 Hello and welcome to Quality of Life, the program where we look at different aspects that can contribute to one's quality of life. Today we're gonna talk about the realm of home health and hospice and how it pertains to quality of life. Joining us today is Tanya Smith from St. Nicholas Hospital of Home Health and Hospice. Welcome Tanya. Thank you. Your current role in that is your director of home health and hospice for St. Nicholas Hospital, correct? That's correct. How long have you been doing that? I've been at St. Nicholas Hospital in the leadership role for this department for seven years now. Wow. What about your overall experience in this area? I have been in the field of home health and hospice for 17 years with St. Nick's and other organizations over the years. Excellent, excellent. To be involved in a role like this, and especially your role as leader, director, what type of education do you have to go through or certifications? Well, I currently have a certification in the national certification in hospice and palliative care nursing, but I also have a bachelor's in science in nursing. And I am currently working on a master's degree in organizational quality and leadership from Marion University and Fond du Lac. Wow, that's a well-rounded education. What about the line staff as far as education? The nursing staff have a minimum requirement of an associate degree in nursing. We do encourage nurses to go on and finish their bachelor's degree. And that rounds them out nicely to be able to care for the patient populations that we serve. Okay, speaking of that with the populations and the programs, what programs do you oversee? I currently oversee the home health program, hospice program. We have a palliative care program, and we also have a lifeline program. Okay. Is that just for St. Nick or in the Sheboygan area, or is that for other areas? I know you have sister hospitals as well with St. Nick, like St. Vincent and St. Mary's in Green Bay. Do they have similar programs? We do. St. Vincent and St. Mary, which are our two sister hospitals in Green Bay, do have a home health program as well, and then they do partner with Unity Hospice in Green Bay to provide those end-of-life services. Okay, do you have any involvement with those programs as well? I do, I oversee the home health program in Green Bay with St. Vincent and St. Mary's as well. Oh, wow, that's a huge scope for an area. Good for you, good for you. Moving along, home health, what would be the definition of a home health service that you provide? Okay, home health services are offered to those people who are perhaps recovering from an illness. Maybe they've been in the hospital and they come home and they need some help getting back to their normal state of functioning. Maybe they need wound care or maybe they're a new diabetic or they have a new diagnosis and they need some teaching with medications, with their diet, so skilled nursing services, or maybe they need some therapy. So we can provide physical therapy, occupational therapy and also speech therapy in the home setting for those folks that are unable to get out and receive those services elsewhere. So home health is a restorative nursing service. Our goal is to help the population that needs the service regain to the maximum ability that they can and then remain independent and in the community rather than having to go into a facility or have alternative living arrangements. Okay, so in a nutshell, it's basically a rehabilitation or rehab program at home if someone would break their arm or something and have to go to rehab, they're strengthening themselves to get back on their feet, so to speak. That's correct. It's another option for that patient population. Okay, one thing I noticed when we had talked earlier, also what the social worker can help with advanced care planning. That's correct. What is an advanced care plan, if you wanna ask? We do have social work services and our social workers can help folks with advanced care planning, which would be looking at their power of attorney for healthcare if they don't have that set up, looking at a living will. Talking about what they'd like to see as they get older and where they would like to see, how they would like to see their living arrangements handled, their finances handled, their healthcare decisions handled, moving forward as they age. So making those decisions, maybe doing some advanced funeral planning, just taking a look at all of those issues that we all face as we get older and making those decisions ahead of time so that they can be assured that their decisions are being carried through as they get older and maybe they're not able to make those decisions anymore at some point. Sure. A while back, I had to actually enlist in home health assistance when my dad had some health issues and such. So I think it went very smooth and the question I have is how does one get in touch to look for a home health service and then what's the timeline usually of the service or package or deal or accommodations that are available? Okay. If you need home health services or you think you might need home health services, you can contact the home health agency directly and we can then take that referral and approach the physician. We are a physician ordered service so we do require a physician's order and oversight to provide those services. However, we can take that referral from the patient themselves, from a family member or the physician office will sometimes call and order home health services. Home health services are then set up and nurse goes out and she does an assessment of the needs of the person at the time, collaborates with the physician on what those needs are and then we come up with a plan of care and set some goals in collaboration with the patient. We move through that plan of care and work towards those goals. Typically, the amount of time varies depending on each person and what their needs are but we relook at every case, every 60 days and we decide if we need to continue on with home health services or if we need to discharge and of course anybody can be discharged at any time when they've reached