Hospice Care Explained with Wendi Gang

Join Kelly and her guest, Wendi Gang, Patient Navigator at ProMedica Heartland, as they discuss hospice care.

In this episode:

✔ What is hospice care? What services are provided?

✔ Does hospice include 24/7 care?

✔ Where can hospice care be received?

✔ When should people start hospice care?

✔ What are the benefits of using hospice care?

✔ How much does hospice care generally cost and who pays for it? 

✔ What questions are important to ask when choosing a hospice care provider?

🔹Watch this episode on YouTube: https://youtu.be/tQ0eehuyuds 

 🔹Learn more about ProMedica Hospice: https://www.promedicahospice.org/ 

For additional information about Kelly, check her out on Linkedin or www.SteadfastAgents.com.

To explore your options for long-term care insurance, click here.

Steadfast Care Planning podcast is made possible by Steadfast Insurance LLC,
Certification in Long Term Care, and AMADA Senior Care Columbus.

Come back next time for more helpful guidance!

Transcript

Kelly Augspurger: [00:00:02] Hey everyone, welcome to Steadfast Care Planning podcast, where we plan for care to live well. I'm your guide, Kelly Augspurger. Today with me is Wendi Gang. Wendi is a Patient Navigator with ProMedica Heartland. Wendi, thanks so much for being here!

Wendi Gang: [00:00:16] Thanks for having me.

Kelly Augspurger: [00:00:17] We are going to be talking about hospice care today and Wendi knows a lot about hospice care. So I'm really excited to have this conversation with you, Wendi, and for you to share some of your expertise with us. Can we jump right in?

Wendi Gang: [00:00:30] Yeah, for sure.

Kelly Augspurger: [00:00:31] Let's do it. Well, first, Wendi, tell us, what is hospice care and what kind of services are provided? What can people expect?

Wendi Gang: [00:00:39] Yeah. Hospice care is actually a support to support and honor individuals on their health journey in a way that they see valuable. So hospice is if you have a chronic illness that's no longer going to get better, things like COPD, dementia, Alzheimer's, any chronic illness, you could qualify actually for the hospice benefit and a lot of people think hospice means very end of life, but we actually have people on service for years. So that's my part. I'm a Patient Navigator, so my job is to educate the community of what hospice is and to be able to get them benefits sooner rather than later because I've experienced people only using the benefit for a few short months when they could be using this benefit. So it's a benefit being able to use wherever a patient calls home.

Kelly Augspurger: [00:01:24] Got it. And so what kind of services are provided within hospice care? What can people expect to receive? What does that look like?

Wendi Gang: [00:01:30] So with hospice care, you get a whole team of people. So you get a nurse, you get a nursing assistant, a social worker, a chaplain. We have volunteers. There's just a whole team of people that's individualized for that person and it's great because you get the same nurse and the same aide coming and you get to really be it's like an extension of your family. And then you also get any medical equipment that you need covered, most medications. So it's really as a whole that we try to do spiritual, physical care for an individual.

Kelly Augspurger: [00:02:02] Got it and so I think a lot of people have a misconception of what hospice is, and they do think it's the very end of life. Maybe it's the last couple of weeks of life, but that is really far from the truth. Like you said, people can be on hospice quite a long time and receive that support, but the idea is you're probably not continuing maybe certain medications to improve your condition. Right? We're kind of going off those medications. We're giving you that support that you and your family need and those last days, weeks, months. Could it even be years, Wendi, that someone's on hospice?

Wendi Gang: [00:02:40] For sure. It could definitely even be years. And yeah, the point of hospice is comfort care to provide you to have the best quality of life is what we want. And there's actually studies out there that show that people live 30 days longer on hospice than they would without hospice because we're doing care in the home. You're not going in and out of the hospital as much. You're not prone to as many infections. You're not seeking that aggressive treatment. You're looking for the value of time, not just the length of time, but you want that value of time with your family. And that's what we're there to support with. My grandpa was actually on our service and he was on it for a year and actually got better because he quit going in and out of the hospital and quit getting infections and you can actually even graduate from hospice. So he graduated and then you can come back on hospice when it's needed again. So there's no you can't only be on hospice once or twice as many times as you need it. If you can graduate and get better, you can come back on it. There's no penalty for that.

Kelly Augspurger: [00:03:34] That's really interesting. Yeah, I don't think most people probably know that. They probably just think, Oh, it's a one time thing. Last couple of weeks of life, not the case. You can go on and off.

