December 12, 2024 • 27 mins
In this episode of Advice From Your Advocates Podcast, Attorney Bob Mannor speaks with Stacey Bruss from St. Croix Hospice to discuss the essential aspects of hospice care, addressing common misconceptions and emphasizing the holistic approach to patient care. Bob and Stacey explore the benefits of hospice, including Medicare coverage, the importance of respite care for caregivers, and the need for families to understand their options when choosing a hospice organization. The discussion highlights the philosophy of hospice as a means to enhance the quality of life for patients and their families during challenging times.
Episode Takeaways:
- Hospice is a comfort care-based philosophy, not just end-of-life care.
- Patients often wish they had known about hospice sooner.
- Medicare covers hospice services fully for eligible patients.
- Respite care is crucial for preventing caregiver burnout.
- Patients can still receive treatment for other conditions while on hospice.
- Hospice eligibility is determined by a medical director, not insurance companies.
- Families should interview multiple hospice organizations to find the best fit.
- Hospice care focuses on the patient's quality of life and comfort.
- It's a common myth that hospice means giving up hope.
- Families can change their minds about hospice at any time
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ABOUT US:
Mannor Law Group helps clients in all matters of estate planning and elder law including special needs planning, veterans’ benefits, Medicaid planning, estate administration, and more. We offer guidance through all stages of life.
We also help families dealing with dementia, Alzheimer’s disease, Parkinson’s disease, and other illnesses that cause memory loss. We take a comprehensive, holistic approach, called Life Care Planning. LEARN MORE...
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
You're listening to Advice from your Advocates, a
show where we provide elder lawadvice to professionals who work
with the elderly and theirfamilies.
Speaker 2 (00:10):
Welcome back to Advice from your Advocates.
I'm Bob Manor.
I'm a certified elder lawattorney in Michigan with a
special focus on dementia andhelping those families that have
a loved one with dementia.
Of course we help others too,but that's our special focus one
with dementia.
Of course we help others too,but that's our special focus.
Today I'm really excited abouta very important topic and a
very special guest, stacey Brussfrom St Croix Hospice.
(00:31):
So we're going to learn a lotfrom Stacey.
There's a lot of misconceptionsabout hospice.
But first, hello, stacey.
How are you doing?
Speaker 1 (00:40):
I'm doing well, thank you.
Thanks for having me.
Speaker 2 (00:43):
Tell us just a little bit about yourself and your
company, and then we'll getright into the meat of the issue
.
Speaker 1 (00:47):
Yes, so my name is Stacey Bruss and I'm the
Regional Director of ClinicalOperations for St Croix Hospice
of Michigan.
We service almost all ofMichigan and Macomb, oakland,
monroe, livingston counties, andSt Croix Hospice is located in
10 states around the Midwestwhere we service patients and
(01:09):
their families.
Speaker 2 (01:12):
I know that you have an office in Brighton and we
just opened an office inBrighton in July of 2024.
So I know that we'll be workingtogether a lot.
Speaker 1 (01:21):
Yes, I look forward to it.
Speaker 2 (01:23):
So Stacey, one of the things.
The first thing I want to talkabout as it relates to hospice
is I'm hoping you can kind ofgive us a little bit of picture
of today's hospice, and what Imean by that is we all have
misconceptions, whether they'remisconceptions or not.
We all have ideas about whathospice is, and I'm going to
have some probing questions foryou, but I want you to start off
(01:45):
with just telling us a littlebit about what hospice is, and
I'm going to have some probingquestions for you, but I want
you to start off with justtelling us a little bit about
what is hospice in 2024.
Speaker 1 (01:50):
So hospice is a philosophy of care.
It's a comfort care based levelof care to where patients elect
this Medicare benefit to reallykeep them comfortable, where
they're not seeking aggressivetreatment but more quality days
over quantity and really focuson, you know, what matters most
(02:12):
to them.
So it's a philosophy of care,to where a interdisciplinary
team comes in and cares for notonly the patient, but a lot of
times we're, you know, caringfor the families just as well.
Speaker 2 (02:26):
You know there was a lot packed into that, so I want
to break some of that down.
One of the things that you'vementioned is, you know,
philosophy of care, and so Ithink there's probably some of
the listeners that think ofhospice, as that's what you do
on your very last day is yourlast week or two of life, and
that's not true, right.
Speaker 1 (02:52):
It isn't true and in fact we try to get patients on
hospice sooner.
A lot of times our patients andfamilies will say that they
wish they would have known abouthospice sooner because so many
misconceptions and myths abouthospice and what it is that we
do.
But statistics show thatpatients live 29 days longer
when they're on hospice servicesbecause they get that extra TLC
and they're focused more on.
Speaker 2 (03:12):
The one thing I wanted to point out that was
really important that you saidis that it's a Medicare benefit.
So, generally speaking, ifsomebody's on Medicare and they
qualify for hospice, they're notgoing to pay anything out of
pocket for this hospice benefit.
Speaker 1 (03:23):
Right, they qualify for hospice, they're not going
to pay anything out of pocketfor this hospice benefit.
Right, that's correct.
So not only are they gettingmedications, but they're getting
their DME supplies, such as abed, a wheelchair, oxygen.
All of that is a part of theirMedicare benefit, as well as
getting a care team that's goingto come right into their home
wherever they call home.
(03:44):
And you know, we haveregistered nurses who are our
in-case managers, we have socialworkers, we have chaplains who
are non-denominational, we havemusic therapy, we have massage
therapy, so it's really focusingon that total patient as a
whole to make sure that theirgoals are being met.
Speaker 2 (04:03):
You said just what I was going to say as a whole very
holistic planning.
Right, we're looking at thewhole person.
We're not just looking at adisease.
We're not just looking at, youknow, treating a specific thing,
like the medical team.
You know medical staff tends todo, and so it is a very
holistic approach to yes.
I want to circle back just tomake it abundantly clear that
(04:24):
this is a Medicare benefit.
So, whether someone's onMedicare, if they have a
Medicare Advantage plan throughtheir insurance company, this is
a Medicare benefit and it's notwhether or not Blue Cross or
whatever insurance company willauthorize this.
