Episode 2

March 31, 2023


#30 | Steve Alfonsi | Family Dynamic when Death is at the Door

Hosted by

Tony Siebers Bina Colman
#30 | Steve Alfonsi | Family Dynamic when Death is at the Door
Parent Projects - Aging In America
#30 | Steve Alfonsi | Family Dynamic when Death is at the Door

Mar 31 2023 | 00:40:24


Show Notes

Steve Alfonsi is the franchise owner of ComForCare Home Care, along with the Founder and CEO of Vital Palliative and Royal Hospice. Steve grew up in a family where his father owned skilled nursing and rehab facilities in multiple States which gave him exposure to the Senior Care industry at an early age. In addition, Steve learned firsthand about caregiving by helping his mother who lost her battle to pancreatic cancer.

Steve also has an abundance of business leadership experience working prior as a corporate executive that he utilizes and has enabled him to build a work culture and environment that provides quality service. He holds a master’s degree in economics and is an active member in many organizations, such as Home Care Association of America (HCAOA), and is also a Board Member of Arizona In-Home care Association (AZNHA).

Royal Hospice: www.royalhospice.com
Vital Palliative Care: www.VitalPalliative.com
ComForCare: www.comforcare.com/scottsdale
ComForCare Hotline: 480-998-0668

Looking for information? Parent Projects takes the stress and intimidation out of the process for families relocating an aged loved one using our educational and self-help downsizing guides found at www.parentprojects.com. Through our “Verified” Business Network, advocates can access the pre-screened professional services they need on their terms with the financial and personal safety peace-of-mind their families deserve.

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00:00 – Intro

00:13 – Welcome to the Show

01:20 – Introduction to Steve Alfonsi

02:12 – Steve Alfonsi’s Call to Action

07:32 – Skysong Tour Ad

08:43 – Preparing for the Death of a Loved One

20:45 – ComForCare Ad

21:46 – Key Conversations to Have as a Family

38:42 – Closing Remarks

39:04 – Outro


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Parent Projects™ Podcast is a resource of stories, interviews, and tips to help families replace guilt and fear with a little love and laughter.

