Hospice Care Explained: Myths, Medicare Coverage, and Why Families Wait Too Long

Hospice care is one of the most misunderstood, and most underused, benefits in healthcare.

Many families believe hospice means giving up, that it’s only for the final days of life, or that it only applies to cancer patients. None of that is true.

In this episode, we sit down with hospice executive and licensed clinical social worker Michelle Gidosh of Ascend Health to break down what hospice really is, who qualifies, what Medicare covers at 100%, and how hospice supports not just the patient, but the entire family.

We cover:
 • The real difference between hospice and palliative care
 • Who is eligible (it’s not just cancer)
 • What services are fully covered by Medicare
 • How hospice care comes to you — wherever you live
 • Why late referrals hurt families
 • How hospice can actually extend quality of life
 • Why choosing hospice is not “giving up hope”
 • How to choose the right hospice provider

If you’re caring for an aging parent, supporting a loved one with serious illness, or planning ahead, this is an essential conversation.

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For Mature Audiences Only is a podcast dedicated to real conversations, honest stories, and practical guidance for families navigating caregiving, aging, and senior living.

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Presented by Archer Law Office https://archerelderlaw.com

Music provided by MIBE https://mibemusic.com/

Transcript

Welcome And Purpose

Shannon 0:02

Welcome back to For Mature Audiences Only, presented by Archer Law Office, the podcast where we break down complex aging, caregiving, and elder care topics into clear, practical guidance that you can actually use.

Why Hospice Is Misunderstood

Mary 0:14

We're your hosts, Mary Shapiro and Shannon Johnson, senior resource specialists at Archer Law Office. And each week we sit down with trusted professionals to help older adults and caregivers navigate real life challenges with less stress and more confidence.

Shannon 0:31

Today we're tackling one of the most misunderstood and underutilized benefits in healthcare, hospice care. If you ever thought hospice means giving up or believe that it is only the final days of life, this episode may completely change how you see it.

What Hospice Is And Who Qualifies

Mary 0:45

Joining us is Michelle Gidosh with Ascend Health. Michelle is a licensed clinical social worker and hospice executive with decades of experience in end-of-life care and palliative care. Michelle helps us demystify hospice, explain who qualifies, what services are covered at 100%, how hospice supports the entire family, and why so many families wait far too long to take advantage of this benefit. If you're caring for an aging parent, supporting a loved one with a serious illness, or planning ahead for yourself, this is an essential conversation. This is for mature audiences only, presented by Archer Law Office. Let's get started.

Shannon 1:43

Joining us today is Michelle Gidosh. Michelle is a Master's Prepared Clinical Social Worker licensed to practice psychotherapy in New Jersey. She has devoted much of her career to hospice and completed postgraduate studies in end-of-life and palliative care at NYU. Over the years, Michelle has served in a variety of roles, including social worker, volunteer coordinator, marketing and business development, regional leadership positions, and executive director. She also has an extensive training and certifications in dementia and memory care, and previously wrote a community advice column called Ask Michelle, where she was answering dementia-related questions for the public. Let's welcome to the show, Michelle Gidosh. So to kick things off, Michelle, for those who may not know, can you explain hospice and what it aims to provide?

Michele 2:27

Sure. Hospice is a program for people with uh terminal diagnosis, usually six months or less to live. We provide symptom management and comfort care for better quality of life at the end of life.

Shannon 2:40

The conversation around hospice, I think, is so great. Last week at a networking meeting that I was at, we got on the topic of it, and the overall consensus that we came to is that it's a misunderstood benefit for people that they often don't take advantage of because they hear the word hospice and they get kind of freaked out. Absolutely.

Mary 2:58

Absolutely. Or they think hospice is a place. Like it's somewhere you have to go that they don't realize hospice goes to you wherever it is that you are.

Shannon 3:08

Right.

Michele 3:09

Correct. So yes, I I I agree with you. People are frightened. They have to just realize, put things into perspective. It's if it's presented as a program of services that you can have to help benefit you and help you through your journey towards your end of life, I think people would feel a whole lot better about it. I think they get scared by that word, just like that big C word, once they get that diagnosis, you know, they freak out. Um, I I think um, you know, if we just all kind of take a deep breath and say, okay, hospice is simply a program.

Shannon 3:43

Right.

Hospice Comes To You

Michele 3:43

Um and it the benefit is um, you know, available to everyone. And it's a conglomerate of different services put together to make sure that you have comfort and symptom management um as you journey through your end of life. Right.

Mary 3:59

Can you talk to us a little bit about the team that is involved for hospice? Sure.

