October 9, 2025 • 51 mins
The concept of hospice was created as a way to help people with only a few weeks to live spend their last days comfortable an surrounded by friends and family in the hope they can pass away peacefully. It’s kind of crazy hospice was ever a radical idea.
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Speaker 1 (00:01):
Welcome to Stuff You Should Know, a production of iHeartRadio.
Speaker 2 (00:11):
Hey, and welcome to the podcast. I'm Josh, and there's
Chuck and Jerry's here too. So this is an old
fashioned root and tootin episode of Stuff you Should Know
and about something we needed to talk about. Chuck.
Speaker 1 (00:22):
Okay, okay, you remember back in like.
Speaker 2 (00:27):
The like about like the two thousand and nine ten
eleven era, when like death was all the rage people
were having, like death cafes and like creating living wills,
and it was just a big thing that everybody talked about.
When was this like two thousand and nine to two
thousand and maybe eleven.
Speaker 1 (00:46):
I don't remember that, but I'll take your word for it.
Speaker 2 (00:48):
It was a real thing, for sure. Unless I've just
completely lost my marbles and I just made up a
whole era of American culture. I don't think I did.
But that has died at so like that it's gone
back to death has gone back to being a bit
of a taboo topic, an uncomfortable topic, at least at
least here in the United States.
Speaker 1 (01:11):
I didn't know that either.
Speaker 2 (01:12):
It's true. I guess I'm just speaking for myself anecdotally.
Speaker 1 (01:17):
Oh okay, that makes a lot more sense.
Speaker 2 (01:19):
So okay, well let's just cut to the chase here.
There's this concept of a good death, yeah right, and
you can probably fill in a lot of the blanks
of what that means and what it means to you
at least, but there's actually like some components to it
that studies have found, like kind of bubble up to
the top that most people can agree this makes a
(01:40):
good death. There are things like getting to say goodbye
to friends and family, having those people at your side
if you want so. A certain amount of control over
the dying process is something being pain free, not suffering, sure,
being in an environment, and having a chance to like
kind of come to terms with the fact you're about
(02:01):
to expire. Those are some of the top things that
people say, like, this to me is a good death.
And not coincidentally, those are the kind of things that hospices,
which we're about to talk about today, are intended to provide.
That's the service they provide is to give you, the individual,
a good death. And it's not something that's relegated to
(02:23):
the rich. It's not something that's relegated to the educated.
It's for everybody. Everybody deserves to have a good death,
and that's pretty much the motto of hospice, And in fact,
I ran across one motto. It said, if you can't
add more days to life, add more life to days.
Speaker 1 (02:44):
That's great. It sounds a little too corporate slogany, but
I like the sentiment.
Speaker 2 (02:48):
Yeah, there's a mascot, Louis the dead guy who's like
always saying that slogan, and he did a partnership with
home Depot for some reason recently.
Speaker 1 (02:59):
Oh boy, well that explains the orange bed sheets and things, right,
all right, so that's probably the last semi joke we're
gonna make. You'll have to forgive us for that. We
did a whole episode on dying, and I don't even
know if we made one joke in that one, So.
Speaker 2 (03:14):
Sure we did, you think, yes? I absolutely think.
Speaker 1 (03:17):
All right, well we'll pair that with this one. And
because we've got a lot of great feedback on the
dying episode and how that could kind of help people out,
so yeah, maybe this will do the same. We should
probably go back in time a bit and explain the
history of hospice, because it is very recent. If you
look at sort of the timeline of people in the
world dying hospice has only been around since like the
(03:39):
sixties or seventies and the form that we know it
because previous to that, for all of time, basically medicine
was like, hey, we're here to cure people, and if
it turns out that we cannot cure you and that
the end is near, for a very very long time
until the last like you know, like I said, since
(04:01):
the sixties or seventies, very shamefully, hospitals and even doctors
would sort of like it was a reminder that they
couldn't save you, so they didn't spend a lot of
time with you. And there are a lot of you know,
well known reports of people kind of like scurrying past
rooms where people were in their final days in a
(04:22):
hospital and stuff like that.
Speaker 2 (04:23):
Yeah, they left the dying who were incurable now to
basically die alone. They withdrew support. That was just what
they did. And like you said, it was a reminder
of the failing of medicine. And this was a time
when modern medicine was not in any kind of mood
to be reminded of failings, because I mean, the twentieth
century was pretty triumphant for it. I mean, I saw
(04:45):
that infant mortality rate declined by ninety percent over the century.
There's like sanitation, clean drinking water, polar vaccine, like science
could do anything, and people who were incurable were just
a reminder that there were limits to that whole thing.
Speaker 1 (04:59):
That's right, right, and another thing that was going on.
And this is also pretty shameful. Well, I guess not shameful,
but they've since revisited how they look at pain management.
But yeah, you had to like really be in pain
to get pain management, and then that had to like
wear off and you had to be really in pain
(05:20):
again for them to administer more pain management. They were
worried about, you know, opioid addiction and stuff like that,
but you know, these days, it's it's definitely more like, hey,
you know, we're not worried about you getting addicted to
opioids in the final possibly days of your life. We
just want to make you feel okay.
Speaker 2 (05:39):
Yeah, that's definitely the hospice philosophy is you don't have
to wait until one pain killer wears off to get
another dose. You can you know, stay comfortable. That's the
point is to make the person comfortable. That's called palliative care.
We'll talk a little more about that, but it's essentially
just taking care of symptoms to keep people comfortable.
Speaker 1 (05:59):
Yeah, for sure, nuns were kind of on the scene
early on, providing you know, emotional support. They couldn't dose
out pain medication of course, and stuff like that, but
they you know, it was a lot of times it
was religious organizations that were stepping forward that were kind
of doing the hospice type work that would come along
in the sixties and seventies, thanks in part to a
(06:19):
couple of big landmark books that came out.
Speaker 2 (06:22):
Yeah, there was this whole thing in the sixties and
seventies that was kind of this rebellious streak that went
across like against some of the just unquestioned institutions, and
one of those was medicine and doctors and hospitals. But
there was a psychiatrist name Elizabeth Koubler Ross who very
famously came up with the five Stages of grief that
was in her nineteen sixty nine book on Death and Dying.
(06:45):
And in addition to being famous for coming up with
the Five Stages of grief, she also basically interviewed people
in the Chicago Hospital's ice you who were dying and
just found that they were just being totally neglect and
so she definitely lobbied for dying and dying people and
(07:05):
their families to be listened to and to be treated
rather than just ignored.
Speaker 1 (07:09):
Yeah, we talked about her and that book in our
dying episode. I don't think we talked about the Denial
of Death from nineteen seventy three, but that was from
an anthropologist named Ernest Becker, and he was writing this
as he was dying himself, so he was in a
position to really give a good, you know, pretty moving
first person account, and he talked about sort of you know,
(07:32):
a good death and accepting the inevitability and stuff like that.
So these things were sort of happening in the cultural
movement when a woman, a hero i think a named
Cecily Saunders came along, eventually the founder of medical director
of Saint Christopher's Hospice in London, and she really changed
the game and kind of birthed the whole sort of
(07:53):
modern hospice movement.
Speaker 2 (07:55):
Yeah, she had a bad back from a young age
and apparently it kept her from her desired career of nursing,
so she instead became basically a social worker. Uh, at
the time they called a lady almoner or distributor of alms, right,
So it's pretty old timey, but it does kind of
(08:16):
it's a nod back to the original hospice which were
founded in the Crusades by the Roman Catholic Church. Ironically,
Cicily Saunders was raised an atheist, but she had a
conversion to Christianity, evangelical Christianity, even when she went on
vacation with a Christian friend and her family. And one
of the other big experiences that letter to found the
(08:39):
hospice movement essentially was she had like some friendships with
some people that she helped essentially as they were dying,
and really kind of was moved by these friendships and
wanted to make sure that other people had that same experience.
So she did something that I mean just kind of
I think really gets across kind of person she was.
(09:00):
And she went to medical school to make her voice
a little more credible.
Speaker 1 (09:05):
Yeah, she started medical school at age thirty three. This
is in the nineteen fifties, and she finished medical school,
she was able to work as a physician. She started
writing articles and stuff about this about people, you know,
being deserted or feeling like they'd been deserted by their doctors,
like the closer they got to death like we were
talking about, and said, hey, there's got to be a
(09:28):
better way to take care of people, not only physically,
but emotionally and spiritually as they as they near death.
So she, you know, got that medical degree, got a
research job at a hospital, started studying. You know, she
wanted to have a legitimate sort of background for this
so people didn't think she was just some some wacky
(09:49):
impath trying to do good, which you know should be enough.
But she figured she was armed with medical training and
real data and on like pain management stuff, that she
would go a lot further in She did.
Speaker 2 (10:01):
Yeah, she went and studied pain management firsthand so she
could come up with her own protocols. One of those
protocols that was really groundbreaking and went against the norm,
was to give dying patients not just heavy doses of
morphine to make sure that they weren't in pain, but
also cocaine to keep them from just being kind of
doped up for the rest of their lives. She would
(10:25):
find out what liquor they preferred and would make sure
that they had their liquor and all of this sounds
like just completely reckless and careless, but she had before
and after pictures of these people terminal cancer patients who
in the before pictures before they had been treated with
her new protocol of pain management and I guess mood
(10:45):
management too if you think about it. They did not
look very good. They looked like terminal cancer patients. And
afterward they were sitting up in bed, perked up. Some
had taken up hobbies like knitting. And she would show
these before and after pictures when she went around the
world speaking on behalf of hospice as she was trying
to found it, and like she would get converts at
(11:08):
every talk she gave just from the before and after
pictures alone.
Speaker 1 (11:12):
Yeah, it was pretty remarkable. This all culminated in nineteen
sixty seven when she founded Saint Christopher's Hospice, Like like
I mentioned earlier in London and kind of right off
the bat, she said, all right, we have a new
way to deal with pain management. We're going to get
rid of visiting hours and people family can come and
go when it's convenient for them, and we're going to
(11:33):
not talk about just you know, physical pain. We're going
to talk about what I call total pain or what
she called that. You know, like we mentioned emotional support,
social support, spiritual suffering that happens with people. And one
of the people that she worked a lot with was
a nurse in the US named Florence Wald who ended
up doing the same thing. In the US. She said,
(11:55):
I think we need this over here. She started up
the very first hospice in Branford, Connecticut and the United States,
and that was six years later after the one in
London in nineteen seventy three.
Speaker 2 (12:06):
Yeah, that first American hospice. They tried a few names
out before they settled on the final one, Hospice rus
MC Dying, and then they just kind of went with
the straight name. Well all right, so yeah, so hospice
that's spread pretty quickly. I think you said Saint Christopher's
opened up in nineteen sixty seven and the one in
(12:29):
Branford opened up in nineteen seventy three. That's pretty good
traction to create a brand new idea in both the
UK and the US and start spreading it around the world.