Wendi Gang: [00:03:43] Yeah.

Kelly Augspurger: [00:03:43] That's really good to know. Wendi, can you talk to us about the length of even during the day, like this is not 24/7 care, right? Talk a little bit about that. What can people expect if they have a loved one that's on hospice? How much time would these professionals be helping your loved one?

Wendi Gang: [00:04:00] Yeah, and I always try to describe hospice as when you're getting care from a family member or even an assisted living or a facility. It's like a cupcake. A cupcake is good, right? But icing on a cupcake is great. And hospice is kind of like that icing on a cupcake. It's giving you extra services. So we're not 24/7, but we do have levels of care, so we tend to look at the individual, make a customized plan. Typically in a home environment, you'll have a nurse coming out 2 to 3 times a week, usually for about an hour at a time. And then our aides come out typically three times a week and for about an hour at a time. Now, if you're experiencing symptoms, if you're having a lot of pain, we do not leave you until that pain is managed. So there might be times where our nurse needs to be there 2 or 3 hours until that pain is managed or that symptom is being managed if you're feeling nauseous or whatever. So we kind of customize it, but typically it's about an hour at a time each time one of our disciplines come, but if it needs to be longer, we can. We do provide a service called continuous care. So if in that stage of passing away, you would like someone to be at bedside, we do provide continuous care and have a nurse 8 hours a day with you during that end of life time.

Kelly Augspurger: [00:05:13] Oh, okay. Good to know. I didn't realize it could really extend that long. I'm familiar with maybe a couple of hours of day. That's what I hear most common, but it is good to know when you get to that point.

Wendi Gang: [00:05:23] Towards the end if a family needs support because it's a scary situation and if symptoms are not managed, we want to be there with the patient.

Kelly Augspurger: [00:05:30] Got it. Okay, great. Where can hospice care be received? Is it anywhere? Are there certain facilities, communities, your home? Talk to us about that.

Wendi Gang: [00:05:38] So hospice care can be received anywhere that you call home, whether that's your home, a child's home, an assisted living, a long term care facility, hospice can be provided there. So wherever the patient calls home is where we can go. And we can even start out in a home and say, maybe it just gets a little too much for the family and they need to go to a assisted living. The great thing is you have a team so our social worker helps you be able to find a place and we're able to go with that patient and so they still know us. And so they're not going into an environment they know nobody. We're able to follow them wherever they go and call home.

Kelly Augspurger: [00:06:12] Yeah to provide that extra comfort level. It really reminds me, similar to when someone has a long term care insurance policy and they're using that. What I tell my clients is it's not a location, it's wherever you call home. So if you're at home, if you're in assisted living, if you're in skilled nursing, you know, adult daycare, it's wherever you call home, that's where you're going to receive benefits. Same is true with hospice care. So when should people start receiving hospice care or looking into hospice care? Wendi because I think people wait too long. So explain what's the best case scenario?

Wendi Gang: [00:06:45] Yeah, 100%. People wait way too long and people don't realize they're paying into this benefit their whole life. So I always tell people when they start seeing a decline, whether that's weight loss, maybe that's even them isolating from activities that they used to be part of, going in and out of the hospital a lot, falls, I mean any decline that you really see. I always say it never hurts to call up hospice and say, hey, because what happens is a nurse needs to come evaluate and then a doctor has to say they're eligible for the hospice benefit.

Kelly Augspurger: [00:07:15] Okay.

Wendi Gang: [00:07:15] So it does not hurt to get an evaluation. It's completely free. What's great is if you start realizing a family falling or declining in health and you ask for that hospice eval, even if they're not eligible, we now have a baseline to go off of and my job as a Patient Navigator is to call that patient or family every 30 days. If they don't qualify, say, "Hey, how are things going checking up?" And if you're like, "You know, Dad's really declined since you guys been out here two months ago." Well, now we have that baseline to go off of. And so that really helps also our nurse. You know, I just had a patient the other day, the nurse went out a couple of months ago and when she went back out this last week, she saw that decline in that patient and could vouch like, "Hey, this was the baseline. Now, here where we're at, they really need that extra level of care."

Kelly Augspurger: [00:08:03] And now for a brief message from our show sponsor. The Steadfast Care Planning podcast is sponsored by Amada Senior Care Columbus. Amada is your one stop shop for in-home caregivers, senior housing advice and long term care insurance claim assistance. Visit AmadaSeniorCare.com/ Columbus-Senior-Care to learn more.

