Hospice Care Explained
November is National Hospice Month. Elizabeth "Dar" Thornsbury, Director of Patient Care Services, explains hospice care.
Featuring:
She has worked in various healthcare settings over the years including Acute Care in hospitals, Skilled Nursing Facilities, Assisted Living Facilities as well as Home Health and Hospice.
Her desire to see excellent quality care be received by all patients fueled her desire to become actively involved in the administration and the management side of health care. Elizabeth has held various positions as Assistant Administrator and Director of Nursing in an acute care hospital, Acting Administrator in a Skilled Nursing Facility, and Administrator of an Assisted Living Facility as well as positions of Quality Management and Director of Nursing for a Home Health agency. Her experience also includes serving as the Regulatory Manger for two hospitals in Major Corporation for the state of California.
She obtained her Certification in Patient Care Quality (CPHQ) in 2012 and is a member of the National Association of Health Care. Elizabeth’s passion is working with the Hospice Program and providing high quality care to patients at the most vulnerable times of their lives.
Elizabeth "Dar" Thornsbury, RN, BSN, CPHQ
Elizabeth Thornsbury’s career began in 1985 as a Licensed Vocational Nurse (LV N). She furthered her education with an Associate Degree in Nursing (AD) and then a Bachelor’s of Science in Nursing.She has worked in various healthcare settings over the years including Acute Care in hospitals, Skilled Nursing Facilities, Assisted Living Facilities as well as Home Health and Hospice.
Her desire to see excellent quality care be received by all patients fueled her desire to become actively involved in the administration and the management side of health care. Elizabeth has held various positions as Assistant Administrator and Director of Nursing in an acute care hospital, Acting Administrator in a Skilled Nursing Facility, and Administrator of an Assisted Living Facility as well as positions of Quality Management and Director of Nursing for a Home Health agency. Her experience also includes serving as the Regulatory Manger for two hospitals in Major Corporation for the state of California.
She obtained her Certification in Patient Care Quality (CPHQ) in 2012 and is a member of the National Association of Health Care. Elizabeth’s passion is working with the Hospice Program and providing high quality care to patients at the most vulnerable times of their lives.
Transcription:
Prakash Chandran (Host): In this episode of Ridgecrest Regional Hospital Podcast, we'll discuss the positive effects of hospice for patients and their families during the final months of life. Here to discuss is Dar Thornsbury, Direct of Patient Care Services at Ridgecrest Home Health and Hospice. I appreciate you being here, Dar. So let's begin with an overview of what hospice care entails, and when a patient might start receiving this type of care.
Dar Thornsbury, RN, BSN, CPHQ (Guest): Well first of all, let me thank you for having me and allowing me to tell your audience a little bit about our hospice program. Under the direction of a patient's physician, our hospice care team consists of members of an RN, which is a Registered Nurse, a Licensed Practical Nurse, and a Certified Home Health Aid. We also have a spiritual counselor and a medical social worker. And what we do, is we work under the plan of the orders of a physician. That plan of care for the purpose of keeping the patient as comfortable as possible and also to support the quality of life for the patient's family, and also their friends, cope with the end of life and care decisions.
Host: Yeah, so that gives us a good definition of what hospice care is, but I've also heard of palliative care. Can you maybe give us a high level difference between the two?
Dar: Well first let me say, we do not have a palliative care program here at Ridgecrest. But the difference- the main difference in palliative care and hospice care is that a palliative care program is still under the direction of a physician, but the patient is still seeking curative or interventional treatment. Under the hospice program, they are no longer seeking intervention or curative treatment. What they're looking for is comfort for the rest of the time they have with their family.
Host: It really sounds like hospice is something that is considered only when there are no other options. So why don't we talk about the various aspects of hospice care in addition to the medical treatment that is offered?
Dar: When we get a referral from a physician, the first thing we do is look to see that they have a terminal diagnosis. Oftentimes it's cancer, but cancer is not the only terminal diagnosis, we do have others. But the majority that we get for this region have been cancer, and that's considered a terminal diagnosis with a prognosis of living up to six months. That does not mean that they won't live longer, but once we get them in here with the physician's orders, we go ahead and we do an assessment of the patient, and then we send out a Registered Nurse to visit with the patient, and we set up a medication regimen where we can manage pain at a level that normally patients are not managed at. So there's a higher level of medication management, there's a higher level of symptom management.
