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>> Well, good evening.

Thank you so much for watching.

LIFE Ahead on PBS Fort Wayne of course this program is a weekly interactive program for adults of all ages.

Some very vital information.

Tonight we'll be talking about understanding hospice care.

There have been a lot of questions about hospice care.

We've had shows on that particular subject before and I'm sure we'll have questions tonight so you'll see the numbers on your screen.

You can actually call and you can be on the air with us or you can have the question transcribed by the person on our phone bank or you can text us and when you text us simply give us your first name if you will, and the town from which you're texting so we can say hello to you.

We have some very special guests tonight, a couple who actually work in the hospice care industry, if you will.

I don't like to call it an industry but hospice care it's a matter of fact we have Jenny down at the end and this is your first time on the program?

>> It is, yes.

And you are an administrator in a hospice care specialist.

Correct.

And then the nice lady next to you, Sandy Steel and your hospice specialist as well.

>> Yes.

And you've been on the program before.

I have.

Thank you for having me back.

>> Absolutely did such a wonderful job.

I had to have you back and we want you to show Jenny House right.

>> Show me how it's done.

And of course we have Heidi Adare who is an elder law attorney and you've been on the program, suffered through the program many, many times anyway not suffered.

>> But it's very nice to have all three of you here.

Thank you.

And we hope to have some questions and some comments from our audience tonight.

So welcome to our LIFE Ahead living room as they call it.

And I want to start off by letting you know and I did some research of course you probably know these stats too.

But according to the Center for Disease Control and Prevention, there are about 60 800 Medicare certified hospice care agencies in the United States caring for nearly two million patients and the average length of stay is about 17 days and about one in four patients enroll in their final week of life and that's according to the CDC.

>> So let's go ahead and get started and of course a lot of people know what hospice care is.

But Jenny, if you don't mind explaining that to those who don't know exactly what it is and what are the benefits to the patient.

>> Sure, hospice care is really a philosophy.

It is about comfort .

It is about quality of life and it is about maintaining some control as you're going through just the end of your life in the process that goes with it.

So there's a lot of benefits that go along with that.

I think in our society we don't like to talk about death and we don't like to talk about what's coming.

There's a lot of unknowns and a beautiful thing about hospice is you have professionals who are trained.

They know what to expect and they walk along with you throughout that journey.

So I think if nothing else people here that benefit that they don't go through this alone.

>> Right.

And that's a big key.

Yeah.

And Ashanti who's eligible for hospice care so it's really anyone with a life limiting terminal illness and it does have to have a six month or less life expectancy by a physician.

I think that is still what's really scary about hospice care people here six months or less and to the stat that you mentioned earlier, people are utilizing their benefit a little bit late in their last weeks of life and hospice is actually the earlier you can use that benefit the more support we can offer for the family and the patient.

So you do have to have a life expectancy of six months or less with that illness but you can be recertified and be on services for even longer than that.

>> Well, and there's also some good news to not everyone who is in hospice care ends up dying at that particular time.

>> Some people have a turnaround in their career.

>> Yes.

Yeah.

And we we love to see that you know, there are times that maybe once symptoms get managed maybe people aren't going back and forth to the hospital or for , you know, really aggressive treatment.

They do stabilize a little bit and we love that sometimes people call it graduating out of hospice and we just say hey, we're here when you need us down the road.

>> And what are the levels after isn't a multilevel thing when it comes to hospice care.

Can you explain that?

Yes.

Under Medicare the Medicare benefit there's actually four levels of hospice.

I think most people are familiar with the routine level of care which is where we are going out and you see us in people's homes in facilities, visiting with people.

But there are also different levels depending on the care that's needed.

There's an inpatient level of care if there is a symptom that has to be managed to seven by skilled professionals in a hospital or in an inpatient unit and there's also a respite level of care which is really beneficial for caregivers who just need a break in allows them to be loved ones instead of being caregivers all the time.

And then there's another one for acute crises that is also available under Medicare.

>> All right.

And Chante, you kind of touched on this earlier but I want to know at what point should we consider admitting to hospice care?

>> So we say it's never too early.

No, no, no, no.

About hospice before you need right.

So it's not something that you should wait for .

You can all what you should plan ahead which I know that's kind the theme for tonight.

We'll talk a little bit more about that.

But again, once you have a life limiting or terminal diagnosis you can reach out to hospice care even if you're not ready then you can reach out to talk about hospice care and when you might be ready because you do have to have that physician certified diagnosis to get all right.

>> Yeah, it's hospice care a place or a service work in hospice agency serve patients and families, Jenny.

