Evo Terra (Host): This is Health Dose from MyMichigan Health. I'm Evo Terra. And I'm joined today by Dawn Duffield, MyMichigan Hospice Manager, to discuss when is the right time to consider hospice. Dawn, thanks for being here.

Dawn Duffield: Thank you for having me.

Host: For those unfamiliar, what is hospice care, and how is that different from other forms of healthcare support for terminal illnesses?

Dawn Duffield: Hospice care is a specialized care for end of life. It provides comfort, and our focus is managing symptoms as they happen, and addressing those as they happen timely rather than waiting to see the physician. So, we have a team that comes into the home and can provide that support rather than having the patient go to the doctor. We come to them.

We are focused on people that have six months or less to live, and that determination is made by two physicians. We know that that is not always something that physicians can determine, but it's an estimate based on how the disease process has been progressing over time.

The differences in care, palliative care, some people are familiar with that term. Palliative care is focused more on patients that have chronic and long-term diseases, not necessarily in end of life. They work alongside the patient's primary care physician to provide support for those diseases. We are not looking at curative care when a patient joins hospice care. We're looking at comfort and ensuring that they have support and quality. So, a patient would need to decide to stop any curative treatments that they may have been having. And as I said, we come to them, which is really handy and helpful to patients, so they don't have to go to the physician or go to the hospital.

Host: And thank you for those clarifications. I, myself, have had a few family members go through hospice care, but I sure didn't know what to expect the first time around. So, I'll ask you this: What are some of the biggest misconceptions people have about hospice care?

Dawn Duffield: think some patients still think that hospice is only for patients with cancer. And honestly, we care for all patients in endof life. One of our largest populations are patients with dementia or Alzheimer's disease or something of that nature. But we also care for patients who have any kind of long-term disease process that's going to end in their death in six months or less. So, heart disease, kidney disease, neurological diseases. So, everything, it's not just cancer.

The other misconception is that patients and families sometimes think that you get on hospice, you lose all hope, and it's over, and I'm giving up. And what we do, our team does, is help patients and families get through that transition and help them understand what is happening to their bodies, what to anticipate, and we hope that they will be able to live some of their life that maybe they haven't been able to in the past weeks or months, that they're able to enjoy some things because we've been able to help manage some of their symptoms that they have.

Another misconception is that hospice is a particular place. And hospice is not a place. It can be provided in many different locations, primarily the patient's home or family, family's home, and then also assisted living facilities, skilled nursing facilities. It can be in hospitals, but that is short-term. It's not a place that they can provide long-term care to. And then, there are hospice facilities that can be provided to the patient that only treats patients on hospice.

So, it's not a place, it's a type of care. Some people feel that once you go on hospice, you don't have any contact with your primary care physician or maybe your specialist. Typically, those physicians do transfer care to the hospice medical director. But we still are able to keep in communication with their primary doctor or their specialist. And the patient can also see that doctor with some limitations on that visit, so they can still have that relationship.

Families do provide much of the care, you know, especially if the patient is in the home. But our job as hospice team is to help give them the tools to do that so that they can understand what is happening to the body, what to anticipate. We make sure they have the medications, they have the supplies, they have the equipment that they need in the home.

And the biggest one that we're challenged with today is that many patients and families, and sometimes physicians feel that hospice is really only for those very last few days of life.

And in order for us to provide the support to families and patients to our best of our ability, we really would like to have patients on service weeks or months sometimes and can help patients transition. But many times we're seeing lately that patients are waiting till those very, very last days of life.

Host: So clearly, there's a lot more to this hospice care than I think most people think about. Well, let's get to the uncomfortable question. How do you know when is the right time to consider hospice care?

Dawn Duffield: Right. Well, I think patients need to have conversations with their doctors, if they do have a long-term disease or a cancer diagnosis, to start talking about what are we going to do at the point where my life is limited to two weeks or months, and having that conversation long before that time comes. That is not something that is typically done, but we certainly encourage that.

Family needs to understand what the patient's advanced directives are. What are their wishes? What have they talked about? What do they want to have happen in those last months of life? Bringing those discussions in can help having the conversation about what to do when I only have days or months to live. You know, thinking about what are the goals of care at that time? What do I want to have happen? Where do I want to live? Bringing in your healthcare provider into that discussion is always helpful. maybe a friend or a neighbor to come in and sit with you while you have that conversation.