Kelly Augspurger: [00:08:24] What are the benefits of using hospice care?

Wendi Gang: [00:08:26] I mean the benefits people don't realize it but when you pay into Medicare you're actually paying into these benefits. So the benefit is we have on call nursing staff 24/7. So to me, that's the biggest benefit in the middle of the night. If someone's not feeling good, if someone falls instead of calling 911, going to the hospital, waiting in the 4 or 5 hours, you can actually call us. Our goal is to be there within 1 to 2 hours and a nurse to do a full body assessment. So they'll do an eval, take your blood pressure. It can really usually manage the symptom there. I mean we can even order antibiotics if we see that there's an infection going on.

Kelly Augspurger: [00:09:04] Okay.

Wendi Gang: [00:09:04] So we can do a lot of things that would be done at a E.R. So the benefit to that is you're not going in the E.R. Every time we see somebody go into the hospital, when they come back, we see a significant decline because it's a lot on an individual. So that's the biggest benefit to me, 24/7 available care if you need it. It also provides any medical equipment you need. So a lot of times, like on home health and stuff, you're having to pay that copay for that bed that you might need or the wheelchair or the oxygen on hospice care that's 100% covered. So we cover all medical equipment that goes to the patient's needs. We also cover most medications and we cover all incontinence supplies. So people are using depends, pull ups, wipes, gloves. People are going bankrupt paying for that, not realizing that this benefit is out there.

Kelly Augspurger: [00:09:53] Oh, it's a huge benefit. Medical supplies just in of itself. Yeah, it definitely can add up and really hurt someone's budget, especially if they're on a tight budget. So you talked about Medicare paying into this benefit. If you qualify, after that nursing assessment, do you have to be a particular age to receive hospice care?

Wendi Gang: [00:10:12] No, so you do not have to be a particular age when you pay into Medicare. People don't realize you actually pay into four buckets of Medicare. That's home health, hospital, rehab, and hospice. Hospice being the biggest bucket. So you're paying into that. So Medicare and Medicaid will 100% cover all costs of that. Say you are younger and might have a private insurance plan. You can still be covered on that. Sometimes you have to meet your deductible, but at that point, if someone's needing hospice care, more than likely they've already met their deductible because they've been going in and out of the hospital and going to tons of doctors appointments.

Kelly Augspurger: [00:10:46] Sure.

Wendi Gang: [00:10:46] So any age can do the hospice benefit. Our ProMedica, usually if it's under 18, you're going to Children's or something like that. So we do anything 18 and above, so it can be any age.

Kelly Augspurger: [00:10:59] Okay. I know there are lots of different hospice care providers out there, so what are important questions to ask when you're choosing a hospice care provider?

Wendi Gang: [00:11:08] Yeah, and I think it's definitely important to talk to a few providers because there might be one that's, you know, just fits you better, but to ask the questions, what area do your nurses and aides cover? Because you kind of want to know what that response time is that they're going to come to you. So do you have nurses and aides in our area? What is your response time? Do you do continuous care, which is at the end of life when we can sit continuous care? Those are really important questions to ask. One thing with ProMedica that I love is we meet the patient where they're at. So a lot of times people think if you're on hospice, you have to sign a DNR, do not resuscitate, and you can't be a full code. So those are questions to ask too. Do I need to be do not resuscitate? Sometimes people aren't ready to make that step and they look at hospice as giving up hope. But it's really not, like you're giving a quality of life. So we want to meet patients where they're at so we do not make patients get off a full code. If they're not ready, we'll educate, we'll talk to them. We'll walk them through that process and we'll meet them where they're at in that stage. So asking those kind of questions, am I allowed to do that? Do I still have the right to go to the hospital? We believe in patient's rights. So say our nurse came out, you called in the middle of the night, nurse comes down, you're like, "You know what? I still feel like mom needs to go to the hospital." You're still in charge of your care, so we're going to value that. All we do is we sign off of the hospice benefit because there's four buckets you pay into. Medicare will only pay for one bucket at a time. So we'll sign off, get you to the hospital if that's what you want to do, and then once you come back home, we get you back on service.

Kelly Augspurger: [00:12:44] Got it.

Wendi Gang: [00:12:45] So those are the kind of questions to ask. So what are my rights? What is your availability and all of those type of things.

Kelly Augspurger: [00:12:52] Okay, great. I think, you know, in really helping the patient, the client and the family through such a difficult time, these people are going to be in your home or wherever you call home, and so you want to be comfortable with them. So don't make

Wendi Gang: [00:13:06] 100%.