This is a Medicare benefit andthey're not going to have
co-pays in order to get hospiceright.
(04:46):
They're not going to get deniedbecause of the insurance
company.
It's going to be the hospiceorganization that determines
whether they're eligible.
Speaker 1 (04:54):
Yes, absolutely so.
We have a hospice medicaldirector who is a physician that
will certify that the patientis eligible for this benefit,
because it is 100%, you know,paid through the Medicare
benefits.
We want to make sure that we'remeeting those Medicare
guidelines in regards toeligibility.
Speaker 2 (05:14):
One of the things that I think a lot of my clients
feel is just a really importantand positive aspect of hospice
is respite care, and so one ofthe things that we see is
frequently we'll have familythat are caring, whether it be a
spouse or kids that are, youknow, providing care and daily
(05:37):
care for their loved one andthat can be very challenging,
especially if you have agranddaughter being born in
another state or if you wantedto go to your niece's wedding or
something like that, and youcan't bring your loved one
because of their physical ormedical condition, and the idea
of respite care is part ofhospice.
(05:58):
Can you talk a little bit aboutthat?
Speaker 1 (06:07):
that, yeah.
So respite care is really forany caregiver burnout.
We see, you know, specificallywith our Alzheimer's patients or
some of our patients who are,you know, very sick, that it's a
lot of work for caregivers totake care of their loved one.
It's a full-time responsibility, and so part of that hospice
benefit is a respite stay wherehospice will actually pay for
(06:27):
the patient to stay in afacility to allow that caregiver
, you know, an opportunity tosometimes sleep or just have
some sort of self-care or, likeyou mentioned, you know if they
have something that's going onout of state or whatnot.
It really is a great part ofthat hospice benefit.
Speaker 2 (06:49):
And can you talk to us a little bit more about that
respite benefit?
Is that something that they canjust do once a year?
How often would they be able toaccess that respite benefit?
Speaker 1 (06:59):
Yeah, so the respite benefit is usually once per
benefit period.
So we go in, you know benefitperiods of 90 days, then 60 days
and 60 days.
So we like to, you knowMedicare has, you know those
guidelines to where it is, youknow, once per benefit period.
So we work, you know, with thepatients and families to
(07:21):
determine when is you know theappropriate time to do that.
Speaker 2 (07:25):
Nice.
So one of the other myths thatI hear often is you can only be
on respite for six months.
And so they say well, you, youknow you have to die within the
six months because hospice willrun out.
That's not true either, correct?
Speaker 1 (07:39):
It is not.
So hospice, you know Medicare,does have a guideline that you
know it's six months or less ifyour disease takes its normal
course.
Normal course looks muchdifferent for multiple different
patients.
So no one has a crystal ball.
So we've had patients who havebeen on hospice services for
years.
They continue to have, you know, small declines to where
(08:02):
they're still eligible for thebenefit because they still have
to remain eligible to receivethe hospice benefit.
But we've had patients who havebeen on for years.
So you know there is many mythsabout hospice and what it is
that we do and you know we hearthat.
You know I don't want to.
You know, pass away today ortomorrow and, like I said
(08:22):
earlier, 29 days longer is thestatistics that you know when a
patient comes on to hospice theylive 29 days longer.
So you know we, like I said,have had patients on for years
and you know there's no crystalball to what it is that we do.
Speaker 2 (08:39):
Now is there a requirement that they have a
physical illness versus acognitive memory, dementia,
alzheimer's type of a thing?
Could they qualify?
If they're not, they don't havea specific terminal illness,
but they have significantdementia or Alzheimer's.
Speaker 1 (09:01):
Yeah, so we see you know different types of
diagnosis for hospice.
You know it's a conversationthat our admission nurse has
with our physician and, based onwhat's going on with that
patient as far as their declines, we look to see what would be
that terminal diagnosis.
So we have had patients whohave been on for Alzheimer's A
(09:23):
lot of times.
You know we have thoseAlzheimer's patients, we have
COPD patients, we havecongestive heart failure
patients.
So you know it really justdepends on what's really going
on with that patient and havinga conversation with that
patient's physician and ourhospice medical director to see
you know which diagnosis youknow would be most appropriate
(09:45):
to bring them onto hospice.
Speaker 2 (09:48):
I had mentioned that we have, so we have in our legal
team, we have what we call carenavigators typically social
workers, in our office, and wehave one of our care navigators
that her previous experience wasin a hospice organization,
which actually fits really wellwith our concept of care
navigation Because, again, it isa very holistic type of
(10:09):
planning opportunity within ourlegal office.
And so the reason I'mmentioning this is I had
interacted with hospice for allof my professional career, and
what was interesting to me ishow much I learned from her
about the nuances of hospice,that I had many misconceptions,
and I'll give you a couple ofexamples.
(10:31):
One was that if you are onhospice, you can't receive
medical treatment.
You can't go to the hospitalfor any reason, and so tell me
if that's accurate.
If you're on hospice and thereason you're on hospice is for
cancer, and then you get a UTIor you break your leg or
something like that, are theygoing to treat the UTI or the
(10:53):
broken leg?
Speaker 1 (10:53):
Yeah, so most definitely, you know that
becomes a comfort issue.
So a lot of times we canrecognize the symptoms of a
urinary tract infection or anyother you know sort of infection
that's going on and you knowour nurses do an excellent job.
The hospice nurse will, youknow, reach out to our physician
and go ahead and be veryproactive in getting that
(11:15):
antibiotic.
So you know we do treat thosesymptoms.
They don't necessarily have togo through any sort of testing
for that, but we're treatingthose symptoms to make sure that
that patient is comfortable.
So most definitely, you know ifthere is a need to go to the
hospital, we address that aswell.
You know there's so many mythsabout hospice and what it is
(11:39):
that we do that you know if apatient has a fall and they have
a broken leg, obviously that'ssomething that we're going to
have to manage and they're goingto have to go to the hospital,
you know, to get that taken careof.
