Amanda Wilde (Host): At end of life, hospice care ensures an environment of support for patients and their families, but the kinds of support and who can use hospice are not necessarily very well understood. So we're getting an accurate window into hospice by tackling common misconceptions with our guests, First Health Director of Hospice and Palliative Care, Tina Gibbs, and Hospice Provider and Medical Director for Hospice and Palliative Care, Dr. Timothy Beittel. Welcome to First Health and Wellness Podcast, connecting you to the people and medical services that make your life healthier. I'm Amanda Wilde. Tina, Dr. Beittel, welcome. So glad to have you here to clear up some questions about hospice.

Timothy Beittel, M.D.: Thanks for having us.

Host: Now, if you don't mind, I'm going to throw out some common ideas about hospice care and get your insights. So, it really is a round of, is it true that, and here's one I've always been confused about. Tina, as a hospice director, maybe you get this a lot. Is it true that hospice and palliative care are the same?

Tina Gibbs, Hospice Director: Thank you for having us. No, it is not really the same thing and it is a very common question that I get asked all of the time. Really, palliative care is for at any diagnosis and it's not limited by time. Looking at hospice, it's really a life expectancy of six months or less.

Host: Dr. Beittel, is it true that hospice then is where you go when there is nothing more a doctor can do?

Timothy Beittel, M.D.: No. Of course folks that come into hospice are generally no longer receiving curative treatment or aggressive care to try to cure a disease or prolong life anymore and have refocused on a more comfort oriented approach where we're trying to maximize symptom management and quality of life and having the best time available to them to interact with their families and loved ones with whatever time is left to them. So, it's really just a refocusing of care.

Host: Well, based on what you said about six months, Tina, is it true you must be in the final stages of dying before you're eligible for hospice?

Tina Gibbs, Hospice Director: In order to be eligible, you really have to have a life expectancy of six months or less, as determined by a physician. But you really do not want to wait until the very final stages of dying. It's really important that people get in sooner than later. It really increases the quality of their life and gives them the opportunity to experience their life more fully and more comfortably.

Host: Yeah, because I think one of the ideas about hospice care is it for people who have given up, because as you just said, Dr. Beittel, you may have given up on curative treatments at this point.

Timothy Beittel, M.D.: Well, of course, it's not necessarily giving up. It's a change in the goals or priorities for the patient and their family. Sometimes, in fact, it does mean they've literally tried and failed every treatment out there for whatever disease they have. But it may also mean they are having side effects that they don't want to continue to experience because of the treatment or they don't want to continue to have all the difficult logistics of going back and forth to appointments and paying for expensive treatments and so on.

And the treatments may be making their lives less quality for them, less pleasant, and they would prefer to, again, refocus on comfort and having the best time that they can, spending that time with their family and loved ones at home and not in a medical setting.

Host: Well, now, Tina, I thought I'd heard that you must leave your home if you choose hospice care.

Tina Gibbs, Hospice Director: Actually, Amanda, that's really not true at all. In fact, the majority of our patients actually receive hospice care in their personal home environment. Now, we do provide care in other areas in the event that it's more appropriate for their needs. We provide patient care and assisted living in skilled nursing facilities and we also do have an 11-bed hospice house on our campus and that is more geared toward patients with acute symptom management needs. But the goal is really always to have patients right in their homes where they're most comfortable.

Host: So, there is this idea, Dr. Beittel, that if you hire hospice, it will be a machine that sort of takes over and where's the family's role in that?

Timothy Beittel, M.D.: Yes, it is another common misconception that some people have that hospice is going to come in and provide 24/7 care for the patient and just take over everything. And that's not really true. It is our goal to provide support for the family and loved ones who are caring for the patient, and since most of our patients are receiving care at home and it's a goal to have them have quality time with their family, they're the ones that are doing the bulk of the care.

Our hospice nurse will come in at least every two weeks, usually every week, sometimes more often as needs grow. We may have a hospice aid that's in there two or three times a week or more. And then there are the other people on the team, social workers, volunteers, the physicians, physician assistants and nurse practitioners and other medical providers and so on, chaplain and spiritual care providers.

But again, it's the family and the loved ones that need to be there with the patient and providing the care and we'll teach them, support them, provide supplies and so on. Now, of course, some families either are not available, may not literally live there with the patient, or for whatever reason, they may hire their own paid caregivers as well. But in some way, the family needs to band together to provide the bulk of the care, and hospice is supplementing and supporting that.

Host: Yeah, supplement's a good word, but even though it's not full time, there is certainly an idea that hospice care is very expensive. Is that true or false, Tina?