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Episode Transcript

Speaker 1 00:00:10 You're listening to parent projects. Speaker 2 00:00:13 Hey everybody, and welcome to this week's episode with parent projects. Uh, we are, we're trying this again, live, and that is always a fun way to do this. But look, uh, the one thing that is truly live is the situation you may be dealing with if you are staring at a hospice situation for the first time. There's a lot of family dynamics, and as we close off the month of sibling rivalry, Steve Alf Fonzi with Royal Hospice and, and a whole suite of companies is gonna talk to us and break down some of the experiences of what it looks like when a family is dealing with those dynamics and death is at the door. Stay tuned. Speaker 1 00:01:12 You're listening to Parent Projects, a family Media and Technology Group Production. Now, here's your host, Tony Sievers. Speaker 2 00:01:21 Hey guys. He's the founder and the c e O of Royal Hospice. He's an author of Aging in Arizona, which is a phenomenal book inspired by, uh, many organizations just collaborating and understanding the totality of what life looks like, uh, as we helped an aging loved one. Um, in, in the world here. I've got Steve Alf Fonzi joining us today. Steve, thank you so much. Speaker 3 00:01:44 Yep. Thank you very much for having me. I look forward to, to spending some time with you. Speaker 2 00:01:47 Yeah, it, and I've, I've, I'm definitely looking forward to this. You and I had some great conversations ahead of time. We had a couple of gremlins that jumped into the system that slowed the conversation. <laugh> coming to bear for us now, but that is what happens when we go live. So, yep. Uh, hey, it is, um, it is, uh, there, there's a, a lot of material. You, you really are a pioneer. You're in front of me. A lot of what I'm doing and, and our organization is doing in trying to gather and harness this expertise and get, and see what the market looks like. You, specifically in Arizona, you did this, you started this several years ago. Uh, you had a great radio show that that started pulling in industry experts and pulling that stuff together. You know, how did, how did you come in? How did you, a business guy end up coming in, dedicating your life into working with people at the end of life? How did you find that as your place? Speaker 3 00:02:39 You know, like, uh, and that, that's a great question and I, I enjoy sharing it, you know, quite often, you know, we, we don't really plan for those things. It just sort of finds us, and a lot of us that get into this industry, it's because a lot of us do have a story. You know? And for me, you know, here I was a, a corporate executive, you know, and on a fast track to continue to advance my career in many different levels that, uh, within the, the corporate world. And lo and behold, you know, I have a, a sick, sick mother, um, ultimately, so I'm, I'm playing that role here as I'm working as a corporate executive, trying to balance my everyday life as a, as in the business world, and trying to take care of my mom. At the same time you lost or battle of pancreatic cancer, it'd been, uh, you know, 17 years tomorrow. So it's, uh, yeah. So it's how I found my way into doing what I'm doing today. Speaker 2 00:03:26 Uh, and I'm, I'm, I'm, I'm sad for that loss. We all, uh, and, and how that works. You know, I, I think you, you know, that, uh, the hospice played a role in my family just a few months ago, even with the young sister dealing with bone cancer and working that through, and cancer's a difficult way to go out. But, uh, one thing that, uh, I think what the beauty and what you've found is you've grabbed from those experiences, you've, you've brought in other expertise to help inform your opinion and how you, how you see all these things are connected. You, you've got a series of brands you've kind of landed into, you know, you've got a hospice company, palliative care company, comfort Care. Someone who's been in industry can understand where those three touch. But can you talk to us about the synergy and how you landed in that synergy? Speaker 3 00:04:07 Yeah. I first got into it, and it would've been in late 2014, early 2015, first got into the Comfort Care model, and Comfort Care is a, it's a franchise group, so there's 250 locations around the country. So I bought in as a franchise owner as once again, going back. And I shared my story of why I got into that. And then ultimately, as I continued on down that path in my journey in meeting with families as we're providing caregiving services, um, always had that question because ultimately, you know, we're not on this great earth forever. And a lot of times you're running into, whether you're battling cancer or other very chronic, other chronic conditions or, or diseases or different things that might happen that might even lead you to more comfort measures. So, as we're continuing to, to get to know families and doing things, I was always asked, you know, can we stay with you, you know, through, into palliative care or into hospice. And so, you know, it was always in that forefront or in my mind that thinking maybe we should do that. And then a few years down the road, I found it and started the Vital Palliative and Royal Hospice from there. So the springboard part of that continuum of care for individuals Speaker 2 00:05:06 And, and, uh, that is fascinating. Okay. So it just, it really came down to success with patients, uh, from, from my, it sounds it's success with patients and wanting to keep, one thing that seems to come out, and it, and it was for us too, is when you grab on and you find an organization or a group of people and a care team on your care team that are, that get it right and they want it capable of it there, you want to keep that team going as long as possible. Uh, do you find a lot of synergy when, when somebody's utilizing, uh, the same, the same organization or generally a, a, a consortium of those organizations? Does it can information flow between one to the next, does, does that work well? Or does each kind of have to, does it have to protect or lock that off? How does that look? Speaker 3 00:05:48 A little bit of both. I mean, so obviously you have the, you know, under HIPAA laws, you know, so health information, privacy acts, so, you know, certain things can and cannot be shared within that. But ultimately, you know, through, through our own disclosures, we're letting individuals know. So if they're part of our comfort care model and we're giving us some different services, we just sort of broach that conversation. We let them also know upfront that we also have sister companies. If in fact, the time comes and, and