Latest / Stuff You Should Know / Everyone Deserves A Good Death

Transcript

Everyone Deserves A Good Death · Stuff You Should Know

0:01
Speaker 1: Welcome to Stuff You Should Know, a production of iHeartRadio.
0:11
Speaker 2: Hey, and welcome to the podcast. I'm Josh, and there's
0:13
Speaker 2: Chuck and Jerry's here too. So this is an old
0:16
Speaker 2: fashioned root and tootin episode of Stuff you Should Know
0:20
Speaker 2: and about something we needed to talk about. Chuck.
0:22
Speaker 1: Okay, okay, you remember back in like.
0:27
Speaker 2: The like about like the two thousand and nine ten
0:31
Speaker 2: eleven era, when like death was all the rage people
0:34
Speaker 2: were having, like death cafes and like creating living wills,
0:38
Speaker 2: and it was just a big thing that everybody talked about.
0:41
Speaker 2: When was this like two thousand and nine to two
0:44
Speaker 2: thousand and maybe eleven.
0:46
Speaker 1: I don't remember that, but I'll take your word for it.
0:48
Speaker 2: It was a real thing, for sure. Unless I've just
0:50
Speaker 2: completely lost my marbles and I just made up a
0:53
Speaker 2: whole era of American culture. I don't think I did.
0:58
Speaker 2: But that has died at so like that it's gone
1:01
Speaker 2: back to death has gone back to being a bit
1:03
Speaker 2: of a taboo topic, an uncomfortable topic, at least at
1:07
Speaker 2: least here in the United States.
1:11
Speaker 1: I didn't know that either.
1:12
Speaker 2: It's true. I guess I'm just speaking for myself anecdotally.
1:17
Speaker 1: Oh okay, that makes a lot more sense.
1:19
Speaker 2: So okay, well let's just cut to the chase here.
1:23
Speaker 2: There's this concept of a good death, yeah right, and
1:28
Speaker 2: you can probably fill in a lot of the blanks
1:31
Speaker 2: of what that means and what it means to you
1:32
Speaker 2: at least, but there's actually like some components to it
1:35
Speaker 2: that studies have found, like kind of bubble up to
1:38
Speaker 2: the top that most people can agree this makes a
1:40
Speaker 2: good death. There are things like getting to say goodbye
1:44
Speaker 2: to friends and family, having those people at your side
1:47
Speaker 2: if you want so. A certain amount of control over
1:50
Speaker 2: the dying process is something being pain free, not suffering, sure,
1:56
Speaker 2: being in an environment, and having a chance to like
2:00
Speaker 2: kind of come to terms with the fact you're about
2:01
Speaker 2: to expire. Those are some of the top things that
2:05
Speaker 2: people say, like, this to me is a good death.
2:08
Speaker 2: And not coincidentally, those are the kind of things that hospices,
2:13
Speaker 2: which we're about to talk about today, are intended to provide.
2:16
Speaker 2: That's the service they provide is to give you, the individual,
2:19
Speaker 2: a good death. And it's not something that's relegated to
2:23
Speaker 2: the rich. It's not something that's relegated to the educated.
2:28
Speaker 2: It's for everybody. Everybody deserves to have a good death,
2:31
Speaker 2: and that's pretty much the motto of hospice, And in fact,
2:35
Speaker 2: I ran across one motto. It said, if you can't
2:38
Speaker 2: add more days to life, add more life to days.
2:44
Speaker 1: That's great. It sounds a little too corporate slogany, but
2:47
Speaker 1: I like the sentiment.
2:48
Speaker 2: Yeah, there's a mascot, Louis the dead guy who's like
2:54
Speaker 2: always saying that slogan, and he did a partnership with
2:57
Speaker 2: home Depot for some reason recently.
2:59
Speaker 1: Oh boy, well that explains the orange bed sheets and things, right,
3:04
Speaker 1: all right, so that's probably the last semi joke we're
3:06
Speaker 1: gonna make. You'll have to forgive us for that. We
3:09
Speaker 1: did a whole episode on dying, and I don't even
3:12
Speaker 1: know if we made one joke in that one, So.
3:14
Speaker 2: Sure we did, you think, yes? I absolutely think.
3:17
Speaker 1: All right, well we'll pair that with this one. And
3:20
Speaker 1: because we've got a lot of great feedback on the
3:22
Speaker 1: dying episode and how that could kind of help people out,
3:24
Speaker 1: so yeah, maybe this will do the same. We should
3:27
Speaker 1: probably go back in time a bit and explain the
3:29
Speaker 1: history of hospice, because it is very recent. If you
3:33
Speaker 1: look at sort of the timeline of people in the
3:35
Speaker 1: world dying hospice has only been around since like the
3:39
Speaker 1: sixties or seventies and the form that we know it
3:43
Speaker 1: because previous to that, for all of time, basically medicine
3:48
Speaker 1: was like, hey, we're here to cure people, and if
3:52
Speaker 1: it turns out that we cannot cure you and that
3:55
Speaker 1: the end is near, for a very very long time
3:58
Speaker 1: until the last like you know, like I said, since
4:01
Speaker 1: the sixties or seventies, very shamefully, hospitals and even doctors
4:06
Speaker 1: would sort of like it was a reminder that they
4:11
Speaker 1: couldn't save you, so they didn't spend a lot of
4:13
Speaker 1: time with you. And there are a lot of you know,
4:16
Speaker 1: well known reports of people kind of like scurrying past
4:20
Speaker 1: rooms where people were in their final days in a
4:22
Speaker 1: hospital and stuff like that.
4:23
Speaker 2: Yeah, they left the dying who were incurable now to
4:27
Speaker 2: basically die alone. They withdrew support. That was just what
4:30
Speaker 2: they did. And like you said, it was a reminder
4:32
Speaker 2: of the failing of medicine. And this was a time
4:34
Speaker 2: when modern medicine was not in any kind of mood
4:37
Speaker 2: to be reminded of failings, because I mean, the twentieth
4:40
Speaker 2: century was pretty triumphant for it. I mean, I saw
4:45
Speaker 2: that infant mortality rate declined by ninety percent over the century.
4:49
Speaker 2: There's like sanitation, clean drinking water, polar vaccine, like science
4:52
Speaker 2: could do anything, and people who were incurable were just
4:56
Speaker 2: a reminder that there were limits to that whole thing.
4:59
Speaker 1: That's right, right, and another thing that was going on.
5:02
Speaker 1: And this is also pretty shameful. Well, I guess not shameful,
5:05
Speaker 1: but they've since revisited how they look at pain management.
5:11
Speaker 1: But yeah, you had to like really be in pain
5:15
Speaker 1: to get pain management, and then that had to like
5:18
Speaker 1: wear off and you had to be really in pain
5:20
Speaker 1: again for them to administer more pain management. They were
5:24
Speaker 1: worried about, you know, opioid addiction and stuff like that,
5:27
Speaker 1: but you know, these days, it's it's definitely more like, hey,
5:31
Speaker 1: you know, we're not worried about you getting addicted to
5:33
Speaker 1: opioids in the final possibly days of your life. We
5:37
Speaker 1: just want to make you feel okay.
5:39
Speaker 2: Yeah, that's definitely the hospice philosophy is you don't have
5:42
Speaker 2: to wait until one pain killer wears off to get
5:44
Speaker 2: another dose. You can you know, stay comfortable. That's the
5:48
Speaker 2: point is to make the person comfortable. That's called palliative care.
5:53
Speaker 2: We'll talk a little more about that, but it's essentially
5:55
Speaker 2: just taking care of symptoms to keep people comfortable.
5:59
Speaker 1: Yeah, for sure, nuns were kind of on the scene
6:01
Speaker 1: early on, providing you know, emotional support. They couldn't dose
6:05
Speaker 1: out pain medication of course, and stuff like that, but
6:08
Speaker 1: they you know, it was a lot of times it
6:10
Speaker 1: was religious organizations that were stepping forward that were kind
6:13
Speaker 1: of doing the hospice type work that would come along
6:16
Speaker 1: in the sixties and seventies, thanks in part to a
6:19
Speaker 1: couple of big landmark books that came out.
