Episode 3

October 28, 2022

00:37:17

S2:E3 Dr Yolanda Suarez - Death From a Distance

Hosted by

Tony Siebers
S2:E3 Dr Yolanda Suarez - Death From a Distance
Parent Projects
S2:E3 Dr Yolanda Suarez - Death From a Distance

Oct 28 2022 | 00:37:17

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Show Notes

Dr. Suarez is board certified in Family Medicine, Hospice and Palliative Care and Geriatrics. She recently completed a Healthcare MBA at Oregon Health and Sciences University (OHSU). She is the medical director of Traditions Health Hospice in Portland and Salem and is a palliative care consultant at OHSU Hillsboro. She is developing a home-based palliative care and chronic disease program that will launch by the first of the year. She has begun training as a Psilocybin Facilitator with the intention of helping terminally ill patients cope with existential pain and she is excited to see where this leads. Most important to Dr. Suarez is her art, travel experiences, her “boys”, Cooper, a mischievous little Yorkie, and Jack, her lounging-loving mixed Corgi, but mostly, her family, especially her grandson, Riker, the love of her life.
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Episode Transcript

Speaker 1 00:00:06 You're listening to parent projects. Speaker 2 00:00:11 Hey guys, is uh, palliative care or hospice a part of the situation for your family? And, uh, specifically are you dealing with it from some level of a distance? Uh, you're gonna wanna stick around for today's show. Dr. Yolanda Suarez with Traditions is gonna be in studio, and we're gonna talk about those things that can help you deal with death from a distance. Speaker 1 00:00:54 You're listening to Parent Projects, a Family Media and Technology Group Production. Now, here's your host, Tony Sears. Speaker 2 00:01:04 Hey, guys. Uh, this week's show, uh, is somewhat of a personal touch, and we're gonna work to get through it. I've got Dr. Yolanda Suarez with Traditions Health. Uh, they are a hospice organization, palliative care organization. She, in particular, is an expert, uh, that has dedicated herself to being able to help those loved ones to help us and to help our loved ones, uh, as they face that time of transition in particular. And so, uh, for me and my personal family, uh, we had the great opportunity to, to work with Dr. SWAs, uh, last month, uh, with the passing and the transition of my own sister. So we'll see how these episodes gonna go. There may be a couple of spots that sit within it, uh, but until that does happen, Dr. Suarez, thanks. Welcome to the show and thank so much to thank you for, but we'll start with today. Thanks for being here. Speaker 4 00:01:56 Hi, Tony. Thank you. Thank you. I'm so excited to be here, and I'm so excited that you asked me to be here. Speaker 2 00:02:02 Well, you're, uh, the calm, the dignity that you provided, uh, you, the information you provided to us. It was, it was a different tone. And we, you know, in our, in our, uh, for some it's a parent project for us in our family. My parent project was also seeing my parents have to deal with, with, um, with bearing one of my siblings and watching one of my, my, my, my only sibling pass. That creates a lot of the parent projects there. That's all a part of this. And, uh, the dignity, that good palliative care, uh, informative, uh, and understanding what's going on in that. And hospice, I think was really key to us being able to say goodbye in a way that will help my family stay healthy, uh, mentally, physically, emotionally. Uh, it helps us recover and just to deal with loss, which is hard in the first place. So thank you for that. Speaker 4 00:02:51 That's my pleasure. Speaker 2 00:02:52 Yeah. As you, um, you know, I've, I've asked you this a couple of different times, but I think it's a, a great story to hear and understanding, Uh, it is a tough thing to deal with. Death is rough families coming in from all over all the complexities of that situation. What gets you, Dr. Sus, to put your life to this? How did you, how did you come into palliative care, hospice care? How did this come to be the mark in your calling? Speaker 4 00:03:20 Yeah, that's a great question. And it's something that I'm asked repeatedly. And, um, it's, it's really hard to say how people are led to a certain type of work. But for me, um, I didn't get any exposure to end of life care in medical school or residency. I had no idea what hospice was. And all of our patients died in the hospital, ex all except for one. And I wrote a prescription for morphine, um, at the, um, request of my attending. And the patient went home. And when I asked them, How is this patient going to be taken care of at home, he just kind of shrugged and didn't say anything. And so for me, patients always died in the hospital. And if they went home, it was a mystery what happened. And then towards the end of my residency, we had a hospice, a local hospice. I did my residency in, in Los Angeles, um, through usc. And there was a, an organization that came to speak to us. Uh, it was a hospice organization, and that was the aha moment for me. And that was, that was the answer I was looking for. And that was very, um, yeah, that's really the beginning of my, my work Speaker 2 00:04:33 When, uh, so is a, is a, a doctor that starts getting that your, your eyes are always the aha moment. You see that, Oh yeah, there's a, there's probably humanity had there at that point in