needed, then we can provide some of those additional services. So we let them know. But it does allow us in the opportunity, cuz we're building these relationships, especially when you start out, initially, if a person going through that model, they might start out just needing a little bit of help from mom and dad. It might just be, you know, a couple days a week just around some those activities of daily living, whether it be meal preparation or, or transfers or some transportation. So we get in there, so we start to build that relationship with mom or dad. And then ultimately, then sometimes then it leads, then obviously we get to know the family, and so that just continues on, but through that and we let them know upfront so we can continue to have those conversations and bringing in additional clinicians so it becomes seamless as it continue to age Speaker 2 00:06:51 Well, and that is, I think it speaks a lot to the culture in which your organization has across the board with all of them, but it's, it's a culture that tends to match really, really well. You know, um, we're gonna take our first break here. We'll talk a little bit of the culture that we do as well here in parent projects and what we develop. But, uh, when we come back, despite that culture, I think one of the first places I really wanna jump into this conversation and the substance here is what, let's talk a bit about what, what, even even a family coming through that, what are those initial challenges? Some of those hardest conversations that families have to have when it clicks up to a hospice type conversation that they, that they might run into. So stay tuned with us, uh, with, uh, Steve Alfonse right after this. I'm Tony Siber, I'm the founder of Parent Projects, and I'm gonna take you on a quick tour of the organization. Come on. The organization is full of surprises and if you've seen one parent project, you've seen one parent project. So generally we just try to be mission driven, objective, virtuous, empathetic, and defendable. We call it being moved. Come on and let me show you the insight. Speaker 2 00:07:57 So our organization lives inside the Arizona State University Sky Song Innovation Center and Scottsdale, Arizona. It gives us an opportunity, be around a lot of creative people and creativity. Well, sometimes it turns into trouble, but most of the time it's gonna turn into quality content for you. I just want to take this moment to tell you, we're pleased to have you here. We look forward to helping you. If there's anything at all that you need, please reach out, follow us on the other socials that you like best in the platform that's your favorite. And until you and I get an opportunity to talk one-on-one, behold and be held, Speaker 2 00:08:44 And welcome back everybody. We're here this week with franchise owner of Comfort Care, home Care, Steve Alfonso, who's gone on as c e o of Vital Palliative Care in Royal Hospice. And we've been talking through, just from their perspective, when they see that continuum of care families that come in and start kind of working their way towards what seems to be, uh, you know, Steve, that inevitable, um, next step that is we, nobody's getting off this rock <laugh> right? Alive from this. We all kind of do share to add a little bit of levity to the situation appropriately. Death is a natural thing that we, um, we gotta come to grips with. But we all kind of different ways in which we, you know, we, we kind of face it in, in what our reactions might be the first time that really gets real. Would you agree? Speaker 3 00:09:30 Oh, oh, a hundred percent. And, and as much as, you know, I shared just in the prior segment, sometimes an individual say, come to us early on and, and they start out into that comfort care model. But also it's, it's quite common where we get calls, we're individuals. We, we live in sometimes in quite often the world of denial. We'll think, we'll, we'll wait till tomorrow to plan these different things. And so ultimately then you get, you know, low and behold you get informed that, you know, these might be your final days or you have a chronic condition. So you're bypassing and sometimes and going right into those other phases. And so that's where we can obviously also help out. So it's, you know, sometimes it's can't really plan for the future, but you can do the best you can. And that's where, you know, providing information such as this and being proactive in your, in your care plan is, is extremely helpful. Speaker 2 00:10:08 Extremely, extremely helpful. Uh, you guys, you, I, I know on your platform we've talked about that and seen you guys put a lot of videos up that, uh, we'll, we'll make sure we can, everyone knows how to find you and come to see that as well. We'll look to integrate, we really look, look forward to taking you up on that. We'll be integrating, uh, that content into, uh, into parent projects and, and to, to highlight. It's just when, when, uh, when a family member's only got maybe 40 minutes a day, 45 minutes a day to spend trying to get up to speed and f and, and to plan ahead <laugh> that's, um, the right information at the right time from the right person, I think could be really critical. So I applaud you guys for leaning forward on that and Speaker 3 00:10:48 What you're doing. Speaker 2 00:10:49 You know, um, your, one of the things that, that I had read that that's in your coming, I think your standard, your story when you communicate your story, uh, talked through, um, standing there with your, with your mom in your own situation and realizing you're spending so much time doing all the other tasks that kind of have to happen around the house. And really what your mom wanted was to stand there and hold your hand. Uh, how, you know, how did, can you, um, you know, the, I mean, it, it touches me, so I'm gonna collect myself for that. Steve, can you, can you talk through that kind of scale? What, I mean, when families are coming into that, um, what is it, what are those common questions or those common things that people are first running into as they understand that they're transitioning into that next step? Yeah. That final, yeah. Speaker 3 00:11:36 Yeah. And more often than not, I mean, we get those phone calls or an email, it's an inquiry into one of our websites that, you know, lo and behold that, you know, it might be a, you know, a mother that found out that her father or her own mom was just diagnosed or might be, you know, have different things that might have happened, happened, it might've led by because of a fall or, or some other issue that led into a hospital visit. And all of a sudden them, they're in panic mode. And so within that, I mean, we get these