6:22
Speaker 2: Yeah, there was this whole thing in the sixties and
6:24
Speaker 2: seventies that was kind of this rebellious streak that went
6:27
Speaker 2: across like against some of the just unquestioned institutions, and
6:31
Speaker 2: one of those was medicine and doctors and hospitals. But
6:34
Speaker 2: there was a psychiatrist name Elizabeth Koubler Ross who very
6:38
Speaker 2: famously came up with the five Stages of grief that
6:41
Speaker 2: was in her nineteen sixty nine book on Death and Dying.
6:45
Speaker 2: And in addition to being famous for coming up with
6:48
Speaker 2: the Five Stages of grief, she also basically interviewed people
6:52
Speaker 2: in the Chicago Hospital's ice you who were dying and
6:57
Speaker 2: just found that they were just being totally neglect and
7:00
Speaker 2: so she definitely lobbied for dying and dying people and
7:05
Speaker 2: their families to be listened to and to be treated
7:08
Speaker 2: rather than just ignored.
7:09
Speaker 1: Yeah, we talked about her and that book in our
7:12
Speaker 1: dying episode. I don't think we talked about the Denial
7:15
Speaker 1: of Death from nineteen seventy three, but that was from
7:18
Speaker 1: an anthropologist named Ernest Becker, and he was writing this
7:24
Speaker 1: as he was dying himself, so he was in a
7:27
Speaker 1: position to really give a good, you know, pretty moving
7:29
Speaker 1: first person account, and he talked about sort of you know,
7:32
Speaker 1: a good death and accepting the inevitability and stuff like that.
7:37
Speaker 1: So these things were sort of happening in the cultural
7:39
Speaker 1: movement when a woman, a hero i think a named
7:44
Speaker 1: Cecily Saunders came along, eventually the founder of medical director
7:47
Speaker 1: of Saint Christopher's Hospice in London, and she really changed
7:51
Speaker 1: the game and kind of birthed the whole sort of
7:53
Speaker 1: modern hospice movement.
7:55
Speaker 2: Yeah, she had a bad back from a young age
7:59
Speaker 2: and apparently it kept her from her desired career of nursing,
8:05
Speaker 2: so she instead became basically a social worker. Uh, at
8:09
Speaker 2: the time they called a lady almoner or distributor of alms, right,
8:13
Speaker 2: So it's pretty old timey, but it does kind of
8:16
Speaker 2: it's a nod back to the original hospice which were
8:18
Speaker 2: founded in the Crusades by the Roman Catholic Church. Ironically,
8:22
Speaker 2: Cicily Saunders was raised an atheist, but she had a
8:26
Speaker 2: conversion to Christianity, evangelical Christianity, even when she went on
8:31
Speaker 2: vacation with a Christian friend and her family. And one
8:34
Speaker 2: of the other big experiences that letter to found the
8:39
Speaker 2: hospice movement essentially was she had like some friendships with
8:44
Speaker 2: some people that she helped essentially as they were dying,
8:48
Speaker 2: and really kind of was moved by these friendships and
8:51
Speaker 2: wanted to make sure that other people had that same experience.
8:54
Speaker 2: So she did something that I mean just kind of
8:58
Speaker 2: I think really gets across kind of person she was.
9:00
Speaker 2: And she went to medical school to make her voice
9:03
Speaker 2: a little more credible.
9:05
Speaker 1: Yeah, she started medical school at age thirty three. This
9:08
Speaker 1: is in the nineteen fifties, and she finished medical school,
9:12
Speaker 1: she was able to work as a physician. She started
9:16
Speaker 1: writing articles and stuff about this about people, you know,
9:19
Speaker 1: being deserted or feeling like they'd been deserted by their doctors,
9:23
Speaker 1: like the closer they got to death like we were
9:25
Speaker 1: talking about, and said, hey, there's got to be a
9:28
Speaker 1: better way to take care of people, not only physically,
9:32
Speaker 1: but emotionally and spiritually as they as they near death.
9:37
Speaker 1: So she, you know, got that medical degree, got a
9:40
Speaker 1: research job at a hospital, started studying. You know, she
9:43
Speaker 1: wanted to have a legitimate sort of background for this
9:46
Speaker 1: so people didn't think she was just some some wacky
9:49
Speaker 1: impath trying to do good, which you know should be enough.
9:53
Speaker 1: But she figured she was armed with medical training and
9:55
Speaker 1: real data and on like pain management stuff, that she
9:59
Speaker 1: would go a lot further in She did.
10:01
Speaker 2: Yeah, she went and studied pain management firsthand so she
10:04
Speaker 2: could come up with her own protocols. One of those
10:08
Speaker 2: protocols that was really groundbreaking and went against the norm,
10:12
Speaker 2: was to give dying patients not just heavy doses of
10:16
Speaker 2: morphine to make sure that they weren't in pain, but
10:18
Speaker 2: also cocaine to keep them from just being kind of
10:21
Speaker 2: doped up for the rest of their lives. She would
10:25
Speaker 2: find out what liquor they preferred and would make sure
10:28
Speaker 2: that they had their liquor and all of this sounds
10:30
Speaker 2: like just completely reckless and careless, but she had before
10:35
Speaker 2: and after pictures of these people terminal cancer patients who
10:39
Speaker 2: in the before pictures before they had been treated with
10:42
Speaker 2: her new protocol of pain management and I guess mood
10:45
Speaker 2: management too if you think about it. They did not
10:49
Speaker 2: look very good. They looked like terminal cancer patients. And
10:52
Speaker 2: afterward they were sitting up in bed, perked up. Some
10:54
Speaker 2: had taken up hobbies like knitting. And she would show
10:58
Speaker 2: these before and after pictures when she went around the
11:01
Speaker 2: world speaking on behalf of hospice as she was trying
11:04
Speaker 2: to found it, and like she would get converts at
11:08
Speaker 2: every talk she gave just from the before and after
11:11
Speaker 2: pictures alone.
11:12
Speaker 1: Yeah, it was pretty remarkable. This all culminated in nineteen
11:16
Speaker 1: sixty seven when she founded Saint Christopher's Hospice, Like like
11:19
Speaker 1: I mentioned earlier in London and kind of right off
11:23
Speaker 1: the bat, she said, all right, we have a new
11:24
Speaker 1: way to deal with pain management. We're going to get
11:26
Speaker 1: rid of visiting hours and people family can come and
11:29
Speaker 1: go when it's convenient for them, and we're going to
11:33
Speaker 1: not talk about just you know, physical pain. We're going
11:35
Speaker 1: to talk about what I call total pain or what
11:37
Speaker 1: she called that. You know, like we mentioned emotional support,
11:42
Speaker 1: social support, spiritual suffering that happens with people. And one
11:47
Speaker 1: of the people that she worked a lot with was
11:49
Speaker 1: a nurse in the US named Florence Wald who ended
11:53
Speaker 1: up doing the same thing. In the US. She said,
11:55
Speaker 1: I think we need this over here. She started up
11:58
Speaker 1: the very first hospice in Branford, Connecticut and the United States,
12:02
Speaker 1: and that was six years later after the one in
12:04
Speaker 1: London in nineteen seventy three.
12:06
Speaker 2: Yeah, that first American hospice. They tried a few names
12:09
Speaker 2: out before they settled on the final one, Hospice rus
12:14
Speaker 2: MC Dying, and then they just kind of went with
12:17
Speaker 2: the straight name. Well all right, so yeah, so hospice
12:22
Speaker 2: that's spread pretty quickly. I think you said Saint Christopher's
12:25
Speaker 2: opened up in nineteen sixty seven and the one in
12:29
Speaker 2: Branford opened up in nineteen seventy three. That's pretty good
12:32
Speaker 2: traction to create a brand new idea in both the
12:37
Speaker 2: UK and the US and start spreading it around the world.
