00;00;00;11 - 00;00;25;21 Speaker 1 And now America's health care advocate, Cary Hall. Hello, America. Welcome to America's Healthcare Advocate show broadcasting coast to coast across the USA, from Alaska to Florida, all the way to Hawaii. We are broadcasting today from the Cape. 1550 a.m. 100.3 AM here in Cape Girardeau, Missouri. This is another in our series of shows we are doing with Saint Francis Health System here in Cape Girardeau, throughout southeast Missouri. 00;00;25;27 - 00;00;40;08 Speaker 1 And as I've told you before, we do run these shows nationally. And the reason for that is because we have a series of doctors, clinicians and experts that come on and talk about various health care issues. Today, we're going to talk about home health care and hospice. I think you're going to find this to be an interesting show. 00;00;40;20 - 00;00;54;21 Speaker 1 You know, there are about 10,000 people a day turning 65. And those people, many of them have parents who are much older than that. So this is a topic that's very important and a lot of people have to deal with, too. Sometimes they're not quite prepared. So that's one of the purposes of doing a show like this today. 00;00;54;29 - 00;01;15;13 Speaker 1 Our producer, Mr. Paul Verna, and I'm your host, Cary Hall. As we always say, this is your show, America. Thank you for joining us and making us one of the most listened to talk shows throughout the United States. 294 affiliates strong. Our newest one in Cannon, Colorado. Also, all of these shows are on podcast platforms. Tune in SoundCloud, iTunes, Spotify and Apple Play. 00;01;15;13 - 00;01;33;21 Speaker 1 So we've got about 3 to 4000 people a month going up there to listen to these shows. This is one of those shows that if you hear it, there's somebody in your family or in your church or somebody you know who's dealing with an issue with a parent or a loved one that's having issues. This is a great way to have them go back up and listen to that show on those podcast platforms. 00;01;33;21 - 00;01;51;18 Speaker 1 So again, SoundCloud to iTunes, Spotify, Apple Play, Odyssey Play, they're all up there on those podcast platforms. If you want to reach out to me, you can do that. The website is Health Radio Dot U.S. Health Radio Dot US. We get a lot of emails. I answer each and every one of them. I do not answer each and every one of the same day. 00;01;51;18 - 00;02;10;21 Speaker 1 So it takes me a little while sometimes. But I do get back to you if you want to reach out to me at that website. Health Radio Dot U.S.. All right. Joining me in studio, Larry Dush RN, BSN and patient care manager of Saint Francis Home Health and Melissa Hale, MSW, LC S.W. patient care manager, Saint Francis Hospice. 00;02;10;21 - 00;02;14;18 Speaker 1 Thank you both for being here today. Good morning. I know you're both busy. You just got back from a cruise. 00;02;14;25 - 00;02;14;29 Speaker 2 To. 00;02;14;29 - 00;02;37;00 Speaker 1 Haiti, so you're tanned, rested and ready today. I'm trying a little bit about our guest, Larry Dush is an RNBSN serves as patient care manager for Saint Francis Home Health. He is responsible for the delivery of care to all patients served by home health, as well as instructing and guiding clinicians to promote more effective performance and delivery of quality home health care services. 00;02;37;08 - 00;03;00;14 Speaker 1 Dush joined Saint Francis Health Care system starting in 2019 as a registered nurse for home health care. In June of 21, with 21 years of home health care experience, Dush has transitioned to the role of interim director of Home Health and Hospice before becoming the patient care manager of Home Health. Melissa Hale is an MSW LCSW. Serves as Patient Care Manager for Saint Francis Hospice. 00;03;00;14 - 00;03;27;20 Speaker 1 She is responsible for maintaining the supervision and direction of skilled nursing, spiritual counseling, pastoral care, social services, volunteers, hospice aide and other therapeutic services within the hospice department. Hale joined Saint Francis health care system in January 2015, with more than ten years of experience working in home health hospice, Hale received her Bachelor of Science in social work from Southeast University and her Master's degree in social work from Saint Louis, U. 00;03;27;23 - 00;03;44;22 Speaker 1 That is a mouthful. You're both very qualified. Yes. And you're busy because Home Health had 7032 visits last year and Hospice had 9486. That's a lot of work. Yes, it is a lot of work. So, Larry, talk and explain the difference between home health and hospice. 00;03;45;13 - 00;04;05;24 Speaker 3 Home health is a more curative or rehabilitative service focus. So we really go into a home and what we try to do is we try to help those patients recover from whatever disease process they're experiencing. We take care of their wounds, their IV needs, should they need IVs, basically trying to get them back to their maximal level of functioning. 00;04;05;24 - 00;04;20;28 Speaker 3 We offer physical therapy, occupational therapy and speech therapy as well. Deal with a lot of CVA patients. Patients have had strokes, hospice, they're the symptom management experts. They're really, really good at what they do. They're actually angels. And I've had family members in hospice. 