And one of the things I think you said about
Saint Christopher's was, even though it was religious or at
least spiritual, it was non denominational, and that is a
(12:50):
huge point about hospice that is lost on a lot
of people. I think a lot of people associated with
religious groups still and like, if you're not, say Christian,
you wouldn't really want to go to a Christian hospice.
That is not at all the way that hospices work.
And in fact, there's plenty of people who are atheists.
They are humanists and they just are like those empathic
(13:13):
do gooders that you were speaking about earlier, and none
of these philosophies clash because they all come together to
essentially say, one of the big parts of dying is
some sort of spirituality or at least some sort of
peace that we associate with spirituality, and it doesn't matter how
you get there, we're all just kind of coming together
(13:35):
to make sure that everybody can experience that. It's a
big misunderstanding of hospice sometimes.
Speaker 1 (13:40):
Yeah, for sure, in the US it's usually, or at
least at first, it was done at home. That was
a difference from the early ones in the UK they
were in patient facilities. But in the US, you know,
it was sort of a budget issue at first because
they couldn't get these facilities and pay for them. But
I think they also realized that people wanted to die
(14:01):
at home. And there was also this sort of long
running institutional distrust that Americans had, and it was a
lot of volunteer work at first, like almost entirely volunteer
early on. It was sometime, like we mentioned, people in
the clergy still doing this kind of work after centuries
of doing so, doctors that were moonlighting that wanted to
(14:22):
help out, and a movement was was, you know, clearly growing,
and it made government sit up and take notice when
they realized that it was saving money on healthcare, because
not only was the movement growing and people were just
feeling better about it, but it was keeping people out
of the hospital sort of off and on, off and on,
(14:42):
off and on, and so much though that the US
government and the Reagan administration said, you know what we
should we should get this covered. And in nineteen eighty two,
the hospice Medicare benefit went through, which allowed people all
of a sudden to be able to pay from you know,
staff run by professionals that were also paid and you know,
(15:04):
get it covered through Medicare.
Speaker 2 (15:06):
Yeah, which opened up the door for people who wanted
to help people during the final days or weeks of
their life, but there wasn't a career associated with it.
Now there was, so you could you could pursue that
kind of medicine, end of life medicine. That's pretty cool
that that was a huge change. I suspect that the
(15:27):
saving money had a lot to do with it, though.
Speaker 1 (15:30):
Yeah, that's usually the case.
Speaker 2 (15:31):
And the reason why, we'll just spell it out explicitly.
The reason why it saves money is because you're taking
a patient off of a very expensive track, which is
a lot of different medical procedures and treatments, and saying
we're like, you're not going to go for the curative
treatment route anymore. We're going to take you out of
this crazy nutso medical world and put you in a
(15:53):
much more peaceful, tranquil world where you can end your
days as a happier person rather than feeling like a
guinea pig being experimented on. And it's just much cheaper
to do that too, as you can imagine.
Speaker 1 (16:07):
It feels like a good breakpoint. Yeah, yay, all right,
we'll come back and we'll talk about how the modern
system works right after this.
Speaker 2 (16:42):
So here in the United States, Chuck Hospice is usually
paid for by Medicare, which is federal insurance coverage for
people who are retirees typically or maybe disabled, and then
also sometimes Medicaid, which covers lower income Americans. And the
upshot of all this is that if you are dying
(17:03):
and choose to go on hospice care, you are not
charged for this, and that is a wonderful thing that
the federal government does. Apparently the UK is very much
like that, but a lot of it is donation driven
rather than paid for by the government, which does chip in,
but the lion's share is paid for by donations in
the UK. But there's eligibility requirements that basically say like,
(17:26):
if you don't check these boxes or if you stop
checking these boxes at any point, you can't be in
hospice anymore.
Speaker 1 (17:33):
Yeah, and those boxes specifically, you have to have two
doctors certify that you have and this is for Medicare,
you know, to get it covered, not just to get
into hospice. Right, you have to have a terminal illness,
You have to have six months or less to live,
and you cannot be going after curative treatments. And we'll
(17:54):
talk about some I don't even know if there are exceptions.
But some things that some people might think are curative
treatments and a curate of treatments. That doesn't mean like
they don't ask for anything at all.
Speaker 2 (18:05):
You know, you can't have a band aid.
Speaker 1 (18:07):
Yeah, you're on your own. So we'll get into those.
But and this is going to be a sticking point
that kind of comes up later and some of the
failings of the current system. But Medicare pays hospice companies
and agencies a daily rate instead of for specific services
they provide like like basically all the other medical treatment
(18:29):
you're ever going to get, and there are four levels
of that care and there are going to be different
rates depending on the level that you're going to get
and also where you.
Speaker 2 (18:40):
Are right, So if you're running a hospice, you would
get a flat fee paid by the government for a
patient who's in routine home care, which is you're not
in crisis, you're still dying, but you're doing okay. And
that usually is just a visit maybe a couple of
times a week. They're coming by to make sure that
(19:01):
their meds are going down right, they maybe have like
their nutrition going there's just essentially just checking on you
that's routine home care. There's also continuous home care where
if that patient slips into a crisis, like maybe they
start vomiting uncontrollably, they start suffering uncontrollable pain, that their
meds aren't doing anything for anymore, changes in consciousness all
(19:23):
of a sudden, Now they have twenty four to seven
hospice access at home.
Speaker 1 (19:30):
Yeah, there's also there's a couple of more. There's inpatient
respite care. That's when a patient goes into like a
you know, they have to leave home to go into
a physical hospice center for up to five days. A
lot of times this is to give their caregiver time off,
because that's one of the brutal parts about end of
life is and I say burden on the family, not
(19:51):
like what a hassle, but you know, it is a
burden on the family. Yeah, people have to besides the
emotional devastation they're going through a lot of times, have
to rearrange their jobs and like even leave jobs sometime
to do this kind of thing full time. So it
can be quite a heavy burden on a family.
Speaker 2 (20:10):
Yeah. Actually, chuck that that's a if you look up
downsides of hospice that's pretty much the number one issue
with it is that it transfers responsibility for caring for
the dying patient from say like a hospital to their family.
And that's it is. It's a very big deal. Yeah.
Speaker 1 (20:29):
And then the last one is general and patient care,
and that is when you're addressing pain control or any
kind of symptom management that you can't that you have
to like go in and take care of at a
specific place. It's not the kind of thing you can
do at home generally. And then you know, palliates of
care is a big part of it. That's what we
kind of mentioned earlier, is is just making people feel
(20:50):
better toward the end. You know, I mentioned things that
don't count as curative treatment, like if you're if you
have heart like active heart failure, they can try and
reverse that. Or if you have some like nasty bedsword
that gets an infection, that that's not going to boot
you off covered hospice care to get that taken care of.
Speaker 2 (21:13):
No, the key to being covered for hospice under Medicare
is that you are not pursuing treatment to cure the
thing that's got you terminally ill. Right, So, like you said,
if you have to develop a heart condition, but that's
not what's killing you. You have terminal cancer, they can,
you know, treat your heart condition. And even if you
(21:33):
do have terminal cancer, if you have nausea from cancer,
pain from cancer, they're going to treat that because they're
not trying to cure the cancer. You have to give
up things like radiation or chemotherapy. Those are curative treatments.
But there's the idea that they're just like, nope, sorry,
we're just going to put you in bed and basically
let you lay there. That's not at all what you
(21:55):
have to give up in order to enter hospice.
Speaker 1 (21:58):
Yeah, and you know, the hospice workers are doing a
lot of stuff for you that goes above and beyond
just making you feel better or maybe sitting with you
and like you know, brushing your hair, Like there's all
that stuff that they're doing, bathing you, housekeeping sometimes you know,
helping out with gathering and administering the medications. But you
(22:23):
know they're doing all kinds of stuff. They might be
shopping for you, they might be babysitting for your family
to give you know, the like we mentioned the people
in your family. They're caring for you, like to give
them a break. They may help with fundraising if you have, like,
you know, money you need raise for your treatment. They
may bring in music and comedy performances to hospice centers.
(22:46):
People that cut hair, like volunteers that will come in
and style somebody's hair. Even I remember that was a
big deal for Emily's grandmother near the end, is you
know that she wanted her hair done and to look
like she looked, And that stuff goes a long way
to just putting people at ease, you know.
Speaker 2 (23:03):
Oh for sure. Another one that volunteers can do is
take care of the person's pet to make sure that
if the person is opting for in home hospice, that
their pet doesn't have to go live with somebody else
because they can't care for it anymore. So you can
go and feed somebody's pet, take them for a walk,
change the litter box, and then something as simple as
(23:23):
just sitting with somebody and watching TV with them is enough.
And like this is just a volunteering opportunity of the
United States, in the UK, basically anywhere there's hospice, they
would very much like you to volunteer to just basically
be there and just being a human being who can
drive a car over to somebody's house is essentially the qualifications'
(23:44):
that's basically all you need to do, and they'll tell
you what to do from there. But no one would
expect you to, like, you know, inject the person. As
a matter of fact, you probably get in big trouble
if you did inject the person with anything. You just
need to be there. And in addition to just being
there for the person, the pay like you said, that
gives the caregiver some time to just go take a shower,
(24:06):
do something, just stop being a caregiver for a couple
of hours too.
Speaker 1 (24:10):
Yeah, you know, even though a lot of them are professionals,
like most of them now, there's still quite a lot
of volunteers that do this kind of thing. That Medicare
law that talked about in nineteen eighty two that stipulated
that hospice facilities have at least five percent of the
patient hours provided for by volunteers. So that's one of
(24:31):
the reasons. And also just because there are people in
the world. You know, some people have maybe gone through
this with the family member and then they want to
give back. Some people are just wired this way as
impaths to want to help people. And then sometimes it's
people that are preparing for career in healthcare and you know,
getting in a hospice and kind of going through the
(24:53):
worst of the worst situations, is I imagine pretty good preparation
on dealing with any kind of patient.
Speaker 2 (24:59):
Yeah, yeah, And you would prepare for a career in
that because hospices, like you said, they are professionally staffed,
and not just with nurses, not just with hospice doctors,
but social workers, bereavement counselors, some of those clergy and
just general aids who can come together and help with
that thing that Sicily Saunders started kind of seeing clearly
(25:23):
the total pain, where you know, if you have psychological pain,
it's going to make your physical pain exacerbated and vice versa.
And the worse off you are, the more hesitant people
might be to come visit you because they feel hopeless
or they're just freaked out or something like that. So
now you have social pain. So if you have all
these people coming together to treat the person's total pain,
(25:44):
you have a much calmer, happier again good death. And
those are called in the hospice industries interdisciplinary groups and
they do. They form a team for each patient to
figure out what to do for each of the patients
to help them find peace and comfort and calm.
