Hospice Isn’t For Sale: How Education and Community Build Trust with Jaime Wasden-Ryum

Speaker A: 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 France.

Speaker B: All right, welcome to the Voices of Hospice Leadership Podcast. Today I'm joined by, uh, Jamie, founder of, ah, Mountain View Hospice in Arizona. Jamie has a background in ER and trauma, and today she's focused in hospice care and community education and dementia friendly initiatives and helping families better understand what happens before and during hospice. So, Jamie, welcome to the podcast.

Speaker A: Thank you so much. I'm so excited to be able to really just let the world know so many of, uh, these great initiatives. Awesome.

Speaker B: Uh, let's start with your background. So how did your experience in ER and nursing eventually lead you to hospice care and then starting Mountain View Hospice?

Speaker A: Yeah, absolutely. So, you know, I really was a trauma junkie. I just have to say that, um, I loved the emergency room trauma. I did flight, all of those kinds of things. Uh, one of the emergency rooms I worked in is in Sun City, in Sun City West. And so we did get a lot of geriatric patients. And I think that's really where it started. It's really that light bulb moment of we, uh, are sometimes trying a little bit too hard for people who just can't accept, um, that this is the end. And sometimes that sounds hard, sometimes that sounds harsh. But, uh, one phrase that you'll hear me say a lot is, unfortunately, one thing is absolutely known across the world, that death is inevitable. And so we want to make sure that we have the best journey for that. So that's really where I started realizing that maybe people needed a little bit different education and that we shouldn't be afraid of the word death. Uh, you know, that shouldn't frighten all of us, that we should really talk about that a little bit more openly and normalize the word death. Uh, so within the emergency room, I got to do so many things and saw so many things. Um, then I got to kind of move myself up in the ranks and I became, you know, directors of departments and those kinds of things. But ultimately it really led me back to a homegrown hospice where I wanted to go into people's homes and I wanted to talk to them and be real with them, ah, and let them know what that really looked like, how we can help them educate that and how to really, and I'll never say accept death. Uh, I'll never say that, but try to normalize it just a little bit and try to have a better conversation surrounding it. And that's where I just absolutely fell in love with hospice, is being able to do those kinds of things. So working in hospice, I realized that, and then I realized I wanted to take it one step further and kind of really do that. More of an education basis and a resource to people. So that's when myself, uh, and a partner went ahead and opened up Mountain View Hospice. Awesome.

Speaker B: Uh, I think that background gives you a, uh, unique perspective. Right. You see patients and families at, uh, all different levels of stages of care.

Speaker A: Yes.

Speaker B: One of the concepts you shared, uh, you shared with me stood out. And that's something you call the new norm. When you talk about the new norm, what do you mean when a senior comes home after, uh, a hospital stay or a rehab or a, uh, skilled nursing stay?

Speaker A: Yeah, I mean, that new norm. I think that's something I didn't even realize being a nurse over 20 years before getting into this is, uh. What does that mean? So, so many times we have our loved one who's aging, who had some kind of event that caused them to go to the hospital. They were in the hospital a week, maybe two weeks after that, they ended up in a rehab for maybe, you know, 23 days, whatever that looks like. And then they're being discharged. Either they're being discharged from rehab, or they're being discharged from a long hospital stay. And everybody's ready for that loved one to come back and resume as normal because they've been discharged. And even though they know they had this event, coming back home means what it was. And so that's the hardest thing is they'll discharge people that can't walk. They will absolutely discharge people who can't maneuver around like they once did. And that doesn't mean it's a fault on health care or the hospital or rehab. It just means that's that new norm for that person, their new normal, and we have to adapt to it. We have so many families who are like, I'm in here every single day. I see what's going on. I can do this. At home. They don't get to see sometimes the late nights, the medications that are being used to help the person stay under control. If they're having sundowning or any of those kinds of things. They don't realize that, uh, now going back home, even though that's been their home for years, that is still now technically a new environment because they've been gone for months, weeks to months. And so getting up in the middle of the night, feeling agitated, having to kind of do it all on your own or where there's not somebody you can call and ring a bell and get the meal, those kinds of things. So the new norm is hard. People go home, and within 48 hours, they're kind of getting back into the hospital because they weren't fully prepared. And so that's the piece that I love to do is really go and talk about what that new norm looks like or could look like.

Speaker B: Right. Yeah. Ah, I think that's an important distinction because, you know, families hear the word discharge and assume everything's going back to the way it was before.

Speaker A: Right.

Speaker B: But that, you know, coming home doesn't necessarily mean returning to the. That previous baseline and so.

Speaker A: Baseline, Absolutely, yes.

Speaker B: What are some of the biggest things families overlook, uh, during those first 24 and 48 hours after, uh, their loved one comes home?

Speaker A: Yeah. I think the top ones that we see the most are unsteadiness and the floor. So sometimes that sounds silly. A hospital floor is very, very flat, and it's. There's nothing in the way, you know. And at home, they may have a different, different type of flooring, even though you think it's flat. Uh, a wood flooring might catch on shoes or bare feet differently than tile flooring, than carpeting, than linoleum. And so the flooring itself, um, can really give way to different things. Also, rugs on the floor, you know, throw rugs, uh, pets, uh, cords, not having it all tied up. Nighttime, um, I think we see a lot early morning and late night. So all of a sudden at 2am they're having to get up and use the restroom. Well, at the hospital, maybe they got up on their own, but a lot of times they have a call bell. But even if they got up on their own, again, it's one direct area that they have been able to go to. And at home, that's not always the case. Sometimes they're getting around a bedside table, they're moving aside the chair, maybe the clothes or the basket's there. Um, the toilet's seated differently. You know, in the hospital, we have a lot of things that are ADA compliant. At home we don't. So sometimes those are those things. And also just eating and drinking differently, not remembering how much to intake and, and how much you actually need and your body needs.

