Netsmart CareThreads
Netsmart CareThreads

Episode · 1 year ago

#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 to net smart care threads, a podcast where human services and post acute leaders across the healthcare continuum come together to discuss industry trends, challenges and opportunities. Listen is we uncover real stories about how to innovate and improve the quality of care for the communities we serve. Let's get into the show. My name is Jason Banks and I'm your host today. I serve as the vice president of post acute care for net smart and I am very excited about our guests today. He is a former colleague of mine. He is a visionary and I consider I'm a great friend Dr Balloon to Trojan. Dr Ne Trojan is the Chief Medical Officer with seasons hospice and Palliative Care, and the topic for today's episode is we're going to talk about how hospice and Palliative care play a role given today's environment, specifically within senior living communities, and what the next six to twelve months might look like for seasons hospice and tied of care, as well as all other hospice and pied of care providers around the country. So, first of all, thank you so much for your time today during this unprecedented time in our country and thank you for the work that you and seasons do every single day on behalf of the patients and families at the at the end of life. How is the team doing? The team is doing well. Thanks, Jason, for taking the time with this. I appreciate being able to converse a little bit. I think that, you know, one of the things that actually has sustained the our team nationwide has been the opportunity to converse. I think that when folks are in isolation that's harder and you know, we at least have been able to virtually get together with colleagues across the country, both internally at seasons right, as well as with folks like you. So that's been helpful. It's tiring this, you know.

I think most people said, okay, this will be a sprint, right, wasn't it? Back in March we were closing schools for two weeks and I came four weeks and now it's like all right, once the second wave. Is it a second wave and are we going to do in this? Are we doing this for another year, another two years? Nobody knows. And so you know, our team members from bedside all the way to support staff administration. Everyone is tired and part of the reason they're tired is we don't know when the end really is. This is now some sort of strange ultramarathon. But that said, I think that our team is also refueled on a daily basis. When I referenced isolation earlier, a lot of folks in senior living, a lot of folks in skilled nursing facilities, their families are still not allowed to see them. And in those cases where we are allowed to visit them, because we're not even allowed in some cases. In those cases, in those places where we are allowed, we serve as a conduit and we are able to phone in the family or use zoom or Microsoft teams or Skype to bring in the family. And in some cases that's the difference between having a memory of their loved one or not. So for us, you know, many of our folks right with a six month prognosis. You know a large number of them are no longer with us. If we go back to the beginning of this thing in March, right where approaching, you know, well into five months, nearly six months, of this new way of living. And so while our teammates are tired and while they're definitely thrown off their game, they're also refueled by the mission on a daily basis, which is to serve our patients, keep them comfortable, but not just keep them comfortable, keep them engaged, because none of us really wants to... isolated. We all might say to our families, leave me alone, but we don't want to be like that forever. We certainly don't like it after two, three, four days. We want some human interaction. And if we think of those seniors, you know many of them are. They're not allowed to congregate at meal time, they're not allowed to interact with one another and they're not allowed their families. And some of that is fear and some of that is a government mandate. And so you put all that together, we have vital work to do and that's really what we've been focusing our energy and well, that's that's great, and I I think about the team often and and have occasion to talk to one or two of them and I know that they are absolutely mission driven to be the conduit between that patient and their family during this time. How has covid impacted the way that the nerse the chaplain, the social work or are providing hospice and pall of care for seasons. How is that change under covid it's wild. Everything is changed. So let's just start with us right, even before we interact with the patient and family, right, our team members. By definition, so the the Medicare hospice mandate, which is wonderful, is we meet right as a team every two weeks at minimum. So we come together and we meet and one of the amazing things about hospice staff in general is when you meet right, you hug. I mean that's one of the most basic things that we do. And so now we can't even really see each other right most of the time. Our meetings are now virtual, right because of social distancing 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's hand and we hold it, and that we might be able to do with the...

