Scott Webb (Host): Many of us spend more time thinking about the beginning of life than the end of life, like whether or not hospice care is something we want. And joining me today to help us understand hospice care and how Franciscan Health can assist with end-of-life planning is Registered Nurse Michelle Morrill.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Michelle, it's so nice to have you here today. We're going to talk about hospice care and that sort of end-of-life planning that many folks have to do. So, let's start here. What is the primary goal of hospice?

Michelle Morrill: The primary goal of hospice is to really celebrate life and to prepare people for ultimately death. We really focus on quality of life and not quantity of life. We also work with family members on the dying process and it's really to educate families. We do a really good job of preparing people for the beginning of life, but not so great a job for the end of life, which we're all going to ultimately meet.

Host: Yeah, that's such a good point. You're right. There's just so much out there about how to get started in life with newborns and infants and NICUs and all these things about bringing little people into this world. But end-of-life planning is important as well. And wondering if there's some misconceptions or what are some of the biggest misconceptions when it comes to hospice?

Michelle Morrill: Well, hospice is a type of care. People often think that it's a place, and while Franciscan is very blessed to have a freestanding hospice building, most people receive care in their home. So, that is one of the misconceptions. Another one is people, we really have to work with them. They think it's giving up, or that they don't want to stop treatment, even though they're tired because they don't want their family to think they're giving up. It's not an easy choice. It's also not just the MD's responsibility to bring up hospice care to families and patients. Families or the patients themselves can bring up hospice care, if they're ready to stop seeking curative treatment. Those are probably the three biggest.

Host: Yeah. And especially the one about hospice at home, right? It's good to know that that is an option despite what Franciscan offers. And we're going to get to that in a second. Just wondering if you can explain hospice respite care, what does that mean?

Michelle Morrill: So, respite care is a hospice benefit. We provide five days of overnight care in our hospice house to families if they're needing a break because, you know, healthcare providers, we all work shifts, typically eight or 12 hour shifts. And then, we go home and that's designed because it wears on a person. It's not only you're doing physical care for them, but you're emotionally attached to the situation. You're going through your own feelings and thoughts, and sometimes you just need a break. You need to be able to know that your loved one is being cared for appropriately so that you can read a book, take a nap, get some groceries, those kinds of things. So, that's what respite care allows.

Host: Yeah, as you say, that sometimes in this, all of this, just in medicine in general, but especially with hospice care, sometimes we have to care for the caregivers, right?

Michelle Morrill: Absolutely. That's a huge part of what hospice does.

Host: Yeah. So, how does Franciscan Health Hospice differ from other agencies in Indiana?

Michelle Morrill: We have a beautiful 16-bed facility right here on the Indianapolis campus. We are obviously connected with the Franciscan system, so we provide continuity of care from those Franciscan doctors directly to our hospice house, but we also take referrals from outside sources as well. We provide social workers, music therapy, pet therapy, massage therapy. We also have spiritual care. Our particular team is very kind, loving, gentle. They really become an extension of the family and function. Just that way, when you become our patient, you become our family. We want to take care of you, answer your questions, and realize that this is such a special time of life, that it's really to be honored.

And I think the quality of the staff here make us very unique and it really changes the outcome. I mean, death is sad and we grieve. But if you know that you did everything you could for that family member, which includes providing excellent care at the end, and you yourself were taken care of, that is just such a positive memory to leave and we take great ownership of that here at Franciscan.

Host: Yeah, for sure. And I just want to clarify, so you said that hospice really, generally for most, is when they're no longer seeking curative treatment for whatever was ailing them or whatever got them to that point. So, can patients still seek treatment if they enter hospice care?

Michelle Morrill: At the time somebody has chosen hospice care, they've decided that they're no longer seeking curative treatment for whatever diagnosis brings them in. So if their diagnosis is cancer, they're no longer seeking chemotherapy, radiation, those types of things. We're really about symptom management at that point. But if they have other conditions that are not related to their primary diagnosis, they do and still can receive treatment or meds for those non-admitting diagnoses.

Host: Right. If they've got other things that are affecting their quality of life here at the end of life, obviously you don't ignore them even though they're not, as you say, maybe still getting chemotherapy or whatever it might be. So, let's talk about all the stuff that needs to be done, filling out wills and choices and estates and all of that. How can a caregiver help a loved one with end-of-life planning?

Michelle Morrill: That's really a big piece of where our social workers come in. We do talk to families and see, you know, do they have advanced directives, things like that, so we can make sure and honor a person's choices at the end of their life. If they don't have those types of things in place, social workers can assist with directing them to the correct type of paperwork, getting signatures, those types of things. And if a lawyer needs to be involved, they would direct them to, you know, use a lawyer, but the basics of what type of care they want at the end of their life. We definitely can assist with that.

Host: Yeah. And those things are so important. I had an experience recently, my wife's dad passed away and he had done much of this beforehand. Having a will and those types of things and having his estate generally in order. And it just makes such a difference for family members, right? Because not only have they lost this loved one whom they are likely celebrating and grieving, but then also trying to sort through all of that. And it really helps to have those I's dotted and T's crossed, right?

Michelle Morrill: Absolutely. And something else that goes along with end-of-life planning that we don't often think about is like a life review from the patient's point of view. Sometimes letting them go through those kind of things and documenting that and leaving that for family is just as valuable as all of those official documents, but it lets them leave a piece of themselves behind as well.

Host: Yeah, a piece of themself, the memories, recollections, whatever it might be. So, let's talk about the cost of hospice services. What options are available to help cover them?

Michelle Morrill: The vast majority of our patients are on Medicare or Medicaid. We also take private insurance and then there's private pay options. Medicare does not cover room and board services. So those fees, if to come to the hospice house, the family has a room and board fee. Their nursing services are covered under that benefit. So, we take a look at all of those things and kind of determine is the patient going to be at home? Do they need more care, more like 24-hour care? Are they going to be in a long-term care facility and assisted living? Those kinds of things or if they'll be at the hospice house.

Host: Sure. Sort of basing their care and where they'll be and all of that on, unfortunately, insurance or Medicare, whatever it might be. Just want to finish up today, and it's been good to get a better understanding of how all of this works. I'm sure lots of folks have questions. You mentioned earlier that folks can do hospice care at home, but I know there's some other options. So, let's just go over the various settings that patients can receive hospice care.

Michelle Morrill: We get a lot of referrals from the hospitals. Some hospices are set up where they provide hospice care in the hospital. Franciscan, since we have a freestanding building, we provide it here at the hospice house, in people's homes, assisted living, nursing homes, or the majority is in their own home, which is nice. Because, as I said earlier, some people think that hospice is a place, but it's really to be able to maintain you where you want to be. And most people say they want to be at home with their family, their pets, their grandkids, whoever is important to them, that's where they'll be.

Host: Yeah, I think that's so important. As you say, that's such a perfect way to put that. When we talk about hospice, it sounds like a place you go and there are places, as you said here with Franciscan and having a freestanding hospice facility. But many people, if given the option, would prefer to be at home with their family, friends, pets, grandchildren, all those things that are important to them. So, appreciate your time today and understanding of how hospice works and what Franciscan offers. Thanks so much.

Michelle Morrill: Thank you.

Host: And to learn more, visit franciscanhealth.org and search hospice care. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.