calls and so for us, and we try to help navigate those, those waters, but those calls will come in and the one of the first questions asked saying, what do we do? I mean, they, they really have quite often like, really no idea where to go. Speaker 3 00:12:14 They're trying to explore various options. Does mom stay in her home? Does she move into a facility? How much care is needed? Do I need, you know, 24 hour care? Do have caregivers come in a couple days a week? What else? Other type of services? I mean, they'll just ask a lot of questions because, you know, it's just so much coming at them all at once. And quite often these individuals are residing outta state, you know, so mom and dad might reside here in the great state of Arizona and they're calling from Chicago. And so that's really in a panic. So it, it, it's a whole slew of different questions because there's just a lot coming out of them and it's drinking from a fire hose all at once. Um, Speaker 2 00:12:50 It really is overwhelming. Speaker 3 00:12:51 Yeah. Speaker 2 00:12:52 Have, have you found a good, have you found a good way to lead them or just to help them assess? It's, that is one, uh, I guess I'll pretext with that, even in emergency management, whether you're helping a, a government get itself back on its feet after a catastrophic collapse or anything in, in my past, in my past experiences, a key to, to starting movements when the confused mind says no one shuts down, is providing some level of assessment where they can assess how everything in front of them relates to their particular situation. You know, what do you, what do you guys recommend or how do you handle those, those families who they just, to them, it just is a fire hose, it's coming at them and it's, it's overwhelming. Speaker 3 00:13:30 Well, you know, I'll, I'll start off with, you know, first off saying, you know, parent project and what you're doing is, is obviously it's also a great solution. So you're, you're providing them a lot of information dating back, you know, as you mentioned early on, you know, years ago, you know, I was doing a radio show and co-oped a book, and it talked a lot of the same things. So it's, it's trying to get enough information at your fingertips, how we also handle it within our own organization. So you have a, a very dedicated and qualified team. And we just start that, that conversation, just trying to ask a lot of different questions. And then for us, it's about listening and best understanding, provide them the best assessment that we can. Quite often then we'll also try to then get out and get eyes on the individual. So if they are coming out of a hospital, we work locally with the hospitals, we work with the case managers, we work with other individuals to best understand, because a lot of times, you know, an an adult child doesn't understand what, you know, the hospital might be telling them. But through our own clinicians, we can have some of those conversations to try to better assess to also then provide the best information for them and, and do everything we can for 'em. Speaker 2 00:14:33 You know, one, one particular challenge that, that seems to strike a lot of families where we see a lot of conversations and questions are, is the role that do we use in industry, the payer model, the role the payer model has in how hospice or palliative care or how these things start to, to play out, right? Who's paying if it's a private payer or if it's coming from a Medicaid or if it's coming from a, a Medicare or whatever those things might look. What, what are, what are things that families, what's the large in dynamics? What do families need to understand about the impact of who's paying for it might have not, you know, not, um, just, just negatively off of that, but pragmatically just practically. Speaker 3 00:15:15 Yes. And and that goes back to, and Tony, that's a great question. And that goes back to your earlier question saying, what's one of the things that's always asked? And a lot of times, or it's assumed that on the caregiving side of it, that, you know, that's covered by Medicare caregiver services, you know, technically are not really covered. I mean, they do, and you can't possibly qualify under a state Medicaid program, but for the most part, caregiving services, it's a private pay situation. You know, companies such as ourselves, and we do take long-term care insurance policies and plans that were very popular back in the eighties, and a lot of times families don't even know whether or not that it's still active or what's covered in that. And that's where we'll help navigate those muddy waters and, and talk to them and what may or may not be covered within that. Speaker 3 00:15:52 But then as other part of the services within you look at palliative care or hospice, now those would be covered by the insurance, you know, programs, let's say Medicare, um, it is a subsidized and covered within that, that particular plan. But those are all things that quite often those early questions saying what's covered, what's not covered, how much, you know, coverage do I get, what does that look like? And, and those are a lot of the same questions that, uh, that are asked early on, like, how much care can I get from mom or dad, you know, and what is covered? And so those are things, what is covered help with Yeah. Speaker 2 00:16:21 Yeah. And people trying to get that. I, I think one way that I, I see a lot of families approach it is their thought is just making those entitlement dollars kind of go as long as they can. Yeah. Uh, and to, to do as much as possible before the family kind of learns to, to, to kick in or start working through the estate. Um, you know, one, one thing we also run against is, uh, who's in charge? Who's making decisions, how does this work? Man, families are complex and, uh, and you know, earlier in earlier stages, I, you know, we, we've, we see in our systems, in, in our, in our area, that that family members are willing to let, you know, whoever's got that durable power of attorney, that's, it's kind of pretty cut and dry. They understand, hey, this person's got the healthcare power of attorney. This family member's got the durable power power of attorney. They, you know, and handles the finances and, and they might balance those things. How do you see that dynamic change at the moment when now we're transitioning into that last chapter and that la that final transition of life? Do you see, do you see family dynamics kind of shift to whether or not they've got that decision where they wanna have some type of input, uh, or, or families assert themselves more? Speaker 3 00:17:30 They they do. And, and, but you know, I also, before I even answer