Advice From Your Advocates
Advice From Your Advocates
Hospice & Hope: Empowering Families For Better Care Decisions
In this episode of Advice From Your Advocates Podcast, Attorney Bob Mannor speaks with Stacey Bruss from St. Croix Hospice to discuss the essential aspects of hospice care, addressing common misconceptions and emphasizing the holistic approach to patient care. Bob and Stacey explore the benefits of hospice, including Medicare coverage, the importance of respite care for caregivers, and the need for families to understand their options when choosing a hospice organization. The discussion highlights the philosophy of hospice as a means to enhance the quality of life for patients and their families during challenging times.
Episode Takeaways:
- Hospice is a comfort care-based philosophy, not just end-of-life care.
- Patients often wish they had known about hospice sooner.
- Medicare covers hospice services fully for eligible patients.
- Respite care is crucial for preventing caregiver burnout.
- Patients can still receive treatment for other conditions while on hospice.
- Hospice eligibility is determined by a medical director, not insurance companies.
- Families should interview multiple hospice organizations to find the best fit.
- Hospice care focuses on the patient's quality of life and comfort.
- It's a common myth that hospice means giving up hope.
- Families can change their minds about hospice at any time
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ABOUT US:
Mannor Law Group helps clients in all matters of estate planning and elder law including special needs planning, veterans’ benefits, Medicaid planning, estate administration, and more. We offer guidance through all stages of life.
We also help families dealing with dementia, Alzheimer’s disease, Parkinson’s disease, and other illnesses that cause memory loss. We take a comprehensive, holistic approach, called Life Care Planning. LEARN MORE...
You're listening to Advice from your Advocates, a show where we provide elder law advice to professionals who work with the elderly and their families.
Speaker 2:Welcome back to Advice from your Advocates. I'm Bob Manor. I'm a certified elder law attorney in Michigan with a special focus on dementia and helping those families that have a loved one with dementia. Of course we help others too, but that's our special focus one with dementia. Of course we help others too, but that's our special focus. Today I'm really excited about a very important topic and a very special guest, stacey Bruss from St Croix Hospice. So we're going to learn a lot from Stacey. There's a lot of misconceptions about hospice. But first, hello, stacey. How are you doing?
Speaker 1:I'm doing well, thank you. Thanks for having me.
Speaker 2:Tell us just a little bit about yourself and your company, and then we'll get right into the meat of the issue.
Speaker 1:Yes, so my name is Stacey Bruss and I'm the Regional Director of Clinical Operations for St Croix Hospice of Michigan. We service almost all of Michigan and Macomb, oakland, monroe, livingston counties, and St Croix Hospice is located in 10 states around the Midwest where we service patients and their families.
Speaker 2:I know that you have an office in Brighton and we just opened an office in Brighton in July of 2024. So I know that we'll be working together a lot.
Speaker 1:Yes, I look forward to it.
Speaker 2:So Stacey, one of the things. The first thing I want to talk about as it relates to hospice is I'm hoping you can kind of give us a little bit of picture of today's hospice, and what I mean by that is we all have misconceptions, whether they're misconceptions or not. We all have ideas about what hospice is, and I'm going to have some probing questions for you, but I want you to start off with just telling us a little bit about what hospice is, and I'm going to have some probing questions for you, but I want you to start off with just telling us a little bit about what is hospice in 2024.
Speaker 1:So hospice is a philosophy of care. It's a comfort care based level of care to where patients elect this Medicare benefit to really keep them comfortable, where they're not seeking aggressive treatment but more quality days over quantity and really focus on, you know, what matters most to them. So it's a philosophy of care, to where a interdisciplinary team comes in and cares for not only the patient, but a lot of times we're, you know, caring for the families just as well.
Speaker 2:You know there was a lot packed into that, so I want to break some of that down. One of the things that you've mentioned is, you know, philosophy of care, and so I think there's probably some of the listeners that think of hospice, as that's what you do on your very last day is your last week or two of life, and that's not true, right.
Speaker 1:It isn't true and in fact we try to get patients on hospice sooner. A lot of times our patients and families will say that they wish they would have known about hospice sooner because so many misconceptions and myths about hospice and what it is that we do. But statistics show that patients live 29 days longer when they're on hospice services because they get that extra TLC and they're focused more on.