00;04;21;07 - 00;04;22;27 Speaker 1 Have wings just like that. 00;04;22;27 - 00;04;48;11 Speaker 3 I've actually had family members in hospice as well as I've seen some hospice patients. But it is I'm not a hospice nurse, but they really manage patients nearing the end of their life. And not just the patients, but they deal with the case, the sorry, the caregivers, they deal with spiritual needs, they deal with socioeconomic needs. They deal with everything to try to make that patient's end of life experience the best that it can. 00;04;48;11 - 00;04;50;13 Speaker 3 They add quality to the patient's life. 00;04;50;19 - 00;05;07;22 Speaker 1 Yeah. You know, it's interesting. I think I mentioned before we went on the air that I've got some experience necessary because my father in law, mother in law, my father and my mother all passed and we had hospice involved in their care all the way through. And it does make an enormous difference. It also takes a huge burden off the family that are trying to be caregivers at the same time. 00;05;08;01 - 00;05;34;21 Speaker 1 So it is it is a very necessary service. And as I said in the opening remarks, there are 10,000 people. They turn 65. I'm 73. My parents aren't alive now, but they were eight, nine, ten years ago. And having the knowing that these services are there and that St Francis is providing the services I think is important. So we'll talk a little bit about what patients are qualified for, for hospice care. 00;05;34;21 - 00;05;42;09 Speaker 1 What what what does it because a lot of people, I think, have the conception that you absolutely have to be terminal to qualify for hospice care. Is that true? 00;05;42;17 - 00;06;02;05 Speaker 2 I mean, you have to have a terminal diagnosis and you're willing not to seek any more life treatment. So that would be like chemotherapy. If you're not seeking chemotherapy, our goal is to give you quality at your home, your home environment. It doesn't have to be cancer. A lot of individuals think with hospice, oh, well, I don't have cancer. 00;06;02;10 - 00;06;14;07 Speaker 2 It's not true. It's a CHF, COPD, AIDS, renal failure, Alzheimer's strokes or any life prolonged life limiting illnesses that qualify for hospice. 00;06;14;21 - 00;06;35;16 Speaker 1 That's that's interesting to me in strokes, as well as Alzheimer's and strokes. And Alzheimer's is extremely difficult because the issue, the burden, it comes back on the caregiver at home. So how do you interact whenever you've got somebody that's got Alzheimer's? They are terminal because Alzheimer's is an end of life disease oftentimes. How do you handle that and interact with the family in that case? 00;06;35;16 - 00;06;53;09 Speaker 2 You know, with hospice, a lot of our education is more with the family than it is the patient. So it's, you know, how to how to provide that quality and understanding that they're not going to eat the way that you and I eat. So allowing them to have you know, if they only want a few bites, that's okay. 00;06;53;18 - 00;07;08;05 Speaker 2 You know, it's a lot of education with the family that they're just their disease process is different. And like I said, it's a lot of education with the family. On how to support them through the end of life. 00;07;08;09 - 00;07;27;14 Speaker 1 You know, that's interesting because that's not the first thing that comes to mind. The first thing comes to mind is if you're there maybe to take care of daily needs with the patient, bathe them, maybe help feed them, check their beds, whatever the case may be. But what do you think about that? That really is probably a critical part of what goes after family, doesn't know what to do. 00;07;27;20 - 00;07;31;03 Speaker 1 It makes it more and more difficult. And people typically don't know what to do, right? They do. 00;07;31;03 - 00;07;47;03 Speaker 2 Not. And that's where our team is great. I mean, they that their focus is on on the education piece. So we spend a lot more time with the families than we do with the patients to make sure that they have everything that they need, all the education they need to provide that care to that patient. 00;07;47;15 - 00;07;57;26 Speaker 1 Yeah, I know, but you're doing an awful lot of it because I said you had 9486. This is how many people in your department. That's a lot of visits throughout this whole area of southeast Missouri. 00;07;58;03 - 00;08;11;06 Speaker 2 Right now we have 11, 11 staff, including myself. That's not including home health. We kind of team up. So a lot of home health patients transfer to hospice. So it's a great working relationship that we have between the two departments. 00;08;11;06 - 00;08;26;23 Speaker 1 So oftentimes they'll start out with home health and then as they as they would say, progress, and that's correct word of it as they progress and move toward end of life, Alzheimer's, stroke, some of these things, then that's where you hand it off. Off to the to the hospice people. 00;08;26;24 - 00;08;53;09 Speaker 3 Yes. Our staff spend educated to look for those patients that qualify for hospice, that have the right diagnosis, have the right life conditions. And so they know that when we go out and see this patient immediately, they know to start thinking, hey, this person really does need hospice. We do it with a lot of our dementia patients, especially our cancer patients, because when we pick up cancer patients, a lot of times it'll be like, I want to make it to September the 15th for my son's wedding. 00;08;53;09 - 00;09;06;07 Speaker 3 And then after that I want to transition to hospice. So a lot of times home health is a stopgap measure just to keep that person managed during that period of time to where we can get them to transition to a hospice situation and they get the care they need. Yeah. 00;09;06;07 - 00;09;20;13 Speaker 1 You know, and as we're coming up on the break, I would imagine it's also important that you set realistic parameters for people about what they can and they can't do what they can't expect and what. Because I think sometimes that's very difficult for people and for families. Am I right? 00;09;20;21 - 00;09;32;29 Speaker 3 Yes. Some nurses have a little trouble and some physicians also have trouble going and having that conversation with those people and saying, look, I'm sorry, but here's the reality of your situation and this is what we can do to give you a better quality of life. 00;09;33;00 - 00;09;37;24 Speaker 1 And that's really what this is all about, isn't it, Melissa, of better quality life, these people, as they come to end of life. 00;09;37;26 - 00;09;38;18 Speaker 2 Absolutely. 