Hospice Is Not Giving Up: What Families Should Know Before Choosing Care

Narrator: Welcome to the Voices of Hospice Leadership Podcast, uh, the show that reveals how to take your hospice to the next level. We cover all things hospice, from marketing and automation to billing and operations. You'll also hear from professionals in the industry as they share their stories of success and practice growth tactics. Here is your host, Brian Franks.

Brian Frantz: All right, welcome to the Voices of Hospice Leadership Podcast where we speak with hospice leaders and, uh, industry experts about what it takes to serve families well and lead with purpose. So today I'm joined by Shahruz, owner of Healing Care Hospice. We're going to be talking about what hospice really is, why hospice is not the, uh, same as giving up, and what families should know before choosing a provider. So charoons, thank you for joining us today.

Shahruz Skulshani: Thank you, Brian. It's a pleasure to be here. Great.

Brian Frantz: And, uh, why don't you start by introducing yourself and tell us a little bit about Healing Care Hospice.

Shahruz Skulshani: Sure. Um, my name is Shirou Skulshani. I'm the founder and president of, uh, Healing Care Hospice. I started the company in 2012. Um, took about three years to get licensed and accredited and Medicare certified. So we were starting to take care of patients, um, towards the end of 2014. So we've been, um, a very active hospice, uh, for about the last 12 years in Southern California.

Brian Frantz: Awesome. I always think it's helpful for families and referral partners to, uh, understand a little bit about the person behind the organization. Uh, I think because hospice is such a personal service. Uh, of course your background was not originally in hospice. What led you to this work and what made hospice feel meaningful, uh, for you?

Shahruz Skulshani: Well, I, I actually started out working for a few, uh, different software companies, uh, and then I switched to commercial real estate. I worked with, um, my mom and dad. We had a small, um, family office, Commercial real estate, family office. And um, you know, it, it was okay. I, I, I enjoyed working with my family, spending, um, time with my dad, my mom and dad. Um, but there was something that was missing, you know, and I had done quite a lot of, uh, volunteerism and advocacy around the issue of homelessness. Um, um, probably for 15 years. I'd done this before I started Healing Care Hospice. And um, you know, I, I, I sat on a couple of nonprofit boards. I even started a program called 1000 Homes that, that was about, um, uh, educating, um, educating people on permanent supportive housing and, and spreading the word and, and uh, influencing decision makers, et cetera. And that was very fulfilling, um, for me. Um, so in 2008, when the commercial real estate market, uh, crashed, I Decided to go to graduate ah, school. I went to business school at UCLA Anderson and I was there, um, work nights and weekends. Program uh, was about, took three years and in 2011 I finished and I was kind of looking for something new to do and um, looked at different, different opportunities uh, in health care in particular. At that time health care was, was really dynamic and changing and growing with the passage of the Affordable Care act and really many other industries were uh, going sideways of not contracting because of the economic downturn. So I, I was looking at different healthcare businesses and I thought that hospice might be a uh, way to kind of start a business and grow it um, and create jobs and create opportunities but also you know, to

Brian Frantz: make um,

Shahruz Skulshani: an impact, you know, to do something positive to um, to basically you know, address needs out there that aren't being met. You know, like much and much like I had done when I, when I worked with um, organizations helping the homeless. You know, I, I thought that this might be a way of doing something, you know, positive for the community.

Brian Frantz: Yeah. Awesome.

Shahruz Skulshani: Yeah.

Brian Frantz: I think that mission piece is so important because uh, hospice can be sometimes misunderstood till know a family actually needs it.

Shahruz Skulshani: Um, when a, when a family asks

Brian Frantz: you what, what is hospice? How do you usually explain it?

Shahruz Skulshani: Okay, that's a, that's a great question. I feel like oftentimes hospice is misunderstood even by some people in the healthcare community. Um, so I think it's important to, to uh, to cover it. So hospice is um, care that is provided at the end of life to bring comfort and support to patients and their families. Right. And I, I, I usually um, describe hospice in two ways. While I'll cover the hospice um, approach to care or the hospice philosophy of care and then I'll talk about the details of the Medicare hospice benefit. Right. So the hospice philosophy of care consists of four parts. First part is the focus is on comfort and support rather than seeking a cure. Um, the practical uh, application of this is that um, when someone comes on hospice they forego curative care. That means that they, they're no longer going to go see their primary care physician unless that primary care physician is going to follow them on hospice. And they're, they're not going to be able to go to see their specialists. Right. So they have cancer. That means no, they're no longer going to their oncologist or if they have heart disease, they're no longer going to see their cardiologist, et cetera. This is probably the most important thing uh, for families to consider is that it, it is a Very, um, stark choice. You know, you are. You are giving up something and you are gaining something new. And I think that's an important thing to, um. To think about. Basically, hospice becomes appropriate. When the costs and burdens of curative care. Start to outweigh the potential benefits of curative care. Right. So the second aspect of the hospice philosophy of care is that, um, we care for the patient and the family as a unit. So while we're doing symptom management. And providing emotional support and spiritual support for the patient, we're also providing emotional and spiritual support for the family. Uh, thirdly, um, it's very important to us to be able to deliver a personalized plan of care for the patient and the family. So it's very important that we get to know, um, the family, their particular dynamics, their culture, values, beliefs, traditions, their goals, very importantly, and that we. We create, uh, a plan of care that is customized for them. And we very much encourage them to be involved in determining that plan of care. And, you know, any changes that may. That may need to be done on an ongoing basis. And then lastly, uh, in hospice care we seek neither to, uh, lengthen life nor to hasten death. So we are, um, provide. Doing symptom management, bringing comfort and support. And providing emotional and spiritual support. Um, but essentially we're allowing nature to take its course.

