, you know, asked if I

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was in pain to me. That's a failure, even though her care was spot on the important things that are

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going to make her feel like I chose the right place. Those were not present that day. So having

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somebody that's on task and is going to do all the things, but also can be human when they do them.

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That's the that's the optimal employee that that we look to have. Yeah, absolutely. And,

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then there are those caregivers that not only are maybe maybe gravitate more towards companion

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care or personal care, but then there's hospice care, another type of care. What kind of a caregiver,

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because not you know, I've got some exceptional caregivers that are in those other two categories,

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but when it comes to hospice care, oh my goodness, you know, not for me and they go the other way,

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which is fine. We wait. There's a place for everybody. What kind of a caregiver is a hospice caregiver?

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So I mean, I think they have to be really comfortable with a death and dying process, number one.

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And they have to be comfortable in their own scents so they can make somebody be comfortable

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that they're taking care of. I think that's number one. Number two, really sizing up the room

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in what you're doing care. You're really trying to make sure, you know, a lot of times families are

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present, a lot of time you're going into somebody's home, really just making sure that that resident has

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everything they need, whether it's an electric hospital bed, whether it's a wheelchair, so they can

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get up and maybe play cards with their grandchildren, you know, making sure all their pain medicine is in,

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so that they never have to go without a, you know, medicine. I think they have to really

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size up the room and look for potential issues that may come and be totally proactive in that.

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That would be the one thing that I think is often forgot about when we train our staff

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and we do both in facility rotations and in the homes, we tell them that you're the eyes in that

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home for the day. Tell us what you see, tell us, you know, ask our patients how they're feeling is

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it, you know, is all their needs being taken care of? Can we do anything that we haven't done yet to make,

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you know, your day better? And then, you know, all of it still goes hand in hand with being compassionate,

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taking our time, communicating appropriately, both with the patient and the family, all of those things,

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I think, really help us give really great care at the bedside. Yeah, and that's that going back to the

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observed, the role of a caregiver is to observe and report and just exactly what you were describing.

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What is it that I'm observing? What is it that I'm reporting back? And it's with the goal of, you

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know, creating a better day for your patient. And that's the bottom line. Whatever that means to them.

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Yeah, it's meeting them where they're at and trying to make sure that anything in a very,

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what seems to be uncontrolled time in their life, that we can bring some control back to the patient

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and really try to make sure that anything that they need, want or desire we can get for them.

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Yeah. And today we're going to focus on hospice care. We're going to talk in specifics about that.

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And I really want to start just with some of the basics. What is hospice care? And I think there's

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so much confusion out there. And in relationship to palliative care. And so maybe we can kind of lay down

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the definitions if you will, because as I understand it, palliative care is used twice. It's used as an

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umbrella term, but it's also used as a specific type of care. So explain that to our audience.

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Sure. So palliative care is when you have chronic diseases. And by that, you know, an example might

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be COPD, CHF, that there's no cure for. So it's really an approach to those diseases. How aggressive,

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how passive you want to be, giving yourself kind of an advanced care plan, sitting down with,

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you know, your family members and talking about what right looks like in treating that disease,

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when don't you want to treat it anymore? Palliative care can be hospice, but hospice can't be

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palliative care. So palliative care is those first initial conversations with the patient, the

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physician, family members, when there's a new diagnosis or when a diagnosis is just being a little

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bit more cumbersome to deal with. Maybe there's more frequent hospitalization, maybe medicines that

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were working, aren't working as well. It's really that conversation and that discussion about what is

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what does right look like when we go and we treat that chronic disease? Do you want to go back to

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the hospital? Do you want to, in some cases have chemotherapy and radiation? Maybe the other two

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times didn't work. And so do you really want to do that again? Really also, and you and I kind of

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talked about this briefly, it's taking the time to really educate the patient and the family

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about what these diseases look like in today's state and then what will they look like as they progress?

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I think we all know that our primary physicians are very busy and those office visits are very

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busy, you know, 15 minutes is the average that a primary doctor spends with with their patients.

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It's really hard to have those heartfelt conversations in 15 minutes where you can really have some

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dialogue back and forth and get people to really start asking themselves questions or maybe, you know,

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daughters or sons start talking to mom and dad a little bit more real like, okay, how are you going

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to stay in the home by yourself if these things continue to be progressed? Do we have a plan in place?

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Even as broad-sacred is, is, do you want to be a full-code or do you want to be resuscitated?

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Having those conversations before chaos is always the best time, but sometimes those important

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conversations don't happen in the physician office like you might think, and so I think that's when

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positive care can be super, super helpful to have a practitioner that works with the family,

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visits the family, monitors how that disease is progressing and continuing to educate that family.

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I think, positive care is awesome and I hope to see it used more because I think it really can

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alleviate a lot of chaos and confusion down the line. When we talk about hospice, that's a little

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bit more defined. You know, hospice is a doctor, actually two doctors, a primary doctor and a hospice

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medical director. Both say, okay, we're looking at the movement of your disease process and we both

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agree that if it moves in the normal medical textbook way that you have six months or less to live.

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And so that is certified by two medical directors and then you would

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be eligible for hospice services and hospice services. Did you want me to explain that part, Mark?

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Oh, sure. Yeah, absolutely because I think there's a lot of confusion as to that and why a lot of people

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don't, one of the my biggest pet peeves is that people wait too long to get on to hospice care.

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And eventually we're all going to need, we should need hospice care at some point, but many people

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miss that opportunity to have those services and take advantage of those services and they're all paid

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for. Right. So for the most part. Yeah, for the most part. And I will say this, we both have talked

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about what people think hospice is. Yeah. And I've, and through this journey of creating a hospice

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program for Friendship Village, you know, I've had even friends of mine say, well, you know, hospice is,

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you just don't feed them anymore, right? I'm like, no, they can eat whatever they want in fact. Well,

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they're just going to starve to death. No, no. Oh, so they're going to die right away once, once again, no.

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So there's a lot of really negative outlooks on hospice. And just that word, you know, is just,

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really that word makes it hard to even break through the wall to even have further conversations.

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So palliative care allows us to kind of have those conversations, a little bit easier, those walls are kind of

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down for a little bit. But has the shares of great benefits? It's, um, 24-value Medicare,

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benefit, benefit, benefit, benefit, your older, obviously commercial insurance plans have cost

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the benefits as well. And just done correctly, you really can set the table for a, a, a, a,

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a real quality, a real quality, dignified passing of your loved ones. Um, we always want to get in as

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soon as possible because we want there to be ample enough time to talk to the chaplain, um, people

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to plan their own funeral in some cases or celebrations of life, which is big on, on my books. I don't

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know why we wait for a funeral to celebrate somebody's life. Why can't we celebrate them? Why they're

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living? It's not a really new idea, but some, something that, you know, I feel like we should

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challenge that a little bit more, um, because the people that are being celebrated want to see all

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those people show up, you know, sometimes they haven't seen those friends for a long time. Um, and so,

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you know, hospice care gives us the ability to provide a nurse, a chaplain, a social worker,

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a personal caregiver, um, you know, we have a medical director that oversees their care as well,

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volunteers, specifically for us. It's been super impactful here at Friendship Village.

