Our Way of Caring: The Vantage Hospice Podcast - Episode 1

In the inaugural episode of "Our Way of Caring: The Vantage Hospice Podcast," Nicole Knight, the administrator of Vantage Hospice, and Dr. Theodore J. Trumble MD, the founding medical director, share their journey of establishing and growing Vantage Hospice over the past 13 years. They discuss the origins of the hospice, the challenges they faced in building a patient-centered care model, and the importance of a strong interdisciplinary team.

The episode highlights the unique aspects of hospice care, including dispelling common misconceptions, the ethical and moral considerations in patient care, and the critical role of a cohesive team in providing comprehensive support to patients and families. Nicole and Dr. Trumbull also touch on the evolution of their palliative care program and its significance in bridging the gap between active treatment and end-of-life care.

Listeners are invited to join them in future episodes as they continue to explore the compassionate world of hospice care, sharing insights and stories that define their commitment to providing exceptional care to the Houston community.

Vantage Hospice & Palliative Care

Our Mission

Vantage Hospice, LLC is dedicated to providing individualized hospice care with services specially tailored to the physical, social, psychological and spiritual needs of patients with life limiting illness, their families and the community, by delivering high quality and compassionate care.

We strive to create a culture dedicated to meeting the needs of our patients, families and employees based on the principles of dignity, respect and compassion.

Hospice recognizes dying as part of the normal process of living and focuses on maintaining the quality of remaining life. It affirms life and neither hastens nor postpones death through a multidisciplinary team approach. Hospice is not a place. It is philosophy.

Chapters

• 0:00 Welcome to Our First Podcast
• 0:28 Meet the Team: Nicole Knight and Dr. Joseph Trumble
• 1:30 The Founding of Vantage Hospice
• 4:23 Challenges and Growth in Early Years
• 6:40 Building a Strong Team
• 12:38 The Importance of Ethical and Patient-Centered Care
• 16:51 The Move to Houston and Expansion
• 21:06 Understanding Hospice and Palliative Care
• 30:03 The Rewards of Working in Hospice
• 32:13 Conclusion and Future Plans

Transcript

Nicole Knight: [00:00:00] Hi, I'm Nicole Knight. I'm the administrator of Vantage Hospice, and I want to welcome you guys today to our very first podcast. So I have been with Vantage for, there'll be 13 years in October. I've been here since the very beginning. I've had numerous roles in the organization, starting off as the admission nurse and then moving through the director of nursing and clinical services all the way up to the administrator.

Nicole Knight: And today I have with me our medical director, Dr. Joseph Trumble. 

Dr. Trumble: Yes, I'm Dr. Joe Trumble. I've been the medical director since the beginning of Vantage Hospice 13 years ago, so the founding hospice medical director. I'm trained in internal medicine, geriatrics, and hospice and palliative care. Boarded in all of those, and 

Nicole Knight: We were very lucky to get you, because thankfully you were shopping at the time for a new endeavor, so we were very lucky that you agreed to come with us all those years ago.

Dr. Trumble: Yeah, I've had some experience in, in, in hospice. My family actually was involved in hospice. My mother was [00:01:00] one of the early hospice nurses. In Houston and so I admired that and thought someday as a physician I might actually be able to be a hospice doctor because I thought it was a high bar to reach.

Dr. Trumble: And then was able to do that early in my career, get some experience and then after having some experience then Nicole and others at Vantage asked me to be the medical director. To help found a local hospice. Yes. 

Nicole Knight: So just a little bit of background on how Vantage came about and who we are and how it was formed.

Nicole Knight: So a group of local physicians joined together to fulfill, for lack of a better word, their desire to provide really awesome Hospice care to Houston and surrounding areas. Once the company was established and all the physicians were on board the real work began, which was really building that clinical piece and that clinical foundation, which is again, why we were so privileged to have Dr.