So definitely a case by casebasis, but if there is a need
for that patient to be seen atthe hospital, then most
definitely they can do that.
Speaker 2 (11:59):
So, stacey, tell us a little bit about more about you
and your role there, how youcame to be working with hospice
and tell us a little bit moreabout St Croix Hospice.
Speaker 1 (12:09):
Yeah, so my position is I'm the Regional Director of
Clinical Operations for St CroixHospice of Michigan, so I
oversee all of the clinicalteams for all of our branches.
So that's our nurses, our aides, our social workers, our
chaplains.
They work with our manager ofclinical services and the
(12:29):
manager of clinical servicesdirectly report to me.
So I oversee the day-to-dayoperations of our clinical team
and ensuring that we areproviding the highest level of
quality of care for our patients.
And I've been in hospice forthe last 15 years.
I've been a registered nursesince 2002.
(12:51):
I've been a registered nursesince 2002.
And I started in hospice whenmy grandmother, who was an
Alzheimer's patient in 2007, shewas diagnosed with Alzheimer's
disease and went on to hospiceand I wanted to learn more,
because in nursing school theydidn't teach us about hospice
(13:12):
and so I was very in tune withthe hospice staff that would
come in to see my grandmotherand I just wanted to know more,
and that's when I got my firstposition was in 2007.
I've been in hospice ever since.
So I've been a communityliaison where I've met with
different community leaders totry to get patients onto hospice
(13:34):
sooner.
I've been in operations, I'vebeen in sales, so I've had a
multitude of different positionswithin hospice, but really what
brings me joy at the end of theday is making sure that our
patients are treated as if theywere a family member and
providing that highest level ofcare.
We recently lost my father.
Last year he was 68 and passedaway with Alzheimer's disease
(14:00):
complications related toAlzheimer's disease and he was
also on hospice.
So it's something that's verynear and dear to my heart.
I've witnessed it firsthand,having my grandmother and my
father both on hospice.
But it's something that I havea very strong passion for to
make sure that these patientsare very well taken care of, and
(14:21):
I always say that there's noredos in the field of hospice.
We've got one shot to make adifference and it's a lifelong
opportunity to make sure that,however many days our patients
have, that they are lived to thefullest and that they were
provided the highest level ofcare.
Speaker 2 (14:41):
I think that's really meaningful, that you've had
your own personal experienceswith that.
You know I've been doing thisfor a long time and I feel like
we've always been very in tuneto our clients' families and
their lives and their strugglesthat they have.
But I can tell you once myfamily was a client when we were
settling my parents' estate andleading up to their deaths.
(15:03):
I did experience it in adifferent level and I suspect
that's true for you too, thatyou can be very passionate about
this topic and the services youprovide.
But it provides a wholedifferent perspective when it's
your grandmother, when it's yourfather.
Speaker 1 (15:20):
Absolutely, and one of the things that I really
enjoy in my position is I havethe opportunity to add
clinicians onto our team and ourinterdisciplinary team, and I
want to make sure that if I wason the receiving end of this
care, would I want this personto care for my loved ones?
So it's an opportunity to makesure that we're adding the
(15:41):
correct team to our currentexisting team.
That will go above and beyond,because there's many hospice
organizations out there and noteveryone does them the same.
St Croix Hospice has specialprograms that every clinician is
dementia certified to make surethat we're able to care for
(16:01):
dementia patients at the highestlevel.
And we have a fall preventionprogram where we have physical
therapy evaluate our patients tohelp prevent falls.
Evaluate our patients to helpprevent falls.
We have a voyage program towhere our patients who need a
higher level of care are seen byour nurse every single day,
based on predictive analytics,so we make sure that we're
(16:22):
present when that patient passesaway, and so not all hospice
agencies do it the same.
I'm very honored to work at StCroix Hospice.
We do things at the highestlevel and I feel like these
programs really set the bar forwhat it is that we do.
Speaker 2 (16:39):
That's a really important point that we need to
make sure that people understandthat they have the choice of
what hospice organization thatthey use.
And so I do think families getconfused about this because and
I'm not complaining orcriticizing, I'm just
acknowledging the fact of itthat a lot of hospital
(17:00):
organizations have a hospicethat's associated or owned by
the hospital or part of the sameorganization, and so sometimes
when you're in the hospital andthey start talking about hospice
, it seems like that is hospice,that's the only option that you
have and that may be the besthospice for you.
But the point of it is that forfamilies to understand that
(17:21):
they have the choice, they havethe option of looking at other
hospices, and if it is somebodywith dementia, it's a good
question Are the people in thehospice organization certified
dementia practitioners?
Do they?
have the fall risk preventionthat you talked about.
These are all important things,what are the expectations?
And I think that when we talkabout hospice, the families are
(17:44):
so overwhelmed because sometimesthis is a bit of a shock to
them that they don't think ofasking these questions.
And I really do think it'simportant that, if you're
exploring hospice, that youactually ask okay, what is
included in this, what is thetraining, what are the options,
what are the services that arebeing provided and covered under
this?
And if you aren't thrilled withthe answer, you can call a
(18:09):
different hospice organization,and so that's a very important
point that you make is that youhave a choice among which
hospice that you choose.
Speaker 1 (18:18):
Absolutely.
I always encourage families tointerview a couple different
hospice organizations to findout what is going to be the best
fit Specifically.
You know, having had two lovedones who had Alzheimer's it's a
very specific disease and ittakes a very special person to
be able to care and manage thesymptoms and everything that
(18:40):
comes along with this horrificdisease.
So I encourage families to dotheir research, to interview
multiple different hospiceorganizations, because, although
hospice is an umbrella of care,there are certain things that
set hospice agencies apart andit's really important that you
find the right fit for you andyour loved one On that same
(19:02):
theme do you have any advice forfamilies that are giving some
consideration as to whether ornot to go with hospice?
Speaker 2 (19:07):
I know a lot of my clients are in that position
where it's not sometimes it'svery obvious right.
Sometimes it's just it'sclearly the right thing to do.
And sometimes families strugglewith it even when it is clearly
the right thing to do.