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Um, so it gives us a, a nice amount of time. It's done right to really get in there,

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to spell the rumors, um, and that's due consistency, um, and making them feel like the sky's not

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gonna fall down, you know, sometimes there are imminent passing that occur really quickly,

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but ideally you would want enough time to be able to really bring in the services that make

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hospice a really special program. And so most of the people that we do palliative care visits are

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appropriate for hospice when we do them. So it's, our most of the hospice patients we bring in probably

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would probably would have caught by six months prior to, um, enrolling them. So education, education,

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education, um, and not only to families, but certainly to, to practitioners and physicians,

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um, to really look at, you know, the diagnosis, lab results, and really look at, yeah, this person's

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been failing and sometimes they only look at them how they are today, but if you look back for three

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months, they've lost 25 pounds. They're not doing well. And so really there's just a lot of education,

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a lot of conversations that need to be handled, you know, handled around the kitchen table about

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how we want to live our last, our last once days or years. Um, it's, it's really super important to

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have those. And, and I think it's important that you mentioned years, and I know that many of the

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patients that we've cared for can last a year or two. Yeah. The most famous case being, you know,

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our president, Jimmy Carter, and he was in hospice. What was it? 12? Was it 14 months? Yeah.

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Something like that. And so you have the article, um, it's on my desk and it's stand-inses, and it's his

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quote to say hospice is not giving up. Yeah. Think about that. That's, I mean, come on. That's awesome.

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Did you know that that over 1.7 million people access hospice care each year and their

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average length of stay is 70 days? Most people have a preconceived notion about what this kind of care

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means, but Stacey's urban says it's time to rethink the negative connotations. We need to focus on

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the experience of living. We need to empower people to have the conversation before they need care

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so they can make their own choices and remove the stress from family members so everyone can focus

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on their time together. We should help them celebrate their life and celebrate the care and

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love the receive. Learn more about friendship village in St. Louis and call today at 314-270-7700.

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This did you know moment is sponsored by Royal Hospice, Oregon.

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Yeah. And there's a lot of negative attitudes towards hospice and that we're trying to overcome and

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it's difficult to overcome some of the stereotypes that are out there because a lot of these stereotypes

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are not being addressed by the medical community and physicians in particular. And sometimes I feel

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like a fish swimming upstream and it's not an easy road to change the paradigm on how we look at

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hospice and we don't need to look at it as a descents. In fact, I think you're in agreement because

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when I was reading some of the things that you wanted to talk about is, yeah, I lost you there for

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a minute, was that hospice isn't about how you die. It's about how you're living. Comment on that.

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Yeah, that's really kind of our mission is it's not about focusing on the end game because as you said

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earlier, we're all going to go there. We all have the same end game. It's the one thing that connects

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if it's unites us. Yeah. Whether we like it or not, we all have that in common. And so what is

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different is how we live. And hospice services is only going to bring more life if that makes sense.

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You know, like we think about hospice as so many families as soon as they sign paperwork, they're

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really visually, you know, for like the first week. You know, there are lots of visitors sitting by

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the bedside because in their mind, they're dying in one or two days. And so when we show them that

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through different interventions, different complimentary therapies that we offer, music therapy,

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massage, you know, our volunteers and guests actually more care. People start to feel better. They

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start to eat more. They start to, you know, participate in conversations that maybe they didn't or

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were able to before. And there are some cases that people graduate for hospice. We have two graduating

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this month. That's a success story. You know, that means that when you say graduating, what does that

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mean? So when we have our team meetings, which is every two weeks, we are looking for hospice

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appropriateness. And so we are looking at who sets the stage for hospice. So our medical director

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in their primary. Yeah, but at the, but who holds you accountable to that Medicare? Medicare.

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And so we have to, you know, turn in all of our documentation, et cetera. And so sometimes in COVID

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was a perfect example of this. There are people that had COVID and COVID and took a very, very,

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very big decline. And so a lot of families, a lot of doctors said, okay, come in with hospice

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because we don't think they're that about that. And so we bring our services in. And with time

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in the right level of care and the right services, they're able to get their strength back.

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They're able to, you know, take in more calories and they're able to get a little bit better. It

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does take time for that. But, you know, sometimes a doctor might say, yeah, this is the trajectory that

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this person is on. I don't see them, you know, changing. So they're appropriate. But then

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there's only one man upstairs that really knows when your time is. And sometimes, you know,

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when we look at the patient holistically, the whole patient, we realize that, oh, they're not

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losing weight. They're not asking, they're not in any pain. They're labs, you know, they're

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actually stabilizing to the point that they're no longer hospice appropriate. And so we will then

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take them off the services and monitor them from a palliative care perspective moving forward.

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So we do graduate people. We do graduate people from hospice because, you know, sometimes,

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you know, the body is an amazing thing that when it's given enough time of healing and the right people

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around them, they do get, they do get better. They stabilize to the point that they're no longer

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qualified for hospice. Yeah. The other thing too is that, you know, our healthcare system is in such

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disarray. And it takes two, three weeks for mom, dad to get an appointment to go see their primary

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physician and they are, you know, starting, they're declining whether they're weight loss and,

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and on and it goes. And, and that goes to show why people, you know, either graduate from

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hospice when you put them on hospice because now all of a sudden, they're not having to get in the

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car, go down to, you know, three, four weeks after a symptom has developed to get the attention from

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their medical doctor. With hospice, you get it immediately. You get it that week. Right. And, you know, we

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we go out often. So if there's any decline, we're there. We do daily visits, we up visits to three

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times a week if we need to. We're really monitoring those changes of condition and some are long lasting

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and they indicate that somebody might be transitioning or it's just a little bump in the road and

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they get over that hurdle and, you know, they're stabilized again. So I think extra eyes are always

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great eyes. And I think too, back to the practitioner, it's not, it's not their fault to some degree

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because it's just the way that the business has changed for those doctors. It's just that they

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usually are interested in solving problems. So when you go to a doctor, unless it's your physical,

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there's your routine appointment. You're there to solve a problem. And so doctors get in that tunnel

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and they solve that problem and that patient is good to the next problem occurs. And then that problem

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comes and they solve that problem. But we don't see a lot of holistic practicing, meaning have we

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looked at how many problems and how frequent the problems are occurring to really then be able to

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get a better picture on how this person is doing. You know, if I look at my wake for today,

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it means nothing, but I look at it for the last six months, it may tell a different story.