Speaker B: Right. Yeah. Those examples like the carpeting and bed rails, just getting, just getting around the home. Right. And those can. Those you Know, seemingly small things like, or, uh, how can they become major safety issues?

Speaker A: You know, one thing that we find that becomes a safety issue, and I giggle, not because it's funny, but, uh, family, they can become a safety issue. You know, either it's the wife or the husband or the adult child hovering and thinking they need to help, and they're helping a little bit too much. And that actually gets in the way. One foot's in the way, then they trip over that foot. Uh, or they're trying to hold them up a little bit differently. And that's not their steadiness. They need something different. Um, and so family can be a big, big safety issue as well. One starts to lose its balance, the other one's pulling them down, then everybody's on the floor. Um, and so that's never what we want. So we always want to talk about. You don't want to rely on someone, you know, someone family member shouldn't be who you're relying on for steadiness and gait and walking.

Speaker B: Right. And there's another part of this that families, uh, may not see, you know, at all because most of their visits happen during the daytime. So why is it so important for families to understand what may be happening at night before their, their loved one comes home?

Speaker A: Yeah, I think that, you know, sometimes they assume, you know, which is okay, but assuming never, always will get us to the right location or the right assumption. So when you assume they sleep through the night, then you're assuming you can sleep through the night. But if they're tossing and turning, if they're coughing a lot, if they're having difficulties, that means you're up, you're not getting the sleep, and then everyone's exhausted. Um, you know, at. Some folks will also have sundowning. You know, if they have any kind of mild cognitive impairment, um, sundowning is a big deal. You know, they can say, well, they never had it before. Now all of a sudden they do. That can happen. It can happen. Sometimes it can be a light switch that will change that. And so being able to be prepared at 5 o', clock, when they're, they' getting upset, they're getting, you know, antsy, they're having some problems. All of a sudden, mom doesn't know how to handle dad anymore. Uh, but I think that the nighttime is one of the scariest times. Uh, as you mentioned, bed rails, you know, when you're rolling over, sometimes you don't realize that little bed rail might just nudge you and it keeps you over. But at home, all of a sudden you're rolling over and you're face planting into the nightstand or off the bed. Um, and that's dangerous. It's very dangerous. So we always want to pay attention. I love to say the first 48 hours of someone being home, it is so imperative to really bring in extra help. Um, especially that nighttime, just having someone there in home, non medical care, um, can do that. And I think that's so important because the hospital readmission rates, we need to stop them. You know, people don't get better all the time in the hospital when they're going back and forth so much. And we need to try to help stop that. And the best way to stop it is safety.

Speaker B: Love it. And, uh, is that one of the reasons you may recommend having that extra caregiver support during those first couple nights?

Speaker A: Yes, absolutely. I mean, that's, you know, it's so funny because I don't own the. I don't own a company that does that. I don't get anything for companies that do that. But I am truly a proponent for it because we see truly the difference when we bring patients home or we see that patients go home and they have care and they don't have care. We see a vast difference, not only for that person, but also the family. The family is not as exhausted, as frustrated, as lost. You know, a discharge paperwork only tells you so much. You can retain what someone's telling you and you get home and then you're living it. It's a whole different story at 2:00am um, yeah.

Speaker B: And now you have a family at home trying to figure all this out. And they may have discharge paperwork, medications, uh, home health referrals, equipment, and several people telling them what to do.

Speaker A: And we make it sound simple. We make it sound so simple. Like home health will do this. You contact this person, this person will contact you. Everything's great. And here it is with a bow. You make it sound so simple. But sometimes what we forget is caregivers loved ones are already tapped out. They're already having that little bit of frustration of like, how am I going to do this? I'm gonna do it, but how? And then we're adding all of these directives on top of it. It's a lot to navigate.

Speaker B: Yeah, definitely. And that's where maybe having someone connect these dots becomes valuable. Mountain View has a, uh, program for this you call Resource. Can you tell us a little bit about what Resource is and why you created it?

Speaker A: Yeah, absolutely. So Resource is truly that, you know, so many Times when people get home, they sit down, they have their first night at home, and they say, holy crow, what am I going to do? I'm in over my head. And it's just, it's. Honestly, I think we hear so many times people are just frustrated that they were discharged. And then you start hearing like they had to have let him out way too early. There's no way they should have discharged my loved one. And they should have probably. But we didn't do a good due diligence of creating, uh, that resource. And so what we do is we go in, sometimes it's a nurse, sometimes it's a social worker, sometimes we go in together, we really create a, uh, plan for that person. Not every resource is the same. So when we go in, we might find out this person is having difficulties at night. Let's bring in non medical in home care to help navigate these next couple of nights to see what is going on. Are they just adjusting to being home or is this a new norm? Sometimes we are reaching out to, um, care management, where care management can get them all of these appointments. Because sometimes you're discharged and you then have 11 appointments to schedule to get to the different specialists, the different blood work, the different checks of X rays of those kinds of things. It is a lot. And sometimes when I say that people think I'm being excessive with 11, honest to goodness, that's sometimes what it is. If you think of cardiology and then a kidney doctor, and then if you have to have a neurologist appointment and then your blood work appointment and then checking with the doctor who released you, I mean, it can go on and on. So a care manager is also a fantastic person who really puts all of the puzzle pieces together. So we would connect them to a care manager. Uh, sometimes it's regards to home health. You know, home health is usually, uh, started as an order from the hospital, has to be started, um, but they only have a couple of days to get it going. And sometimes family kind of sits back and waits. And so we really get involved early to push the needle on that, to make sure it's happening and what's going on. Because if you miss that deadline, then you have to get a whole new order and you're having to jump through a couple more hoops, which just creates more frustration. Um, and so the list goes on and on of the different types of things that we would try to listen to to find out what we can do to help navigate that. Sometimes it's connecting them with VA services, sometimes it's connecting them with specific type of equipment dme different equipment. Instead of having them go and buy everything, let's find the lending closet out, you know, in their area that they can borrow it for the time. So I think that's really what resource is about. Resource is, uh, a friend that comes in, holds your hand for a little bit, connects the dots. I always say we're the yellow pages, um, and we really just get people, the right people in their pathway.

