Scott Webb (Host): Hospice care is often thought of as end-of-life care, and for many it is, but unlike most other medical care, hospice care often includes the family in the decision-making for what's best for the patients. I'm joined today by registered nurse Barbara LaFrance. She's the President and CEO of Home Health and Hospice Care, a member of SolutionHealth, and she's here today to explain hospice care and why it's a calling for the folks who work with patients and families.

This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb, Barbara, it's so nice to have you here today. We're going to talk about hospice care, and we'll probably get to some of the misconceptions about hospice care.

But before we get there, just generally speaking, what is hospice care?

Barbara Lafrance, RN, FACHE: Thank you, Scott. Hospice is specialized health care. When you receive a prognosis that's measured in months instead of years, and curative treatment is really not an option, that's when you need hospice care. The goal of hospice care is to provide comfort and to continue to enjoy doing what matters most to you.

Hospice care, you know, really doesn't include just the patient. Unlike other healthcare industries, it includes the family. It's important for us all to remember that hospice is a specialty for end-of-life care, so it's similar to if you need a cardiologist for heart surgery, you should be looking for a hospice care when you face serious illness.

Host: Yeah, I see what you mean. And you mentioned families there that it's both patients and families, which makes hospice care unique in many ways, but of course, specifically about the services and things that are offered. So, let's talk about that. What are some of the services that hospice provides to patients and families?

Barbara Lafrance, RN, FACHE: Yeah, hospice provides a lot of different services. First, talk about medical services. The most important thing for a hospice is to make sure patients are comfortable. And so medical services are provided that include controlling pain and many symptoms. This can include medications, but there's other treatments that help with controlling pain and symptoms.

In addition, we know that it's a very difficult time and it can be very emotional and spiritual challenges as someone faces end of life. So, we provide emotional and supportive counseling services, that are available for the patients and the families. Also, at end of life, bereavement services are needed for the family and hospice provides up to a year of bereavement services for families and any significant others. And also, after that year, there are peer group support groups that can provide support as grief continues past that year. So, what many individuals don't understand about the coverage of hospice services is that there are additional services. Hospice is an insurance benefit. So, it not only covers the clinical services, but also covers the cost of medications and equipment, such as oxygen, hospital beds. In addition, hospice covers inpatient stays when someone needs advanced care, such as for pain and symptoms and needs a nurse 24/7. So, for instance, if somebody needs the care at our hospice house, the insurance benefit of hospice covers those stays.

Also, covers respite breaks. So, if a loved one is a caregiver, and they need just a break from care for up to five days; hospice covers those stays at a hospice house or another contracted facility. So really hospice is a very inclusive benefit and really keeps you out of the hospital and comfort-free.

Host: Yeah, so it does sound, uh, really comprehensive, I guess is the word when it comes to care and coverage. And I touched on there as we got rolling here today about misconceptions, and I think there are a lot of misconceptions about hospice care. So, let's clarify some things. What are some of the most common misconceptions that folks have about hospice care?

Barbara Lafrance, RN, FACHE: Now Scott, I have four thoughts about really the myths that I hear most often surrounding hospice care. The first and the most common that I hear is hospice is about giving up. You know, the fact is hospice is about living to your fullest, the way that you want to live for the time you have left.

Also, hospice is adding care. And so, we actually add additional care to your current treatment. And we have treatments. So, I think that's one of the misconceptions is, there are no more treatments. We actually add treatments. The second myth, that I hear often is hospice is only for six months. The fact is, six months is a timeframe that Medicare sets and most insurance sets as a time to renew your hospice services.

So, we have physicians and they're required by the insurance benefit to just check on your care to make sure you'e still eligible for the hospice services. And many patients are on hospice more than six months. And actually, you know, we're just reading about Jimmy Carter who's been on hospice services for over a year now, and he's been, you know, living very well the way he wants to.

So that's a good example of someone that has been on hospice for more than six months. The third myth, that I hear too, is I cannot change my mind about curative treatment once I elect hospice. It's important to understand that hospice is actually an election that you choose. And so just as you choose it, you can choose to come off hospice.

So, at any time you'e on hospice care and you decide that you wanted to seek more aggressive therapy, you can seek to be revoked off of hospice. Also, we have patients that graduate from hospice. So actually patients oftentimes do better and then they come off of hospice, they actually discharge from hospice and then receive, back to their primary care or their specialist service.

The fourth myth and the last one that I think I'll talk about today is, that hospice is only provided in the home setting. So, hospice is provided wherever you call home. So that could be in your home, it could be in assisted living, you know, it could be in a nursing facility. We have also provided hospice in shelters for the homeless and in long-term stay hotels.

So, wherever you reside you can receive hospice services.

Host: Yeah, I see what you mean. And it is interesting, right? And, we certainly understand the misconceptions or myths, if you will, that hospice care feels like end-of-life care, and it often is for many, but as you say, some folks, you know, will change their minds and seek curative care again, or for the first time, or, some folks may sort of graduate from hospice care, you know, and survive, and it may not be the end of their lives.