 Sometimes if you've had multiple hospitalizations, it might be the time to start talking about that. What do we want to have done next time you go to the hospital? Do we want to think about hospice or going to another location?

And the other thing we need to also think about is if I'm getting treatment for a particular disease process, is it easy for me to get there? Am I needing to have an ambulance take me to the hospital? Or am I still able to walk? Those are limitations that will determine if I still want to go to the hospital and see the doctor.

Host: What about a family's approach? If they have a family member that needs or they think might need hospice, how do they start that conversation?

Dawn Duffield: I think you just talk about it. If it's let's say it's their dad and say, "Dad, you know, you've gone to the hospital now three times in the last month. Every time we go, we stay in the emergency department, maybe we get admitted for a day, but then you're coming home. And really, things aren't changing. The treatments aren't as effective as they once were. What do you think about being on hospice care? We'll provide support to you, and you can be comfortable. You know, you don't have to go back to the hospital." Because that is often one of the things that people don't want to keep doing, is going back to the hospital.

Finding a quiet place to have that discussion. Maybe if you have a spiritual care person in your life, maybe having that person come and sit with you while you're having that conversation.

Host: Yeah. Always a difficult conversation no matter what's going to happen. Tell me a little bit about the hospice care team there at MyMichigan Health. What does it look like? And what kind of people are involved in this end care?

Dawn Duffield: Hospice is an interdisciplinary team. We have our hospice medical director who oversees the medical care. And then, we have nursing who are really the case managers. They're the ones that are looking at all the components of the care needed and making sure that all the right people are involved. The nurses are communicating with the providers on pain and symptom management needs. And we, as a team, meet every two weeks at a minimum. And many times, we're talking daily with the medical team about what changes we need to make.

In addition to the clinical component, we have our social worker, medical social , who are there to provide resources maybe the family needs to help provide care. They can help in developing advanced care planning, help with funeral arrangements, being just somebody else to provide emotional support to during this time. We have a spiritual care coordinator who is available for spiritual support. Most times, it's not focused on a religious component, but really more a spiritual component, meeting the patient where they're at, often just a listening ear.

We have home health aides who come in and can assist with personal care, and that's if needed. You know, not every patient needs that, or maybe their changes occur over time and might need that support later on down the road, they can come in and help with bathing. And sometimes just some companionship.

And then, the wonderful thing that hospice has been built around from years and years is the volunteers. These are folks from the community that have gone through a training program to be able to be present with patients and families that are in the end-of-life process and can provide respite. It can also provide companionship. We have volunteers that read to patients, play music. We have a patient who's teaching a volunteer how to crochet. So just a lot of nice things that can also help support the family, so the family might be able to step out and go get groceries and feel confident that somebody's with their loved one.

So, it's really a huge team that communicates on a daily basis to make sure that we're meeting the patient's need. And the patient and the family obviously are the center of that. They're the ones that are determining what components of the team they want involved.

Host: Great, great. Dawn, I know you have a lot of experience in this, so I'm going to make this the final question. What is your recommendation on finding information or support that will help make informed decisions about hospice care?

Dawn Duffield: Sure. You can certainly always go to the Medicare site, medicare.gov/care-compare. That site will show you all the hospices in your area and will compare them, so you can start there.

I always think that word of mouth is probably one of the best ways to find a hospice that fits your needs. MyMichigan obviously provides care in eight counties. And we provide free informational meetings, so we can come to your home. We could meet you at your doctor's office to talk to you about what we can provide you. We meet patients in the hospital. So, that is available to learn more about us. And then, another site that you might want to check out is hospicefoundation.org, and that really is designed for the layperson, and you can get some information about the program similar to what we've just talked about.

Host: Great. Dawn, once again, thank you very much for all the information.

Dawn Duffield: Thank you for having us.

Host: MyMichigan Health offers compassionate hospice care in a variety of settings to meet each patient's needs and preferences, including private homes, assisted living communities, skilled nursing facilities, and the Woodland Hospice House in Mount Pleasant, Michigan. The Woodland Hospice House is a peaceful eight-suite residence designed to provide privacy, comfort, and personalized care that honors each patient's wishes.

To learn more about hospice care options and find the right setting that's right for you or your loved one, please visit mymichigan.org/hospice or call 1-800-862-5002-. I'm Evo Terra, thanking you for watching this episode of Health Dose from MyMichigan Health.