But there's other times whereit is sort of they have a
decision to make.
Well, the person might beeligible for hospice.
(19:28):
The family has to decide ifthat's the right timing for it.
So do you have advice forfamilies that are facing that
struggle?
Speaker 1 (19:35):
Yeah, my best advice is if your physician or if you
feel like your loved one isdeclining and they've reached a
certain point to where they wantto be comfortable, and not
saying that they even have to bea DNR because we have multiple
patients who are a full code.
That's one of the myths as wellis that you have to be a do not
(19:56):
resuscitate, and that is notthe case.
We have multiple patients whoare a full code.
But I always encourage familiesto get an evaluation, get a
consult with hospice and learnwhat we have to offer.
It is a great service and mostfamilies say that they wish that
(20:17):
they would have known about thehospice team sooner or the
hospice benefit sooner, becauseit is all encompassing.
It is a relief for the family, apeace of mind to have a nurse
come to your house, wherever youcall home, an aide to help with
(20:39):
baths and changing and dressingand doing all of the things.
You don't have to do this alone,and that's what hospice is for.
It's such an underutilizedbenefit in the United States
that so many people do not takeadvantage of because they feel
like it's giving up, and it'snot.
(21:01):
It's not giving up.
You can come off of hospice atany time, right, it's not
something to where you sign onand you have to stay on forever
If you change your mind or ifyou decide to go a different
course of action.
It's something that you canchange your mind at any time.
But if you're eligible, it'ssuch a tremendous benefit that
(21:24):
not only benefits the patientbut it also benefits the family
with the medications andeducation and the you know
durable medical equipment thatyou can get.
It's just my best advice is tocheck into it and, you know, get
the answers to the questionsthat you have.
(21:45):
And I know that initial stepmight be scary, but I think that
once that you get theinformation and you really learn
what hospice is about, it's notas scary as you think it is and
it's actually a tremendousbenefit.
Speaker 2 (22:01):
That's really important and I think that's one
of the things that sometimesthere's a lot of things that our
clients will ask us about.
Can they assume that it'scovered under Medicare, you know
, when they're not on hospiceand they assume that this is
just a standard Medicare benefitfor like different medical
equipment and things like that.
Or they assume that respitecare might be a medical benefit
(22:24):
that they get through theirinsurance company and
realistically, there's a lot ofthings that are provided by
hospice that are not providedunder your regular Medicare and
your supplemental or MedicareAdvantage benefits.
You really can only get thosebenefits when you're under
through the hospice program.
Speaker 1 (22:41):
Yeah, absolutely.
And you know, although hospiceis a wonderful Medicare benefit,
we also, you know, hospiceswill take Medicaid and different
you know types of insurance.
So although it's covered, youknow, 100% through Medicare, we
do also accept other payersources as well.
So it really is, you know,meeting the patients and the
(23:03):
families where they're at intheir journey, no matter where
that journey is matter wherethat journey is.
Speaker 2 (23:12):
Yeah, and that's actually where we can help folks
too, because sometimes folkswill say, oh well, we don't need
those legal services becausewe're going on hospice.
Actually, our legal serviceswork hand in hand with hospice
because we can look towardsgetting additional benefits
Medicaid benefits that mightsupplement the hospice benefits
in home care or maybe through anursing home if that's necessary
(23:32):
, and having Medicaid pay forthe bulk of those things.
And we help people getqualified for Medicaid, or maybe
it's veterans benefits thatwill supplement the benefits
provided by hospice, and that'ssomething that we help folks
with.
And, frankly, then, it's justalso making sure that we have
the legal positions in place.
Really, a big part of the legalissues are do you have people
(23:57):
you love and trust and, if so,do we want them to be involved
in making decisions?
If you can't, if eventually youcan't make all of your own
decisions, rather than have acourt appoint someone?
And so that's a big part of thisconversation rather than have a
court appoint someone, and sothat's a big part of this
conversation.
So it is, when we talk aboutholistic planning, really the
legal planning is part of thatholistic planning and that the
(24:18):
legal services and the hospiceservices actually do work very
much hand in hand.
That's great.
Through St Croix Hospice do youalso do palliative care?
Speaker 1 (24:27):
We do not do palliative care and you know I
was always taught all hospice ispalliative care.
We do not do palliative careand you know I was always taught
all hospice is palliative butnot all palliative is hospice
and what we mean by that is.
Hospice is such a tremendousbenefit where you get a full
team who comes in to your homeand manages those symptoms and,
(24:47):
you know, takes care of thepatient holistically, whereas
palliative care is usually justa nurse practitioner who's
coming in, you know, once amonth or twice a month to really
manage those symptoms.
Hospice is such a betterbenefit for our patients and
families that you know our focusreally is hospice services.
Speaker 2 (25:08):
Well, stacey, appreciate your time and
everything that you do for ourcommunity and for the folks that
you serve.
Is there any advice that you'dlike to leave our listeners?
So our listeners tend to bepeople within the long-term care
industry, social workers,people within the health care
industry and then just thegeneral public that's interested
(25:29):
in these aging issues.
So any advice that you'd liketo leave them with?
Speaker 1 (25:35):
Yeah, I would say the best advice that I could give
is, you know, hospice isn'tabout giving up hope.
It's really about focusing onthose days and, you know, making
the most of your days.
One of the things that we reallyfocus on at St Croix Hospice is
we've recently been certifiedin age-friendly care and one of
(25:58):
the things that we ask ourpatients whether it's a
registered nurse or it's ourchaplain or it's our social
worker is what matters most toyou as the patient and you know
we get all sorts of answers.
It could be what matters most isthey want to sit outside in the
sun or they want their son tocome in from out of town, or
(26:22):
whatever it may be.
But you know that's one of thethings that our hospice in
particular is really focused onmaking sure that those goals are
met.
You know we don't have acrystal ball whether we're on
hospice or we're not on hospicein life.
We don't know how much timethat we have here on this earth,
but we want to make sure that,however much time that we have,
(26:43):
that we're making the most ofthose days.