Brian Frantz: So we're.

Shahruz Skulshani: We're not, uh, taking measures to. Extraordinary measures to lengthen life. And um, even though sometimes, you know, families may ask, we do not take, uh, any measures to shorten, uh, life as part of hospice. So that's. That's the hospice philosophy of care. Now, what is the Medicare hospice benefit? And I say Medicare because most of our patients are, um, Medicare, um, patients. Um, and then anyone else that comes on hospice, whether it's covered by medi cal or commercial insurance. That typically the Medicare model for hospice is what governs. So that's. That's why it's important to kind of go over the details of that. Um, care is. Is. Is delivered through an interdisciplinary team. Uh, at the head of the team is our physician. The um, physician and uh, the nurse are working hand in hand to address m. Any symptoms, uh, or distress that the patient may be feeling. So, um, pain, nausea, vomiting, shortness of breath, constipation, et cetera. They're working, uh, very diligently to minimize, um, those symptoms. Uh, typically, uh, the RN Case manager, uh, is going to be visiting the family one to three times per week. Uh then there's an aide that's there to do personal Care. So bathing, dressing, toileting, ambulation, um, range of motion exercises if appropriate or um. Yeah. And the aid is typically visiting three times a week. Sometimes uh, we can do up to five times a week aid visits if the family really uh, needs it. Um, there's a social worker that's there to provide emotional and spiritual support but also to help with any type of legal or financial like paperwork or to make referrals for um, benefits or services that may be available in the community. Typically the social worker is visiting the family one to three times per month. But if they're working on a project for a family, um, they're going to be there more often, they're going to be spending more time with the family. And um, there's a spiritual counselor that uh, is there to provide emotional and spiritual support in a way that is appropriate for that family. So they're very knowledgeable in um, different cultures, different religions. And really the idea is that they're, they're there to meet the family where they're at. So um, the family is, let's say for example Catholic and very religious. They can speak um, that language and know the, know those traditions and it. But if the family is not religious at all and you know, is not really interested in that, um, the spiritual counselor can speak to them in a more kind of human to human basis. And um, so, so that's the team. Typically what the family will experience is someone from our uh, agency coming maybe four to five times per week. They come for about 45 minutes to an hour and then they leave. And the reason I explain it like that is because um, while we're visiting, you know, what would seem like quite often four to five times per week, maybe about 20 to 22 times per month. Um, we're there for about an hour and then we're leaving. So um, we're not in the home all that much in reality. So it's I, I like to think of it as a partnership between uh, our agency and the family where we're doing the medical management, um, and providing emotional and spiritual support. And the family is doing that the day to day to day, hour by hour, personal care. Now we're always available 24 7, you know, so they can, they can call us, talk to a nurse within a couple minutes, day or night, even in the middle of the night. And if we need to, we can send a nurse. Um, that will usually take about an hour. Um, but we can send a nurse if they, if the nurse needs to, she can stay. Um, if the patient Is experiencing out of control symptoms that cannot be addressed with that one hour visit. We do have the ability to do a different level of care called continuous care, where the nurse will, a nurse will come and stay for an eight hour shift and then we'll replace that nurse with another eight hour shift. And we can do this until uh, the patient is stabilized. We also have the ability in an emergency type of situation with out of control symptoms to take the patient to a nursing home for what's called general inpatient care. And um, you know, maybe for a few days until they stabilize and then bring them back. And then there's another option called respite care where um, if a family needs rest or maybe the caregiver needs to go out of town or needs to take care of some of uh, his or her own medical needs, um, the family can take the patient to a nursing home for up to five days. Ah, and then bring them back, uh, so they can get that respite essentially. So, um, those are the levels of care and just uh, lastly, medications that are related to the hospice diagnosis, we cover and they're delivered to the home. Um, medical equipment, any medical equipment that the, that the patient may need we have delivered to the home. And then we also help with medical supplies like um, uh, diapers and trucks and gloves and wipes and things like that. We can, we send a certain amount to the family each month. Um, and that's, that's hospice care.

Brian Frantz: Awesome.

Shahruz Skulshani: Hospice 101.

Brian Frantz: Yeah, I think that was a. There's a number of really important distinctions in there. And uh, I think many families hear the word hospice and immediately they like, you know, no more care, end of care. Right. When it really is just a different type of care.

