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 to net smart care threads,a podcast where human services and post acute leaders across the healthcare continuum come togetherto discuss industry trends, challenges and opportunities. Listen is we uncover real stories abouthow 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 yourhost today. I serve as the vice president of post acute care for netsmart and I am very excited about our guests today. He is a formercolleague of mine. He is a visionary and I consider I'm a great friendDr Balloon to Trojan. Dr Ne Trojan is the Chief Medical Officer with seasonshospice and Palliative Care, and the topic for today's episode is we're going totalk about how hospice and Palliative care play a role given today's environment, specificallywithin senior living communities, and what the next six to twelve months might looklike for seasons hospice and tied of care, as well as all other hospice andpied of care providers around the country. So, first of all, thankyou so much for your time today during this unprecedented time in our countryand thank you for the work that you and seasons do every single day onbehalf 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 the time with this. I appreciate being able to converse a littlebit. I think that, you know, one of the things that actually hassustained the our team nationwide has been the opportunity to converse. I thinkthat when folks are in isolation that's harder and you know, we at leasthave been able to virtually get together with colleagues across the country, both internallyat seasons right, as well as with folks like you. So that's beenhelpful. It's tiring this, you know.

I think most people said, okay, this will be a sprint, right, wasn't it? Back inMarch we were closing schools for two weeks and I came four weeks and nowit's like all right, once the second wave. Is it a second waveand are we going to do in this? Are we doing this for another year, another two years? Nobody knows. And so you know, our teammembers from bedside all the way to support staff administration. Everyone is tiredand part of the reason they're tired is we don't know when the end reallyis. This is now some sort of strange ultramarathon. But that said,I think that our team is also refueled on a daily basis. When Ireferenced isolation earlier, a lot of folks in senior living, a lot offolks 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'renot even allowed in some cases. In those cases, in those places wherewe are allowed, we serve as a conduit and we are able to phonein the family or use zoom or Microsoft teams or Skype to bring in thefamily. And in some cases that's the difference between having a memory of theirloved one or not. So for us, you know, many of our folksright with a six month prognosis. You know a large number of themare no longer with us. If we go back to the beginning of thisthing in March, right where approaching, you know, well into five months, nearly six months, of this new way of living. And so whileour teammates are tired and while they're definitely thrown off their game, they're alsorefueled 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 sayto our families, leave me alone, but we don't want to be likethat 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 andthat'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 talkto one or two of them and I know that they are absolutely mission drivento be the conduit between that patient and their family during this time. Howhas covid impacted the way that the nerse the chaplain, the social work orare providing hospice and pall of care for seasons. How is that change undercovid 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 teammembers. By definition, so the the Medicare hospice mandate, which is wonderful, is we meet right as a team every two weeks at minimum. Sowe come together and we meet and one of the amazing things about hospice staffin general is when you meet right, you hug. I mean that's oneof the most basic things that we do. And so now we can't even reallysee each other right most of the time. Our meetings are now virtual, right because of social distancing responsibilities, and so that, right is kindof where it starts. Then we get to the bedside. What do wetypically do? We take the patient's hand and we hold it, and thatwe might be able to do with the...

...gloved hand, but it's not foras long as it used to be. Right, and the conversations are usinga mask and you're dealing with someone who's probably hard of hearing, and that'sif they're fortunate enough to even track. But we've always believed neurologically that evenif someone has advanced dementia, they can still hear us. They may notnecessarily process it, but they can hear tone of voice, they can hearlove, and so it's very different. One of our executive directors wrote somethingand she had been in touch with someone who had been hospitalized and so shewas 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 weresaying about me, my spouse couldn't come be with me and all I gotor eyes and that was it. And we always talk about the five centsand how they all matter in terms of human interaction, and we've taken awayso many of those. And so it has been important for us to beextra 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 timethe right message comes across. Yeah, goodness, I even think about justthe 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 tocontinue to serve those that are most vulnerable,...

...whether that be in a hospital settingor in a senior living community? What could and should we come togetheras a community to focus on doing in the current state? So first isI think we need to acknowledge right that this is hard. That's the mostimportant thing, right. If we don't acknowledge that right, then it becomesdifficult 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 andit's hard for staff. We need to acknowledge that right there. There wassomething I read the other day which was really powerful, which is simply tryingto 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 youalso have to acknowledge right the parts that are less desirable. So we haveto acknowledge that right, because I think that that will disarm folks through theconversation. And then I think once we do that, then I think weneed to come to agreement that prolonged isolation is not okay. And if wecan 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 willthen figure out virtual ways of communicating and we will partially liberalize who can getto that bedside, right, the sort of person that can serve as theconduit more often. It made sense in March, in April, right,okay, we're just going to lock everything down, because it felt like wewere going to lock everything down for a...