And so, you know, my bestadvice that I can give to anyone
is, if you are even consideringthis level of care is to check
into it and get the informationthat you are needing to make
that you know best decision,because chances are you will
(27:04):
wish that you would have done it.
Speaker 2 (27:06):
I think that's a beautiful way of saying it and
summing it up.
I think that was perfect way tokind of define what the hospice
philosophy is.
So thank you for listening andthank you, Stacey Bruss from St
Croix Hospice for joining us mypleasure.
If you enjoyed this podcastAdvice from your Advocates, know
that you can subscribe at anyof the places that you listen to
(27:28):
podcasts and that way you getnotified when we have great
guests like Stacey for us, andso I hope you subscribe and
we'll see you next time.
Speaker 1 (27:46):
Thanks for listening.
To learn more, visitmanorlawgroupcom.
You're listening to Advice from your Advocates, a
show where we provide elder lawadvice to professionals who work
with the elderly and theirfamilies.
Speaker 2 (00:10):
Welcome back to Advice from your Advocates.
I'm Bob Manor.
I'm a certified elder lawattorney in Michigan with a
special focus on dementia andhelping those families that have
a loved one with dementia.
Of course we help others too,but that's our special focus one
with dementia.
Of course we help others too,but that's our special focus.
Today I'm really excited abouta very important topic and a
very special guest, stacey Brussfrom St Croix Hospice.
(00:31):
So we're going to learn a lotfrom Stacey.
There's a lot of misconceptionsabout hospice.
But first, hello, stacey.
How are you doing?
Speaker 1 (00:40):
I'm doing well, thank you.
Thanks for having me.
Speaker 2 (00:43):
Tell us just a little bit about yourself and your
company, and then we'll getright into the meat of the issue
.
Speaker 1 (00:47):
Yes, so my name is Stacey Bruss and I'm the
Regional Director of ClinicalOperations for St Croix Hospice
of Michigan.
We service almost all ofMichigan and Macomb, oakland,
monroe, livingston counties, andSt Croix Hospice is located in
10 states around the Midwestwhere we service patients and
(01:09):
their families.
Speaker 2 (01:12):
I know that you have an office in Brighton and we
just opened an office inBrighton in July of 2024.
So I know that we'll be workingtogether a lot.
Speaker 1 (01:21):
Yes, I look forward to it.
Speaker 2 (01:23):
So Stacey, one of the things.
The first thing I want to talkabout as it relates to hospice
is I'm hoping you can kind ofgive us a little bit of picture
of today's hospice, and what Imean by that is we all have
misconceptions, whether they'remisconceptions or not.
We all have ideas about whathospice is, and I'm going to
have some probing questions foryou, but I want you to start off
(01:45):
with just telling us a littlebit about what hospice is, and
I'm going to have some probingquestions for you, but I want
you to start off with justtelling us a little bit about
what is hospice in 2024.
Speaker 1 (01:50):
So hospice is a philosophy of care.
It's a comfort care based levelof care to where patients elect
this Medicare benefit to reallykeep them comfortable, where
they're not seeking aggressivetreatment but more quality days
over quantity and really focuson, you know, what matters most
(02:12):
to them.
So it's a philosophy of care,to where a interdisciplinary
team comes in and cares for notonly the patient, but a lot of
times we're, you know, caringfor the families just as well.
Speaker 2 (02:26):
You know there was a lot packed into that, so I want
to break some of that down.
One of the things that you'vementioned is, you know,
philosophy of care, and so Ithink there's probably some of
the listeners that think ofhospice, as that's what you do
on your very last day is yourlast week or two of life, and
that's not true, right.
Speaker 1 (02:52):
It isn't true and in fact we try to get patients on
hospice sooner.
A lot of times our patients andfamilies will say that they
wish they would have known abouthospice sooner because so many
misconceptions and myths abouthospice and what it is that we
do.
But statistics show thatpatients live 29 days longer
when they're on hospice servicesbecause they get that extra TLC
and they're focused more on.
Speaker 2 (03:12):
The one thing I wanted to point out that was
really important that you saidis that it's a Medicare benefit.
So, generally speaking, ifsomebody's on Medicare and they
qualify for hospice, they're notgoing to pay anything out of
pocket for this hospice benefit.
Speaker 1 (03:23):
Right, they qualify for hospice, they're not going
to pay anything out of pocketfor this hospice benefit.
Right, that's correct.
So not only are they gettingmedications, but they're getting
their DME supplies, such as abed, a wheelchair, oxygen.
All of that is a part of theirMedicare benefit, as well as
getting a care team that's goingto come right into their home
wherever they call home.
(03:44):
And you know, we haveregistered nurses who are our
in-case managers, we have socialworkers, we have chaplains who
are non-denominational, we havemusic therapy, we have massage
therapy, so it's really focusingon that total patient as a
whole to make sure that theirgoals are being met.
Speaker 2 (04:03):
You said just what I was going to say as a whole very
holistic planning.
Right, we're looking at thewhole person.
We're not just looking at adisease.
We're not just looking at, youknow, treating a specific thing,
like the medical team.
You know medical staff tends todo, and so it is a very
holistic approach to yes.
I want to circle back just tomake it abundantly clear that
(04:24):
this is a Medicare benefit.
So, whether someone's onMedicare, if they have a
Medicare Advantage plan throughtheir insurance company, this is
a Medicare benefit and it's notwhether or not Blue Cross or
whatever insurance company willauthorize this.
This is a Medicare benefit andthey're not going to have
co-pays in order to get hospiceright.
(04:46):
They're not going to get deniedbecause of the insurance
company.
It's going to be the hospiceorganization that determines
whether they're eligible.
Speaker 1 (04:54):
Yes, absolutely so.
We have a hospice medicaldirector who is a physician that
will certify that the patientis eligible for this benefit,
because it is 100%, you know,paid through the Medicare
benefits.
We want to make sure that we'remeeting those Medicare
guidelines in regards toeligibility.