Shahruz Skulshani: Um, what do you think? Palliative. It's palliative care versus curative care. Right? Yeah, love it. But, but there, you know, I can't speak for the entire hospice community. I can just speak for my company. But um, families oftentimes have this fear and uh, you know, that we're just basically going to give the patient morphine and wait for them to pass away. But that's not the case. Like um, we, we actually do a lot of things clinically um, that set us, set us apart from other hospices. So we can, we can do labs, you know, to see if there's an infection and then prescribe medications, you know, um, patients coming from the hospital that are on artificial nutrition, for example, the families sometimes request that they continue artificial nutrition. We can do that for a limited amount of time. Um, with a product called clinomix, um, IV hydration or IV antibiotics we can do for short amount of time. Um, uh, if a patient has fluid buildup in the abdomen, you know, ascites or they have, uh, fluid buildup in their lungs, we can, um, have a paracentesis or thoracentesis done, you know, one or two a month. Um, where, you know, we. If the patient is, is on a pain pump and they need a pain pump, uh, you know, we can accommodate that or if they have challenging wounds, we can accommodate that. Uh, high flow oxygen is also something that we do up to uh, 60 liters, um, CPAP, BIPAP, so, so there's a lot of things that we do clinically, uh, in the pursuit of comfort, but also in helping families make that trans tradition, that transition from, uh, the hospital home. We like to say, we like to say yes. We don't want to say no when families ask things of us. Of course, uh, you know, the care that we provide has to be clinically indicated. And some of the things that I just described are kind of transitional, is kind of short term. But, um, it is oftentimes very helpful to help families make that tradition to a hospice care.

Brian Frantz: Yeah. You mentioned one of the misconceptions there. Uh, what are some of the biggest misconceptions families, ah, families have about hospice?

Shahruz Skulshani: Sure. So, um, I think the biggest fear is probably that, you know, hospice care, if we put our loved one on hospice care, we're abandoning them or, um, we are, um, you know, stopping all care and that the patient is going to die very quickly. You know, sometimes, um, sometimes we have patients and we admit them and, and they live a few days. Sometimes we have patients and you know, we admit them and they live a year and you know, they, they kind of stabilize and then, you know, we, we have to discharge them for extended prognosis because they're, they're not declining and they no longer meet the criteria for hospice care. Right. So, um, hospice care is not, um, does not mean that your loved one is going to pass away very quickly. It just depends on how they're doing. Actually, studies have shown that people,

Brian Frantz: um,

Shahruz Skulshani: tend to live longer when they're on hospice care compared to curative care if they're, if they're at end stage, um, because their needs are being met and their symptoms are being managed and you know, uh, out of control pain or shortness of breath is no longer, you know, taxing the body because it's being addressed. Right.

Brian Frantz: Yeah. I love it. And Uh, I think you kind of hit it there. 1. One of them, when I. That I was thinking, right, it doesn't mean you're giving up. Right. It's not right about giving up.

Shahruz Skulshani: Maybe, uh, it's. It's a reframing. Right. So, um, you know, unfortunately, um, you know, when your loved one gets to the point that the, um, curative care that they have available to them is no longer working. Right. Um. Um, this is. So, unfortunately, families have to come to terms with the fact that their loved one is declining and will. Will pass away. You know, I went through the same thing a few years ago with my father. You know, it was hard for our family. My mom had a very hard time with it. Um, but part of coming onto hospice and. And the hospice team, you know, doing what they do is helping families kind of come to acceptance that, you know, curative care is not working. But, um, so it's a shift from wanting a cure to perhaps, you know, making a commitment that you're gonna make the most of the time that you have left. Yeah. You know, so it's a reframing, right. Um, from seeking a cure to. To really focusing on quality of life, focusing on, um, um, addressing, you know, life closure issues, m. Um, mending, you know, um, relationships, um, telling your loved ones how much you love them, you know, um, saying sorry if you need to, or allowing them to say, uh, you know, sorry. Um, basically kind of, if possible, you know, to wrapping life up in a. In a.

Brian Frantz: In a.

Shahruz Skulshani: In a positive, healthy way. Uh, so. So it's not. It's. It's not giving up, and it's. It's just a different. It's a different undertaking. You know, rather than. Rather than trying to cure illness, you're.

Brian Frantz: You're.

Shahruz Skulshani: You're. You're working on a positive life closure.

Brian Frantz: Yeah. Yeah. Um, I think that can really help families, uh, feel maybe less afraid to ask questions earlier.

Narrator: Um,

Brian Frantz: what do you think of.

Shahruz Skulshani: It's very difficult. It's difficult for families. Uh, it was difficult for my family. Um, if. If it. It is easier if the physicians that.

Narrator: Are.

Shahruz Skulshani: The specialists that are taking care of your loved one, um, are. Are good communicators and give the family the time that they need to understand really, what is happening with their loved ones and, you know, what their prognosis is and if there are any treatment options, what the likelihood of success of those treatment options are. You know, so if families have all of this information and it's explained to them, um, and they can make a decision with open Eyes. It's easier. Oftentimes, you know, families are in this state of kind of haze and confusion and there's different family members involved in the decision making. And um, they don't have, you know, the full information or they don't understand really what's going on with their loved one. And there's also denial and pain and trauma, you know, kind of mixed into there. So it. It just becomes very difficult.