12:40
Speaker 2: And one of the things I think you said about
12:42
Speaker 2: Saint Christopher's was, even though it was religious or at
12:46
Speaker 2: least spiritual, it was non denominational, and that is a
12:50
Speaker 2: huge point about hospice that is lost on a lot
12:53
Speaker 2: of people. I think a lot of people associated with
12:55
Speaker 2: religious groups still and like, if you're not, say Christian,
13:00
Speaker 2: you wouldn't really want to go to a Christian hospice.
13:03
Speaker 2: That is not at all the way that hospices work.
13:06
Speaker 2: And in fact, there's plenty of people who are atheists.
13:08
Speaker 2: They are humanists and they just are like those empathic
13:13
Speaker 2: do gooders that you were speaking about earlier, and none
13:18
Speaker 2: of these philosophies clash because they all come together to
13:21
Speaker 2: essentially say, one of the big parts of dying is
13:25
Speaker 2: some sort of spirituality or at least some sort of
13:29
Speaker 2: peace that we associate with spirituality, and it doesn't matter how
13:33
Speaker 2: you get there, we're all just kind of coming together
13:35
Speaker 2: to make sure that everybody can experience that. It's a
13:38
Speaker 2: big misunderstanding of hospice sometimes.
13:40
Speaker 1: Yeah, for sure, in the US it's usually, or at
13:45
Speaker 1: least at first, it was done at home. That was
13:47
Speaker 1: a difference from the early ones in the UK they
13:49
Speaker 1: were in patient facilities. But in the US, you know,
13:53
Speaker 1: it was sort of a budget issue at first because
13:56
Speaker 1: they couldn't get these facilities and pay for them. But
13:58
Speaker 1: I think they also realized that people wanted to die
14:01
Speaker 1: at home. And there was also this sort of long
14:04
Speaker 1: running institutional distrust that Americans had, and it was a
14:09
Speaker 1: lot of volunteer work at first, like almost entirely volunteer
14:12
Speaker 1: early on. It was sometime, like we mentioned, people in
14:15
Speaker 1: the clergy still doing this kind of work after centuries
14:19
Speaker 1: of doing so, doctors that were moonlighting that wanted to
14:22
Speaker 1: help out, and a movement was was, you know, clearly growing,
14:28
Speaker 1: and it made government sit up and take notice when
14:31
Speaker 1: they realized that it was saving money on healthcare, because
14:35
Speaker 1: not only was the movement growing and people were just
14:37
Speaker 1: feeling better about it, but it was keeping people out
14:40
Speaker 1: of the hospital sort of off and on, off and on,
14:42
Speaker 1: off and on, and so much though that the US
14:45
Speaker 1: government and the Reagan administration said, you know what we
14:47
Speaker 1: should we should get this covered. And in nineteen eighty two,
14:50
Speaker 1: the hospice Medicare benefit went through, which allowed people all
14:56
Speaker 1: of a sudden to be able to pay from you know,
14:59
Speaker 1: staff run by professionals that were also paid and you know,
15:04
Speaker 1: get it covered through Medicare.
15:06
Speaker 2: Yeah, which opened up the door for people who wanted
15:10
Speaker 2: to help people during the final days or weeks of
15:13
Speaker 2: their life, but there wasn't a career associated with it.
15:17
Speaker 2: Now there was, so you could you could pursue that
15:19
Speaker 2: kind of medicine, end of life medicine. That's pretty cool
15:23
Speaker 2: that that was a huge change. I suspect that the
15:27
Speaker 2: saving money had a lot to do with it, though.
15:30
Speaker 1: Yeah, that's usually the case.
15:31
Speaker 2: And the reason why, we'll just spell it out explicitly.
15:34
Speaker 2: The reason why it saves money is because you're taking
15:36
Speaker 2: a patient off of a very expensive track, which is
15:39
Speaker 2: a lot of different medical procedures and treatments, and saying
15:43
Speaker 2: we're like, you're not going to go for the curative
15:46
Speaker 2: treatment route anymore. We're going to take you out of
15:48
Speaker 2: this crazy nutso medical world and put you in a
15:53
Speaker 2: much more peaceful, tranquil world where you can end your
15:57
Speaker 2: days as a happier person rather than feeling like a
16:00
Speaker 2: guinea pig being experimented on. And it's just much cheaper
16:04
Speaker 2: to do that too, as you can imagine.
16:07
Speaker 1: It feels like a good breakpoint. Yeah, yay, all right,
16:10
Speaker 1: we'll come back and we'll talk about how the modern
16:12
Speaker 1: system works right after this.
16:42
Speaker 2: So here in the United States, Chuck Hospice is usually
16:47
Speaker 2: paid for by Medicare, which is federal insurance coverage for
16:53
Speaker 2: people who are retirees typically or maybe disabled, and then
16:56
Speaker 2: also sometimes Medicaid, which covers lower income Americans. And the
17:00
Speaker 2: upshot of all this is that if you are dying
17:03
Speaker 2: and choose to go on hospice care, you are not
17:06
Speaker 2: charged for this, and that is a wonderful thing that
17:10
Speaker 2: the federal government does. Apparently the UK is very much
17:13
Speaker 2: like that, but a lot of it is donation driven
17:16
Speaker 2: rather than paid for by the government, which does chip in,
17:19
Speaker 2: but the lion's share is paid for by donations in
17:22
Speaker 2: the UK. But there's eligibility requirements that basically say like,
17:26
Speaker 2: if you don't check these boxes or if you stop
17:29
Speaker 2: checking these boxes at any point, you can't be in
17:32
Speaker 2: hospice anymore.
17:33
Speaker 1: Yeah, and those boxes specifically, you have to have two
17:37
Speaker 1: doctors certify that you have and this is for Medicare,
17:41
Speaker 1: you know, to get it covered, not just to get
17:42
Speaker 1: into hospice. Right, you have to have a terminal illness,
17:46
Speaker 1: You have to have six months or less to live,
17:50
Speaker 1: and you cannot be going after curative treatments. And we'll
17:54
Speaker 1: talk about some I don't even know if there are exceptions.
17:57
Speaker 1: But some things that some people might think are curative
17:59
Speaker 1: treatments and a curate of treatments. That doesn't mean like
18:02
Speaker 1: they don't ask for anything at all.
18:05
Speaker 2: You know, you can't have a band aid.
18:07
Speaker 1: Yeah, you're on your own. So we'll get into those.
18:09
Speaker 1: But and this is going to be a sticking point
18:13
Speaker 1: that kind of comes up later and some of the
18:15
Speaker 1: failings of the current system. But Medicare pays hospice companies
18:20
Speaker 1: and agencies a daily rate instead of for specific services
18:25
Speaker 1: they provide like like basically all the other medical treatment
18:29
Speaker 1: you're ever going to get, and there are four levels
18:32
Speaker 1: of that care and there are going to be different
18:35
Speaker 1: rates depending on the level that you're going to get
18:39
Speaker 1: and also where you.
18:40
Speaker 2: Are right, So if you're running a hospice, you would
18:45
Speaker 2: get a flat fee paid by the government for a
18:48
Speaker 2: patient who's in routine home care, which is you're not
18:51
Speaker 2: in crisis, you're still dying, but you're doing okay. And
18:55
Speaker 2: that usually is just a visit maybe a couple of
18:59
Speaker 2: times a week. They're coming by to make sure that
19:01
Speaker 2: their meds are going down right, they maybe have like
19:04
Speaker 2: their nutrition going there's just essentially just checking on you
19:07
Speaker 2: that's routine home care. There's also continuous home care where
19:11
Speaker 2: if that patient slips into a crisis, like maybe they
19:14
Speaker 2: start vomiting uncontrollably, they start suffering uncontrollable pain, that their
19:19
Speaker 2: meds aren't doing anything for anymore, changes in consciousness all
19:23
Speaker 2: of a sudden, Now they have twenty four to seven
19:27
Speaker 2: hospice access at home.