Speaker 1 (26:02):
Yeah, and this is a you know, it's a booming
industry now in the United States, and we'll sort of
get to the downsides of that and a little bit.
But statistically, from two thousand hospice centers in two thousand
and one to about fifty seven hundred today twenty you know,
(26:23):
twenty four to twenty five years later, it's really grown
a lot. Utilization grew by thirty two percent between twenty
thirteen and twenty twenty two. There was a twenty five
percent increase in Medicare beneficiaries. Obviously is the boomer generation
is aging, but that doesn't account for all of it,
you know, twenty five compared to thirty two percent. About
(26:45):
half of people now in the United States and roll
in a hospice before their death. If you have cancer,
you're far more likely to do so. As well as
being female and more educated and also older, which it
first seemed like a like a well of course, but
just so far as to say, if you're someone very
(27:06):
tragically in your younger life, that is stricken with something
like this, you're far less likely to enroll in hospice.
Speaker 2 (27:12):
Yeah, and there's actually a lot of reasons why people
don't enroll in hospice. A good majority of them just
don't either aren't really aware of it or don't understand it.
And there's stigmas about hospice too, Like there's a whole
idea that if you go into hospice, you're giving up
on fighting for your life, you're giving up on living,
and that's just absolutely not true. Like, if you have
(27:33):
a terminal illness and it's really no longer treatable, a
good doctor will say, like, there's nothing more we can
do for you. There's plenty of stuff we can do
for you, but none of it is going to extend
your life. It's going to make your last days pretty miserable.
We recommend that you go into hospice and have like
good last days, hang out with your friends and family,
(27:53):
like be peaceful. That's actually, as far as the American
Society of Clinical Oncology is concerned, that's a sign that
you've had good cancer care that toward the end, in
the last few weeks, your cancer team says you've reached
the you know, incurable stage. There's nothing we can do
for you anymore except let's put you into hospice. The
(28:16):
problem is is there are plenty of doctors out there
who do see that as quitting, do see that it
is giving up, and are known to steer people into
hospice too late, to where essentially they just spend like
the last couple or few days in hospice and they
don't have a chance to actually develop what again is
referred to as a good death.
Speaker 1 (28:37):
Yeah, and there's even evidence that going like trying to
cure yourself and sort of ceasing that process and starting
up with hospice can actually make people live longer a
lot of reasons. Maybe you're being monitored a little more closely,
Maybe maybe your symptoms are being managed a little little better,
(28:57):
and just everything that goes into the non physical you know,
sick and dying part that we've been talking about, the
emotional part and everything else, Like if all of that
is eased, studies show that you can you can make
it a little bit longer.
Speaker 2 (29:12):
Yeah, that actually happened to Umi's dead. He was in
hospice and given I remember not very Yeah, there was
just a just a pretty raw time. He was given
not much time to live at all, I think like days,
and he didn't didn't pass, and you started to notice
he was actually kind of he was eating more, he
(29:32):
was his mood was starting to improve, and she convinced
the hospice doctor that he was not dying anymore. And
one of the things that became really clear that being
in hospice at home can do to improve your health
is that you're getting better nutrition, you're getting good sleep,
you're surrounded by people who don't have to come see
(29:53):
you in the hospital setting during visiting hours, and all
of those things are terribly managed in the hospital, so
at home you can just get better and better. And
Human's dad eventually left hospice, was discharged alive, and went
on to live for another three years.
Speaker 1 (30:09):
Man, I remember all that going down and Jerry and
I all of us being like, oh man, this is like,
this seems like it's it, and you were bringing reports
You're like, man, the darnedest thing. Yeah, and then I
just I think we all suspected it was just going
to happen again right after that, and it was, Yeah,
it was a few years. It was just what a story.
Speaker 2 (30:31):
Yeah, I've never been more proud of anybody than I'm
of Vium. She was the only one who saw, like, yeah,
she saw it, and she had to convince everybody else,
including me, that he's not dying, and she brought him
back for sure.
Speaker 1 (30:45):
So yeah, what a gift.
Speaker 2 (30:46):
It really was a gift. Yeah, I'm very proud of her.
Speaker 1 (30:50):
All right, shall we take another break?
Speaker 2 (30:53):
I think we should.
Speaker 1 (30:53):
Man, all right, we'll be right back, and we're going
to finish up with hospice right after this one thing
(31:25):
we should mention kind of briefly. We don't have to
get too much into it, but hospice and right to
die and assisted dying, these are two things that you
know don't go together, but they obviously kind of do
go together in a lot of ways because you've got
a group of people that are it's the same group
(31:45):
of people. Mainly. It's even i think legally designated in
places where you do have the right to die, you
have to have doctor sign off that you're within six
months and there is no cure, and it kind of
is in locksed up with hospice. But it's not the
same thing because the you know, it's just not the
(32:06):
World Health Organization very much defines palliative care as something
that neither hastens nor postpones death. It is not the
point of hospice to go in and you know, find
an impath who will help assist you along a little
quicker if you live in one of those states. I
think it's an amazing gift to be able to do that,
(32:27):
and there are there's a track for doing that, but
it's not hospice. No.
Speaker 2 (32:32):
And the reason why it riles up hospice people who
are against that is because there are one of the
reasons that people do choose medically assisted dying is to
end their suffering, and hospice people are like, no, we
know how to end their suffering without them having to die. Yeah,
And that's why it really gets under their skin. Although
that said, there are plenty of hospice people, probably humanists,
(32:55):
who are like, it's anybody's inalienable right to choose how
or when they die.
Speaker 1 (33:02):
Yeah.
Speaker 2 (33:03):
So, yeah, it is kind of a tricky thing, but
it isn't. I think it is generally unfairly associated with
hospice and even palliative care. I don't think we said
explicitly that is to treat and manage symptoms, pain, nausea,
that kind of stuff, symptoms that come along with terminal illnesses,
and that is a part of hospice, but not all
palliative care is hospice. You can get that same stuff
(33:25):
as you're pursuing like curative treatments, right, So it's not
like they're going to be like you're getting curative treatments
for cancer. Sorry, we can't do anything about the nausea.
Then it makes it. It has a place in both
of them. And it has nothing to do with assisting
someone and dying. It has to do with helping them
die comfortably when they die naturally.
Speaker 1 (33:42):
Yeah, and you know you're not going to get you'll
get morphine and you'll get like the good stuff these days,
morphine plus. But you're not going to get the cocaine
and the liquor.
Speaker 2 (33:53):
No. I mean unless you have a family member who
knows somebody.
Speaker 1 (33:57):
I mean there's somebody's got a guy maybe, yeah, or
if you just have like a you know, pretty empathic,
like really empathic, like on the downlow hospice worker, right.
Speaker 2 (34:10):
And I mean even if you do score for them,
they might not even want it. Like I tried to
give you and he's dad a bunch of cocaine and
he's like, no, I'm good with the pain stuff. I'm
on now.
Speaker 1 (34:20):
Yeah, and then what to do with it? You know?
Uh so look we found another joke. Amazing, so right
right before the dark side.
Speaker 2 (34:30):
Yeah, because there is a dark side to this, and again,
the one downside to hospices it puts it's just the
burden on the caregivers. We'll talk a little bit more
about that in a second. But the kind of generally
agreed upon dark side of hospice is that there's such
a thing as for profit hospices. And contrary to our
private equity theme in our private equity episode, we should
(34:53):
say that there are plenty of for profit hospitals hospices
that are perfectly well run.
Speaker 1 (34:58):
Yeah.
Speaker 2 (34:59):
The people who who the family members who have patients
and family dying there are totally happy give them great reviews.
Being for profit as a hospice isn't necessarily a bad thing.
Where they start to get lower marks than other kinds
of hospices, specifically nonprofit hospices is when they are part
of a publicly owned corporation, like a hospice went with
(35:21):
the IPO at some.
Speaker 1 (35:23):
Point, Yeah, like a chain.
Speaker 2 (35:24):
Exactly or surprisingly or not, private equity owns the hospice.
And the reason why it's problematic is because the way
that payment is structured has a built in incentive for
for profit hospices to cut corners and cut costs.
Speaker 1 (35:42):
Yeah, there was a survey in twenty twenty four that
twenty five percent of hospices in the US are owned
by private equity firms. Now, so you can refer to
that episode as to exactly what goes into that. But
you know, I said earlier to put a pin in
the payment structure, which is they don't get paid through Medicare,
they don't get paid out per treatment given or for
(36:04):
specific treatments given. It's just this flat fee. Uh. And obviously,
if you have a chain, a hospice chain that is
for profit and has gone through the IPO process and
has shareholders to answer to, very sadly, many times you're
going to get hospice centers that that get that flat rate,
(36:27):
but they're cutting staff and people are getting the bare
minimum treatment required by law.
Speaker 2 (36:33):
Right, and I saw there's a there's a thing where
it's supposedly federal regulations say that you have to visit
an in home hospice patient no less than twice a month. Yeah,
just twice a month, right, And then a lot of
for profit hospices like just basically do that minimum. And
(36:53):
if you most people agree, if you are in some
sort of crisis, you're getting more visits. But if you're
not in a since, you're getting fewer visits because they
need to balance that out to cut costs, right or
keep costs down. It turns out that's a myth. The
federal government doesn't require two visits a month at minimum.
The federal government doesn't have any requirements for how often
(37:15):
or how little a hospice has to visit a patient
at home.
Speaker 1 (37:19):
They have no requirements or they're not enforcing anything.
Speaker 2 (37:22):
They don't have any requirements. And that's another problem too.
They don't enforce a lot of the rules that there are,
and there's already a lot of rules that have loopholes.
So this is a system that is just set up
for abuse. Luckily, most of the people who run hospice
companies they're not in it to abuse the system. They're
(37:45):
in it to help people. But there is a place
for bad actors to milk the system overcharge. Like apparently
there's it's extremely complex, but there are ways that you
can charge more than the flat ray per day. And
I guess a study from I THINK twenty twenty one
in the Journal of Geriatric Care. I THINK found that
(38:08):
for profit hospices tend to charge medicare thirty four percent
more than nonprofit hospices. There's just a lot of stuff
you can do to gain the system.
Speaker 1 (38:20):
Yeah, and you know, to be clear, hospice in general
gets good marks from people. Even for profit hospices generally
get good marks from people. But they've drilled down and
they found the ones that get the lowest ratings for
care are the ones that are publicly traded corporations and
(38:42):
owned and or owned by private equity firms. So do
your research, you know, if you're getting into this, because
there's there are all Like we said, there's fifty seven
hundred of them in the US, and hopefully there's one
near you that will take care of you a little
bit better to remain on hospice. There's also you know,
all kinds of rules as far as what's called live discharge, right,
(39:05):
you have to demonstrate ongoing steady decline at recertification inuals
every ninety days for the first six months, then every
sixty days after until death or discharge, and discharges is
basically exactly what it sounds like. You're discharged, like you're
discharge at a hospital. It may be because you want
(39:27):
to try, you know, curative care again, which is which
is great, and you're right, it could because of an
emergency that you have to go to the hospital for
which will boot you off, which really stinks. But there
are guidelines about discharge and not all of them seem fair.