Narrator: Yeah.

Brian Frantz: Might be getting mixed messages and.

Shahruz Skulshani: Yeah.

Brian Frantz: You know, some might be closer to the family, a member of the family or, you know, maybe a little farther away and still wanting to hang on.

Shahruz Skulshani: Uh, when.

Brian Frantz: When do you make.

Shahruz Skulshani: They might be getting mixed messages even from the. The medical community. Exactly. You know, where. Where maybe the hospitalist at the hospital is telling them one thing and then, you know, their. Their specialist is telling them another thing and their PCP is maybe saying another thing and you know, a patient is declining and has. Needs would really benefit from hospice, but they don't want to make the wrong decision, understandably. Um, and you know, they. They will sometimes. Families will sometimes, you know, pursue curative, ah, Care, um, you know,

Brian Frantz: uh, for

Shahruz Skulshani: a while and until it's, you know, it's obvious that um, really it's not working and the. That hospice care would be a better option. But, uh, sometimes at that point, you know, there's not a lot of time left.

Brian Frantz: Right.

Shahruz Skulshani: Unfortunately, yeah.

Brian Frantz: When do you think a family should start asking questions about hospice? Even if they're, you know, not. Not sure they're ready?

Shahruz Skulshani: Yeah. I mean, if

Brian Frantz: the.

Shahruz Skulshani: I feel like for families the best time to talk about hospice and even the best time to talk about, um, decision making, like advanced care planning. Right. Um, you know, the, the idea of talking about like, whoa, if you end up in a situation where you can't make decisions for yourself, um, who do you want to step in and make those decisions for you? You know, assigning an agent or if you're in a. If you're in a position where, um, you need, you know, artificial respiration. Is that something that you want? You know, et cetera. Right. Um, the best time to make these decisions and to think about these issues is when they're not really imminent. You know, like, so the sooner the better. Like I say that families should engage in advanced care planning with, um, maybe an attorney or maybe with someone in their, you know, doctor's office or with their medical group, um, as soon as possible. You know, if you have an elderly m. Parent, you know, you. You should encourage them to, um, to. To undertake this type of work and to have a plan. You know, a lot of times seniors, for example, are living by themselves, uh, or maybe there's a senior couple and you know, one of them passes away and then the, the remaining remaining family member is still living by themselves sometimes for many years. And, and that's what they want and that's wonderful. Right. But families should still be thinking about what, what happens if mom can no longer safely live by herself. They should have some type of plan, um, think through these issues rather than have to deal with it when you know, she has a fall, for example, and ends up in the emergency room and is admitted and then the case managers, uh, ah, at the hospital don't feel comfortable discharging her back to her home because there isn't a full time caregiver and the family can't afford a full time caregiver. They haven't thought about it, they haven't planned for it and you know, they don't know whether she should, they should, you know, she can live with one of the, you know, the siblings, etc. So when, when you say when is the best time to think about hospice, I, where my mind goes is even before hospice. You know, like advanced care planning is a very important thing, um, and life planning is a very important thing and families that do it tend to have an easier time and that families that, that put it off, um, end up kind of in this, you know, crisis situation with the, you know, having difficult conversations with the case manager at the hospital about, you know, where's mom going to go. Um, but I think that for, for medical professionals it's good to talk about hospice care and introduce hospice care. If they feel like a patient has a prognosis of one year or less to just bring it up, they're not appropriate for hospice at that point. They should not go on hospice at that point. But it doesn't hurt for them to know about it, what it is, what it includes, what the choice involves. Uh, I think it's best to, to uh, to educate people and for people to learn about things when they don't need to make that decision right at that moment. You know, so they can kind of like live with it a little bit and it can kind of sink in and you know, they can talk about it with different family members or maybe maybe an attorney or maybe uh, their, their primary care physician and you know, kind of process these issues in a slow and deliberate way.

Brian Frantz: Give them time to digest it. Right. I think exactly. You know, let's not wait until there's a crisis and. Exactly. And now you're overwhelmed and uh, yeah, I love that. Um, let me ask you this. Do families need a doctor's order before calling hospice, you know, to learn more, ask questions?

Shahruz Skulshani: No. Families can call us, you know, anytime and talk to us and we're happy to come and visit with them and you know, talk about hospice care, um, or talk about it with them over the phone and answer their questions. Um, once. Um, if, if we feel like their loved one is appropriate for hospice or you know, and they want to start hospice care, then at that point we do need an order. So we would reach out to their primary care physician or a specialist that they're working with and, and ask for an order and explain the situation. Um, if, if there's a situation where there's no doctors, the patient hasn't um, hasn't seen a doctor for years, there's no one, you know, taking care of that, that, that patient, et cetera. Uh, we do have the ability of sending our own doctor for, for a hospice evaluation. Uh, and they can, they can write an order, but we would prefer not to do that.