time. Had you had a family situation, was it, was it something you could tie in personally to, or really was it just being able to recognize, wow, we could do better in a healthcare system if we understood this element and and layered that in? Yeah. How did that unfold for Speaker 4 00:04:58 You? So I've been really lucky that my family, um, it's, you know, up until I have a very small family. And so, um, so thankfully I didn't have anything going on there, but I'm just drawn to people. And I mean, I think medicine to me is, is a puzzle involving people. And, but the most important person is, is, is is the patient. And, and understanding the patient, being curious about that person. And I, that was this curiosity about people, I think is what, um, what I think drew me to that, that a lot I do is dealing with patient themselves, less so about the medicine, right? I mean, it's, it's about understanding the patient, what they want, what their, what their priorities are, and that family. And I think that's what I, I love so much about. He gives me the opportunity to, to deal with the entire patient as opposed to just their disease. Um, you know, we're past that, We're past the curative space, we're, it's about the patient now. And like that's, um, I think that's what draws me to this. And the opportunity to work in teams is also very appealing because I have whole, I have to do it all myself. I have whole team and, and all that just comes, comes together. That's really important work. Speaker 2 00:06:22 And, and the, the mark of, we'll call it, I don't know if it's the right term from that, but bed bedside manner, I think is a term that I've heard in the past of the doctors use to explain and the patients, what that, what that hospice situation or what that looks like. Is there a, when family comes in to the situation, and, and I think that's, we were talking offline, that eventually becomes most hospice or home palliative care, that becomes some element. It's to get them home. And so there's probably gonna be some intro introduction of, of that. Is there, is there, is there training, is there a special training or, or what's the, what's the thoughts that help prepare, uh, the physicians and the staff and the team that's there for hospice? Where are they coming from, um, when that moment happens as families starting to come back in, everything's now transition maybe out of a hospital, back into the house and kind of coming through in that day. Well, you know, it's what, where, where's, where's the, where are you guys coming from? What are the things you guys are seeing, thinking or, or feeling for? Speaker 4 00:07:22 Yeah, so that's a really good question. And there's a lot of, of training that, that goes into this. I think that some people are better at it than others. I think there's only so much you can train people to, um, um, Cause these are very difficult conversations. And so how do you approach these conversations? And the way that I always approach it is, um, you know, the patient is, is, is in the forefront. I recently had an intern come with me and to, um, to talk to a patient who was in the hospital and who was delirious. And she was surprised that I was gonna go talk to the patient. And I thought, Well, I, I need to talk to the patient. I need to know what the patient wants. Delirium is not the same as dementia delirium. Mm-hmm. <affirmative>, um, you know, waxes and weighs. And so the important thing is, is who the patient is, what their goals are, what what is important to that patient. I think that's the key. It's not what's important to me, what's important to the resident. Um, it's what's important to the family. It's what's important to that patient. And, and getting a really good understanding of that will help lead the conversation and bring in the family and discuss, um, discuss that. Because once we have a clear idea of what the patient wants, it's just a, a much easier conversation. Speaker 2 00:08:45 Yeah. Uh, that makes complete sense from that standpoint. I think oftentimes when a family's coming into it, you're looking at where taking that break to focus on you, you kinda have all your baggage. It's coming through the door. And, and one thing I think I really want to talk about when we get into this next segment after this break is, uh, you know, if you're walking in as a family member, what are healthy things to do? Walking into that situation? What are, what, what, what, what's right it's supposed to kind of look like or maybe not, right? Cuz if you've seen one projects, one project, but what are, what, what could success look like that would help that situation, that would help those other conversations continue to unfold? Is the, the medical staff needs to have that with the, the, you know, dignified dying, they're passing or, um, yeah. Speaker 2 00:09:32 So I, I think, uh, after this, this, uh, we're gonna take a break here. When we come back, we're gonna sit and talk with Dr. Yolan Suarez, uh, and really talk maybe as family that's coming in from outta town. Um, some proper ways that you can step into that and things to think about once you hit the ground. Stay to it. Hey guys, uh, this is Tony at the Parent Projects podcast. And if you are powered by coffee the way that I'm powered by coffee, I think you'll appreciate knowing a way that you can help the last lost and least of us that didn't have a great transition. You see, The Refuge Coffee Company is a