The Interdisciplinary Care Team

Michele 4:04

So hospice, um, okay, so Medicare set the the guidelines for what um is required for a certified hospice and all others follow suit. So even if it's private insurance that you're um that you're using to pay for your services, certainly they would um we would include all of the services that Medicare has set the guidelines for or precedents for. So we would start with a medical director. We have a medical director over all of the services he would, he or she would guide um the care and the plan. We need uh at least uh once every two weeks, discuss every patient that's on service. Uh, they would oversee the care as well as the RN case manager. Um, that does not mean that you have to use our medical director as your primary care physician.

Mary 4:56

I was gonna say a lot of people worry that they have to give up their physician, not that it works with your physician.

Michele 5:02

Absolutely. So you have another set of eyes on your care that could make maybe some recommendations or suggestions to your primary care physician. Sure.

Shannon 5:11

They know that part about it.

Michele 5:12

You know, it's always good to have more than less. I mean, and especially when you have someone who really specializes. So if you have a primary care physician, they may not be, you know, a certified, you know, end-of-life or palliative care physician overseeing that care. So they, you know, um, they do that every day. Um, just like every field, you know, everyone specializes in their own. Sure. If you and you do see a cardiologist, absolutely.

Mary 5:37

They are palliative and end-of-life physicians. Exactly.

Michele 5:40

So, um, so we have a medical director, uh, we have an RN case manager. Also within our team for each patient, they would receive all of these services and benefits. We have a social worker for emotional um support. They also would provide resources in case you need, let's say, housing or your insurance. There was issues with, you know, um insurance or work issues, you need FMLA, um, you need, you know, you don't have any food in the house, you know, those kinds of services. Those resources, concrete services and emotional support for the entire family. So people don't realize when you sign on to hospice is not just the person receiving the care, it's the entire family unit. When I say family unit, it doesn't have to be traditional family. It could be a partner, it could be a friend, it could be a neighbor, um, whoever it is that's close to you that's involved in your care. Everyone would be included in that unit of care. So you have a social worker, then you have a chaplain. Chaplains are non-denominational. Um, they're not coming in and pushing religion on you. Um, it's where you want to go with it. If you're if you are religious, um, then they would pray with you, of course. But if not, they would be another support. Um, spirituality has many different realms, um, and they would be there to support that.

Mary 7:02

And would they, so to speak, that's the kind of role that would reach out if someone was a particular religious faith, but maybe had not practiced in a while. Absolutely. But wanted a visit from a priest or a rabbi or a rabbi, absolutely. They would be the ones that could reach out to a local, yes.

Michele 7:19

Um, that good point, Mary. Um, they would reach out to get those services if you want last rites or help you with funeral arrangements. There's many different because that again takes that burden off of the family. You know, people don't think about that. You know, when they get that diagnosis, that's the last thing. I mean, they don't, you know, but to have things in place prior to, and I always say this because it's a very scary conversation. Um, my background is in clinical social work. So, you know, I put on my social work hat when I speak to these families and I say, hey, look, you know, it's something to think about. You know, we need to plan. Uh, it's easier to plan ahead than to have to be, you know, left like that. Yes, when they pass. Um, we need a place to call because obviously we're going to be doing the pronouncement in the home if that's where they live. And we want to know who to call to, you know, the funeral home and at least be able to provide resources for them as well if they don't have um the resource. In addition to those services, we also have volunteers. So, way back when, when hospice started, grassroots is it was all volunteer. It was volunteerism. No, yes, it was visiting the sick and helping people. It's kind of like midwifery.

Shannon 8:31

Okay.

Volunteers And Origins Of Hospice

Michele 8:32

So now we have end-of-life doulas, which is kind of the same thing. Um, back in the day, um, and that's not too long ago, because actually the hospice benefit under Medicare has only been approved um, I guess, since 1982. Yes. It's pretty recent. So this is a new program per se. Um, so back in the day, it started as volunteer, just volunteers going out and visiting the sick. And when Medicare decided to um make it reimbursable and really find, you know, um benefit to being able to provide services to people who were dying at home, um, you know, instead of being in the hospital, sure. Um, it saved money. Uh, so they decided that they were going to reimburse for it back in 1982. So when that happened, they decided they didn't want to take away from or, you know, change um the whole realm of what hospice was. So they decided to keep volunteers and volunteerism part of a big part of the program that had it's actually in the regulations that 5% of any kind of clinical care, nursing care, has to be um also provided by um 5% of volunteer hours to their to the hours that the the clinical team does.