Speaker 2 (39:42):
Yeah, And you can imagine if you're dying of a
terminal illness being moved from a hospice to a hospital
to continue treatment maybe home, where you have a bunch
of emergency room visits ahead of you because your symptoms
are going to flare up. It's not a comfortable thing
to be discharged from one place to another. It's also
a huge burden on the family too, because again the
(40:04):
care is being transferred from medical professionals to the family.
But also the whole premise of it is just faulty
because not all diseases follow the same trajectory in the
decline of the person, and yet they're all held to
the same standard, which is essentially the standard that cancer
(40:24):
creates a decline and a patient too, So essentially just saying,
if you have a terminal illness that's certified by doctors,
that doctors recertify, say every sixty days, you don't have
to face a live discharge, like you can stay in
hospice until you die. Your death doesn't have to cooperate
with federal guidelines. That would be a huge change and
(40:45):
a really simple one to hospice rules, but apparently that's
not happening right now.
Speaker 1 (40:52):
Yeah, and even if you know you aren't moved home,
let's say, let's say you move to a different facility,
because there definitely is a problem with like you know,
not having enough beds at different places, and the family
gets can get ideally into a routine at least, and
you know, they kind of figure it out. And then
(41:13):
with Emily's grandmother, it seemed like once we everyone got
into the routine and everything had kind of been figured out,
then all of a sudden some change would happen where
Mary would have to go somewhere else, and then all
of a sudden, it's new visiting hours, it's in a
different place and everyone and you know, that's just on
the family of course, just like you mentioned, the move
for the patient is really burdensome. So there's still so
(41:36):
much they can do, I think, to clean this whole
system up, you know.
Speaker 2 (41:40):
For sure, and even chuck if they're not impatient. Just
at home hospice basically overlays this support structure for you,
the hospice patient in your home right, so you have
like medical equipment, you have medications that are like delivered
to you at times. If you need a walker, you
got to walk. Just all of this support like you've
(42:02):
got bereavema counselors dropping by, if a social worker, you're
doing telehealth visits with a well like all it just
stops when you're discharged from hospice alive. They come and
they take the medical equipment, they take your walker away,
You stop getting your medications delivered to you. You might
not even have those prescriptions any longer after that, if
they were prescribed by the hospice doctor. It's a really
(42:25):
bad jam. And the other thing about it too, that
Medicare has often taken to task for is they don't
really pay enough for in home hospice, Like that's the
lowest pay rating I guess is in home non crisis
hospice care, and that means that if you are trying
(42:49):
to stay at home, you either have to have a
bunch of family members who are willing to commit their
lives to taking care of you in your final days,
or you have to have a bunch of money to
pay somebody to do that same thing. And if you
don't and you want to die at home, you're sol
because you have nobody to take care of you at home,
because there's not enough pay to pay people in hospice
(43:10):
to come by, and not enough volunteers to take care
of you take care of your needs on a regular basis.
Speaker 1 (43:17):
You know, Grandma Mary, former foremost general in the stuff
you should know Army, had a T shirt that says
you can take my walker when you pry it for
my cold dead hand.
Speaker 2 (43:28):
That's all, Oh my god, that would be such a
great T shirt. We got to get that one.
Speaker 1 (43:33):
You imagine taking a walker from somebody for that that's
your job. Like you're the person they're like, yeah, go
over to go over to Grandma Mary's house and take
her stuff.
Speaker 2 (43:43):
I know it couldn't even be the person who also
delivers it, because it's such a mean job that there
has to just be one specialist who doesn't like anybody
who just goes around the houses and takes the medical
equipment back.
Speaker 1 (43:54):
Yeah, sin Ronnie, uh, you got anything else? No, I
have nothing else. Hopefully this serves some people, and you know,
just just look around and do your homework and see
if you can find a place that works for you
and your family.
Speaker 2 (44:09):
Yeah. And another good piece of advice is to do
that sooner than later, like to share your wishes with
your family. Maybe if you go so far as to
create a living will or some sort of medical documents
saying like I do want to go into hospice, I
want to stop curative treatment at some point. And then yeah,
do like read reviews, like just find out who you
(44:29):
would go to if it starts to seem like that
might be a possibility coming down the pike.
Speaker 1 (44:34):
Yeah, oh man, my god, get a living will. No,
I don't care how old you are. That's it's very
easy thing to do. And it's that and a will
or the two biggest gifts you can give your family
as you grow old.
Speaker 2 (44:46):
That's right, you want to impress your parents in your
seven start thinking about a living will, Start talking about
a living will to your parents. Yeah, and they will
just be blown away totally.
Speaker 1 (44:56):
That seems like something in like a TV show about
a precocious kid.
Speaker 2 (44:59):
Yeah, for sure, like Alex p.
Speaker 1 (45:02):
Keaton, he would do that, Yeah, exactly. How you know
he had one.
Speaker 2 (45:06):
So before we finished, I just also wanted to give
a huge shout out to Yumi's dad's hospice doctor, doctor Pijari,
who did not have any sort of ego and was
totally willing to listen to Yumi and helped get her
dad out of hospice too.
Speaker 1 (45:20):
So I love it.
Speaker 2 (45:21):
Shout out doctor Pajari. And since I shouted out doctor Pejari,
as was foretold by the Ruins in two thousand and eight,
I've just unlocked the listener mail.
Speaker 1 (45:33):
This is gen z Stare speaks back. I have three
emails I'm going to try and sort of hit the
highlights of because we got what I felt like was
three really sort of legitimate answers as to what the
gen z Stare is all about. That now I understand,
you know, it may not be my jam, but like
(45:55):
it doesn't need to be my jam because I don't
have to put my gen X stuff onto gen Z.
That's that's true, Hey guys, twenty two years old gen
Z very much in the gen Z stare era. I
work in customer service, which is where I use it
the most. But we were raised with if you have
nothing nice to say, don't say thing at all, so
hence staring. So I guess they took that very much literally. Yeah,
(46:18):
it's not something just done to adults either, and this
person points out that they do it for their friends.
As far as the phone call, no one calls us
when they do, it's a spam call, which I was
always told the double hello people, I didn't know that
was a thing. When they answered the phone accused the robot.
Speaker 2 (46:34):
Did you know that?
Speaker 1 (46:35):
Yes, okay, I didn't know that, so I just answer
and sit in silence until the awkward is this Josie
follows and that is from Josie Boozer. This is another one,
Hey guys, gen Z person. I think the explanation you're
probably looking for is a lot of gen Z are
using it. Are used to being interrupted, not taking taken seriously,
(46:59):
or have our responses to stories be given a weird look.
The example for someone finishes the story and the person
just stand there can either be one. I don't have
anything interesting to say about that story, and I don't
want to make something up. Two, I'm so used to
having my opinions not taken seriously that I'm just not
even going to bother responding. Many of us are socially
awkward and have trouble creating small talk with people that
(47:20):
aren't close to us. Another reason maybe because most of
our conversations are online and have been online as we aged,
and many people will give an emoji reaction to it
a long story or just get a smile and that's cool.
In response. That is from Sam Okay, so it's kind
of tracking along the same lines. And then this is
(47:42):
from Catherine, who's been listening for five years as a
twenty three year old. I've heard people blame the pandemic,
but I don't think it fully explains a generational trend
since we all live through the same period. I think
there are two main causes. First, my generation has spent
much more time in front of a screen than any
previous generations did. We've grown used to one content consumption.
You would look crazy if you responded to a YouTube
(48:03):
video the way you would a phone call or an
in person conversation. So we're a little out of practice
with responding to prompts instead of just watching something. This
is all makes total.
Speaker 2 (48:13):
Sense, It totally does.
Speaker 1 (48:15):
And then secondly, gen Z seems to be more likely
than previous generations to forego the fake politeness that used
to be expected in conversations. I think this is partially
because we're constantly inundated with advertisements. We've become highly sensitive
to fake niceness because someone is trying to manipulate our
emotions at every turn and sell us something. My generation
(48:35):
seems much more likely to prefer genuine reactions, even if
they're negative, because when we're online, it's the only way
to note something is not an ad wo man, this
is something else? Huh.
Speaker 2 (48:49):
Yeah. Those are deep from Josie, Sam and Catherine right.
Speaker 1 (48:54):
Yeah, And I think they all sort of track along
the same lines, and that explains a lot. So, Yeah,
if a gen Z person is just staring at you,
maybe you think maybe they think you're a real jerk
and just don't want to say anything.
Speaker 2 (49:07):
Right, they assume you're manipulating them, right then?
Speaker 1 (49:10):
Yeah, or the other reasons mentioned, I think they're all
valid in their own generational way.
Speaker 2 (49:15):
I feel like that really explains the discomfort that people
like say from gen X get when we're treated like
that because we are used to fake niceness I know,
you know, and like we're willing to go along with
that kind of thing just to keep from a situation
being uncomfortable.
Speaker 1 (49:30):
Yeah. Also, though, quick tip the if you don't have
anything nice to say, don't say anything at all. I
recently went through an experience with a TO two artist
getting my tattoo covered up with my dogs and it's
a great I he'd I appreciate it. He did a
great job, but he, let's just say, we weren't the
(49:52):
same kind of person. He had a lot of interesting
theories on things. And here's a little tip to my
gen Z friends. You don't have to not say anything.
Just keep nodding and go interesting.
Speaker 2 (50:05):
Oh yeah, I.
Speaker 1 (50:07):
Did that over and over and over for hours.
Speaker 2 (50:09):
It goes a long way.
Speaker 1 (50:11):
Yeah interesting and sure, well no, I don't even know
if I am lying. It was interesting, yeah, just not
for me.
Speaker 2 (50:19):
Right exactly. Maybe the tone was a lie.
Speaker 1 (50:23):
Maybe.
Speaker 2 (50:23):
So the guy did you an amazing job? You said
he did it like freehand too.
Speaker 1 (50:28):
Right. Oh yeah, I'll put pictures up at Chuck the podcaster.
He's a sort of amazing artistic dude. Yep, just like
looking at pictures of dogs and drawing them on my arm.
It wasn't like stenciled out of my arm first.
Speaker 2 (50:45):
It's nuts man. Well, thanks a lot again to Josie,
Sam and Catherine for explaining that to us. You guys
did a knockout job and we appreciate it. And I'm
not being fake nice right now. I'm being quite legitimate
and serious and genuine. If you want to get in
touch with us and tell us about your generation, we
(51:05):
love hearing that kind of stuff, you can send it
off to stuff Podcasts at iHeartRadio dot com.