Speaker 2 (05:14):
One of the things that I think a lot of my clients
feel is just a really importantand positive aspect of hospice
is respite care, and so one ofthe things that we see is
frequently we'll have familythat are caring, whether it be a
spouse or kids that are, youknow, providing care and daily
(05:37):
care for their loved one andthat can be very challenging,
especially if you have agranddaughter being born in
another state or if you wantedto go to your niece's wedding or
something like that, and youcan't bring your loved one
because of their physical ormedical condition, and the idea
of respite care is part ofhospice.
(05:58):
Can you talk a little bit aboutthat?
Speaker 1 (06:07):
that, yeah.
So respite care is really forany caregiver burnout.
We see, you know, specificallywith our Alzheimer's patients or
some of our patients who are,you know, very sick, that it's a
lot of work for caregivers totake care of their loved one.
It's a full-time responsibility, and so part of that hospice
benefit is a respite stay wherehospice will actually pay for
(06:27):
the patient to stay in afacility to allow that caregiver
, you know, an opportunity tosometimes sleep or just have
some sort of self-care or, likeyou mentioned, you know if they
have something that's going onout of state or whatnot.
It really is a great part ofthat hospice benefit.
Speaker 2 (06:49):
And can you talk to us a little bit more about that
respite benefit?
Is that something that they canjust do once a year?
How often would they be able toaccess that respite benefit?
Speaker 1 (06:59):
Yeah, so the respite benefit is usually once per
benefit period.
So we go in, you know benefitperiods of 90 days, then 60 days
and 60 days.
So we like to, you knowMedicare has, you know those
guidelines to where it is, youknow, once per benefit period.
So we work, you know, with thepatients and families to
(07:21):
determine when is you know theappropriate time to do that.
Speaker 2 (07:25):
Nice.
So one of the other myths thatI hear often is you can only be
on respite for six months.
And so they say well, you, youknow you have to die within the
six months because hospice willrun out.
That's not true either, correct?
Speaker 1 (07:39):
It is not.
So hospice, you know Medicare,does have a guideline that you
know it's six months or less ifyour disease takes its normal
course.
Normal course looks muchdifferent for multiple different
patients.
So no one has a crystal ball.
So we've had patients who havebeen on hospice services for
years.
They continue to have, you know, small declines to where
(08:02):
they're still eligible for thebenefit because they still have
to remain eligible to receivethe hospice benefit.
But we've had patients who havebeen on for years.
So you know there is many mythsabout hospice and what it is
that we do and you know we hearthat.
You know I don't want to.
You know, pass away today ortomorrow and, like I said
(08:22):
earlier, 29 days longer is thestatistics that you know when a
patient comes on to hospice theylive 29 days longer.
So you know we, like I said,have had patients on for years
and you know there's no crystalball to what it is that we do.
Speaker 2 (08:39):
Now is there a requirement that they have a
physical illness versus acognitive memory, dementia,
alzheimer's type of a thing?
Could they qualify?
If they're not, they don't havea specific terminal illness,
but they have significantdementia or Alzheimer's.
Speaker 1 (09:01):
Yeah, so we see you know different types of
diagnosis for hospice.
You know it's a conversationthat our admission nurse has
with our physician and, based onwhat's going on with that
patient as far as their declines, we look to see what would be
that terminal diagnosis.
So we have had patients whohave been on for Alzheimer's A
(09:23):
lot of times.
You know we have thoseAlzheimer's patients, we have
COPD patients, we havecongestive heart failure
patients.
So you know it really justdepends on what's really going
on with that patient and havinga conversation with that
patient's physician and ourhospice medical director to see
you know which diagnosis youknow would be most appropriate
(09:45):
to bring them onto hospice.
Speaker 2 (09:48):
I had mentioned that we have, so we have in our legal
team, we have what we call carenavigators typically social
workers, in our office, and wehave one of our care navigators
that her previous experience wasin a hospice organization,
which actually fits really wellwith our concept of care
navigation Because, again, it isa very holistic type of
(10:09):
planning opportunity within ourlegal office.
And so the reason I'mmentioning this is I had
interacted with hospice for allof my professional career, and
what was interesting to me ishow much I learned from her
about the nuances of hospice,that I had many misconceptions,
and I'll give you a couple ofexamples.
(10:31):
One was that if you are onhospice, you can't receive
medical treatment.
You can't go to the hospitalfor any reason, and so tell me
if that's accurate.
If you're on hospice and thereason you're on hospice is for
cancer, and then you get a UTIor you break your leg or
something like that, are theygoing to treat the UTI or the
(10:53):
broken leg?
Speaker 1 (10:53):
Yeah, so most definitely, you know that
becomes a comfort issue.
So a lot of times we canrecognize the symptoms of a
urinary tract infection or anyother you know sort of infection
that's going on and you knowour nurses do an excellent job.
The hospice nurse will, youknow, reach out to our physician
and go ahead and be veryproactive in getting that
(11:15):
antibiotic.
So you know we do treat thosesymptoms.
They don't necessarily have togo through any sort of testing
for that, but we're treatingthose symptoms to make sure that
that patient is comfortable.
So most definitely, you know ifthere is a need to go to the
hospital, we address that aswell.
You know there's so many mythsabout hospice and what it is
(11:39):
that we do that you know if apatient has a fall and they have
a broken leg, obviously that'ssomething that we're going to
have to manage and they're goingto have to go to the hospital,
you know, to get that taken careof.
So definitely a case by casebasis, but if there is a need
for that patient to be seen atthe hospital, then most
definitely they can do that.
Speaker 2 (11:59):
So, stacey, tell us a little bit about more about you
and your role there, how youcame to be working with hospice
and tell us a little bit moreabout St Croix Hospice.
Speaker 1 (12:09):
Yeah, so my position is I'm the Regional Director of
Clinical Operations for St CroixHospice of Michigan, so I
oversee all of the clinicalteams for all of our branches.
So that's our nurses, our aides, our social workers, our
chaplains.
They work with our manager ofclinical services and the
(12:29):
manager of clinical servicesdirectly report to me.
So I oversee the day-to-dayoperations of our clinical team
and ensuring that we areproviding the highest level of
quality of care for our patients.
And I've been in hospice forthe last 15 years.