and get into that, I also want to, uh, to let everybody know, I mean, they definitely need to, to, to get advanced directives in place, do some different things, and have the best wishes. You know, so have those conversations early on with your mom and dad or, or even your significant other about planning for the future so that that helps, you know, know that, that, uh, and I shared that that comment earlier about muddy to the waters. It's just having those plans in place, it's, you know, can't have those, those conversations early enough. Um, but with that, and as you get later into life, a lot of times once they come to embrace the fact that their, their loved one might be, you know, moving on and, and ultimately and, and will behold do have a life-limiting illness and might be passing, then the conversations do change because ultimately, you know, hopefully individuals do have that heart and they want what's best, you know, for their loved one. And that's where we start talking through the comfort measures that might be in place within a hospice program. And try not only just for that of the patient, but then also then for that of the families. And that's what we're trying to there to be supportive through our social workers and chaplains, to spend time with the family members because it is tough, but ultimately trying to rally together, but what is best for everybody and to include that of the patient we're caring for. Speaker 2 00:18:42 Well, and I think understanding too, that your, your siblings, uh, your siblings response, when grief starts getting involved, the siblings response may or may not make sense. Right. It may or may not be logical. It may or may not even be in line with how they had acted up until that moment. Yeah. Uh, and, and finding that way to give, you know, grace in that situation to adapt and open that up to allow some level of dialogue, an appropriate place for dialogue Yeah. Uh, to happen. So that it's, it's informing in one, one term we have in the, from the industry side, but we talk with vendors, if you don't know where the families get involved, you probably won't like where the family's gonna get involved. Uh, but that's to the same thing for families, right? If you, if you don't know where all of your family's gonna get involved or where they stand on these issues because you didn't have an, an advanced directive done, or maybe that conversation was only held with, with two family members and not with, you know, that third family member who lived outta state or has been in Costa Rica for the last couple of years, or, you know, something to that nature is, is there anything that you've seen that a trick to the trade or, or do you guys set aside or make a recommendation to the families, kind of take a moment to tactically pause and have those discussions with that person at that time? Speaker 2 00:19:52 Or how would you handle that? Speaker 3 00:19:53 Yeah, like I said, it's, it's really for the most part, and for those that are watching, is trying to be, to do it in advance, you know, to do it early on, um, before that time even comes. But even if, if, if in fact, and lo and behold it does, it's happening now, then it's a matter of trying to, uh, embrace it, you know, and, and start to have those conversations. And that's where if, in fact, let's say if a patient, uh, becomes onto our, our hospice program that's even involved, where we're having our, our social workers and chaplains, as I mentioned, and start trying to rally the individuals and the family together to make sure that they're all, um, you know, aligned and then also comfortable with themselves. Speaker 2 00:20:28 That's fantastic. We're gonna take a, a quick break here and we're gonna see can, uh, a bit of you guys in action to get an understanding of, of what you guys are doing here. And then when we come back, we'll work through, uh, a couple of those conversations of, um, some of those questions that would set you up best. Let's further that. So stay tuned. Speaker 4 00:20:46 Sometimes I'd like to smack old age, right in the kisser. Wow. I always get the best parking spot. I think she needs a little more help. Monday, what I really need is a boyfriend that can drive at night. I can make a fashion statement out of anything. I will be fabulous. Speaker 5 00:21:07 I have a little crush on my pharmacist With comfort Care at your side, you can live your best life possible. We know families can't be there 24 7, which is why we can help with as much or as little home care as you need from medication reminders and meal prep to everyday chores and errands so you can live in your own home on your terms. Speaker 4 00:21:29 I wouldn't let aging stop me from being me. Speaker 5 00:21:32 Call Comfort Care now and let us create your personalized care plan and find the perfect caregiver match. Speaker 4 00:21:38 Can you show that number again? She was texting Speaker 5 00:21:42 Together with Comfort Care, you can both live your best life possible. Speaker 2 00:21:47 Welcome back. I, uh, this week we're talking with Steve Alfonse, uh, who's got a great perspective from the back end of the market or the back end of the market, really, of, of the, of, of, um, of a project where your parent project might be. And that's in those, those closing moments truly win when the family's looking at deaths at the door at some way, shape or form, uh, the family dynamics, uh, that we deal with at that point in time. Uh, you know, this is, uh, a, a couple of, of important things, Steve, that I really enjoyed in particular was, uh, in, in preparation from that families being able to spend time with advanced directives with, uh, the conversations that they're having with their loved ones, uh, and breaking down, um, maybe in the mindset, introducing them with the major healthcare providers that they've got. Speaker 2 00:22:35 Uh, we're gonna, we're gonna try to, we're gonna try to see if we <laugh> we can get, uh, yeah, there we go. We, there we go. Um, you know, I really want to try to break down, if we could, some of those, maybe those top preparation, those things that if you're a family and you've, um, you know that hospice is gonna come, or palliative care, something's going to gonna kick down. But let's talk through some of those, those key conversations that you could have as a family, uh, to maybe knock down the, the, the, um, the emotion of it while you're on the spot, having to engage that person up front. So, uh, advanced directive, let's, let's lock and load there, Steve. Yeah. Um, the, uh, what is, how do you guys use an advanced directive? What does that, what do that really mean for companies like, like you guys in, once you get into palliative care or in, uh, in