Speaker 2:The one thing I wanted to point out that was really important that you said is that it's a Medicare benefit. So, generally speaking, if somebody's on Medicare and they qualify for hospice, they're not going to pay anything out of pocket for this hospice benefit.
Speaker 1:Right, they qualify for hospice, they're not going to pay anything out of pocket for this hospice benefit. Right, that's correct. So not only are they getting medications, but they're getting their DME supplies, such as a bed, a wheelchair, oxygen. All of that is a part of their Medicare benefit, as well as getting a care team that's going to come right into their home wherever they call home. And you know, we have registered nurses who are our in-case managers, we have social workers, we have chaplains who are non-denominational, we have music therapy, we have massage therapy, so it's really focusing on that total patient as a whole to make sure that their goals are being met.
Speaker 2:You said just what I was going to say as a whole very holistic planning. Right, we're looking at the whole person. We're not just looking at a disease. We're not just looking at, you know, treating a specific thing, like the medical team. You know medical staff tends to do, and so it is a very holistic approach to yes. I want to circle back just to make it abundantly clear that this is a Medicare benefit. So, whether someone's on Medicare, if they have a Medicare Advantage plan through their insurance company, this is a Medicare benefit and it's not whether or not Blue Cross or whatever insurance company will authorize this. This is a Medicare benefit and they're not going to have co-pays in order to get hospice right. They're not going to get denied because of the insurance company. It's going to be the hospice organization that determines whether they're eligible.
Speaker 1:Yes, absolutely so. We have a hospice medical director who is a physician that will certify that the patient is eligible for this benefit, because it is 100%, you know, paid through the Medicare benefits. We want to make sure that we're meeting those Medicare guidelines in regards to eligibility.
Speaker 2:One of the things that I think a lot of my clients feel is just a really important and positive aspect of hospice is respite care, and so one of the things that we see is frequently we'll have family that are caring, whether it be a spouse or kids that are, you know, providing care and daily care for their loved one and that can be very challenging, especially if you have a granddaughter being born in another state or if you wanted to go to your niece's wedding or something like that, and you can't bring your loved one because of their physical or medical condition, and the idea of respite care is part of hospice. Can you talk a little bit about that?
Speaker 1:that, yeah. So respite care is really for any caregiver burnout. We see, you know, specifically with our Alzheimer's patients or some of our patients who are, you know, very sick, that it's a lot of work for caregivers to take care of their loved one. It's a full-time responsibility, and so part of that hospice benefit is a respite stay where hospice will actually pay for the patient to stay in a facility to allow that caregiver, you know, an opportunity to sometimes sleep or just have some sort of self-care or, like you mentioned, you know if they have something that's going on out of state or whatnot. It really is a great part of that hospice benefit.
Speaker 2:And can you talk to us a little bit more about that respite benefit? Is that something that they can just do once a year? How often would they be able to access that respite benefit?
Speaker 1:Yeah, so the respite benefit is usually once per benefit period. So we go in, you know benefit periods of 90 days, then 60 days and 60 days. So we like to, you know Medicare has, you know those guidelines to where it is, you know, once per benefit period. So we work, you know, with the patients and families to determine when is you know the appropriate time to do that.
Speaker 2:Nice. So one of the other myths that I hear often is you can only be on respite for six months. And so they say well, you, you know you have to die within the six months because hospice will run out. That's not true either, correct?
Speaker 1:It is not. So hospice, you know Medicare, does have a guideline that you know it's six months or less if your disease takes its normal course. Normal course looks much different for multiple different patients. So no one has a crystal ball. So we've had patients who have been on hospice services for years. They continue to have, you know, small declines to where they're still eligible for the benefit because they still have to remain eligible to receive the hospice benefit. But we've had patients who have been on for years. So you know there is many myths about hospice and what it is that we do and you know we hear that. You know I don't want to. You know, pass away today or tomorrow and, like I said earlier, 29 days longer is the statistics that you know when a patient comes on to hospice they live 29 days longer. So you know we, like I said, have had patients on for years and you know there's no crystal ball to what it is that we do.
Speaker 2:Now is there a requirement that they have a physical illness versus a cognitive memory, dementia, alzheimer's type of a thing? Could they qualify? If they're not, they don't have a specific terminal illness, but they have significant dementia or Alzheimer's.