Brian Frantz: Yeah.

Shahruz Skulshani: Yeah, gotcha.

Brian Frantz: I think that's important for, for families to understand. Right. I think it's not. Uh, that first step doesn't mean commitment. Right. It's just information. Just kidding. Yeah, exactly.

Shahruz Skulshani: I look m m. The way I look at it is hospice is not for everyone. Right. Hospice is a very nice service for families that need it.

Narrator: Mhm.

Shahruz Skulshani: And families that want it. Right. And I think that um, it's very important that families understand what it is that you know, what it is and what they're getting and what they're giving up importantly so that they can go into it with open eyes and really, you know, benefit from what we have to offer. Which is again, you know, our hope for our, for our patients and our families is that they have a peaceful, um, hopefully positive life closure. Right. And that we've made a positive impact on that family and, and that patient and, and possibly on that family, you know, for years to come, uh, because of that experience. So you know, if, if, if a family doesn't, doesn't want it, it's ah, you know, they shouldn't go on it, you know, because all that's going to happen is as, as soon as that there's some type of change of condition, they're going to call 911 and they're going to be in the emergency room. But uh, but uh, you know, the, the decision to come on to hospice also Is not, does not have a, you know, a very rigid finality to it. Right. So a family can decide, you know, they want to come out of hospice, and then a week later, a month later, they could change their mind and they can go, go back to curative care if they decided that, you know what, this is not really for us.

Brian Frantz: Yeah, Yeah, I think that's important. Yeah, I love that. Uh, you know, and it's, it's not a contract. Right. They can, they can revoke that privilege. They could graduate. Right. They could come in, the team can come in, they can get cared for. And now that patient doesn't meet the criteria anymore. They're, they're stable and uh, yeah.

Shahruz Skulshani: If the patient is not actively declining. Yeah. And you know, they haven't had infections or falls, and there's no, really no reason for them to be on hospice, then, um, they should not be on hospice. You know, and Medicare has very, um, you know, strict guidelines about that.

Narrator: Yeah.

Brian Frantz: Once the family is ready to learn more, what's, uh, the next challenge, I guess maybe is knowing, like, who to choose or like what provider to choose. Right. What hospice provider?

Shahruz Skulshani: Uh, sure.

Brian Frantz: What should families look for in choosing a hospice provider?

Shahruz Skulshani: Well, um, Medicare has actually done a lot of work to help families choose providers. So, um, there's a website called Medicare Peer Compare and they can go on there and they can search for hospices in their area and they can see, you know, what hospices have high star ratings. Right. And the star ratings are, um, they come from, um, different data that Medicare collects. Whether it's patient care data or it's, um, you know, client satisfaction data that, that are, you know, the families that we've been taken care of, they get survey surveyed by a third party and then they turn these surveys in and they get uploaded to Medicare's, you know, databases, though they can check a hospice's star readings. I think that's a good, good place. Um, many people, you know, will ask for, um, you know, referrals from their primary care physician. Mhm. You know, etc. And I think that's fine. Although, you know, sometimes, uh, sometimes doctors are employed by hospices, you know, and you know, they feel obligated to refer all their patients, you know, to that hospice that they're employed with. And sometimes those hospices, they're not the best. So that's why I think it's still, you know, good for families to research and check the star ratings and also, uh, go on Yelp and check reviews and do your research, you know, call Call and ask a bunch of questions and see how, you know, how the interaction is going, how you, you know, how it feels.

Brian Frantz: Yeah, I think that's great advice.

Shahruz Skulshani: Yeah.

Brian Frantz: Many people might not realize, right. They actually have a choice in this and who provides their care.

Shahruz Skulshani: Yeah, yeah. If a patient has Medicare, they have total choice. Uh, if patient has medi cal and they're part of a managed medi cal plan, um, there may be like a more limited network of contracted hospices, but they still have a choice among those. Right. Um, and same with commercial insurance, you know, so, um, nobody should feel like, um, you know, they're. They're obligated to work with a particular hospice company because that's who they were referred to. You know, in fact, I would be very, um, you know, wary of that and recommend to people to check, you know, star ratings on the Medicare website and also to read reviews on. On Yelp and Google.

Brian Frantz: Love it. Uh, you mentioned, you know, that, you know, ask a bunch, asking a bunch of questions. They should. What, what are some questions that they, uh, should. They should be asking or looking for?

Shahruz Skulshani: That's, that's a great question. So, um, I think a one, one really important determinant of quality care is, you know, who's doing your case management. Is it RNs or is it LVNs? You know, like, for us, we only use RNs for case management and we use LVNs for unscheduled visits. Right. Um, that's an important factor also, you know, how long is it, you know, how long is it going to take you to get to me if I call you, um, call you in the middle of the night? You know, what's your response time? You know, um, let's see. What other questions. How often, how often are people going to come and visit? You know, what I described earlier where, you know, our staff is making four or five visits, four or five, sometimes six visits a week of, uh, 20, 20, 20 to 22 visits a month. That's for healing care hospice. You know, some hospices, they do less. They. Maybe they do the. They do the bare minimum. Maybe they don't have the staffing or, um, you know, the costs for something like that are too high. So really just dig into, dig into all the details.