Mary 9:52

I don't think people realize that. Yes. So we didn't know. Yes, absolutely.

Michele 9:58

So we have um volunteers that do one-on-one visits. I mean, even if it's just to go into the home and sit with a a patient while the family goes out and runs errands, goes grocery shopping, even the wife that just wants to go to the hairdresser and get her hair done. Sure, you know, once a week, we would have someone to come and sit with them and oh, I love that.

Shannon 10:18

And that's great.

Michele 10:19

And our veterans program as well. So we would have veterans that would go and sit with a a vet who may be dying and wants to um, you know, talk about their experiences while serving. Um, so you know, it's it's a wonderful benefit. In addition to all of that, we um, okay, so that is what Medicare requires for a certified hospice. In addition to that, since we've been what well, our hospice, Ascend Hospice, has been in operations for three decades. So we kind of surpassed, you know, the basic requirements and we have added on so many other supplementary um programs in addition to, which are all under, you know, it's no cost to the family. I got full-time massage therapists, full-time music therapists. We have um, you know, obviously pet therapy, which most of the time comes under the volunteer program as well. We have specialty programs, a specialized dementia program uh for people that are living end stage um dementia. So we have a whole program just geared to and um customized to that particular um, you know, situation. Sure, that comes with its own needs. It does, it does. And a cardiac program as well. Um, so all of those services and your medical equipment, your DMA, don't forget that. So we're gonna probably put a hospital bed to help care at home, uh, walkers, wheelchair, you know, whatever it is that they need, the medical equipment, medications related to the end stage diagnosis. They're all covered in any wound care that maybe need to be done, you know, gloves and under, you know, um incontinence supplies and all of that. That's all covered.

Mary 12:07

Is there a copay? So there's no copay for families then.

Beyond Basics: Therapy And Specialty Programs

Michele 12:10

No copay, no copay. That's if they have Medicare, um, their Medicare part A is um elected, and that is where the hospice benefit is, and everything is paid in full 100%.

Mary 12:24

What if someone is too young for Medicare and they have, you know, an insurance plan? You work with their insurance. Absolutely.

Michele 12:32

If they if they have a hospice benefit under their their in private insurance, of course we're gonna utilize that. Um, if they have no insurance, we have charity care. You know, everyone, okay, so hospice is a benefit that everyone is entitled to. It does, it is not based on ability to pay or, you know, if you can't pay for it, you don't get it. Like, you know, sometimes with private home care, you know, if you can't pay privately, you know, you can't have it. Fortunately, and it's expensive to me. Um, but hospice is not like that. If you have the diagnosis and you fit the criteria, um, and you are certain that your doctor certifies you, you know, six months or less, given your diagnosis and the prognosis of your illness, then you are entitled to be on hospice regardless of your ability to pay. Wow. I don't think people realize that. No, and it does it's so underutilized, that's really sad. It really is.

Shannon 13:30

So that's one of my kind of my next questions. Do you have to go out and educate people about everything that you have, right? Is that kind of like an uphill battle that you're kind of always fighting against? Just trying to explain to people what the benefit is and not just getting afraid of the word hospice.

Coverage, Costs, And Access

Michele 13:43

You know, that's the best part of my job. I hate to say it, because as you know, I like to talk. Um, but truly sitting with the family and explaining to them and their eyes getting big and wide. Wow, all of that. I mean, you really can't. And I think once they get past the fear of the word hospice. Um, and let me tell you, when I started way back in the 90s, okay, in hospice care, myself, um, working for hospice, um, a lot of education with the physicians, even doctors. Uh, they were like, oh no, really, cavorky. It was terrible, it was terrible stigma. Right. Attached. Even from the physicians. The physics they weren't. Here's the thing: there's no class in med school.

Mary 14:28

Right.

Michele 14:28

There's no residency in now, there is palliative care and all of that, but an end-of-life care. Now it's it's mandated.

Shannon 14:37

Um I guess it's just an assumption on medical.

Michele 14:39

They need it a whole day now before they used to get like an hour. Like, here's my deal, and this is what you do. This is how you give bad news and move on.

Mary 14:47

Well, that's where a lot of the myths came from, too, where physicians thought they would lose control of their patients, etc. So, you know, it's no, it's it certainly has changed.

Michele 14:59

You know, they're trained to save lives.

Mary 15:01

Of course.

Michele 15:02

And, you know, cure and you know, doing no harm to me is giving them the benefit and the gift of hospice. Here, we're not stopping. This is not, you know, this we're we're giving you, you know, a gift to transition comfortably.

