Cheryl (Host): This podcast is for informational purposes only and is not intended to be used as personalized medical advice. What exactly is hospice care and when is it appropriate? Dr. Erica Pope and Dr. Alyssa Anderson will answer these questions and more on this episode. They are both passionate about bringing hope to individuals and families.

Facing a life limiting illness. Dr. Pope is a medical director at Hospice of the Northwest and Dr. Anderson is an Assistant Medical Director This is be Well with Skagit Regional Health. I'm Cheryl Martin, Dr. Pope and Dr. Anderson. Great to have you on to discuss hospice care and specifically the place where both of you serve Hospice of the Northwest.

Lissa Anderson, MD: Thank you for having us

Erika Pope, DO: Thanks. It's good to be here talking with you today.

Cheryl (Host): So first, Dr. Anderson, what exactly is hospice care and how does it differ from palliative care or other end of life services?

Lissa Anderson, MD: What exactly is hospice care and how does it differ from palliative care or other end of life services? Palliative care is more of an umbrella term that encompasses all kinds of excellent care for people who may be facing a life limiting or life threatening illness, or just the severe chronic illness.

And palliative care can range anywhere from advanced decision making, for people who have early dementia to symptom management and a person getting chemotherapy for cancer. Under that umbrella falls Hospice Care and Hospice Care is a specific benefit from insurance companies that gives someone in-home care if we believe that they have less than six months to live.

Now, sometimes we're wrong about that. We are never certain. But if we honestly believe that we would not be surprised if someone had six months or less to live, then they're entitled to this. Hospice benefit, which provides very comprehensive in-home care to support them and their family through that time and even after the person passes away.

Cheryl (Host): You mentioned six months time. So Dr. Pope, when is the right time to consider hospice care? Should families start talking about this much earlier, and then the signs that indicate that it might be appropriate?

Erika Pope, DO: So the right time to consider hospice care and some signs that indicate it might be appropriate the short answer from someone who gets to see the benefits of hospice care regularly is to come onto hospice as soon as you're eligible. So, Dr. Anderson talked about the six month piece.

So we as hospice providers, need to feel like it's more likely than not that person will die within the next six months. So, Generally speaking, if there's a terminal diagnosis cancer or heart disease respiratory difficulty or dementia are the, most common overarching illnesses and that. Care becomes comfort focused.

Those are good times to reach out to hospice to learn more, kind of understand and as we go through the process of admission onto hospice, we can determine eligibility, look at multiple different factors. Someone losing weight or becoming more confused or decreasing functional status, you know, not able to do the things that they used to.

And if those pieces are declining or they're not able to do those things in the same way, then those are all good reasons to learn more if hospice might be a good option.

Cheryl (Host): So what are the most common misconceptions families have about hospice care?

Lissa Anderson, MD: What are the most common misperceptions that families have about hospice care? First of all, I think it's really crucial in families understanding. To know how hospice care was introduced to them. Unfortunately, there is a stereotype that people choose hospice when there's quote, nothing more we can do, and that puts us in the position of being the quote unquote do nothing team.

And we're very far from being the do nothing team. We do so many things for our patients and our families. From medical care to medication management to spiritual care psychosocial support and counseling. So we do everything except nothing. The other misconceptions that I worry about are that a person would have to be actively dying to qualify for hospice care.

So again, we have this prognostic requirement where we have to. Sign that a person has six months or less to lift in order for them to qualify for hospice care, but they don't have to be actively dying. And some of our patients are still quite active people and we're happy to have them on our hospice service earlier so that we can learn more about what they need and support them for longer, because ultimately we wanna enhance their quality of life.

Another common misperception is that we discontinue maintenance medications for a person. That's very far from the truth. In fact, we find that a lot of our patients with heart disease in particular, actually feel better when they're on hospice because we have our expert nurses going to their home and assessing their congestive heart failure symptoms.

And then we treat those symptoms to help them feel better, but also help them be able to do more. So actually sometimes our medication management ends up being more intensive rather than less intensive.

Erika Pope, DO: A few other misconceptions that we commonly hear is that hospice provides caregiving. So the hospice model provides visits throughout the week intermittently, but not routine or scheduled or extensive caregiving. So that falls to either families or facilities or paid caregivers to do the. Day in and day out caregiving aspects.