Nicole Knight: Trumble, who had a lot of experience with [00:02:00] previous, a previous hospice that he was You know, very 

Dr. Trumble: involved with that and, the experience that we both have with hospices, it's not so much a competitive business. It is something which is necessary needed valuable for patient care and in the medical community to serve a number of different purposes.

Dr. Trumble: But awareness has not always been as good. People are not aware of what hospice is or what hospice does or what it doesn't do. And Have you having experience and me having experience and from different avenues. We never worked together. No, we had 

Nicole Knight: not 

Dr. Trumble: but one of the If there's going to be a new hospice, we can make it good We can make it better than we've had in the past and try to make it the best 

Nicole Knight: I think one of the best things about working with you in the beginning was really again, I hate to harp on this, but all the knowledge that you brought that I wasn't even thinking about and all the standard orders and all the things that really made a whole lot of sense and really focused on patient care versus maybe the, penny pinching side for lack of a [00:03:00] better word.

Nicole Knight: I think one of the best things about it is the patient centered care that we really focused on from the very beginning and providing the best care that we could. 

Dr. Trumble: Yeah, and I think you touched on a topic that I, you have to dispel the myths of hospice. You said the penny pinching. This hospice is just out here to make money and cut all the medicines away so they can save money or they're not going to give me the care that I deserve.

Dr. Trumble: It's just not true. Hospice wants to provide the care that's necessary but not do unnecessary things. Medications can accumulate in a patient's profile. which may have had a good purpose or may, may not have, they may have just accumulated. And with hospice, we rethink everything. So from the medicine standpoint, try to cut it down to what's on, what's going to be necessary for for comfort or for maintenance of of diseases that need chronic care, not necessarily terminal, but if you were to stop.

Dr. Trumble: I think a thyroid medication is something I never stopped thyroid medicine, even though it is not [00:04:00] specifically a comfort medicine. But if someone's with us for a number of months and they become hypothyroid then they may not feel well and they may have other symptoms that come up. Utilizing the health care dollars.

Dr. Trumble: For our patients is really what we do from that standpoint, from the money standpoint. Exactly. Exactly. So symptom management always is a very important thing. But going back to where we started, I remember the first admission that we did. So that was we didn't know each other, obviously.

Nicole Knight: We had met one or the one or two other times in the office, and then we had our first admission on December 26th, 2011, the day after Christmas, which was very interesting. And I still remember when we went out there together, like two, two or three weeks later to meet the patient. It was a big deal.

Nicole Knight: Our first patient since then we are now our census usually runs between 70. So since this is the number of patients that we have on service that we are actually privileged to provide care to we know that there are a million. Choices that you have in health care and allowing Vantage to be the [00:05:00] choice is a huge honor for us.

Nicole Knight: So we started literally with one, one patient. And we had one patient for quite a while. It was like a month. So getting our foot in the door, even though Dr. Trumble was very well known the physicians that were in the group with us were very well known. But, again, just. It's trying to get people to trust who we were and what we had to offer and making sure that we, followed through with what we were saying we were going to do.

Dr. Trumble: Is there a certain number of patients that we had to limit ourselves to initially? Yes, there was. Before we got certified? Because, okay, the regulatory aspect of hospice. Yes, so 

Nicole Knight: there is a regulatory aspect. So we in the beginning were not certified with Medicaid. So we could not take any nursing home patients that were room and board.

Nicole Knight: So that was a challenge. So we did turn down some referrals because of that. But also we had to service, I think, seven patients before we could actually get certified with Medicare. So we went through that process and that was fun, obviously. A lot of fun, not. So yeah, it's been quite the journey over the [00:06:00] past, 13 years almost.

Nicole Knight: We started off with myself and Dr. Trumble. We had one business office person and One aide. Must have 

Dr. Trumble: had aides. We had one aide, we had one aide, 

Nicole Knight: and we had one social worker and one chaplain. 