I've been a registered nursesince 2002.
(12:51):
I've been a registered nursesince 2002.
And I started in hospice whenmy grandmother, who was an
Alzheimer's patient in 2007, shewas diagnosed with Alzheimer's
disease and went on to hospiceand I wanted to learn more,
because in nursing school theydidn't teach us about hospice
(13:12):
and so I was very in tune withthe hospice staff that would
come in to see my grandmotherand I just wanted to know more,
and that's when I got my firstposition was in 2007.
I've been in hospice ever since.
So I've been a communityliaison where I've met with
different community leaders totry to get patients onto hospice
(13:34):
sooner.
I've been in operations, I'vebeen in sales, so I've had a
multitude of different positionswithin hospice, but really what
brings me joy at the end of theday is making sure that our
patients are treated as if theywere a family member and
providing that highest level ofcare.
We recently lost my father.
Last year he was 68 and passedaway with Alzheimer's disease
(14:00):
complications related toAlzheimer's disease and he was
also on hospice.
So it's something that's verynear and dear to my heart.
I've witnessed it firsthand,having my grandmother and my
father both on hospice.
But it's something that I havea very strong passion for to
make sure that these patientsare very well taken care of, and
(14:21):
I always say that there's noredos in the field of hospice.
We've got one shot to make adifference and it's a lifelong
opportunity to make sure that,however many days our patients
have, that they are lived to thefullest and that they were
provided the highest level ofcare.
Speaker 2 (14:41):
I think that's really meaningful, that you've had
your own personal experienceswith that.
You know I've been doing thisfor a long time and I feel like
we've always been very in tuneto our clients' families and
their lives and their strugglesthat they have.
But I can tell you once myfamily was a client when we were
settling my parents' estate andleading up to their deaths.
(15:03):
I did experience it in adifferent level and I suspect
that's true for you too, thatyou can be very passionate about
this topic and the services youprovide.
But it provides a wholedifferent perspective when it's
your grandmother, when it's yourfather.
Speaker 1 (15:20):
Absolutely, and one of the things that I really
enjoy in my position is I havethe opportunity to add
clinicians onto our team and ourinterdisciplinary team, and I
want to make sure that if I wason the receiving end of this
care, would I want this personto care for my loved ones?
So it's an opportunity to makesure that we're adding the
(15:41):
correct team to our currentexisting team.
That will go above and beyond,because there's many hospice
organizations out there and noteveryone does them the same.
St Croix Hospice has specialprograms that every clinician is
dementia certified to make surethat we're able to care for
(16:01):
dementia patients at the highestlevel.
And we have a fall preventionprogram where we have physical
therapy evaluate our patients tohelp prevent falls.
Evaluate our patients to helpprevent falls.
We have a voyage program towhere our patients who need a
higher level of care are seen byour nurse every single day,
based on predictive analytics,so we make sure that we're
(16:22):
present when that patient passesaway, and so not all hospice
agencies do it the same.
I'm very honored to work at StCroix Hospice.
We do things at the highestlevel and I feel like these
programs really set the bar forwhat it is that we do.
Speaker 2 (16:39):
That's a really important point that we need to
make sure that people understandthat they have the choice of
what hospice organization thatthey use.
And so I do think families getconfused about this because and
I'm not complaining orcriticizing, I'm just
acknowledging the fact of itthat a lot of hospital
(17:00):
organizations have a hospicethat's associated or owned by
the hospital or part of the sameorganization, and so sometimes
when you're in the hospital andthey start talking about hospice
, it seems like that is hospice,that's the only option that you
have and that may be the besthospice for you.
But the point of it is that forfamilies to understand that
(17:21):
they have the choice, they havethe option of looking at other
hospices, and if it is somebodywith dementia, it's a good
question Are the people in thehospice organization certified
dementia practitioners?
Do they?
have the fall risk preventionthat you talked about.
These are all important things,what are the expectations?
And I think that when we talkabout hospice, the families are
(17:44):
so overwhelmed because sometimesthis is a bit of a shock to
them that they don't think ofasking these questions.
And I really do think it'simportant that, if you're
exploring hospice, that youactually ask okay, what is
included in this, what is thetraining, what are the options,
what are the services that arebeing provided and covered under
this?
And if you aren't thrilled withthe answer, you can call a
(18:09):
different hospice organization,and so that's a very important
point that you make is that youhave a choice among which
hospice that you choose.
Speaker 1 (18:18):
Absolutely.
I always encourage families tointerview a couple different
hospice organizations to findout what is going to be the best
fit Specifically.
You know, having had two lovedones who had Alzheimer's it's a
very specific disease and ittakes a very special person to
be able to care and manage thesymptoms and everything that
(18:40):
comes along with this horrificdisease.
So I encourage families to dotheir research, to interview
multiple different hospiceorganizations, because, although
hospice is an umbrella of care,there are certain things that
set hospice agencies apart andit's really important that you
find the right fit for you andyour loved one On that same
(19:02):
theme do you have any advice forfamilies that are giving some
consideration as to whether ornot to go with hospice?
Speaker 2 (19:07):
I know a lot of my clients are in that position
where it's not sometimes it'svery obvious right.
Sometimes it's just it'sclearly the right thing to do.
And sometimes families strugglewith it even when it is clearly
the right thing to do.
But there's other times whereit is sort of they have a
decision to make.
Well, the person might beeligible for hospice.
(19:28):
The family has to decide ifthat's the right timing for it.
So do you have advice forfamilies that are facing that
struggle?
Speaker 1 (19:35):
Yeah, my best advice is if your physician or if you
feel like your loved one isdeclining and they've reached a
certain point to where they wantto be comfortable, and not
saying that they even have to bea DNR because we have multiple
patients who are a full code.
That's one of the myths as wellis that you have to be a do not
(19:56):
resuscitate, and that is notthe case.
We have multiple patients whoare a full code.
But I always encourage familiesto get an evaluation, get a
consult with hospice and learnwhat we have to offer.