19:30
Speaker 1: Yeah, there's also there's a couple of more. There's inpatient
19:32
Speaker 1: respite care. That's when a patient goes into like a
19:36
Speaker 1: you know, they have to leave home to go into
19:38
Speaker 1: a physical hospice center for up to five days. A
19:42
Speaker 1: lot of times this is to give their caregiver time off,
19:45
Speaker 1: because that's one of the brutal parts about end of
19:48
Speaker 1: life is and I say burden on the family, not
19:51
Speaker 1: like what a hassle, but you know, it is a
19:54
Speaker 1: burden on the family. Yeah, people have to besides the
19:58
Speaker 1: emotional devastation they're going through a lot of times, have
20:01
Speaker 1: to rearrange their jobs and like even leave jobs sometime
20:06
Speaker 1: to do this kind of thing full time. So it
20:08
Speaker 1: can be quite a heavy burden on a family.
20:10
Speaker 2: Yeah. Actually, chuck that that's a if you look up
20:13
Speaker 2: downsides of hospice that's pretty much the number one issue
20:17
Speaker 2: with it is that it transfers responsibility for caring for
20:22
Speaker 2: the dying patient from say like a hospital to their family.
20:26
Speaker 2: And that's it is. It's a very big deal. Yeah.
20:29
Speaker 1: And then the last one is general and patient care,
20:32
Speaker 1: and that is when you're addressing pain control or any
20:35
Speaker 1: kind of symptom management that you can't that you have
20:38
Speaker 1: to like go in and take care of at a
20:40
Speaker 1: specific place. It's not the kind of thing you can
20:42
Speaker 1: do at home generally. And then you know, palliates of
20:45
Speaker 1: care is a big part of it. That's what we
20:47
Speaker 1: kind of mentioned earlier, is is just making people feel
20:50
Speaker 1: better toward the end. You know, I mentioned things that
20:54
Speaker 1: don't count as curative treatment, like if you're if you
20:59
Speaker 1: have heart like active heart failure, they can try and
21:01
Speaker 1: reverse that. Or if you have some like nasty bedsword
21:04
Speaker 1: that gets an infection, that that's not going to boot
21:08
Speaker 1: you off covered hospice care to get that taken care of.
21:13
Speaker 2: No, the key to being covered for hospice under Medicare
21:17
Speaker 2: is that you are not pursuing treatment to cure the
21:21
Speaker 2: thing that's got you terminally ill. Right, So, like you said,
21:25
Speaker 2: if you have to develop a heart condition, but that's
21:28
Speaker 2: not what's killing you. You have terminal cancer, they can,
21:31
Speaker 2: you know, treat your heart condition. And even if you
21:33
Speaker 2: do have terminal cancer, if you have nausea from cancer,
21:37
Speaker 2: pain from cancer, they're going to treat that because they're
21:40
Speaker 2: not trying to cure the cancer. You have to give
21:42
Speaker 2: up things like radiation or chemotherapy. Those are curative treatments.
21:47
Speaker 2: But there's the idea that they're just like, nope, sorry,
21:51
Speaker 2: we're just going to put you in bed and basically
21:52
Speaker 2: let you lay there. That's not at all what you
21:55
Speaker 2: have to give up in order to enter hospice.
21:58
Speaker 1: Yeah, and you know, the hospice workers are doing a
22:04
Speaker 1: lot of stuff for you that goes above and beyond
22:07
Speaker 1: just making you feel better or maybe sitting with you
22:10
Speaker 1: and like you know, brushing your hair, Like there's all
22:13
Speaker 1: that stuff that they're doing, bathing you, housekeeping sometimes you know,
22:18
Speaker 1: helping out with gathering and administering the medications. But you
22:23
Speaker 1: know they're doing all kinds of stuff. They might be
22:25
Speaker 1: shopping for you, they might be babysitting for your family
22:28
Speaker 1: to give you know, the like we mentioned the people
22:31
Speaker 1: in your family. They're caring for you, like to give
22:33
Speaker 1: them a break. They may help with fundraising if you have, like,
22:37
Speaker 1: you know, money you need raise for your treatment. They
22:40
Speaker 1: may bring in music and comedy performances to hospice centers.
22:46
Speaker 1: People that cut hair, like volunteers that will come in
22:48
Speaker 1: and style somebody's hair. Even I remember that was a
22:51
Speaker 1: big deal for Emily's grandmother near the end, is you
22:55
Speaker 1: know that she wanted her hair done and to look
22:57
Speaker 1: like she looked, And that stuff goes a long way
23:00
Speaker 1: to just putting people at ease, you know.
23:03
Speaker 2: Oh for sure. Another one that volunteers can do is
23:06
Speaker 2: take care of the person's pet to make sure that
23:09
Speaker 2: if the person is opting for in home hospice, that
23:13
Speaker 2: their pet doesn't have to go live with somebody else
23:15
Speaker 2: because they can't care for it anymore. So you can
23:17
Speaker 2: go and feed somebody's pet, take them for a walk,
23:20
Speaker 2: change the litter box, and then something as simple as
23:23
Speaker 2: just sitting with somebody and watching TV with them is enough.
23:27
Speaker 2: And like this is just a volunteering opportunity of the
23:30
Speaker 2: United States, in the UK, basically anywhere there's hospice, they
23:34
Speaker 2: would very much like you to volunteer to just basically
23:36
Speaker 2: be there and just being a human being who can
23:39
Speaker 2: drive a car over to somebody's house is essentially the qualifications'
23:44
Speaker 2: that's basically all you need to do, and they'll tell
23:46
Speaker 2: you what to do from there. But no one would
23:48
Speaker 2: expect you to, like, you know, inject the person. As
23:51
Speaker 2: a matter of fact, you probably get in big trouble
23:53
Speaker 2: if you did inject the person with anything. You just
23:55
Speaker 2: need to be there. And in addition to just being
23:58
Speaker 2: there for the person, the pay like you said, that
24:02
Speaker 2: gives the caregiver some time to just go take a shower,
24:06
Speaker 2: do something, just stop being a caregiver for a couple
24:09
Speaker 2: of hours too.
24:10
Speaker 1: Yeah, you know, even though a lot of them are professionals,
24:13
Speaker 1: like most of them now, there's still quite a lot
24:16
Speaker 1: of volunteers that do this kind of thing. That Medicare
24:20
Speaker 1: law that talked about in nineteen eighty two that stipulated
24:23
Speaker 1: that hospice facilities have at least five percent of the
24:27
Speaker 1: patient hours provided for by volunteers. So that's one of
24:31
Speaker 1: the reasons. And also just because there are people in
24:34
Speaker 1: the world. You know, some people have maybe gone through
24:37
Speaker 1: this with the family member and then they want to
24:39
Speaker 1: give back. Some people are just wired this way as
24:43
Speaker 1: impaths to want to help people. And then sometimes it's
24:46
Speaker 1: people that are preparing for career in healthcare and you know,
24:50
Speaker 1: getting in a hospice and kind of going through the
24:53
Speaker 1: worst of the worst situations, is I imagine pretty good preparation
24:57
Speaker 1: on dealing with any kind of patient.
24:59
Speaker 2: Yeah, yeah, And you would prepare for a career in
25:01
Speaker 2: that because hospices, like you said, they are professionally staffed,
25:05
Speaker 2: and not just with nurses, not just with hospice doctors,
25:08
Speaker 2: but social workers, bereavement counselors, some of those clergy and
25:13
Speaker 2: just general aids who can come together and help with
25:18
Speaker 2: that thing that Sicily Saunders started kind of seeing clearly
25:23
Speaker 2: the total pain, where you know, if you have psychological pain,
25:27
Speaker 2: it's going to make your physical pain exacerbated and vice versa.
25:30
Speaker 2: And the worse off you are, the more hesitant people
25:34
Speaker 2: might be to come visit you because they feel hopeless
25:36
Speaker 2: or they're just freaked out or something like that. So
25:38
Speaker 2: now you have social pain. So if you have all
25:40
Speaker 2: these people coming together to treat the person's total pain,
25:44
Speaker 2: you have a much calmer, happier again good death. And
25:49
Speaker 2: those are called in the hospice industries interdisciplinary groups and
25:52
Speaker 2: they do. They form a team for each patient to
25:55
Speaker 2: figure out what to do for each of the patients
25:57
Speaker 2: to help them find peace and comfort and calm.
