 Welcome to my program, Elderhood, Aging Gracefully. I am so grateful to Think Tech Hawaii for the opportunity to partner with them and to have this chance to share with you what I understand to be a phase of life, a wonderful phase of life that you can make real and wonderful. I like to coach people on how to make this part of their life the best part of their life ever. We have childhood, we become adults. I mean, childhood, we are adolescents and we have adulthood. And I say we have an elderhood. It's a stage of life. And in each stage of life, there are tasks that the man of us will ask of us, at least, our attention. And when we pay attention to them, when we relate to them, then we have an opportunity to really flourish. I was with my brother this past weekend and my brother said that there are things in his life that he just can't understand that are going on. Well, he's a year younger than I. Started to try and coach him, but he didn't want my coaching. But it happens that we can share with each other, both in group and in one-on-one, some of the insights that we have from psychology, from sociology, from medical, and make this really a wonderful opportunity for us in this world. I welcome you in the spirit of Aloha. One poet said, you know, I don't have any strangers. I just have friends that I haven't yet met. And I consider you to be friends that I haven't yet met. I look forward to that. In my work as a chaplain at Bristol Hospice, I have had the delightful opportunity in Bristol Hospice, Hawaii, to share with people as they go through this end of life stage. Now, I know nobody likes to talk about end of life. All of us think we're going to live almost forever. But end of life can bring up so many different anxieties that we like to push those away. I have made myself and had the opportunity with so many wonderful experiences of people and families going through their end of life process that have so deeply enriched me that I'm no longer afraid of even using the words end of life, because it does happen for us all. So how do we approach our end of life? When I was on the East Coast, I was up and down the Appalachian Mountains. And one day, flying over Asheville, North Carolina, we were in the mountains. And there were storms underneath us. And so the pilot came on and said, I can't just drop down of the thunderstorms. I'm going to search for crews around here up here and search for an opening. So we cruised around for a while. And then he found an opening, came on and said, and we're going down. And he went, zoom right down to the landing strip, I mean, to the runway. And I think most of us were white knuckled at that time, just holding on. But that's the way some of us approach end of life. We wait until there's a crisis. And then when the crisis hits, zoom. And it truly is frightening. And it can be upsetting for the whole family system. So that's one way to approach end of life. And hospice care can help at that kind of end of life. I don't mean to say we won't be there for you. But also, there's another way I think to look at it. And last night, I said, already mentioned, I came from California. And coming into Honolulu, do you remember coming to Honolulu with your flight? How does it land? Well, there's nothing like this. It's just as a nice, gentle, well-sustained, strong glide path into the landing strip. And what I like to do with this program and with some of the coaching I do independently is to give a chance for you to make those choices in your life and help you with those choices that are going to provide a glide path into the end of lifetime through your elder hood that makes it a really and wonderful experience. The five tasks that I've identified that are part of this elder hood time, and it's my elder hood as well as others. But there are five tasks that I've identified. One is grieving. We do this more than we do at this time than we've done before. And it can surprise us. What's all this grief about? Well, it's about lots of losses that we go through. The second thing that I say we do is we sort out our stories. We sort out our stuff, certainly. We sort out our stories as well, which are stories about who we are. And we often tell ourselves these stories all of our life. And we need to sort those out and find ourselves saying, is this really me? Who am I now? Am I this story? Or do I need a new story? You can write new stories for this time of our life also. The third thing is forgiving. I don't mean that as a mandate from a religious perspective. Though I do find many religions recognize the benefit of forgiveness. But rather than forgiveness and reconciliation, differ a bit. We cannot always have reconciliation. But you can always forgive. We can always unilaterally forgive and release ourselves from the burden of expectation, disappointment, whatever else goes along with the crisis we may have experienced. The fourth thing is preparing. And preparing, we prepare internally that we often have some idea of what life's going to be like after life. Maybe it comes from religion. Maybe it comes from our childhood. Maybe it comes from our family or our culture. And we begin to rehearse that. And do I really believe that? What do I expect? What I think is really going to happen. Sorting that out and making sense of that. But also in preparing, this is one of the wonderful things about Hawaii. We have so many resources available to assist us. And one of the things I'm committed to as a hospice chaplain in this program is giving all of my viewers a chance to know what kind of resources are available, especially in the hospice care. So that as you come into that glide, if it seems appropriate and you want to move into hospice care, you're going to already feel comfortable with it. You're going to feel, I know so much about it now that you'll be able to feel comfortable about that kind of a decision. And finally, letting