social enterprise operated by Catholic charities of central and Northern Arizona, where they use this coffee in this business model to help homeless veterans at the Mana House transitional community get back on their feet, help a veteran turn a handout into a hand up by giving them the opportunity to earn your business. Purchase coffee [email protected] That's the refuge az.com. If you order six or more bags, shipping will be free. And if you tell 'em that parent projects sent you, I'm gonna send you a travel coffee mug. Thank you again, and let's get back to the show. Speaker 2 00:10:47 We're here today with Dr. Yolanda Suarez, uh, a Traditions Hospice. Uh, played a personal role in our family, uh, in many other families, uh, a across the country. The, uh, the, the focus today we're looking at is really that death from a distance. It's this kind of palliative care basics for remote family caregivers in particular, Dr. Fares. Let's, let's talk about the families coming in. Uh, they've gotten that phone call in the middle of the night or whatever it is. You know, it's, uh, Hey, your, your mom, your dad, your sisters ready to make some difficult decisions. They're asking for you to come into town. Um, what, what should, what, what is most helpful when family coming into that situation? You've just recently probably transferred back with the client, the patients just moved back into the home. What are some things we should be thinking about? Speaker 4 00:11:39 So these are various, sometimes these are very complex cases, Tony. I think that, um, death sometimes brings out the best in people, but oftentimes it brings out the worst in people. Um, and their conflicts can arise. But I think the most important thing is there has to be some trust. There has to be a lot of, um, trust in the, in the healthcare professional. And so what I try to do is have the family pick one person that will be the spokesperson and that can communicate because it, things can get very muddled if I talk to one person, uh, the provider, and then I have to talk to another person. Um, it just gets very complex because people hear different things. You may say the same thing to one person, but people's perspectives can be different. And I think, so I think when there's, especially when there's a lot of family members is, um, having one person and usually the local person that is, um, closest to the, uh, uh, the patient, um, who can speak directly with the providers and then have that person communicate it. And the providers social workers can also help facilitate those conversations so that if there are more family members that want to hear it all at one time, that can be facilitated. Sure, sure. I think the lack of information is probably, or the lack of understanding of a situation is probably the, um, the, the biggest obstacle to, um, or, or, or causes the greatest amount of Speaker 2 00:13:18 Conflict. So those, that family member that you're looking for to talk to, um, may or may not be a power of attorney or something working there, because at this point in time, you're, you're still trying to really work with, you're working with a patient directly. Right? Usually when, when the, when things are kicking off. Okay. Mm-hmm. <affirmative>, uh, and Speaker 4 00:13:35 Yeah, Well, you bring up a girl. Good point. Because one of the key things, and a lot of things that, um, that we see so often at end of life that hasn't occurred is that the patient has not designated a power of attorney or somebody to speak on their behalf. But oftentimes, power of attorneys step in when they're not supposed to. That power of attorney is responsible for the care only when the patient can't make those decisions on, on their own for themselves. But that is, um, so a spokesperson can be different from a power of attorney, obviously, you know, uh, one person who may have knowledge of, of healthcare might be a better, um, point of contact and, uh, resource for the family, and then they can communicate with the, um, the person who has been appointed the, the power of attorney at that point. But, um, there's also a lot of common misconceptions about hospice that brings on a lot of conflicts within families as well. And so, um, helping great Speaker 2 00:14:30 <laugh> hum up <laugh>. Speaker 4 00:14:33 Yeah. So, uh, clarifying some of those, and, you know, and demystifying some of those things is also really important. Speaker 2 00:14:40 Yeah. And, and is that Easely done, uh, from that, will you talk maybe into that one family person to have them distribute that or talk to that information? Is it trying to get people in one place to level set and hear the same thing at the same time? Is there one thing that works better than the other? Is it just Yeah. Up to family. To family? Speaker 4 00:14:59 So I, I mean, each situation is unique. Yeah. Um, some families are very cohesive and you can have that conversation with everybody at one time. And then, um, and that works great. Other times that doesn't work so great. Um, but also, you know, there's also medical literacy that we talk about all of the time, and especially with our elders or people who, um, who, you know, English is not necessarily their first language. Um, and so being able to communicate that information in a way that everybody can understand is also really challenging. And so when you have somebody that has medical knowledges, that's very helpful. But if you don't, we as