00;09;38;21 - 00;10;00;26 Speaker 1 We come back from the break. We're going to continue this fascinating conversation. If you want to learn more about Saint Francis home health and hospice, you can do that at the website SFMC.net/HomeHealthHospice, at SFMC.net/HomeHealthHospice. Stay tuned. We'll be right back after the break. You're listening to America's health care advocate broadcasting here on the HIA radio network. 00;10;01;04 - 00;10;03;23 Speaker 1 Coast to coast across the USA. We've got more. 00;10;04;12 - 00;10;16;28 Speaker 4 ### 00;10;20;07 - 00;10;37;21 Speaker 1 Welcome back. You're listening to America's Health Care Advocate Show, broadcast coast to coast across the USA here on the HIA Radio Network. You can find out more about us by going to the website. Health Radio dot U.S. Health Radio dot U.S. My producer, the always perfect Mr. Paul Vrrnon I'm your host Cary Hall. Thank you for joining us again today. 00;10;37;28 - 00;10;59;12 Speaker 1 In studio with me today, Lawrence Dush patient care manager, Saint Francis, Home Health, and Melissa Hale, patient care manager of Saint Francis Hospice. We're happy to have them here. Obviously, the topic of the show is home health and hospice. Again, you know, we're broadcasting here in Cape Girardeau, Missouri, at from the Cape Radio 1550 AM.. Yet we're broadcasting all over the country. 00;10;59;12 - 00;11;18;14 Speaker 1 And if you're wondering why I'm doing that, because this is a chance you've got two experts here that are talking about a topic that's very difficult. You heard, you know, Larry mentioned this a minute ago. It's difficult for a lot of people to deal with this. And what we're trying to do is explain to you that, you know, here in southeast Missouri, Saint Francis health care system provides these services. 00;11;18;20 - 00;11;38;28 Speaker 1 But across the country, this is something people have to deal with. And you get a chance here to listen and learn from these folks who are experts in their field. So, Larry, let's talk about how do they know when we think we have a problem. We're not sure how it's causing problems. You know, Dad's tried to take care of mom, you know, whatever the case may be. 00;11;39;04 - 00;11;49;11 Speaker 1 And how do they know when when is the time that they want to think about reaching out to you all and seeing, do we need to get somebody in or do we qualify? How does all that work? 00;11;49;19 - 00;12;09;05 Speaker 3 We have a lot of conversations with patients and their caregivers. They just call us and they'll say this is what's going on with my loved one and do they qualify for home health or should we look at hospice? So that helps when the person on the phone knows what the qualifying conditions are. So hospice and home health have totally different qualifying conditions. 00;12;09;25 - 00;12;28;04 Speaker 3 Medicare has set five specific qualifications for Home Health admission. The first thing they have to have is a doctor. The doctor has to be willing to go and order the home health care. We can't just go out and see him without that. Also, the physician has to manage the plan of care, the interventions and the goals that we set for those patients. 00;12;28;20 - 00;12;46;06 Speaker 3 They have to have an intermittent skilled service need if they're going to be in home health. So that would be physical therapy, speech therapy. We do a lot of wound care. We take care of a lot of patients with IVs in the home. That's a really important thing we do. A lot of certain types of injections are covered under the Medicare benefit as well. 00;12;47;00 - 00;12;55;14 Speaker 3 And just an interesting fact, private insurance pretty much just follows whatever Medicare says. So what I'm saying now goes for private insurance as well as Medicare patients. 00;12;55;14 - 00;13;12;02 Speaker 1 So if they have a medicare, they have Medicare Part B, they've got A and B, they signed up for either pay. Yes. Now, maybe it's got a medicare Advantage plan or they've got a medicare supplement plan that those guidelines basically follow whatever the protocol is for Medicare. Correct. If you qualify for one, then it's going to qualify with the carrier. 00;13;12;06 - 00;13;17;00 Speaker 1 It's not an issue of jumping through a lot of hoops to get to that. Correct. Like an automatic qualification, right? 00;13;17;01 - 00;13;18;02 Speaker 3 That's exactly correct. 00;13;18;03 - 00;13;35;10 Speaker 1 So, you know, if people are in doubt about that, how do they what do you suggest they do in terms of, you know, we're not quite sure, you know, if maybe the doctor hasn't recommended it yet. They're dealing with things at home. Maybe the doctor's not even aware of you know, what's going on. That may be issues for them. 00;13;35;10 - 00;13;35;23 Speaker 1 So a lot of. 00;13;35;23 - 00;13;51;23 Speaker 3 Times we act as an advocate for those patients. We will go in and we will talk to the patient if we will make a courtesy visit or we can do it over the phone. We get all the data, all the information, gather it, and then go back and call the physician and say, listen, your patient has reached out to us. 00;13;51;28 - 00;14;09;07 Speaker 3 They feel they have a need. We assess them. We really think they do have a need. And it's home health, something that you would consider ordering for them. And then they would say yes or they would say no. Or if we get there. And I'm like, listen, I'm really sorry, but, you know, you're not going to do a lot of times the patients are self-determine that because they're like I'm not doing any more treatments. 