Dr. Trumble: Okay, which is basically a core team. Our 

Nicole Knight: core team, right? We had our core team of people. So we, and we had no on call staff.

Nicole Knight: It was me, I was the admission nurse, which is funny because we had an admission nurse and a case manager. But I was on call, so I did the on call stuff because I wasn't doing a whole lot of admissions. So I was working on call with our one patient. We were not very busy back then, but for the first 30 patients, it was difficult trying to get people, not only patients to come on board, but also employees because even though we had these grandiose ideas about how wonderful Advantage was going to be, people didn't always believe in our dream and see our vision.

Nicole Knight: So getting people to come on board was a challenge in the beginning. Nurses, social workers, chaplains, as we started to [00:07:00] grow it was hard when you had Even when we had 10 patients, it's really getting to the limit of what a nurse can, feasibly manage by herself.

Nicole Knight: And then we were looking for another case manager, right? And nobody wanted to come on board because they were like, you don't have any patience. I'm going to, you don't have any patience. And even though we kept saying, trust us, we're going to have patience. So we finally got a really good core group of people that grew with us for a very long time.

Nicole Knight: And we still have some of them with us today. Mary May, our business office manager has been with us for 12 years. Most of our chaplains and social workers have been with us for extended periods of time as well. So we have a very stable team and all the same positions, really. 

Dr. Trumble: Yeah, because we knew hospice we had, starting up a new hospice, we have, because of the regulatory issues, you have to have policies and procedures, so we adapted one so we used in the past, and so we had the, the files and all that.

Dr. Trumble: But taking care of the patients was not the most challenging issue it is forming a team. Yes. Forming a, really what [00:08:00] we consider a family. We still consider a family here of, Doctors, nurses, aides social worker, chaplains. And we had to start with one in each of those, yes.

Dr. Trumble: Those roles and grow that or organically and just find our identity. We had the idea of what it was gonna be, but we had really had to just become 

Nicole Knight: that. Yes. And some of my fondest memories honestly were, starting, because you were like, it was you and me doing the teams. Like it was you and I sitting around the table with, social worker and chaplain and people were serious.

Nicole Knight: I remember in the beginning, everybody was just so serious. And one of my favorite stories about Dr. Trumble is you made a joke at one, I don't know if you remember this or not, but you had made a joke at one of the IDTs and they were all looking at me like. Is that, is it okay to laugh?

Nicole Knight: And I was like, it's okay to laugh. 

Dr. Trumble: Yeah, and along those lines I know that my resting face is, honestly, it's been serious and that's okay because hospice medicine, taking care of people's lives is serious business but it doesn't have to be serious all the time. Sometimes I let it out that I do have a sense of humor.

Dr. Trumble: You do have [00:09:00] a sense of humor. Yes, sir. And that. But yeah, we want to make sure that we're professional and I think that that's the main thing. But yeah, I also want people to be put at ease. And people may not know that I do have a good sense of humor and I usually am in a good mood. Yes. 

Nicole Knight: He's a very funny man.

Nicole Knight: Yes, sir. Yes, but again, talking about just the team aspect, that is probably the most important part of not only vantage, but of hospice in general. So it's really one of the only aspects of healthcare where you have a patient centered team approach where it's not just the doctor necessarily calling all the shots and making all the decisions.

Nicole Knight: It's. A team and a group of people that are involved with that patient that come in to give their input into what is best for the patient. 

Dr. Trumble: Yeah, and our teams, which are regular, we have to have a team of individuals, which we've mentioned most of them.

Dr. Trumble: We, I run a team differently, and I teach the other doctors to run a team. Basically, the doctor does not run the team. Specifically, [00:10:00] we wanted to be interdisciplinary. And when physicians are in a room, oftentimes people defer to the physician. And since hospice is so interdisciplinary, we need all of the aspects, especially the AIDS input, the social workers input, chaplain and the nurse who's on site.