providers, that's our responsibility. We have to make ourselves understood. Right. Um, because you want to make sure that everybody understands what's going on so that they have, um, so there's less, less confusion and less, um, uh, less conflict later on. Speaker 2 00:15:54 Yeah. Is there, you know, in, in one, maybe in that confusion and conflict, uh, time, the less so that you have, the more that kind of heightens awareness and, and things get very, very, you know, difficult, um, engaging. I think that's one of the first things I know I wanted to try to gauge. And I saw many other people when they first came in, uh, they were trying to gauge as well, how much time do we have here? Is this a do I, do I have 25 minutes? Do I have, you know, two and a half days? Do I have 25 days? Like, how, how long is this gonna work through? It seems like families are trying, when family members first come in, it's one thing to do. And it probably helps us gauge what level of conversation we have to have at that time and what's gonna pass. Is there something about the, the general setup of hospice, especially at home or palliative care at home? Is there something about the setup that can help clue you in to where you might be in, uh, transition at all? Speaker 4 00:16:55 As far as life expectancy, you mean? Sure. Yeah. Oh, that's a topic in and of itself. That's a, is it really? That's a really great point though, because, um, it's what we refer to as prognostication. And so some doctors are better at it than others. But, um, it's, you know, it's hard to predict because we're not God, but there are certain things that we, we look for, We look for, you know, functional status, disease process. We look for mental status, um, you know, what brought them to the hospital in the first place. So there's a lot of things that we, um, go through and, um, I've done this for a long time, so I can pretty much gauge, um, um, I'm, I'm, I can pretty much gauge the life expectancy at that point. But if, if there is a life threatening illness and, um, there is not much time, the the best thing is just to bring family in to have those conversations say, this is a good time to come in if you can, and, um, say goodbye or, you know, come visit. And I think that the earlier the better because you don't wanna miss that. Um, that window of opportunity for somebody who wants to visit and see their loved one, or needs to take care of, of caregiving or of their, you know, their, their assets, their homes, whatever it is that they have to take care of there, there has to be a conversation around that. And, and, um, and when that should happen, Speaker 2 00:18:27 Well, you know, key to those conversations from our experience was, uh, my sister and, and I, and I know others that we've seen in hospice situations, being able to, uh, be in a comfortable spot themself once they came down and, and when they were in control and working through that, that allowed the rest of us to kind of gauge those, have those conversations, to work through those conversations, which I think is a huge benefit of why you use hospice and palliative care. It is, it is a huge upside to have resolved, uh, or to, you know, to work through those things in a, um, not a hospital environment necessarily. Uh, and it could even ha at some element, some of it even happened in a hospital environment, honestly, when you were treating, uh, you know, my sister up at O H S U in Hillsborough, um, I still was able to have, she just had hit a piece for one of the first times one night that she and I could have great conversations in FaceTime. Speaker 2 00:19:25 And I think that's a, that was something that came real valuable. So I would tell if family members that are out there, if, if this is something that, uh, they're having a hard time calming into or working through, start seeking this out. If you haven't been presented an organization that can do this, find one, start looking for something. Uh, and I'm really happy, we are really happy with traditions. And, uh, and I was hoping kind of between, uh, this topic and kind as we segue into talking about, uh, maybe what the most common questions are that you hear from everybody when they hit the ground. Mm-hmm. <affirmative>, I like to highlight traditions a little bit and show other people what it was that we found and really what could be there. If that's, that's okay with you. We'll take a break to there. Speaker 5 00:20:12 At Traditions Health Enhancing your quality of life is our greatest priority. That's why we pride ourselves on providing top medical professionals the latest technology and highest level of care all to fulfill our healthcare promise to you and your family. This channel features everything you need to know about home health, hospice, and palliative care, from tips on how to live well with a chronic illness, to heartwarming stories about exceptional patient care. Subscribe now to see how we are changing people's lives for the better. Speaker 2 00:20:52 Hey guys, we're back in this week. We are talking about death from a distance, uh, for family caregivers that might have to come into a situation, or you're coming back and we're looking specifically at the industries of palliative care and hospice and the impacts they have there. We have with us, Dr. Yolanda Suarez, who is the medical director with Transitions, uh, in addition to that, I mean, she, she works, uh, palliative care, geriatrics, Oregon Health