...couple weeks or a month and thatwould 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 fourteendays and will be good. Well, the virus is smarter than us thatway, and so we need to rehumanize how we do things and the isolation, I think, has to be a huge part of this. I thinkwe can do it, I really do. I think we can do it bybeing safe. There are a few things that we've learned those institutions thathave been extra careful, right, about personal protective equipment and extra masks andsocial distancing and hand washing, all those things. You know, their infectionrates 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 vulnerablepopulation. And then we look at the National Basketball Association and the National HockeyLeague, right, and those two bubbles. The cases at the time of thisrecording between those two leagues is still zero. And these gentlemen are allin 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 meansis we can find ways to de ice, to late our folks without being foolishand while mitigating exposure risk. We can't completely take it away, butcompletely taking away and isolating an entire population, I don't think that's sustainable. Ithink we've tried that long enough. I would agree with you and totallyagree that there's absolutely something to be said for things like human interaction, humantouch, beyond the virtual screen element of...

...that. So now I'm going toask you the most difficult question. Nobody's been able to do this and Iknow it's unfair to ask you to do it, but what do you thinkthis looks like six to twelve months from now in terms of caring for patientsauspice and Pawut of care patients specifically in senior living community? So I'm askingyou to be a bit clairvoyant here and again, I know that's that's probablynot fair, but wanted to get your perspective on what you think the futurelooks like over the over the upcoming months. Yeah, I'm going to be cautiouslyoptimistic, I think. I think in twelve months we are starting tofind ways out of this. I think in six months it's harder. Insix months it's February and you and I both live in Chicago, so weknow 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 theholidays are over, the spring isn't here yet and everyone's tired of wearingthe hat and the gloves and everything else, and so now, if we overlaya 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'sa vaccine, right, but we would still be in the midst of administeringit, and so we would be looking at covid and influenza right, andwe 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 implementedit 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 dowe know? Both in senior living as...

...well as in skilled nursing, we'vebeen 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 todo that, then later we should be able to apply some of those lessonslearned and right for the future and in the same setting, even as wede isolate all of ourselves. So we're going to figure the vigilance with whichwe are cleaning door knobs and, you know, maintaining some separation, especiallywhen someone's got a cough, that sort of thing. I'm hoping that's hereto stay because if that's here to stay, we'll be able to keep our lovedones around potentially a lot longer than we do today. Awesome. Andthen what what can we be do doing it? You know, the averageperson, you know, has much more free time, so to speak.Now, what can we be doing, and I get this question a lotfrom 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 lawsyou 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 thingsthat that we should be thinking about or can do to help those that areagain on the front lines of this really really dedicated team members? What canwe do to help? What should we be doing help? What should webe thinking about them? Yeah, I'll tell you. There's so many simplethings that could be done right. So let's say you know you, youknow folks who are in healthcare, right, and part of it goes again backto that social de isolation, but then some of it gets really practical, right. So your kids, I...

...think, are just going back tovirtual school right now. My fourteen year old just started high school at ourat our kitchen table, and my eleven year old is starting middle school herein a couple of weeks. Right. A simple thing, right, thatyou could do is if I'm overwhelmed and I am busy trying to get toa patient and, you know, and he's tugging at me for help withmath, 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 oneparent among you know, their peer group was hosting English classes and one washosting social studies, etc. Etc. There are ways, I think,that we can connect with one another right and help out with things that thekids might need right from a phone of friend perspective. You know, we'vebeen arranging at seasons tailgating opportunities. So we ordered these chairs. Okay,good, outside where your masks go outside the office, spread apart right andsit 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 totalk about Rossi and what he's done at all. Right, but if youwere to give me a call and say hey, how are things, ortext me and say you want to chat about the cubs sometimes, let meknow, I would welcome that. Right. It's not about masks. There's nothingto talk about, right, and we could sit there and complain aboutthe 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 itand serving the folks around them has been difficult. And then our team membersplead. Then then they feel guilty. Right, okay, am I amI bringing this disease home? Am I...

...short changing my family? Not Myfamily'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 outletsare gone. Right. One of the ways that my wife contributed, she'san Orthodonis, but one of the ways she contributed for my colleagues she teachesmeditation. So she hosted meditation sessions which at seasons. We created a numberof different venues to do that. So, if you've got a skill set ofsome kind right sharing that with the human beings that make up the healthcarecommunity 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 thatin two thousand and sixteen and pick up on a roll US chap and whenthe time is right to go, to go in the championships up. Iwant 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 podcastand 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 changingvalue 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 viewsof care histories that inform better decisionmaking and better outcomes. visit us today atintstcom. Net smart serving you so you can serve others. Thanks for listeningto the net smart care threads podcast. Through collaboration and conversation. We canwork together to make healthcare more connected than ever before and better support the communitieswe serve. To ensure you never miss an episode, please subscribe to theshow in your favorite podcast player, if you use apple podcast. We'd lovefor you to give us a quick rating for the show. Just have thenumber of stars that you think the podcast deserves. Until next time,.

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