>> So it's both overall it's a philosophy of care and so it is a service that's provided and it can be provided wherever somebody considers their home.

It can be in a home setting a facility, a group home setting apartments.

We've seen people in hotel settings.

It's wherever they consider their home to be.

But there are also inpatient hospice units so it also can be a place as well.

>> OK, very, very good.

Let's go to Heidi.

All right.

I haven't been ignoring this interesting kind of building up to you.

>> Yeah, but the role of an elder law attorney why should they get involved in this?

>> Well, the elder law attorney is going to help make sure you've got all the legal documents in place that you're going to need.

And believe it or not, sometimes the elder law attorneys are just the place where you can come and sort of get centered like this is what's happening to me.

I just heard this from the doctor what do I do now?

And in addition to helping people figure out legal documents, we can encourage contacting hospice or thinking about home health care if you're not eligible for hospice care yet or need additional type of care.

>> Well, you know, you mentioned documents and what documents that a person consider having in place to qualify for the services.

>> Well, it's just really important to have powers of attorney naming somebody as your health care decision maker in your financial power of attorney to have that in place while you're still able competent to sign documents because many times, you know, people family members will call us and people have not executed those powers of attorney and it makes things very difficult for the family to carry on and take care of things for you.

And you mentioned power of attorney.

What is the power of attorney and who can be one?

Sorry I'm talking lingo aren't I?

Well that's OK.

That's so a power of attorney is a document where you name somebody else who's going to help you make other health care decisions or manage your finances if you can't handle them for yourself, who's eligible to do that kind of thing?

It's really anybody that you think would be a good decision maker for you.

Often it's a family member or a close friend.

There are people in our community that you can pay to be your power of attorney if you don't you know your family's all far away or you don't have anyone that you trust or feel comfortable in that role.

>> There are people that you can pay to do those things as well.

OK, and there's a form or document that you have to have signed and that has to be legalized signed in properly witnessed or notarized.

OK, very good.

So we've got the power of attorney but there's also a position of someone being the health care representative who would that be?

That again is somebody that you think is going to honor the wishes that you've made known to them while you were well and that you trust to make good decisions for you so power of attorney and a health care representative?

>> Yes, absolutely.

Should I name one person to do both?

It just depends on what works well for you if you have sometimes you've got one child who's a health care worker who you think would be great as your health care representative and you know they're terrible.

They don't balance their checkbook.

They're bad with money.

You don't want them in charge of your finances.

So put that person on health care and then maybe you've got another kid who's what like a banker or something really serious and you know, studious with their money.

That can be your financial power of attorney.

OK, I want to get back to you in just a few minutes.

>> We're going to talk about how all this is funded and how we can pay for this.

>> But I want to go back over to let's go with Chanty.

>> What disciplines make up a hospice team so hospice has a medical director so a hospice physician and then also on the team would be a nurse, a home health aide, social workers, spiritual care counselors.

There's also hospice trained volunteers and some hospice agencies have music therapy, massage therapy, extra disciplines like that.

>> Wow.

I didn't realize that was that extensive as far as an entire care team and it's really Jenny mentioned earlier it's really hospice.

The philosophy is a really holistic approach to care.

It's really about bringing all those care team members to you to the patient in their home and adding additional support not just for them but for the family and the caregivers and volunteers.

>> What do they do?

Can you explain that, Jenny?

Sure.

Volunteers can do a lot of different things we see volunteers who may be involved in more of an administrative side or volunteers that want to sit and provide companionship.

Sometimes it's a matter of doing more of those practical task whether it's going to the grocery store for somebody or taking the dog out for a walk or sitting with somebody so the family can go to a church service.

But it really is filling needs and it's great because they go in truly because they want to volunteer their time in are just person to person which is so important no agenda.

>> I'm sure that it's not only rewarding for the staff but also for the volunteers.

>> They wouldn't do it.

Absolutely.

Yeah, absolutely.

OK, Heidi, let's go back to you.

I want to talk about the programs that are actually available to help pay for hospice care both in-home and hospital hospice care.

>> So hospice is generally covered by insurance.

So if you're a Medicare person, an older person with Medicare that would cover your your hospice care and traditional insurance often covers hospice and Medicaid can cover hospice as well.

>> OK, and what about the program requirements in regard to a person's health ?

>> Again, you need the doctor statement that you have a terminal diagnosis less than six months expected of life, OK and the program requirements regarding a person's assets.

>> Now this is where we're going to get into some legal stuff, right?

>> Yeah.

Yeah.

So you know the Medicare and traditional insurance that's pretty straightforward.