Speaker 1 (51:13):
Stuff you Should Know is a production of iHeartRadio. For
more podcasts myheart Radio, visit the iHeartRadio app, Apple Podcasts,
or wherever you listen to your favorite shows,
Welcome to Stuff You Should Know, a production of iHeartRadio.
Speaker 2 (00:11):
Hey, and welcome to the podcast. I'm Josh, and there's
Chuck and Jerry's here too. So this is an old
fashioned root and tootin episode of Stuff you Should Know
and about something we needed to talk about. Chuck.
Speaker 1 (00:22):
Okay, okay, you remember back in like.
Speaker 2 (00:27):
The like about like the two thousand and nine ten
eleven era, when like death was all the rage people
were having, like death cafes and like creating living wills,
and it was just a big thing that everybody talked about.
When was this like two thousand and nine to two
thousand and maybe eleven.
Speaker 1 (00:46):
I don't remember that, but I'll take your word for it.
Speaker 2 (00:48):
It was a real thing, for sure. Unless I've just
completely lost my marbles and I just made up a
whole era of American culture. I don't think I did.
But that has died at so like that it's gone
back to death has gone back to being a bit
of a taboo topic, an uncomfortable topic, at least at
least here in the United States.
Speaker 1 (01:11):
I didn't know that either.
Speaker 2 (01:12):
It's true. I guess I'm just speaking for myself anecdotally.
Speaker 1 (01:17):
Oh okay, that makes a lot more sense.
Speaker 2 (01:19):
So okay, well let's just cut to the chase here.
There's this concept of a good death, yeah right, and
you can probably fill in a lot of the blanks
of what that means and what it means to you
at least, but there's actually like some components to it
that studies have found, like kind of bubble up to
the top that most people can agree this makes a
(01:40):
good death. There are things like getting to say goodbye
to friends and family, having those people at your side
if you want so. A certain amount of control over
the dying process is something being pain free, not suffering, sure,
being in an environment, and having a chance to like
kind of come to terms with the fact you're about
(02:01):
to expire. Those are some of the top things that
people say, like, this to me is a good death.
And not coincidentally, those are the kind of things that hospices,
which we're about to talk about today, are intended to provide.
That's the service they provide is to give you, the individual,
a good death. And it's not something that's relegated to
(02:23):
the rich. It's not something that's relegated to the educated.
It's for everybody. Everybody deserves to have a good death,
and that's pretty much the motto of hospice, And in fact,
I ran across one motto. It said, if you can't
add more days to life, add more life to days.
Speaker 1 (02:44):
That's great. It sounds a little too corporate slogany, but
I like the sentiment.
Speaker 2 (02:48):
Yeah, there's a mascot, Louis the dead guy who's like
always saying that slogan, and he did a partnership with
home Depot for some reason recently.
Speaker 1 (02:59):
Oh boy, well that explains the orange bed sheets and things, right,
all right, so that's probably the last semi joke we're
gonna make. You'll have to forgive us for that. We
did a whole episode on dying, and I don't even
know if we made one joke in that one, So.
Speaker 2 (03:14):
Sure we did, you think, yes? I absolutely think.
Speaker 1 (03:17):
All right, well we'll pair that with this one. And
because we've got a lot of great feedback on the
dying episode and how that could kind of help people out,
so yeah, maybe this will do the same. We should
probably go back in time a bit and explain the
history of hospice, because it is very recent. If you
look at sort of the timeline of people in the
world dying hospice has only been around since like the
(03:39):
sixties or seventies and the form that we know it
because previous to that, for all of time, basically medicine
was like, hey, we're here to cure people, and if
it turns out that we cannot cure you and that
the end is near, for a very very long time
until the last like you know, like I said, since
(04:01):
the sixties or seventies, very shamefully, hospitals and even doctors
would sort of like it was a reminder that they
couldn't save you, so they didn't spend a lot of
time with you. And there are a lot of you know,
well known reports of people kind of like scurrying past
rooms where people were in their final days in a
(04:22):
hospital and stuff like that.
Speaker 2 (04:23):
Yeah, they left the dying who were incurable now to
basically die alone. They withdrew support. That was just what
they did. And like you said, it was a reminder
of the failing of medicine. And this was a time
when modern medicine was not in any kind of mood
to be reminded of failings, because I mean, the twentieth
century was pretty triumphant for it. I mean, I saw
(04:45):
that infant mortality rate declined by ninety percent over the century.
There's like sanitation, clean drinking water, polar vaccine, like science
could do anything, and people who were incurable were just
a reminder that there were limits to that whole thing.
Speaker 1 (04:59):
That's right, right, and another thing that was going on.
And this is also pretty shameful. Well, I guess not shameful,
but they've since revisited how they look at pain management.
But yeah, you had to like really be in pain
to get pain management, and then that had to like
wear off and you had to be really in pain
(05:20):
again for them to administer more pain management. They were
worried about, you know, opioid addiction and stuff like that,
but you know, these days, it's it's definitely more like, hey,
you know, we're not worried about you getting addicted to
opioids in the final possibly days of your life. We
just want to make you feel okay.
Speaker 2 (05:39):
Yeah, that's definitely the hospice philosophy is you don't have
to wait until one pain killer wears off to get
another dose. You can you know, stay comfortable. That's the
point is to make the person comfortable. That's called palliative care.
We'll talk a little more about that, but it's essentially
just taking care of symptoms to keep people comfortable.
Speaker 1 (05:59):
Yeah, for sure, nuns were kind of on the scene
early on, providing you know, emotional support. They couldn't dose
out pain medication of course, and stuff like that, but
they you know, it was a lot of times it
was religious organizations that were stepping forward that were kind
of doing the hospice type work that would come along
in the sixties and seventies, thanks in part to a
(06:19):
couple of big landmark books that came out.
Speaker 2 (06:22):
Yeah, there was this whole thing in the sixties and
seventies that was kind of this rebellious streak that went
across like against some of the just unquestioned institutions, and
one of those was medicine and doctors and hospitals. But
there was a psychiatrist name Elizabeth Koubler Ross who very
famously came up with the five Stages of grief that
was in her nineteen sixty nine book on Death and Dying.
(06:45):
And in addition to being famous for coming up with
the Five Stages of grief, she also basically interviewed people
in the Chicago Hospital's ice you who were dying and
just found that they were just being totally neglect and
so she definitely lobbied for dying and dying people and
(07:05):
their families to be listened to and to be treated
rather than just ignored.
Speaker 1 (07:09):
Yeah, we talked about her and that book in our
dying episode. I don't think we talked about the Denial
of Death from nineteen seventy three, but that was from
an anthropologist named Ernest Becker, and he was writing this
as he was dying himself, so he was in a
position to really give a good, you know, pretty moving
first person account, and he talked about sort of you know,
(07:32):
a good death and accepting the inevitability and stuff like that.
So these things were sort of happening in the cultural
movement when a woman, a hero i think a named
Cecily Saunders came along, eventually the founder of medical director
of Saint Christopher's Hospice in London, and she really changed
the game and kind of birthed the whole sort of
(07:53):
modern hospice movement.
Speaker 2 (07:55):
Yeah, she had a bad back from a young age
and apparently it kept her from her desired career of nursing,
so she instead became basically a social worker. Uh, at
the time they called a lady almoner or distributor of alms, right,
So it's pretty old timey, but it does kind of
(08:16):
it's a nod back to the original hospice which were
founded in the Crusades by the Roman Catholic Church. Ironically,
Cicily Saunders was raised an atheist, but she had a
conversion to Christianity, evangelical Christianity, even when she went on
vacation with a Christian friend and her family. And one
of the other big experiences that letter to found the
(08:39):
hospice movement essentially was she had like some friendships with
some people that she helped essentially as they were dying,
and really kind of was moved by these friendships and
wanted to make sure that other people had that same experience.
So she did something that I mean just kind of
I think really gets across kind of person she was.
(09:00):
And she went to medical school to make her voice
a little more credible.
Speaker 1 (09:05):
Yeah, she started medical school at age thirty three. This
is in the nineteen fifties, and she finished medical school,
she was able to work as a physician. She started
writing articles and stuff about this about people, you know,
being deserted or feeling like they'd been deserted by their doctors,
like the closer they got to death like we were
talking about, and said, hey, there's got to be a
(09:28):
better way to take care of people, not only physically,
but emotionally and spiritually as they as they near death.
So she, you know, got that medical degree, got a
research job at a hospital, started studying. You know, she
wanted to have a legitimate sort of background for this
so people didn't think she was just some some wacky
(09:49):
impath trying to do good, which you know should be enough.
But she figured she was armed with medical training and
real data and on like pain management stuff, that she
would go a lot further in She did.
Speaker 2 (10:01):
Yeah, she went and studied pain management firsthand so she
could come up with her own protocols. One of those
protocols that was really groundbreaking and went against the norm,
was to give dying patients not just heavy doses of
morphine to make sure that they weren't in pain, but
also cocaine to keep them from just being kind of
doped up for the rest of their lives. She would
(10:25):
find out what liquor they preferred and would make sure
that they had their liquor and all of this sounds
like just completely reckless and careless, but she had before
and after pictures of these people terminal cancer patients who
in the before pictures before they had been treated with
her new protocol of pain management and I guess mood
(10:45):
management too if you think about it. They did not
look very good. They looked like terminal cancer patients. And
afterward they were sitting up in bed, perked up. Some
had taken up hobbies like knitting. And she would show
these before and after pictures when she went around the
world speaking on behalf of hospice as she was trying
to found it, and like she would get converts at
(11:08):
every talk she gave just from the before and after
pictures alone.
Speaker 1 (11:12):
Yeah, it was pretty remarkable. This all culminated in nineteen
sixty seven when she founded Saint Christopher's Hospice, Like like
I mentioned earlier in London and kind of right off
the bat, she said, all right, we have a new
way to deal with pain management. We're going to get
rid of visiting hours and people family can come and
go when it's convenient for them, and we're going to
(11:33):
not talk about just you know, physical pain. We're going
to talk about what I call total pain or what
she called that. You know, like we mentioned emotional support,
social support, spiritual suffering that happens with people. And one
of the people that she worked a lot with was
a nurse in the US named Florence Wald who ended
up doing the same thing. In the US. She said,
(11:55):
I think we need this over here. She started up
the very first hospice in Branford, Connecticut and the United States,
and that was six years later after the one in
London in nineteen seventy three.
Speaker 2 (12:06):
Yeah, that first American hospice. They tried a few names
out before they settled on the final one, Hospice rus
MC Dying, and then they just kind of went with
the straight name. Well all right, so yeah, so hospice
that's spread pretty quickly. I think you said Saint Christopher's
opened up in nineteen sixty seven and the one in
(12:29):
Branford opened up in nineteen seventy three. That's pretty good
traction to create a brand new idea in both the
UK and the US and start spreading it around the world.