26:02
Speaker 1: Yeah, and this is a you know, it's a booming
26:05
Speaker 1: industry now in the United States, and we'll sort of
26:08
Speaker 1: get to the downsides of that and a little bit.
26:12
Speaker 1: But statistically, from two thousand hospice centers in two thousand
26:18
Speaker 1: and one to about fifty seven hundred today twenty you know,
26:23
Speaker 1: twenty four to twenty five years later, it's really grown
26:26
Speaker 1: a lot. Utilization grew by thirty two percent between twenty
26:30
Speaker 1: thirteen and twenty twenty two. There was a twenty five
26:33
Speaker 1: percent increase in Medicare beneficiaries. Obviously is the boomer generation
26:39
Speaker 1: is aging, but that doesn't account for all of it,
26:42
Speaker 1: you know, twenty five compared to thirty two percent. About
26:45
Speaker 1: half of people now in the United States and roll
26:48
Speaker 1: in a hospice before their death. If you have cancer,
26:52
Speaker 1: you're far more likely to do so. As well as
26:55
Speaker 1: being female and more educated and also older, which it
27:01
Speaker 1: first seemed like a like a well of course, but
27:04
Speaker 1: just so far as to say, if you're someone very
27:06
Speaker 1: tragically in your younger life, that is stricken with something
27:09
Speaker 1: like this, you're far less likely to enroll in hospice.
27:12
Speaker 2: Yeah, and there's actually a lot of reasons why people
27:15
Speaker 2: don't enroll in hospice. A good majority of them just
27:18
Speaker 2: don't either aren't really aware of it or don't understand it.
27:22
Speaker 2: And there's stigmas about hospice too, Like there's a whole
27:25
Speaker 2: idea that if you go into hospice, you're giving up
27:28
Speaker 2: on fighting for your life, you're giving up on living,
27:31
Speaker 2: and that's just absolutely not true. Like, if you have
27:33
Speaker 2: a terminal illness and it's really no longer treatable, a
27:37
Speaker 2: good doctor will say, like, there's nothing more we can
27:39
Speaker 2: do for you. There's plenty of stuff we can do
27:41
Speaker 2: for you, but none of it is going to extend
27:43
Speaker 2: your life. It's going to make your last days pretty miserable.
27:47
Speaker 2: We recommend that you go into hospice and have like
27:50
Speaker 2: good last days, hang out with your friends and family,
27:53
Speaker 2: like be peaceful. That's actually, as far as the American
27:57
Speaker 2: Society of Clinical Oncology is concerned, that's a sign that
28:01
Speaker 2: you've had good cancer care that toward the end, in
28:04
Speaker 2: the last few weeks, your cancer team says you've reached
28:09
Speaker 2: the you know, incurable stage. There's nothing we can do
28:12
Speaker 2: for you anymore except let's put you into hospice. The
28:16
Speaker 2: problem is is there are plenty of doctors out there
28:18
Speaker 2: who do see that as quitting, do see that it
28:20
Speaker 2: is giving up, and are known to steer people into
28:24
Speaker 2: hospice too late, to where essentially they just spend like
28:27
Speaker 2: the last couple or few days in hospice and they
28:30
Speaker 2: don't have a chance to actually develop what again is
28:35
Speaker 2: referred to as a good death.
28:37
Speaker 1: Yeah, and there's even evidence that going like trying to
28:41
Speaker 1: cure yourself and sort of ceasing that process and starting
28:46
Speaker 1: up with hospice can actually make people live longer a
28:50
Speaker 1: lot of reasons. Maybe you're being monitored a little more closely,
28:53
Speaker 1: Maybe maybe your symptoms are being managed a little little better,
28:57
Speaker 1: and just everything that goes into the non physical you know,
29:01
Speaker 1: sick and dying part that we've been talking about, the
29:04
Speaker 1: emotional part and everything else, Like if all of that
29:07
Speaker 1: is eased, studies show that you can you can make
29:11
Speaker 1: it a little bit longer.
29:12
Speaker 2: Yeah, that actually happened to Umi's dead. He was in
29:15
Speaker 2: hospice and given I remember not very Yeah, there was
29:19
Speaker 2: just a just a pretty raw time. He was given
29:23
Speaker 2: not much time to live at all, I think like days,
29:26
Speaker 2: and he didn't didn't pass, and you started to notice
29:29
Speaker 2: he was actually kind of he was eating more, he
29:32
Speaker 2: was his mood was starting to improve, and she convinced
29:35
Speaker 2: the hospice doctor that he was not dying anymore. And
29:39
Speaker 2: one of the things that became really clear that being
29:42
Speaker 2: in hospice at home can do to improve your health
29:47
Speaker 2: is that you're getting better nutrition, you're getting good sleep,
29:50
Speaker 2: you're surrounded by people who don't have to come see
29:53
Speaker 2: you in the hospital setting during visiting hours, and all
29:56
Speaker 2: of those things are terribly managed in the hospital, so
29:58
Speaker 2: at home you can just get better and better. And
30:02
Speaker 2: Human's dad eventually left hospice, was discharged alive, and went
30:07
Speaker 2: on to live for another three years.
30:09
Speaker 1: Man, I remember all that going down and Jerry and
30:14
Speaker 1: I all of us being like, oh man, this is like,
30:17
Speaker 1: this seems like it's it, and you were bringing reports
30:20
Speaker 1: You're like, man, the darnedest thing. Yeah, and then I
30:24
Speaker 1: just I think we all suspected it was just going
30:26
Speaker 1: to happen again right after that, and it was, Yeah,
30:29
Speaker 1: it was a few years. It was just what a story.
30:31
Speaker 2: Yeah, I've never been more proud of anybody than I'm
30:35
Speaker 2: of Vium. She was the only one who saw, like, yeah,
30:38
Speaker 2: she saw it, and she had to convince everybody else,
30:41
Speaker 2: including me, that he's not dying, and she brought him
30:44
Speaker 2: back for sure.
30:45
Speaker 1: So yeah, what a gift.
30:46
Speaker 2: It really was a gift. Yeah, I'm very proud of her.
30:50
Speaker 1: All right, shall we take another break?
30:53
Speaker 2: I think we should.
30:53
Speaker 1: Man, all right, we'll be right back, and we're going
30:55
Speaker 1: to finish up with hospice right after this one thing
31:25
Speaker 1: we should mention kind of briefly. We don't have to
31:28
Speaker 1: get too much into it, but hospice and right to
31:33
Speaker 1: die and assisted dying, these are two things that you
31:37
Speaker 1: know don't go together, but they obviously kind of do
31:39
Speaker 1: go together in a lot of ways because you've got
31:41
Speaker 1: a group of people that are it's the same group
31:45
Speaker 1: of people. Mainly. It's even i think legally designated in
31:51
Speaker 1: places where you do have the right to die, you
31:54
Speaker 1: have to have doctor sign off that you're within six
31:57
Speaker 1: months and there is no cure, and it kind of
31:59
Speaker 1: is in locksed up with hospice. But it's not the
32:02
Speaker 1: same thing because the you know, it's just not the
32:06
Speaker 1: World Health Organization very much defines palliative care as something
32:11
Speaker 1: that neither hastens nor postpones death. It is not the
32:14
Speaker 1: point of hospice to go in and you know, find
32:19
Speaker 1: an impath who will help assist you along a little
32:22
Speaker 1: quicker if you live in one of those states. I
32:25
Speaker 1: think it's an amazing gift to be able to do that,
32:27
Speaker 1: and there are there's a track for doing that, but
32:29
Speaker 1: it's not hospice. No.
32:32
Speaker 2: And the reason why it riles up hospice people who
32:35
Speaker 2: are against that is because there are one of the
32:39
Speaker 2: reasons that people do choose medically assisted dying is to
32:43
Speaker 2: end their suffering, and hospice people are like, no, we
32:46
Speaker 2: know how to end their suffering without them having to die. Yeah,
32:49
Speaker 2: And that's why it really gets under their skin. Although
32:51
Speaker 2: that said, there are plenty of hospice people, probably humanists,
32:55
Speaker 2: who are like, it's anybody's inalienable right to choose how
33:00
Speaker 2: or when they die.