Kelly Augspurger: [00:13:07] You don't need to make this decision necessarily overnight. Right? Maybe take a little bit of time to do your due diligence and research and talk to them because you're going to be spending a good amount of time with these people and they're going to probably become very close to you. So you want to be comfortable with them. You want your family member who needs the hospice care to feel comfortable with them because you are going to be spending a good amount of time with them. So I think, yeah, those are great, great questions, Wendi.

Wendi Gang: [00:13:32] Yeah, I used to be an aide for us a long, long time ago back when I first started with hospice care. I've been in the field for 20 years and I would have patients, you know, for a year or two and you become their family. And so that's why it's great to get services sooner rather than at the end because you get to know them. And then when it comes to that difficult time at the end of life, you're not sitting with a stranger. You're really sitting with someone who you've gotten to know.

Kelly Augspurger: [00:14:00] Yeah and who you've really formed a friendship and a relationship with. Yeah. That really does provide comfort. And I know that is the comfort care that is the goal of hospice. Well, Wendi, any other final advice on how people can plan now to live well?

Wendi Gang: [00:14:13] Yeah, I definitely say, these conversations are tough, right? And it's not an easy conversation to have. We're never ready to let go, you know, but to start having those conversations, to ask what your loved ones wants and just, you know, if you start seeing that decline, reach out to a hospice provider, ask the questions, have them get that baseline. So really just starting to open up the conversations and even having me like I love to go to groups to talk to about the benefit because it's about taking the fear out of hospice because it really should not be feared. This is a benefit you paid into your whole life and you deserve the highest quality care you can get. So to educate on that and to get families just comfortable talking about it.

Kelly Augspurger: [00:14:58] Right, plan now to really live well and reduce consequences to your family. These can be awkward, but the more often that you have these conversations, the less awkward and uncomfortable it will be and the better off everyone in your family will be. So, yeah, don't be afraid to bring this up. Talk about it, you know, what do they prefer? Do they have maybe even special music that they want played? In my family with my grandparents, one of them who who really enjoyed listening to hymns and my mother in law played hymns for her like the last couple of weeks of her life, and it just really, really gave her peace and she really enjoyed that, but if they're not able to vocalize that at that time, you don't know. So you want to talk to them about it while they're still competent and healthy and and can make those decisions.

Wendi Gang: [00:15:45] Exactly. You want to have that conversation early, especially in this, you know, Alzheimer's and dementia is so big right now. And unfortunately, there's no handbook to that. It's all an individual. So I run support groups for Alzheimer's too and to have those conversations before it gets too late to where they can't vocalize. And if you are in that situation, don't be fearful to look out for support in the Alzheimer's support groups and stuff because we need support and that's what hospice care is, support for the patient, but it's also support for the loved ones going through it because it's an emotional toll on everybody that's involved.

Kelly Augspurger: [00:16:19] Yeah.

Wendi Gang: [00:16:19] So you need that support too, as a caregiver to anyone you're taking care of.

Kelly Augspurger: [00:16:24] Oh, absolutely. The caregivers need just as much support as does the care recipient. So don't be afraid to ask for help and ask for support. There are lots of resources available, one of which is Wendi. So, Wendi, where can people find more information about you and how you help people?

Wendi Gang: [00:16:38] Yeah, for sure. So I can give out my number and they can call our intake number. So you can always look up ProMedica. Our main office is in the Columbus area, but we cover all over and I can help all over, even in different states. But our office number is (614) 601-5540 and people can also email me at Wendi.Gang@Promedica.org and I'd be happy to email information or even come talk to a family about the benefits of hospice.

Kelly Augspurger: [00:17:09] That's great and that's Wendi with an i and I will have her contact information in the show notes. So yes thank you Wendi. Really appreciate your time and your insights here with hospice care. We want to take the fear out of hospice and get people comfortable with having these conversations because at the end of the day, it's going to be a benefit that's going to be extremely valuable for your family.

Wendi Gang: [00:17:31] Exactly and you never know when it's going to happen. I mean, every day I wake up and I was like, okay, I have another purpose. I'm here. So we never know. So having those conversations as early as possible is really the best thing you can do with a loved one.

Kelly Augspurger: [00:17:44] Agree. Well, Wendi, thanks so much for your time. Have a great day!

Wendi Gang: [00:17:47] Thank you. Yes, you, too. Thank you so much.