And one of the things I think you said about
Saint Christopher's was, even though it was religious or at
least spiritual, it was non denominational, and that is a
(12:50):
huge point about hospice that is lost on a lot
of people. I think a lot of people associated with
religious groups still and like, if you're not, say Christian,
you wouldn't really want to go to a Christian hospice.
That is not at all the way that hospices work.
And in fact, there's plenty of people who are atheists.
They are humanists and they just are like those empathic
(13:13):
do gooders that you were speaking about earlier, and none
of these philosophies clash because they all come together to
essentially say, one of the big parts of dying is
some sort of spirituality or at least some sort of
peace that we associate with spirituality, and it doesn't matter how
you get there, we're all just kind of coming together
(13:35):
to make sure that everybody can experience that. It's a
big misunderstanding of hospice sometimes.
Speaker 1 (13:40):
Yeah, for sure, in the US it's usually, or at
least at first, it was done at home. That was
a difference from the early ones in the UK they
were in patient facilities. But in the US, you know,
it was sort of a budget issue at first because
they couldn't get these facilities and pay for them. But
I think they also realized that people wanted to die
(14:01):
at home. And there was also this sort of long
running institutional distrust that Americans had, and it was a
lot of volunteer work at first, like almost entirely volunteer
early on. It was sometime, like we mentioned, people in
the clergy still doing this kind of work after centuries
of doing so, doctors that were moonlighting that wanted to
(14:22):
help out, and a movement was was, you know, clearly growing,
and it made government sit up and take notice when
they realized that it was saving money on healthcare, because
not only was the movement growing and people were just
feeling better about it, but it was keeping people out
of the hospital sort of off and on, off and on,
(14:42):
off and on, and so much though that the US
government and the Reagan administration said, you know what we
should we should get this covered. And in nineteen eighty two,
the hospice Medicare benefit went through, which allowed people all
of a sudden to be able to pay from you know,
staff run by professionals that were also paid and you know,
(15:04):
get it covered through Medicare.
Speaker 2 (15:06):
Yeah, which opened up the door for people who wanted
to help people during the final days or weeks of
their life, but there wasn't a career associated with it.
Now there was, so you could you could pursue that
kind of medicine, end of life medicine. That's pretty cool
that that was a huge change. I suspect that the
(15:27):
saving money had a lot to do with it, though.
Speaker 1 (15:30):
Yeah, that's usually the case.
Speaker 2 (15:31):
And the reason why, we'll just spell it out explicitly.
The reason why it saves money is because you're taking
a patient off of a very expensive track, which is
a lot of different medical procedures and treatments, and saying
we're like, you're not going to go for the curative
treatment route anymore. We're going to take you out of
this crazy nutso medical world and put you in a
(15:53):
much more peaceful, tranquil world where you can end your
days as a happier person rather than feeling like a
guinea pig being experimented on. And it's just much cheaper
to do that too, as you can imagine.
Speaker 1 (16:07):
It feels like a good breakpoint. Yeah, yay, all right,
we'll come back and we'll talk about how the modern
system works right after this.
Speaker 2 (16:42):
So here in the United States, Chuck Hospice is usually
paid for by Medicare, which is federal insurance coverage for
people who are retirees typically or maybe disabled, and then
also sometimes Medicaid, which covers lower income Americans. And the
upshot of all this is that if you are dying
(17:03):
and choose to go on hospice care, you are not
charged for this, and that is a wonderful thing that
the federal government does. Apparently the UK is very much
like that, but a lot of it is donation driven
rather than paid for by the government, which does chip in,
but the lion's share is paid for by donations in
the UK. But there's eligibility requirements that basically say like,
(17:26):
if you don't check these boxes or if you stop
checking these boxes at any point, you can't be in
hospice anymore.
Speaker 1 (17:33):
Yeah, and those boxes specifically, you have to have two
doctors certify that you have and this is for Medicare,
you know, to get it covered, not just to get
into hospice. Right, you have to have a terminal illness,
You have to have six months or less to live,
and you cannot be going after curative treatments. And we'll
(17:54):
talk about some I don't even know if there are exceptions.
But some things that some people might think are curative
treatments and a curate of treatments. That doesn't mean like
they don't ask for anything at all.
Speaker 2 (18:05):
You know, you can't have a band aid.
Speaker 1 (18:07):
Yeah, you're on your own. So we'll get into those.
But and this is going to be a sticking point
that kind of comes up later and some of the
failings of the current system. But Medicare pays hospice companies
and agencies a daily rate instead of for specific services
they provide like like basically all the other medical treatment
(18:29):
you're ever going to get, and there are four levels
of that care and there are going to be different
rates depending on the level that you're going to get
and also where you.
Speaker 2 (18:40):
Are right, So if you're running a hospice, you would
get a flat fee paid by the government for a
patient who's in routine home care, which is you're not
in crisis, you're still dying, but you're doing okay. And
that usually is just a visit maybe a couple of
times a week. They're coming by to make sure that
(19:01):
their meds are going down right, they maybe have like
their nutrition going there's just essentially just checking on you
that's routine home care. There's also continuous home care where
if that patient slips into a crisis, like maybe they
start vomiting uncontrollably, they start suffering uncontrollable pain, that their
meds aren't doing anything for anymore, changes in consciousness all
(19:23):
of a sudden, Now they have twenty four to seven
hospice access at home.
Speaker 1 (19:30):
Yeah, there's also there's a couple of more. There's inpatient
respite care. That's when a patient goes into like a
you know, they have to leave home to go into
a physical hospice center for up to five days. A
lot of times this is to give their caregiver time off,
because that's one of the brutal parts about end of
life is and I say burden on the family, not
(19:51):
like what a hassle, but you know, it is a
burden on the family. Yeah, people have to besides the
emotional devastation they're going through a lot of times, have
to rearrange their jobs and like even leave jobs sometime
to do this kind of thing full time. So it
can be quite a heavy burden on a family.
Speaker 2 (20:10):
Yeah. Actually, chuck that that's a if you look up
downsides of hospice that's pretty much the number one issue
with it is that it transfers responsibility for caring for
the dying patient from say like a hospital to their family.
And that's it is. It's a very big deal. Yeah.
Speaker 1 (20:29):
And then the last one is general and patient care,
and that is when you're addressing pain control or any
kind of symptom management that you can't that you have
to like go in and take care of at a
specific place. It's not the kind of thing you can
do at home generally. And then you know, palliates of
care is a big part of it. That's what we
kind of mentioned earlier, is is just making people feel
(20:50):
better toward the end. You know, I mentioned things that
don't count as curative treatment, like if you're if you
have heart like active heart failure, they can try and
reverse that. Or if you have some like nasty bedsword
that gets an infection, that that's not going to boot
you off covered hospice care to get that taken care of.
Speaker 2 (21:13):
No, the key to being covered for hospice under Medicare
is that you are not pursuing treatment to cure the
thing that's got you terminally ill. Right, So, like you said,
if you have to develop a heart condition, but that's
not what's killing you. You have terminal cancer, they can,
you know, treat your heart condition. And even if you
(21:33):
do have terminal cancer, if you have nausea from cancer,
pain from cancer, they're going to treat that because they're
not trying to cure the cancer. You have to give
up things like radiation or chemotherapy. Those are curative treatments.
But there's the idea that they're just like, nope, sorry,
we're just going to put you in bed and basically
let you lay there. That's not at all what you
(21:55):
have to give up in order to enter hospice.
Speaker 1 (21:58):
Yeah, and you know, the hospice workers are doing a
lot of stuff for you that goes above and beyond
just making you feel better or maybe sitting with you
and like you know, brushing your hair, Like there's all
that stuff that they're doing, bathing you, housekeeping sometimes you know,
helping out with gathering and administering the medications. But you
(22:23):
know they're doing all kinds of stuff. They might be
shopping for you, they might be babysitting for your family
to give you know, the like we mentioned the people
in your family. They're caring for you, like to give
them a break. They may help with fundraising if you have, like,
you know, money you need raise for your treatment. They
may bring in music and comedy performances to hospice centers.
(22:46):
People that cut hair, like volunteers that will come in
and style somebody's hair. Even I remember that was a
big deal for Emily's grandmother near the end, is you
know that she wanted her hair done and to look
like she looked, And that stuff goes a long way
to just putting people at ease, you know.
Speaker 2 (23:03):
Oh for sure. Another one that volunteers can do is
take care of the person's pet to make sure that
if the person is opting for in home hospice, that
their pet doesn't have to go live with somebody else
because they can't care for it anymore. So you can
go and feed somebody's pet, take them for a walk,
change the litter box, and then something as simple as
(23:23):
just sitting with somebody and watching TV with them is enough.
And like this is just a volunteering opportunity of the
United States, in the UK, basically anywhere there's hospice, they
would very much like you to volunteer to just basically
be there and just being a human being who can
drive a car over to somebody's house is essentially the qualifications'
(23:44):
that's basically all you need to do, and they'll tell
you what to do from there. But no one would
expect you to, like, you know, inject the person. As
a matter of fact, you probably get in big trouble
if you did inject the person with anything. You just
need to be there. And in addition to just being
there for the person, the pay like you said, that
gives the caregiver some time to just go take a shower,
(24:06):
do something, just stop being a caregiver for a couple
of hours too.
Speaker 1 (24:10):
Yeah, you know, even though a lot of them are professionals,
like most of them now, there's still quite a lot
of volunteers that do this kind of thing. That Medicare
law that talked about in nineteen eighty two that stipulated
that hospice facilities have at least five percent of the
patient hours provided for by volunteers. So that's one of
(24:31):
the reasons. And also just because there are people in
the world. You know, some people have maybe gone through
this with the family member and then they want to
give back. Some people are just wired this way as
impaths to want to help people. And then sometimes it's
people that are preparing for career in healthcare and you know,
getting in a hospice and kind of going through the
(24:53):
worst of the worst situations, is I imagine pretty good preparation
on dealing with any kind of patient.
Speaker 2 (24:59):
Yeah, yeah, And you would prepare for a career in
that because hospices, like you said, they are professionally staffed,
and not just with nurses, not just with hospice doctors,
but social workers, bereavement counselors, some of those clergy and
just general aids who can come together and help with
that thing that Sicily Saunders started kind of seeing clearly
(25:23):
the total pain, where you know, if you have psychological pain,
it's going to make your physical pain exacerbated and vice versa.
And the worse off you are, the more hesitant people
might be to come visit you because they feel hopeless
or they're just freaked out or something like that. So
now you have social pain. So if you have all
these people coming together to treat the person's total pain,
(25:44):
you have a much calmer, happier again good death. And
those are called in the hospice industries interdisciplinary groups and
they do. They form a team for each patient to
figure out what to do for each of the patients
to help them find peace and comfort and calm.
Speaker 1 (26:02):
Yeah, and this is a you know, it's a booming
industry now in the United States, and we'll sort of
get to the downsides of that and a little bit.
