 Welcome to my program, Elder Hood, Aging Gracefully. I extend you that lo-ha experience of Hawaii, that beautiful concept of welcoming people into the company of the whole family with sharing one breath and one life. And I don't know all of you, but like one famous author said, all of you are just friends I have yet to meet. So thank you for coming and being a part of this on-show experience. I'm looking at Elder Hood, Elder Hood as a stage of life. You had your childhood, we had our adolescents, we've had our adulthood. And now we have a stage called Elder Hood, I like to say. Elder Hood, I want to offer you as an opportunity to, with my coaching and with other resources available, make that experience of life real and wonderful. I've approached this Elder Hood, and I'm grateful for Think Tank Hawaii for giving me this opportunity to share it with you. But I've approached this stage of life as having five tasks that are called spiritual tasks. Those spiritual tasks beside me here are grieving, sorting out our stories, forgiving, and letting go. And each one of those has some depth to it that I'm exploring here on these programs. The preparing piece, usually when we talk about preparing, of course we look at the externals. And I'm going to look at those with my guests today in just a few minutes. Some of the externals that are available, the resources that you want to look into to learn about what Elder Hood can be and will be when you make some positive, health-affirming choices. There's also an internal dimension to preparing, the internal dimension of imagination. What do you imagine your Elder Hood to be? If you imagine your Elder Hood to be, some of the old stories that we have had, a decrepit, loss of everything, abilities, if we imagine that's what we're going into, we very likely will make that happen. I'm not saying that imagination is everything, but on the other hand, if we think of it as capable of being wonderful and full of health and well-being, then we are very likely to find those resources and to incorporate them into our decision-making and create a new story for us. Two weeks ago, my guest was Mary, from Los Angeles. And Mary talked with us about the different stories when we get into this time of life. They bring with us stories from the past, which often are stories like, I have to be fat, I have to be big, I have to... Everyone in my family has diabetes, I'm going to have diabetes. It goes on and on of the stories that we tell ourselves and sometimes inherit. I said to be careful because every time you hear yourself saying, I'm always, that's a story. It's not a reality, it's the story. And you can know what your stories are just by listening to yourself talk. I also told you that two weeks ago, I was going to start a new program of health management myself. And part of that, the first piece with my coach, is weight loss. And you probably can't tell, but I've lost five pounds last week. Which is an important part of my new journey. I only have 55 left and I'm going to make it. So grieving, sorting out our stories, forgiving and preparing ourselves. Preparing for an elderhood and for a life at the end of life full of meaning and significance and wonder. This is our opportunity today. And I've likened this to two different kinds of ways of landing an airplane. I came in to land on an airplane in Asheville, North Carolina, over the Blue Ridge Mountains. And the pilot came on and said, we're over thunderstorms. I can't just go through the thunderstorms. We're going to circulate up here above the storms until I find an opening and then we'll go in. So we were there 10 minutes, came online and said, OK, I got an opening and I'm going in. Well, he didn't just take a gradual approach. He dove through the clouds and everybody was a white knuckle. Everybody was a white knuckle experience for all of us. As he plunged to the earth and plunged to the landing strip. That's how many of us are planning to end our lives eventually. We'll think of ourselves as being above it all. No problems, no problems, even though there may be difficulties that we're in. We're in denial. We are in ignoring the facts of what was before us sometimes. And then suddenly there's a plunge and everybody grabs their chair and goes, what has happened? We didn't anticipate this. And that's exactly right. We didn't anticipate this. The other kind of approach in elderhood seems to me is like landing in Honolulu. You start off way out over the ocean and take a nice gradual, easy approach to the landing strip. Plans are made. You strengthen yourself all along. You get the resources together like I'm going to do to lose weight, to become healthful instead of following the old stories that may oftentimes lead to our dis-ease with ourselves and with our life. There are so many amazing resources. We have 250,000 residents in Hawaii, over 65, and that's about a quarter of the population. But that's a lot of folks. Fortunately, that has provided impetus for us to have a lot of resources available too. And I'm wanting to introduce you to one of my colleagues from Bristol Hospice, where I am a chaplain serving as a chaplain. And Erin Hamilton is the director of community development. And I'm so grateful to welcome her here today. Erin, thank you so much for coming. Thank you for having me. You're welcome. And I love what you were saying about how perception is kind of the basis of our preparations in life. Okay. Good. Well, Erin, would you just share a little bit about hospice care to start off with? Bristol Hospice, I say, and because I have a great affection for it, is a company that I'm proud to say lives out its tagline, which is embracing a reverence for life. And I think we do that. Tell us in general about the benefits of hospice care. What do you see, and when you go out to meet with people, what's on your mind to say, why