Tina Gibbs, Hospice Director: Yes, I think people have asked that question routinely as well, and it's really important to know that our hospice services are essentially covered by most all insurances, and no person, if they would come to us and they say we're uninsured, no person is ever turned away because of the inability to pay. So that's definitely not an issue that patients or families should be concerned about with hospice care.

Host: Such a compassionate way of approaching it. Dr. Beittel, is it true that hospice care is only for cancer patients or the elderly?

Timothy Beittel, M.D.: No, now hospice certainly did start, I mean, back in the 1960s, primarily aimed at patients who were dying from cancer. But over the years, in part because of other advances in medical care and nutrition and sanitation and so on that have extended our lifespan; cancer is still very common and a frequent finding in hospice censuses, but we're almost being overtaken by some of the other chronic illnesses that we as humans accumulate in our lives now.

We have a lot of folks with Alzheimer's and other types of dementia, and then a lot of folks with chronic heart or lung disease, or various chronic neurologic diseases like Parkinson's and multiple sclerosis and others like that. And while it is also true that probably it certainly does skew towards the elderly or geriatric side, it is a benefit that is open to anyone with a life limiting illness regardless of age.

And we have a patient in their 30s on service right now and often have folks, sort of from ages 20s to 50s, you know, that wouldn't normally be considered elderly or geriatric. And then although, of course, it's much less common, since children don't tend to have life limiting illnesses, some of them, of course, do, and, we have had children on service before and are ready to take care of them again if there is a future need. And there are certainly hospices in more major metropolitan areas that are dedicated to children's services.

Host: Tina, is it true that family support provided through hospice ends after the patient dies?

Tina Gibbs, Hospice Director: No, that is not actually true at all. One of the really special things about hospice care is bereavement services are offered after a loss for up to 13 months for all family members and even longer as needed. First Health has an actual grief resource and counseling center on site, and we provide extensive group opportunities for adults, children, and teens.

We have a regular mailing program. We have a full lending library on site. We do individual, family, and group counseling as well. We also host an array of special events throughout the course of the year related to grief and bereavement issues, and there's no cost for those services that are provided in bereavement.

Host: Wow, it's great that hospice recognizes that bereavement is an ongoing process and to provide support around that. Tina, why do you think there are so many misconceptions out there about hospice care?

Tina Gibbs, Hospice Director: I think quite often, Amanda, that people do not think about hospice care until they actually need the service, and sometimes it's in a state of an emergency. I think it's important for people to learn about services ahead of time, to learn what is provided, and to have opportunities like this to answer questions and really turn to the experts to see what is available to them.

Host: Do either of you have any other myths we have not addressed that you would like to?

Timothy Beittel, M.D.: I would love to jump in with one, Amanda, that I commonly hear and would love to address. One thing we hear as a concern or worry or reason for people not wanting to come on hospice, especially earlier in their illness, which is better, as Tina alluded to, because it gives the hospice team and the patient and their families time to get to know each other and build that supportive trusting relationship.

What people think is that hospice speeds up the dying process or comes in and takes away all the care and just waits for the patient to die, but that is just not the case. Again, it's a refocusing from perhaps aggressive curative treatment to focusing on comfort and quality of life and staying at home and as much out of hospitals and other medical facilities as possible,

but it's still providing a lot of care. As you probably can tell from the questions we've discussed so far, folks are still getting a lot of attention. And what we often find is that there are plenty of folks who end up, at least temporarily, feeling and getting a little bit better, and in some cases living longer than predicted.

We believe probably because of the close attention that they're getting from their families and loved ones and the hospice providers and the rest of the hospice team. And sometimes backing off on some of those heavy duty, for example, chemotherapy agents and things like that, it lets their bodies relax and be able to function a little longer and a little easier. And again, it's not certainly the majority of folks, but there's occasionally folks that, as we say, graduate from hospice. They seem to stabilize or actually improve for a few months or so and are able to leave hospice, at least temporarily, and they can always come back when they start to decline again.

Host: Yeah, to me it just sounds like an amazing safety net and support and that hospice has evolved into that over the last few decades. Dr. Beittel, Tina, thank you so much for addressing the myths and clarifying what hospice care really is.

Timothy Beittel, M.D.: Thank you again for having us.

Tina Gibbs, Hospice Director: Yes, thank you.

Host: To learn more about hospice care at First Health visit firsthealth.org/hospice. If you found this podcast helpful, please share it on your social channels and you can check out the full podcast library for other topics of interest to you. Thank you for listening to First Health and Wellness podcast brought to you by First Health of the Carolinas. We look forward to you joining us again.