So, it's really interesting, a lot of layers, uh, great to have your expertise today, and we've talked about how comprehensive all of this is, so maybe you can talk about the different types of healthcare professionals that are typically a part of the hospice care team.

Barbara Lafrance, RN, FACHE: Yeah, the hospice team includes specially trained very comprehensive team of physicians, nurse practitioners, social workers, chaplains, we have bereavement counselors, nursing assistants to help with personal care, and a pool of volunteers. Now, all these specialists go through months of training with mentors that have experience in end-of-life care.

And not only are they learning all the clinical skills and competencies needed to provide that skilled care throughout the end-of-life journey, but they're also learning the compassion that it takes to work in this specialty. It really takes a special person to witness and help somebody through this journey, and that's as important as the clinical care. Many of our staff become nationally certified in hospice care. That is available to all of the physicians, nurses, nurse practitioners, social workers, and this just helps further their expertise and their knowledge in providing end-of-life care. You know, we have a pool of over 200 volunteers at our agency, and they also receive an intensive training, and have a peer and a coach with the volunteer pool to make sure that they can care gently for our patients.

And also, they receive certifications specific in whatever volunteer they're doing. I think one of our, you know, example is our pet therapy. Not only are they learning how to care for hospice patients and how the pets should approach the care of patients, but they also are certified in their pet partners.

So, we really make sure that everyone who is touching the patient has the compassion and the specialty. And most importantly, what I find about healthcare professionals, is that it's a calling. And I would say that's true even for myself. I've been in the hospice field for over 20 years, and it is a calling to work in this field.

It's a privilege to be with someone at end of life. And it's such a rewarding field and I know those that remain in the hospice field feel the same.

Host: Yeah, that's so true. And, that's such a common thread whenever I've talked to you know, healthcare professionals about hospice care. I hear that a lot that, you know, hospice care is unique, requires a high level of compassion and it really is a calling, as you say, for you and for others and really, special to be a part of this, this end of life care, which is, you know, probably not for everybody, not every medical professional, right? But as you say, the folks that are there on this team, this comprehensive team, they all want to be there, and they all have that compassion and calling.

I just want to finish up here, you know, and ask you, how does hospice care help patients and families navigate, there's so many complex decisions, so how do you help them navigate those decisions surrounding end-of-life care?

Barbara Lafrance, RN, FACHE: Scott, it is a very difficult time and a lot of decisions need to be made. And it's so important to have the specialized team to help prepare and understand the choices ahead. So, on admission, the hospice team meets with the patient and the family to match the care with their individual goals.

And that's so important. What we do is we anticipate what's going to happen with every illness and every patient and family unit is unique. And it all depends on their choices ahead. So, we meet with them, we talk about the choices, we talk about the progression of the disease, and we develop a plan and we match what the patient and family wants with the care that's going to move ahead in the next coming months. For instance, sometimes the patient and families, want to go to an upcoming wedding. So most importantly for them is to be well enough to attend a wedding, or perhaps they have a graduation. So, we're going to continue to match whatever treatments or care that they want to be able to do their final wishes.

It may be that working in the garden is the most important thing that they want to do for the next few months. So, our care will be wrapped around, all those decisions and the comfort that is needed to make those goals happen. There are a lot of complex decisions such as, you know, I think we hear a lot about, maybe some feeding tubes or, you know, do not resuscitate.

Those are all bundled in these decisions. We always count on the specialists that have always been involved in the team already to be part of our conversations with the patients and the families and help guide them and anticipate what those risks and benefits are. Sometimes the treatments can be worse and not beneficial than they were in the past as patients progress.

So again, the experienced, specialized doctors, physicians that we have in our organization and all those that are hospice and palliative care certified, they have seen the progression of illness and they can help guide by just letting the patients and their families have choices and we will match whatever the patient and their family wants to do with those choices along the way. And this isn't just a one time thing that we do on admission. We meet constantly as that whole medical team that we talk to, to talk about the patient and the family's goals. And as the disease progresses and patients decline, we have conversations about what goals need to be adjusted and what needs to change.

So, we're continually updating that throughout the patient's condition, anticipating and telling them what's to come, you know, until the final days. Every hospice journey is individual, and that's why it does take a team. It maybe that pain and symptom management is the most important thing to focus on, or maybe the spiritual anxiety and care.

And so, taking a team, walking with a family, holding them is so important. I mean, our hospice, you know, our main role is for patients to die peacefully in comfort and families are supported through this difficult time.

Host: Yeah, I certainly love hearing that the patients and families are a big part of this, a major part of this, the decision-making, that there's a lot of communication, open, honest, transparent, and that it's not one size fits all. You know, it's very individualized; it may all fall into the umbrella of hospice care, but it's really about the patient, their families, their needs, their goals. This has been really great today. Thank you so much.

Barbara Lafrance, RN, FACHE: Thank you, Scott.

Host: And to learn more, visit hhhc.org. And if you enjoyed this podcast, please be sure to tell a friend and share on social media. This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. Stay well, and we'll talk again next time.