Netsmart CareThreads
Netsmart CareThreads

Episode · 1 year ago

2: #hospice #palliative The Role of Hospice in Senior Living Communities


Isolation is tough on everyone. People are tired. Many of us feel like we're running an ultramarathon, and we have no idea where the end lies. 


During this time, people who receive a six-month prognosis know they won't outlive the pandemic. That realization has led many hospice professionals to redouble their efforts. 


We have vital work to do. 


In this episode of NetSmart, Jason Banks, vice president of post acute care for Netsmart talks with Balu Natarajan, M.D., chief medical officer with Seasons Hospice and Palliative Care. 


Jason and Balu discussed: 


- How COVID has impacted the way hospice and palliative care professionals work in senior living commuities 


- Ways we can improve hospice service during the pandemic 


- The future of hospice and palliative care in senior living communities 


- How the average person can help serve hospice staff during COVID 


If you want to hear more episodes like this one, look for the Netsmart CareThreads podcast on Apple Podcasts, Google Podcasts, Spotify or Stitcher.

Welcome TI nhet smart care, threads, apodcast were human services and postocute leaders across the healthcarecontinuum come together to discuss industry trends, challenges andopportunities. Listen is we uncover real stories about how to innovate andimpreve the quality of Care Tor, the communities we serve? Let's get intothe show. My name is Jason Banks, and I am yourhost today I serve as the vice president of posecte care for Netsmart,and I am very excited about our guest. Today he is a former colleague a bi. Heis a visionary and I consider Hi'm a great friend Dr Balloonatrajan. DrNotragan is the chief medical officer with seasons, hospice impelitive care,and the topic for today's episode is we're going to talk about how Hospisimpelitive care play a role given today's environment, specificallywithin senior living communities, and what the next six to twelve monthsmight look like for seasons, hospice antid of care, as well as all otherhospiices inpeed of care providers around the country. So, first of all,thank you so much for your time today during this unprecedented time in ourcountry, and thank you for the work that you and seasons do every singleday in behalf of the patients and families at the at the end of life. Howis the team doing the team is doing? Well, thanks, Jason, for taking thetime with this, I appreciate being able to converse a little bit. I think thatyou know one of the things that actually has sustained the our teamnationwide has been the opportunity to converse. I think that when folks arein isolation, that's harder- and you know we at least have been able tovirtually get together with colleagues across the country, both internally atseasons right as well as with folks like you, so that's been helpful. It'stiring this. You know I think most...

...people said okay. This will be a sprintright. WASN'T IT BACK! In March we were closing schools for two weeks awen. Icame four weeks and now it's like all right, when's, the second way Isit asecond wave and are we going to do in this? Are we doing this for anotheryear, another two years? Nobody knows, and so you know our team members frombedside all the way to support staff administration. Everyone is tired andpart of the reason. They're tired is we don't know when the end really is. Thisis now some sort of strange ultra marathon, but that said, I think thatour team is also refueled on a daily basis when I referenced isolationearlier a lot of folks in senior living a lot of folks in skilled nursingfacilities, their families are still not allowed to see them and in thosecases where we are allowed to visit them because we're not even allowed insome cases in those cases in those places where we are allowed, we serveas a condo it and we are able to phone in the family or use zoom or Microsoftteams or Scipe to bring in the family and in some cases that's the differencebetween having a memory of their loved one or not. So for us you know many of our folks right withhe six month prognosis, you know a large number of them are no longer withus. If we go back to the beginning of this thing in March, right wereapproaching. You know well learned to five months, nearly six months of this new way of living, and so whileour teammates are tired and while they're definitely thrown afteir a gamethey're also refueled by the mission on a daily basis, which is to serve ourpatients, keep them comfortable, but not just keep them comfortable, keepthem engaged, because none of us really...

...wants to be isolated. We all might sayto our families, leave me alone, but we don't want to be like that forever. Wecertainly don't like it after two three four days. We want some humaninteraction and, if we think of those seniors, you know, many of them arerthey're not allowed to congregate at meal time. They're not allowed tointeract with one another and they're not allowed their families, and some ofthat is fear, and some of that is governmentmandate, and so you put all that together, we have vital work to do andthat's really what we've been focusing our energy. Well, that's that's great,and I I think about the team, often and and have occasion to talk to one or twoof them, and I know that they are absolutely mission driven to be theconduit between that patient and their family during this time. How has covidimpacted the way that the nurse the chaplain, the social worker, areproviding hospice and hite of care or for seasons? How is that change? Oundercoven? It's wild everything is changed. So, let's just start with usright even before we interact with the patient and family right, our teammembers, by definition, so the the Medicare hospis mandate, which iswonderful, is we meet right as a team every two weeks at minimum? So we cometogether and we need- and one of the amazing things about hospice staff ingeneral is when you meet right. You Hug, I mean that's one of the most basicthings that we do, and so now we can't even really see each other right mostof the time. Our meetings are now virtual right because of socialdistancing responsibilities, and so that right is kind of where it starts.Then we get to the bedside. What do we typically do? We take the patient'shand and we hold it...