Dr. Trumble: to know what's going on. And so I allow other people to speak and to have a greater voice. Because when a physician speaks, people do tend to listen. And that's okay if it's a medical issue. But a lot of what happens in hospice is not specifically it's psychosocial, it's family oriented, a lot of things that will come up in the spiritual nature of that.

Dr. Trumble: So that's one way to get a team to come alive is don't be the dominating force. Even if, especially if you are one as a physician on a regular basis. 

Nicole Knight: Very interesting aspects. It's true. I remember in the very beginning, again, talking about the hands on experiences of both you and I another one of my [00:11:00] fondest memories, so I still talk about today, is the patient that we had in Belleville.

Nicole Knight: We remember the ALS patient. She was, 40 years old and we had gone to do an extubation because she had decided that she didn't want to be, on a, on life support anymore and, be kept alive by machines. One of the most, I think, incredible things about you was that you were there the whole time.

Nicole Knight: From the it was a long ordeal. We had the team was there. So it was me, Dr Trumble our social worker and our chaplain were there. And I think the aid was there to, I think, just to provide support to the family. But Just to give you an idea about how hands on both of us were definitely in the beginning, being able to be there.

Nicole Knight: We're giving orders and really monitoring and controlling that situation. And the outcome was as well. It was really spiritual and, it was amazing, an amazing experience to be present for that. 

Dr. Trumble: And that's what it would be even now, at the beginning, but it's [00:12:00] just that case required the presence of healthcare professionals, a physician, if you're going to the point where you're extubating somebody who is alert and then has decided that they no longer want artificial support.

Dr. Trumble: It's a very important decision. You have to make sure that it's done properly. But then when you're when you get down to the execution of the of the treatment plan you want to make sure that you're there to support that and support the team because I think that It can be very emotional.

Dr. Trumble: It is. Absolutely. It is very emotional and you want to have the confidence that you're doing the right thing at the right time. 

Nicole Knight: I think one of the things that I also admire about you, sir, is the just the ethic and ethical and moral compass that you give our organization. One of the things that I always say to people is that we never have to worry about whether we're doing the right thing or not because we have people in place like Dr.

Nicole Knight: Trumble who, are very clear about, Ethical and moral issues and making sure that we are looking at every aspect of those. So I always if it's the right thing to do, it's [00:13:00] something that's going to happen for a patient, which is really phenomenal. Which is another one of the things that I think really makes Vantage different.

Nicole Knight: Because we are a locally owned, quote unquote company. 

Dr. Trumble: We're not corporate. We're 

Nicole Knight: not corporate. 

And with, not that there's anything necessarily wrong with that, but the closer you are to the beginning and to individuals, and the, you have more control over the resources. And the decision making in the policy.

And that's what we were able to do is to develop our policies. What is the right thing to do? Oftentimes there's different opinions on the exact right thing to do. But when you come together and you work with people that you admire and use your experience and then and accept feedback and say is this the right thing at this point?

And keep it patient centered. Exactly. Because there's always a grapple, the ethical issues usually don't have a right answer. And that's when we have our, we have ethics conferences and ethics committee, talk about it. It's we're not going to come up with the right answer on this ethical question because if if there were one, there probably wouldn't be an ethical issue.

Exactly. There's going to be what do we need to do at this point, at this time [00:14:00] for this patient? Hypothetical patients don't exist. And so that, that's how we, that's how we run it. So that's that shows through in our values as a hospital. 

Nicole Knight: Yes, and I think being able to build those values.

Nicole Knight: With more than just one person's input, like you said. It took a group of people to come together to talk about things, but once it came down to fulfilling those and completing those, hiring the right people, making sure that they were on the team, making sure that it was that the right people were on the right seats on the bus.

Nicole Knight: I think that was probably one of the biggest challenges we had in the beginning. Because not everybody. Buys into the philosophy of hospice or what we do as an organization. And the big, I think one of the big differences between corporate hospice and a locally owned hospice is the ability to make those decisions without really a lot of the red tape.