But when you're wanting to use which is probably most of the time going to cover the hospice care where Medicaid can be very helpful to people is if they are low income low asset hospice can be there to cover but with some extra type of planning even if a person has some assets we can maybe get Medicaid structured to offer some additional home care because hospice is it's not twenty four hour a day care it's it's for the most part.

But if you need to layer on some additional services you can look at Medicaid maybe covering some home health care services and what about a person's income?

>> How does that affect any type of funding for this?

So really people go online and they see that there is an income requirement to qualify for Medicaid and it's roughly twenty nine hundred dollars but really there's ways to work around that situation so you should never just dig a little deeper on that income requirement because we can set up something called a Miller Trust to siphon off some of that income to make it so that you could be eligible for Medicaid.

All right.

>> Anything regarding I guess we don't get into irrevocable trust and things like that when it comes to hospice, is that correct?

>> No, but it goes along with planning ahead.

So when you as you are aging or if you get a diagnosis, hospice is one of the tools in your tool belt but absolutely planning for Medicaid services, extra home health care services is a huge part of going into aging really generally not even just necessarily hospice issues but just trying to plan ahead because it's going to give you a lot more options to age and in the way that you want to and in the place that you want to now is hospice regarded as long term care?

>> No.

So long term care policy if you have an insurance policy for long term care would not cover that.

No.

OK now but you could layer that long term care policy a lot of times long term care policies cover assisted living or home a home care or facility care and then hospice can layer in on top of that to get you even more care.

OK, I've got a client right now whose mom is I mean it just amazes me what they've been able to do with her.

She's in her home and we started out with some just little bits of help from aging and in-home services.

>> We've layered on hospice care.

We've layered on Medicaid care at this point we might even apply for VA to have some more money coming available to get her even more home care.

And I mean it's just incredible to me with all of these resources coming towards this lady, she's been able to be in her home for a very long time.

>> So when should somebody start their estate planning and maybe keeping these things in mind?

>> I mean really anyone who's 18 should have an estate plan.

Do powers of attorney and a simple will.

But as you're you know, as you see yourself in life starting to slow down a bit, it's time to really grab hold and get a plan talk with your family members, your loved ones of what you want your aging your dying process to look like and talk to an elder law attorney and come up with a way to how am I going to fund this plan and by planning ahead it's just going to open so many more options opportunities for you.

>> Well, and I don't want to get too far off the subject but when you come into the estate planning, what type of things are you going to start planning in your estate?

>> Well, you're going to figure out who's going to get your stuff when you're gone.

OK, but you're also going to if you would just be surprise how many people come in and I say OK, let's make a list of what you have asset wise and they just don't know.

And so we start doing some investigating digging and you got to know what you have so you know you can structure how you can pay for what you want this to look like if you want to be in assisted living with hospice coming to visit you in assisted living, we need to know you can afford to pay for it and so you just got to get sort of a I'm not a financial planner but I do help people kind of dig deep into their file cabinet and figure out what's going on.

>> Right.

Well, for those of you who are just tuning and we're talking about understanding hospice and we have a couple of very special guest on hand we have let you get to my last name so I can say that last names as well.

But we have a couple of hospice care specials.

We have Jenny Reilly on hand and in Chandy Steel also with us and of course our elder law attorney Heidi O'Dare.

And please call we still have about seven, eight minutes left in the program and we could take some text or some telephone calls and the numbers are on your screen.

But I want to talk about one of the questions that came up to ask you this evening is to dispel some of the myths about hospice and I can't imagine any myths.

>> I've never heard any myths.

But what are those?

I think even the statistic that you said at the very beginning goes into some of the myths that you have to be in your last couple of days.

You have to be in your last week before you can get hospice involved or that you have to have a cancer diagnosis and you know those are myths and like Cheney said, the sooner we get involved the better the more that we can actually do and help.

I also hear from families a lot that hospice means giving up and they're afraid when we talk about hospice does that mean that my loved one is going to stop trying to live and stop trying to enjoy and so there's a lot of education done about quality of life and what does this look like and what's important to them?

I would say those are probably the main myths that I hear.

>> Yeah, we hear a lot of them and myths or stigmas, whatever you want to call them is correct.

She hit on a lot of them.

But we also hear not just is hospice about giving up, is it giving up hope and you know, is it going to speed up death?

Is it going to bring it on or speed it up and actually once hospice get involved gets involved in those symptoms or managed oftentimes you mentioned earlier sometimes people come off of hospice but oftentimes they can live a little longer because those symptoms are managed and they're they're stable.

>> You know, they're we're taking care of them.

So I've I've always found it very interesting that hospice you call symptom management and I say people are just much more comfortable and it just amazes me that it's hospice that helps you be comfortable and who wouldn't want that, right?

