Good afternoon, everyone. I'm Sarah with connect our elders and today I have Ashley Highland, a liaison with Silverado hospice with us here today. She is quite phenomenal. I actually just learned this even though we have been communicating. She got her degree in gerontology. And she's been with Silverado hospice right out of college for the last five years. So I hope you're as excited as I am to get to know Ashley and learn why she works in hospice and to learn specifically about hospice care, and Silverado. So welcome with us. Ashley, thank you so much for having me today. I'm very excited to be here. Wonderful. So I have to know, and I'm really interested to know, anytime that somebody works in hospice, what is your Why? Why do you work in hospice? Yeah, I get that a lot, especially from my friends. So right out of college, when I told them what I was doing, everyone's like, you're so young, why are you going into something like hospice? Personally, I had a bad experience with my grandfather, on hospice when I was younger. So one thing led to another and I interned with Silverado during when I was finishing my career, sorry, finishing my degree. And I just I fell in love with Silverado, I fell in love with the culture, I fell in love with everything. A hospice has to offer a patient and a family. Well, I'm sorry to hear that you had that that negative experience with with your grandfather, but you know, what better way to try to deal with that experience, then, you know, get into hospice and make it better for all of the families that you interact with, right, or all of the families that your team interacts with? So let's, um, if you could for the audience, could you please define the team members in a hospice team? Because I don't think a lot of people understand that there is a first of all, I'm always surprised at how many people don't actually understand what Hospice is, and what a beautiful benefit it is. But then to take a step further, it takes a whole team approach. So share with us what, what team members are there on a hospice team, and what are they. So there's a huge team, I always say more people just to love up on your loved ones. So there is a attending physician, and this can be a patient's primary care physician, or we have physicians on our staff that are specialized in hospice and end of life. They also receive an RN case manager, but more than that, they really receive a team of nurses. So we have nurses here in the office, we have live nurses, 24, seven, so if someone needs to call in, um, you can always talk to an RN, and then home health aide. So that's someone that can come out to give patient a bath, you know, really just make them feel good. Nobody. That's one of the biggest components is if a patient feels good, you know, that's all we care about. Social Work spiritual Chaplin as well. We also have volunteers that go out and then we pass when somebody is on hospice, we have a whole bereavement coordination team. So hospice services aren't just for when a patient is on our service, it's way beyond it as well. I don't have this on my list of questions right now, but it just came to mind. So I hope you don't mind me asking, but would you mind explaining for the audience? What is hospice? Totally. So says carry term for most people, um, I, I despised hospice for my own family. And I've had several personal experiences. So I know how scary it can be when someone says, I want you to talk to somebody from hospice. So Hospice is a program that is covered under most insurances. We work primarily with Medicare Part A, it's a covered benefit at 100%. And it's for people who have terminal illnesses that are no longer seeking aggressive treatment. And their life expectancy normally is about six months or less. But it's really a program to help give quality to those patients during You know, one of the most difficult times, that's as simple as I can make it. I know, there's so much I want to say to you know, just a couple things I would add to that is that it's I urge people don't be afraid, at least explored as an option. It does not mean that your loved one is going to die immediately. As soon as you engage hospice. You know, is it is it true or not true? Sometimes, right? Somebody can come on hospice and actually see an improvement because of the added support. That doesn't mean that you know, there won't be declined, but there is some improvement sometimes. What about it and we'll get more into this, but it kind of goes along with what we're saying right now. So, people think that one, if they go on hospice, they're gonna die immediately. Right? Yep. Or, you know, they say you have six months or less. So you have six months, and then you're gone. But what is the actual case? I mean, it, it spans the spectrum, right? Absolutely. So nobody really knows, right? A doctor can't tell you when someone will pass away, I mean, nothing in life is guaranteed. So all we have to do as a hospice company, is be able to submit to Medicare, that a patient continues to decline. And we are the happiest when we have people graduate off of hospice. And we've actually seen it quite a bit right now. Because the beginning of the pandemic, there was a big decline. So we needed some more support at home, we were able to provide that safely at home for them. And now they're getting better. So we do discharge and we graduate people off hospice often, yes, yes. It always makes me a little sad when you hear that, and I'm not sure if this is still an accurate fact or not. But um, that the average length of stay is two weeks when people at a minimum could take advantage of it of the extra support and the quality of life for at least six months, you know. And I think it really is the fear that gets in the way and makes it such a short stay. Absolutely. That is very common, especially out of the hospital or post acute setting, our average length of stay is about four months to so it's really about that early education. So it's even, you know, I have friends who will call me and say, Hey, I have