Speaker B: Yeah. You're helping families solve some problems. Right. And what I find interesting about resources that, ah, someone may m m not even be ready for hospice at all. Um, you may simply be helping that family navigate what comes next. And that, uh, seems to connect with the bigger philosophy you have, uh, about serving the community. Why invest time and resources in helping people who may not need hospice right now or six months from now, year, perhaps ever.

Speaker A: Right. And, you know, and I think sometimes we get looked at like that so much, and I think the biggest thing that rests on my heart is it's truly the giver's game. We are good stewards of our community, no matter what that looks like. If they have called us or crossed our path, how can we help? They may never need hospice. They may never come across that path. But you don't know who they know, you know? So I think if you're just a good steward in your community and you're a good person, that in my. In my book, it'll always come back to you. Um, but more than that, it's. It's really about you. You want to reduce the frustration when you see someone in a grocery store. And I'll tell this story very quickly. Uh, one time I saw someone in a grocery store, and she just couldn't reach a can. Very, very simple. She couldn't reach a can. So I had My son, who's 6 5, I said, hey, reach that can. And grabbed that for her. And she was so flustered at, uh, us, uh, assisting her to get this can. And I was like, oh, man, I'm so sorry. That's not what the intent was. And then I just took one minute and asked her, are you okay? And she wasn't. She's like, I've been sent home. I have this sack of paperwork. They tell me the medications are here, they're not here. The list went on and on and on. And she was just releasing. She had no clue what my background was. She had no idea anything. Uh, I was in flipp flops and shorts. And, uh, you know, she just really Released. And I was able to just take a second and say, would you be okay having me come to your home and really sitting down and finding out with all the paperwork, going through this and finding out how we can help the best? And, you know, I will just say I was able to do that. And two years later, I still talk to that couple. They, They've not needed hospice. They don't need us. Uh, but man, oh, man, would they have. And that's where also my question goes. If we don't intervene and we don't try to help, I think people can then unfortunately sit at home and get worse because there's. They don't want to go back to the hospital. I just don't even deal with that anymore. They discharge me like this. And that's not what we want. We want to make sure that people can live as long as possible as independently as possible. And that's on us to be able to help provide those resources so they

Speaker B: can love that and that Givers gain philosophy, love that as well. Um, that community first approach also shows up in another area. You're passionate about those dementia, uh, friendly communities. So why is it important to educate not only families, but I think you mentioned restaurants and businesses and other organizations in the, uh, in the. In the community of act. Dementia.

Speaker A: Yes, absolutely. You know, when you say passion boy, I don't know what words right above that, but that's where it is for me. Um, so I am part of dementia friendly Arizona. So we run memory cafes. I get to be a part of three of them out here in Arizona. There's many of them. Um, but I get to be a part of three of them in the west side. And I can tell you what, you know, dementia memory cafes are one of the best ideas. Whoever created it wasn't me. Um, but it is one of the best ideas. And the idea behind it is simply the cafe itself is to be able to bring the caregiver, loved one, and, uh, the person living with dementia together one day. And they get to be around all other people who are also dealing with this and having this journey. And they get to see they're not alone. They get to see how other people handle different situations. Not all dementias are the same. Not every person with dementia acts the same or does the same things, but they're able to see that they're not alone in their feelings. They're not alone in their frustrations. They're not alone in their guilt. You know, so many times we hear people in support groups say, I love Them so much. I am struggling so much. And two things can be true at the same time. They can love them so, so much and be so, so frustrated and struggling, you know, and we love to give that space. But along with, um, the Buckeye, uh, area for dementia friendly, we go out to businesses, libraries, gas stations, restaurants, and we try to train all the different entities out there. And the main reason is they are going to come across these folks out there. This is these people's, you know, area. This is their community. And they want to go out to restaurants still. They want to be able to go to the library, they want to go to the post office. And sometimes the looks or the, um. I guess I would say not understanding of what's going on can really deter them. And that really can create more isolation. And so we're trying to avoid that. We're trying to really allow them to get out there. So sometimes let's just take an ice cream shop that's out there. Um, you know, I went and I did a really fun training. It was young kids, you know, not too young, but teenagers, uh, teen, uh, kids that all work there. And I gave a little dementia training to understand what dementia is and some of the things that they possibly could see and come across. All of a sudden, this one boy is like, that's the problem. I was like, oh, no, what's the problem? And he's like, we have the. The set of sisters that come in here all the time, and there's a little frozen yogurt shop, and they put toppings on, and then you have to go weigh it. And he said, they go through the line and they always, you know, weigh. And then the one sister sits down, she starts eating the toppings, and she always tries to come back, get more. And I have to tell her, you can't do that. And he says, well, the sister tells me, well, she. She has, you know, dementia. And he's like, but I didn't understand. But I keep yelling at her to tell her, don't get more toppings. You know, and the owner's like, don't yell at her. Don't yell at her. It's okay, you know, but it's bringing awareness and really bridging that intergenerational gap to let people know that, uh, you know, the number one thing we hear is like, you don't look like you have dementia. I don't know what that looks like. You know, what does that look like? So many times people think it's, you forget things or, I can't Name your name. That might be Alzheimer's, but dementia overarching has so many things within there. And so that's something that we really like to just bring out to the public and let them know. You know, in hoas, if you're at the mailbox and you see someone who looks a little bit lost, let's stop, let's talk, let's ask questions. Um, out here, we've had it way too many times where the person living with dementia gets in a car they haven't driven in years and ends up in California. Many times that seems to be the route people go here. Uh, and you even see that they had to stop at a gas station and go in. You know, one particular case that she had gone in, and she was so confused on what she needed to do. She needed to get gas, and she was really flustered. And the gas attendant's like, I'll come help you. That's fine. Gas her up and let her head on, on her way. You know, if we would have just stopped to think about some of those kinds of things, maybe, just maybe, we could have avoided some of that. And so that's why we get out there. That's why we want to educate the public who maybe don't have the education behind it or even knowledge of what that means.