Mary 15:19

And um, I want to just circle back to a word you brought up. Exactly. A lot of people don't understand the difference between what palliative care is and hospice. So can you just talk a little bit about that? Absolutely. I would be happy to.

Michele 15:35

Great. Um, in at Ascend Hospice, we do have palliative care as well as hospice care. It's a whole separate department. It's a whole, as a matter of fact, they have a another medical director um overseeing that program. Um, a lot of hospices or a lot of programs say, oh, we have palliative care. And then they have the hospice nurse go out, you know, and just follow a, you know, someone um that may need some symptom management and then transition them right into hospice. Um, so that's their goal, their end stave, and um, end goal, actually. Um, with our program, it's a true palliative care program. We have nurse practitioners that go out and make all of the visits. We have a medical director overseeing all of um all of those patients making recommendations. Um, most of our patients right now are um in skilled nursing in in sub-acute um situations, and they are receiving palliative care um visits. And if if they meet the criteria for hospice once they're discharged, then we'll be happy to take them on. That's not it's not, we're not doing that to make sure that they're gonna make sure they get that. Okay. So it's a little, it's, it's definitely um uh right now we're not um, you know, um in homes. We're not doing like one-on-one um in the homes, but we are um hooking up um with um some of the facilities and providing in the subacutes. Um currently we have almost 400 patients in the state of New Jersey that we are servicing just on palliative care.

Shannon 17:14

Wow. Wow.

Michele 17:15

So it's a big program. I mean, it's a it's a legit program.

Shannon 17:20

Wow. So Mary and I love that aspect of it because when we we talk about this all the time. Yeah. When we have clients that are in skilled nursing facilities, we, and I've learned this from Mary, try to get them on some sort of palliative care or hospice care. Just to give them additional support. Absolutely.

Educating Families And Physicians

Michele 17:36

Okay, so here's here's what's going with that. So people confuse hospice palliative care. So palliative care can be for anyone who has a chronic illness that is suffering even diabetes and needs some good symptom management, needs a nurse to like enter, like kind of look at the whole picture, give them education, um, even if it is an end stage diagnosis, but they're not quite ready for hospice yet. Um, they're still receiving treatment, or maybe they'll never receive hospice. Sure. But it's to help with the conversations, um, maybe even getting their pulse in order, their and you know, their end-of-life care in order, or um just for symptom management. I mean, like someone with chronic, you know, diabetes, the complications from that would probably make them ineligible for hospice, but diabetes itself won't. And it takes a long time for that to happen. So even if you're in because you had an amputation because, you know, your sugar was so bad, um, you know, our palliative care can can take over. So I always look at it this way. So hospice is palliative care. Palliative care is not hospice. Okay. So that's the way you have to look at it. That's a good way of putting it.

Shannon 18:48

Love that. Great. When should when would someone be considered appropriate for hospice and what sort of factors come into play with that?

Michele 18:54

Okay. Good question. Um if and and late referrals come in, and that's that's what's really sad. People need time to really get into the program, get that symptom management, uh, meet the team, get the benefits from the extra services, and waiting, like, oh, they're actively dying now, so let's put them on hospice and like, you know, a day or two, they're gone. Um, they don't really get the benefit of what we have to offer. But even um, you know, backing up from that, um people don't realize that just because you know, you have a terminal diagnosis and the doctor says, oh, you know, six months or less, that doesn't, you know, we don't have a there's no crystal ball for that. There's no there's no crystal ball. So we don't know. We've had patients on a year, two years. They have there have been studies, okay, done to say that people live much longer when they elect to use hospice because symptom management has given them better quality of life. Um, so let's say they're in pain, so they're not eating, and then they start breaking down, they get wounds, and then they get infections. So sometimes once that pain is resolved or even managed to a tolerable level, um, they start to eat more. And then the wounds start to heal, and then they get stronger, and they may even get out of bed. I'm not saying we're curing them by no means, but certainly they will long live longer and have a better quality of life in the end.

Mary 20:34

Are there benefit periods with hospice? There are.

Shannon 20:39

See how you're doing because you're so smart, my Mary.

Palliative Care Versus Hospice

Michele 20:45

So there are. Um, okay, so interesting fact, again, I'm gonna go back to it back in the day. This is very interesting, and I think I don't think a lot of people realize this. Today, hospice is for any end stage chronic illness. Okay. It's for cardiac, it's for dementia, it's for pulmonary disease, um, not cancer, not just cancer. So, way back when I started, um hospice was only for cancer patients. If you did not have a cancer diagnosis, you were not getting on hospice. And I think that's kind of where some of that stigma came from. You have cancer, that big C word, you're gonna die, you know, and we've come a long way. So back in the day, there were four benefit periods. You had literally six months. And if you didn't die by your third benefit period, you were coming off.