hospital, maybe even comfort care too. Yeah. Speaker 3 00:23:27 It, it even really even starts, you know, early on. So it's like, you know, what are mom or dads or, you know, that individual, what are their wishes? And so ultimately, so sometimes we find, and we had that conversation prior, so is it to, to remain and stay in their home? Um, you know, so as they age or they might have a setback, you know, such as a fall and come out out of a rehab in a hospital. I mean, are they wanting to go into an assisted living community? Are they wanting to stay in their home? Um, and those are some of the, the, some of the most important things. Um, you know, along with that, outside of, you know, other, the, you know, the other clinical aspect, you know, whether to be on a, you know, to be on life support or, or different things that might be associated to that, or seeking, you know, curative treatments. Speaker 3 00:24:06 If you're diagnosed with cancer, sometimes individuals saying, I don't want to, to, to go through all the chemo and radiation. I want to just prefer to just, you know, go on to hospice. And those are the conversations that it's really important to have upfront, because sometimes in even such as myself and you shared about, you know, my mom who, you know, passed away 17 years ago tomorrow, um, you know, she had pancreatic cancer and so she chose, I mean, she didn't want to go through, she knew that the, it was an uphill battle. I mean, it's a very low survival rate with pancreatic cancer. And so once diagnosed, I mean, you know, she only had a, a few months and she didn't want to spend all of her final days and weeks, you know, going through that very hardcore chemo and radiation. And those are conversations within that advanced directives. Speaker 3 00:24:50 And we quickly went into more of those comfort measures. And then with us, it's about spending time as myself, as being a, a son to her holding her hand and trying not to do all those different types of caregiving types of support and bringing in additional help, um, that can play that role that are, you know, such as our agencies, that, that can do some of those clinical aspects in doing different things and let the children be children to their parents that might be passing. So those are all part of those dialogues and conversations that can be part of those advanced correct. Correctives. Speaker 2 00:25:19 Yeah. Y you know, in, in the conversations around it, I know it in, in cases that we've seen, and actually in personal cases as well, that advanced directive there, there's some documentation that will, that will take that, and then even add a layer. So for instance, in my, in my, my, um, in my own, my own family, a part of what was really important to her was, uh, despite where she may go in caregiving, she wanted to return home. Yeah. To pass. It was important to her to pass in a particular way and, and how that was gonna happen. And that's not the advanced directive played a role off of all of that. But there, you know, we've had great conversation. You know, we had auto shill on here and an, an attorney that really broke down the importance and that conversation of understanding what's not just written in the letter to the letter of it, it is having a conversation to understand what their intent is beyond that. Cuz sometimes it's just, that's a standard, it's a standard template that they may have picked up, and it doesn't by far handle the, uh, the majority of the little, what seems like a small decision, but they really have pretty big impacts. Yeah. Uh, especially in those final moments. Speaker 3 00:26:27 And those, those are key things. And as you mentioned that, you know, it ties back into that sibling challenges, you know, so it's like saying, mom or dad may want this. Well, a lot of times in mom or dad, it's, it's written about what their wishes were within those advanced directives. So it helps, you know, guide, you know, those, those adult children to figure out what is best for them. And going back to that, you know, here's an example. You know, just yesterday we were dealing, been dealing with a family that we providing care for, for the, you know, for their father. And, and who lo and behold had a, a setback, went to the hospital, um, you know, was living in the, in the independent living community. Um, but then ultimately then found out as it just went to the hospital that, you know, has, uh, unfortunately is going to be needing to go onto hospice, but, you know, here's where we can step in. Speaker 3 00:27:08 But within that, the family got involved and found within their will and different things like that. Wow. Dad wants to really go back home. It was written in there, he wants to pass it home. So now we're helping to, to get dad back out of the community into the senior living community, but now back into his home. But the good thing about services such as us, you know, we, we provide it, we, we go to wherever home is. And so yeah, we are providing care in the assisted living community, independent living community, but now we'll transfer that care and, and get him back home to where then he will spend his final days. Speaker 2 00:27:36 Yeah. Or, or even, I mean, we, even, in our case, some of the hospice pushed into the hospital and making that transition happened off of that side in, in making that work really smoothly for us. And that care team, uh, particularly in some instances, you know, cancer, we could, we ended up having to exit out a hospice, go back via an ambulance, like physically exit off that, go back to the hospital to get in charge of pain control, to then bring it back up and then come back into a hospice situation. So these can be really fluid dynamics. What I, what I like is that use of understanding maybe the different, maybe the different phases, those standing phases of, of, um, of kinda how it will digress where the situation will, will work as they progress or weigh it through this transition. Could you, and using that and having that conversation of advanced directive, maybe under each of those stages to understand how mom and dad or, or you know, your, your loved one would see using that advanced directive. Are their wishes in writing exercised in each of those kind of phases? Could you Speaker 3 00:28:36 Go ahead? Yeah, yeah. I just wanna make sure I understand the question. Yes, go ahead. Speaker 2 00:28:39 Yeah. Well, and I'll apply, I think maybe the best way to do is could you couch, uh, palliative care hospice? Could you, for, for the average family that sits out there, what could you couch where that comes in, in that continuum? And what's the difference between those two? Speaker 3 00:28:52 Yeah, yeah. That, and, and