Caregiver’s Toolbox Ep. 11: “Hospice Myths Part 1”
Caregiver’s Toolbox Ep. 11 “Hospice Myths Part 1” on Apple Podcasts
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Ryan:
Hello, everybody and welcome to The Caregiver’s Toolbox, Tools for Everyday Caregiving. In this podcast, we provide tips, education and information on caregiving and senior care topics. My name’s Ryan McEniff and today we’re going to be talking about the nine myths of hospice and this is going to be broken up into three podcasts, so this is part one. I have a special guest with me this week and for this podcast, whenever we talk about occupational therapy and when we talk about hospice and her name is Debbi and she works for a hospice company in Massachusetts. How’s it going, Debbi?
Debbi:
Great.
Ryan:
Before we get into it, let’s talk about your resume and give the listeners an idea and letting them know that you are an expert in these fields and you do know what you’re talking about. What’s your past professional past been?
Debbi:
Okay. I started my career in occupational therapy as a director of a contract rehab company, did that for a little over 15 years, decided I was ready for a change and moved into the hospice world where I’ve been for the last four, little over four, as an account manager.
Ryan:
Excellent. Basically, what you’re trying to say is you know what you’re talking about?
Debbi:
Yes. Most days.
Ryan:
Excellent. Well, let’s get right into it then. Today’s discussion is going to be three out of the nine myths of hospice and the first myth that we’re talking about is that death is imminent with hospice. Tell me how this a myth and why it’s a myth and what your thoughts on it are.
Debbi:
Okay. Most people, and I hear this on a daily basis, believe that hospice is when somebody is actively dying or death is imminent and in fact, hospice care is meant for the last six months of somebody’s life. Obviously, it’s not an exact science. There’s no crystal balls, but there would have to be, two doctors would have to certify that if a person’s illness took its natural trajectory, without aggressive treatment, that that person would probably pass within six months. That being said, we care for patients for a lot longer than six months, because death is a process, it’s not just one event.
Ryan:
What is the last thought on the idea that death is imminent and that being a myth?
Debbi:
Is that it, like I said, it’s for the last six months of life, understanding that there are no crystal balls. People do stabilize. We see that frequently, especially when somebody’s on, with some type of a dementia, the illness itself tends to have rapid declines and then people stabilize for a while, so the Medicare guidelines and any other type of insurance that would cover hospice guidelines say that the person has to have a continual decline, so we do see patients that graduate off of hospice.
Ryan:
Interesting. I bet most people don’t know that people come on and off of hospice on a, probably, regular basis. The next topic we’re going to talk about is that hospice means you’re giving up. This kind of ties into the last topic that it’s where death is imminent and that means that if you’re going on hospice, you’re completely giving up and you’re just going to get doped up with morphine and that’s basically it. Why is this a myth and what should people really know about this?
Debbi:
Is that there’s, hospice is care. It doesn’t mean that there’s no care given and there’s care pathways. When somebody gets diagnosed with an illness, they can choose to continue to have aggressive treatment for their illness and sometimes that’s effective and sometimes it’s not and I think they need to know that hospice is another care path. It means that we’re focusing on quality, comfort and goals, the wishes of that patient. It doesn’t mean, if you’re on hospice care for cancer or for end stage CHF and you get a pneumonia, because you’re on hospice does not mean that you won’t be treated for that pneumonia. It just means that you’re not going to seek aggressive treatment for the cancer or the CHF or whatever your qualifying diagnosis is.
Ryan:
What you’re saying is there’s two different types of courses of care pathway, which is aggressive and then there’s hospice?
Debbi:
Correct.
Ryan:
What happens when somebody stops going on the aggressive side and just goes on the hospice side?
Debbi:
Their illness continues to progress, which is going to happen and the focus of care, rather than looking to cure an illness is to focus on quality of life and what’s important to that patient and how they want to spend their remaining days.
Ryan:
Absolutely, so there’s a lot of conversation, I imagine, with the patient and the family on what the next steps are going to be?
Debbi:
Exactly. Even if they choose, let me just add, even if they choose hospice and they decide a month into it, a couple weeks into it, a couple days into it, that they really do want aggressive treatment, it’s as simple as signing a piece of paper and ending hospice service, so it doesn’t have to be that forever decision.
Ryan:
Yeah, so it’s truly the patient’s choice?
Debbi:
Absolutely, and it can change.
Ryan:
They can go on it and they can go off of it. The last one that we wanted to talk about in this podcast was that hospice is a physical place where people think that they go to. Why is this is a myth and what is the actual, what is the reality of this myth?
Debbi:
The reality of it is that hospice is care. It’s a care path, as we just talked about. There are such things as hospice houses, which is a physical place that people can go to, but choosing hospice doesn’t mean that you automatically go to a hospice house. It means that you receive the care in your own home.
Ryan:
All right, so when it’s own home, can we define that a little bit more in the sense of does that mean just in residences? Does that mean, what about facilities that people are in and things like that?
Debbi:
Yep. It’s whatever they call home. It can be their private home, a family member’s home, an assisted living, a nursing home, rest home. Whatever physical address they’re at, they can receive hospice care.
Ryan:
All right. Well, I’m sure that’s relieving to a lot of people to know that that type of care is out there and it can be given anywhere rather than having to uproot somebody from where they’ve maybe lived their whole life and have all their memories and have those mementos around their home and changing where their, the most difficult time of their life is going to be occurring, which is ultimately passing away. At least-
Debbi:
Exactly and if you ask most people, their wish is that they die in their own home.
Ryan:
Absolutely.
Debbi:
Again, whatever that is, but there are times where a hospice house is indicated and those certainly are there for that reason.
Ryan:
Absolutely. What would be a reason that a hospice house would be indicated?
Debbi:
It might be that the person’s care can’t be managed at home. There’s pain, there’s agitation issues that aren’t being managed well and they need that one to one attention more frequently. It can also be that the family, it’s a lot to care for somebody in those very last days and sometimes, though families try, they are just unable to and that might be a time that a hospice house would be indicated.
Ryan:
Excellent. Excellent. Well, this is going to be our first part in three parts about the different myths of hospice. Debbi, thank you very much for taking the time to give us your insight.
Debbi:
My pleasure.
Ryan:
Thank all the listeners for listening to The Caregiver’s Toolbox, Tools for Everyday Caregiving. Our podcasts come out every Tuesday. Thank you very much for listening and have a great day.