Yeah.

Yeah, yeah.

>> Because you're just shifting that focus right.

You're no more you're not focusing on the cure anymore.

You're focusing on comfort and quality of life.

That's your focus now.

So you're just shifting focus.

You're not giving up.

You're just shifting.

>> And what is the dilemma in delineating factor between making the choice of having hospice care at home versus in a hospice care center?

>> Why would you choose one or the other that just personal choice?

>> Any part of it comes down to personal choice and part of it comes down to your caregiving options you know who you have available to help and then also some of it is going to be your condition there is that Medicare benefit for that inpatient level of care if you have got some symptoms that have to have that 24/7 nurse assessing adjusting to try to get that managed.

But most people, you know, choose if they can to stay at home.

>> OK, I think the question I think I would do and I saw that question pop up I don't think it would be great for director.

>> Let's get an application tonight.

Yes.

A question just came up in fact while you were answering that question there CHANDY So the question is it's from Steve and he is asking what is the difference between palliative care and hospice care?

>> Good question.

Thanks.

Great question when we get all the time oh OK.

Wait so palliative in itself is it means comfort right.

And so hospice can actually be seen as a type of palliative care because palliative is like an umbrella term if you will.

But what we hear a lot is palliative medicine, palliative consults, palliative clinic and so for our society what that usually is indicating is that somebody maybe has a chronic condition, a life limiting condition but they are not ready to stop with their curative treatment and so or maybe they don't have six months or less prognosis but they still need some additional assistance with getting comfort care is a palliative can be that comfort care until somebody is either physically eligible for hospice or emotionally ready to go into hospice care?

>> OK, very good source.

>> I have a few more minutes left.

I'd like to get some personal stories personal outlooks from you.

>> Not everybody is clamoring to get into the hospice care type of work.

So let me start with you Chanty.

Why are you in this type of work?

>> You know, people ask when when they say well what do you do when you say I'm in hospice care and they oh my gosh, I'm so sorry.

>> Yeah.

And it's it's very rewarding.

You are with people in a very you know, when they need support and we know that we can provide that support and we know how to how to bring that to them and how to be there for them and we can really it's just really beautiful and it's very rewarding.

>> Does it ever bring you down though seeing some of these cases?

>> I think any anything that we do on a daily basis has the potential to bring us down.

Yeah, but the reward that you get from it outweight far outweighs that and far outweighs the benefits far outweigh the the the things that can bring you down in this in this particular job.

>> And Jenny, would you chime in please?

Yeah, I've actually been in hospice care for about twenty years now and I will say I've experienced both professionally and personally you know on both sides of it it it is an opportunity to walk along side a person in their circle of support and one of the most vulnerable times of their life and quite honestly it's an honor to be invited in to that.

And so I think that keeps things in perspective.

It's a very sacred time and for people to allow us to come in is so incredibly to be part of that.

>> Grateful for that.

Yeah.

Yeah.

I was going to ask you especially after this the person that you're taking care of I mean finally is has died for the lack of better words.

>> How how does the family thank you and you know what kind of rewards do you get from those family members?

>> Not that you're looking for rewards but I'm sure there are some there.

>> I think when we are able to meet the goals of a patient in their family, what they want their death to look like, who they want to be there, what they want to accomplish beforehand, you know that really is the gratitude knowing that we've been able to provide that for the families and for the patient before they pass.

There's nothing no reward better than that.

>> I bet I bet we've got a little less than a minute to go here, Heidi.

But I want to give an opportunity for some some notes for folks to ponder over after the show.

>> Yeah, I just I know hospice is a scary word but I've been been an elder law attorney for more than 30 years and I have literally never heard anyone complain about hospice.

I mean I've heard complaints about every other thing under the sun you could imagine someone complaining about but I have never heard a complaint about hospice.

It's that good of care so do not hesitate to to get them involved.

>> And we also want to remind our viewers to get that estate plan going too.

Yes.

Yes.

Yeah.

So call your local elder attorney and get that taken care of and so you won't have as much to worry about down the road.

Ladies hospice care specialist and administrator we have of course Jenny Reilly and then hospice care specialist Chante Steele.

>> Thank you so much for being here and thank you for all you do.

Thank you.

Thank you for having us.

Absolutely.

Heidi, always great to see you.

Thank you for coming and I'm sure you'll be on further shows down the road.

Yeah.

All right.

And if you'd like to watch this program or any others that we have a LIFE Ahead you can see those on YouTube also PBS Fort Wayne dog until next time please enjoy and embrace your life at here.

Thanks for watching