Michael R. Anderson, MD (Host): Hello everyone and welcome to this episode of the FortCast, the official podcast of Fort Healthcare. I'm your host, Dr. Michael Anderson, ENT doc and President and CEO of Fort Healthcare. I'm very excited today. We have two special guests today on the FortCast. They are our friends and colleagues from Rainbow Hospice, so thank you. We have Shauna Lambrecht and Dana Traynere. Thank you, Shauna and Dana, for being with us today. I would love it, I would love it if you could introduce yourselves to our audience. Tell us a little bit about yourself and how long you've been part of the Rainbow Hospice team.

Dana Traynere, RN: Hi, Dr. Anderson. Thank you for having us here from Rainbow Community Care. I've been a nurse since 2017. I did a bit of a stint at the hospital, had a little bit of interaction with hospice care in that setting, and then my co-workers, my friends met some people who worked at Rainbow and decided to come on board as a hospice case manager with them, in 2019.

Took a year off amidst COVID, to run a facility in Fort Atkinson as Director of Nursing and then came back to Rainbow, where I have passion.

Host: Well, that is fantastic. Shauna, how about you?

Shauna Lambrecht, APNP, FNP-C: My name is Shauna Lambrecht, Nurse Practitioner with Rainbow Community Care. I am one of the Nurse Practitioners in the Palliative Care Program and the Director of Provider Services. So I like to say I grew up in healthcare and that I started working as a CNA at 16 at some of the local nursing homes.

Then graduated as a nurse in 2010. Initially worked as a critical care ICU nurse, then became a Nurse Practitioner where I started in cardiology, some hospital medicine, and then did some outpatient chronic care management and mental health facility. And some experience with hospice and end of life care for five years until I came to Rainbow.

At that time was Rainbow Hospice Care, now rebranded to Rainbow Community Care, which Dana will talk to a little bit more. But I came to Rainbow in January of 2023.

Host: Well, and I'm sure Rainbow is just delighted to have both of you part of their team. So that is a perfect segue, Shauna. So you kind of led this into, maybe Dana, you can explain, you mentioned a rebranding from Rainbow Hospice to Rainbow Community Care. So give us a little bit of insight.

 Maybe just start with how long Rainbow Hospice has been around. Cause it's been around for a decent amount of time and we've always supported Rainbow Hospice and been good community partners. And then take us a little bit on the journey of how it evolved into the Rainbow Community Care.

Dana Traynere, RN: Quite a while ago, before my time, in 1988, actually, a small group of really dedicated volunteers saw the need in the community, for some end of life care. So that task force in 88 eventually, in 1990, started Rainbow Hospice care in Jefferson.

The name actually came after a storm and these volunteers saw the rainbow and it was perfect timing. So that's how we got the original name. Throughout the years as they worked with families, they realized that people needed support long before hospice care. So Rainbow's expanded its services over the past 34 years.

We're not just about end of life care. We're about supporting people throughout their entire journey with aging and serious illness. Something kind of unique about us is that we're one of the few local, independent, non profit hospice companies left in Wisconsin. We're your friends and we're your neighbors.

We know you, Dr. Anderson. We have our school nurses that we know, yeah, we run into in the grocery store. We're not owned by big corporations or stockholders. Our board is made up of some local people who are passionate about our community and the work we do. Now we jump ahead 34 years. As we've alluded to in our rebrand, January of 2024, our board of directors, those local folks, they took a big step and rebranded us to Rainbow Community Care.

They, and we, feel that this better reflects who we are and what we do. Before we were known for hospice. Now we offer six additional different programs that help people live well as they age or face serious illness. I think our growth has been guided by a simple principle. This is your life and your journey.

And we're here to support you in living as fully and as comfortably as possible, whether that's through our hospice or palliative care programs, advanced care planning, grief support, parish nursing, or volunteer programs. We think wellness is for people who are young, but it's not. At Rainbow, we believe wellness is important at every stage of life.

It's about more than physical health. It's about mind, spirit, soul, and relationships, too. When people are willing to think and talk about these topics early on, it can prevent a lot of unnecessary suffering later on.

Host: Well, Dana, I have to say, I really, like that new branding. Anytime you can emphasize the community aspect of it, I think that is excellent. Rainbow Community Care, we do share that. We share something in common. We're both nonprofits. Fort HealthCare is a nonprofit. Fort HealthCare is also independent and community based. So we're cut from similar cloths. So it is wonderful to see that rebrand. I want to dive in a little bit to something that you mentioned about the services that you provide and maybe, ask Shauna a little bit more pointed question, and that is, Shauna, what are the key differences between the palliative care and hospice? And why is it so important to understand the differences?