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And so I think that sometimes in this busy, busy world where these appointments happen and we have

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to get them in and, you know, hospitals aren't with them used to be either, that we've got to,

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we've got to slow down and really look at these people holistically to be able to forecast and

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help them in the best way. Yeah, absolutely. And the other thing too is that doctors, like you said,

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they're in a curative mode frame of mind. And there, and a lot of times seniors, when they do go in,

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I've seen this with my own parents, I've seen it with others that we care for when they get in

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front of a physician or a medical professional of any kind, they always paint a better picture than

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what's really going on. Yes, yes, I have an 86 year old father and I go to every appointment

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because of that, right? They're always given best case scenarios. They're, you know, painting a

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picture because they don't want anyone to think they can't live where they're at, they can't be

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independent. So I, I, I do you think that's valid and so I, I always preach to children of seniors as

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I've got to be involved, they've got to be an advocate for their loved ones because otherwise,

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they're going to get really missed and just, they're just becoming a number at that point.

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And then when, when somebody is considering going on, you know, maybe it's the adult children

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of mom and dad that are considering hospice and they, they have that, they have to get over that

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fear of bringing up the H word, right? Okay, so how, how do you have that conversation with mom because,

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or dad because there is that stigma that is out there that have, oh, you mean I'm going to die.

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If I have this conversation, I had this, I mean, I'm a hospice operator and I had that fear

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with my mom and my dad, especially my dad and, and I had to have the conversation with them and

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explain the whole process of this is just these are additional services that are going to help you

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live your best life possible. And, but there's some caveats to that. Like you have to give up going

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to the hospital, you have to give up. There's some, some things you have to give away.

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Yeah, I mean, I, I can remember having the most specific conversation with my mom,

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she hears an earth, she's been in the hospital with COP duty for every month and, and every

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visit gets worse and it takes longer to get out of the hospital. And for me, I just kept seeing a

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more exhausted version of my mother coming out of the hospital. And so really just to talk to her,

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in the context, call it anything you want to call it, but it really gets down to how,

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the why? Do we know why we're doing this, mom? Do we know why? You know, how, are you want to go to the

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hospital? You've been to the hospital three out of the last four months. Do you want to be on oxygen?

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Do you want, how can I, is your daughter, is your advocate? Help you live the life you want to live?

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All things considered with your diagnosis. That was hard. That was, that was a little bit. That was

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not something that I was really trained or prepared or there was really no in service for that conversation.

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A lot of times. Do you think, Stacy, do you think that it's harder for you than it was for your mom?

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Because I often, yeah, I want to, because I go back and I, it was harder for me

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having that conversation with my dad, then I think my dad was inheriting it. But you do have to use the right

371
00:42:38,320 --> 00:42:45,040
verbiage, like, okay, dad, we're, by being on hospice, the one of the myths that you talked about was,

372
00:42:45,040 --> 00:42:50,480
oh, being on hospice means you stop eating, so you can't feed anybody anymore. No, no, no, that's not,

373
00:42:50,480 --> 00:42:55,840
that's not hospice. Right, right, right. Yeah, I mean, so sometimes I think,

374
00:42:57,760 --> 00:43:04,480
for residents understand, you know, if they're of a later in age, and obviously there's always more

375
00:43:04,480 --> 00:43:10,800
horrific stories of younger people and, you know, different circumstances, but if you take your basic

376
00:43:10,800 --> 00:43:20,720
84 year old senior, they've had people pass away. Death is not new to them. Yeah, they've lost

377
00:43:20,720 --> 00:43:29,600
friends. They've lost maybe a spouse. They've lost family. They're still going to protect the children

378
00:43:29,600 --> 00:43:40,080
from the thought of losing them. They're still the protectors. And so I do think there is this kind of

379
00:43:40,080 --> 00:43:46,800
you know, where the daughter doesn't perhaps want to have that heart to heart with mom,

380
00:43:48,080 --> 00:43:55,680
but the mom doesn't want to leave the daughter. You know, it's that kind of thing. The mom knows

381
00:43:55,680 --> 00:44:02,400
where they're going and the mom, you know, sometimes they miss their spouses so much they want to be

382
00:44:02,400 --> 00:44:08,880
reunited with them, right? And so, but they don't want their children to be in any pain

383
00:44:08,880 --> 00:44:16,640
after they're gone. They're okay with the plan. They're okay with hospice. And I always say that,

384
00:44:16,640 --> 00:44:22,960
you know, my mother is in a better place. We might not be in a better place without her,

385
00:44:22,960 --> 00:44:32,240
but she for certain is in a better place without the suffering and having the hardship she did with

386
00:44:32,240 --> 00:44:38,480
her own personal disease process. But I do think parents always still try to protect their kids from

387
00:44:38,480 --> 00:44:44,960
that pain. Yeah. And so I do think that's why you see people where when you look at their records,

388
00:44:44,960 --> 00:44:49,760
it doesn't make sense whether they continue with chemotherapy or radiation, everything basic

389
00:44:49,760 --> 00:44:58,080
resets that these things are, these things are no longer curative. But if you ask them, it's well,

390
00:44:58,080 --> 00:45:04,160
my my daughter wants me to keep doing it or my son, you know, doesn't want me to give up. And so,

391
00:45:04,160 --> 00:45:10,560
you see kind of that yin and yin and so boy, advanced directives are pretty helpful at that point

392
00:45:10,560 --> 00:45:18,160
to refer to and just kind of talk about what they wanted for themselves before there was

393
00:45:18,160 --> 00:45:24,960
this crisis or this big decision that needed to be made. But I agree that those conversations are

394
00:45:24,960 --> 00:45:32,640
tough. But I think once you just start healing back that on in and really focus on how you can really

395
00:45:32,640 --> 00:45:39,120
be impactful from a quality perspective with your hospice program, I think you get there and you get

396
00:45:39,120 --> 00:45:46,240
there well. Yeah. The other thing too is that I think we don't give enough credit to mom and dad

397
00:45:46,240 --> 00:45:53,840
for they understand and know their situation probably better than we do. And they're just grateful

398
00:45:53,840 --> 00:46:00,080
that you took the time to acknowledge that so that that takes a little bit of the pressure of

399
00:46:00,080 --> 00:46:08,880
them having to have this conversation with you. Yeah. I'd say it's almost like giving permission

400
00:46:08,880 --> 00:46:18,080
to be okay to pass away. Yeah. And how many times have we around a bad, when somebody's in their

401
00:46:18,080 --> 00:46:25,760
final moments have said, why is this person hanging on? Why is this person hanging on? And really,

402
00:46:25,760 --> 00:46:34,960
it's that permission to pass. And, you know, I think my goal would be let's have those conversations

403
00:46:34,960 --> 00:46:40,640
ahead of time. So we're not at that point, right? Let's have these open conversations like these are

404
00:46:40,640 --> 00:46:46,880
the disease processes. These are the treatment options that we have for them. Where do you want to go

405
00:46:46,880 --> 00:46:51,440
with them, mom? Where do you want to go with them, dad? And really have those at a positive care

406
00:46:51,440 --> 00:46:58,880
level. So you're not trying to give somebody permission at the bedside in a very imminent stage.