go. And I touched on letting go last week. That's a profound experience. But today we're preparing again. And I am happy to introduce you to one of my favorite people in the world, Roxanne Cruz, who is part of the staff of Bristol Hospice Hawaii. Roxanne, I welcome you. And thank you so much for this opportunity to be in conversation. I'm talking about social work. Why does a social worker do anyway? Yeah. What do we do? Would you like to start us off with just a kind of commentary or a talk story about yourself, about how you came into hospice care, where you've come from, how you've been, how you grew up perhaps even, just in a quick way? Sure. So I was born and raised in Palo Alto Valley. And I moved to Maui for a time for about 10 years. And then I came back home. But I worked for the Sheraton Moana for 25 years in hospitality. And so I got hurt and decided to go back to school. And so I went back to school. I started volunteering for Kids Hurt 2, which is a nonprofit set up for kids that are grieving, a loss of someone. Any family member. A unique kind of grief experience. Yes. Yeah, it's grilled. I mean, it's built more on the children. So it's more play therapy, more of an outward instead of inward, whereas adults usually put it inward. And the kids get out their grief. So they have to physicalize it and get it out. They get it out through different styles, not necessarily communicating about the grief. And every time I go to the meetings, there are a lot of social workers that were older than me that said, I just graduated my master's. So I thought, you know, I think I'm going to go do that. And I really thought I would get into the bereavement side of hospice. And then I went out and did a visit with the family. And I thought, this is incredible, because they're letting us into their home at their most vulnerable time. And when a social worker comes in, they're still shocked. What, they told me I have sick months. So it's still new, still raw, and just helping them through that process. CrystalHospice-Hawaii.com is the website where people can get introduced to the first introduction to hospice care. But you really personalize it in a beautiful way. So you're talking about that entry. Have you found many barriers to getting in? Entering into the home and into their vulnerable by the time of their lives? So being born and raised here and growing up in Hawaii, when we heard the word hospice, we instantly thought death. We instantly thought they're going to starve you to death. This is all the myths that we have that are surrounding our local communities about it. But in actuality, it's such a great tool that is there for families that will help them through the process of grieving or financially, getting their paperwork in order, making sure that their children, if they have kids, young children, that they're prepared and have counseling set up. So I really believe that once our families have hospice coming in, they say, why didn't we start sooner? You find that a lot, you find that a lot of times. Almost, because usually they don't come on to the end. So when they're coming on, if you come on when you first get diagnosed, we have time that we can help prepare you. I mean, chaplains is amazing work. Our chaplains and nurses and everyone that's involved. CNAs, so being here and being local, I understand the stigma that we have. And then another stigma they have about social workers are we, they're going to take their kids away, we're going to turn them in for fraud. I mean, we just have this stigma, but really we're just coming in to help provide that psychosocial support. And sometimes they just need someone to listen to them that is not family. It's not going to question and bringing their biases. And I think for an example, I had a nurse practitioner that actually works out in the community and I had her mother. And so I asked if I could sit with her and after her through, she started crying. She said, I understand now what a social worker does. Cause even in her, she was thinking, what does a social worker do? Like, why do we need a social worker on our team? And after we sat and had the, let her just express herself, she said, I understand now why. So yeah. Well, you've said a couple of things, I think are really important Roxanne, you've said a team and you've said, why do we have a social worker? Those kinds of things are a question. That comes up an awful lot, I'm sure. And I'd like to say that, and I often say, well, little I've begun, I've known, I've been in hospice care for several years, but Cicely Saunders, who was the founder of the hospice movement in England, identified what she called total pain. She identified four pains. You know this, oh yeah, well, may I do it? Yes, you're the boss. The first pain is of course physical, physical pain. The second pain is relational. And the third pain is economic. And the fourth pain is spiritual. Well, on IDT, or an interdisciplinary team, as we call it, we address all four of those with professional, certified, the best people that we possibly can handle, I think. Yes, I think. And we have a physical pain, we have... Nurse. Nurse, medical director, CNA. CNA. Heroes in my book, for the family and the economic, social worker, and spiritual chaplain. And there's some overlap in some of that, but it's because the patient experiences this. Not because we said, oh, we're gonna have this program and we're gonna make it good, but because that's how we want to address the patient. Right, because it's not an individual of, let me go ahead and help them individually. It's a whole team that goes in that encompass the family. Because I will go in and say, well, how are you doing? And I say, how's your para-life going? And then they say, oh, I'm really struggling, I'll call the chaplain. So it's very important to have that communication open. If they say, I really need three days a