Shannon 21:37

Really?

Michele 21:38

Right, because you needed that last 30 days when you really started, you know, taking the turn. And that was your lifetime benefit under Medicare. You had four benefit periods, and that was it. Now it's unlimited. So you do have benefit periods, and at at the end of each one of those benefit um certification periods, and you know. 60 days or 90 days, whatever it happens to be, um, you um would have to be recertified. You would have to show some kind of decline that you are not, you know, leveling at. It's not custodial care. You have to remember that. This is, you know, showing decline. I mean, I'm saying even if you just lost a pound or two, even if you, you know, were taking a little more time eating more than you used to, maybe your pain is increased and we had to, you know, or you have a wound, or you had another infection or something, or maybe even a hospitalization, who knows? Um, or a fall, you're getting weaker. Um, all of those things are taken into consideration. Um, the RN case manager and the medical director, and actually the entire team are documenting on that um throughout the the benefit period or that certification period. And um they're determining or making sure that you're still fitting the criteria um that Medicare has set. And if you meet those guidelines, you will be renewed every benefit period. And it's unlimited.

Mary 23:05

Now, say you graduate from hospice.

Michele 23:08

I love that. I used to call them flunkies because they plugged out. Like I said, you're a hospice flunky. Good for you. That's the best thing to fail at, right?

Mary 23:19

But does that mean you're done? Like, say you graduate because you're become eligible for a new treatment, or you're just not meeting the criteria anymore. But then fast forward six months to a year, can you go back on hospice?

Timing, Benefit Periods, And Recertification

Michele 23:35

Absolutely. You are always entitled to come back on. You sign off at any time, even if you change your mind, even if it's like, oh no, this is just too much, you know. So nobody can force you. Exactly. Exactly. Or I'm not ready for it yet. Right, you know, sure. I want to take that European trip and I don't care. You know, my family's gonna schlep me around in the wheelchair and I'm gonna do this. This is my last hurrah, and God bless you, go do it. Do you know what I mean? Come off and do your thing and come back on. Um, as long as you meet that criteria, you know, everyone, we're very compliant and we're very diligent about making sure each and every um patient on the sense hospice's, you know, senses is, you know, legit.

Mary 24:18

Um I think that's important for people to know too, because I think so many people think it's written in stone that this is that I'm going on hospice and that's and not seeing it as just a program that you're entering that you can leave for whatever reason. Absolutely.

Michele 24:36

Absolutely.

Shannon 24:38

Let's talk about your journey getting into this whole healthcare conglomerate because you said, you know, you're a licensed social worker. That's how you got started in the field. So what brought you there and what brought you to here now where you are.

Michele 24:50

Okay, so way back in the day, I started out in nursing, believe it or not. Um, and unfortunately, while I was in, I was actually my third year in a BSN program, actually at Bloomfield College, New Jersey. I'm giving you a little plug there. Um, anyway, um, when I was in nursing school, um, my stepdad unfortunately was um diagnosed with Huntington's disease. A horrible, herbal uh neurogenic disease. It was horrible actually. Um, so I was um a young adult, I guess late teens, like 19, 20 years old. Um I elected to leave um school and come home and help. My mom um had to oversee the family business. So she was running that. And I was, you know, one of the one of my sisters and I took on a big part of that role as well as my mom. Um you were caregiving at a young age. I was a caregiver, correct. Uh eventually he was placed in long-term care and he was um put on hospice. And um it just was a great experience. As a matter of fact, it was this hospice. It was Garden State hospice at the time. We had a wonderful experience. Um, and then when I gra then I went back to school and then became a social worker and decided, um, you know, when I graduated, I applied to the VNA essential jersey. And they said, we have a position for you in HASA. So I was like, what? Like, okay, let's give it a try. I have to tell you, it's it's been um, you know, a big part. I did not, I knew it was wonderful when we had those services with my stepdad, but it was even more wonderful. Um, you know, once I you were the one impacting the other family. Yes. I didn't realize how um gratifying, like truly, it truly is it's a gift every day, an honor every day to be involved. This is the most intimate time of someone's life. There's, and I always say this to people, there's no do-over. You either get it right this time or there's no do-over, no regrets. I don't want anyone to have any regrets. And um, I do tell the families that I say, look, we do this every day and we want to help you foresee issues, foresee problems. We want to make this transition for you as smooth and as, you know, person-centered as we can. We want to give you the gift of not having to struggle more than you have to. Sure.