407
00:46:58,880 --> 00:47:04,880
Yeah. Yeah. And sometimes it's easier to have those conversations when there is a life

408
00:47:04,880 --> 00:47:14,160
limiting, you know, illness or disease. But a lot of times, you know, my mom is a case in point where

409
00:47:14,160 --> 00:47:23,600
she doesn't have any long-term chronic illnesses or diseases. But she's 95. And, you know,

410
00:47:23,600 --> 00:47:31,680
the engine is burning out. Yeah. So we made a, and then she's been falling. She's been losing weight.

411
00:47:32,480 --> 00:47:39,440
And so talk a little bit about how to have that conversation with when the fuel is just running

412
00:47:39,440 --> 00:47:51,120
out in the body. And the body is just saying, you know, I'm tired. And so we took, and she had chronic,

413
00:47:51,120 --> 00:47:59,040
the biggest thing she had was chronic UTIs. And she looked at me the last time she went to the hospital

414
00:47:59,040 --> 00:48:06,640
and they put her on IVs. And she says, I'm done. I don't want to do this anymore. She knew, you know,

415
00:48:06,640 --> 00:48:12,000
and I said, okay, well, then there are some additional services that we can provide you so that you

416
00:48:12,000 --> 00:48:18,560
don't have to mom come back into the hospital or go see the doctor and wait another three to four weeks

417
00:48:18,560 --> 00:48:24,240
before you get in. And let's consider the hospice services. And she said, okay.

418
00:48:26,720 --> 00:48:36,000
Yeah. I mean, I think they, they do always say, I'm tired. I'm just, I'm just not what I used to be or,

419
00:48:36,000 --> 00:48:43,200
you know, things aren't as easy for me as I used to be. And I think as we tell our caregivers,

420
00:48:43,200 --> 00:48:50,400
right, kids are caregivers, be aware. Those are, those are introductions to a bigger conversations.

421
00:48:50,400 --> 00:48:57,280
And in fact, you could look at them as guests because they really are opening, cracking that door for

422
00:48:57,280 --> 00:49:02,000
a bigger discussion without you having to bring it up. But you can certainly dive in to say, well,

423
00:49:02,000 --> 00:49:07,920
tell me more about that, mom. You're tired. What, what, what does that mean? Are you, are you just,

424
00:49:07,920 --> 00:49:14,880
is it harder for you? Are you struggling? You know, maybe let's, let's see what we can do. So it's not

425
00:49:14,880 --> 00:49:22,480
so obtrusive for you anymore. You know, let me use on my contacts and see what we can do to make

426
00:49:22,480 --> 00:49:27,920
things a little bit easier for you. I think a lot of people say that to their kids. And then I think

427
00:49:27,920 --> 00:49:36,240
a lot of kids say, well, mom, you're fine. You know, everything will be fine, I'm tired too. But really,

428
00:49:36,240 --> 00:49:44,320
we need to use those little things, those little nuggets as gifts because they're really telling you,

429
00:49:44,320 --> 00:49:57,680
I'm there. Yeah. And I need help. And I need you to be okay with it. And I think that is so huge. And

430
00:49:57,680 --> 00:50:05,280
that's why I think I'm such a really proponent. Not only, you know, as I think hospice is such an

431
00:50:05,280 --> 00:50:11,760
amazing thing that we can do for people that we love, but that positive care conversations sure

432
00:50:11,760 --> 00:50:17,120
sets the table for those deeper conversations. And the hope would be you start having more of those

433
00:50:17,120 --> 00:50:23,040
palliative care conversations. So you're not just waiting for somebody to tell you they're tired

434
00:50:23,040 --> 00:50:29,440
or they're kind of done, you know, and so I do think they go hand in hand and I hope more and more

435
00:50:29,440 --> 00:50:36,480
people are just open to learning more about both. Yeah. Yeah. The, the, the other thing that we noticed in

436
00:50:36,480 --> 00:50:45,440
with my mom's health is that once we did put her on hospice, we went through her regimen of medications

437
00:50:45,440 --> 00:50:52,800
and she, she had very little compared to most seniors. And I think she had maybe three,

438
00:50:52,800 --> 00:51:01,760
three medications and then some, you know, occasional Tylenol or, you know, some vitamin E and all

439
00:51:01,760 --> 00:51:08,640
that kind of stuff, you know, but the one medication in particular was a memory medication. And I

440
00:51:08,640 --> 00:51:15,120
always said, I'm not a huge believer of that stuff anyhow because it, they're, there really isn't a

441
00:51:15,120 --> 00:51:20,240
medication to, you know, correct somebody's memory. They're, they're usually, they're,

442
00:51:20,240 --> 00:51:26,480
there are other medications that were used for something else. And when we took her off of those

443
00:51:26,480 --> 00:51:36,160
medications, her UTIs improved. So maybe, not always, but maybe the amount of medications that,

444
00:51:36,160 --> 00:51:42,640
if you've got a loved one that is experiencing a lot of UTIs, it could be that the medications that

445
00:51:42,640 --> 00:51:50,320
they're putting into their bodies is what's taintening the well. Well, and this goes back to, you know,

446
00:51:50,320 --> 00:51:56,880
what I would tell a friend that's a daughter or a son to somebody and get involved. Start,

447
00:51:56,880 --> 00:52:04,080
start looking in the medicine cabinet. You will be amazed at what they keep and what they're taking.

448
00:52:04,080 --> 00:52:11,680
And we don't have a healthcare system that speaks to each other, meaning everybody comes out of the

449
00:52:11,680 --> 00:52:18,160
hospital now with a specialist and every specialist prescribes different medicines. And not all the

450
00:52:18,160 --> 00:52:26,160
doctors talk to each other to say, well, does this make sense? Or why are we doing it?

451
00:52:26,160 --> 00:52:34,400
You know, and sometimes there's interaction. I mean, there are some people that are on 20 medicine.