Brian Frantz: Love it. Yeah. I think, you know, once family chooses the hospice, it's important for them to know they still have, you know, options and, and rights.

Shahruz Skulshani: Right.

Brian Frantz: So I think you mentioned it a little bit, A little bit, uh, just a minute ago, but a patient can revoke or, you know, their Privilege or uh, you know, choose another provider if needed. Right.

Shahruz Skulshani: Yeah. If, if um, you, your, you're on hospice care and you, you're not happy for whatever reason, you can, you can stop hospice care. That's called, that's called revoking hospice care. If you're not happy for your provider, you think it's not a good, good provider, you can transfer once, this is for Medicare. You can transfer once per benefit period to a different provider. And so, you know, you're not revoking, um, you're just transferring. But yeah, you know, Medicare uh, wants you to, wants you to be happy, wants you to receive good care. They're, they're certainly paying, spending a lot of money on hospice care and, and they expect as, as should all, you know, families that the care is good.

Brian Frantz: Yeah. Maybe we could talk a little bit about human care, uh, specifically. I think, you know, the provider a family chooses can really uh, shape their experience. So what, what do you believe makes Healing Care hospice different from other, other providers?

Shahruz Skulshani: Sure. So, uh, many things.

Narrator: Um,

Shahruz Skulshani: like one thing I can say is, um, families are typically dealing with their rn, right? Um, as I mentioned, the RN is working with the doctor to do symptom management, but the doctor is not, um, coming to the home, uh, typically. But ah, at Healing Care, if the family wants to talk to the doctor or if they want the doctor to come and visit, we can accommodate that. Right. And that can be very helpful for families that are, you know, worried that, you know, maybe hospice is not the right option. Maybe they, you know, they came out into hospice too soon. Um, and, and having a doctor come and, and, and um, you know, assess the patients again and to talk, talk them through their options can be very, very helpful. Um, also, um, a lot of the um, clinical care that I described earlier, um, is, is you know, unique to Healing Care. Um, I, you know, there may be some other large hospices that can do some of this stuff like IV hydration, IV antibiotics, artificial nutrition, hair synthesis, thoracentesis, heme pumps, et cetera. Um, but you know, we, I feel like we go above and beyond, you know, to accommodate, um, patient and family's clinical requests when, when appropriate. Uh, also, uh, Healing Care has a long tradition of um, you know, focusing on the Latino community and, and you know, a great, a majority of our staff are Spanish speaking. Right. And it's, and if the family wants an intact, an all Spanish speaking team, um, we can accommodate that. You know, so from, from the clinical liaison that comes and meets with the family and, and explains hospice Care and describes hospice care and they sign up for hospice care to um, their RN case manager, their social worker, their chaplain, their aide can be all Spanish speaking.

Brian Frantz: Yeah. Awesome.

Shahruz Skulshani: Uh, yeah, also, um, we also for patients that are with Optum, um, we do ah, palliative care. So ah, um, we participate in a palliative care program with Optum Health. And uh, so that's kind of like a pre hospice option. Um, you know, we have a, um, a lot of patients that we work with with Optum. So um, that's also a unique thing that you know, we're sending a nurse practitioner or a doctor once, once or twice a month, um, to, to basically make sure that you know, patients are okay. Their, their, their needs are being met, they're staying compliant with their care plans, but it's not hospice. They can still go and get care from any specialists that they uh, that they're working with.

Brian Frantz: Right. Awesome. Yeah, I think hospice, uh, care requires you know, a lot of compassion and uh, I think, you know, it also requires systems and communication and accountability.

Shahruz Skulshani: Absolutely.

Brian Frantz: How do you balance compassion and, or with like high standards and accountability?

Shahruz Skulshani: Yeah, that's a great question, Brian. Um, I'm glad that you brought that up.

Brian Frantz: So

Shahruz Skulshani: we take great care in who we hire. Right. Um, it's very important for us to hire people that fit into our culture. And our culture is um, patient care first. Right. That's, that stands above all things, you know, kind of ah, family, family atmosphere, family environment, teamwork, uh, and also continuous, you know, learning, um, and development. Right. So, so it's very important that we hire the right people that, that have the requisite skills, but also the right mindset and attitude. You know, a service oriented attitude, uh, um, a caring attitude, compassionate. They have the right skills. And then we do a great deal of training. You know, ah, there's classroom training, there's one on one, one on one mentorship. Um, we have a skills lab, et cetera. So we're, we have um, a whole host of courses that we've created web based courses that, that our staff go through. So it's, it's a, it's ah, combination of you know, hiring and, and, and training and then, and then a culture that has very high standards. Um, you know, if, if we have um, nurses that aren't doing a good job, that aren't turning in their notes on time or, or you know, we're getting complaints from uh, families that you know, they're not very compassionate. They don't last. Yeah, you know, they don't last. It's just. It just we. We cannot fulfill our mission of, um, making a positive and lasting impact on patients and families. You know, if we don't have the right people, you know, showing up to people's houses and, you know, they have to be very, um, well trained and, and also I think very importantly, um, we try very hard not to put our staff in compromising, um, situations. Ethically compromising situations. So, um, we expect the highest ethical standards from them and we expect them to be good nurses and aides and social workers and chaplains, et cetera. And you know, in return, we provide them a platform where they can do the work that they were. They were trained to do, that they were meant to do. You know, and if, um, you know, we can find people that, you know, for whom this. This work is a calling, you know, all the better, you know, because, you know, those are. Those are the people that, that really do well, do well with families and do well at our company.