week having my mom cared for by the CNA, then we can talk to the nurses. So the nurses will call me or email me and say, okay, they have a lot of psychosocial problems. There's some family dynamics going on. Can you come in? So as a team, we can address their needs. Yeah, and this is the most exciting part for me of, at least this is my perception of hospice care is, working as a team, we are human with one another. We get to know each other. We know the strengths that we bring to the table and we want to make those kinds of strengths available to everybody. We're gonna take a minute break here and our break is gonna give you a chance to see some more about Think Tech Hawaii, this marvelous organization. And then we'll be back with Roxanne for some of those specifics. What does a social worker do anyway? Be right back. Thanks to our Think Tech underwriters and grand tours, the Atherton Family Foundation, Carol Mun Lee and the Friends of Think Tech, the Center for Microbial Oceanography Research and Education, Collateral Analytics, the Cook Foundation, Dwayne Kurisu, the Hawaii Community Foundation, the Hawaii Council of Associations of Abarbon Owners, Hawaii Energy, the Hawaii Energy Policy Forum, Hawaiian Electric Company, Integrated Security Technologies, Galen Ho of BAE Systems, Kamehameha Schools, M.W. Group, the Shidler Family Foundation, the Sydney Stern Memorial Trust, Volo Foundation, Eureko J. Sugimura. Thanks so much to you all. Come back to elderhood, aging gracefully. Some of you are not even, don't even really qualify for elderhood yet. You will eventually, but you may know someone who does and with whom you have a close relationship and anything that we address in this program, anything we address today, anything that we address in the rest of our videos for this show can be a great resource for you and you can always call a Bristol Hospice Hawaii or connect with me through larryg.live-connections.com and we will respond with all the resources that we have to offer you. Today I have with me one of our fantastic social workers and they are heroes, heroines in my book for all that they do and her name is Roxanne Cruz. Roxanne told us a little bit about her background and how she moved into hospice care and I have asked her if she would share with us some of the things that are done by a licensed social worker within the context of that team work that we offer to the patient and family. So first of all, Roxanne, I'm gonna give you a list of some questions. So first of all, how do I qualify for hospice care? Well, boy, that's technical, that's a liaison question but I'll try to answer you if we can get qualified by two doctors to be approved for hospice care. You have to have a diagnosis of six months or less. Yeah, I think that's the basics of how you get qualified through your doctor. So hospice is free, it is through Medicare, everything, your supplies, everything that you receive is free so there's no, and we have to talk about their DMEs, wheelchair, hospital beds, everything that you can think of will be provided for each family tailored to their needs. She used the term DME, which stands for? I don't know. Medical equipment, recommended. I do, but I can't remember. It's medical equipment, that's what it is. So everything is provided, I think that's one thing again that people might not, you know. And medications that are to do with your diagnosis is also covered, so you wouldn't have that cost. So I'm a hospice patient and I want you to come over and talk to me about where shall I live? What's the best, I wanna live at home. Can I live at home? Yes, of course, most patients, I think 90% are in their own homes and then we have patients in facilities. But if the patient says I want to remain in the home and he has the support or her have the support of family or hired caregivers, it's actually better for them to be in the home because then the family, it's more personable. It's not like, oh, you're in a facility and you're sick and you're ill and then you're gonna pass, but when you're at home you have the support of your family and friends. I mean, it could be anyone, pastor, chaplains that actually know them on a personal level, also that can actually come in and help with the family. Yeah, very good, because then I have my own familiar support system as well as this new one that's coming in to give assistance. Right, and statistics show you do well at home versus in a facility. So what's the difference between Medicaid and Medicare? Well, Medicare covers for the elderly, right? 65 and older, you can get Medicare, everyone, across the state. Medicaid is for the low income of families, like so that are on a quest that needs help. They're not 65, but they'll get Medicaid if they're younger than the 65 or older. So Medicaid provides room and board. Medicaid provides room and board. But not Medicare. But Medicare does not. Yes, yes, so it depends. Okay, so if I'm going, if my kids decide, well, that's too bad, Dad, we're gonna place you. We think you'd do better off not here because we can't really care for you as we're stressed. And they're working and they have kids, yes. They say, and I say, I don't wanna be a burden. I really wanna go somewhere where I relieve you of that pressure and I don't have the enough funds. I don't have personal insurance, I don't have long-term care insurance. Don't have anything to sustain other than a regular insurance. Can I get Medicaid? Well, you can try to get Medicaid because Hawaii is a higher income. Oh. Yeah, so it's not, you know, I think you can have, don't quote me, but you can have up to like 700,000 equity and you can get qualification. So it depends on one, your insurance and your family, to get together and say, we're gonna have to pay 7,000 for private care. But if you bring someone in the home, private care, it'll be 24,000, it costs more than what it would at a facility, yeah. So