452
00:52:34,400 --> 00:52:44,000
They're 99 years old. What? And so we really like have to continuously,

453
00:52:45,280 --> 00:52:52,720
you know, pro versus card risk reward when we talk about these medicines. Your mom was falling.

454
00:52:52,720 --> 00:52:57,280
I would go to medicines right off the bat as I'm sure you did and say, is there anything in this,

455
00:52:57,280 --> 00:53:04,480
in this list that could be contributing to that, you know? And so you sound the UTI problem. You

456
00:53:04,480 --> 00:53:10,080
also probably sound the fall problem problem, but these practitioners because they don't have a system

457
00:53:10,080 --> 00:53:14,720
to speak to each other and to stay in the loop with each other as much as we think they should be able

458
00:53:14,720 --> 00:53:20,480
to. We've got a lot of different people prescribing a lot of different things and there's drug interactions.

459
00:53:20,480 --> 00:53:26,400
And sometimes we're moving some of those people feel better. Yeah, the other thing I want you to

460
00:53:26,400 --> 00:53:34,320
come in on too is that one of the myths that is out there with hospice care is that that individual

461
00:53:34,320 --> 00:53:40,880
needs to be bed bound. And there's this idea, it's kind of like with the stop eating type thing,

462
00:53:40,880 --> 00:53:49,760
but it's, oh, you can't walk around. You're too healthy for hospice care. And my mom's been on hospice for,

463
00:53:49,760 --> 00:53:59,440
was it about four months now? And her life just keeps improving. I mean, she is declining. She is

464
00:53:59,440 --> 00:54:06,240
losing weight. She is, you know, she's all the traditional things that go along with the body declining.

465
00:54:07,120 --> 00:54:14,400
But we try to keep her as mobile as we can because think of it in terms of

466
00:54:14,400 --> 00:54:22,640
you're giving, you're helping somebody to live their best possible life with a quality of life

467
00:54:22,640 --> 00:54:30,400
and keep the body is designed to move. So if you can, keep them as mobile because there will be a time

468
00:54:30,400 --> 00:54:36,080
when she won't be mobile, but if you can, keep them mobile and create an atmosphere of living,

469
00:54:36,080 --> 00:54:43,680
living life, the way she has always wanted to live life. And we try to create that atmosphere. I had

470
00:54:43,680 --> 00:54:50,800
family members come in and say, well, you can't be, you can't be taking her on trips to the beach or,

471
00:54:50,800 --> 00:54:58,240
yes, we can because that's where she wants to go. And we're going. And we're going. Yeah. And my family

472
00:54:58,240 --> 00:55:02,320
is looking at me like, what are you doing? You're going to kill her. You know, I mean, that's the,

473
00:55:02,320 --> 00:55:08,800
that's the way it comes across and I go, oh my goodness. Doesn't that get back to what the picture of

474
00:55:08,800 --> 00:55:16,320
hospice looks like? Yeah. That the stigma, right? Yeah. We think hospice doctors think this way.

475
00:55:16,320 --> 00:55:21,680
I think caregivers to some degree, they're not qualified for hospice. They just went down at the

476
00:55:21,680 --> 00:55:26,320
dining room with their walker. Yeah. Okay, but that doesn't mean that they have great

477
00:55:27,840 --> 00:55:32,880
heart function, lung function. Doesn't mean that they don't have a cancer. Doesn't mean that their

478
00:55:32,880 --> 00:55:40,800
dementia is any, I mean, so yeah, that just goes to the stigmatism that surrounds hospice, which I

479
00:55:40,800 --> 00:55:48,080
think is sometimes why people don't get that prescribed or referred for hospice because they're not

480
00:55:48,080 --> 00:55:54,720
bad enough yet. Yeah. They're not, they're not on their deathbed. They're not, yeah. Yeah. Yeah. Well,

481
00:55:54,720 --> 00:55:59,760
nothing I'm going to do today, I want you to cure X diagnosis.

482
00:55:59,760 --> 00:56:06,080
Hospice isn't going to cure a chronic disease, right? Yeah. Or somebody that's just frail,

483
00:56:06,080 --> 00:56:12,000
failure to thrive, all the things. And so, yeah, we've got a lot of work to do. We need more

484
00:56:12,000 --> 00:56:20,240
conversations like this to really just say, why wouldn't we want them to be able to go to their

485
00:56:20,240 --> 00:56:26,720
daughter's wedding? Yeah. Why wouldn't we want them to go to their granddaughter's graduation?

486
00:56:26,720 --> 00:56:32,480
Does that mean they're not dying? No, doesn't. It just means that we have a gift still that she give,

487
00:56:32,480 --> 00:56:38,480
we can give her those moments. Yeah. You know, and so people get really kind of scared

488
00:56:38,480 --> 00:56:46,800
to operate on those guidelines, but the guidelines specifically tell you when somebody can qualify

489
00:56:46,800 --> 00:56:52,320
for those services. And we've painted our backed ourselves in a corner that it has to

490
00:56:52,320 --> 00:56:56,560
look like something and it really doesn't. And so I hope that these

491
00:56:56,560 --> 00:57:03,760
members can help that because if you could take your mom to the beach, you'd escape her the best gift

492
00:57:03,760 --> 00:57:09,760
ever, but you got one too. Yeah. So why can we, right away? I tell that, I tell that to my siblings

493
00:57:09,760 --> 00:57:15,680
all the time. Take her, go, go, go do things, go do what she wants to do. And they, they've come

494
00:57:15,680 --> 00:57:21,200
around. And because when we first put her on hospice, it was like, oh, put on the kid gloves,

495
00:57:21,200 --> 00:57:26,960
we have to treat her now, put her into bed, you know, and say good, your go buys and the family would

496
00:57:26,960 --> 00:57:34,400
come over. Like I think you mentioned it earlier when you first put somebody on hospice, all the families

497
00:57:34,400 --> 00:57:42,080
come over and they're ready to say goodbye. Well, in some cases, that may be true, especially if the

498
00:57:42,080 --> 00:57:49,840
physician and the family has neglected to observe really what's going on and they wait until the very end.

499
00:57:49,840 --> 00:57:55,760
Yes. Yes. Because a lot of times, another one of my pet peeves is that, you know, people don't get

500
00:57:55,760 --> 00:58:00,480
to take advantage of the services because they wait till their last week of life.

501
00:58:00,480 --> 00:58:10,240
Yeah. And we, we then have a very chaotic situation that we're expected just to go make right

502
00:58:10,240 --> 00:58:16,320
in a very small amount of time. And it's just not, it's not how it was supposed to be. It's not

503
00:58:16,320 --> 00:58:23,520
designed that way. And so I am just hoping that the work both of us do, the conversations, both of us

504
00:58:23,520 --> 00:58:31,600
are having starts to change that narrative around hospice. Yeah. It's really such a great gift we can

505
00:58:31,600 --> 00:58:38,480
give somebody. We just got back from the beach and she wants to go back. And so we're going to go back

506
00:58:38,480 --> 00:58:46,400
and this later this week. And then, and I look at it as an opportunity to give her the gift of life,

507
00:58:46,400 --> 00:58:52,880
living, living the life that she wants to live. And if she dies in the process, then she lived her life.