Shauna Lambrecht, APNP, FNP-C: Yeah, and that's a really good question, Dr. Anderson, and it's very confusing to patients, families, and really like health care providers too, or health care workers. So most people are familiar with hospice care, and if you're in Jefferson County or surrounding areas and you hear Rainbow, you usually immediately think hospice care.

But Rainbow Community Care has had a Palliative Care Program since 2016, which has grown and evolved over time. But hospice and palliative care, though they do have some similarities, that the focus is on helping improve the patient's quality of life through better symptom management and focus on comfort and has a holistic approach.

Palliative care differs in that it can be provided along with curative treatments or restorative measures. So, for example, somebody who has cancer and is undergoing chemotherapy or a patient who has advancing Parkinson's disease but they're wanting to continue with seeing a specialist and going to therapy and try to restore as much function as possible.

Palliative care, is provided in different locations. So most providers might be familiar with palliative care in the tertiary center. So in a hospital setting. It can be provided in a clinic, or our program is a community based palliative care program. So we're seeing patients in the home.

So the focus of palliative care is improving the patient's quality of life and that's through a couple different things. So we can help with symptom management and optimizing the symptom management. Palliative care doesn't assume the care of the patient, but instead we work in collaboration with their primary care provider or their specialist.

And the focus on improving their symptoms is to hopefully optimize their quality of life. So we can do things like give recommendations for medication management or looking at the patient holistically. So helping get emotional support involvement or chaplain involvement, or just helping them get the practical care that they need to improve their quality of care in home.

But even more than just optimizing their symptoms, palliative care spends a lot of time on goals of care conversation, which is really a lot of our time that is spent. So helping the patients define the things that are important to them, and helping them understand their medical conditions.

And help them declare what their goals are for their healthcare journey. So we can also help with them creating a healthcare power of attorney and advanced directives. So making sure they have all their ducks in a row and talking about resuscitation status, those types of things.

So that's palliative care, where hospice care on the other hand, like I had mentioned is similar to palliative care in that we're helping improve their quality of life and helping with symptom management, but hospice is a program that's reserved for people who have a prognosis of six months or less and that's determined by a bunch of different factors. And hospice, the focus isn't on prolonging life or curing disease, but rather on treating the symptoms related to their diseases.

Host: Okay. So there's a pretty big difference between palliative care and hospice care. And I appreciate you bringing us through that because for a long time Rainbow has just been known for their hospice care, hence the name. But now it sounds like the palliative care is, really a big part of your organization and it certainly fills such a community need to have that palliative branch. So, one question I do have though, Shauna, just a little bit of follow up, you mentioned palliative care versus hospice care. When is the best time, you mentioned a six month timeline, it's hard to have a crystal ball for these kind of things, so when do you know or when do you feel is the best time to refer somebody for hospice care?

Shauna Lambrecht, APNP, FNP-C: So hospice, like I mentioned, is reserved for patients with a prognosis of six months or less. And that's determined by a bunch of things. But what we do know from the data that we collect, is that patients are being referred way too late. And specifically patients from the hospital, oftentimes only are on service for a few days.

So the best time to refer a patient to hospice is when you're noticing a change in their clinical status, their functional status, if they've had recurrent emergency room visits or hospitalizations. If they've been having any falls, wounds, unintentional weight loss, those are usually clinical triggers to identify a need to refer somebody to hospice, but, the better question is when they should be referred to palliative care.

So palliative care in the easiest sense is kind of, if you think of it as the program before hospice care, and the qualifications for being referred to palliative care is, really anybody can be provided at any age and any stage of illness, but we do know the sooner the referral the better.

And really if somebody doesn't know, they can send a general referral to us and we can help guide that. We do know that doctors and providers, they don't like to use the H word, hospice, with their patients, so we do often get general referrals or referral to palliative care that after we go in for an initial visit, it's very obvious that they're hospice eligible, and it's very obvious that their goals align with hospice, So we welcome that as well, too.

Host: Well, I tell you, there's a lot of words we don't like to use, but, I guess hospice, it has a little bit of a stigma to it. But getting back to the palliative care or referral or the hospice, referral, certainly, people don't wanna hear the word hospice and then automatically think they're transitioning their life. So getting back to the referral stage, who's capable of making a referral for either palliative or hospice care? Can family members? Does it have to be a provider or a physician? Can it be a chronic care nursing? Take us through a little bit of the referral process.