...and that we might be able to do withthe gloved hand, but it's not for as long as it used to be right and theconversations are using a mask and you're dealing with someone who's,probably hard of hearing, and that's, if they're fortunate enough to eventrack. But we've always believed neurologically that, even if someonehas advanced dimension, they can still hear us. They may not necessarilyprocess it, but they can hear tone of voice, teak and hear love, and so it'svery different. One of our executive directors wrote something and she had been in touch with someone whohad been hospitalized, and so she was able to write this through the eyes ofthat personwass hospitalized. This was early on and essentially what themessage was was I only saw eyes. I could not tell what someone was thinking about me.What they were saying about me. My spouse couldn't come be with me and allI got were eyes, and that was it and we always talk about the five senses andhow they all matter in terms of human interaction and we've taken away. Somany of those, and so it has been important for us to beextra intentional about all of our interactions, because, first of all theinteractions are precious they're limited, but secondly they are eitherguarded or they are modified, and so everything has to be so intentional, sothat in that precious time the right message comes across yeah, O goodness. I even think aboutjust the eyes just being able to see the eyes. That's that's incrediblypowerful. So what do you think can and should be done... the current state to continue toserve those that are most vulnerable, whether that be in the hospital settingor in a senior living community? What could and should we come together as acommunity to focus on doing in the CRRIST STATE? So first is. I think weneed to acknowledge right that this is hard. That's the most important thingright, ' ve! If we don't acknowledge that right, then it becomes difficultto come up with any plans right because you need common understanding first, sowe need to acknowledge that it's hard for the hospitals, they're trying. Weneed to acknowledge that it is hard for senior living communities. It is hardfor nursing facilities and then it's hard for family members and it's hardfor stuff. We need to acknowledge that right there there was something I readthe other day, which was really powerful, which is simply trying tocheer lead our way through this right is not it's not an option, it doesn'twork. You need to look at things optimistically, but you also have toacknowledge right. The parts that are less desirable, so we have toacknowledge that right, because I think that that will disarm folks through theconversation and then I think once we do that, then I think we need to cometo agreement that prolonged isolation is not okay, and if we can do those two things, thenwe'll find ways to deisolate folks. It may not mean that they're going tophysically interact, but at least will then figure out virtual ways ofcommunicating and we will partially liberalize who can get to that bedsideright, the sort of person that can serve as the kind do it more often itmade sense in March and April right: okay, we're Ono just going to lockeverything down because it felt like we were going to lock everything down fora couple weeks or a month, and that...

...would be good right. It was areasonably logical thing to do if the virus surrived for fourteen days andwe'll just lock everything down for fourteen days and will be good well,the virus is smarter than us that way, and so we need to rehumanize how we do things anddeisolation. I think has to be a huge part of this. I think we can do it. Ireally do. I think we can do it by being safe. There are a few things thatwe've learned: those institutions that have been extra,careful right about personal protective equipment and extra masks and social,distancing and handwashing all those things you know their infection ratesare far lower than the percentage is reported by the World Health oforganization, and, if you take that right, these are folks dealing with themost vulnerable population, and then we look at the National BasketballAssociation in the National Hockey League right and those two bubbles. Thecase is at the time of this. Recording between those two leagues is Still Zero,and these gentlemen are all in each other's faces, some of them withoutmasks and basketball, ATO withot MASKD. So we figured something out beingcareful matters and what that means is we can find ways to deisolate our folkswithout being foolish and while mitigating exposure risk, we can'tcompletely take it away, but completely taking away and isolating an entirepopulation. I don't think that's sustainable. I think we've tried thatlong enough. I would agree with you and totallyagree that there's absolutely something to be saidfor things like human interaction, human touch beyond the virtual screenelement of that. So now I'm going to...