is it important that I would even consider hospice care at this stage of my life? Of course. So I think to kind of just add to your fact about how we just have such a large population of, you know, aging people here as well. And then preparation. I think the biggest thing that we struggle with when we get into the field and when we typically are getting a hospice referral is going to be, it's a late referral. So unfortunately, a lot of the time we just don't want to facilitate these discussions with our family members, whether it be cultural beliefs, or kind of just if it's a taboo subject, which I feel like it kind of is for us. You're saying even hospice, talking about hospice care is taboo? Yeah. So I think definitely nobody wants to kind of talk about that, you know, that elephant in the room or the gorilla in the corner, and especially now that we have a lot more medical advances, we're doing a lot more treatments, you know, it's important to be hopeful, but I think it's also important to kind of just talk about all possibilities and just be prepared for that as well. So, you know, one of the things with hospice care is not only preparing the individual, but as well as the family and giving them support too, like yourself. So they get a chaplain, they get a social worker, they get a registered nurse, case manager, they get a nurse's aide. They have their attending physician as well and a physician from the hospice as well. Their medical equipment, their medications, that's all a part of it, and it's just what we all paid for, like when we pair Medicare taxes, that's where it's going. And I think a big part of that perception is number one, we don't want to talk about it because it's kind of taboo, or we don't want to offend or give up hope, but at the same time, it's important to kind of acknowledge that we're all getting that same ticket to that same place and let's just try to embrace, like you're saying, the reverence of our lives. And I'd like to say, Tag, Ride the Cotales is one thing you said, which was having the family together, and we have a, it's a great advantage to us and to the family when we can bond with the family earlier in the process of that dying process, the eventual dying process and really walk the journey alongside them rather than wait until they suddenly land in our laps and they're frantic, the family's frantic, the patient's frantic. What's the first prescription for being eligible for hospital hospice care? The first prescription or... Six months. Yeah, so they would definitely have to have a terminal diagnosis of six months or less by two physicians. Typically it's going to be the referring physician, the specialist, or the... Two physicians. It would be two, and then usually our physician, the hospice physician, is that second certification. But that's nothing usually, that the family's usually, or the patient usually has to worry about. It's really just kind of taking that leap and let's just talk about this because it doesn't mean that you're giving up hope and there are, as we would say, hospice graduates, which you kind of know about. And those are going to be patients that maybe do get a little bit better and they are able to get off services and maybe pursue a little bit of treatment that they were willing to or wanting to pursue prior. Or maybe they gained a little weight or their functional ability is a little bit better and then they can always come back onto hospice services later on. So if we have a chance to bond with that family right at the beginning of getting that news, six months out, there's a death, imminent death, probably in six months. We can bond with them and walk that journey. We can bring all these resources to bear on the comfort and care and peace of the patient and the family. Absolutely. And then also after. So I think the biggest part of why patients often do not want to talk about it with their family members is because they don't want to worry them, right? We don't want to worry. We don't want to burden my children. We don't want to burden my husband or my wife. True. But at the same time, you know, when that person is no longer here, the family is usually the ones kind of left with that situation to kind of go with so that support in terms of like the chaplain, the social work and the bereavement is offered even after the person is no longer here. We've got about a one minute to break, Aaron. Sure. I'm sorry. I took a long time talking. No, no. What is one or two, what are one or two aspects of Bristol hospice that you think set that service apart from the others on the island? Oh, definitely. So I think then the first thing is that we offer a lot of palliative care. So I think that, you know, a lot of the time people think that hospice is only for end of life or the last few hours, but we can do palliative radiation. We can do IV hydration. A lot of things that maybe 10 years ago or even presently some other hospices wouldn't be interested in doing. Interesting. So I would say the palliative service is... Palliative means to cover. I don't know if you've ever, you know what pallbearers are. Yeah. They took care of the covering over the casket, which was the pall. Right. So palliative comes from that same word. Cover the pain, cover the anguish, and to ease life then through that. Is there one more thing about Bristol that you think is really wonderful? Oh, I would say that we have amazing staff like yourself and our clinical staff. Our medical directors are really, really involved. Our nurses are just super caring and we do probably the most nursing visit with our patients. Beautiful. We're going to come back and look at some resources that are available in this community. Erin has an amazing website. I want to introduce you two, and please stick with us. Aloha. I'm Jane Sawyer with the Small Business Administration and one of