Nicole Knight: It's the decisions for Medication coverage, equipment coverage, whether or not we're going to do something really does fall on a core set of people who, are different. Who come together with [00:15:00] different values and thoughts and ideas, but tend to, have faith and trust and respect for each other, which I think makes a huge difference.

Nicole Knight: So one of the biggest things I think about Vantage is that the core group of people that are Sitting, driving the bus, all have the same belief system, which really is patient centered care and providing the best care that we possibly can for patients. So that, I think that's what differentiates us a lot.

Nicole Knight: Hospice in itself, if you, which is, probably not right to say right now, but hospices are limited to what they can do. It's the program is the program, you can't really go outside of that program and do a lot of things that are really above and beyond the benefit. So I think what really makes a hospice different and makes them stand out is the people that actually provide that care.

Nicole Knight: And then the philosophy of the hospice and how they Give that care and support the people that are in the hospice as well. 

Dr. Trumble: And the regulations are the same for all [00:16:00] hospices. No matter how big or how small they are. And I think that's how you as you said, differentiate yourself. And I really don't feel that there's a great competition between hospices.

Dr. Trumble: It is raising awareness that hospice exists and then having the philosophy of the hospice that you're working with. And there's a number of them in Houston and the United States that, that work similarly but differently. Exactly. And a corporate structure does have different layers in it.

Dr. Trumble: And and they can. Function efficiently. Of course, course I work with corporate hospices. And then, but I prefer the local one. I guess it's just more of a personal feel and then getting, be able to talk to the to the owners . And to and to the staff.

Dr. Trumble: And it's not a big turnover and our and our level of leadership. Yes. And so that that's reassuring. So it started off really in Katy. So yeah, so 

Nicole Knight: we started off in Katy there, in this small one room. I don't know if you, I'm sure you probably remember, but we had remodeled like five or six times because we kept growing.

Nicole Knight: But in the beginning, We had [00:17:00] people that were, sitting across from each other on desks and like my office was like this little cubicle that we couldn't, you couldn't really even meet and we had to go out into the conference room to meet. And as we've grown, with this handful of people that were probably in the very beginning, I think there were like seven, we had seven core employees.

Nicole Knight: And we've grown to right now, I think we have 113 employees over the last, three years. 13 years, we've added a lot of people. We started off with one medical director, one team. And now we have, seven teams or eight teams with associate medical directors that report to Dr.

Nicole Knight: Trumble. And then, So we stayed in Katy and we moved down the hall because we got a bigger space. Still the same suite number, but we moved down the hall and re, re remodeled a different space. And then we moved about two years ago in June to really the heart of Houston. So now we're really in the Galleria area.

Nicole Knight: We have a beautiful view on the 16th floor of the KHOU building. And [00:18:00] it's, it's a, it's just an amazing journey, I think, to think that we started off with. One patient, 13 years ago. 

Dr. Trumble: Yeah, and you're right, so we were sort of Katie based at the beginning. But serving all of Houston since the beginning, so we were based there, that's where the offices were.

Dr. Trumble: And then we'd even have to move here didn't really, Change so much the care. No, not at all. Location is not important. It is for for the staff and for the ability to be more centralized. And a lot of our teams now are virtual partly because of the COVID epidemic. But even before then, I think we were doing some Some of the teams by by phone in my phone.

Dr. Trumble: And 

Nicole Knight: yep. So 

Dr. Trumble: we're already there. 

Nicole Knight: Yes. Very proactive in our forward thinking. One of the other things I think that is interesting and different about Vantage, a differentiator. Again, not as a competition thing, but just as a who we are thing. Everything that we do is under one roof.

Nicole Knight: So we only have [00:19:00] one office. So when, if anybody were to call any patients or referral sources or anybody calls, they get the same group of people all the time. And if somebody needs something or if there's a question or if a caller, especially, families if they're in crisis on the phone, there's a group of nurses that are literally sitting.