33:02
Speaker 1: Yeah.
33:03
Speaker 2: So, yeah, it is kind of a tricky thing, but
33:05
Speaker 2: it isn't. I think it is generally unfairly associated with
33:09
Speaker 2: hospice and even palliative care. I don't think we said
33:11
Speaker 2: explicitly that is to treat and manage symptoms, pain, nausea,
33:15
Speaker 2: that kind of stuff, symptoms that come along with terminal illnesses,
33:19
Speaker 2: and that is a part of hospice, but not all
33:22
Speaker 2: palliative care is hospice. You can get that same stuff
33:25
Speaker 2: as you're pursuing like curative treatments, right, So it's not
33:28
Speaker 2: like they're going to be like you're getting curative treatments
33:30
Speaker 2: for cancer. Sorry, we can't do anything about the nausea.
33:32
Speaker 2: Then it makes it. It has a place in both
33:35
Speaker 2: of them. And it has nothing to do with assisting
33:37
Speaker 2: someone and dying. It has to do with helping them
33:39
Speaker 2: die comfortably when they die naturally.
33:42
Speaker 1: Yeah, and you know you're not going to get you'll
33:46
Speaker 1: get morphine and you'll get like the good stuff these days,
33:50
Speaker 1: morphine plus. But you're not going to get the cocaine
33:52
Speaker 1: and the liquor.
33:53
Speaker 2: No. I mean unless you have a family member who
33:56
Speaker 2: knows somebody.
33:57
Speaker 1: I mean there's somebody's got a guy maybe, yeah, or
34:00
Speaker 1: if you just have like a you know, pretty empathic,
34:05
Speaker 1: like really empathic, like on the downlow hospice worker, right.
34:10
Speaker 2: And I mean even if you do score for them,
34:12
Speaker 2: they might not even want it. Like I tried to
34:14
Speaker 2: give you and he's dad a bunch of cocaine and
34:15
Speaker 2: he's like, no, I'm good with the pain stuff. I'm
34:18
Speaker 2: on now.
34:20
Speaker 1: Yeah, and then what to do with it? You know?
34:23
Speaker 1: Uh so look we found another joke. Amazing, so right
34:29
Speaker 1: right before the dark side.
34:30
Speaker 2: Yeah, because there is a dark side to this, and again,
34:33
Speaker 2: the one downside to hospices it puts it's just the
34:36
Speaker 2: burden on the caregivers. We'll talk a little bit more
34:38
Speaker 2: about that in a second. But the kind of generally
34:41
Speaker 2: agreed upon dark side of hospice is that there's such
34:43
Speaker 2: a thing as for profit hospices. And contrary to our
34:48
Speaker 2: private equity theme in our private equity episode, we should
34:53
Speaker 2: say that there are plenty of for profit hospitals hospices
34:57
Speaker 2: that are perfectly well run.
34:58
Speaker 1: Yeah.
34:59
Speaker 2: The people who who the family members who have patients
35:02
Speaker 2: and family dying there are totally happy give them great reviews.
35:06
Speaker 2: Being for profit as a hospice isn't necessarily a bad thing.
35:10
Speaker 2: Where they start to get lower marks than other kinds
35:13
Speaker 2: of hospices, specifically nonprofit hospices is when they are part
35:17
Speaker 2: of a publicly owned corporation, like a hospice went with
35:21
Speaker 2: the IPO at some.
35:23
Speaker 1: Point, Yeah, like a chain.
35:24
Speaker 2: Exactly or surprisingly or not, private equity owns the hospice.
35:31
Speaker 2: And the reason why it's problematic is because the way
35:34
Speaker 2: that payment is structured has a built in incentive for
35:38
Speaker 2: for profit hospices to cut corners and cut costs.
35:42
Speaker 1: Yeah, there was a survey in twenty twenty four that
35:44
Speaker 1: twenty five percent of hospices in the US are owned
35:47
Speaker 1: by private equity firms. Now, so you can refer to
35:50
Speaker 1: that episode as to exactly what goes into that. But
35:54
Speaker 1: you know, I said earlier to put a pin in
35:56
Speaker 1: the payment structure, which is they don't get paid through Medicare,
36:02
Speaker 1: they don't get paid out per treatment given or for
36:04
Speaker 1: specific treatments given. It's just this flat fee. Uh. And obviously,
36:10
Speaker 1: if you have a chain, a hospice chain that is
36:14
Speaker 1: for profit and has gone through the IPO process and
36:17
Speaker 1: has shareholders to answer to, very sadly, many times you're
36:22
Speaker 1: going to get hospice centers that that get that flat rate,
36:27
Speaker 1: but they're cutting staff and people are getting the bare
36:30
Speaker 1: minimum treatment required by law.
36:33
Speaker 2: Right, and I saw there's a there's a thing where
36:37
Speaker 2: it's supposedly federal regulations say that you have to visit
36:40
Speaker 2: an in home hospice patient no less than twice a month. Yeah,
36:45
Speaker 2: just twice a month, right, And then a lot of
36:48
Speaker 2: for profit hospices like just basically do that minimum. And
36:53
Speaker 2: if you most people agree, if you are in some
36:56
Speaker 2: sort of crisis, you're getting more visits. But if you're
36:59
Speaker 2: not in a since, you're getting fewer visits because they
37:02
Speaker 2: need to balance that out to cut costs, right or
37:05
Speaker 2: keep costs down. It turns out that's a myth. The
37:07
Speaker 2: federal government doesn't require two visits a month at minimum.
37:12
Speaker 2: The federal government doesn't have any requirements for how often
37:15
Speaker 2: or how little a hospice has to visit a patient
37:18
Speaker 2: at home.
37:19
Speaker 1: They have no requirements or they're not enforcing anything.
37:22
Speaker 2: They don't have any requirements. And that's another problem too.
37:26
Speaker 2: They don't enforce a lot of the rules that there are,
37:29
Speaker 2: and there's already a lot of rules that have loopholes.
37:34
Speaker 2: So this is a system that is just set up
37:36
Speaker 2: for abuse. Luckily, most of the people who run hospice
37:40
Speaker 2: companies they're not in it to abuse the system. They're
37:45
Speaker 2: in it to help people. But there is a place
37:49
Speaker 2: for bad actors to milk the system overcharge. Like apparently
37:54
Speaker 2: there's it's extremely complex, but there are ways that you
37:57
Speaker 2: can charge more than the flat ray per day. And
38:01
Speaker 2: I guess a study from I THINK twenty twenty one
38:04
Speaker 2: in the Journal of Geriatric Care. I THINK found that
38:08
Speaker 2: for profit hospices tend to charge medicare thirty four percent
38:14
Speaker 2: more than nonprofit hospices. There's just a lot of stuff
38:18
Speaker 2: you can do to gain the system.
38:20
Speaker 1: Yeah, and you know, to be clear, hospice in general
38:24
Speaker 1: gets good marks from people. Even for profit hospices generally
38:29
Speaker 1: get good marks from people. But they've drilled down and
38:32
Speaker 1: they found the ones that get the lowest ratings for
38:36
Speaker 1: care are the ones that are publicly traded corporations and
38:42
Speaker 1: owned and or owned by private equity firms. So do
38:47
Speaker 1: your research, you know, if you're getting into this, because
38:49
Speaker 1: there's there are all Like we said, there's fifty seven
38:51
Speaker 1: hundred of them in the US, and hopefully there's one
38:56
Speaker 1: near you that will take care of you a little
38:58
Speaker 1: bit better to remain on hospice. There's also you know,
39:01
Speaker 1: all kinds of rules as far as what's called live discharge, right,
39:05
Speaker 1: you have to demonstrate ongoing steady decline at recertification inuals
39:12
Speaker 1: every ninety days for the first six months, then every
39:14
Speaker 1: sixty days after until death or discharge, and discharges is
39:21
Speaker 1: basically exactly what it sounds like. You're discharged, like you're
39:24
Speaker 1: discharge at a hospital. It may be because you want
39:27
Speaker 1: to try, you know, curative care again, which is which
39:29
Speaker 1: is great, and you're right, it could because of an
39:32
Speaker 1: emergency that you have to go to the hospital for
39:34
Speaker 1: which will boot you off, which really stinks. But there
39:38
Speaker 1: are guidelines about discharge and not all of them seem fair.