Mary 27:23

So we encourage our families to call a couple different agencies. Absolutely. You know, if they're again, we've talked in our other episodes about, you know, just being handed a list and pick from a list and you know, not everything. They need to follow exactly.

Graduating, Leaving, And Rejoining Hospice

Michele 27:40

It's not, and like I said, we've had three decades to get this right. Sure. I mean, in order to be able to, and here's the thing even your initial like interview with someone, um, you know, an another, you know, hospice. I mean, certainly you can tell whether or not you're going to, you know, jive with them. You can tell whether or not, you know, I mean, simply asking about the person that's coming on the who's coming into the home or who's gonna go visit their loved one. Exactly. Or even asking, what did they do for a living? Sure. You know, who are they? Sure. Like, who are they as a person? Like, let's like we go right for that. Were they a veteran? We need to honor, honor them. We need to do these things, you know. There's, you know, we have limited time and let's make the best of it. Let's make this journey as, you know, uh quality of life and and it is you know, meaningful as possible.

Mary 28:35

And if someone say does start off with a relationship because they were starting to work with this one company, can they switch to another hospice? Oh my gosh, absolutely. That's a great question.

Michele 28:48

I don't think people realize there's choices here. Yeah. And this this is crazy. It's gonna sound crazy, but I'm gonna say it anyway. When I started, there were like maybe a handful, four, maybe four hospices in the entire state of New Jersey. There are over a hundred certified hospice companies in the state of New Jersey. There are many choices. There are new ones popping up every day. There are ones that get it right all the time, and then there are ones that don't. Um but I do have to tell you, you know, no one's perfect. We're all gonna make mistakes. Sure. But give whatever hospice, you know, the opportunity to make things right. If you're not happy, they don't know it's broke unless, you know, they talk about it. Unless you talk about it. Um, you know, no one's perfect, but some hospices do get it right. Some, you know, um are growing, you know, there's growing pains out there. But um, yes, if you're not happy and you're not getting, you know, even after discussing issues, um, you're just not satisfied, then um you have every right to um, you know, change hospices.

Mary 30:00

We've been in that position in this role with being an advocate for families and you know, families telling us we had XYZ company, but we really want ABC company. So we will help, you know, encourage them to advocate for themselves. And you know, and sometimes you're not even given a list.

Michele 30:22

Sometimes it depends on where you are.

Shannon 30:24

That's a good point.

Choosing And Switching Hospice Providers

Michele 30:25

That is a good point. You know, Medicare says you have to give choice. Right. Um, but sometimes there is no choice. Sometimes you said, this is the hospice we use. So we're we've called them, we got the ball rolling, the nurse will be in to see you um in the hospitals. That happens, you know, a lot. Um, whether they own their own hospice or they use one particular hospice. And, you know, I get that you get comfortable using, um, but you do have to give it, I would say, at least two to three choices. Hey, look, we use this hospice, but there was these other ones. Why don't you call them? I mean, it's kind of like, you know.

Mary 31:02

I know. I have hospice in my background.

Shannon 31:04

Right.

Mary 31:05

Uh and I always encouraged when families were interviewing me to interview other people. Absolutely. Because it is the most important relationship you're gonna form. It's the truth. It's the last. Correct.

Michele 31:17

And it's a lasting, you know, like I said, we don't get a do-over. This is like you can't sometimes you can't fix it. And it's, you know, and it leaves the impressions um on the families. I'll never use hospice again. I had the worst experience, or, you know, um were traumatized. Well, you know, it it's it's a wonderful, you know, um service and wonderful program. Um, and there's many out there. Um just, you know, you have to pick the one that they're comfortable, they have to do their research.

Shannon 31:51

A lot of that also I think goes into the part of the families are coming to you in crisis mode. If they have a family that's yes, you know, they're just looking for somebody to, you know, you never think your loved ones were going to pass away. So you're always looking for somebody to blame, you know, this happened because this happened wrong because of this. And you know, you kind of gotta take it with the grain of salt because they're in such a heightened emotional state. They agree with you.

Mary 32:12

That's true. That's true.

Shannon 32:13

I had a director of nursing uh that I used to work with that as soon as we had a a resident of ours that went on hospice, she was always with that family. And a big word that she would use is dignity. You know, we want to make sure that this person is wherever they are in their journey, that's right, they're having a dick dignified care. So she would always push it on the families, kind of, you know, wherever that person was in their journey to get all those extra benefits, and then the families, you know, in wherever their loved one was, you know, it was such an easier transition for them if their loved one did pass, because you know, they had all the services leading up to the end of it. So I think it is just a great benefit that a lot of people should take more advantage of. And that's leading up to my question was do you think that do you find where you get patients they probably should have been with you three, four, five months ago?