Dana Traynere, RN: It's important to know because it's anyone, for hospice can make a referral. So we've had neighbors, you know, concerned neighbors with an elderly woman at home; they've seen the ambulance several times and they've had conversations. And they talk to them and say, Hey, I've heard about this company, Rainbow.

Can I give them a holler for you? And then they, get connected. So there's no order needed for hospice care to make a referral, I should say. So we welcome any phone calls from anyone. We ask that the patient has a heads up, but we are experts in having these conversations, like Shauna said.

So by any way of getting us the name and phone number of someone who needs more help, like I said, we have more services, so not just hospice care, palliative care, anyone can call us to make a referral for palliative care. Although that program does require an order from a physician and that's how the referral process goes.

Our main line goes right to a triage nurse who can get you to the program that you need.

Host: So it sounds like if somebody calls and has questions, you can guide them through the referral process. Is that accurate?

Shauna Lambrecht, APNP, FNP-C: That's accurate. Yeah. And if somebody is referred to hospice and they're found not to be appropriate for hospice; we often then offer them our palliative care program. So yeah, referral comes in, we find which program's most appropriate to them for them.

Host: So the palliative care program, you've talked a little bit about that, and if we could just go in a little bit deeper into how patients and or their family members can benefit from these services prior to the end of life. Can you take us through that?

Dana Traynere, RN: Studies have shown that patients and families report higher satisfaction when they're on the hospice benefit longer. It's not just hospice. It's not just the benefit. The more time that we as experts, quote unquote, have time with families and patients, the more time that we get to have these conversations with them. Signing on to service earlier or when eligible means they have more time to do the things that need to be done. The team, the nurse and the social worker can work on controlling pain and other uncomfortable symptoms. There's also an emotional and spiritual factor that comes into play when we are aging.

Like birth, death is inherently hard and we're all going through it. So there's certainly an emotional and spiritual factor there. We have more time to build a relationship with the patient and provide that support. And we get to meet the families. We get to educate the families on what to expect.

This can reduce stress and anxiety for everyone involved. There is a study done by the National Hospice and Palliative Care Organization in 2020. The median length of stay, so the average time that we have with patients on hospice, is 18 days. It's not a lot of time to do the important work that we're talking about. Now, I'm not saying that when patients sign on later, they still absolutely benefit from our hospice services. Although they may have less time for effective symptom management, it takes time to try different medications, less opportunity for emotional support, and the families may feel rushed and stressed trying to prepare.

Like Shauna said, these later referrals coming from the hospital, it's a tight timeline to have these important and thoughtful conversations. The bottom line is hospice isn't about dying. It's about living as comfortably and as fully as possible for whatever time remains. The earlier we can start providing that support, the more impact we can have on the quality of life for both the patient and their loved ones. So, that's why we really want to advocate and have these conversations that hospice sooner rather than later isn't a negative thing. It's not giving up. But it's about getting the support you need at the right time.

Host: And I just want to emphasize something that you brought up. It's amazing the impact that not only on the patient, but the patient's family, the ripple effect that care can have and the stress that family and loved ones go through while their loved one is being treated. So I can't emphasize that enough.

And if Rainbow can impact that and improve that, that is a wonderful asset to anybody's care. So, I tell you, it's been wonderful to sit down, Shauna and Dana, with both of you and learn more about, Rainbow. And I just want to highlight a couple things because I've been around for, a little while.

So, Rainbow Hospice is now Rainbow Community Care. You're more than just hospice. You have palliative care. You're expanding your services. And if anyone feels that they would benefit from a palliative care or a hospice referral, please reach out to Rainbow Community Care and they will walk you through that process.

They're here to support you. They're here to treat your loved ones and to help everyone's families as you go through that treatment. So, Shauna, Dana, so much for being a part of this on this episode of the FortCast.

Shauna Lambrecht, APNP, FNP-C: Thank you for having us.

Dana Traynere, RN: Thanks, Dr. Anderson, for having us. It was a pleasure.

Host: Well, thank you. So I hope you enjoyed this episode of the FortCast. Please check out our library on our website. We have a whole list of podcasts that we've done in the past. Also, please feel free to link this to your social channels. Once again, this is Dr. Michael Anderson signing off for this episode of the FortCast.

Take care, everyone. So long.