this friend across the country who they're grim in the process. Can you just talk to them? And absolutely, anyone who works for hospice just loves to give information about the benefit? Oh, absolutely. So, so you as a liaison, please share with us what your role entails, you just mentioned education. But if you don't mind to take us through a day of Ashley Prado. Well, my phone is always next to me. And if you're ever know that my work phone is my lifeline. So an average day is, you know, speaking to either physicians, hospitals, ALS, rcfe is the whole spectrum about the benefit of hospice and really checking in to see who may need hospice. So following up to see if a patient is at the hospital, and they need help getting back to wherever they were living. Or even just meeting with families, I sometimes I meet with three families a day, and just explain hospice services. And then it's doing whatever those ALS and rcfe is, I have a territory. So then it's connecting my clinical team with whatever the needs are in the community. So if someone needs, you know, more supplies, if there's a visit that's needed, I'm the liaison between my clinical team and my partner's out in the community. Thank you. So let's talk about someone does decide, okay, we are going to accept that it's time for hospice. Let's Let's do this. What does service look like? For patients that are receiving hospice care? Yeah, that's a really good question. And I always tell families, when I'm meeting with them, it can be a little overwhelming at first. So if someone wants, you know, hospice, and they're appropriate, you know, a doctor is recommended it. So either myself or team member goes out, meets with them explains the whole Medicare benefit. And then we have a nurse that comes out, does the evaluation finds patient appropriate, and we had met that day. So that whole process can be within an hour, so it's very fast. And then the magic shows up. So all of our nurses will order medications, DMV, the durable medical equipment, and families will say stuff just started showing up there was a hospital bed and oxygen and you know, a comfort kid. So I would like to prepare families for that. And then within the first seven days of a patient being on service, with Silverado, you actually get a visit from each team member. So one day the nurse is going to go out the next day the social worker is going to go out then the home health aide, that way we're touching base and really making sure the patient and family understands hospice and it's very comfortable with it. Our doctors will actually go out to patients homes as well. So that's something a little bit unique with us too. So physically goes and meets the patient and family even during the if the family is comfortable. Okay, wonderful. And so I just want to reiterate the point for the audience that yes, there is the patient right and that's what the care team is centered around but hospice isn't just for the patient. Hospice is for the entire family. Computer, and a lot of us need that our patients need their family to be supported. I have that personally with one of my mom's good friends. She really before she left this earth she needed to know her family was taken care of. And my mom's older right before she passed, we we have it. We have your girl will take care of her. And she left in that moment. So yeah, absolutely. Hospice is about empowering the family as a unit. And I don't care if the mailman if that's the grocery store clerk, anyone who's in your circle working right? Anybody that matters to you? Yep. Okay, what's the process? So Oh, another question. Before I ask this next one, I just think Hospice is phenomenal. So, um, can does a family, right or an individual? Do they have to wait for the doctor to say, I think you might be hospice appropriate? or could they say to their physician advocate for themselves or their loved one? No, I would really like to get an eval done. patients and families can absolutely advocate for themselves. I unfortunately, a lot of doctors still don't understand the benefit of hospice. A lot of them believe that they're going to lose the patient, they're not going to be able to see them. And that's not the case. So yeah, absolutely. patients and families should advocate for themselves. Yeah, I'm a big fan of that it comes down to the patient and their family and what they want for themselves. You know, and doctors, of course, like they're, they're in the business of saving lives. And so I have noticed over the years, you know, sometimes they, it's difficult for them to, quote unquote, quit right on their patients. And it's just the the psychology behind it. So I want the families out there listening that you have to remember that it's still your life, right? And it's your decision. And so if you feel like your loved one or yourself is is appropriate for a hospice eval, advocate for yourself with your physician, okay. All right. So somebody has decided that they want to move forward. What's the process of someone getting started on hospice care? Yep. So again, it's can be done within the hour. So it's pretty fast if the family wants it. So we would just need someone to go out, explain benefits sign consents, have a nurse, you know, review the history and physical and then call a doctor and make sure that they agree a doctor does have to sign off on on the certified terminal illness CTI and then we can admit right then, so it's very fast, very fast. Real quick, what are the criteria to be hospice eligible? You have to have a terminal diagnosis and not seeking aggressive treatment. So But more than that, you know, especially right now, we see a lot of people who maybe have depression, and there's just so much going on with the patient. So let's say that somebody has COPD CHF. But they also are falling frequent fliers back to the hospital, they have UTI eyes. So we look at a patient as a whole and not just one specific diagnosis. And we can always just have a nurse go out, do it evaluation, we call them softy, Val's and just see if patients