your hosts for Adventures in Small Business, a partnership with ThinkTech and with the Hawaii Small Business Development Center, the Mink Center for Business and Leadership, and the Veteran Business Outreach Center. All serving small businesses in Hawaii and telling you the story about their strategies, their ideas, their drive, and the way they help Hawaii succeed and be a bright light in small business. You'll find it here every Thursday at ThinkTech. Thanks for joining us, and we hope to see you soon. Aloha. This is Rob Hack. My show is exporting from Hawaii every other Thursday from 12 to 12.30 p.m. where I bring in people involved in the entire exporting infrastructure in Hawaii, including government, academia, and manufacturers and shippers themselves. Please join me every other Thursday, 12 to 12.30 p.m., and exporting from Hawaii. Mahalo. We're back here from Honolulu, and the program is Elderhood, Aging Gracefully, and I am convinced with the help of folks like my client or my companion here today, we can age gracefully into and through our Elderhood, which is a stage of life. Thanks for being a part of this, and thanks for ThinkTech Hawaii and all that they make available to us to share these explorations, to challenge our intellects, and to enable me to share with you some of the coaching basis of my own coaching for Elderhood, which I would do with you if that's something that you would like to get involved in. Aaron Hamilton is our director of community development at Bristol Hospice. Aaron, what about this website? You have an amazing website that you introduced me to, and Eric will pull it up here for us, and share a little bit first about how you decided to get into it, and how did you decide to develop it? Sure, so I think it was definitely being in the field, and definitely along the themes of the show is preparation, and when I would meet families, I would say the most common denominator that a lot of people shared was just not being prepared on so many aspects of it, and not really having the access to the resources that, even the professionals in the field, we struggle with, you know, getting all the new updates and everything like that. So that was kind of the catalyst for me to start a website, and I just wanted to make sure that everybody in the public had access to all of this information that we get a kind of experience in our day-to-day lives at work. Erin is a certified social worker, and has moved into this role, having also served as the ASON for Bristol Hospice, which means that she connects with people who are coming into the service. So if Eric will bring that up now, we'll start to use that as you think might be best. Sure, so I would say definitely in terms of, you know, your quick kind of go-to, you can look at the Community Resource Library and go ahead and click that, and you can just click on Resource Library, and it's going to give you a list of topics. So I think one of the first things on the list is going to be the Advanced Healthcare Directive and the PULS. If we click on that, that's going to bring you to kind of an area that will explain what the Advanced Healthcare Directive is, the Power of Attorney, or the Living Will, and then also if you scroll a little bit down, it's going to have four different options for you. So you can click on the Advanced Healthcare Directive, you can click on the PULS, which a PULS is the Physicians Orders for Life Sustaining Treatment, and that's probably going to be a bright green paper that a lot of you have probably seen, and you can really just look at the different topics there and see what are the choices and what that means to you. This can be completed at any time in your life and as many times as you want and can be changed, and then a doctor is needed. Just as an aside, because I'm here alone, my girls, my daughters are in Denver, Colorado, so I didn't have anybody. I thought, you know, if I have an accident, how is anybody going to know what to do? And so I filled out my PULS and I filled out my Advanced Directives with a piece called Five Wishes, and I've made that available to my physician, I've even given it to my business to my supervisor. So yeah, I really think any time of your life it's important to have that in place. You think so, huh? Absolutely. So we'll go back to the website. And then if you go back to the website and look under the Resources Library, you can go back to the Resource Library as well. I think a large portion of this as well is as we age, there's going to be different challenges in our lives and levels of care that you may need. So housing is usually one of the most complicated issues to really navigate, especially when we're in a hospital setting, maybe we're meeting the families there or we're meeting them at home and there's an anticipated decline in whatever disease state they're currently being challenged with. There's different options. So there's a care home, a foster home, a nursing facility, assisted living facilities. There are going to be patients that do not even have a home or housing available so that would be more like a transitional or emergency shelter situation. A lot of people do not know necessarily about the community care foster homes and that's a good way of kind of navigating this as well. That's more of a home setting. So if you click on that link right there, it's going to redirect you to the government site for all the certified licensed foster homes, their addresses, their phone numbers, their contact information as well. So you can find if it's for mom or dad, you can see who's the nearest one to you. And then when you go back to the resource library as well, let's say maybe the foster home situation is not for you and you want to go ahead and look at maybe the skilled nursing facilities and housing. There's also the assisted living and senior community. So