508
00:58:52,880 --> 00:58:59,600
I mean, I'd rather, what better way to pass away? Oh, I'd rather pass away in the car or

509
00:58:59,600 --> 00:59:05,760
at the in front of the window at the beach than to be sitting in moping at your own home,

510
00:59:06,400 --> 00:59:12,000
you know, saying, whoa is me? And whatever else goes through people's minds, no, stay active.

511
00:59:12,000 --> 00:59:17,600
If you can't, not, not everybody can. Yeah. I think you can't be afraid to have those moments. Yeah.

512
00:59:17,600 --> 00:59:23,760
I mean, today is, I mean, I think we've learned through COVID and other things that you can get a,

513
00:59:23,760 --> 00:59:29,120
you can get around, even if you're real chair bound. Yeah. Absolutely. There's buses, how there's,

514
00:59:29,120 --> 00:59:35,920
there's vans, what get them, go share some experiences. You are creating the lasting impression.

515
00:59:35,920 --> 00:59:41,120
And that's what I like to think that we create with hospice is that truly lasting impression.

516
00:59:41,120 --> 00:59:48,720
And if we can give a family that with their, with their loved ones, that's a gift. That is just a gift.

517
00:59:48,720 --> 00:59:54,960
And we need more gifts like that. Planned celebrations. Like my mom's birthday is coming up.

518
00:59:54,960 --> 01:00:00,720
It's February 28th. Celebration of life. Life celebration. And so I told all my siblings, I said,

519
01:00:00,720 --> 01:00:04,960
we're having, we're already starting, mom and I are already starting the planning of the

520
01:00:04,960 --> 01:00:10,800
her birthday party. It's going to be at the home. It's going to be a Mexican theme because mom and

521
01:00:10,800 --> 01:00:19,680
dad used to love to go to Mexico for, you know, for playtime. And so last year we did Hawaii. This year

522
01:00:19,680 --> 01:00:28,080
we're doing Mexico. And I said, come prepared to celebrate, to celebrate her life. And that's one of

523
01:00:28,080 --> 01:00:35,680
the things that we are trying to talk to our families about. Like why, every birthday is important,

524
01:00:35,680 --> 01:00:43,440
right? It's our day. It's that person's day. And so make it a celebration. I mean, this is a time

525
01:00:43,440 --> 01:00:51,120
to be happy and let them plan it. Let them have some, you know, say in a voice in that, how awesome is that?

526
01:00:51,120 --> 01:00:57,840
I am really big in celebrating birthdays. And like I said, doing celebrations of life,

527
01:00:57,840 --> 01:01:04,160
when people are alive to celebrate their lives with everybody that is important to them. So kudos,

528
01:01:04,160 --> 01:01:12,480
kudos to you because that is definitely something I feel very strongly about. Yeah. Now let's shift

529
01:01:12,480 --> 01:01:20,640
years a little bit. So we've talked about, you know, living, you know, your best life possible day to day,

530
01:01:21,760 --> 01:01:29,440
there will be a time when, I'll use my mom as an example where she will be bedridden. She will be so

531
01:01:29,440 --> 01:01:38,320
weak and tired that she cannot get out of bed. Talk a little bit about the stages. I don't know if

532
01:01:38,320 --> 01:01:46,000
you're prepared to do this, but this, if you can, talk a little bit about what goes through the last

533
01:01:46,000 --> 01:01:52,320
moments of somebody's life. And I think that's an important conversation to have because it helps to

534
01:01:52,320 --> 01:02:01,680
prepare us. And it's, it's also a part of the natural process of accepting death that we're all

535
01:02:01,680 --> 01:02:08,880
going to face at some, some place somewhere along the line. And we're all going to experience it

536
01:02:08,880 --> 01:02:15,840
a little bit differently. I understand that. I've seen many, many people pass my dad passed in front

537
01:02:15,840 --> 01:02:22,400
in my arms, my grandfather passed in my arms. I'm assuming my mom will pass in my arms,

538
01:02:22,400 --> 01:02:31,360
assuming I'm here, you know, if I'm that fortunate. But there's a process. Explain what that looks like.

539
01:02:31,360 --> 01:02:37,760
So and I think if I would go back and say the myths about hospice is that they don't eat anymore.

540
01:02:37,760 --> 01:02:45,200
If your loved one is referred to hospice and they're not eating anymore, like on day one,

541
01:02:45,200 --> 01:02:52,640
they were not referred soon enough. I do think that somebody can be mobile like your mother and then

542
01:02:52,640 --> 01:03:01,360
not get up out of bed, stay in bed longer. Maybe their appetite starts to decline. And then it ultimately

543
01:03:01,360 --> 01:03:09,680
will diminish just like we don't feel like eating when we have an illness, right? Cold the flu.

544
01:03:11,040 --> 01:03:18,320
That happens when somebody is transitioning as we like to call it. So the three big things that

545
01:03:18,320 --> 01:03:24,640
I always say to people when they call or even friends because I think once your friends know that

546
01:03:24,640 --> 01:03:29,280
you're involved in hospice or any senior care, you then become the expert whether you have any

547
01:03:29,280 --> 01:03:35,600
business being the expert or not, they call you and I'll say, "Oh, okay. Well, have they ate today?"

548
01:03:36,400 --> 01:03:42,560
And they'll be like, "Well, just a little bit." I'm like, "Okay. Have they drank anything?"

549
01:03:42,560 --> 01:03:46,400
Yeah, they're still drinking, just not eating. I go, "Okay."

550
01:03:46,400 --> 01:03:52,880
Have they are they still going to the bathroom? Yes. You've got some time.

551
01:03:52,880 --> 01:03:58,080
Now what does time look like? Time isn't months, you know? It might not even be longer like the

552
01:03:58,080 --> 01:04:04,560
week, but I would always say that those are signs that the body is swirling down. And I always

553
01:04:04,560 --> 01:04:10,720
then reiterate what we know. There's a misnomer that they're going to have hunger pains,

554
01:04:10,720 --> 01:04:16,560
that they're going to dehydration is painful. And I think that, you know, it is like to reiterate

555
01:04:16,560 --> 01:04:23,760
that studies have shown that, like, you know, there's a euphoria that goes kind of on when somebody

556
01:04:23,760 --> 01:04:30,640
hasn't ate. They're not in any pain if they stop eating. They're not in any pain if they stop drinking.