00;14;09;12 - 00;14;26;29 Speaker 3 I'm not going back to the emergency room. I don't want anymore interventions. I don't want dialysis, I don't want chemotherapy. I don't want radiation. If that's the case, then that's when we say, you know, you're more appropriate for a hospice referral and then hospice will do the same thing. They'll reach out to the physician and say, we need an order for hospice. 00;14;26;29 - 00;14;32;03 Speaker 3 And and then once the patient's admitted to hospice, their medical director will take over the care. 00;14;32;03 - 00;14;51;20 Speaker 1 So then, you know, staying on the topic home, Elfman, you mentioned E.R. So, you know, this is interesting. My wife broke her leg in Hawaii on a vacation three years ago, and it was a nightmare getting home. But one of the things that we have is we add on health care. So when they came in, you know, they they changed dressings. 00;14;51;20 - 00;15;02;22 Speaker 1 They did all these other things. They also did physical therapy. They checked her meds. So it's not necessarily people that are that that are end of life or even approaching end of life. It could be somebody that fell and broke a hip. 00;15;03;03 - 00;15;03;12 Speaker 3 Yeah. 00;15;03;12 - 00;15;06;10 Speaker 1 For home health, somebody has a stroke and they're recovering. 00;15;06;10 - 00;15;28;02 Speaker 3 Yes, sir. Now, again, Home Health focuses on rehabilitation and curative. We are not end of life hospices. End of life and home health. So hip, hip replacements, knee replacements, broken bones, as you said, multiple vehicle accidents, car accidents. We get a lot of those patients that have wound care, new ostomy patients. If a patient gets a new ostomy, there's a lot of education. 00;15;28;08 - 00;15;52;10 Speaker 3 Diabetes is a really huge thing for us. We do a lot of diabetic teaching, diabetic management in this community especially. That's a really big diagnosis. A lot of our people in this area, our patients have diabetes and so we are a supplement to the education they get from the diabetic educators or from their physicians. And we actually go out, man, we cannot really manage their meds, but we can educate them on how to manage their meds. 00;15;52;21 - 00;16;04;17 Speaker 1 So you mention diabetes. So type one diabetes is obviously going to be very, very difficult and that's going to be high on the level of people that you're checking A1, CS, Their insulin medications, all the other things that come with that. 00;16;04;17 - 00;16;25;12 Speaker 3 We actually take care of more diabetes type two patients than diet type one. Really? Yes, because type ones, they're more specifically educated. They have to have insulin. They know a lot better management of their diets and what they can and can't eat. A lot of us diabetic type two people, you see us? Yes. Some of us are not the most compliant patients. 00;16;25;12 - 00;16;48;26 Speaker 3 And so sometimes we'll go to the Mexican restaurant and fudge and eat a whole basket of chips or, you know, it's really good to go eat some ice cream because it's really cold outside. And so those are the kinds of patients that we see on a daily basis that really, really need that education. And it really does help that if you're a person who has that condition, you can one on one with that person and say, look, I know how hard this is because I'm there with you and I'm doing this. 00;16;49;03 - 00;16;53;00 Speaker 3 So it's really, really it's it's it's a challenge. 00;16;53;00 - 00;17;11;26 Speaker 1 It really is. Yeah. It's interesting. Listen, you talked because I get the distinct impression that when people are listening to you and you're interact with them, that it's like you. They can tell that you really care about what you're doing and you really care about these people and you're connecting with them in a personal way that helps them manage the disease, manage the issue. 00;17;11;26 - 00;17;15;16 Speaker 1 They're dealing with it at the same time, hopefully improve their health. 00;17;15;24 - 00;17;22;23 Speaker 3 Right. This is definitely a calling. And our organization has a mission that is Christ focused. And I hope that's okay to tell you that. 00;17;22;24 - 00;17;27;23 Speaker 1 Of course it's about self. Yeah, it's yes. When you walk in that hospital at Saint Francis right there. 00;17;27;23 - 00;17;37;19 Speaker 3 Yes. Our our mission is Christ focused. And so that's you know, this is a definite mission. This is not a job for me. This is my this is my ministry. This is what I do. 00;17;38;02 - 00;17;52;24 Speaker 1 Yeah. I think that I think that speaks volumes. I mean, there's there's not a lot of that out there in the world today. And I think that the community here is very, very fortunate. The Saint Francis health system and what you bring to this community and what you offer the community. And, you know, I think it's important for people to hear that. 00;17;52;24 - 00;18;11;09 Speaker 1 And, you know, it's they want to reach out to you. They can do that once again through the website. It's FMC dot net slash home health hospice. So you can go to any of those to that website, reach out there and connect with Larry or his staff. And they will be happy to help you in any way that they can see if they can be of service. 00;18;11;09 - 00;18;28;02 Speaker 1 You. We come back from the break. We're going to kind of dove into hospice here because there's a lot here to cover. You know, when I did the introduction from Lissa, you know, we talked about pastoral care, social services, volunteers, hospice aid and other therapeutic services. We're going to talk a little bit about that. What does what does all that mean? 00;18;28;02 - 00;19;10;24 Speaker 1 What does all that break down to and how does that interact with that person or that person's family? So stay tuned. We'll be right back with more. You're listening to America's health care advocate. Broadcasting here on the radio network coast to coast across the U.S. We'll be right back. Stay tuned. And welcome back. You're listening to America's health care, a big chunk broadcasting coast to coast across USA here on the radio network. 