We also have a Certified Home Health Aide who will go in there and help with personal care. So if the patient needs bathing or the patient needs assistance in other ways, that Certified Home Health Aid will be there. We have a medical social worker who we also send in, and the medical social worker will assist them with making plans for the end of life arrangements, or look at their insurance with them to see if there are other resources they need.
We also have volunteers that we send in, and those volunteers often will just sit and read with the patient, or they'll sit with the patient so a family member can take a break and maybe go to the grocery store, go get their hair done. Just some way for them to get a break as they're all going through this.
And then we also offer respite care. Respite care is where we actually take the patient out of the home, and we have a contract with a skilled nursing facility and we can put them in there for four days and provide care there so the family can have a break.
Host: Yeah, that really does sound like a comprehensive set of care. And one of the things that I love is that it's not just for the patient, but for the family as well during what is a pretty difficult time. So one of the questions I wanted to ask is can patients utilize hospice care while living at home? Or does it need to be in a hospice care facility or hospital?
Dar: We go to the patient's home wherever they are. If the patient lives in a shack down at the end of the road, and that is their home, that is where we go. It makes no difference to us. If they live with a family member, we can go there, the only requirement is that they do have someone in the home twenty-four hours a day to provide care for that patient, because we're not in the house twenty-four hours a day. We are available twenty-four hours a day, and we have nursing services available twenty-four hours a day, but the patients still have to be in a home where there is a family member or a caretaker there twenty-four hours a day. And on occasion it actually has been in a private home that takes in hospice patients, but that is still considered their home.
Host: Yeah, I think it's so wonderful to hear that the only requirement is there's someone there all the time, which can be a family member or a Registered Nurse. So I want to talk about the expenses of hospice care. Can people use insurance for this?
Dar: They can. We look at all insurance. Different patients have different insurance, but we look at all those insurances. But for our hospice agency, we do accept Medicare, Medi-Cal, Tricare, and private insurance.
Host: That's good to hear. So it seems like if families need this, they can rest assured that their insurance will assist them. So I want to move into the emotional well-being of both the patient and their family members. I imagine that for a lot of people, they're reluctant to begin this end of life care just because of what it truly means. So how do you help patients and their families deal with this transition?
Dar: We come across this quite often. It's a hard decision. This is a very personal decision, not only for the patient, but for the family. A lot of them have a problem reaching that point where they say, "Okay, we're not going to go ahead and seek more curative. We've decided that we just want our loved one to be comfortable for the rest of the time they have," and be able to spend some quality time with that patient instead of running to doctor appointments or the hospital.
So the big key for us is educating the patient and the family so they can understand that we understand the decision is hard, and we try to inform that this is the good decision for the patient and the family, that they'll benefit from the hospice services, that we provide support and resources they don't have to worry about. They don't have to worry about how they're going to get help when a patient is declining or if they just need an extra hand to give the patient a bath. They don't have to worry if they need to run an errand. We provide those services, and the main thing for that patient is they're no longer seeking all this treatment- and I'm not saying that treatment is not great, but when they reach the point that they no longer want to go through the treatment, which is sometimes painful in itself, and they want to have comfort and quality of time with their family. To be able to educate them to that and help them bridge that gap, it's huge, so we do our best to help with them, to educate them on the benefits of the hospice program.
Host: Yeah, it really seems like you're there to hold their hand throughout the entire process. But I want to ask about after a loved one passes. Can you maybe talk to some of the services you offer families that are grieving?
Dar: The hospice program was never ever developed just for the patient. The hospice program includes the family, even extended family members and friends that come in, and we offer a bereavement program for up to thirteen months after the patients has already passed away. Families go through a lot at that time, and to be able to reconcile that the patient is gone. Many of these caregivers, especially close family members, they're at that bedside twenty-four hours a day. That becomes their life, and when the patient passes, there's a huge gap there for them, there's a great loss. It's not only grieving, it's a loss of what they've done for so long. They become part of that, so for them to be able to let go and grieve, they need some bereavement services, and we have a wonderful program for that, that we reach out to these families on a routine basis, like I said, for thirteen months.