...ask you the most difficult questionnobody's been able to do this and I know it's unfair to ask you to do it.But what do you think this looks like six to twelve months from now in termsof caring for Patiente ouspice, impeitivecarepation, specifically in senior living community? So I'm asking to beabot a bit clear buoyant here and again I know- that's that's, probably notfair, but wanted to get your perspective on whatyou think. The future looks like over the over the upcoming months. Yeah I'mgoing to be cautiously optimistic. I think I think in twelve months we arestarting to find ways out of this. I think in six months it's harder and sixmonths, it's February and you and I both live in Chicago. So we know thatFebruary and Chicago right- and I don't know about February in Warmer Sunnierareas but February in colder. cloudier areas are miserableanyway, because the holidays are over th spring, isn't here yet, andeveryone's tired of wearing the hat and the gloves and everything else, and sonow, if we overlay a year of some degree of quarantine or somedegree of social distancing, I think in February it's still hard right. Ifwe're lucky there's a vaccine right, but we would still be in the midst ofadministering it, and so we would be looking at covid and influenza rightand we would still be trying to get our arms around exactly what to do. So. Ithink six months from now we have a plan, but we haven'timplemented it fully. Yet I think, twelve months from now in the seniorliving setting, we have a much better plan and we've learned lessons. So what dowe know both in senior living as well... in skilled nursing, we've been able to figure out right how to stemthe tide of a deadly infection? So that means in the worst of times. Ifwe were able to do that, then later, we should be able to apply some of thoselessons learned right for the future and in the same setting,even as we deisolate all of ourselves, so we're going to figure the vigilancewith which we are cleaning doorknobs and you know maintaining someseparation, especially when someone's got a cough. That sort of thing I'mhoping that's here to stay, because if that's here to stay we'll be able tokeep our loved ones around potentially a lot longer than we dotoday awesome and then what? What can we bedoing? You know the average person you know has much more free time so tospeak. Now. What can we be doing- and I get this question a lot from from anumber of people that I know that are looking to serve right. They want to beable that out, those that are on the front match you and your team andfwithout putting you or the people that youserve the patients and families inHarrors way. So what are some things that that we should be thinking aboutor do to help those that are again on the front lines of this really reallydedicated team members? What can we do to help? What should we be doing now?What should we be thinking about it? Yeah tell you there's so many simplethings that could be done right. So let's say you know Yo, you know folkswho are in healthcare right and part of it goes again back to that socialdeisolation, but then some of it gets...

...really practical right. So your kids, I think, are just going backto virtual school right now right. My fourteen year old just started highschool at our at our kitchen table and my eleven year old is starting middleschool here in a couple of weeks right, a simple thing right that you could dois if I'm overwhelmed and I am busy tryingto get to a patient- and you know and he's tugging at me for help with mathright. I think I read Ashton cutcure or someone like that right they werecalling their friends and they were building cohorbs, where you know theparents were all dividing and conquering subjects, and so one parentamong you know their peer group was hosting English classes and one washosting social studies, etc. Etca there are ways I think that we can connectwith one another right and help out with things that the kids might needright from a phone. A friend perspective. You know, we've beenarranging at seasons tail getting Opportunitie, so we ordered thesechairs. Okay, go o outside wear your mask, go outside the office, spreadapart right and sit and chat. You know you love sports. I have missed Jasonthe opportunity to chat about the cubs with you. We haven't been able to talkabout Rossy and what he's done at all right. But if you were to give me acall and say hey hour things or text me and say I you want to chat about thecub. Sometimes let me know I would welcome that right. It's not aboutmasks, there's nothing to talk aouright and we could sit there and complainabout the lack of a closer and that would be Cathartic for me right. So the tendency is to feel like I have todo something healthcare related, but every one of these folks in health carehas a whole life outside of it and serving the folks around them has beendifficult and then our team members they then then they feel guilty right.Okay, am I am I bringing this disease...

...home? Am I short changing my family.Now my family is home. I can't be there they're, not out of the house they'renot able to compete in sports like they usually do. All the outlets are goneright. One of the ways that my wife contributed Che's in Orthodonis, butone of the ways she contributed for my colleagues. She teaches meditation, soshe hosted meditation sessions which at seasons we created a number ofdifferent venues to do that. So if you've got a skill set of some kindright sharing that with the human beings that make up the healthcarecommunity right now, that's probably the biggest thing. Many of them need awesome. Well, I agree with you and-and I think the cups can do like they didto two thousand and sixteen and pickup an a roll this chap when the time is right to go to go win the championshipsup. I want to thank you again, dark an Natrogan for sharing your experience. Iwant to thank the audience for listening to the netsmark Hare treadspodcast, and appreciate all of your time to that. Thanks much at that SMART, we understand thechallenges facing provider organizations. Our team will help younavigate changing value, based care models with solutions and services thatmake person centered care or reality will equip you with technology andservices that provide holistic, real time. Views of Care Histories thatinform better decision may in and better outcomes visit us today atntstcom Netsmart serving you, so you can serve others thanks for listeningto the Netsmart Care, threads podcast through collaboration and conversation,we can work together to make healthcare more connected than ever before andbetter support the communities we serve to ensure you never miss an episode.Please subscribe to the show in your favorite podcast player, if you useapple, podcast, we'd love for you to give us a quick rating for the showjust havp the number of stars that you think the podcast deserves until nexttime.

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