...gloved hand, but it's not for as long as it used to be. Right, and the conversations 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 even track. But we've always believed neurologically that even if someone has advanced dementia, they can still hear us. They may not necessarily process it, but they can hear tone of voice, they can hear love, and so it's very different. One of our executive directors wrote something and she had been in touch with someone who had been hospitalized and so she was able to write this through the eyes of that person who was hospitalized. This was early on and essentially what the message 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 all I got or eyes and that was it. And we always talk about the five cents and how they all matter in terms of human interaction, and we've taken away so many of those. And so it has been important for us to be extra intentional about all of our interactions because, first of all the interactions are precious, they're limited, but secondly they are either guarded or they are modified, and so everything has to be so intentional so that in that precious time the right message comes across. Yeah, goodness, I even think about just the eyes, just being able to see the eyes that's that's incredibly powerful. So what do you think can and should be done in the current state to continue to serve those that are most vulnerable,...

...whether that be in a hospital setting or in a senior living community? What could and should we come together as a community to focus on doing in the current state? So first is I think we need to acknowledge right that this is hard. That's the most important thing, right. If we don't acknowledge that right, then it becomes difficult to come up with any plans right, because you need common understanding first. So we need to acknowledge that it's hard for the hospitals. They're trying. We need to acknowledge that. It is hard for senior living communities, it is hard for nursing facilities, and then it's hard for family members and it's hard for staff. We need to acknowledge that right there. There was something I read the other day which was really powerful, which is simply trying to cheer lead our way through this right, is not it's not an option. It doesn't work. You need to look at things optimistically, but you also have to acknowledge right the parts that are less desirable. So we have to acknowledge that right, because I think that that will disarm folks through the conversation. And then I think once we do that, then I think we need to come to agreement that prolonged isolation is not okay. And if we can do those two things, then we'll find ways to de isolate folks. It may not mean that they're going to physically interact, but at least will then figure out virtual ways of communicating and we will partially liberalize who can get to that bedside, right, the sort of person that can serve as the conduit more often. It made sense in March, in April, right, okay, we're just going to lock everything down, because it felt like we were going to lock everything down for a...

...couple weeks or a month and that would be good. Right. It was a reasonably logical thing to do. If the virus survives for fourteen days and we'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 and the isolation, I think, has to be a huge part of this. I think we can do it, I really do. I think we can do it by being safe. There are a few things that we've learned those institutions that have been extra careful, right, about personal protective equipment and extra masks and social distancing and hand washing, all those things. You know, their infection rates are far lower than the percentage is reported by the World Health Organization. And if you take that right, these are folks dealing with the most vulnerable population. And then we look at the National Basketball Association and the National Hockey League, right, and those two bubbles. The cases 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 without masks and basketball without without masks. So we figured something out. Being careful matters, and what that means is we can find ways to de ice, to late our folks without being foolish and while mitigating exposure risk. We can't completely take it away, but completely taking away and isolating an entire population, I don't think that's sustainable. I think we've tried that long enough. I would agree with you and totally agree that there's absolutely something to be said for things like human interaction, human touch, beyond the virtual screen element of...

...that. So now I'm going to ask you the most difficult question. Nobody'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 terms of caring for patients auspice and Pawut of care patients specifically in senior living community? So I'm asking you to be a bit clairvoyant here and again, I know that's that's probably not fair, but wanted to get your perspective on what you think the future looks like over the over the upcoming months. Yeah, I'm going to be cautiously optimistic, I think. I think in twelve months we are starting to find ways out of this. I think in six months it's harder. In six months it's February and you and I both live in Chicago, so we know that February in Chicago right, and I don't know about February in warmer, Sunnier areas, but February in colder, cloudier areas are miserable anyway because the holidays are over, the spring isn't here yet and everyone's tired of wearing the hat and the gloves and everything else, and so now, if we overlay a year of some degree of quarantine or some degree of social distancing, I think in February it's still hard. Right, if we're lucky, there's a vaccine, right, but we would still be in the midst of administering it, and so we would be looking at covid and influenza right, and we would still be trying to get our arms around exactly what to do. So I think six months from now we have a plan but we haven't implemented it fully yet. I think twelve months from now in the senior living setting, we have a much better plan and we've learned lessons. So what do we know? Both in senior living as...