00;19;11;00 - 00;19;30;07 Speaker 1 You can find out more about us by going to the website. Health Radio dot U.S. Health Radio dot U.S. My producer, Mr. Paul Verne. And I'm your host, Gary Hall, in studio with me today. Larry, does patient care manager St Francis Home Health, Melissa Hale Patient Care Manager of St Francis Hospice. And again, the purpose of this show is to educate you. 00;19;30;08 - 00;19;49;05 Speaker 1 You're you're learning a lot today. It's like drinking out of a fire hose, listening to these guys talk about everything you do and how they do it. It's it's to educate families and about how to deal with this situation, because it happens to almost everybody. And and it's difficult a lot of times for families to deal with that. 00;19;49;05 - 00;20;08;10 Speaker 1 And that's one of the things that we're trying to do here today is to educate you if you want to learn more, if you're here in southeast Missouri and you want to learn more about Saint Francis and how they these programs work, go to the website, FMC dot net home health hospice. It's slash home health hospice s FMC dot net slash home health hospice. 00;20;08;18 - 00;20;32;02 Speaker 1 All right. Well, as I said, going out of that last break that we were going to dove into hospice care, you know, I use basically your biography here, your bio that was given to me that talked about all these different things because I know a little bit about hospice, but I certainly didn't think of all of this. So you've got counseling, you've got pastoral care, social services, volunteers, hospice aid and other therapeutic services. 00;20;32;10 - 00;20;38;24 Speaker 1 So kind of let's just kind of break some of that down. So counseling and pastoral care, what what does that consist of and how does all that work? 00;20;38;28 - 00;21;03;28 Speaker 2 You know, for the pastoral, we want to make sure their spiritual needs, you know, hospice isn't just medical, it's their spiritual needs, you know, you know, if they come in and a lot of our patients may not have a faith base and we want to make sure that that piece is also captured. So that's where our chaplains come in and make sure that, you know, when that time comes that they do have peace. 00;21;04;09 - 00;21;09;06 Speaker 2 That is our goal. And it's not just the medical pain, peace, it's the spiritual as well. 00;21;09;06 - 00;21;19;23 Speaker 1 So you said chaplains and obviously this is a Catholic hospital and Catholic. Absolutely. Health care system. So how many other religions do you service with your chaplains. 00;21;20;08 - 00;21;22;03 Speaker 2 Whatever religion they are, really? 00;21;22;03 - 00;21;22;19 Speaker 1 So we. 00;21;22;19 - 00;21;23;04 Speaker 2 Need more. 00;21;23;07 - 00;21;26;27 Speaker 1 Alien or they're Methodist or they're Baptist, correct? Jewish, whatever it. 00;21;26;27 - 00;21;32;16 Speaker 2 Is, whatever their spiritual need or what they classify as their spiritual, we meet them where they're at. 00;21;33;01 - 00;21;36;13 Speaker 1 That's really remarkable. That's that's that's that's quite a task that's a lot. 00;21;36;17 - 00;21;37;10 Speaker 2 Is that it is. 00;21;37;12 - 00;21;39;21 Speaker 1 A lot on those guys see that's a lot of different religions. 00;21;39;21 - 00;21;44;02 Speaker 2 It sure is and they're very well educated in each. And if they don't know and they. 00;21;44;02 - 00;21;46;26 Speaker 1 Ask, I was going to ask you that. So what happens when they don't know? 00;21;46;26 - 00;21;53;12 Speaker 2 If they do not know, they verbalize it. You know, teach me so I can be there for you, for those spiritual needs. 00;21;53;20 - 00;21;57;17 Speaker 1 And I assume that's that that interaction occurs with the family as well. 00;21;57;17 - 00;22;03;05 Speaker 2 Absolutely. Absolutely. You know, like I said, hospice isn't just about the patient. It's the whole the whole family. 00;22;03;27 - 00;22;12;24 Speaker 1 So talk a little about social services and in how that what does that represent? So there is there a social service worker assigned to. Okay, so how does that work? 00;22;13;00 - 00;22;43;13 Speaker 2 So social workers, their job is to go and assess the home environment. So do they have insurance? Do they need insurance? Do they need to go from home to a nursing home? Do they need respite services? So they do more of the social aspect of the home and also support to the patient, you know, allowing them you know, we see a lot of the patients are more open with their social workers where they can't talk about their families, about the end of life process or what's going on with them internally. 00;22;43;22 - 00;22;53;15 Speaker 2 So they do have that one on one peace with the social worker. So it gives them a ability to talk about what's going on that we normally don't see. 00;22;54;01 - 00;22;57;03 Speaker 1 That's interesting because it sounds like it's almost like a safe harbor. 00;22;57;07 - 00;22;57;21 Speaker 2 Slightly. 00;22;57;23 - 00;23;20;25 Speaker 1 Because they're like you said, this is I don't want to talk to my daughter about this for my son about that's too difficult for them to do that. But that but that but that social service worker is there. You can talk to them about that. So this is another interesting thing. If they if they really do need to go to a nursing home because the husband or the wife is the primary caregiver in the home, you know, the kids, they may not live in the same community. 00;23;20;25 - 00;23;39;04 Speaker 1 People scattered all over this country anymore. And and so that's a difficult conversation to have. And oftentimes, children are scared to death to have it because parents are typically the first thing you'll hear out of a parent's mouth oftentimes is you're not put me in a nursing home. Correct. So how how how do you get over that hurdle? 