Speaker B: Um, that's beautiful. And what, what have you seen, uh, what have you seen people living with dementia, uh, gain from, from these gatherings?

Speaker A: So I would say the people living with dementia, what they can gain from it is sometimes understanding, because having dementia doesn't mean that you have no clue what's going on. Many of them do, you know, many of them still have a little bit of an understanding of what's going on. And so sometimes they're able to find different tips and tricks for themselves. Um, use, you know, they have different types of tools that we will put in the way. So if they grab something out of the oven, this tool is right there and they're like, oh, I'm going to use this instead of having it hidden away in a drawer. So we try to bring education to them as well if they're at that stage. But also during Memory Cafe, they get to do life enrichment. And so it's typically a stimulating activities. And I say that with plural because it's an hour long and we don't try to do one activity for a whole hour. Sometimes it's some, um, uh, fun recognition games that will play old commercial theme songs and you have to name that tune type kind of thing. And it's really neat to watch a family member say, I haven't heard my husband speak in months. And all of a sudden he's yelling out pink Panther. You know, to be able to see that different kind of a recognition in some people is really great. You know? Um, but also on the flip for the support, um, it's able to have those caregivers and loved ones smile and laugh again and find the good things. As a society, sometimes we get stuck on the wrong things and the bad things and the hard days more than the easy ones, the good ones and the happy ones. And so we try to create a space where they're able to feel the love again and feel like that person's loved one. Um, when a husband's made a flower bouquet in Life Enrichment and comes over to bring it to his wife, and you just see him beaming, and he leans in to kiss her and say, I love you. And she just. She's like, please record that. I need that. And so then she can watch that during those hard days. And so sometimes it's just those tools.

Speaker B: Love it. Yeah. Ah, the. The caregiver side. Right. Is just as important. And, um. Uh, you shared a story with me that I think shows why, uh, these groups matter. Um, you talked about a caregiver who admitted that there were moments when they wish their loved one would pass. Right. And instead of being judged, other caregivers said they have the same way.

Speaker A: Yes.

Speaker B: Do you think one of the most valuable parts of these groups is helping caregivers realize they're not alone?

Speaker A: I think so. I think that the number one thing is you start to isolate yourself. You start to. To judge yourself. You start to believe that you are wrong. How could I want someone not to be here that I love so much? Or how could I be grieving? We have people who say, all I do is, I'm so upset. I'm grieving the loss of my loved one. But he's right here. He's still here. But I can't get past the grief, you know? And it's being able to. To talk about it, number one. And it's not a therapy session. It's not a counseling session. They're not coming to tell me these things. And me telling them what they need to feel or do. What they're doing is they're finding community. They're finding other people who are on a journey, whether it's the same as theirs or similar. Never the same, similar to theirs or completely different. It's someone who can understand that every day is a Day that they don't know. Every day, you know, they say so many times, I'm going to wake up today and see what today even brings me. Because you just never know. Hour to hour, being able to say, my loved one puts all of the toilet paper in the toilet every single time she sees toilet paper. And another person saying, my mom did the same thing. I found this thing on Amazon. You can clip it on toilet paper. Let me send you the link. And then two months later, she's walking in, happy as could be. Like, I. I just. I. This worked. It worked. I can't believe it worked. I'm never frustrated about that anymore. Another funny one is, you know, he overfeeds our dog. Our vet says that our dog is going to be £100 for a little Shih Tzu here, and I need to make him stop feeding. He's obsessed with feeding the dog. And someone else saying, you know what? Uh, me too. But this is what I found. I found this, and it worked out perfect. And then for them to be able to say, oh, my gosh, thank you. That's a lifesaver. Toilet paper, dog food. I mean, is that a lifesaver? Yes, it is for them.

Speaker B: Yeah, it's powerful. And, uh, I want to shift from the dementia support into hospice itself because there. There are so many, I think, misconceptions, uh, about who hospice is actually, for you, you said something that I thought was powerful. And you're allowed to be walking, talking, very confident person, and still be on hospice.

Speaker A: Yes, Yes. I want to scream it from the mountaintop sometimes. Yes. You know, so many times I hear people who say, well, my mom's still walking and talking, so I guess we won't qualify. I mean, you know, we want to be able to really educate. And, you know, so many times people want to checklist. Like, what, uh, do I check off? So then how do I know when I contact hospice? And I would love to say there should never be a checkoff list, because let's just say one person has a heart condition that could, you know, possibly qualify them. Um, but another person has a heart condition that's not as bad, but that person also has a kidney problem, a, you know, a stomach problem, or this or that. This or that. And so we take the whole person and we look at the whole person to see what's going on. If someone is completely bedridden, not talking, hasn't eaten in days, you've missed the boat. On that whole care that hospice can do for you ahead of time. Yes. You can absolutely still contact hospice at that point and they will absolutely come in and help out and be such a blessing, I hope. But all of that beforehand stuff is really what hospice is about, helping keep them out of the hospital, out of ah, pain, controlling the symptoms. You know, there are criterias for hospice. There absolutely are strict regulations and guidelines for hospice. Um, but to have the conversation and to start talking to someone about what is hospice and what would it look like for your loved one is critical to do earlier than you think, right?