Nicole Knight: Behind our office staff, so they just go grab one which is really interesting. We don't have a north and a south or an east and a west. It's all just one group of people. We're all under the same roof which, I guess could be contributed to my Sense of control or whatever you want to call it.

Nicole Knight: But I just think it's easier. It's easier to manage people when you can see them and it builds rapport and people are, there's a higher level of accountability when the administrator is down the hall. Literally, I can get up and talk to people and I'm involved or I overhear conversations and can intervene real time versus maybe waiting for a meeting a week later to hear about an issue or a problem.

Nicole Knight: So I think that is something that, yeah. I think [00:20:00] that really is one of the reasons that we are so successful because the process is the process, and there's only one. There's only one process. And we monitor that process all the time. 

Dr. Trumble: But the teams are coordinated as North, Southeast, different areas, even though we have the one office, as you say, so that I think that is advantageous.

Dr. Trumble: And we've thought about whether to have satellite offices. We have. But what are the, what would be the benefit and would it be better for the staff or the team or the patients? And I guess we've always come up with no. No. No. We can do it under one roof. 

Nicole Knight: Yeah, we've always agreed that, I mean like the core structure of who Vantage is under one roof.

Nicole Knight: Again, like you said, teams are in geographical regions across Houston. Nurses live where they provide care. Aids live where they provide care. The social workers, the chaplains are all in that area and, builds that sense of community so that they're available quickly, in the event that a hospital, a patient needs something or a family needs something or a referral source needs something.

Nicole Knight: But then just the overall business aspect of Vantage and [00:21:00] decision making things are all. 

Dr. Trumble: There's, the concept of hospice and palliative care is sometimes confusing to people. What's the difference between it? Both hospice and palliative care provide a symptom symptom centered care.

Dr. Trumble: And the main difference really is a hospice patient has a terminal illness with a limited lifespan measured in terms of months. Palliative care also addresses symptoms. Symptoms, that's the center of the care, but it may be longer than a month, maybe years. It's not necessarily a terminal illness and some people are better able to relate to palliative care because they don't feel like, maybe dying is an issue that they're not able to.

Dr. Trumble: Address. And so there's some overlap sometimes it's, it is a a continuum and so we decided that we needed to have that in order to communicate better what the goals are for hospice. And Nicole had an interest and [00:22:00] expertise and the drive. 

Nicole Knight: So we I've been a nurse for, well since 19, no not 19, 2000, 2000 is when I graduated from nursing school.

Nicole Knight: But and had been a nurse for, quite some time and realize when we start talking about palliative care and the interest of palliative care and the need of palliative care. We started interviewing nurse practitioners, because I couldn't do it. I'm an RN, and then after interviewing a lot of people, again, my sense of control, I think overwhelmed everybody, myself included.

Nicole Knight: It's a good sense of control. Yeah. Control. So I was like, and as a joke at one of our management meetings, I had said, why don't I just go back to school? Cause at least we'll know that whoever. I understand hospice. I understand palliative care. I know what I want our program to be.

Nicole Knight: Why don't I go do it? And surprisingly, they said, Sure, go ahead. And I'm like, Oh, okay, so and 

Dr. Trumble: you were surprised. I was completely 

Nicole Knight: surprised in 2019. I went back to [00:23:00] school and got my nurse practitioner in 2020. 2020. Was it that? I think it was 2020. I think it was 2020. Yeah, it was a hands on, actually it was both.

Dr. Trumble: So nine 

Dr. Trumble: years into our 

Nicole Knight: nine years into our hospice. Yeah, I went back to school in the height of, I think it was 2018 actually is when we started because it took me two years to do it. 

Dr. Trumble: Okay. 

Nicole Knight: But Dr. Trumble graciously wrote my recommendation letter for school, which was awesome. But yeah, so we decided to start palliative care.