their goals. Okay. Does the home health plan enlist other agencies that may help with, where I'm going with this let's say I need home health services for a bit and I've broken my leg or I can't get around so I may need help with grocery shopping or laundry or things like that. Does that come under that umbrella as well that you can help facilitate? Yeah, we are able to provide very minimum custodial care is what you're referring to, right? We do have home health aids that can come in and help with more of the bathing and dressing and things of that nature but we can refer on to some additional services through other community agencies and there are a number of different agencies within the community that provide caregiver assistance with laundry and errands and shopping and those sorts of things. Okay, thank you for that. With home health services, does insurance plans pretty much cover services for that or is it out of the realm of what insurance covers? That's a great question. Medicare does cover home health care 100% if it is ordered by the physician, if there is a skilled need and the patient is homebound where they cannot easily get out to attain those services elsewhere. There is no copay at this time with Medicare, they do cover 100% as well as Medicaid. Other commercial insurances, it depends on the insurance plan. Sometimes there's a copay, a deductible and all of those plans, when we get a referral, if we do have a commercial insurance plan, we evaluate those on a case by case basis and we'll bring what those expected costs are going to be to the patient upfront so they can decide if this is an option that they want to go forward with. Okay. How much of a success rate have you seen with a program like this where it helps people that makes them comfortable because, like they always say, one always feels better when they sleep in their own bed or in their own surroundings. What's the feedback you receive from a program like that? Well, I think generally people just really want to be in their own home and if they can recover in their own home, they just feel better all the way around, they recover faster. So we get a lot of positive feedback about the home health program. It's very successful at keeping people out of the hospital, helping them to maintain independence and I think our patients are very grateful for the ability to recover in their own home with their loved ones surrounding them and just their own surroundings. Excellent. Okay, now I'd like to move on to hospice and that service. So could you describe what hospice is? Absolutely. Hospice is end of life care for anybody who has been diagnosed with a terminal illness. They have life expectancy of six months or less if the disease runs its normal course and they are not seeking curative treatment any longer. They qualify for hospice benefit and hospice program. Hospice also can be provided in the patient's home, wherever the patient calls home. So it can be in the patient's home in an assisted living in a nursing home or even in the hospital. We do hospice as well. What we really focus on with hospice care is providing that quality of life at the end of life and making sure that we're identifying with the patient and their loved ones what their goals are, what gives them quality of life, what gives their life meaning and trying to help them to reach that and to come to a place where they feel acceptance and that they've been able to have healing and it may not be physical healing from their disease, but maybe it's emotional healing, spiritual healing, healing of relationships with loved ones and controlling their symptoms during that time and making sure that they're comfortable. What's one of the primary differences in care provided or services required between, let's say, home health and in a hospice? And the life has been defined with hospice, but what are some of the differences in the services that are required in a hospice that maybe aren't in a home health situation? Good question. We do provide the nursing services obviously in hospice as well. We have medication management, symptom management. So nursing services are involved. We have social workers that work with patients not only on the advanced care playing if they haven't done that already, but just to work through some of those emotional issues, some of those issues that might come up that we know people are facing as they're approaching the end of their life. So helping them cope with what's happening with them, working with the families. We have a chaplain on our hospice team that can provide spiritual support for the patient and their family if they wish, or we can connect them with a spiritual advisor of their choosing, whatever the patient or the family wishes. We can provide home health aid services to help with hygiene needs. We can have a homemaker go in and help them with some home making needs, which is not available in the home health service. And we do have volunteers and we really rely on our volunteers. They're great people that just give their time and they do everything from helping us out with administrative type things in the office to going into patients' homes and sitting with patients and providing that comfort and company and companionship that some patients really appreciate. I'm glad you brought up the volunteer staff and their dedicated means because the nature of today's subject, I mean, day after day after day, I mean, you deal with people passing on and such. And I still say it because I did work in healthcare from the administrative side, obviously, but to see the actual healthcare people in action and their dedication and devotion to healthcare, it just still blows me away to be dedicated like that. I don't know what the burnout rate is if there is, but that's just a different caliber of people in my mind. Well, and especially with hospice, that our hospice team is very caring. They're very compassionate and they become very intimate with the family and the patient that's a very emotionally charged time of a person's life. So it can be very hard on our staff as well going through that process and moving, getting past that death