Speaker B: Yeah. You know, one thing that uh, that I always come back to, it's like, you know, a person can enter hospice and they could graduate, right? They could, they could uh, leave hospice. They could, they've come, you know, the care team has come in, they've been cared for and maybe they don't meet the criteria anymore. So they are not necessarily appropriate for hospice anymore. And so, yeah, that's not some of

Speaker A: the reasons we see that. So I'd love to talk about that just briefly. Um, but sometimes we see people who are leaving rehab or skilled nursing and did not thrive there. You know, some people thrive, some people do not. And it did not thrive there. And they thought, boy, we've just had this decline since they started here. Then that person gets home, they get surrounded with the things that they know and love. They start, you know, being able to do those kinds of things. And they get better, they feel better, they're able to do different things that bring them joy, brings them out of those kinds of things. And so sometimes those ones are discharged off it for what's called extended prognosis. So, you know, people love the word graduate. Absolutely. You know, so that's sometimes what we see. But we also sometimes see, uh, an elderly couple that lives together alone, no family really involved or around. And what, when we go in, um, the conditions are not as what we would want our loved ones to be in. And you know, we don't know is this a true decline, what does this look like? And so we kind of get involved to see what that looks like. We might help them. We don't place, but we might help them find a good placement where there's people who can take care of them, make sure that the meals are there, make sure that they're taking the medications as they should. Um, you know, sometimes as we get older, I say it all the time. For me, I never get my kids names right. I have to go through the whole list of them before I can get the right name. Um, but you know, sometimes they don't always remember which medicines to take or if they even ate that day. Um, but helping them with different resources, um, can then help them hopefully improve. Sometimes they come onto hospice because they have a true hospice diagnosis, but then they start to get better and they're not declining as they were. So. Yeah, absolutely. And, ah, you know, with that, I always say anybody who signs up for hospice, you didn't sign in blood. You know, you, if you choose in two weeks, 30 days, two months, whatever that looks like, that you want to go seek aggressive treatment or that you want to try again, or you don't want to be on hospice, you just let them know it's okay. There's nothing, there's no contract to say that you have to stay there.

Speaker B: Yeah, I love that. Yeah, that's, that's the other thing. Like they, they can revoke the privilege, uh, at, uh, any time, right?

Speaker A: Yes.

Speaker B: Yeah. Yeah. So, um, but, so why, why do you think so many families wait until the, the very end before considering hospice?

Speaker A: You know, I think, you know, a couple of things. Fear, you know, what are you afraid of? I'm afraid of that feeling of losing my loved one. It's kind of going back to normalizing death. You know, Um, I don't ever want to say that we should all be excited for it. You know, we don't want to be excited for our loved one to pass because it hurts. But I think that when you admit that someone, um, might need hospice, we have seen a lot of families think that if I say that my loved one will then give up and they'll just stop. And I can understand how that can be portrayed that way. And that's why I like to try to go in and just educate families, not just about hospice. I love to start from non medical and go through the whole gamut of different resources that are out there and really educate on, uh, each one of them bringing up hospice and bringing up what hospice really is. You know, it's amazing to me how many times I go to an evaluation for resource where they're like, we just want to know what else we can do here. And I start talking about everything from A to Z, I bring up hospice. I just kind of, usually I just kind of sprinkle it on there just to see how that's going to go. Um, and then, you know, we've had a handful of folks say, that's what I want to do. How come I can't do that? And the family's like, I didn't want to even say that word. You Know, and so sometimes it takes a stranger to come in and say the heavy words. You know, I can go in and I can say, I'm, um, I'm about to say something pretty heavy. I need everybody to be ready for this. If your heart stopped today, do you want us to do compressions to start your heart again? And when all the family shaking their head like, yes, say, yes, dad. Dad's like, no, I'm 92. I've lived a good life. You know? And those conversations are so important because then families not suck guessing what dad wants, but it's so hard to bring it up yourself to dad. So having a, uh, stranger come in and bring up those questions so family can hear. Dad doesn't want a feeding tube if he stops eating and drinking, which can be very normal. He doesn't want to go in and have these tubes placed in him for artificial food and being able to let the family hear that so there's no disagreements and that they know his wishes.

Speaker B: Yeah. Even once hospice begins, there can still be some confusion. Confusion around what hospice actually provides. You described it as supplemental care. What should families expect from their hospice team, and what should they understand, uh, about maybe what hospice does not provide?

Speaker A: Yeah, absolutely. I think this is always so key because just like, um, wonderful foods that are out there, marketing can kind of make you think it's something it shouldn't be, you know? And so that's a little bit about hospice. Medicare gets to be the boss of it all. They get to be the boss of it all, no matter what kind of insurance you have. Um, and hospice is considered supplemental care. And so what that means is hospice doesn't mean you go, take my loved one and here, go take her somewhere and take care of her. There are aspects to hospice that can do that for short periods of time. But hospice as a whole is supplemental care, meaning that each person gets a care plan. And so within that care plan, it will dictate the nurse needs to go once a week for this patient A or twice a week for patient B. A CNA will go twice a week. Uh, a chaplain will see patient A once a month. A chaplain might see patient B every two weeks. It's dependent upon what's going on with that person. And sometimes the things that get a little, little confused is when people feel like their loved one needs a lot of help. And what we have to remember is that hospice is the medical oversight for people. We are not the companion or adl, which is the activities of daily living. And so we have to kind of create two separate buckets for that. Activities of daily living are changing a brief toileting, um, dressing, feeding, um, making them comfortable. Hygiene care. That is activities of daily living. And that's that 24, 7 care that someone might need. Hospice is the medical oversight. And they're able to have a CNA come in twice a week for helping with hygiene. But the CNA is not an every single day person because that then compares to the activities of daily living. So that's that difference. Also, um, hospice doesn't cover where that person lives. So if that person needs to move into a place to be cared for, hospice doesn't cover the cost of that. Um, hospice itself, you know, there's lots of entities out there, but that's, uh, kind of what that looks like. So hospice is the supplemental care of medical, uh, oversight.

Speaker B: Yeah. And how, how important is it to set, set those expectations, uh, you know, at the beginning of care?