Sometimes people will come onto service and be worried that we're just going to increase their comfort medications or medicate to sedation, and really we focus on. Treating patients within their goals focusing on what's most important to them. And if they value alertness, we will tailor their medication routine or their PRN medications even to help support their wishes within their goals.

Then one last common misconception is that a physician needs to refer a patient and uniquely, I think in medicine we always feel like we need, to have a referral to go see the next doctor. But with hospice care, any physician, but then also a family member or even a patient themselves can refer to hospice, and that's because the eligibility process is rolled into the admission process.

And so, you don't have to wait to have a referral from a physician to seek admission to hospice care.

Cheryl (Host): So glad you're clearing up a lot of the misconceptions. You've touched on this a little bit, but I'd like for you to expand on how hospice care actually improves the quality of life for both the patient and their loved ones, Dr. Anderson.

Lissa Anderson, MD: Yes. How can hospice care actually improve the quality of life for both the patient and their loved ones? We really are patient focused, and I know that that's a goal in a lot of healthcare, but we have the advantage of coming into the person's home and serving them in the place that they feel the most comfortable.

With their chosen people around them. And that gives us a huge amount of insight into what's important to that person. And as Dr. Pope said, we really tailor symptom management to what that person wants. So some people want to try to have as little pain as possible, even if that means that they're sleepy and we honor that, whereas other people.

Say that alertness is the most important thing to them, or that driving safety is the most important thing, and even sometimes some limited measures to prolong life. Really, we focus on whatever it is that the person finds most important to them, and then we have a lot of interdisciplinary resources to contribute to that process.

We are able to support so many aspects of the person with our chaplains, who we call spiritual counselors, with our social workers, with our massage therapists and pet visits aromatherapy and then grief support after the person passes for their people left behind. So we're really able to improve the quality of life in all different domains, not just strictly the medical care.

Also our team has walked people through this process so many times that we're really able to help explain to people what's going on with themselves or their loved one and help support them in the difficult time. And we step up support as someone's symptoms might increase. So in that way, I feel very proud of how we can help quality of life.

Cheryl (Host): You mentioned some of the others on the team. Would you like to expand on that in terms of the role that the hospice team play and anyone else who's typically part of that team?

Lissa Anderson, MD: Yes, the hospice team is really crucial to the functioning of our hospice, so this is one of the things that most drew me to hospice as a career is getting to work within this team. So the hospice care model includes doctors, nurse practitioners, nurse case managers, social workers, spiritual counselors, and certified nursing assistants.

And this is a team that works together, again, focused on what the person themselves finds most important. To help with their care. And then we also have the privilege of working with integrative services like massage therapy, music therapy, and then we have a huge group of volunteers who provide all kinds of services for our patient population.

as part of that, we have pet therapy. So we really get to try to address as many different aspects of supporting the person as we possibly can.

Cheryl (Host): And that support is personalized based on the patient

Lissa Anderson, MD: It is. It's all about what's most important to them.

Cheryl (Host): Dr. Pope, how can families start the conversation about hospice care with their loved one or their healthcare provider?

Erika Pope, DO: Yeah, so starting a conversation about hospice care with your loved one can be very difficult. And when presenting that information and you're not sure what the response is going to be, I like to recommend to start with the benefits and then have curiosity. Approach it with curiosity. So things like do you think it would be better to have visits at home?

Or I think it might be helpful to get some additional support. What do you think might be ways to kind of understand where your loved one is coming from when you want to broach that topic? And when discussing with a healthcare provider? I think just asking, you know, I'm wondering if it might be helpful to have hospice services.

Asking for that conversation separate. If you have not yet brought it up with your loved one can all be ways to navigate that situation. There's a broad understanding of what hospice care is and sometimes those understandings need to be adjusted in order for people to be willing to accept the help that we have to offer.

Cheryl (Host): Dr. Pope, I know that you know personally, you've had a personal experience and you approach this with great sensitivity. Just share with us briefly your personal journey of finding a new purpose in medicine that led you to hospice care.

Erika Pope, DO: Yes. So when I was a young aspiring doctor, I wanted to be Dr. Anderson. I didn't know her at the time, but thought I wanted to be a neurologist and, specialize in movement disorders, which is her career path. And because I grew up in a family with medical challenges.