Sciences University. Um, you, you've done, you've done an MBA as well Yes. In and around that. So you're understanding just the complexities of how I think that moves into, into, uh, into medicine as well. What's the business element of that? What is the touch points between where medicine comes in? This is a really, I find it to be a very, very interesting soft touch between, sometimes there was, I used to think of this traditional medicine, maybe they call it alternative medicine. But when you're going home and you're working through some of those things and those touches, uh, of just not being in a facility necessarily, being inside a, a hospital, um, and you do a, you do a great job of that. So, again, that, that's who we've got. We've got, uh, Dr. Asez with us today. Thanks again for joining us. Speaker 4 00:22:04 Yeah, thanks. So my, my MBAs in is, actually, it's in healthcare. I mean, I think our, our particular healthcare system is really complex. Yeah. And, um, understanding that is, is it's is kind of difficult at times, even, even for healthcare providers. You know, Speaker 2 00:22:22 I, you know, it is, I think not only difficult, but when you look at the fact that generally, uh, a single healthcare event could wipe out a family these days, when it comes down to the costs of those things, uh, you know, we, we look the, for the first time ever, also, we're an aging population globally the first time in the history of humankind. The organ, he or the, uh, uh, the World Health Organization is saying the average human being across the globe can expect to be 65 years of age. Uh, and that is, I think we'll just continue to see that go up with, with the introductions of stuff like with medicine and the advancement of medicine. So I love that's what you're focusing on. Thank you very much. And I think that, um, the transition, what I'd really like to get into are, man, there's common questions. I am sure that we asked and messed it all up, coming into it as a family. It's, it's, it's, Speaker 4 00:23:18 No, Speaker 2 00:23:19 We do the best Speaker 4 00:23:20 You guys. Speaker 2 00:23:21 Yeah. I, I mean, honestly, you're doing the best that you can. There's a lot of complex stuff that's going on. We had a great conversation in the last block, and if you missed it, make sure you go back and you watch that. Um, and make sure that you're, you're, you know, subscribing if, uh, to the channel, understand this, see the other resources. We're gonna post some of the resources that transitions and Dr. Schwarz has provided for us along in show notes and everything down below. So check that out. But if, um, is, if we talked already kind of about what would be great things to know, Can I ask what, what are the most common questions? What are the, even if they're not the right questions, what are the most common things that families are looking for when they come into that situation and they're looking at it all happened? Speaker 4 00:24:04 Yeah. So we hit a little bit about that, um, in the last segment, which is, you know, how, how long, you know, how much time do we have with our, our, our loved one, my mom? Um, you know, what do I have to do to get ready, um, for, for, sorry, if the patient's coming home, uh, from the hospital, what, what do I have to do to get ready to res, you know, to bring my, my loved one home? And that's a whole other conversation. Cause it's very, it's very complex cuz as we talked about, um, you and I, um, before it's, um, our, our Medicare, which is primarily what patients use for hospice care, doesn't cover caregiving, doesn't cover housing. So what happens to somebody like a person who's still working? How do we, how do they take care of their mother and still work? Speaker 4 00:25:00 You know, um, how does that happen? Where do they find caregiving and who pays for the caregiving? It's another, is another option if they can't bring them home, What, what are the options for, for housing and placement? Um, in your sister's case, it was, she wanted to come home. She was a very, she she was, she made that very clear from the beginning. And so we did what, And, you know, in, in your, in her situation, she was so fortunate that she had all this loving family that was able to, to, to want her to come home and, and, and honor her wishes. But not everybody has that. Some people don't have families, um, or, or, or the, the daughter or the son or the only family members out of state. So how do they negotiate that from far away? Um, you know, hospice has social workers, has, you know, we had, there's a whole team that can help, um, that can help families navigate that system. Speaker 4 00:25:55 But it, it becomes very complicated. You know, where do you, where do you find those resources? How do you visit facilities from far away? Right? You know, you live in another state. How do you know this is the right place for your, for your mother, your father, your aunt? Um, and so those are all very, those are questions that we, we, um, we get all of the time. Um, the, um, you know, primarily with, with the placement, you know, what happens afterwards, you know, who pays for funeral, is there, are there funds? But if there are no funds available for, for that, how, what happens after that? Um, so that's, um, that's also very common. The other thing is, um, can I still get medical care while I'm a hospice? What are my options? So, uh, and when, when patients are on Medicare, their