Speaker A: I think that's one of the biggest things that, you know, for my company, that's one of the biggest things that I want us to, right up front, find out what that family's expectation is and making sure that they understand hospice. So many times people say, yes, yes, my grandfather was on hospice. I understand exactly what you guys do. But do you, you know, and how long ago was that and what did that look like? Um, as I said, sometimes there's some amazing, you know, marketing ploys out there that people will say, hey, you will do this, this, this, and this for you if you come be our patient. But then unfortunately, if it's not a regulation, um, that can be dropped very quickly. So I think the number one thing I love people to know is, is the importance of what, uh, we do provide. You know, sometimes they want it written out like, will you come every day? I can't say yes and I can't say no. It really depends on what's going on. We are symptom management. So if there's a symptom going on that's not decline. Decline is anticipated. We anticipate decline. Symptom is infection, pain, anxiety, restlessness. You know, the list can go on and on, but it's a symptom. We make sure that we go more often for symptom management. So, you know, I never want to say this is what we do. Always. This is what we don't always do. It is a care plan per person. And that, uh, person, when they come on hospice, we create a care plan. And almost always by the time that person's no longer on hospice, that Care plan is changed 15, 20 times. Because when things change, the care plan changes, right?

Speaker B: Yeah. And the quality, uh, of that care obviously depends on the people providing it. And one thing that came through very clearly is how much you value education for your team. And so why is that education or that continuing education, uh, so important for say, the hospice nurses and other members of the care team?

Speaker A: I think in nursing school and any type of school that we've all been in medically, um, CNA doesn't matter. You're taught one thing about one type of diagnosis or disease process. And then all of a sudden we take care of people who have four, five or six different ones that are all meshed together. That's going to create a whole different need. And so making sure that we're educating constantly, whether that's about a disease process or whether that is about a, uh, caregiver, Caregiver burden, um, because that's just as important. Um, it could be about how to handle someone who, um, has a spiritual break and that they really just want to understand that a little bit more and what key words we need to hear to engage our spiritual coordinator. Um, also I think that, you know, just making sure that understanding what that person feels is so important. Um, family dynamics. Oh, family dynamics. You know, some family dynamics can just be. And education all in itself. And so every time something's coming up or something kind of maybe caught us off guard a little bit, you can bet we're doing an education on that, the next series, um, just to really be able to help manage that. You know, when there's lots and lots of folks involved, there's lots and lots of feelings and there's lots and lots of strong, um, personalities. So we're always trying to give the tools to our staff. And hospice is hard. Hospice is emotional. Hospice is very, um, taxing emotionally to the workers. Um, it's not just the person who's living with that, that disease or their caregiver, uh, us, uh, coming in and out of there and working with them. Ah, it is an emotional, you know, uh, hardship on us as well. Whether that be watching people that we get close to, um, that we lose them often, or whether that be a very, very difficult family that we just feel like we're not reaching education wise and that we're trying so hard to help them, um, have a good journey with this, but it's just not because they're not open to it. And how do we help open those doors? By giving our nurses the tools and giving them that space, Space to Learn a little bit different.

Speaker B: Want to finish by, uh, talking, talking about growth. Because your, your approach at, uh, Mountain View is different from what is often seen in hospice. Right? You told me my Mountain View hospice does, doesn't rely on traditional hospice marketers. Instead, you.

Speaker A: We have none.

Speaker B: Yeah, yeah, it's incredible. And instead, you've grown through community education, relationships, uh, reputation, resources, and the carrier team provides. So how did you or why did you choose that approach?

Speaker A: Yeah, I think that when we first started, just like anything, you're going to hear how different people do it. And as a nurse, when I'm listening to other people make promises, you know, a marketer make promises that as a nurse, I'm like, oh, no, no, no, don't say that. Don't, don't say that. We, that can give a false impression. Um, we really realized that marketing hospice isn't for sale. We shouldn't market hospice. We should educate on hospice. And so that's really the approach that we ended up taking, is that we don't want somebody to go out and try to sell hospice because it's not for sale. There's just no entity about it that should be for sale. And so instead what we do is, as you said, we do a lot of community education. We try to get out there and we try to educate on, um, the journey, not just hospice. And I think that's so critical that we're not just going out there and talking about hospice, we're going out there and talking about the journey, whether that be, you know, non medical care management, home health. You know, I really try to partner, partner myself up, uh, with these entities that are fantastic. I want to find the really good ones so that I can say they are great. This is who you need to contact. And hopefully when that person then does need me, they're going to say, ah, remember they gave you to us. And we want to be able to give that back. Um, or again, our staff goes out. So our staff provides great care. Um, and our CNAs are amazing. Our CNAs are so great. They just take the time and we give them the caseload that they're able to take the time to do nails. We call it spa day. They'll do the nails. How many women want the deepest of darkest red lipstick put on each week? It's crazy, but they do. And so we want to make sure that we have that time and they feel good. It doesn't matter if maybe they can't get out of bed anymore. When you hand them a mirror and they're Able to see their lips, and they're, you know, doing these kissy faces and feeling, ah, good, that's what it should be about. And then all of a sudden, another resident might see that, or a neighbor comes over, or someone from church is coming in and saying, oh, this is great. I would love this, you know, and that's how ours gets out there. Our name gets out there by other people. The, you know, referral basis that we have from our families is fantastic. We get so many returning families over and over again. You know, it's a sad state, but it is true, you know, that we are able to take care of so many family members because we did such great care. And same with churches, organizations, when they come in, you know, a pinnacle group. You know, we had a whole pinnacle group that we took care of a lot of the husbands there. Um, this group of ladies got together because they all had, um, ailing husbands. And it was interesting to see it was kind of one after another and that they really relied on us and they got to know us very well. They've come and donated a lot of items that other families can use. Um, and then having our staff just be real, you know, I. I think that's the biggest thing, too, is be very honest and be very real, um, with the best compassion ever. That's the. The best thing out there.