Nicole Knight: We had a handful of patients that we were providing care to. And then we ended up finding a really awesome nurse practitioner, Sony, who stepped in and really just spearheaded everything and has taken the program from, one patient to, I think 70 is what we usually run right now in the palliative program in service.

Nicole Knight: The entire city of Houston. Always available to help if anybody has any questions about that about palliative care. So palliative care is an interesting little caveat, [00:24:00] I think, to, we were, it's funny because we were just talking about that in my office before we came in here about the just.

Nicole Knight: the pocket of what palliative care really is. It's, there are no technical requirements. There's no list of requirements you have to be on palliative care other than have a chronic illness. A lot of people view palliative care as a like a stepping stone to hospice.

Nicole Knight: I've heard it referred to as hospice light a lot. Really it's managing symptoms at home. The goal for palliative care is to keep people out of the hospital, but you can still. pursue aggressive treatment, which is different than hospice. So hospice is more comfort focused. We want to make sure the patient is comfortable and symptoms are managed.

Nicole Knight: And you're really at the point where you're not aggressively seeking curative measures for your illness, whereas palliative, you can still do those things. You can still get radiation, for example, you can still be doing, chemotherapy for cancer treatments. It's probably one of the easiest things to talk [00:25:00] about is a cancer patient who maybe has uncontrolled nausea and vomiting.

Nicole Knight: And we, they can't get it controlled, and it's a big issue, and it's a, a quality of life issue for the patient. You could refer that patient over, or the patient could call the palliative care program for an uncontrolled symptom, which is, nausea and vomiting, and then we could.

Nicole Knight: Come in and manage that symptom while you're still aggressively pursuing chemotherapy. So that's one of the cleanest cut, I think, explanations of the difference between palliative and hospice. 

Dr. Trumble: Yeah, and there's a, there's different payment sources for palliative care they have available to them that hospice doesn't because they want to get into the Medicare Part A, Part B.

Dr. Trumble: Correct. And hospice is limited to the Part A. Palliative care is not limited to the hospice Medicare benefit. And so they're still in traditional Medicare or other payment sources. Correct. And so that's why there's availability to do different forms of therapy and treatment, which [00:26:00] really would be outside of the ability for hospice to pay for.

Dr. Trumble: And then of course, you're right, they don't have a terminal illness. It's more of a chronic care. Yes. Chronic care. Focus. On patients. 

Nicole Knight: Again, I think one of the most important things about palliative care, and one of the things that really drew me to it, is the ability to meet the patient where they're at.

Nicole Knight: Because it really focuses on what are your needs, making sure the patient has the right level of care at the right time. One of the things, being a hospice nurse for, 20 years before we, started the palliative care program, one of the biggest things that I always heard as an admission nurse way back when, is I wish I had known about hospice sooner.

Nicole Knight: That's one of the things that we always heard. And so being able to talk to patients sooner and not necessarily admit them to a hospice program sooner, but letting them know that hospice is out there and what it truly is. Because as we all know, hospice is a scary word. People get scared when they hear the word hospice and they think that it means, I'm dying tomorrow.

Nicole Knight: They're going to give me some morphine and I'm going [00:27:00] to, I'm going to die tomorrow. That is not what hospice is. And I think palliative care really does provide that bridge 

to 

Nicole Knight: bridge the gap between the unknown and the known and how we get them from a place of getting the right level of care at the right time, because that really is across the board.

Nicole Knight: The most important thing I think that families and patients need to focus on is. Making sure you're where you need to be, when you need to be there and getting the benefit, the full benefit of whatever that program may be as soon as possible versus waiting to the last minute because building and establishing rapport with a hospice team is important.

Nicole Knight: And not that we don't, hospice has come in all the time. I'm like, a little off topic here, but hospice companies can come in, at the 11th hour and definitely provide support and care, but it would be much more beneficial to the family, to the patient and to the team. If [00:28:00] we were able to establish that rapport with that family sooner versus later and really have them get the benefit of the support that we offer.