Brian Frantz: Yeah, I, I love that. I, ah, heard that. And so, like talking to so many different, uh, people in hospice, right. They all have that heart. They all have that, uh, that calling, uh, for this work. And I think the quality of the team. Right. Really affects the quality of the care and, uh, in the family's experience.

Shahruz Skulshani: Absolutely, absolutely. I, I always will describe it in this way when I'm, When I'm talking to new hires, you know, I say we're, we're trying to accomplish big things, you know, big, big spiritual things with families. You know, if we, if we do our work right, you know, maybe, um, families can mend, you know, broken relationships, you know, before. Because end of life is. Is a. Is a difficult thing. It's a sad thing. It's also a big opportunity because in. At the end of life, people's. People are open, you know, uh, you. You know, there are times when we're reaching out to family members, you know, that. That haven't spoken to their loved one in decades and say, well, you know, your brother's on hospice. You want to come in, um, you want to come and reconcile with him, you know, uh, because he's not going to be around for too long. And they come, you know, and, and you know, we, um. So. So end of life can be opportunity. And, and if we, if we do our job right, we can accomplish great things, important things, I believe for that family.

Brian Frantz: Yeah.

Shahruz Skulshani: Now that takes trust. You know, you have to earn family's trust. That takes, you know, you have to earn their respect. Um, there's. There's nothing that will destroy that trust in that respect more than a, uh, poor customer service.

Brian Frantz: Yeah.

Shahruz Skulshani: Right. So if a family calls you and says, you know, this, this wheelchair that you delivered, it doesn't work. Right. Can you replace it? Right. Simple thing, simple thing to do. You know, one call to our DME company and they can swap it out. Right. But if you mess that up, then the family is going to put their guard up. You know, they're not going to trust you, they're not going to respect you. Or maybe like they call you and say, family calls and says, we need a medication refill. Right. Perfectly reasonable request and necessary. And if you take too long to, to do that, then they're going to put their guard up, you know, they're not going to trust you. They're not going to respect you. So in order for the family to trust and respect us and allow us into their lives and, and allow us the possibility of helping them, you know, have a positive experience in hospice, positive life closure, maybe, you know, um, address some, you know, issues within the family, et cetera, at this time, we have to get the customer service aspect right? Because otherwise you cannot have that. You're not going to have that trust and respect.

Brian Frantz: And I know, uh, I, uh, possibly heard, you know, from, from many, many, many different people I've talked to, but it can be emotionally heavy. And how would, how do you support your, your staff and help them prevent burnout?

Shahruz Skulshani: That's a great question. So, because, you know, in hospice, um, it's very different from, let's say like, uh, the emergency room or the. Or you know, the, the hospital, you know, the med surg floor at the hospital, um, where, you know, those patients are short term and, and you know, the staff is, um, they care, they care very much, but they're not. The patient is not there so long to, you know, for, for them to really bond. Um, but in hospice care, you know, we encourage that bonding. You know, we encourage that connection. And it can be very difficult on staff when they lose patients that they spend a lot, long time caring for. And they built relationships with families. So, um, you know, we have a generous PTO policy, you know, and we encourage them to take time off and kind of replenish. Um, we have done things in the past where, you know, we've done support groups, you know, for the team. Uh, we, uh, we've done events around, you know, grief and loss. Um, you know, because like you said, it, you know, the burnout can be very real and it's, it's important for Us to keep, you know, keep the staff healthy.

Brian Frantz: Yeah. And I think, you know, supporting your staff. Right. That's going to translate into better care for the patients and families.

Shahruz Skulshani: Exactly.

Brian Frantz: Yeah. Yeah. As we start to wrap up, I wanted to bring. Bring this back to the families who may, uh, who may be listening, wondering what the next step should be. So what is one thing you wish every family knew or understood about hospice?