00;23;39;04 - 00;23;46;17 Speaker 1 How do you how do how do they communicate that situation so that they're willing to listen and see? This probably is what you really do need to do. 00;23;46;17 - 00;24;06;03 Speaker 2 Right on admission. We have those conversations right out of the gate. Okay. If you're not able to provide the care to mom, what is the next step? What what is life going to look like if you can't keep her in a home environment? Are we going to look at a nursing home or an assisted living? And so we have those conversations absolutely right out of the gate. 00;24;06;03 - 00;24;12;27 Speaker 2 And we kind of take the burden off of the family of having that conversation with their loved one. Let us have that heart conversation. 00;24;12;27 - 00;24;31;14 Speaker 1 Oh, so you're taking it so that it kind of comes down to I assume a lot of that comes down to daily needs, bathing, feeding. Are they ambulatory or are they not ambulatory? Do they need to get to medical appointments? And if there aren't people there to do that or they can't handle all of it, I mean, that's that's that's a difficult process. 00;24;31;14 - 00;24;40;08 Speaker 2 Absolutely. And it doesn't have to be long term care. We can do respite. So the families need a break. We can arrange for short term stays at the local nursing homes here. 00;24;40;24 - 00;24;48;16 Speaker 1 Okay, that's important. So it doesn't have to be it could be just you're going in there for a week or ten days just to get back on track and maybe. 00;24;48;25 - 00;25;00;28 Speaker 2 Yeah. And a lot of families are like, we're going to go on vacation, we need a break. So we make those arrangements and we send them to the nursing home. We follow them and we bring them back home after the loved one has returned. 00;25;01;17 - 00;25;08;28 Speaker 1 That's remarkable. Yes. So you've got I see this volunteers. You have people that actually volunteer to help you do this. 00;25;09;15 - 00;25;21;08 Speaker 2 The volunteers, they go to the home or they bereavement. We have a bereavement program which is also on here as well, follow up with families making sure they're good for that 13 months, if not longer. 00;25;21;21 - 00;25;23;06 Speaker 1 And 13 months. 00;25;23;06 - 00;25;24;20 Speaker 2 Absolutely. That's a minimum. 00;25;24;28 - 00;25;25;08 Speaker 1 Yeah. 00;25;25;08 - 00;25;26;24 Speaker 2 Yeah. And then sometimes longer. 00;25;26;29 - 00;26;00;12 Speaker 1 So so the bereavement piece is kind of interesting, you know, as you as you become chronologically challenged, like I am, you know, obviously it's something you think about that you have been married 36 years. I mean, when you think about that, how difficult that is when you lose a spouse, how important is that bereavement piece? Because if they don't have that kind of help, things that can happen that aren't good as a result of that depression, anxiety, you know, use of alcohol, I mean, you get down the list, it's not good. 00;26;00;28 - 00;26;23;28 Speaker 2 Absolutely. And for our we have a pretty phenomenal bereavement program. We also have a support group second Tuesday of every month. We want families to come with our bereavement coordinator. You know, family families don't want to talk about the death or how, you know, it's hard to talk with my brother about if, you know, our father was to pass away. 00;26;24;04 - 00;26;46;12 Speaker 2 But it's easier to talk to a bereavement coordinator and tell stories. So it's an uncomfortable conversation to have or that they are struggling. They don't want to talk to their families, that they are struggling, that their wife has passed. So we do mailings, telephone calls, in-person visits, even after the patient has passed. We are very accessible to our families after that, after the death. 00;26;46;18 - 00;26;50;16 Speaker 1 So that's similar. But just that that includes extended family. 00;26;50;18 - 00;26;51;12 Speaker 2 Oh, absolutely. 00;26;51;13 - 00;26;52;20 Speaker 1 Okay. So if anybody. 00;26;53;00 - 00;27;01;08 Speaker 2 Anybody who and even if they were not even affiliated with Saint Francis Hospice, anybody in the community is more than welcome to be on our bereavement program. 00;27;01;28 - 00;27;16;28 Speaker 1 That's fascinating. And so it's not limited to just people that were absolutely in the St Patrick's program. We're coming on the break and then it's just quick therapeutic services. What are those therapeutic services that you're offering through hospice? 00;27;16;28 - 00;27;37;22 Speaker 2 Francis Hospice does things a little differently. We do not give up hope if they are wanting to do physical therapy. Absolutely. We're going to provide the physical therapy in the home or speech therapy or occupational. We want to give them the chance to have that quality of life forever, how long that is. And our goal is to extend that and and make those services available to them. 00;27;37;26 - 00;27;53;24 Speaker 1 That's interesting. I never would have thought of that. I mean, that's just not something you would typically think of. But I you know, it's I heard a story of a woman who was 96 or 97 years old, and she was doing physical doing physical therapy in her home, in her wheelchair. She was continuing to do it because that's what she wanted to do. 00;27;53;27 - 00;28;05;22 Speaker 1 Yes. So when you think about it, I guess I guess it depends on what that person wants. But again, if that if that if that makes them feel better about where they are and what's left of their life, that's an important piece of it. 00;28;06;03 - 00;28;14;27 Speaker 2 Yes. And also is education again with the families on maybe how to do a wheelchair transfer. And we need a physical therapist to be able to educate them on that. 00;28;14;27 - 00;28;18;07 Speaker 1 So to get them from the chair to the bed chair to. 00;28;18;17 - 00;28;30;10 Speaker 2 Absolutely. If that is their goal, as you know, I'm tired of being in the bed. I want to get up to a wheelchair and go outside. Well, the physical therapist will go out there and show the family the safe way of transferring them and be able to do those goals that they have. 00;28;30;21 - 00;28;48;08 Speaker 1 You know, they're very basic things. But what you don't you're not you wouldn't in everyday life you don't think about that. But when you're confronted with the situation, you know, I'm watching you nod your head, Larry, as well. But when you're confirmed, that situation, that's pretty important. People, again, we're back to educating the family, which seems to be a huge piece of this. 00;28;48;09 - 00;28;50;19 Speaker 2 It's the biggest piece of laws that education. 