Speaker 1:Yeah, so we see you know different types of diagnosis for hospice. You know it's a conversation that our admission nurse has with our physician and, based on what's going on with that patient as far as their declines, we look to see what would be that terminal diagnosis. So we have had patients who have been on for Alzheimer's A lot of times. You know we have those Alzheimer's patients, we have COPD patients, we have congestive heart failure patients. So you know it really just depends on what's really going on with that patient and having a conversation with that patient's physician and our hospice medical director to see you know which diagnosis you know would be most appropriate to bring them onto hospice.
Speaker 2:I had mentioned that we have, so we have in our legal team, we have what we call care navigators typically social workers, in our office, and we have one of our care navigators that her previous experience was in a hospice organization, which actually fits really well with our concept of care navigation Because, again, it is a very holistic type of planning opportunity within our legal office. And so the reason I'm mentioning this is I had interacted with hospice for all of my professional career, and what was interesting to me is how much I learned from her about the nuances of hospice, that I had many misconceptions, and I'll give you a couple of examples. One was that if you are on hospice, you can't receive medical treatment. You can't go to the hospital for any reason, and so tell me if that's accurate. If you're on hospice and the reason you're on hospice is for cancer, and then you get a UTI or you break your leg or something like that, are they going to treat the UTI or the broken leg?
Speaker 1:Yeah, so most definitely, you know that becomes a comfort issue.
Speaker 1:So a lot of times we can recognize the symptoms of a urinary tract infection or any other you know sort of infection that's going on and you know our nurses do an excellent job. The hospice nurse will, you know, reach out to our physician and go ahead and be very proactive in getting that antibiotic. So you know we do treat those symptoms. They don't necessarily have to go through any sort of testing for that, but we're treating those symptoms to make sure that that patient is comfortable. So most definitely, you know if there is a need to go to the hospital, we address that as well. You know there's so many myths about hospice and what it is that we do that you know if a patient has a fall and they have a broken leg, obviously that's something that we're going to have to manage and they're going to have to go to the hospital, you know, to get that taken care of. So definitely a case by case basis, but if there is a need for that patient to be seen at the hospital, then most definitely they can do that.
Speaker 2:So, stacey, tell us a little bit about more about you and your role there, how you came to be working with hospice and tell us a little bit more about St Croix Hospice.
Speaker 1:Yeah, so my position is I'm the Regional Director of Clinical Operations for St Croix Hospice of Michigan, so I oversee all of the clinical teams for all of our branches. So that's our nurses, our aides, our social workers, our chaplains. They work with our manager of clinical services and the manager of clinical services directly report to me. So I oversee the day-to-day operations of our clinical team and ensuring that we are providing the highest level of quality of care for our patients. And I've been in hospice for the last 15 years.
Speaker 1:I've been a registered nurse since 2002. I've been a registered nurse since 2002. And I started in hospice when my grandmother, who was an Alzheimer's patient in 2007, she was diagnosed with Alzheimer's disease and went on to hospice and I wanted to learn more, because in nursing school they didn't teach us about hospice and so I was very in tune with the hospice staff that would come in to see my grandmother and I just wanted to know more, and that's when I got my first position was in 2007. I've been in hospice ever since. So I've been a community liaison where I've met with different community leaders to try to get patients onto hospice sooner. I've been in operations, I've been in sales, so I've had a multitude of different positions within hospice, but really what brings me joy at the end of the day is making sure that our patients are treated as if they were a family member and providing that highest level of care.
Speaker 1:We recently lost my father. Last year he was 68 and passed away with Alzheimer's disease complications related to Alzheimer's disease and he was also on hospice. So it's something that's very near and dear to my heart. I've witnessed it firsthand, having my grandmother and my father both on hospice. But it's something that I have a very strong passion for to make sure that these patients are very well taken care of, and I always say that there's no redos in the field of hospice. We've got one shot to make a difference and it's a lifelong opportunity to make sure that, however many days our patients have, that they are lived to the fullest and that they were provided the highest level of care.
Speaker 2:I think that's really meaningful, that you've had your own personal experiences with that. You know I've been doing this for a long time and I feel like we've always been very in tune to our clients' families and their lives and their struggles that they have. But I can tell you once my family was a client when we were settling my parents' estate and leading up to their deaths. I did experience it in a different level and I suspect that's true for you too, that you can be very passionate about this topic and the services you provide. But it provides a whole different perspective when it's your grandmother, when it's your father.