we can click on the assisted living and senior communities tab and that's going to really just talk to us about what is the difference between an assisted living situation of retirement and a senior community. So the assisted living facilities are going to offer your meals, they're going to do your laundry, but what does that look like financially and really kind of just again going back to the idea of preparation and planning. So you can go through that whole tab and just really check out each one and maybe there's going to be a part of your life where doing assisted living is going to work or another when you'll maybe need a foster home or a nursing facility but at least having that accessibility to those resources are important. I want to be in my own home. Let's say I have six months to death to dying prognosis for whatever reason and I get in touch with Bristol Hospice and I say I want to stay at home as long as I can. So what are the financial arrangements? Let's say that I'm staying at home and how can I have help with there's no way that I can do it on my own but what about the financial arrangements available for the rest of that six months for me? Yeah, absolutely. So definitely I would say the most common thing is most people want to stay in their home, right? That's very, very normal. That's what we all usually want. Nine out of ten of us. So hospice services are paid for by Medicare when you're in the home setting. So when you're 65 and older it's going to be Medicare if you're 65 and under. It's going to be either your typical insurance that you have, whether that be a laser or Medicaid. That would cover it as well. And then if you have, let's say you have an HMSA plan, some of them will actually pay for you to be in a nursing facility but again if that's not the route that you want to go, your Medicare or your normal insurance would pay for that to be in your home setting. That would include your entire staff, your interdisciplinary group. So that chaplain all the nurses and medical help as well as the equipment and medications as well to help sustain you in your home setting. When I worked in Denver, a hospice in Denver in the Denver area, it was set up as a long-term care facility. That's how it was established but specializing in hospice care. So we had patients who were there for several years on long-term care. And then we would recertify them every six months for the eligibility to, for hospice care within our facility. I understood that the facility went that direction in the first place so that Medicaid could be used for room and board. Is that accurate? Yeah, so if a person qualifies I think it's a big thing and actually if you go to the website too as well, there's a section for what is Medicare and what is Medicaid. So I think I often hear those terms kind of switched back and forth and really the difference is going to be if again we're 65 and older, Medicaid's going to be based on financial criteria. If a person meets financial criteria, they would be able to hospice benefit pays for them in the room and board situation in a long-term care setting like that. Yeah, okay. What else? So if we're going to go back to the main resource library on the website I would say that a big part of it is definitely like kind of what you're talking about is support groups and senior centers as well. So really just talking to everyone in your situation, in your circle and just finding others to connect with and see what has worked for them and what hasn't worked for them and really just getting that feedback as well. You can go and click on the different links and see in your town or your zip code which support groups or senior centers are available. So I think that's definitely resourceful as well. So there's a lot of resources out there so many. So even dependent upon your diagnosis. So let's say you know you have renal disease or Alzheimer's or mom and dad has Alzheimer's or dementia a lot of the time too the resources are there for the family members right because yes the patients going through it too but then the family members the spouse are going through it as well and often just need someone to touch with and kind of reflect about what they're going through. Sicily Saunders who originated hospice care was a social worker a physician a nurse and a self-proclaimed member of her church of England. And she identified four different pains in that. There was a social pain of relationship with others and financial issues sometimes there was a pain of the physical pain of course medical pain I mean medically addressed there was a pain of what was the third one and then the fourth one the spiritual pain but she built hospice care around those four pains and really around her own personality so we inherited that and our interdependent or interdisciplinary team is made up of those folks the social worker the medical director nurse and CNA the bereavement caregiving for community and then also spiritual care so all hospice attempts to do that Bristol hospice has its own special abilities I think. This goes this is going to go global I have friends in Sweden and other places in London we're going to watch this so it's applicable anywhere but you're specific I mean the general categories but you're specific offering of this this website is just a gem Erin thank you and I know you've done this out of your own selfless desire to help and thank you very much. And I just want to throw it out there that it's 100% free there's no signing up or anything like that anyone can access it and the more we know the better we can prepare and make decisions so thank you so much for having me. It is just a really pleasure Erin thank you. In my coaching I want to help you make your elderhood real and wonderful and I can do that through groups I can do it online with you individually make it real make it wonderful