Shahruz Skulshani: That it's. It's okay to. To call and, you know, talk to us. Um, if. If. If they feel like their loved one is declining and, and you know, they may need hospice in the future, but not right now, it's okay to reach out to us and talk to us. You know, we're. We're happy to speak over the phone. We can, we can, um, you know, schedule, um, meetings. Meetings at the home and, you know, we can have just a. Kind of a educational session. Um, and just so that, again, families are informed, you know, they can. They can go into these decisions with their eyes open. And, you know, when they do eventually start hospice, they, you know, they can get something out of it. You know, they can get something really positive out of it. So I would say, um, you know, reach out to us. We're. We're happy to speak to you. Um, it's not. Again, I don't believe in trying to, like, sell families on. On hospice. I think hospice is a nice service. It's what we do. It's, um. But I don't think it's for everyone. I think it's for families that need it and it's for families that want it. You know, and when you have those two things, then, you know, families can really benefit from it. But, uh, again, you know, maybe my approach is a little bit different than others, but, um, I'm very big on, uh, information, you know, sharing information, education. Um, yeah. And a lot of times even, you know, when families reach out to us, uh, we give them information about hospice, but we also give them a lot of information about how, you know, uh, housing, um, you know, nursing homes and assisted livings and boarding cares and, you know, what, you know, their situation. So we can be very helpful, you know, prior to hospice also with some of that, some of that work.

Brian Frantz: Yeah, that's, ah, that's awesome. All that. That was sharing. Those are all important, ah, takeaways, especially for families who, you know, may be waiting because they're. They're scared. Uh, maybe. Maybe some are just, you know, unsure, not ready. But, you know, they don't want to make the wrong decision.

Shahruz Skulshani: Absolutely.

Narrator: What.

Brian Frantz: What advice would you give to a family that's wondering whether it's too soon to call hospice?

Shahruz Skulshani: It's very important that. That families understand what is happening with their loved one and what their options are. And if they're not getting that information from their specialists, then they need to ask for it. You know, like I'll give you an example. Um, patients that are. That are dealing with cancer. Right. It's a very difficult thing. Um, there's a lot of treatment options now for cancer. And, you know, doctors, oncologists, you know, are very easy, eager to.

Brian Frantz: To.

Shahruz Skulshani: To put patients on these treatment options because, you know, they want to extend their lives, they want to cure them if possible. Um, there have been, you know, tremendous breakthroughs, and all of that is wonderful. Right. But if. If you're sitting with your specialist and they're saying, okay, this. This treatment option didn't work, but we have another one for you that we want to try. Um, I think it's important to ask, you know, like, what are going to be the side effects? You know, what's the likelihood of success? And how long, you know, how long do you think I have left? And if the answer to the. To that question is the side effects are going to be severe, the likelihood of success is very, very low. And maybe you have, you know, two to four weeks left to live, then, you know, families may. May consider a different option, but they. They m. They might not be getting that information if they don't ask for it.

Brian Frantz: Yeah. How can families and caregivers, uh, referral partners, how can they learn more about healing care hospice?

Shahruz Skulshani: Um, they can go to our website. You know, uh, we have a website, healing carehospice.com. there's a lot of information on there. And they can call us and, you know, you know, talk to. Talk to one of our team members. If they have questions, we're, uh, happy to talk to them. Um, I like to, you know, point people to Medicare care, compare, and they can, you know, look at our metrics, you know, objective metrics, and. And also I'm on. They can read our reviews on Yelp and see what, you know, families have been saying about us, that, you know, that. That we've taken care of their loved ones, how they, you know, how they speak about us. So, um, any of those. Any of those avenues would be okay, awesome.

Brian Frantz: And promise we'll share that in the show notes and, uh, so make it easy for them. Uh, Shirouz, thank you for joining us today.

Shahruz Skulshani: Thank you, Brian. I appreciate it. I Enjoyed the conversation.

Brian Frantz: Yeah. Awesome. I think one of the biggest takeaways from this conversation is hospice is not giving up. It's not about giving up. Uh, it's about comfort, right, dignity, support and helping, uh, families. Um, so thank you again.

Shahruz Skulshani: I, I just, I'll just end by saying, um, you know, my hope for families is that they, they have all of the information that, that they need to make to make the decisions that they need to make. Right? So if, if the medical community is, is providing that, then great. Uh, if, if, if it's not, then they have to get it so that they can make decisions that they're comfortable with. And, and you know, these are the situations where I feel like we can provide the most benefit. Where um, you know, families are again, their loved one is appropriate for hospice and the family wants hospice because they understand that the curative path is, you know, is no longer a great option for them. And then now they're looking at a more palliative approach. So, um, my, my last takeaway is just, I encourage families to get the information that they need from their, you know, from their, from their physician, from their specialists, from the health system that they're, that they're working with so that they can make the best decisions and that we're, you know, we're happy. We're here to help. We're and happy to help.

Brian Frantz: Love it. Thank you again Charuth and the team at Healing Care Hospice. And thank you for listening to the voice of Hospice.

Narrator: If you're looking to attract more families and share your hospice mission with a Wider community, visit hospicecaremarketing.com schedule to schedule your free consultation with marketing expert and founder Brian France. Plus, join our free hospice marketing mastermind group on LinkedIn to connect with other practice leaders and stay up to date with the latest strategies. If you enjoyed this episode, please take a moment to leave us a five star review. We'd love to hear from you.