But statistically, from two thousand hospice centers in two thousand
and one to about fifty seven hundred today twenty you know,
(26:23):
twenty four to twenty five years later, it's really grown
a lot. Utilization grew by thirty two percent between twenty
thirteen and twenty twenty two. There was a twenty five
percent increase in Medicare beneficiaries. Obviously is the boomer generation
is aging, but that doesn't account for all of it,
you know, twenty five compared to thirty two percent. About
(26:45):
half of people now in the United States and roll
in a hospice before their death. If you have cancer,
you're far more likely to do so. As well as
being female and more educated and also older, which it
first seemed like a like a well of course, but
just so far as to say, if you're someone very
(27:06):
tragically in your younger life, that is stricken with something
like this, you're far less likely to enroll in hospice.
Speaker 2 (27:12):
Yeah, and there's actually a lot of reasons why people
don't enroll in hospice. A good majority of them just
don't either aren't really aware of it or don't understand it.
And there's stigmas about hospice too, Like there's a whole
idea that if you go into hospice, you're giving up
on fighting for your life, you're giving up on living,
and that's just absolutely not true. Like, if you have
(27:33):
a terminal illness and it's really no longer treatable, a
good doctor will say, like, there's nothing more we can
do for you. There's plenty of stuff we can do
for you, but none of it is going to extend
your life. It's going to make your last days pretty miserable.
We recommend that you go into hospice and have like
good last days, hang out with your friends and family,
(27:53):
like be peaceful. That's actually, as far as the American
Society of Clinical Oncology is concerned, that's a sign that
you've had good cancer care that toward the end, in
the last few weeks, your cancer team says you've reached
the you know, incurable stage. There's nothing we can do
for you anymore except let's put you into hospice. The
(28:16):
problem is is there are plenty of doctors out there
who do see that as quitting, do see that it
is giving up, and are known to steer people into
hospice too late, to where essentially they just spend like
the last couple or few days in hospice and they
don't have a chance to actually develop what again is
referred to as a good death.
Speaker 1 (28:37):
Yeah, and there's even evidence that going like trying to
cure yourself and sort of ceasing that process and starting
up with hospice can actually make people live longer a
lot of reasons. Maybe you're being monitored a little more closely,
Maybe maybe your symptoms are being managed a little little better,
(28:57):
and just everything that goes into the non physical you know,
sick and dying part that we've been talking about, the
emotional part and everything else, Like if all of that
is eased, studies show that you can you can make
it a little bit longer.
Speaker 2 (29:12):
Yeah, that actually happened to Umi's dead. He was in
hospice and given I remember not very Yeah, there was
just a just a pretty raw time. He was given
not much time to live at all, I think like days,
and he didn't didn't pass, and you started to notice
he was actually kind of he was eating more, he
(29:32):
was his mood was starting to improve, and she convinced
the hospice doctor that he was not dying anymore. And
one of the things that became really clear that being
in hospice at home can do to improve your health
is that you're getting better nutrition, you're getting good sleep,
you're surrounded by people who don't have to come see
(29:53):
you in the hospital setting during visiting hours, and all
of those things are terribly managed in the hospital, so
at home you can just get better and better. And
Human's dad eventually left hospice, was discharged alive, and went
on to live for another three years.
Speaker 1 (30:09):
Man, I remember all that going down and Jerry and
I all of us being like, oh man, this is like,
this seems like it's it, and you were bringing reports
You're like, man, the darnedest thing. Yeah, and then I
just I think we all suspected it was just going
to happen again right after that, and it was, Yeah,
it was a few years. It was just what a story.
Speaker 2 (30:31):
Yeah, I've never been more proud of anybody than I'm
of Vium. She was the only one who saw, like, yeah,
she saw it, and she had to convince everybody else,
including me, that he's not dying, and she brought him
back for sure.
Speaker 1 (30:45):
So yeah, what a gift.
Speaker 2 (30:46):
It really was a gift. Yeah, I'm very proud of her.
Speaker 1 (30:50):
All right, shall we take another break?
Speaker 2 (30:53):
I think we should.
Speaker 1 (30:53):
Man, all right, we'll be right back, and we're going
to finish up with hospice right after this one thing
(31:25):
we should mention kind of briefly. We don't have to
get too much into it, but hospice and right to
die and assisted dying, these are two things that you
know don't go together, but they obviously kind of do
go together in a lot of ways because you've got
a group of people that are it's the same group
(31:45):
of people. Mainly. It's even i think legally designated in
places where you do have the right to die, you
have to have doctor sign off that you're within six
months and there is no cure, and it kind of
is in locksed up with hospice. But it's not the
same thing because the you know, it's just not the
(32:06):
World Health Organization very much defines palliative care as something
that neither hastens nor postpones death. It is not the
point of hospice to go in and you know, find
an impath who will help assist you along a little
quicker if you live in one of those states. I
think it's an amazing gift to be able to do that,
(32:27):
and there are there's a track for doing that, but
it's not hospice. No.
Speaker 2 (32:32):
And the reason why it riles up hospice people who
are against that is because there are one of the
reasons that people do choose medically assisted dying is to
end their suffering, and hospice people are like, no, we
know how to end their suffering without them having to die. Yeah,
And that's why it really gets under their skin. Although
that said, there are plenty of hospice people, probably humanists,
(32:55):
who are like, it's anybody's inalienable right to choose how
or when they die.
Speaker 1 (33:02):
Yeah.
Speaker 2 (33:03):
So, yeah, it is kind of a tricky thing, but
it isn't. I think it is generally unfairly associated with
hospice and even palliative care. I don't think we said
explicitly that is to treat and manage symptoms, pain, nausea,
that kind of stuff, symptoms that come along with terminal illnesses,
and that is a part of hospice, but not all
palliative care is hospice. You can get that same stuff
(33:25):
as you're pursuing like curative treatments, right, So it's not
like they're going to be like you're getting curative treatments
for cancer. Sorry, we can't do anything about the nausea.
Then it makes it. It has a place in both
of them. And it has nothing to do with assisting
someone and dying. It has to do with helping them
die comfortably when they die naturally.
Speaker 1 (33:42):
Yeah, and you know you're not going to get you'll
get morphine and you'll get like the good stuff these days,
morphine plus. But you're not going to get the cocaine
and the liquor.
Speaker 2 (33:53):
No. I mean unless you have a family member who
knows somebody.
Speaker 1 (33:57):
I mean there's somebody's got a guy maybe, yeah, or
if you just have like a you know, pretty empathic,
like really empathic, like on the downlow hospice worker, right.
Speaker 2 (34:10):
And I mean even if you do score for them,
they might not even want it. Like I tried to
give you and he's dad a bunch of cocaine and
he's like, no, I'm good with the pain stuff. I'm
on now.
Speaker 1 (34:20):
Yeah, and then what to do with it? You know?
Uh so look we found another joke. Amazing, so right
right before the dark side.
Speaker 2 (34:30):
Yeah, because there is a dark side to this, and again,
the one downside to hospices it puts it's just the
burden on the caregivers. We'll talk a little bit more
about that in a second. But the kind of generally
agreed upon dark side of hospice is that there's such
a thing as for profit hospices. And contrary to our
private equity theme in our private equity episode, we should
(34:53):
say that there are plenty of for profit hospitals hospices
that are perfectly well run.
Speaker 1 (34:58):
Yeah.
Speaker 2 (34:59):
The people who who the family members who have patients
and family dying there are totally happy give them great reviews.
Being for profit as a hospice isn't necessarily a bad thing.
Where they start to get lower marks than other kinds
of hospices, specifically nonprofit hospices is when they are part
of a publicly owned corporation, like a hospice went with
(35:21):
the IPO at some.
Speaker 1 (35:23):
Point, Yeah, like a chain.
Speaker 2 (35:24):
Exactly or surprisingly or not, private equity owns the hospice.
And the reason why it's problematic is because the way
that payment is structured has a built in incentive for
for profit hospices to cut corners and cut costs.
Speaker 1 (35:42):
Yeah, there was a survey in twenty twenty four that
twenty five percent of hospices in the US are owned
by private equity firms. Now, so you can refer to
that episode as to exactly what goes into that. But
you know, I said earlier to put a pin in
the payment structure, which is they don't get paid through Medicare,
they don't get paid out per treatment given or for
(36:04):
specific treatments given. It's just this flat fee. Uh. And obviously,
if you have a chain, a hospice chain that is
for profit and has gone through the IPO process and
has shareholders to answer to, very sadly, many times you're
going to get hospice centers that that get that flat rate,
(36:27):
but they're cutting staff and people are getting the bare
minimum treatment required by law.
Speaker 2 (36:33):
Right, and I saw there's a there's a thing where
it's supposedly federal regulations say that you have to visit
an in home hospice patient no less than twice a month. Yeah,
just twice a month, right, And then a lot of
for profit hospices like just basically do that minimum. And
(36:53):
if you most people agree, if you are in some
sort of crisis, you're getting more visits. But if you're
not in a since, you're getting fewer visits because they
need to balance that out to cut costs, right or
keep costs down. It turns out that's a myth. The
federal government doesn't require two visits a month at minimum.
The federal government doesn't have any requirements for how often
(37:15):
or how little a hospice has to visit a patient
at home.
Speaker 1 (37:19):
They have no requirements or they're not enforcing anything.
Speaker 2 (37:22):
They don't have any requirements. And that's another problem too.
They don't enforce a lot of the rules that there are,
and there's already a lot of rules that have loopholes.
So this is a system that is just set up
for abuse. Luckily, most of the people who run hospice
companies they're not in it to abuse the system. They're
(37:45):
in it to help people. But there is a place
for bad actors to milk the system overcharge. Like apparently
there's it's extremely complex, but there are ways that you
can charge more than the flat ray per day. And
I guess a study from I THINK twenty twenty one
in the Journal of Geriatric Care. I THINK found that
(38:08):
for profit hospices tend to charge medicare thirty four percent
more than nonprofit hospices. There's just a lot of stuff
you can do to gain the system.
Speaker 1 (38:20):
Yeah, and you know, to be clear, hospice in general
gets good marks from people. Even for profit hospices generally
get good marks from people. But they've drilled down and
they found the ones that get the lowest ratings for
care are the ones that are publicly traded corporations and
(38:42):
owned and or owned by private equity firms. So do
your research, you know, if you're getting into this, because
there's there are all Like we said, there's fifty seven
hundred of them in the US, and hopefully there's one
near you that will take care of you a little
bit better to remain on hospice. There's also you know,
all kinds of rules as far as what's called live discharge, right,
(39:05):
you have to demonstrate ongoing steady decline at recertification inuals
every ninety days for the first six months, then every
sixty days after until death or discharge, and discharges is
basically exactly what it sounds like. You're discharged, like you're
discharge at a hospital. It may be because you want
(39:27):
to try, you know, curative care again, which is which
is great, and you're right, it could because of an
emergency that you have to go to the hospital for
which will boot you off, which really stinks. But there
are guidelines about discharge and not all of them seem fair.