Michele 33:03

Absolutely. There's always late, I mean, always late referrals. And I have to tell you, with our obviously the surveys that come back, I mean, they're always, you know, once someone's admitted and then the services are provided. Uh the press Gini, I think, is our surveyor. Um, they send the surveys um to the families after the services are done. The running theme is we should have done this a whole lot sooner. Sure. You know, not that they were, they feel like they could have had, you know, it it would have made things easier. Not that they weren't given great service, you know, they didn't have time for the the services.

Dignity, Hope, And Real Outcomes

Mary 33:42

It's just that they would have, you know, um had more information uh quicker and um, and that's where I think prepared conversations like this need to happen when folks aren't in crisis, when they can process information differently, when they can recognize that's right, it's so all the benefits there are to a hospice program. Even if it's too early, which sometimes that does happen, they're like, I'm getting hospice, I don't care.

Michele 34:09

Let's like well, even if it's too early, at least, you know, uh there's nothing wrong with going out and doing an evaluation, right? Right. Check it out. We'll show medical information. If they're not ready, okay, we'll we can check back. But certainly, you know, um always, you know, I mean, if you find that you're, you know, there's no more treatment available and you're, you know, you're having symptoms and you you want good quality care. And whether it be, you know, if you're going home or you're in a nursing home or an assisted living or wherever it is that you live, that's where your service would be provided. And that's what we could do for you.

Mary 34:46

I think a piece too that I always hear along with hospice is hope that I'm gonna quote, give up hope. And I think the conversation needs to change to hospice aggressively treats the symptoms, but this isn't something that is curable, but we can aggressively treat what symptoms are coming up. And that is something I agree. I know I've used in conversations with my own family members. It's not about losing hope.

Michele 35:14

As a matter of fact, I always present it as a gift. We're giving you this gift to help you through this because you know what? This might be your first journey with this, but we do this every day and we can get it right. You don't want to have any regrets. You want to make sure that your loved one is comfortable. Um, you know, again, back to the, you know, um, you know, get getting it right the first time. Um so so yeah, it's a gift. You're not, you know, giving up on hope, uh, for sure.

Shannon 35:47

Um I always just like to focus on it doesn't mean that it's the end of anything. Yeah, correct. You know, I again had a resident that used to live in our building that was she was a dementia patient in her 90s, diagnosed with cancer. The family obviously wasn't gonna keep uh wasn't gonna, you know, pursue any care. Um they were put on hospice with the plans of thinking that their mom was going to last three or four months. She ended up living for another two years. And I remember she was able to see her great-granddaughter came to the building on her graduation day and all of her stuff, but she was able to see that. And the family said, That's beautiful, had we not had this in place with all this extra care, she may have already passed. Exactly. She lived another two years after that. So it doesn't necessarily mean the end.

Michele 36:29

And extra eyes on, it's extra care. Like, think about it. You're getting personalized care. What better gift is that? I've even said that to physicians. Like, have like this is a gift to your patient. Like, we're gonna be there to like help them through this. Like, I mean, that's a reflection on you, like good care. Like instead of say, well, you know, there's not a whole lot more I can do, but I'm not putting you on hospice because, you know, or or string you along and give you treatments that aren't working anymore.

Shannon 36:55

The thing with the physicians really surprises me. I guess just as an assumption, I would figure that they would know exactly the kind of benefits the hospital provide for their patients.

Mary 37:04

I know, but think about when it started, how they were so locked into they had to guarantee someone was gonna pass in six months.

Michele 37:12

Now it's a g but now it's pretty much in in your honest professional opinion. Given the prognosis and the diagnosis, do you think this person will be alive in six months? And if they say no, that's all, you know, that's all Medicare can ask from them from them.

Shannon 37:30

Yeah. It's an unfair question to ask.

Michele 37:32

Yeah, it is. But unfortunately, you know, that's the benefit.

Shannon 37:36

Yeah. All right, Michelle, we cannot end this podcast without talking about guru. Healthcare gurus. Healthcare gurus on Facebook is something. Well, I'll let you kind of kind of describe what healthcare gurus is.