even meet criteria, if not great. Doesn't matter doesn't cost anything, you know, to the patient. I'm just more information for them. Okay, that's good, right? You're going to empower them with some information and education. Okay, so what are and this is going to be audience Listen up. This is huge. What are some of the common myths around hospice? Oh, yes. The Ms. Also the names we get working in hospice, and if there's any other hospice liaisons out there, and I can guarantee their friends have called them Grim Reaper ambulance drinkers, we get it all. We get it all. I think the common most common myth is that you're giving up, you're giving up on yourself, you're giving up on your patient on your family. That's not true. You're just providing them a different level of care. Really, in the US a society we believe in fixing things and not really taking a step back and looking at, you know, what's the benefit and value of this, if you will. So, yeah, providing comfort is just what we want to do. Other myths, you can't go see your doctor. You can go see your doctor. You if the doctor chooses to follow, they can follow you so they are still in charge. You have to stop all medications. That's not true. Don't just come in and pump you full of morphine. That's absolutely not true either. morphine is used, you know, at the end for certain symptoms. What? What about certain things like, well, if they go in hospice, then we don't treat anything at all anymore. And a common one that I've encountered is, what if mom gets a UTI? Are they just going to let it go and not treat it? Well, you know, you're uncomfortable. So if a patient gets a UTI, we're going to treat it because it's for the patient's comfort, a UTI is very uncomfortable for a patient, we're gonna treat it. A very common myth is once you know, six months happens, and they're still with us they get discharged. Not true. As like I said, as long as a patient continues to have a decline, they can stay on our services. Also, let's say a patient is admitted for I know I'm not clinical, so I need to be very careful. There are certain diagnosis that we bring patients on and they can still continue other treatments. For example, the patient comes on with maybe a cancer diagnosis, and is no longer seeking aggressive treatment, any chemo, but they also need dialysis. We take a look as a clinical team, and really that patient's individualized plan of care to see okay. Is the dialysis prolonging life or is it comfort for them at this point? So there's always that conversation. It's not Oh, well, mom's on dialysis. So she can't receive hospice? No, that's not necessarily true. So it's always worth a conversation. Right. I think the big takeaway from from that particular situation is that it's still even though it's, you know, this big benefit. And there's criteria, it can still very much be specific to the individual. Right, the situation? Yeah. Okay. Would you like to talk a little bit about the the bereavement services that you guys have for the families after someone passes away? Yeah, absolutely. And I want to make sure anybody who needs bereavement help, we're here to help. So you don't even have to have used our services. So we have groups, I mean, I have friends that need bereavement services, and I have my my team members call them I'm like, please call them maybe it's a milk. So bereavement is offered through Medicare for up to 13 months after a patient passes away. However, if you've ever lost someone close, some people don't start the grief process until two years later. So we're really here to support whenever and for however long a family needs. So there's groups that you can meet together. You can meet one on one via phone in person, whatever that patient and family's needs are. Why is it 13 months and not 12? I have no idea to be honest with you. I think I have an idea. I think it's because you know, if it's 12 months, right? You're basically leaving that person right around the time the anniversary of the passing, right. And so it seems to be that you know, with the 13th you're gonna get them past that traumatic anniversary, you know, of the death. I'm wondering if I'm right, I think that that's what it is, but let me know. I'm gonna ask around. I'm gonna. I'm currently in our office. So I'm gonna ask our bereavement coordinator after that. Well, you Yeah, definitely shoot me an email or texting. Let me know. I'm curious. Okay. So there are many hospice companies just like there are many home care companies and many home health companies. Right. So what sets Silverado hospice apart in the community? Yes. Hi. I encourage families to always do your research. And there's not one perfect hospice company. I'm just gonna say it. We're pretty close. But no, it's really about the employees. So when families are interviewing multiple hospices, I always empower families to ask certain questions. What, you know, do the case managers do they live in their territories? The reason for that is if something happens first thing in the morning, you want to be able to get to your patient pretty quickly. And by pretty quickly, I mean, within under 15 minutes, right. So what do the after hours support look like after hours? and health care is so so weak? And with hospice, it's not. So we have we have a live Team 24 seven. So we have nurses staffed throughout San Diego County and across I mean, the United States Silverado is throughout the US that are here to help. So the families really need to ask, am I getting a live person when I call after hours, you'd be surprised. There are some hospice companies that it's an answering machine. Yeah, yeah, that's one of my biggest pain points. I'm sorry. Moving on. Um, and what there are more hours after hours than there are in regular, a regular 40 Hour Workweek. Right? So from five o'clock until about 8am, the next morning, how many hours? Right? So that's more than a normal work day. weekend support. So families need to ask, what about weekend support? We have somebody that can go out 365 days a