medicare benefits cover mostly, you know, their everyday care. Speaker 4 00:26:45 Once they're on hospice, their hospice benefit kicks in. So that hospital stay is no longer covered. And so patients, um, the care is just different. It's, it's, the focus shifts to quality as opposed to preventive and, and life extending. But those are also, you know, can I keep my same medications? People come in thinking that we're gonna take all their medications off and that's not the case. We'd like patients to take as little medications as possible because it's better for them. But, um, we don't come in and automatically, um, you know, cut, cut out everybody's medications. Speaker 2 00:27:17 Um, well I, and I'd say I think a, um, an eyes wide open moment, uh, for me in that is that I, I think maybe be in most of the experiences I'd seen before, it was a pretty linear process in, in my sister's case. And I gotta imagine other people have that too. It kind of came back and forth. I mean, we, we came home, we had hospice. We ended up having to go back to the hospital in order to make certain adjustments into medications and things like that. Then we came back over, not like there was this, it's a very fluid to fluid situation. And, and so what you understand for one day might only work for that day. Mm-hmm. <affirmative> and, and they can go with understanding that aspect of, um, like the payer system is what I, you know, we, I we hear that referred to, uh, as is uh, is how insurance and actuary kind of impacts how healthcare happens. Uh, are there anybody that you, you guys generally recommend? Do you, does, is it social workers on side, the team that start to explain those things? Do you have a recommendations, um, on, on how to understand that aspect? Speaker 4 00:28:23 It's, it's, it is really complex. Uh, and we do have social workers that assist with that. The social workers. Um, their job is to understand patient's financial, um, status, uh, to see what funding is available, um, and work within that, um, that capacity. Um, you know, caregivers are extremely important cuz hospice is not in the home 24 hours a day. It's a, we we're available 24 hours a day, but we're not there. And so caregiving is essential. And so, but how, how do you get caregiving when, you know, for instance, you're far, you're so far away or you don't have the resources. It's, it's quite, quite challenging. And so our social workers can cap tap into some of those resources. There's, there's organizations that, that will help support some of that. I'm involved in a, in a wonderful organization that helps, uh, um, hospice patients with wishes. Speaker 4 00:29:16 Like sort of like gifted wishes. It's called gifted wishes, but it's, um, it's like a make a wish for hospice, uh, patients. So, so there's ways that we can, um, find, but, but funds are, are very good. And so dot go of is a really good tive site, um, for that health. Um, because a lot of patients come into this thinking that end of, you know, when they need it, Medicare will pay for housing, they will pay. And it's, it's, that's, that's not the case at all. Medicare pays for medical care, but, um, housing caregiving, that is usually separate. Speaker 2 00:29:57 And I think you, we may have had a little bit of a gremlin in the system. Can you give us that website one more time please? And Speaker 4 00:30:03 Yeah, it's the cms.gov. Um, let me see if there's a specific, I had written it down somewhere, but, um, yeah, so it's the, um, CMS dot gov's website, um, and then you just navigate to, um, Medicare fee for service the site. And, um, it, it, it, it's pretty easy to read. So it's not, it's, it's made for the public. So, um, it's, it's pretty informative. And for patients seeking hospice and palliative care, it'll lead you into the hospice. And it, it does a really nice, uh, um, it gives a really nice explanation of what's covered and what's not covered and, and how your regular Medicare, uh, benefits work. Um, and what changes once you're on hospice. Um, and so really the the key thing when you're on hospice is that you are aware that your Medicare benefits are gonna switch. You know, you're no longer gonna be, it's not no longer gonna pay hospital care. Speaker 4 00:31:03 Um, you can still keep your attending. You're, if you're very attached to your primary care provider, you're, you're able to, uh, to keep your primary care provider. And so that's a really important thing for some patients to, to, to know that their doctor can still be involved. And so if patients, for instance, fall in the home and they break their hip or they, they hurt themselves and they're bleeding, we, they can still get care in the emergency room. You know, most of the time hospice has to be involved of some sort, but if they need more care and they choose to receive that care, then they can always come off of hospice to receive that care. So it does, as we talked about before, it's it's quite fluid. Yeah. Uh, and some patients, um, actually graduate from hospice. They get better and they, and they come off care. And so then their Medicare benefits just right back in. So you never will lose them if you, if you want them, if you come off hospice, they, they come right back Speaker 2 00:31:54 On. And I think a, a good thing because the show goes out nationally to think through is you can look through there, there's a national set, but really state Medicaid systems tend to guide where this is