I invite you in and I am ready to share all of my financials with you. Social workers do not handle financial. Yes, so we do not call a lawyer, we can give you resources, you know, legal affairs, legal aid, you know, we can give you the resources, you know, there's Scott Gardner, there's a lot of companies that can help prepare the family to either get them in the nursing home or at home. So you make the connections, you have all the resources that I'm gonna need that you'll connect me with. Right, to connect you to the right person for finances. So as a social worker, we go over the, do not resuscitate, the post it's called P-O-L-S-T and we wanna know what your wishes are because when you are diagnosed, it's all about what you want. Sometimes the family wants different things and the patient saying, no, I want, this is what my wishes are and I'd like it to be respected. So that's why you have the post because it's their wishes. Would you, this is P-O-L-S-T, what does that stand for? I don't ask for those. Physicians, all the rest of something. But it tells the physician and it tells the community what your desires are. What your desires are. And so even in the families when there's, we say trouble, we can bring out the post and say, this is the wishes of the patient. And so that's who, you know, you're gonna wanna, we listen to is what their wishes are and what they desire. If they wanna be full-fledged, they can be full-fledged. So it's actually what the patient wants. And if the patient is past that stage where he's not communicating, most times they will have it in their will or they have it on an advanced health care directive. Yes, advanced health care directives. Right, so and if they don't, then you need to find a surrogate. So, so I can be confident, sorry, so I can be confident that my wishes are gonna be respected by my family, physician and everybody. Even though it may be difficult for them, I have to clarify that with them ahead of time. Yes. Okay, okay. But the social worker will help me do that. Oh yes, we can have a family meeting or I can talk to the family separately or we can, you know, it can be worked out just so that the family understands where the patients come from. So this was another thing. So I'm diagnosed, I tell my family and I have a brother that really doesn't like me at all and all he says is, oh well, about time. Or he really doesn't have a very good relationship. And I have an ache about this relationship. It's there, and I share that with you. Share it with the chaplain. Is there a way that maybe that can be the end of life kind of dealt with? Sure, I mean, you know, we can ask the patient, do you have a number? Would you like us to call them? Would you like us to connect with them? And then we can go from there. You'd be an advocate for me at that point. Sure, we advocate for the patient. And if that's his needs and desire, you wanna help them fulfill that need. You know, but even in hospice, we have, which is called the dream foundation. It's like the cat, for youths that have make-a-wish foundation. But the adults have a dream foundation. Oh, they do. Yes, we do. And so we can apply our patients and say I've had people fly from here to Tahiti because they wanna be with their family or a family member, or the patient wants to go to Disneyland for the last time or they wanna go to Las Vegas. And so we can apply for that and they will make that wish come true. Oh, neat, I didn't know that. So they have their own, yeah. They have their own, we, yeah. Make a dream come true. Yeah, it's called dream foundation. Dream foundation. Yeah, for adults. For adults, cool. Yeah. So if we are, it's better than if we are, if I enter in, I get my diagnosis, then I enter into hospice care right at the beginning of my diagnosis. Then I have all that time to work with the social worker to get the resources. And it's still, you still need to qualify. So even if, unless you're like a stage four, or you know, you're like, then of course you're gonna come right on, you know, being diagnosed. And a lot of, we have a lot of patients like that. They went in for a cold and found out they had lung cancer, or you know, really devastating things. So yeah, they can come on to, and then we do have more time to work with them. You know, as we can work, oh, do you have a wish? You have a goal? Cause it's about living, right? So, you know, not just, you don't have to stay home. You don't have to be in the bed. It's about living. It's about living. And that is what it's about. Yeah, yeah. We have just about a minute and a half, Roxanne. Is there a quick story about one of your patients without breaking confidentiality? Of course that you could share. Well, I had a patient that, he was on the younger side, 50, you know, on the younger side and he loved Disney. And we set it up where he could go to Disneyland to the Dream Foundation, but then he started declining. So what we did is we brought it to him. So the nurse, Christie and I, you know, dressed up a little like a fairy tale and all his family came over. So we had a celebration of life. Oh, wonderful. We got all the Disney characters and we brought, it was really great. From Disneyland to him. Oh, he smiled the whole day. I mean, he was so thrilled. So we have a lot to offer patients and families. And if we even, I think people that work for hospice, we are special. Why? Because we really care. And social workers are special because they're so social. Yeah, we are. I am so happy you came to help me out with this, Roxanne. Thank you so much. And you all call Bristol hospice dash, get on the website. If you like, call us at Bristol hospice dash Hawaii.com connect. And I'm happy to respond Larry G at live dash connections.com. Thank you so much for being a part of this. Two weeks from today will be our last for the year program for the year. And I hope you'll come join me again. Oh.