the biggest differential is it's, and I, going back to the example that we had in place, let's say an individual does have cancer. And so, and I was mentioning before about seeking curative treatments. And so because they are still taking chemo, radiation, doing some different things for that particular ca cancer patient, they would not qualify. They would not fall into hospice because they are seek still seeking that. So they would fall into a palliative program. And within that palliative program, that's where a team such as, you know, vital palliative and our clinicians work side by side with that of the, with the specialty doctors and other individuals, as it's still, it's a life limiting illness, but it's a different types of services that are being provided. Um, now on the flip side, if individuals, if they choose not to seek some of those different, um, curative treatments, then it becomes more of the comfort measures. And within that comfort measures, they would transition into a hospice program. That means that they're foregoing to, to try to do some of the chemo and radiations. And that's where then we step in and help that with that patient and the family through those comfort measures. Speaker 2 00:29:55 Well, uh, one question I had I'd received before on social media was, um, if a family member decides to fight to the end, would that mean they would stay in a palliative care community until the end? Or would there be some transition? Uh, likely How would, how would that typically look for family? Speaker 3 00:30:11 Yeah, and typically, I mean, and, and that's, it's, you know, a lot of times we, we don't wanna lose hope, you know, but at the same token, you know, you can sometimes, and it's challenging sometimes for families, and sometimes it's even challenging for that of, you know, it's a, you know, for the doctors to share that saying, Hey, here's the, here's statistically what it's looking like. But, you know, to go back and to answer your question, you know, it's, it's not uncommon where individuals may do, do try to do both. And ultimately they may be trying to seek that through the cur of treatments, but then ultimately those final days, weeks and months, a lot of times they, oncologists or other doctors are gonna say, Hey, you know, it's time, it's time that, you know, here, here's where it is. And we need to transition into that hospice program because there are some extreme benefits. Speaker 3 00:30:50 And quite often individuals do not take advantage of those benefits early enough. And one of the things that we hear more often than not is that, wow, we wish we would've went on to hospice sooner, um, because of the, the strain and aggravation. And, and not to say that individuals not to lose hope and not to do those different things, but it, it, it's very common. And unfortunately when you look at statistically that individuals just do not go on to hospice really enough. And that's why the length of stays are short as they are. But I, I do wanna make sure and, and stress that a lot of times it's very common individuals saying, wow, we just should have done it sooner. Speaker 2 00:31:24 Yeah. One of, one of the things that, uh, that I also see or, or have heard people talk through there is, uh, that bump up once, uh, oftentimes when a patient hits into hospice or starts into hospice, there's a bump up in a, in, in a, in a, across the board in general, right? There's that kind of last push. And it is, it is something that sometimes it provides an unexpected reprieve to families that have watched this suffer, suffer, suffer in the fight, and the difficulty and all those things, and then they hit the hospice pipeline. I don't know that it's for everybody, but there's this kind of bump in this softening Yeah. Of things around the board. Can you explain that or talk through what that dimension looks like? Speaker 3 00:32:03 Yeah, and a lot of times, I mean, keep in mind, depending on the situation, so, you know, let's say if it's an individual that's not getting a lot of care and all of a sudden then they go into hospice, now all of a sudden, now you have, not to overwhelm them, but you know, you have the, you know, registered nurses that are popping in that are a case manager. And so, and they, you know, most of which you will have that, that great bedside manner. You know, it's, it's, it's amazing They got into hospice, so now they're coming out, you have a certified nursing assistant that's popping in and doing some bathing assistants. You have a social worker that's coming out and meeting with the, the patient and the family, and then you have, you know, a chaplain. So you have these individuals that are coming in. So now all of a sudden, you know, it's very important from a social aspect, you, you get all this additional attention. So it's not uncommon to where sometimes an individual might thrive and bounce back a little bit because now you're getting this extra love, um, you know, from individuals and, and that attention to go with it. So it's, it's quite common and it, it does happen. So Speaker 2 00:32:56 Can you talk to, uh, benefits to a family off a hospice of a counseling or other aspects like that, that oftentimes hospice companies are able to provide to the family to help them be that caretaker and be there and be that presence for their fa for their loved Speaker 3 00:33:12 One? Yeah. And, and, and as much as the care that we provide the say under Royal Hospice, as much as it is in this comfort measures for that family, but yeah, there's the team of individuals such as that social worker and chaplain to try to prepare them and, and to talk through, you know, the various things. And it goes back from their historical, you know, their history of, you know, as far as learning a little bit more about mom or dad or their loved one. And so spending quality time and preparing them, uh, for what's next. And so that, that, that part of it is a key component, and it doesn't end even at the time of death and the passing of their loved one, it continues on through a bereavement program. And so, in fact, even we just had a, an annual celebration of life where we got together and we had individuals that we brought in that we provided services for over the past 12 months and brought in their families to recognize and remember. And so we did that as just a little bit of a, as a give back, because everybody will continue, not everybody, but a lot of times will continue to suffer throughout those remaining days, weeks, months, and even years. And so when we even do some of those different things, and those services are still provided through that bereavement and grief program, Speaker 2 00:34:16 That's fantastic. And, and