Host: Yeah, I think it's really important what you said there, and most people probably don't realize this, that hospice and the hospice program was not developed just for the patient, but for their families as well. So it seems like in this stage of life, that hospice care can really be a positive experience for not only the patients but the families during a difficult time. So I want to thank you so much for educating us on hospice care. Is there anything else that we missed today that you want to mention, Dar?
Dar: I think- so you know, we accept referrals from several different sources. So we accept them from physicians that are here in town, or we accept referrals from out of town. We get referrals from all over, from different hospitals, rehab centers, convalescent home community members, and if we get it from a community member, then the doctors are contacted for orders. So there are different ways that we get these.
Host: Well, it's so wonderful to know that you and members of your team are there for the community during what's a pretty difficult time for a family. And I also think it's worth noting that the Ridgecrest Regional Hospital Development Foundation has a goal to raise $300,000 which is going to help bring a six to eight bedroom hospice facility to Ridgecrest, and the Foundation actually just held its second annual wine auction and gala dinner which raised approximately $33,000, so we're well on our way there.
So for more information regarding hospice care with Ridgecrest Regional, please visit www.HospiceAtRRH.org/services. My guest today has been Dar Thornsbury. I'm Prakash Chandran, thank you so much for listening.
Prakash Chandran (Host): In this episode of Ridgecrest Regional Hospital Podcast, we'll discuss the positive effects of hospice for patients and their families during the final months of life. Here to discuss is Dar Thornsbury, Direct of Patient Care Services at Ridgecrest Home Health and Hospice. I appreciate you being here, Dar. So let's begin with an overview of what hospice care entails, and when a patient might start receiving this type of care.
Dar Thornsbury, RN, BSN, CPHQ (Guest): Well first of all, let me thank you for having me and allowing me to tell your audience a little bit about our hospice program. Under the direction of a patient's physician, our hospice care team consists of members of an RN, which is a Registered Nurse, a Licensed Practical Nurse, and a Certified Home Health Aid. We also have a spiritual counselor and a medical social worker. And what we do, is we work under the plan of the orders of a physician. That plan of care for the purpose of keeping the patient as comfortable as possible and also to support the quality of life for the patient's family, and also their friends, cope with the end of life and care decisions.
Host: Yeah, so that gives us a good definition of what hospice care is, but I've also heard of palliative care. Can you maybe give us a high level difference between the two?
Dar: Well first let me say, we do not have a palliative care program here at Ridgecrest. But the difference- the main difference in palliative care and hospice care is that a palliative care program is still under the direction of a physician, but the patient is still seeking curative or interventional treatment. Under the hospice program, they are no longer seeking intervention or curative treatment. What they're looking for is comfort for the rest of the time they have with their family.
Host: It really sounds like hospice is something that is considered only when there are no other options. So why don't we talk about the various aspects of hospice care in addition to the medical treatment that is offered?
Dar: When we get a referral from a physician, the first thing we do is look to see that they have a terminal diagnosis. Oftentimes it's cancer, but cancer is not the only terminal diagnosis, we do have others. But the majority that we get for this region have been cancer, and that's considered a terminal diagnosis with a prognosis of living up to six months. That does not mean that they won't live longer, but once we get them in here with the physician's orders, we go ahead and we do an assessment of the patient, and then we send out a Registered Nurse to visit with the patient, and we set up a medication regimen where we can manage pain at a level that normally patients are not managed at. So there's a higher level of medication management, there's a higher level of symptom management.
We also have a Certified Home Health Aide who will go in there and help with personal care. So if the patient needs bathing or the patient needs assistance in other ways, that Certified Home Health Aid will be there. We have a medical social worker who we also send in, and the medical social worker will assist them with making plans for the end of life arrangements, or look at their insurance with them to see if there are other resources they need.
We also have volunteers that we send in, and those volunteers often will just sit and read with the patient, or they'll sit with the patient so a family member can take a break and maybe go to the grocery store, go get their hair done. Just some way for them to get a break as they're all going through this.
And then we also offer respite care. Respite care is where we actually take the patient out of the home, and we have a contract with a skilled nursing facility and we can put them in there for four days and provide care there so the family can have a break.
Host: Yeah, that really does sound like a comprehensive set of care. And one of the things that I love is that it's not just for the patient, but for the family as well during what is a pretty difficult time. So one of the questions I wanted to ask is can patients utilize hospice care while living at home? Or does it need to be in a hospice care facility or hospital?