So my father and sister both had Huntington's disease, which is a rare genetic illness. And my sister was becoming more ill at the age of 30. She started to become more symptomatic and through medical school I decided it was more important for me to be close to home than to be far away and pursue neurology.

And so I switched career paths to family medicine so that I could stay and train in the area. And my sister passed away on service with Hospice of the Northwest at the age of 33. during my very first week of family medicine residency and throughout residency, I felt like I was a wandering soul, a little bit, not exactly sure what my purpose was, and found love in family medicine and primary care and treating patients and whole families and, after several years of being in family medicine and providing primary care in our community, I was asked to take on this role in hospice, and I knew that that was always the long-term goal.

But it wasn't my timing of coming over to Hospice of the Northwest, but I could not be more thrilled to be a part of this community and to serve our community in the way that we do. In very difficult times for our patients and their families.

Cheryl (Host): That's wonderful. It's almost paying it forward, so to speak, as a result of what you went through as a family. tell us about Hospice of the Northwest and what distinguishes it from other hospices, Dr. And.

Lissa Anderson, MD: I'm so incredibly proud of the work that we do at Hospice of the Northwest, and in fact, I live quite far away and commute to this job because I am so impressed by just how very person centered our care is here. One thing that makes me so proud is our interdisciplinary group meetings, which are Medicare requirement.

And can feel a little bit rote if they're not done in the best way. But here, whenever we talk about a patient, which is required, we always mention what's most important to them as a person. That is always where we lead things off so that we always keep our discussions focused on what matters to them.

And I feel that the whole team really collaborates to reinforce what's most important to the person themselves. We also have unparalleled bereavement support for families, both of our hospice patients as well as community members. And we far exceed sort of the Medicare requirements for that. Our volunteer involvement similarly is just incredible way beyond what's required because the community is so invested in this agency.

As well as the pet therapy program. Again, not a requirement, but something that we provide along with things like massage therapy. we have a mini horse of all things. Is there anywhere else in the country where you could get a mini horse visit? And then we have a really powerful and supportive foundation that helps us be able to afford to grant requests to patients that might be a little bit outside the box.

Cheryl (Host): The hospice care, is it always in the home or they have the option of another location as well?

Lissa Anderson, MD: So hospice care, is wherever the patient calls home. So it could be a private home or apartment. It could be an assisted living. It could be an adult family home or a nursing facility. Sometimes we even serve unhoused people and meet them wherever they are. And our social work team helps the person to find a different living arrangement if the place that they're living isn't satisfactory to them.

Cheryl (Host): Dr. Pope, tell us the areas where Hospice of the Northwest serves patients.

Erika Pope, DO: Yes, we have a huge geographic area, so we see patients on San Juan Island orcas and Lopez as well. All the way down to South Woodby on the west side. Then we see patients all the way up Highway 20 to Marble Mount to the Whatcom County border to the north, and then all the way down into Snohomish County and onto Camino Island.

So very large geographic area.

Cheryl (Host): What do you enjoy most about serving these Pacific Northwest communities?

Erika Pope, DO: So being from here, the thing that I enjoy the most about serving these communities is that it's a diverse population. Lots of different unique needs in those areas, and. I love that our team can show up and bring some calm and normalcy to a situation that feels very unfamiliar and sometimes even scary to families, and that we can be that presence that helps relieve some of that stress.

Cheryl (Host): what would you say to families who feel that choosing hospice means giving up hope?

Erika Pope, DO: The thing that I would say to families who feel like choosing hospice means giving up hope, is that I understand that making that decision to not treat or not continuing to go through. The process of treatment can feel like giving up, but what I find is when someone comes onto hospice, the focus changes.

It's about looking at what is most important and treating for comfort, and I frequently see that the hope for living their best life in the time that they have left flourishes for our patients.

Cheryl (Host): Thank you so much, Dr. Erica Pope and Dr. Lisa Anderson. Thank you for sharing your heart and your expertise on hospice care and introducing us to Hospice of the Northwest. Great information.

Erika Pope, DO: Thank you.

Lissa Anderson, MD: Thank.

Cheryl (Host): To learn more, visit skagit regional health.org. If you found this podcast helpful, please share it on your social media and be sure to check out our entire podcast library for other topics of interest to you. Thanks for listening to be Well with Skagit Regional Health.