00;28;50;23 - 00;29;11;28 Speaker 1 Very interesting. We come back from the break. We'll continue this conversation. Wrap it up. You're listening to America's health care advocate broadcasting here on the HIV radio network. If you want to learn more, the website is SFMC.net/HomeHealthHospice, SFMC.net/HomeHealthHospice. You can go up there lots of information and you can connect with these folks as well. 00;29;11;28 - 00;29;20;07 Speaker 1 Stay tuned. We'll be right back with more. You're listening to America's health care advocate broadcasting here on the radio network coast to coast. We'll be right back. 00;29;20;08 - 00;29;34;11 Speaker 4 Stay tuned for a lot sooner. We'll be one. What? Tell me. Down at my right arm. 00;29;37;01 - 00;29;59;16 Speaker 1 Welcome back. You're listening to America's health care advocates broadcasting coast to coast, across fruited plain here on the radio network. You can find out more about us by visiting website. Health Radio dot U.S. Health Radio dot yes. Hey, you heard you're listening to this, right? It's pretty interesting. Maybe there's somebody in your church, maybe there's a neighbor, maybe there's somebody at work, maybe there's a a friend, maybe it's a family member. 00;29;59;16 - 00;30;20;17 Speaker 1 Maybe you're in a district part of the country, whatever the case may be. Go to the podcast platforms. SoundCloud, TuneIn, iTunes, Spreaker, Apple Play. We're on all of them. You can tell them to listen to the show up there. We abbreviate the show. It's all the information is there and it can be extremely helpful to people. It's a lot easier than trying to regurgitate everything. 00;30;20;17 - 00;30;43;07 Speaker 1 You're hearing. These experts sit here and talk about so that that's why we suggest you go to that podcast platform. It can be very helpful. In studio with me, Larry Douche, he is here, patient care manager here at Saint Francis, home health Mosgiel patient care manager of Saint Francis Hospice. Again, we're talking about home health and hospice. That's a topic that we're delving into today. 00;30;43;13 - 00;30;51;08 Speaker 1 So let's talk a little bit about this 24 seven nurse available. You've got a both for home health and hospitals, correct? 00;30;51;15 - 00;31;14;01 Speaker 3 Correct. That is actually a regulatory compliance issue. We have to address that. Both home health and hospice have a nurse available 24 hours a day, seven days a week. They can call any time. And then what we'll do is will for home health. On the home health side, we will manage the questions they have. If it's a medication, we'll kind of talk about the medication. 00;31;14;01 - 00;31;30;06 Speaker 3 If it's a pain issue, we'll talk about that. We determine whether it's an air trip or not. We really don't want our patients going to air. One of the goals for home health is to keep people away from the air just because if we can do an intervention to prevent that unnecessary trip to the air, it's better for the patient. 00;31;30;06 - 00;31;39;15 Speaker 3 It's better for the health care system, not not Saint Francis, just the whole overall health care system. And CMS is really happy with us if we stay like if we get them out of. 00;31;39;15 - 00;31;40;06 Speaker 1 The office once. 00;31;40;06 - 00;31;42;16 Speaker 3 Yes, yes. On zero visits. 00;31;42;16 - 00;31;43;19 Speaker 1 And that's a big deal. 00;31;43;20 - 00;31;47;07 Speaker 3 Yes. And then hospice. I'll let Melissa kind of talk about hers real quick. Sorry. 00;31;47;08 - 00;32;09;13 Speaker 2 No, that as well. We are 24 seven nursing we Treos the phone calls we a lot of the misconceptions or information that is given out to patients and families is that we are in the home 24 hours a day. We are not we do have a nurse that's available 24 seven. We answer the phone calls and then we determine the needs and then go out to the home. 00;32;09;19 - 00;32;21;09 Speaker 2 Most of the time is what is needed for hospice if the families are calling than they need us. And then the nurses do go out in the middle night, even at 2:00 in the morning, to make sure that the patient's taking care of, but also the family. 00;32;21;15 - 00;32;26;11 Speaker 3 I would also like to add one thing really quick. The chaplains and the social workers will also go out. 00;32;26;11 - 00;32;26;29 Speaker 2 Absolutely. 00;32;26;29 - 00;32;27;14 Speaker 3 Yes, yes. 00;32;27;26 - 00;32;29;20 Speaker 2 Sorry. That's okay. 00;32;29;20 - 00;32;49;08 Speaker 1 So so let's go back to that for a minute. So it's 2:00 in the morning and mom's terminal and it doesn't look good. And they call and they're like, we don't know, but we don't think we think that this is getting worse. Yeah. At that point, you actually send a nurse out there and or chaplain or both, whatever. 00;32;49;08 - 00;33;03;01 Speaker 2 All the above. All the above. And even if it's 2:00 in the morning, a lot of times what they'll do is they'll be on the phone with the family is as they're driving to the home and then when they get there, they take over and manage the symptoms for the patient. 