Speaker 2 (39:42):
Yeah, And you can imagine if you're dying of a
terminal illness being moved from a hospice to a hospital
to continue treatment maybe home, where you have a bunch
of emergency room visits ahead of you because your symptoms
are going to flare up. It's not a comfortable thing
to be discharged from one place to another. It's also
a huge burden on the family too, because again the
(40:04):
care is being transferred from medical professionals to the family.
But also the whole premise of it is just faulty
because not all diseases follow the same trajectory in the
decline of the person, and yet they're all held to
the same standard, which is essentially the standard that cancer
(40:24):
creates a decline and a patient too, So essentially just saying,
if you have a terminal illness that's certified by doctors,
that doctors recertify, say every sixty days, you don't have
to face a live discharge, like you can stay in
hospice until you die. Your death doesn't have to cooperate
with federal guidelines. That would be a huge change and
(40:45):
a really simple one to hospice rules, but apparently that's
not happening right now.
Speaker 1 (40:52):
Yeah, and even if you know you aren't moved home,
let's say, let's say you move to a different facility,
because there definitely is a problem with like you know,
not having enough beds at different places, and the family
gets can get ideally into a routine at least, and
you know, they kind of figure it out. And then
(41:13):
with Emily's grandmother, it seemed like once we everyone got
into the routine and everything had kind of been figured out,
then all of a sudden some change would happen where
Mary would have to go somewhere else, and then all
of a sudden, it's new visiting hours, it's in a
different place and everyone and you know, that's just on
the family of course, just like you mentioned, the move
for the patient is really burdensome. So there's still so
(41:36):
much they can do, I think, to clean this whole
system up, you know.
Speaker 2 (41:40):
For sure, and even chuck if they're not impatient. Just
at home hospice basically overlays this support structure for you,
the hospice patient in your home right, so you have
like medical equipment, you have medications that are like delivered
to you at times. If you need a walker, you
got to walk. Just all of this support like you've
(42:02):
got bereavema counselors dropping by, if a social worker, you're
doing telehealth visits with a well like all it just
stops when you're discharged from hospice alive. They come and
they take the medical equipment, they take your walker away,
You stop getting your medications delivered to you. You might
not even have those prescriptions any longer after that, if
they were prescribed by the hospice doctor. It's a really
(42:25):
bad jam. And the other thing about it too, that
Medicare has often taken to task for is they don't
really pay enough for in home hospice, Like that's the
lowest pay rating I guess is in home non crisis
hospice care, and that means that if you are trying
(42:49):
to stay at home, you either have to have a
bunch of family members who are willing to commit their
lives to taking care of you in your final days,
or you have to have a bunch of money to
pay somebody to do that same thing. And if you
don't and you want to die at home, you're sol
because you have nobody to take care of you at home,
because there's not enough pay to pay people in hospice
(43:10):
to come by, and not enough volunteers to take care
of you take care of your needs on a regular basis.
Speaker 1 (43:17):
You know, Grandma Mary, former foremost general in the stuff
you should know Army, had a T shirt that says
you can take my walker when you pry it for
my cold dead hand.
Speaker 2 (43:28):
That's all, Oh my god, that would be such a
great T shirt. We got to get that one.
Speaker 1 (43:33):
You imagine taking a walker from somebody for that that's
your job. Like you're the person they're like, yeah, go
over to go over to Grandma Mary's house and take
her stuff.
Speaker 2 (43:43):
I know it couldn't even be the person who also
delivers it, because it's such a mean job that there
has to just be one specialist who doesn't like anybody
who just goes around the houses and takes the medical
equipment back.
Speaker 1 (43:54):
Yeah, sin Ronnie, uh, you got anything else? No, I
have nothing else. Hopefully this serves some people, and you know,
just just look around and do your homework and see
if you can find a place that works for you
and your family.
Speaker 2 (44:09):
Yeah. And another good piece of advice is to do
that sooner than later, like to share your wishes with
your family. Maybe if you go so far as to
create a living will or some sort of medical documents
saying like I do want to go into hospice, I
want to stop curative treatment at some point. And then yeah,
do like read reviews, like just find out who you
(44:29):
would go to if it starts to seem like that
might be a possibility coming down the pike.
Speaker 1 (44:34):
Yeah, oh man, my god, get a living will. No,
I don't care how old you are. That's it's very
easy thing to do. And it's that and a will
or the two biggest gifts you can give your family
as you grow old.
Speaker 2 (44:46):
That's right, you want to impress your parents in your
seven start thinking about a living will, Start talking about
a living will to your parents. Yeah, and they will
just be blown away totally.
Speaker 1 (44:56):
That seems like something in like a TV show about
a precocious kid.
Speaker 2 (44:59):
Yeah, for sure, like Alex p.
Speaker 1 (45:02):
Keaton, he would do that, Yeah, exactly. How you know
he had one.
Speaker 2 (45:06):
So before we finished, I just also wanted to give
a huge shout out to Yumi's dad's hospice doctor, doctor Pijari,
who did not have any sort of ego and was
totally willing to listen to Yumi and helped get her
dad out of hospice too.
Speaker 1 (45:20):
So I love it.
Speaker 2 (45:21):
Shout out doctor Pajari. And since I shouted out doctor Pejari,
as was foretold by the Ruins in two thousand and eight,
I've just unlocked the listener mail.
Speaker 1 (45:33):
This is gen z Stare speaks back. I have three
emails I'm going to try and sort of hit the
highlights of because we got what I felt like was
three really sort of legitimate answers as to what the
gen z Stare is all about. That now I understand,
you know, it may not be my jam, but like
(45:55):
it doesn't need to be my jam because I don't
have to put my gen X stuff onto gen Z.
That's that's true, Hey guys, twenty two years old gen
Z very much in the gen Z stare era. I
work in customer service, which is where I use it
the most. But we were raised with if you have
nothing nice to say, don't say thing at all, so
hence staring. So I guess they took that very much literally. Yeah,
(46:18):
it's not something just done to adults either, and this
person points out that they do it for their friends.
As far as the phone call, no one calls us
when they do, it's a spam call, which I was
always told the double hello people, I didn't know that
was a thing. When they answered the phone accused the robot.
Speaker 2 (46:34):
Did you know that?
Speaker 1 (46:35):
Yes, okay, I didn't know that, so I just answer
and sit in silence until the awkward is this Josie
follows and that is from Josie Boozer. This is another one,
Hey guys, gen Z person. I think the explanation you're
probably looking for is a lot of gen Z are
using it. Are used to being interrupted, not taking taken seriously,
(46:59):
or have our responses to stories be given a weird look.
The example for someone finishes the story and the person
just stand there can either be one. I don't have
anything interesting to say about that story, and I don't
want to make something up. Two, I'm so used to
having my opinions not taken seriously that I'm just not
even going to bother responding. Many of us are socially
awkward and have trouble creating small talk with people that
(47:20):
aren't close to us. Another reason maybe because most of
our conversations are online and have been online as we aged,
and many people will give an emoji reaction to it
a long story or just get a smile and that's cool.
In response. That is from Sam Okay, so it's kind
of tracking along the same lines. And then this is
(47:42):
from Catherine, who's been listening for five years as a
twenty three year old. I've heard people blame the pandemic,
but I don't think it fully explains a generational trend
since we all live through the same period. I think
there are two main causes. First, my generation has spent
much more time in front of a screen than any
previous generations did. We've grown used to one content consumption.
You would look crazy if you responded to a YouTube
(48:03):
video the way you would a phone call or an
in person conversation. So we're a little out of practice
with responding to prompts instead of just watching something. This
is all makes total.
Speaker 2 (48:13):
Sense, It totally does.
Speaker 1 (48:15):
And then secondly, gen Z seems to be more likely
than previous generations to forego the fake politeness that used
to be expected in conversations. I think this is partially
because we're constantly inundated with advertisements. We've become highly sensitive
to fake niceness because someone is trying to manipulate our
emotions at every turn and sell us something. My generation
(48:35):
seems much more likely to prefer genuine reactions, even if
they're negative, because when we're online, it's the only way
to note something is not an ad wo man, this
is something else? Huh.
Speaker 2 (48:49):
Yeah. Those are deep from Josie, Sam and Catherine right.
Speaker 1 (48:54):
Yeah, And I think they all sort of track along
the same lines, and that explains a lot. So, Yeah,
if a gen Z person is just staring at you,
maybe you think maybe they think you're a real jerk
and just don't want to say anything.
Speaker 2 (49:07):
Right, they assume you're manipulating them, right then?
Speaker 1 (49:10):
Yeah, or the other reasons mentioned, I think they're all
valid in their own generational way.
Speaker 2 (49:15):
I feel like that really explains the discomfort that people
like say from gen X get when we're treated like
that because we are used to fake niceness I know,
you know, and like we're willing to go along with
that kind of thing just to keep from a situation
being uncomfortable.
Speaker 1 (49:30):
Yeah. Also, though, quick tip the if you don't have
anything nice to say, don't say anything at all. I
recently went through an experience with a TO two artist
getting my tattoo covered up with my dogs and it's
a great I he'd I appreciate it. He did a
great job, but he, let's just say, we weren't the
(49:52):
same kind of person. He had a lot of interesting
theories on things. And here's a little tip to my
gen Z friends. You don't have to not say anything.
Just keep nodding and go interesting.
Speaker 2 (50:05):
Oh yeah, I.
Speaker 1 (50:07):
Did that over and over and over for hours.
Speaker 2 (50:09):
It goes a long way.
Speaker 1 (50:11):
Yeah interesting and sure, well no, I don't even know
if I am lying. It was interesting, yeah, just not
for me.
Speaker 2 (50:19):
Right exactly. Maybe the tone was a lie.
Speaker 1 (50:23):
Maybe.
Speaker 2 (50:23):
So the guy did you an amazing job? You said
he did it like freehand too.
Speaker 1 (50:28):
Right. Oh yeah, I'll put pictures up at Chuck the podcaster.
He's a sort of amazing artistic dude. Yep, just like
looking at pictures of dogs and drawing them on my arm.
It wasn't like stenciled out of my arm first.
Speaker 2 (50:45):
It's nuts man. Well, thanks a lot again to Josie,
Sam and Catherine for explaining that to us. You guys
did a knockout job and we appreciate it. And I'm
not being fake nice right now. I'm being quite legitimate
and serious and genuine. If you want to get in
touch with us and tell us about your generation, we
(51:05):
love hearing that kind of stuff, you can send it
off to stuff Podcasts at iHeartRadio dot com.
Speaker 1 (51:13):
Stuff you Should Know is a production of iHeartRadio. For
more podcasts myheart Radio, visit the iHeartRadio app, Apple Podcasts,
or wherever you listen to your favorite shows,
Stuff You Should Know News
Hosts And Creators
Chuck Bryant
Josh Clark
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