gonna go. So make sure you look within your state Medicaid center. Uh, for our family, I know we are able to pretty quickly understand what that flow was and how that would go when we had to come outta hospice back in the traditional, uh, particularly because my sister used that Medicaid system. So if your family members on that Medicaid system here in Arizona, and we have all techs and we have some other versions of that as well that are specifically set up for seniors, depending on where they may be housed or how that works, um, state specific look through that CMS within your state too, uh, will, will help guide you into what that looks like. Speaker 2 00:32:40 But it sounds like really your hospice provider state to state should have a good understanding of that. And that's part of that, that team, which I think is one of the last things I was hoping to transition to as we go to close for a family, when you're coming into this, you are a medical director, uh, in, in and involved in a many times, you're providing that, that medical, uh, direction. What, what medicines are gonna be used as they work through those things. There is an entire, uh, spectrum of people not spec i'd. I mean, there's, there's a, we, we, we had a chart. I remember we used to understand everybody that played a role. And there's, there's something like six or seven different roles from social workers to chaplains and others. Um, how is it that all of that stays synchronized with a, how, how do you guys know what's going on from that in case management as far as it, it looks, what, what can a family, what should they know and what can we expect from that out of a hospice or palliative care? Speaker 4 00:33:37 Yeah, it's a, it's a really good question. So the, the core team members are the medical director, the chaplain or spiritual care coordinator, social worker, and of course the, the nurse case manager. The other services that we provide, um, are a health aid that helps with, um, some caregiving, uh, bathing, um, you know, some housekeeping. Um, and that's, that's a very, uh, a little little bit about housekeeping, just tidying things up. Um, we can have music therapists, massage therapists as well. And so there's, um, additional services. But the four, the four people are the nurse, the doctor, the social worker, and this virtual care coordinator. And we have meetings, we talk all the time and we, and, and in our meetings, we, we, we do our plans of cares, we identify the needs of the patients, and, um, as a team, we, um, discuss them and we come together. Speaker 4 00:34:31 And that's the beauty. And I think that's what, what I love so much about the work that I do is that I don't have to do this by myself. Yeah. I, my job is that entire person. They're spiritual, they're, they're physical, they're emotional. All of that is my responsibility. But I have people that help me do that cuz I'm not an expert in all of those things. I help coordinate the care and, um, and as a team, we're able to do this and we provide exceptional care. And, and most hospices are, are, you know, this, I mean, you have very dedicated people that do this type of work. And so it's, it's beautiful work. And it's not depressing. People always think, uh, you know, that it's depressing work, it's beautiful, we're happy. And it's, it's just such a rewarding, rewarding field, uh, to be in. It's, um, it's wonderful. Speaker 2 00:35:17 Well, I I don't think we could really wrap it in anything better than that. It was really well said. Uh, you're brilliant to have on your, uh, the perspectives that you shared with us, super helpful, especially for family caregivers. Uh, I think you had, you had great perspective there, and oftentimes they get left out in the conversations and the prep up from all of that, and then that can make us sometimes be more of a problem than a benefit to the situation. So we really appreciate the time that you took to, to walk us through that. And just in general for my family, on behalf of my family as well. But, but for all of our membership here, I just, I really appreciate you sharing your time, your talents, and your treasures. Thanks, Speaker 4 00:35:54 Tony. Yeah, I, it was, it was a pleasure being here, so thank you. Speaker 0 00:35:57 Thanks. Speaker 6 00:36:03 Well, that's it, Fitz team this week, and thanks for joining us. If you've enjoyed the content, remember to subscribe and to share this episode on the app that you're using right now. Your reviews and your comments, they really help us expand our reach as well as our perspectives. So if you have time, also drop us a note. Let us know how we're doing for tips and tools to clarify your parent project, simplify communication with your stakeholders and verify the professionals that you choose. You can find us on YouTube, follow us on Instagram and Facebook. Thanks again for trusting us. Until our next episode, behold and be held. Speaker 1 00:36:35 Thank you for listening to this Parent Projects podcast production. To access our show notes, resources or forums, join us on your favorite social media platform or go to parent projects.com. This show is for entertainment purposes only. Before making any decisions, consult a professional. This show is copyrighted by Family Media and Technology Group Incorporated and Parent projects llc. Written permissions must be granted before syndication or rebroadcast.

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