It is a great service and mostfamilies say that they wish that
(20:17):
they would have known about thehospice team sooner or the
hospice benefit sooner, becauseit is all encompassing.
It is a relief for the family, apeace of mind to have a nurse
come to your house, wherever youcall home, an aide to help with
(20:39):
baths and changing and dressingand doing all of the things.
You don't have to do this alone,and that's what hospice is for.
It's such an underutilizedbenefit in the United States
that so many people do not takeadvantage of because they feel
like it's giving up, and it'snot.
(21:01):
It's not giving up.
You can come off of hospice atany time, right, it's not
something to where you sign onand you have to stay on forever
If you change your mind or ifyou decide to go a different
course of action.
It's something that you canchange your mind at any time.
But if you're eligible, it'ssuch a tremendous benefit that
(21:24):
not only benefits the patientbut it also benefits the family
with the medications andeducation and the you know
durable medical equipment thatyou can get.
It's just my best advice is tocheck into it and, you know, get
the answers to the questionsthat you have.
(21:45):
And I know that initial stepmight be scary, but I think that
once that you get theinformation and you really learn
what hospice is about, it's notas scary as you think it is and
it's actually a tremendousbenefit.
Speaker 2 (22:01):
That's really important and I think that's one
of the things that sometimesthere's a lot of things that our
clients will ask us about.
Can they assume that it'scovered under Medicare, you know
, when they're not on hospiceand they assume that this is
just a standard Medicare benefitfor like different medical
equipment and things like that.
Or they assume that respitecare might be a medical benefit
(22:24):
that they get through theirinsurance company and
realistically, there's a lot ofthings that are provided by
hospice that are not providedunder your regular Medicare and
your supplemental or MedicareAdvantage benefits.
You really can only get thosebenefits when you're under
through the hospice program.
Speaker 1 (22:41):
Yeah, absolutely.
And you know, although hospiceis a wonderful Medicare benefit,
we also, you know, hospiceswill take Medicaid and different
you know types of insurance.
So although it's covered, youknow, 100% through Medicare, we
do also accept other payersources as well.
So it really is, you know,meeting the patients and the
(23:03):
families where they're at intheir journey, no matter where
that journey is matter wherethat journey is.
Speaker 2 (23:12):
Yeah, and that's actually where we can help folks
too, because sometimes folkswill say, oh well, we don't need
those legal services becausewe're going on hospice.
Actually, our legal serviceswork hand in hand with hospice
because we can look towardsgetting additional benefits
Medicaid benefits that mightsupplement the hospice benefits
in home care or maybe through anursing home if that's necessary
(23:32):
, and having Medicaid pay forthe bulk of those things.
And we help people getqualified for Medicaid, or maybe
it's veterans benefits thatwill supplement the benefits
provided by hospice, and that'ssomething that we help folks
with.
And, frankly, then, it's justalso making sure that we have
the legal positions in place.
Really, a big part of the legalissues are do you have people
(23:57):
you love and trust and, if so,do we want them to be involved
in making decisions?
If you can't, if eventually youcan't make all of your own
decisions, rather than have acourt appoint someone?
And so that's a big part of thisconversation rather than have a
court appoint someone, and sothat's a big part of this
conversation.
So it is, when we talk aboutholistic planning, really the
legal planning is part of thatholistic planning and that the
(24:18):
legal services and the hospiceservices actually do work very
much hand in hand.
That's great.
Through St Croix Hospice do youalso do palliative care?
Speaker 1 (24:27):
We do not do palliative care and you know I
was always taught all hospice ispalliative care.
We do not do palliative careand you know I was always taught
all hospice is palliative butnot all palliative is hospice
and what we mean by that is.
Hospice is such a tremendousbenefit where you get a full
team who comes in to your homeand manages those symptoms and,
(24:47):
you know, takes care of thepatient holistically, whereas
palliative care is usually justa nurse practitioner who's
coming in, you know, once amonth or twice a month to really
manage those symptoms.
Hospice is such a betterbenefit for our patients and
families that you know our focusreally is hospice services.
Speaker 2 (25:08):
Well, stacey, appreciate your time and
everything that you do for ourcommunity and for the folks that
you serve.
Is there any advice that you'dlike to leave our listeners?
So our listeners tend to bepeople within the long-term care
industry, social workers,people within the health care
industry and then just thegeneral public that's interested
(25:29):
in these aging issues.
So any advice that you'd liketo leave them with?
Speaker 1 (25:35):
Yeah, I would say the best advice that I could give
is, you know, hospice isn'tabout giving up hope.
It's really about focusing onthose days and, you know, making
the most of your days.
One of the things that we reallyfocus on at St Croix Hospice is
we've recently been certifiedin age-friendly care and one of
(25:58):
the things that we ask ourpatients whether it's a
registered nurse or it's ourchaplain or it's our social
worker is what matters most toyou as the patient and you know
we get all sorts of answers.
It could be what matters most isthey want to sit outside in the
sun or they want their son tocome in from out of town, or
(26:22):
whatever it may be.
But you know that's one of thethings that our hospice in
particular is really focused onmaking sure that those goals are
met.
You know we don't have acrystal ball whether we're on
hospice or we're not on hospicein life.
We don't know how much timethat we have here on this earth,
but we want to make sure that,however much time that we have,
(26:43):
that we're making the most ofthose days.
And so, you know, my bestadvice that I can give to anyone
is, if you are even consideringthis level of care is to check
into it and get the informationthat you are needing to make
that you know best decision,because chances are you will
(27:04):
wish that you would have done it.
Speaker 2 (27:06):
I think that's a beautiful way of saying it and
summing it up.
I think that was perfect way tokind of define what the hospice
philosophy is.
So thank you for listening andthank you, Stacey Bruss from St
Croix Hospice for joining us mypleasure.
If you enjoyed this podcastAdvice from your Advocates, know
that you can subscribe at anyof the places that you listen to
(27:28):
podcasts and that way you getnotified when we have great
guests like Stacey for us, andso I hope you subscribe and
we'll see you next time.
Speaker 1 (27:46):
Thanks for listening.
To learn more, visitmanorlawgroupcom.
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