and then going on and working with more other patients that are in the hospice program. So they are a very special group of people, absolutely. Coming back to the quality of life and what people are looking for when people want to go into a hospice program, what are the main things of their quality of life that they're looking for to maintain and to pass on to the next with if you could elaborate on that. Well, what most of our patients are really looking for when they are enrolling in hospices, they're looking for one comfort. They wanna be as free of their symptoms from their disease as they can be, but they are looking to just have peace and however they define that and everybody defines that differently, but they just want to live out the remaining time that they have with their family around, with their friends, whatever gives them meaning and everybody defines that differently, but we try to really make that happen for them with whatever means that we can. Excellent, excellent. Now you had mentioned hospice, it can be at home or it can be in another facility and there's several facilities in the county that can do that. I guess what defines where they really go for their hospice is it just a matter of the patient's choice or are there certain needs that just really doesn't work out at home or what defines that? It really is both. We really do want to honor patient choice if somebody can stay at home and they have the support to do that, meaning family, the support of hospice, they have to have a caregiver at home. Hospice is not intended to be in the patient home 24 hours a day, so if they want to be at home, they need to have a caregiver or somebody who's gonna be able to care for them when they are not able to care for themselves on a continual basis. So in order to stay at home, they need to be safe. So we work with them and with their families to make sure that we can come up with a plan that's going to meet those needs. There are times though that they can't and whether that be because they don't have a family nearby or they don't have family that's maybe able to take care of their needs, maybe there's an elderly spouse who just is not physically capable of meeting those end of life needs. Then we need to explore other options, maybe assisted living or a skilled nursing facility. So we explore those with the patient and the family and we make those moves to a different care setting when that becomes necessary to do so. Okay, so one common thing if I have understanding you correctly is just like with a home health plan, you almost have to do a risk assessment and a plan for hospice as well so that way you can get the best plan in place to maintain that quality of life. That's right, up front we really look at all of the elements and we try to foresee out what some of the issues are that we might encounter and come up with a, if you, per se, a plan B for the patient and their family and we work in collaboration with them to determine what those plans are going to be should we have them move to another plan. Okay, like we had talked about with home health, with hospice, financial obligations, insurance cover that 100% as well, same matrix. Right, Medicare, for those who have Medicare coverage, hospice is covered 100%. Anything that is related to the patient's terminal illness is covered under the hospice benefit which is really a great benefit for those folks that enroll in hospice or have a terminal illness that they're no longer treating. So for instance, if there are any medications that are needed to help control pain or nausea or any symptoms that are related to the terminal disease itself, hospice pays for those medications and sometimes those medications can be quite costly so that is a benefit for those patients. Any equipment that's needed, if the patient needs oxygen or a hospital bed or if we need a walker or a wheelchair at some point, all of that equipment is covered under the hospice benefit as well and again, Medicare covers that at 100% as does Medicaid. Private insurances may work a little bit differently and again, just like home care, we look at each policy and we determine what the level of coverage is and then we work with the patient and the family and decide what the best course of action is at that point based on what their cost share is going to be. Okay, thank you for that. Now I'd like to move on to palliative care. And if you could, what is palliative care all about if you could define that for us? Okay, palliative care is similar to hospice although a patient does not have to be, have a terminal diagnosis with six months or less to live. They maybe have a life limiting condition, something that's causing them symptom management issues or maybe they're struggling and they're having some spiritual issues or emotional issues, but it can be a chronic disease that they're struggling with. Palliative care services then can be ordered by a physician and the patient can receive support, supportive nursing, social work, again, aid services and we can help that patient to one, get control of their disease and their symptoms and do some disease teaching, but to also work with them in defining quality of life. So palliative care two is about quality of life just as hospice is, but it's really more of a, before you get to the stage where you're looking at a limited life expectancy. So we really want to help people focus on what gives them meaning in their life. We focus on how they want to utilize the healthcare system. So we really wanna be able to help folks not have to go into the emergency room, not have to continue to come back into the hospital to treat the symptoms of their disease. We wanna teach them how to manage their disease, how to manage their symptoms, how to stay in the setting that they're choosing whether that be home or assisted living and give them quality of life. Okay, so part of the palliative care, advanced care plan could include home health services. It could, yes. You know, being referred to that to help manage that. So that way, like you had said, they're not going to the emergency room or in the hospital all the time. That's