...well as in skilled nursing, we've been able to figure out right how to stem the tide of a deadly infection. So that means in the worst of times, if we were able to do that, then later we should be able to apply some of those lessons learned and right for the future and in the same setting, even as we de isolate all of ourselves. So we're going to figure the vigilance with which we are cleaning door knobs and, you know, maintaining some separation, especially when someone's got a cough, that sort of thing. I'm hoping that's here to stay because if that's here to stay, we'll be able to keep our loved ones around potentially a lot longer than we do today. Awesome. And then what what can we be do doing it? You know, the average person, you know, has much more free time, so to speak. Now, what can we be doing, and I get this question a lot from from a number of people that I now that are looking to serve right, they want to be able to help those that are on the front laws you and your team and fit without putting you or the people that you serve, the patients and families, in harms way. So what are some things that that we should be thinking about or can do to help those that are again on the front lines of this really really dedicated team members? What can we do to help? What should we be doing help? What should we be thinking about them? Yeah, I'll tell you. There's so many simple things that could be done right. So let's say you know you, you know folks who are in healthcare, right, and part of it goes again back to that social de isolation, but then some of it gets really practical, right. So your kids, I...

...think, are just going back to virtual school right now. My fourteen year old just started high school at our at our kitchen table, and my eleven year old is starting middle school here in a couple of weeks. Right. A simple thing, right, that you could do is if I'm overwhelmed and I am busy trying to get to a patient and, you know, and he's tugging at me for help with math, right. I think I've read Ashton culture or someone like that. Right. They they were calling their friends and they were building cohorts where, you know, the parents were all dividing and conquering subjects, and so one parent among you know, their peer group was hosting English classes and one was hosting social studies, etc. Etc. There are ways, I think, that we can connect with one another right and help out with things that the kids might need right from a phone of friend perspective. You know, we've been arranging at seasons tailgating opportunities. So we ordered these chairs. Okay, good, outside where your masks go outside the office, spread apart right and sit and chat. You know you love sports. I have missed, Jason, the opportunity to chat about the cubs with you we haven't been able to talk about Rossi and what he's done at all. Right, but if you were to give me a call and say hey, how are things, or text me and say you want to chat about the cubs sometimes, let me know, I would welcome that. Right. It's not about masks. There's nothing to talk about, right, and we could sit there and complain about the lack of a closer and that would be Cathartic for me. Right. So the tendency is to feel like I have to do something healthcare related, but every one of these folks in healthcare has a whole life outside of it and serving the folks around them has been difficult. And then our team members plead. Then then they feel guilty. Right, okay, am I am I bringing this disease home? Am I...

...short changing my family? Not My family's home. I can't be there, they're not out of the house, they're not able to compete in sports like they usually do. All the outlets are gone. Right. One of the ways that my wife contributed, she's an Orthodonis, but one of the ways she contributed for my colleagues she teaches meditation. So she hosted meditation sessions which at seasons. We created a number of different venues to do that. So, if you've got a skill set of some kind right sharing that with the human beings that make up the healthcare community right now it's probably the biggest thing many at them need awesome. Well, I agree with you and I I think the cubs can do like that in two thousand and sixteen and pick up on a roll US chap and when the time is right to go, to go in the championships up. I want to thank you again, Dr to Trojan, for sharing your experience. I want to thank the audience for listening to the net smart care threads podcast and appreciate all of your time to that next much. At Net smart, we understand the challenges facing provider organizations. Our team will help you navigate changing value based care models with solutions and services that make person centered care a reality. Will equip you with technology and services that provide holistic, real time views of care histories that inform better decisionmaking and better outcomes. visit us today at intstcom. Net smart serving you so you can serve others. Thanks for listening to the net smart care threads podcast. Through collaboration and conversation. We can work together to make healthcare more connected than ever before and better support the communities we serve. To ensure you never miss an episode, please subscribe to the show in your favorite podcast player, if you use apple podcast. We'd love for you to give us a quick rating for the show. Just have the number of stars that you think the podcast deserves. Until next time,.

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