Speaker B: Yeah, I love that so much. Uh, today, uh, reputation doesn't only spread through word of mouth. Families are also going online, uh, before making decisions. Google Reviews have become a meaningful source of referrals for Mountain View Hospice. What have you learned about asking families for reviews and, uh, building that online reputation?

Speaker A: Yeah, I laugh. Only because when you say meaningful again, I'm gonna have to say what's above that, because Google Reviews is our number one referral source. Is our number one referral source. And it just, it outdoes it all, you know, And I think that whenever we were speaking last time, I went back and I looked and we had 101 Google, um, fines to us that called us for hospice. Um, and so that's. That's enormous. That's absolutely enormous. And so what we have found is, when is the best time to ask for a Google review? Uh, the last thing you want to do is have a loved one that passes and then go in and say, hey, I'm so sorry. Would you give us a Google review? That's never what we would do. We would not want that. And so what we have trained our staff to hear is when I go in as a nurse, I Say, I see that our CNA Brenda Jo was just here. How'd she do? Oh, my gosh, I love Brenda Jo. She is the best. You know, with my dad, she takes the time and she does this. I'm like, you know what? She would love if you do a Google review for her. I have a little QR code that's on the back of, uh, my binder. Could I help you do that? And she's like, yes, because I. I just love her. I love all of you. You guys have all done so great. Perfect, you know, so all of our staff wants to say, hey, I see that our chaplain was just here. How'd that go? You know, a. Then we're. We're able to nip something if, if it's needed to be. Well, you know, I. I don't know. I just didn't really connect. Okay, let's see what we can do. You know, and then we want to be able to connect that a little bit better before it becomes something. But mostly it's about them saying, oh, they are the best. I just. Everything about it, it just put me at such ease. Do you think you'd be willing to do that? You know, and they're like, yes, I would absolutely do that. You know, show me how. I don't know how to do that on here. You know, and sometimes we're able to help them walk through that. Um, but not only that, we make sure, especially for our folks that are here, they have so many family members, kids that live out of state, out of the country, too. And that what we do is we want to make sure, with permission, if anybody needs that we send an email after every visit, after every visit. They're getting used to it. They're knowing that, you know, uh, Brenda's going to be sending an email. I can't wait. See what silly thing mom did today. You know, what color. And she'll take pictures. What color her nails today. Um, did she put a kitty cat sticker on that finger like she really wanted to? Those kinds of things. And then we're able to kind of connect with that family and say, you know, how have things been going? We just always like to do a check in to see how things are. And they're like, I love it. You know, they are such great communicators. This, this, this. Would you mind doing a Google review for us? And so you're able to ask it when they're on that. I'll call it a high. When, when you've been able to trigger a good Emotion for them. Uh, they're able to then put that review in there. And we get so many people who call and say, I saw your Google reviews. I'm at the hospital right now. They said, my mom needs hospice. I wasn't going to just go with who they said, I googled good hospices. You guys came up with over 100 reviews, all, ah, five star. That's what we want. We want people to be able to see us and recognize us. Uh, not just that, but, you know, very specific, specific ways that you would create your website too. And I, I am not an expert in this, so I won't try to pretend to use the correct verbiage. Um, so if you're an it, uh, web designer, forgive this, but, you know, when you create a website, it looks different on your phone. And so you want to make sure whomever your person is knows that. Because the amount of people that we get that see everything we do on their phone, the numbers are staggeringly different. And so we want to make sure that we're capturing those kinds of things. And we do a lot of education on our website. I love writing, I love talking, if you can tell. But I love to really be able to educate. And so we do lots of blogs and so that education gets to be out there. They're searching. What do I do when my dad yells at me? I mean, how silly this is. But then they're able to be linked to one of our blog posts about sundowning, how that can come across as anger, what that looks like. And they're able to then be connected and then they see what we do and then they're linking us and calling us. And so I think that, you know, overall, uh, Google social media, I'll say it, uh, even TikTok, you know, some people might think I'm a little too old for TikTok, but even TikTok, um, has brought us referrals. You know, I teased the very first TikTok referral I got last year. Um, someone said, you know, I saw you on TikTok and I only want you to come. Well, I got a little nervous. I was like, I'm not sure, I don't know. I called my husband and he's like, well, if somebody saw you on Google, what would you say? Well, I would go. He said, what's the difference? I don't know. But I went. And, yeah, it worked. And we've had so many more from TikTok tok that, uh, it's just great. Again, it's just education it's being able to have a platform to say it's okay to be frustrated or your mom can still walk and talk and qualify for hospice, you know, and those kinds of things. So we love talking about those kinds of things. And I would say social media, Google, uh, reviews. You know, I can't speak to this because again, I'm not an expert, but I will say what we, uh, have done for years, every time our staff come to our office, uh, we have them use Google Maps every single time, type in our address, and Google Map yourself back to the office. And you know, someone somewhere somehow told me that really kind of helps with those kinds of things. And so who knows, you know, it might be a placebo, but we do it. And, uh, it seems to work. You know, again, I think that that really helps us with growth because every month we lose a handful of patients, and every month we're able to gain a handful of patients that see us online or through our Google reviews.

Speaker B: Yeah. Oh, my God. You just. There's so much brilliance and everything you just shared, uh, from the reviews, you, uh, spoke a lot just about paying attention to how your mobile website is like the mo. Like the viewing of your mobile, uh, or your website on mobile, how important that is. And obviously you thought about that a lot of your traffic, um, probably more than 50% of your traffic is going to be coming from a mobile phone. So, uh, yeah, there was, ah, I loved all of that. Thank you for sharing all that. Um, even when a family gets, say, a recommendation for hospice study from a doctor or facility, or do you still. Do you still see them going to Google and researching before making a decision?