Nicole Knight: So that's what palliative care is. That's what we're using palliative for, is a stepping stone 

Dr. Trumble: to help. And so if they're still undergoing treatment, curative treatments or at least diagnostic and curative treatments to get through a certain diagnosis, they don't have a terminal illness, but it's possible, especially if the treatment fails.

Dr. Trumble: So if they're undergoing chemotherapy and radiation for cancer with the hope of being cured, but they have a lot of symptomatology that's possible. It's palliative. Exactly. If it gets to the point where it's clear that the treatment has not been successful. And they're going to need to transition to a terminal condition beyond hospice and to have the same providers, at least the same company, to say this is the same people that have been helping me out with the palliative care now will help me at this stage, which is something that maybe they [00:29:00] didn't want.

Dr. Trumble: But the reality is that they're going to be going to be dying. They're going to have, need symptom management through that. And we can provide both services, palliative and 

Nicole Knight: hospice. Absolutely. I think one of the other things that you just triggered in my brain is just the diagnoses. It's not just cancer.

Nicole Knight: So we're not, we're not just, hospice and palliative care is not just focused on cancer. That's how it started. And we were very focused. Medicare was very focused on cancer and making sure that cancer patients were very well palliated and had an option, if when they, When their treatments were no longer successful.

Nicole Knight: But that's not all that we do. We manage all kinds of diagnosis, disease 

Dr. Trumble: well with heart disease, lung disease, heart disease, lung disease a lot of neurodegenerative diseases. Absolutely. There's a whole list of them, Alzheimer's and dementias are, yes, are a big one.

Dr. Trumble: Big one. And then chronic lung disease and heart disease. And those, kidney disease, any organ system that reaches the point where it's failing and no longer can support life. That's where hospice is. 

Nicole Knight: Exactly. Just to wrap things up [00:30:00] and in conclusion I just wanted to Say, essentially how grateful we are about where we started and where we've ended up and just how fulfilling it has been just physically, not physically, that's not the right word professionally and personally how rewarding working in hospice truly is and being able to help people In a, in real time.

Nicole Knight: When you're a nurse on the floor, you see these people for one, maybe two days, and you never know what happens to them after that. Unless they come back to the hospital, but in hospice and palliative care, you are with patients at least every week. You see them every week, families, you become part of their, their inner circle and their support system.

Nicole Knight: And you know that you're helping. There is no doubt. There, it is instantaneous. When you are. You do something and you see an outcome, a patient is in pain, we give them medication, we stay there until they feel better. It's just an instantaneous, gratifying thing, 

Dr. Trumble: yeah, and as I think back about it, as I said [00:31:00] earlier, I admired my mother. Who was involved in early hospice establishment in, in Houston and I wanted to be involved in hospice. And it was amazing to realize that at some point I was able to be a hospice doctor and then get involved with hospice.

Dr. Trumble: And then, Get that experience, and I think one of the best decisions I've made was to say yes to come to be with Vantage Hospice. I had turned down other hospices before. I'm glad that I said yes, because it's proved to be very rewarding. The vision that I had and that I shared with others at Vantage has really come to fruition.

Dr. Trumble: And probably exceeded what I thought it would be in terms of how large we've become. I know, agreed. How many people we've been able to help. at this point, at this special point in life where, you know, where you're dying. Yep. And you can help them, the families and then the even the healthcare professionals that are involved with that care.

Dr. Trumble: It needs to be satisfying, [00:32:00] rewarding in, in many ways. But primarily to know that you're doing the right thing at the right time in somebody's life, and that may be the end of life. 

Nicole Knight: Thank you for watching our podcast. It's so as stated earlier, this is the first of many that we're hoping to complete.

Nicole Knight: So please stay tuned and come back and see us.