correct, absolutely. Okay, is there a certain stage or I think I already know the answer, but I'm gonna ask it anyway because I can. Is there a certain stage or an area where all of a sudden people get moved from palliative care or whatever to a hospice program? And it's probably because it's when they're diagnosed terminally. Would be my question, but is there any other factors that may come into that? Absolutely, we do have patients who are in our palliative program that do have a life-limiting illness and they're just not ready to be done with treatment. They are still receiving treatment. They want to continue to fight and keep going. So we honor that and we honor those decisions, but at the point when a patient decides that they no longer want to receive any curative treatment, then we would have that discussion about them if that's at that point, if they want to pursue hospice care. Or if we have somebody in our palliative care services and they have a chronic disease that just continues to worsen and they get to a point to now, they really are looking at a limited life expectancy and there are no treatment options. We can then look at hospice care for them as well. It is nice to know at least there are some options available for people to go out to the next step through their life and in peace. As the chaplain you had mentioned, I had him on the show a while back on a spirituality episode and that's one thing he defined as well is with that, your quality of life and you have your plan, he's seen it where people actually, when they're ready, they go peacefully. That's the ultimate, when that time does come. And we do see that as well in our hospice program and we've seen many instances where people really do seem to sometimes choose when that time is and who they want to be there and sometimes they're alone and they don't want anybody there and sometimes they wait until every last family member they have is there. It's really amazing how it just seems almost too coincidental the timing of that but I would agree that spiritual peace is huge in quality of life and end of life. It's a huge component of what we do. Definitely. The last service that you oversee or involve with I'd like to go to is called Lifeline. Right. And could you tell us what Lifeline is all about? Yes, Lifeline is a service, it's an emergency response system and many people are familiar with it. It's a unit that is placed in the home and the patient or the subscriber has a button that they wear around their neck or they can have a wrist bracelet with a button and if they would need help, if they fall, if there's anything happening where they feel they need to have emergency services, they can push that button and that gets transmitted to a call center that then will check on them over the special phone and find out if they need help. So many, many people in our community are able to stay in their home and remain independent that otherwise would not. It would be a safety concern perhaps with the help of the Lifeline services. We also have a auto alert button. This is a relatively newer feature. It's a, just like the button that they wear around their neck but it has a sensor in it that will sense a rapid changing position, so fall. And if the person that is wearing the button does not write themselves within 30 seconds, it automatically calls emergency medical services. So if somebody falls and they're knocked unconscious, they are obviously not going to be able to push their button. This technology is able to automatically do that for them. I know on TV you see some of the service that are being advertised now, they actually gotta tie it into windows if they're broken or temperature or fire and things like that go off. Is that something that's included with or is it just basically Lifeline is just push the button because you're in trouble or you don't feel good or something? Yeah, the Lifeline service, it's a Phillips Lifeline through Phillips and it is connected to the person. So the person would have to push the button. We do have another scenario where the person has to check in and actually activate something on the unit at certain times of the day. Otherwise the unit or the call center will contact them to find out if they're okay. So it can be set up in different ways but it is just personally connected to the person and not necessarily their surroundings. Okay, and likewise with that, obviously there's a cost to have that and then insurance companies as well cover that or is that out of pocket? Typically insurance companies do not cover the Lifeline services. It is mostly a private pay expense. The Lifeline service at St. Nicholas Hospital has a $30 installation fee and then it is $30 a month which is a very reasonable cost for that peace of mind. So essentially a dollar a day to have that peace of mind that there's somebody at your fingertips that you could call if you needed that. And we do waive that installation fee quite often just so we can get the units out to people and so they have that peace of mind. Sure, and if you look at the big picture, I mean $30 a month or a dollar a day is probably a lot cheaper than living in another facility or assisted living facility at what they charge. It certainly is. Definitely. I know we have to wrap here pretty quick. So if somebody wanted to find out about a service, home health, hospice, palliative care, where would they contact you at? In the Sheboygan area, they can call 457-570, area code 920, again that's 457-570. That is the main number for home health and hospice. They will get the receptionist and they can just let her know what they need and we can take that information from them. Otherwise, they can certainly go on our webpage for St. Nicholas Hospital and that is www.stnicholashospital.org. Okay, Tanya, I'd like to thank you for being on the show and talking about palliative care, home health and hospice. I think this was a great episode. Thank you, thank you for having me. Okay, that concludes our show. If anybody has any questions, they can contact the TV station from our website at www.wscsheboygan.com. Thank you for watching. I'm Dave Augustine for Quality of Life.