Healthcare Gurus Community

Michele 37:53

Healthcare gurus is one of my babies for sure. It's a place that um healthcare, I guess, providers can go to. Um, it's a social media group. I started it eight years ago now, I believe it is, which is crazy because my original intention was I had so many healthcare friends on Facebook, and I wanted a place for us all to go so that we can discuss work issues and, you know, maybe share referrals and do those kinds of things. Um, and more of a professional level than, you know, on our regular Facebook where everyone's gonna, you know, our family is our friends, they don't want to be bothered with that. So we started the healthcare group just literally with 50 of my closest friends. And it grew and it grew and it grew. And people were inviting. So I always say, you know, you remember that old hair um was it? She she told two friends. Oh yeah. She told two friends that okay, so that's kind of the way I look at it. Like, oh my gosh, it just grew beyond. Right now we're almost at 2,000 members. Wow. I know in eight years, but we're very particular. Everyone is vetted, everyone is screen and really as you should. And I want everyone in the group to feel comfortable. I want them to be safe from scammers or whatever. And you don't let people can't advertise. No, no, no. Well, here's it's a different everyone knows what everyone does. When they're introduced, every person is introduced individually. They're able to tell everyone what they do, where they're from. Um, we do share a lot of referrals, uh, we share job um opportunities or you know, um positions that may be open. We share events that are happening in the community. We share promotions.

Shannon 39:49

Right.

Michele 39:50

Um, if if let's say an agency is adding on another service, there they can definitely talk about that. That's not an issue. Um it's a resource center. It really is a resource center. Good. That's that's nice to hear. It's a resource center, yeah. Because people will come on and say, hey, look, whose services of VM? Yes, I need a home care company take Medicaid, I've done it, you know, a straight Medicaid, and I need them like now. And and they they've got like 10 people answering them saying, We can do it, we can do it, we can do it. And that's a wonderful thing, a place to go. And even like there's a lot of times it's like someone will come to me and ask me, you know, who does this or where, or do you have a contact at this place? You know what? People move around a lot in the industry. So it's good to go to a place to like find out who's where and what's happening. And even if you don't know, you can just put it out there. Right. And it's it's it's such a polite forum, I have to tell you. It is. I've never had anyone get snarked. Very professional. Extremely. And I'm so proud of, as a matter of fact, um, last year, or yeah, was it this year? Last year, um, we received a community connections um leadership award. And I'm very proud of that um for starting this group. Uh, it was huge um help and resource during COVID as well.

Mary 41:09

Um and like when people couldn't see each other, exactly get information, like you said, find out resources where people you could put a question up there and know you were gonna get answers. Absolutely.

Shannon 41:23

And you do a great job of welcoming new people to the group. Hate to such and such. Feel free to reach out to juice up, then you see a hundred comments. Welcome to the welcome to the field, welcome to the group.

Michele 41:33

I just love our group. And Mary is one of our um administrators.

Mary 41:36

I'm a silent administrator. I'm back up. She's watching, she's watching. Backup because you really run the show.

Closing And How To Get Help

Shannon 41:44

But I wanted to bring that up to say it is truly a resource, and that's what this podcast is really all about. Another place where professionals in the industry can go to find more resources for themselves.

Michele 41:54

Seriously, look us up. It's healthcare guru um professional networking forum, and it's on Facebook.

Shannon 42:02

And that's how I got into the field, also.

Michele 42:03

So that's awesome.

Shannon 42:06

Five years ago, here we are. I can't even believe it was that long ago. Yeah. Yeah.

Michele 42:12

Congrats. That's awesome. Thanks for the plug.

Shannon 42:16

Absolutely. Um, Michelle, thank you so much for coming today. Uh, thank you for sharing your insights on hospice. Um, again, it's such an important, I think, benefit that's just not utilized enough.

Mary 42:27

No, it's a conversation that needs to continue to happen. Absolutely so. I agree, I agree.

Michele 42:32

A lot of education needs still needs to be done, unfortunately, after all of these years. But I can't thank you enough. I mean, I know Ascend hospice is, you know, honored to have been highlighted in this episode. And I have to tell you, um, I appreciate you both so much, and I'm honored to have been um asked to be a guest today. Thank you.

Shannon 42:54

Absolutely. Uh, thanks for tuning in to another episode of For Mature Audiences Only, presented by Archer Law Office. If you found this episode helpful, please be sure to subscribe, leave a review, and share it with someone that could benefit.

Mary 43:05

Just remember you don't have to navigate aging or caregiving alone.

Shannon 43:09

If today's conversation raised questions about elder law, long-term care, or planning ahead, visit jerseyelderlaw.com or call 609-842-9200 to find resources and support.

Mary 43:22

This is for mature audiences only, presented by Archer Law Office. Until next time, keep pushing forward and keep the conversation going.