Speaker 1:Absolutely, and one of the things that I really enjoy in my position is I have the opportunity to add clinicians onto our team and our interdisciplinary team, and I want to make sure that if I was on the receiving end of this care, would I want this person to care for my loved ones?
Speaker 1:So it's an opportunity to make sure that we're adding the correct team to our current existing team. That will go above and beyond, because there's many hospice organizations out there and not everyone does them the same. St Croix Hospice has special programs that every clinician is dementia certified to make sure that we're able to care for dementia patients at the highest level. And we have a fall prevention program where we have physical therapy evaluate our patients to help prevent falls. Evaluate our patients to help prevent falls. We have a voyage program to where our patients who need a higher level of care are seen by our nurse every single day, based on predictive analytics, so we make sure that we're present when that patient passes away, and so not all hospice agencies do it the same. I'm very honored to work at St Croix Hospice. We do things at the highest level and I feel like these programs really set the bar for what it is that we do.
Speaker 2:That's a really important point that we need to make sure that people understand that they have the choice of what hospice organization that they use. And so I do think families get confused about this because and I'm not complaining or criticizing, I'm just acknowledging the fact of it that a lot of hospital organizations have a hospice that's associated or owned by the hospital or part of the same organization, and so sometimes when you're in the hospital and they start talking about hospice, it seems like that is hospice, that's the only option that you have and that may be the best hospice for you. But the point of it is that for families to understand that they have the choice, they have the option of looking at other hospices, and if it is somebody with dementia, it's a good question Are the people in the hospice organization certified dementia practitioners? Do they?
Speaker 2:have the fall risk prevention that you talked about.
Speaker 2:These are all important things, what are the expectations? And I think that when we talk about hospice, the families are so overwhelmed because sometimes this is a bit of a shock to them that they don't think of asking these questions. And I really do think it's important that, if you're exploring hospice, that you actually ask okay, what is included in this, what is the training, what are the options, what are the services that are being provided and covered under this? And if you aren't thrilled with the answer, you can call a different hospice organization, and so that's a very important point that you make is that you have a choice among which hospice that you choose.
Speaker 1:Absolutely. I always encourage families to interview a couple different hospice organizations to find out what is going to be the best fit Specifically. You know, having had two loved ones who had Alzheimer's it's a very specific disease and it takes a very special person to be able to care and manage the symptoms and everything that comes along with this horrific disease. So I encourage families to do their research, to interview multiple different hospice organizations, because, although hospice is an umbrella of care, there are certain things that set hospice agencies apart and it's really important that you find the right fit for you and your loved one On that same theme do you have any advice for families that are giving some consideration as to whether or not to go with hospice?
Speaker 2:I know a lot of my clients are in that position where it's not sometimes it's very obvious right. Sometimes it's just it's clearly the right thing to do. And sometimes families struggle with it even when it is clearly the right thing to do. But there's other times where it is sort of they have a decision to make. Well, the person might be eligible for hospice. The family has to decide if that's the right timing for it. So do you have advice for families that are facing that struggle?
Speaker 1:Yeah, my best advice is if your physician or if you feel like your loved one is declining and they've reached a certain point to where they want to be comfortable, and not saying that they even have to be a DNR because we have multiple patients who are a full code. That's one of the myths as well is that you have to be a do not resuscitate, and that is not the case. We have multiple patients who are a full code. But I always encourage families to get an evaluation, get a consult with hospice and learn what we have to offer. It is a great service and most families say that they wish that they would have known about the hospice team sooner or the hospice benefit sooner, because it is all encompassing.
Speaker 1:It is a relief for the family, a peace of mind to have a nurse come to your house, wherever you call home, an aide to help with baths and changing and dressing and doing all of the things.
Speaker 1:You don't have to do this alone, and that's what hospice is for. It's such an underutilized benefit in the United States that so many people do not take advantage of because they feel like it's giving up, and it's not. It's not giving up. You can come off of hospice at any time, right, it's not something to where you sign on and you have to stay on forever If you change your mind or if you decide to go a different course of action. It's something that you can change your mind at any time. But if you're eligible, it's such a tremendous benefit that not only benefits the patient but it also benefits the family with the medications and education and the you know durable medical equipment that you can get. It's just my best advice is to check into it and, you know, get the answers to the questions that you have. And I know that initial step might be scary, but I think that once that you get the information and you really learn what hospice is about, it's not as scary as you think it is and it's actually a tremendous benefit.