year, right? Our triage nurses were really lucky to our triage nurses used to work in San Diego. So they're very familiar with the demographics. So they know that if a patient is transitioning and needs a visit very quickly in Oceanside, we should be sending a North nurse, not someone who lives in Chula Vista. Right, okay. Right. Six o'clock, San Diego pre COVID was kind of hard to get from one into the county. Oh, for sure. And just culture, you know, asking, asking those questions about really just the individualized plan of care, you know, asked to speak to the administrator asked what the involvement of the director of nursing is, I mean, all of those components, if you're calling a hospice, and you can't get ahold of an administrator, I would say that's a little bit of a red flag. Again, I'm very fortunate, my administrator do when I have a whole, I have a whole team of cheerleaders that they come out with me, and they want to make sure that our services are going well, that you know, doesn't that always make you feel so much more confident in the services that you're you're presenting to, you know, your referral partners in the community, and as well as the families? What about, and I only learned this several years, well, I don't know, three, four years ago, I guess it was, but people have a choice, which hospice, they go to, you know, you don't have to just go just because your doctor recommends this hospice doesn't mean that that has to be the hospice that you use, you have a choice. And then the other thing is, if you do engage, right, you sign on with one hospice, but then you're not satisfied. You're not locked in. You're not locked in. Yeah. And I was I was gonna bring that up. Thank you. You can transfer services at any point, and you can transfer. So there's about I think it's 108 hospice companies right now in San Diego. Yeah, yeah. And families should always go on medicare.gov. You can type in hospice companies, and get the real Medicare data. And that's what I always encourage people to do that, because it's so powerful. And you really, you know, we live in a time of Yelp, you know, sometimes skews people. But yeah, go on medicare.gov. And you can compare hospice companies. It's, that's great. That's great information to have. I'll make sure that when I repost this, that I'll put that link there. Now. So, um, so you said that you had an experience with your grandpa, what was his name? And it sounds like you were exceptionally close with him. I was. So his name was Dale. He actually was. And it's so funny. You bring him up because he worked for Oceanside police department, and I'm a local girl. And on Halloween, he would bring his cop car to my parents house to my home. And he would like make a joke. And he'd always he'd put my siblings and I in the back of the car and like drive away. So beverage talking my mind. Yeah, I was very close with him. Unfortunately, he did pass from a cancer. And he was in a little bit of denial about his cancer, sorry, grandpa. And he let it get reported that he lost a leg and then from there just really declined. Um, he had a hard time leaving the third. He the hospice nurses came in gave, you know, certain comfort meds, and he was really agitated at the end. And so that was really hard to see. And I went, you know, my grandma called me and said, it's time to say goodbye. So I get there. And I mean, there is like Oceanside police cars lying to the street, the fire department's there on all to say goodbye to this incredible man. And I get there and my grandma said he's calm. He's upstairs. He's just gonna look like he's sleeping. It was also 10. Right? So I go upstairs and that was not the case. He was not. He was not sleeping. He was pretty agitated. I'm so sorry. It was kind of hard to see. But I fully believe that he put me in this path because I didn't like hospice. I had a social worker coming to me and she you know, for these art therapy sessions. I hate drawing. I hate even writing like and I told Her, I'm pretty sure my family was probably put on some red flag list, because I think I cussed at her. But I was mad. I didn't want this course you were. I was 10 my grandpa was dying. Like, I didn't want the stranger coming in. And, you know, talking to me about that. So that's why when I'm meeting with these families, that's, that's how I always look at it because it's so hard. And it's such a personal and intimate time in their life, right. Besides the birth of the pilot, it's one of the most intimate times. Absolutely, absolutely. Well, I'm glad that we had the chance to talk about your grandpa. Um, I'm glad I'll, uh, I'll keep him in my thoughts. No, this evening. But that's, you know, I want to say beautiful, I don't know if that's the right word. But the best situation that you experienced right with with the ending of his life and how you're turning it into how you, you take that into your career as a hospice liaison and help families i think that that is beautiful. So thank you. Alright, Ashley, how can people reach you? If they have more questions about hospice about Silverado, if they want to partner with you? How can they find you? You call me you can text me and share my direct cell phone number? I'm always here, literally 365 days a year where they can even call our main number and asked to speak with me to Okay, do you want to provide that or do you want me to put it? Post? Okay, yeah. So my direct cell is 858-204-8778. And then I'll give the main office number as well, as a lot of eights covered at number is 888-328-4558. Thank you. Thank you. Well, everyone. Thank you for tuning in today. Ashley, thank you for being a guest. As a reminder, my name is Sarah and I'm the founder of connect our elders. Our entire intent is to empower aging. And we do that through education around elder care resources, navigation through those resources and ongoing advocacy and it is my pleasure to have people like Ashley come on the show, who truly have a passion in the heart for helping our elders in our community. Thank you, Ashley. Thank you.