those, I can really see it, it's, it's when we've heard of things like that that have stepped up where families really afterwards are like, oh my gosh, like this, we should have done this earlier. Yeah, this, this, this would show, mom should have done this and mom would've done this earlier. Right? And, and those conversations, uh, you know, the families maybe talk mom Yeah. And the waiting or dad and the waiting. Yeah. Speaker 3 00:34:37 And, and they can share it with other, other families. I mean, so they're all there together, so they're all going through a lot of the same things. It may be different stages, stages or phases, but a lot of times then it's great to have, you know, to compare and to talk through stories. And we even at Royal Hospice even provide, you know, as we call that Royal Remembrance, and we even provide, you know, little royal bear. And so a lot of times, you know, the families are picking out the, the type of what mom or dad's type of, you know, favorite type of colors or cloth, and we're creating these little, little keepsake bears and different things too. So just trying to, you know, it doesn't end even at the passing of their loved one and neither do our services. So we try to continue on to try to provide that support for them. Speaker 2 00:35:12 That's a great understanding, and, and I appreciate you, you know, opening that up and provide that perspective of what that does into the family. You've been pretty candid. That's, it's not easy, it's difficult. People come at it, and a lot of people end up coming at you probably under-prepared, severely under-prepared. Our, our hope is to prepare more and more people, uh, as they come to you, so that that's a smoother transition. They understand what to expect and how to make the most use of you. Uh, Steve, how, how can, um, where can people find you guys? Where can they get more information if they wanna follow you guys and, uh, or, or have conversations with Royal Vial or Comfort Speaker 3 00:35:44 Care? Yeah. Yeah. So we brand ourselves at as three different entities. However, it all rolls up into, to one big umbrella. And part of the reason before I share what, where they can find us. But, you know, we do that because we understand just like, as we were talking about being a little bit in denial, and sometimes let's saying, Hey, you know, if you're talking about caregiver services, you, you wanna try to keep far away from, from that of hospice or, or vice versa. So a lot of times, so we brand ourselves separately, but uh, within that sense, we were just talking about hospice. You can find [email protected]. Um, and I can provide, you know, the phone numbers, you know, probably will pop up onto the side or I can provide that, or vital palliative.com or along with that is comfort care.com and, and our location's, comfort care.com/scottsdale. So you can find us on the web. Um, and the phone numbers are probably provided, but I'll rattle them off quickly as well. Um, you know, so for the big part, you can always call in to the, the comfort care at 4 8 0 9 9 8 and 0 6 6 8, and you can even just start there. But any one of the staff members can, can point you in the right direction. Speaker 2 00:36:40 Wonderful, wonderful. Uh, you look the, just kind of recapping against that and some of those important conversations to be having, you know, ahead of time when you work through looking into those advanced directives, maybe, you know, couching the conversation with your family's, having a difficult time comprehending and understanding what's going on, break down the differences, make sure they can understand the differences of, of what that home care is in the front end when we might see a palliative care, when hospice might come in, and that everybody's got a level set of those things, it's a good opportunity. You know, we might encourage you to, as, as the same way we talk with families about knowing those ADLs and understanding those activities of daily living in order to know how your payer models work or, or what's gonna get paid for or, or how you start utilizing those services at the, especially the home care level. Speaker 2 00:37:25 Yeah. Uh, it's important to probably have those conversations, those about the advanced directives or what your loved one's wishes are. Maybe a good starting point is within those areas when they're at home or in a home care kind of environment, maybe when they're in the fight. Uh, and, and really just trying to be comfortable in, in that fight and longevity of life. And then perhaps once they, they've understood that that transition's gonna happen, embrace that with a hospice side, how they would like to see that there, uh, would be a great way to start tackling those conversations. You know, Steve, when I might also ask if a family's having a hard time talking about this, what is it that, what, what can you guys do to help them have that conversation? Speaker 3 00:38:02 Yeah, and sometimes I think that individuals, if it is, have a hard time personally within themselves talking about it. I mean, it's just that, uh, you know, we're more than glad to be involved. Um, you know, we have individuals that will come into your home. Um, we call that within a sofa visit. And we, you know, it's never a, a pushy, it's a free, you know, type of service just for us to come out and to, to be part of that dialogue with you, uh, and, uh, and to try to help out the best way we can. So I always ask and, and say that, you know, it doesn't cost you anything, but maybe just a few minutes a time just to reach out and start having that conversations with us. Get us involved early, early on. And we've been more than glad to help out. Speaker 2 00:38:37 Yeah. Without a doubt. Uh, I, uh, I just genuinely appreciate what you do personally, respect, especially that end of the marketplace, the piece your industry provides in there, and the fact that you're reaching out to so many families trying to help them understand what that is and make the use of it, man, much, much, uh, many blessings onto you and to your companies. You continue to go forward. We look forward to having you back in the show sometime to talk Speaker 3 00:38:59 More. Yeah. Thank you very much for the opportunity. I appreciate it. Appreciate it. Take care, Tony. Speaker 2 00:39:02 You too. Yeah. Speaker 6 00:39:08 Well, that's it for the team this week, and thanks for joining us. If you've enjoyed the content, remembered it, subscribing 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 perspective. 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 00:39:41 Thank you for listening to this Parent Projects podcast production. 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