557
01:04:31,520 --> 01:04:38,000
And so, you know, just really kind of let them look for those things. So when you're with your mom,

558
01:04:38,000 --> 01:04:44,720
you know, ask the staff how many times you went to the bathroom. You know, really focus on

559
01:04:44,720 --> 01:04:51,840
not so much the food, but the drinking, you know, water. And just kind of spell out kind of those

560
01:04:51,840 --> 01:04:59,840
steps that lead us to believe that they are going to pass away sooner than later. So, I mean, you

561
01:04:59,840 --> 01:05:04,800
know, there's always respiration. There's always the use of pain medicine. Do they look more anxious?

562
01:05:04,800 --> 01:05:10,320
Are they more anxious? Are they having to use routine pain medications? Whereas before they were

563
01:05:10,320 --> 01:05:15,600
using them as needed, I think those are all the things that kind of paint the picture that

564
01:05:15,600 --> 01:05:23,280
somebody is transitioning towards, you know, death and passing away versus maybe being a stable

565
01:05:23,280 --> 01:05:35,200
as they once were. And then is there bodily? So like when my dad passed, I mean, he was gurgling

566
01:05:35,200 --> 01:05:41,520
with what they call gurgling, explain what so that somebody that is with their loved one,

567
01:05:41,520 --> 01:05:46,400
that they're not going to panic and they're not going to, you know, and how you approach that whole

568
01:05:46,400 --> 01:05:52,160
thing. Yeah. And I think that that is where that hand holding by the nursing staff of the hospice

569
01:05:52,160 --> 01:05:58,000
team really has to be visible and they really have to make sure that they understand what the dying

570
01:05:58,000 --> 01:06:04,880
process looks like for this particular patient and where they are in that process. So definitely,

571
01:06:04,880 --> 01:06:11,120
you know, the rattling, the gurgling, you know, we may have to use suction, we may not have to use

572
01:06:11,120 --> 01:06:20,480
suction. You know, there's different smells that occur. There's, you know, sometimes wounds develop,

573
01:06:21,040 --> 01:06:29,200
you know, so just really educating that family as to this is what you should expect. Let's not

574
01:06:29,200 --> 01:06:39,920
hide because deaths can be angelic and they can be very calm and peaceful, but they're also our

575
01:06:39,920 --> 01:06:46,080
deaths that you can do a lot of things. You can do everything right and they're still very hard

576
01:06:46,080 --> 01:06:54,160
to be a part of and to watch. I saw that firsthand. And so I think, you know, and I'll say I'm not a nurse,

577
01:06:54,160 --> 01:06:58,720
I know enough to be dangerous certainly, but you know, there's certain things that the body is telling

578
01:06:58,720 --> 01:07:06,800
you that the organs are shutting down, you know, the respirations are slowing down. You know,

579
01:07:06,800 --> 01:07:15,680
the breathing, the gurgling, the smells, the urine output, all those things, paint a picture,

580
01:07:16,400 --> 01:07:24,480
that yes, we are nearing, you know, this person transitioning and passing away. And this is where

581
01:07:24,480 --> 01:07:31,360
you talked about earlier about being observant, observant and report. So pick up the phone, call

582
01:07:31,360 --> 01:07:38,000
the hospice team so that they can come in and provide the kind of support that they're trained to do.

583
01:07:38,800 --> 01:07:46,320
Yeah, and I've read, I mean, I read a lot of just different notations for our team and it is constant

584
01:07:46,320 --> 01:07:52,160
education, provide about what next steps look like, what the process looks like, what to expect in

585
01:07:52,160 --> 01:08:01,680
the next couple days. If you aren't educating your families before those things occur, and then as

586
01:08:01,680 --> 01:08:07,120
they're occurring, you're really missing the boat. You're really missing how impactful you can be,

587
01:08:07,120 --> 01:08:14,240
because there is really no reason why a family should be going into a deathbind without having,

588
01:08:14,240 --> 01:08:22,320
now every death works different, but they should have a little bit of information that they can feel

589
01:08:22,320 --> 01:08:28,480
like, oh, you know, nursery told me to expect this. No, but I talked to my nurse the other day. She

590
01:08:28,480 --> 01:08:33,520
said probably in the next couple days, be looking for these things to occur. That's when you've done your

591
01:08:33,520 --> 01:08:45,520
job to just to relieve that family of fear and really chaos. So I hope that there's a lot of

592
01:08:45,520 --> 01:08:51,920
conversations going on around the bedside about what to expect. Yeah, and I think that's where,

593
01:08:51,920 --> 01:09:00,960
you know, your motivations or what is it that drives a hospice team? And I think that

594
01:09:02,640 --> 01:09:12,160
from my perspective, life is sacred. Absolutely. And if you don't have a team around you that doesn't

595
01:09:12,160 --> 01:09:17,840
believe that life is sacred, you've got the wrong team because they're not going to have the

596
01:09:17,840 --> 01:09:29,200
compassion to walk you through those steps. And to make this an angelic experience for not only the

597
01:09:29,200 --> 01:09:38,000
the individual, the patient, but also for the family. It is, it's the why. Right? You were given the

598
01:09:38,000 --> 01:09:46,640
privilege of taking care of them at the most imminent stage. And it is a privilege that should not

599
01:09:46,640 --> 01:09:52,560
be taken lightly. And if you aren't kind of doing all those things that we just discussed,

600
01:09:53,280 --> 01:09:59,760
then to me, you're not mission driven about what what hospice, what right hospice looks like. And

601
01:09:59,760 --> 01:10:05,520
it is a sure way that you won't be in business any longer because the families are going to be the

602
01:10:05,520 --> 01:10:13,440
ones that brag about what Nurse Terry did to make their experience better. And who do you mean?

603
01:10:13,440 --> 01:10:19,520
Sometimes their experience is is better that they're talking about maybe not so much,

604
01:10:19,520 --> 01:10:30,640
remember dad. So I really think that every residence we can be impactful for what right looks like

605
01:10:30,640 --> 01:10:36,720
when they need it when they need it most. Yeah. And I think bringing it full circle, we started out

606
01:10:36,720 --> 01:10:45,680
the conversation with caregivers. And every hospice team member is a caregiver. And if you're a

607
01:10:45,680 --> 01:10:51,920
transactional caregiver, you're going to miss the boat, especially when it comes down to hospice.

608
01:10:51,920 --> 01:10:59,040
You've got to be relational and you've got to look at life as being sacred. And you have to have a

609
01:10:59,040 --> 01:11:07,280
perspective of that social awareness and that presence. And it's that is such a simple thing being

610
01:11:07,280 --> 01:11:14,240
present. But I've seen and witnessed many, many hospices that are not present. And that's sad.