39:42
Speaker 2: Yeah, And you can imagine if you're dying of a
39:43
Speaker 2: terminal illness being moved from a hospice to a hospital
39:48
Speaker 2: to continue treatment maybe home, where you have a bunch
39:52
Speaker 2: of emergency room visits ahead of you because your symptoms
39:56
Speaker 2: are going to flare up. It's not a comfortable thing
39:58
Speaker 2: to be discharged from one place to another. It's also
40:01
Speaker 2: a huge burden on the family too, because again the
40:04
Speaker 2: care is being transferred from medical professionals to the family.
40:09
Speaker 2: But also the whole premise of it is just faulty
40:13
Speaker 2: because not all diseases follow the same trajectory in the
40:17
Speaker 2: decline of the person, and yet they're all held to
40:20
Speaker 2: the same standard, which is essentially the standard that cancer
40:24
Speaker 2: creates a decline and a patient too, So essentially just saying,
40:27
Speaker 2: if you have a terminal illness that's certified by doctors,
40:31
Speaker 2: that doctors recertify, say every sixty days, you don't have
40:36
Speaker 2: to face a live discharge, like you can stay in
40:38
Speaker 2: hospice until you die. Your death doesn't have to cooperate
40:41
Speaker 2: with federal guidelines. That would be a huge change and
40:45
Speaker 2: a really simple one to hospice rules, but apparently that's
40:50
Speaker 2: not happening right now.
40:52
Speaker 1: Yeah, and even if you know you aren't moved home,
40:55
Speaker 1: let's say, let's say you move to a different facility,
40:58
Speaker 1: because there definitely is a problem with like you know,
41:00
Speaker 1: not having enough beds at different places, and the family
41:05
Speaker 1: gets can get ideally into a routine at least, and
41:10
Speaker 1: you know, they kind of figure it out. And then
41:13
Speaker 1: with Emily's grandmother, it seemed like once we everyone got
41:16
Speaker 1: into the routine and everything had kind of been figured out,
41:18
Speaker 1: then all of a sudden some change would happen where
41:21
Speaker 1: Mary would have to go somewhere else, and then all
41:22
Speaker 1: of a sudden, it's new visiting hours, it's in a
41:26
Speaker 1: different place and everyone and you know, that's just on
41:29
Speaker 1: the family of course, just like you mentioned, the move
41:31
Speaker 1: for the patient is really burdensome. So there's still so
41:36
Speaker 1: much they can do, I think, to clean this whole
41:39
Speaker 1: system up, you know.
41:40
Speaker 2: For sure, and even chuck if they're not impatient. Just
41:44
Speaker 2: at home hospice basically overlays this support structure for you,
41:49
Speaker 2: the hospice patient in your home right, so you have
41:52
Speaker 2: like medical equipment, you have medications that are like delivered
41:57
Speaker 2: to you at times. If you need a walker, you
41:59
Speaker 2: got to walk. Just all of this support like you've
42:02
Speaker 2: got bereavema counselors dropping by, if a social worker, you're
42:05
Speaker 2: doing telehealth visits with a well like all it just
42:08
Speaker 2: stops when you're discharged from hospice alive. They come and
42:12
Speaker 2: they take the medical equipment, they take your walker away,
42:15
Speaker 2: You stop getting your medications delivered to you. You might
42:19
Speaker 2: not even have those prescriptions any longer after that, if
42:22
Speaker 2: they were prescribed by the hospice doctor. It's a really
42:25
Speaker 2: bad jam. And the other thing about it too, that
42:29
Speaker 2: Medicare has often taken to task for is they don't
42:32
Speaker 2: really pay enough for in home hospice, Like that's the
42:37
Speaker 2: lowest pay rating I guess is in home non crisis
42:42
Speaker 2: hospice care, and that means that if you are trying
42:49
Speaker 2: to stay at home, you either have to have a
42:51
Speaker 2: bunch of family members who are willing to commit their
42:53
Speaker 2: lives to taking care of you in your final days,
42:57
Speaker 2: or you have to have a bunch of money to
42:58
Speaker 2: pay somebody to do that same thing. And if you
43:01
Speaker 2: don't and you want to die at home, you're sol
43:04
Speaker 2: because you have nobody to take care of you at home,
43:07
Speaker 2: because there's not enough pay to pay people in hospice
43:10
Speaker 2: to come by, and not enough volunteers to take care
43:13
Speaker 2: of you take care of your needs on a regular basis.
43:17
Speaker 1: You know, Grandma Mary, former foremost general in the stuff
43:23
Speaker 1: you should know Army, had a T shirt that says
43:25
Speaker 1: you can take my walker when you pry it for
43:27
Speaker 1: my cold dead hand.
43:28
Speaker 2: That's all, Oh my god, that would be such a
43:32
Speaker 2: great T shirt. We got to get that one.
43:33
Speaker 1: You imagine taking a walker from somebody for that that's
43:37
Speaker 1: your job. Like you're the person they're like, yeah, go
43:40
Speaker 1: over to go over to Grandma Mary's house and take
43:43
Speaker 1: her stuff.
43:43
Speaker 2: I know it couldn't even be the person who also
43:46
Speaker 2: delivers it, because it's such a mean job that there
43:48
Speaker 2: has to just be one specialist who doesn't like anybody
43:51
Speaker 2: who just goes around the houses and takes the medical
43:53
Speaker 2: equipment back.
43:54
Speaker 1: Yeah, sin Ronnie, uh, you got anything else? No, I
44:00
Speaker 1: have nothing else. Hopefully this serves some people, and you know,
44:05
Speaker 1: just just look around and do your homework and see
44:07
Speaker 1: if you can find a place that works for you
44:08
Speaker 1: and your family.
44:09
Speaker 2: Yeah. And another good piece of advice is to do
44:11
Speaker 2: that sooner than later, like to share your wishes with
44:15
Speaker 2: your family. Maybe if you go so far as to
44:17
Speaker 2: create a living will or some sort of medical documents
44:20
Speaker 2: saying like I do want to go into hospice, I
44:22
Speaker 2: want to stop curative treatment at some point. And then yeah,
44:26
Speaker 2: do like read reviews, like just find out who you
44:29
Speaker 2: would go to if it starts to seem like that
44:31
Speaker 2: might be a possibility coming down the pike.
44:34
Speaker 1: Yeah, oh man, my god, get a living will. No,
44:38
Speaker 1: I don't care how old you are. That's it's very
44:39
Speaker 1: easy thing to do. And it's that and a will
44:43
Speaker 1: or the two biggest gifts you can give your family
44:45
Speaker 1: as you grow old.
44:46
Speaker 2: That's right, you want to impress your parents in your
44:49
Speaker 2: seven start thinking about a living will, Start talking about
44:52
Speaker 2: a living will to your parents. Yeah, and they will
44:55
Speaker 2: just be blown away totally.
44:56
Speaker 1: That seems like something in like a TV show about
44:58
Speaker 1: a precocious kid.
44:59
Speaker 2: Yeah, for sure, like Alex p.
45:02
Speaker 1: Keaton, he would do that, Yeah, exactly. How you know
45:04
Speaker 1: he had one.
45:06
Speaker 2: So before we finished, I just also wanted to give
45:08
Speaker 2: a huge shout out to Yumi's dad's hospice doctor, doctor Pijari,
45:12
Speaker 2: who did not have any sort of ego and was
45:15
Speaker 2: totally willing to listen to Yumi and helped get her
45:19
Speaker 2: dad out of hospice too.
45:20
Speaker 1: So I love it.