Speaker A: Even my own friends, Absolutely. I just went yesterday to, uh, one of my girlfriends, um, her family and her grandmother needed some guidance, you know, I'll say that. Ah. And so I sat down with, with the whole section of them and they all let me know how they Googled us. You know, even my girlfriend, she says, I did. I went on and I looked and it just makes me proud. Good. You know, Good, good. You should. And I tell people a lot, especially if they don't know us and they're having a little bit of, like, I wasn't sure. Talk to a couple. Don't overwhelm yourself. Don't, don't go speaking to five, six, seven different hospices, but pick a couple that you feel like might. You might be drawn to. Go talk to two or three, have them come talk to you, ask them the same types of questions. It's so important, you know, um, and it, And I will say that I feel, um, we win those more than ever because they go back to those Google reviews. They go back to what people say. Our Google's reviews are not our employees saying, I love working here. You know, our Google reviews, our families, our community partners that see how we handle things, uh, you know, when they're having a. In home care and they can tell that hospice is needed and they call us in, they get to see how we handle the situation day in and day out, and the communication, not only that we give to that family, but also our community partner.

Speaker B: Love it. And like you mentioned, right. Google's not the only place families are finding. You mentioned something that I think may surprise some hospice owners out there. And, uh, people found you or found Mountain, um, view Hospice through TikTok. So what does that tell you about, you know, maybe how families are researching hospice today?

Speaker A: I think it really tells you a lot about how families want information. They don't want somebody to always hand them a booklet or a pamphlet. Um, you know, when they're looking at pamphlets, it's only words. And I'm not dismissing pamphlets. Please know that we have them. But, you know, pamphlets only go so far. And the great thing about the world is we all have such different personalities and we are all connected in different ways. You might really love reading. I don't. I like to really talk to people. I like to really feel people. And I think you can feel that, especially through social media, when you're able to see videos of people, when you're able to ask them questions, that you're not connecting yourself or your loved one into it. And sometimes we have the grandkids, even great grandkids, um, that are finding us on social media and sending it to their mom or their aunt and just being able to say, listen, what she said, it means it's okay, you know, let's just talk. Because it's. There's no commitment, just having a conversation. A conversation is very simple, you know, and so being able to just have that conversation and I so freely let people know. You can text me any question you have. Because sometimes just answering those, um, behind, you know, a, uh, screen can help people. You know, we always call them keyboard warriors. But sometimes being able to say it in the privacy of your own home in the dark, I'll call it doesn't, um, make it real. Um, it doesn't mean that you want that person to die. Um, sometimes it's just that start of the conversation. And so it's needed sometimes not Everybody knows how to express themselves or even understand what to feel. So I. I think that, you know, being able to allow families to hear and feel different things and then them be able to reach out instead of just being handed pamphlets of like, well, you should call people. Why? What? You mean my mom's gonna die? That's what they hear. They get handed a hospice pamphlet. You should call them. Oh, my gosh. What's going on? She looks okay. She looks okay, but her kidneys. Her kidneys are failing. So let's have that conversation now so we can talk about what to expect, you know, And I think that's the key thing. And being able to do this on video, uh, posting different things online, different educations via Facebook, LinkedIn, um, TikTok, the website, uh, all of those things, I think just reaches different demographics and then they're able to share amongst each other.

Speaker B: Yeah. When I look at everything we've talked about today, there seems to be, uh, one philosophy or, uh, connecting it all, I think. Education and resource, uh, docs, development reviews, social media, uh, and helping families even when there isn't an immediate need. Do you say your approach is really about being a good steward of the community first and trusting that growth follows from. From doing that?

Speaker A: Well, I do. I really do think if you're a good steward of your community, community being where you know where you're at, that that's what matters most. It's not a hospice referral. It's not them coming onto your hospice. It's making sure that that person's okay. And that's what life should be about. How can we help someone be okay? You know, I use the term okay because the journey is the journey, but how they live that journey is. Is what matters. And so if it's just us uh, being able to help out a little bit, uh, you know, we love doing root beer float days at some of the different, uh, living senior, uh, living communities, just to bring a smile on their face, just to get them out of their room, and not to encourage isolation, but encourage community. So I do think that everything for us stems around community and being good stewards.

Speaker B: Love it. And I think we'll close with, uh, one final question here. Do, uh, you could change one thing about the way families or maybe health care professionals understand hospice. What would you want them to know?

Speaker A: What a loaded question for the last question. Um, I think the thing that I would want people to know most, um, about hospice that I think maybe they don't know is it is not the last days of Someone's life. It's not always the last weeks of someone's life. It's not even the last months of someone's life. Remember, hospice is a Medicare benefit that's free. And there are so many, um, benefits to hospice that Medicare sets in place that you get to utilize over a period of time, not for a limited time. So I think that's the biggest thing I would love people to know.

Speaker B: Love it. Thank you so much for joining me. I think there are so many takeaways, uh, here from this conversation especially, uh, the idea that, uh, supporting families doesn't begin the day someone signs into, you know, into hospice. Uh, begins with education and community support and helping people understand what they're, what they're facing. So, um, before we wrap up, where can people learn more about Mountain View Hospice and, uh, or connect with you?

Speaker A: Well, I'll say TikTok, but, you know, online, I think that, you know, number one, we try to have a really good online presence. So mountainviewhospice.com, you can see our different blogs that we put. We have a whole dementia series in there. Um, we have the Contact us, you get to see the staff that's involved with our care and just the different things that we do. Um, we're also on Facebook, you know, Mountain View Hospice. So I would say those are the best places to start. Then you can kind of see all the different things that we're doing in the community. Um, on Facebook we love to post that and show people a good time and then again, remembering it's a journey and let's make it a good one. Awesome.

Speaker B: Uh, yeah, I'll be sure to, uh, link all those resources you shared and thank you so much for being here and thank you to everyone listening and, you know, we'll see you on, um, the next episode. Thank you so much.

Speaker A: Thank you so much, Brian. 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, uh, you.