Speaker 2:That's really important and I think that's one of the things that sometimes there's a lot of things that our clients will ask us about. Can they assume that it's covered under Medicare, you know, when they're not on hospice and they assume that this is just a standard Medicare benefit for like different medical equipment and things like that. Or they assume that respite care might be a medical benefit that they get through their insurance company and realistically, there's a lot of things that are provided by hospice that are not provided under your regular Medicare and your supplemental or Medicare Advantage benefits. You really can only get those benefits when you're under through the hospice program.
Speaker 1:Yeah, absolutely. And you know, although hospice is a wonderful Medicare benefit, we also, you know, hospices will take Medicaid and different you know types of insurance. So although it's covered, you know, 100% through Medicare, we do also accept other payer sources as well. So it really is, you know, meeting the patients and the families where they're at in their journey, no matter where that journey is matter where that journey is.
Speaker 2:Yeah, and that's actually where we can help folks too, because sometimes folks will say, oh well, we don't need those legal services because we're going on hospice. Actually, our legal services work hand in hand with hospice because we can look towards getting additional benefits Medicaid benefits that might supplement the hospice benefits in home care or maybe through a nursing home if that's necessary, and having Medicaid pay for the bulk of those things. And we help people get qualified for Medicaid, or maybe it's veterans benefits that will supplement the benefits provided by hospice, and that's something that we help folks with. And, frankly, then, it's just also making sure that we have the legal positions in place. Really, a big part of the legal issues are do you have people you love and trust and, if so, do we want them to be involved in making decisions? If you can't, if eventually you can't make all of your own decisions, rather than have a court appoint someone?
Speaker 2:And so that's a big part of this conversation rather than have a court appoint someone, and so that's a big part of this conversation. So it is, when we talk about holistic planning, really the legal planning is part of that holistic planning and that the legal services and the hospice services actually do work very much hand in hand. That's great. Through St Croix Hospice do you also do palliative care?
Speaker 1:We do not do palliative care and you know I was always taught all hospice is palliative care. We do not do palliative care and you know I was always taught all hospice is palliative but not all palliative is hospice and what we mean by that is. Hospice is such a tremendous benefit where you get a full team who comes in to your home and manages those symptoms and, you know, takes care of the patient holistically, whereas palliative care is usually just a nurse practitioner who's coming in, you know, once a month or twice a month to really manage those symptoms. Hospice is such a better benefit for our patients and families that you know our focus really is hospice services.
Speaker 2:Well, stacey, appreciate your time and everything that you do for our community and for the folks that you serve. Is there any advice that you'd like to leave our listeners? So our listeners tend to be people within the long-term care industry, social workers, people within the health care industry and then just the general public that's interested in these aging issues. So any advice that you'd like to leave them with?
Speaker 1:Yeah, I would say the best advice that I could give is, you know, hospice isn't about giving up hope.
Speaker 1:It's really about focusing on those days and, you know, making the most of your days.
Speaker 1:One of the things that we really focus on at St Croix Hospice is we've recently been certified in age-friendly care and one of the things that we ask our patients whether it's a registered nurse or it's our chaplain or it's our social worker is what matters most to you as the patient and you know we get all sorts of answers.
Speaker 1:It could be what matters most is they want to sit outside in the sun or they want their son to come in from out of town, or whatever it may be. But you know that's one of the things that our hospice in particular is really focused on making sure that those goals are met. You know we don't have a crystal ball whether we're on hospice or we're not on hospice in life. We don't know how much time that we have here on this earth, but we want to make sure that, however much time that we have, that we're making the most of those days. And so, you know, my best advice that I can give to anyone is, if you are even considering this level of care is to check into it and get the information that you are needing to make that you know best decision, because chances are you will wish that you would have done it.
Speaker 2:I think that's a beautiful way of saying it and summing it up. I think that was perfect way to kind of define what the hospice philosophy is. So thank you for listening and thank you, Stacey Bruss from St Croix Hospice for joining us my pleasure. If you enjoyed this podcast Advice from your Advocates, know that you can subscribe at any of the places that you listen to podcasts and that way you get notified when we have great guests like Stacey for us, and so I hope you subscribe and we'll see you next time.
Speaker 1:Thanks for listening. To learn more, visit manorlawgroupcom.