00;33;03;26 - 00;33;20;14 Speaker 1 That's remarkable, Larry. Let's go back to home health a little differently here. So this this issue, keeping them out of the E.R., the readmissions to E.R., maybe they've had a broken leg. Maybe it's a wound issue. Maybe it's some other issue. Does that does that so you you talk to them over the phone. It's Sunday at 2 p.m.. 00;33;20;14 - 00;33;32;26 Speaker 1 Whatever the case may be, are you typically going into a follow up visit after that, or is it necessary to have somebody go out there so quickly to keep they think they need to go to E.R. You don't want them sitting for 2 hours waiting in an air. Correct. 00;33;33;03 - 00;33;52;14 Speaker 3 And so if it's something that we can go out and do an intervention for immediately, we'll send a nurse. If it's like if, say, this patient has congestive heart failure and they need an extra dose of Lasix and the doctor has given us an order to do the extra dose of Lasix in the home. We can send the home health nurse out immediately and they can give that extra dose of Lasix. 00;33;52;21 - 00;34;10;26 Speaker 3 And then we would follow up the next day with a phone call and a visit just to make sure that kept them out of the emergency room or out of a life threatening situation. And if it doesn't work, then we would send them to the E.R.. If someone calls me and says, I've fallen and I've hit and hit my head and then my head is split open and I am bleeding. 00;34;10;26 - 00;34;20;28 Speaker 3 Not to be overly graphic. No, no, no. That's an air trip. There's nothing I can do as a home health nurse. I can go out there and suture head. So we would send someone like that to the E.R.. Yeah. 00;34;20;28 - 00;34;41;26 Speaker 1 And you're typically in case that that you're going to send out an ambulance and a medical team to get them transferred. Correct. And determined and maybe start steps to get that obvious. Maybe it's something where they fell and you don't know if they broke their hip. Correct. Or reinjured themselves. Maybe they've got a history of that. Yes. You know, it's because oftentimes as people age, that falling thing becomes a risk. 00;34;41;26 - 00;34;47;11 Speaker 1 You're both shaking your head. Yes. That becomes a really big issue after family can't determine whether or not. 00;34;47;13 - 00;35;04;21 Speaker 3 Then then one, one one thing I want to clarify, if you're on home health, that does not mean we don't let you go to the E.R.. I don't want that to get the message to get through this somehow. Know if if the person calls me and they say, I'm having chest pain, I'm going to the emergency room, we say, okay, we'll make a note in the chart. 00;35;04;21 - 00;35;14;01 Speaker 3 I'll have a nurse call you in the morning to follow up to make sure you're doing okay. That's how that works. So it's not like you can't go to the E.R. It might be send a nurse. I don't want anybody to feel that. 00;35;14;01 - 00;35;18;23 Speaker 1 Well, if they don't. But but if if there's something you can take care of it, you don't have to. Exactly. 00;35;18;23 - 00;35;20;04 Speaker 3 Right, exactly. 00;35;20;09 - 00;35;21;28 Speaker 1 And sit there. Wait. You know. 00;35;22;12 - 00;35;39;22 Speaker 3 Especially since COVID, you know, the thing to think about as you get out there and and you sit in the air and you don't know if someone sitting next to you has COVID or not. So a lot of these older patients that we see, they want to stay home and they want us to come and see them. And that's one of the huge benefits of having that home health nurse available. 00;35;39;22 - 00;35;53;05 Speaker 1 Yeah, it's really interesting you say that, because even in the hospice situation, Melissa, I think I don't know. I'm guessing statistically the vast majority of people would much prefer to stay home. Am I correct in that? 00;35;53;05 - 00;36;06;28 Speaker 2 And that's the whole that's the whole point is to keep them at home. Let us be your medical team. Let the medical come to you instead of you going to the medical. And that is the whole philosophy of hospice is that we bring the medical team to you in your own home. 00;36;07;07 - 00;36;28;13 Speaker 1 Yeah. And again, you know, you're bringing it to their home, but, you know, the interaction with the family and giving that family, that sense of security around what's going on, it's a difficult time. It's I've been through this four times. It's yeah. Two of which ended, you know, in their lives in our home the other two into their lives in in our and my brother and sisters. 00;36;28;21 - 00;36;48;22 Speaker 1 But the point is, it's a very difficult time for people to deal with that. And having this level of care in this level of service, whether it's end of life or whether it's just somebody like my wife fell and broke her leg. Right way to set up the bed. We a three story house at the time. We set the bed, the bed up outside in the sunroom because she couldn't go up and down steps. 00;36;48;22 - 00;37;01;13 Speaker 1 And it was remarkable. Yeah. Thank you both for doing this. I think this really helped a lot of people today. And I think it's important for people to get an understanding of how this how all this works, because a lot of families are going to face this issue as time goes on. 00;37;01;29 - 00;37;02;01 Speaker 2 In. 00;37;02;01 - 00;37;24;18 Speaker 1 This current. But if you want information here in southeast Missouri, the website is SFMC.net/HomeHealthHospice. That's FSFMC.net/HomeHealthHospice. And now, ladies and gentlemen, I leave you with this message from Dr. Martin Luther King. Americans must learn to live together as brothers and sisters or we will surely perish together as fools. 00;37;24;20 - 00;37;43;10 Speaker 1 Sure, words were never spoken. Thank you for listening to America's health care advocate. Broadcasting here on the HIV Radio Network, coast to coast across the USA. Goodbye, America.