45:21
Speaker 2: Shout out doctor Pajari. And since I shouted out doctor Pejari,
45:25
Speaker 2: as was foretold by the Ruins in two thousand and eight,
45:28
Speaker 2: I've just unlocked the listener mail.
45:33
Speaker 1: This is gen z Stare speaks back. I have three
45:37
Speaker 1: emails I'm going to try and sort of hit the
45:40
Speaker 1: highlights of because we got what I felt like was
45:44
Speaker 1: three really sort of legitimate answers as to what the
45:48
Speaker 1: gen z Stare is all about. That now I understand,
45:52
Speaker 1: you know, it may not be my jam, but like
45:55
Speaker 1: it doesn't need to be my jam because I don't
45:56
Speaker 1: have to put my gen X stuff onto gen Z.
45:59
Speaker 1: That's that's true, Hey guys, twenty two years old gen
46:02
Speaker 1: Z very much in the gen Z stare era. I
46:05
Speaker 1: work in customer service, which is where I use it
46:07
Speaker 1: the most. But we were raised with if you have
46:11
Speaker 1: nothing nice to say, don't say thing at all, so
46:13
Speaker 1: hence staring. So I guess they took that very much literally. Yeah,
46:18
Speaker 1: it's not something just done to adults either, and this
46:20
Speaker 1: person points out that they do it for their friends.
46:22
Speaker 1: As far as the phone call, no one calls us
46:25
Speaker 1: when they do, it's a spam call, which I was
46:27
Speaker 1: always told the double hello people, I didn't know that
46:31
Speaker 1: was a thing. When they answered the phone accused the robot.
46:34
Speaker 2: Did you know that?
46:35
Speaker 1: Yes, okay, I didn't know that, so I just answer
46:39
Speaker 1: and sit in silence until the awkward is this Josie
46:43
Speaker 1: follows and that is from Josie Boozer. This is another one,
46:48
Speaker 1: Hey guys, gen Z person. I think the explanation you're
46:51
Speaker 1: probably looking for is a lot of gen Z are
46:53
Speaker 1: using it. Are used to being interrupted, not taking taken seriously,
46:59
Speaker 1: or have our responses to stories be given a weird look.
47:02
Speaker 1: The example for someone finishes the story and the person
47:04
Speaker 1: just stand there can either be one. I don't have
47:06
Speaker 1: anything interesting to say about that story, and I don't
47:09
Speaker 1: want to make something up. Two, I'm so used to
47:12
Speaker 1: having my opinions not taken seriously that I'm just not
47:15
Speaker 1: even going to bother responding. Many of us are socially
47:18
Speaker 1: awkward and have trouble creating small talk with people that
47:20
Speaker 1: aren't close to us. Another reason maybe because most of
47:23
Speaker 1: our conversations are online and have been online as we aged,
47:28
Speaker 1: and many people will give an emoji reaction to it
47:30
Speaker 1: a long story or just get a smile and that's cool.
47:35
Speaker 1: In response. That is from Sam Okay, so it's kind
47:40
Speaker 1: of tracking along the same lines. And then this is
47:42
Speaker 1: from Catherine, who's been listening for five years as a
47:45
Speaker 1: twenty three year old. I've heard people blame the pandemic,
47:48
Speaker 1: but I don't think it fully explains a generational trend
47:50
Speaker 1: since we all live through the same period. I think
47:52
Speaker 1: there are two main causes. First, my generation has spent
47:55
Speaker 1: much more time in front of a screen than any
47:57
Speaker 1: previous generations did. We've grown used to one content consumption.
48:01
Speaker 1: You would look crazy if you responded to a YouTube
48:03
Speaker 1: video the way you would a phone call or an
48:05
Speaker 1: in person conversation. So we're a little out of practice
48:09
Speaker 1: with responding to prompts instead of just watching something. This
48:12
Speaker 1: is all makes total.
48:13
Speaker 2: Sense, It totally does.
48:15
Speaker 1: And then secondly, gen Z seems to be more likely
48:18
Speaker 1: than previous generations to forego the fake politeness that used
48:22
Speaker 1: to be expected in conversations. I think this is partially
48:24
Speaker 1: because we're constantly inundated with advertisements. We've become highly sensitive
48:29
Speaker 1: to fake niceness because someone is trying to manipulate our
48:32
Speaker 1: emotions at every turn and sell us something. My generation
48:35
Speaker 1: seems much more likely to prefer genuine reactions, even if
48:38
Speaker 1: they're negative, because when we're online, it's the only way
48:43
Speaker 1: to note something is not an ad wo man, this
48:48
Speaker 1: is something else? Huh.
48:49
Speaker 2: Yeah. Those are deep from Josie, Sam and Catherine right.
48:54
Speaker 1: Yeah, And I think they all sort of track along
48:56
Speaker 1: the same lines, and that explains a lot. So, Yeah,
49:00
Speaker 1: if a gen Z person is just staring at you,
49:03
Speaker 1: maybe you think maybe they think you're a real jerk
49:06
Speaker 1: and just don't want to say anything.
49:07
Speaker 2: Right, they assume you're manipulating them, right then?
49:10
Speaker 1: Yeah, or the other reasons mentioned, I think they're all
49:13
Speaker 1: valid in their own generational way.
49:15
Speaker 2: I feel like that really explains the discomfort that people
49:18
Speaker 2: like say from gen X get when we're treated like
49:21
Speaker 2: that because we are used to fake niceness I know,
49:24
Speaker 2: you know, and like we're willing to go along with
49:26
Speaker 2: that kind of thing just to keep from a situation
49:29
Speaker 2: being uncomfortable.
49:30
Speaker 1: Yeah. Also, though, quick tip the if you don't have
49:33
Speaker 1: anything nice to say, don't say anything at all. I
49:36
Speaker 1: recently went through an experience with a TO two artist
49:41
Speaker 1: getting my tattoo covered up with my dogs and it's
49:46
Speaker 1: a great I he'd I appreciate it. He did a
49:48
Speaker 1: great job, but he, let's just say, we weren't the
49:52
Speaker 1: same kind of person. He had a lot of interesting
49:55
Speaker 1: theories on things. And here's a little tip to my
50:00
Speaker 1: gen Z friends. You don't have to not say anything.
50:02
Speaker 1: Just keep nodding and go interesting.
50:05
Speaker 2: Oh yeah, I.
50:07
Speaker 1: Did that over and over and over for hours.
50:09
Speaker 2: It goes a long way.
50:11
Speaker 1: Yeah interesting and sure, well no, I don't even know
50:14
Speaker 1: if I am lying. It was interesting, yeah, just not
50:19
Speaker 1: for me.
50:19
Speaker 2: Right exactly. Maybe the tone was a lie.
50:23
Speaker 1: Maybe.
50:23
Speaker 2: So the guy did you an amazing job? You said
50:27
Speaker 2: he did it like freehand too.
50:28
Speaker 1: Right. Oh yeah, I'll put pictures up at Chuck the podcaster.
50:34
Speaker 1: He's a sort of amazing artistic dude. Yep, just like
50:39
Speaker 1: looking at pictures of dogs and drawing them on my arm.
50:43
Speaker 1: It wasn't like stenciled out of my arm first.
50:45
Speaker 2: It's nuts man. Well, thanks a lot again to Josie,
50:49
Speaker 2: Sam and Catherine for explaining that to us. You guys
50:52
Speaker 2: did a knockout job and we appreciate it. And I'm
50:55
Speaker 2: not being fake nice right now. I'm being quite legitimate
50:58
Speaker 2: and serious and genuine. If you want to get in
51:01
Speaker 2: touch with us and tell us about your generation, we
51:05
Speaker 2: love hearing that kind of stuff, you can send it
51:07
Speaker 2: off to stuff Podcasts at iHeartRadio dot com.
51:13
Speaker 1: Stuff you Should Know is a production of iHeartRadio. For
51:16
Speaker 1: more podcasts myheart Radio, visit the iHeartRadio app, Apple Podcasts,
51:20
Speaker 1: or wherever you listen to your favorite shows,