611
01:11:14,560 --> 01:11:20,960
That's something I can't say what that is, but that is that's just,

612
01:11:20,960 --> 01:11:30,800
yeah, it's not it. It's just not it. Yeah. So anyhow, I think, you know, coming full circle, I think,

613
01:11:30,800 --> 01:11:35,600
that's where we need to probably leave this conversation unless you have something else that you

614
01:11:35,600 --> 01:11:41,040
want to say in particular. But I think it was a great starting point. Obviously, there is more to

615
01:11:41,040 --> 01:11:48,960
the union that we could unpack layer by layer. But you know, this is a great conversation. And I hope

616
01:11:48,960 --> 01:11:55,920
that many that were listening will begin to ponder and ask all the difficult questions. And

617
01:11:55,920 --> 01:12:04,320
you know, a great place to start is your physician, but maybe not. I mean, not all physicians get it,

618
01:12:04,320 --> 01:12:10,160
not all physicians because they're more what we talked about. Curative. So, but there are a lot of

619
01:12:10,160 --> 01:12:17,040
resources out there. And are there any resources that you could share with the rest of us that you

620
01:12:17,040 --> 01:12:23,200
found to be inspirational or impactful in shaping your vision of what hospice should be?

621
01:12:23,200 --> 01:12:28,320
I mean, so, yeah, there's a lot of great national hospice,

622
01:12:28,320 --> 01:12:34,400
powder care associations out there. You know, when we went through our accreditation, we learned a lot

623
01:12:35,200 --> 01:12:42,960
from those organizations, podcasts like this help us, you know, understand what's out there,

624
01:12:42,960 --> 01:12:51,280
we're in the Midwest, you know, what's what else is going around in the country. Sometimes you

625
01:12:51,280 --> 01:12:55,760
think you're so fast and a mover in a shape, and you realize that somebody else has been doing

626
01:12:55,760 --> 01:13:02,400
the same thing for 10 years. So, I really think really checking out your local,

627
01:13:03,440 --> 01:13:10,960
palliative care and hospice organizations in your state as a provider, but if you're like a potential

628
01:13:10,960 --> 01:13:17,600
family member that needs help, you know, maybe ask, it's not so much that doctor that may have

629
01:13:17,600 --> 01:13:24,240
the right resources, but I for sure know, their nurses usually know who to refer to and who to ask

630
01:13:24,240 --> 01:13:31,600
questions or sometimes they have case managers in the physician group. But really, you know, my only

631
01:13:31,600 --> 01:13:37,040
final thought is, and sometimes as providers, we're the worst for our own families, but to really

632
01:13:37,040 --> 01:13:43,120
lean into what's hard, and sometimes what hard is, is to sit down with mom or dad and ask, what are

633
01:13:43,120 --> 01:13:50,640
their wishes? You know, what is concerning, you know, tell me how to handle this mom, if this were

634
01:13:50,640 --> 01:13:58,320
to happen, do it before the chaos starts because it's a lot easier to take care of mom or dad's wishes

635
01:13:58,320 --> 01:14:04,560
when there's no chaos and know that they've told you exactly what to do versus the opposite. So,

636
01:14:04,560 --> 01:14:10,800
you know, lean into what's hard and really hospices and hard hospices again.

637
01:14:10,800 --> 01:14:13,760
Yeah, absolutely. Then everybody should be able to have.

638
01:14:13,760 --> 01:14:17,120
And if somebody wanted to get in touch with you, what's the best way to do that?

639
01:14:17,920 --> 01:14:24,240
Sure. So, I'm with Friendship Village. So my email is zerbanzirb.org.bz.org. And boy,

640
01:14:24,240 --> 01:14:34,240
A.M. Stacey, stac.@fznfranc.viznvictor.stl.com. You can look up Friendship Village, St. Louis,

641
01:14:34,240 --> 01:14:40,480
Google us and we'd love to hear about your story or help someone out that needs some direction.

642
01:14:40,480 --> 01:14:44,560
All right. Stacey, what a pleasure to have you on and to meet you finally.

643
01:14:45,280 --> 01:14:49,840
And let's do it. Let's do it again because like I said, we've only touched the surface of what is

644
01:14:49,840 --> 01:14:54,000
hospice care and I think that there's so much more that we can talk about.

645
01:14:54,000 --> 01:15:00,080
Yeah, I look forward to this not being our last conversation, Mark. So thank you so much for having me.

646
01:15:00,080 --> 01:15:04,720
All right. And this is Mark Terrible. Your host and I want to thank all of you for tuning into

647
01:15:04,720 --> 01:15:11,200
Aging Today. We are the podcast where together we're exploring the many options to aging on your

648
01:15:11,200 --> 01:15:18,400
terms. Join us every Monday when we release a new conversation on Aging Today to your favorite podcast

649
01:15:18,400 --> 01:15:24,960
channel. And remember this, we're all in the process of aging and as we age, we really are

650
01:15:24,960 --> 01:15:33,440
better together. So stay young at heart. You make me feel so young. You make me feel like spring

651
01:15:33,440 --> 01:15:42,400
as spring. And every time I see your face, I'm such a happy individual, the moment that she's

652
01:15:42,400 --> 01:15:51,600
being. I want to go play hide and see. I want to go and bounce the moon just like a Torre

653
01:15:51,600 --> 01:16:01,920
Balloon. Well, you and I are just like a bullet. Running across the metal.

654
01:16:01,920 --> 01:16:07,760
They can have lots of forget me night. So you made me feel so young.

655
01:16:09,280 --> 01:16:15,760
You made me feel there are songs to be sung. There will still be wrong and wonderful things to be found.

656
01:16:15,760 --> 01:16:23,360
And when I'm old and grey. You've been listening to Aging Today, where together we explore the

657
01:16:23,360 --> 01:16:29,600
options to aging on your terms. Join Mark in his guest next week for another lively discussion

658
01:16:29,600 --> 01:16:36,560
on proactively aging on your terms, connecting you to the professional advice of his special guests.

659
01:16:36,560 --> 01:16:42,800
With the goal of creating better days throughout the aging process, your host has been Mark Turnbull.

660
01:16:42,800 --> 01:16:49,440
Join Mark in his guest every week on Aging Today, your podcast to exploring your options for aging

661
01:16:49,440 --> 01:17:00,320
on your terms. And you went all in grey. You make me feel the way I feel today. Cause you make me feel so.

662
01:17:01,200 --> 01:17:16,160
You make me feel so. You make me feel so young.

663
01:17:16,160 --> 01:17:21,160
♪ It's all young ♪