Dar: We go to the patient's home wherever they are. If the patient lives in a shack down at the end of the road, and that is their home, that is where we go. It makes no difference to us. If they live with a family member, we can go there, the only requirement is that they do have someone in the home twenty-four hours a day to provide care for that patient, because we're not in the house twenty-four hours a day. We are available twenty-four hours a day, and we have nursing services available twenty-four hours a day, but the patients still have to be in a home where there is a family member or a caretaker there twenty-four hours a day. And on occasion it actually has been in a private home that takes in hospice patients, but that is still considered their home.
Host: Yeah, I think it's so wonderful to hear that the only requirement is there's someone there all the time, which can be a family member or a Registered Nurse. So I want to talk about the expenses of hospice care. Can people use insurance for this?
Dar: They can. We look at all insurance. Different patients have different insurance, but we look at all those insurances. But for our hospice agency, we do accept Medicare, Medi-Cal, Tricare, and private insurance.
Host: That's good to hear. So it seems like if families need this, they can rest assured that their insurance will assist them. So I want to move into the emotional well-being of both the patient and their family members. I imagine that for a lot of people, they're reluctant to begin this end of life care just because of what it truly means. So how do you help patients and their families deal with this transition?
Dar: We come across this quite often. It's a hard decision. This is a very personal decision, not only for the patient, but for the family. A lot of them have a problem reaching that point where they say, "Okay, we're not going to go ahead and seek more curative. We've decided that we just want our loved one to be comfortable for the rest of the time they have," and be able to spend some quality time with that patient instead of running to doctor appointments or the hospital.
So the big key for us is educating the patient and the family so they can understand that we understand the decision is hard, and we try to inform that this is the good decision for the patient and the family, that they'll benefit from the hospice services, that we provide support and resources they don't have to worry about. They don't have to worry about how they're going to get help when a patient is declining or if they just need an extra hand to give the patient a bath. They don't have to worry if they need to run an errand. We provide those services, and the main thing for that patient is they're no longer seeking all this treatment- and I'm not saying that treatment is not great, but when they reach the point that they no longer want to go through the treatment, which is sometimes painful in itself, and they want to have comfort and quality of time with their family. To be able to educate them to that and help them bridge that gap, it's huge, so we do our best to help with them, to educate them on the benefits of the hospice program.
Host: Yeah, it really seems like you're there to hold their hand throughout the entire process. But I want to ask about after a loved one passes. Can you maybe talk to some of the services you offer families that are grieving?
Dar: The hospice program was never ever developed just for the patient. The hospice program includes the family, even extended family members and friends that come in, and we offer a bereavement program for up to thirteen months after the patients has already passed away. Families go through a lot at that time, and to be able to reconcile that the patient is gone. Many of these caregivers, especially close family members, they're at that bedside twenty-four hours a day. That becomes their life, and when the patient passes, there's a huge gap there for them, there's a great loss. It's not only grieving, it's a loss of what they've done for so long. They become part of that, so for them to be able to let go and grieve, they need some bereavement services, and we have a wonderful program for that, that we reach out to these families on a routine basis, like I said, for thirteen months.
Host: Yeah, I think it's really important what you said there, and most people probably don't realize this, that hospice and the hospice program was not developed just for the patient, but for their families as well. So it seems like in this stage of life, that hospice care can really be a positive experience for not only the patients but the families during a difficult time. So I want to thank you so much for educating us on hospice care. Is there anything else that we missed today that you want to mention, Dar?
Dar: I think- so you know, we accept referrals from several different sources. So we accept them from physicians that are here in town, or we accept referrals from out of town. We get referrals from all over, from different hospitals, rehab centers, convalescent home community members, and if we get it from a community member, then the doctors are contacted for orders. So there are different ways that we get these.
Host: Well, it's so wonderful to know that you and members of your team are there for the community during what's a pretty difficult time for a family. And I also think it's worth noting that the Ridgecrest Regional Hospital Development Foundation has a goal to raise $300,000 which is going to help bring a six to eight bedroom hospice facility to Ridgecrest, and the Foundation actually just held its second annual wine auction and gala dinner which raised approximately $33,000, so we're well on our way there.
So for more information regarding hospice care with Ridgecrest Regional, please visit www.HospiceAtRRH.org/services. My guest today has been Dar Thornsbury. I'm Prakash Chandran, thank you so much for listening.