Our Way of Caring: The Vantage Hospice Podcast

Our Way of Caring: Vantage Hospice Podcast [Episode 9] Hospice 101: Support, Care, and What To Expect

• Vantage Hospice & Palliative Care • Season 1 • Episode 9

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In this episode of the Vantage Hospice podcast, host Nicole Knight sits down with Brandi Gabriel, the Director of Clinical Services at Vantage Hospice, to discuss what patients and their families can expect when signing up for hospice care. Brandi explains the initial process, the roles of various hospice team members, the importance of a personalized care plan, and what to anticipate during the first week of service. Additionally, this episode sheds light on end-of-life care and what families can expect when a loved one passes away in hospice care. Join us for this comprehensive discussion to better understand the journey of hospice care.

  • 00:00 Introduction and Guest Introduction
  • 00:32 Understanding the Initial Hospice Process
  • 00:54 Meeting the Hospice Team
  • 02:43 First Week on Hospice: What to Expect
  • 04:19 Routine Hospice Visits
  • 05:05 Building Relationships and Communication
  • 08:20 Preparing for the End: Honest Conversations
  • 12:19 Final Days and Support
  • 17:10 Conclusion and Final Thoughts


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.

Nicole:

Welcome to our podcast., Today we're gonna talk with Ms. Brand. Gabriel, if you wanna just start by telling us a little bit about yourself and,

Brandi:

Well, my name is Brandi Gabriel. I'm Director of Clinical Services here with Vantage Hospice. I've been here for almost nine years, however, I've been in hospice. Since, , about 2003 and served in various roles. And right now again, I'm serving as a director of clinical services.

Nicole:

Awesome. So we're gonna talk today about just what to expect in hospice.'cause, you know, I think when people sign up for hospice, they get really nervous. And scared and they don't know what's coming. And you know, that first week on service can be really kind of overwhelming. Yes. So when a person signs up, , what happens? Like they, they sign the consents and then what happens?

Brandi:

So you meet a host of people., The first person you typically you will meet is the RN that will do the start of care visit and as our admission nurse. So the admission nurse will do, , an assessment of you and your family's needs. The psychosocial assessment where we're talking about, you know, do you need any services like, , caregivers, , do you need any access to community resources? You might need help completing legal documents like FMLA paperwork if you're a caregiver and you need to take time off to assist in the care of your loved one. So things like that., You may also. Require or request the need for a chaplain, and we will do that assessment,, and we provide spiritual support to you., We also connect you if you so wish to be connected to someone in the community of your own faith affiliation. So we act as a liaison between us and your faith, community. Community., You may also require, , a hospice aide. The hospice aide is a certified nursing assistant, , trained. Specifically in hospice and end of life. And we provide assistance with personal care and ADLs, and that's the activities of daily living. So dressing, grooming, bathing, some like house chores in the home., Those things that would help maintain dignity and your overall hygiene. And then, , also your skilled nurse. So that nurse or your case manager is separate from the start of care nurse or the admission nurse. The case manager is the nurse that you'll see on a routine basis and they'll come out and help develop that plan of care, really determine how often you need nursing services, , and tell you what days of the week he or she will come. And they also coordinate with the aid and determine the frequency of the aid visits that you may require.

Nicole:

So it's important to note , that first week, there are a lot of people coming into your home. Yeah. So we're mandated by CMS to do, , assessments. Our initial assessments within five days of the day that you, , are admitted to service. So a flurry of activity, a flurry of activity, and those first five days, you're gonna have the admission nurse, the case manager. Mm-hmm. The social worker. The chaplain and probably the eight, at least two to three times a week probably. So it's important to note that that first week is, is not probably what's gonna happen moving forward. Life is gonna be a lot calmer. You know, you get to establish rapport with people as they come in and out of your home. But those init, that initial week is like hectic.

Brandi:

It is hectic, but it's also a time where you get all of kind of like the busy busyness of it out of the way. Typically when family members bring their loved one on hospice, you have all the people who met her most in the patient's life. So, , it could be the children who are in from out of town, the neighbors, everyone's come in because this is new. Mm-hmm. And so there are a lot of people who are invested in the life of the patient, and we wanna make sure that the entire team can see those patients within the first five days. It's also required by CMS like Nicole indicated, but it's also a great time to get all the people who matter most to that patient. Involved in that plan of care. They know what to expect. It's kind of like being pregnant, what to expect when you're expecting. Yeah, there. There you go. It's like what to expect when you're on hospice. So all the people who are a core part of that hospice team will be there within that first five days.

Nicole:

Awesome. So as you move. Past that first week really the first two weeks. Because you're still, I mean, if you're anything like get to know your face. Yeah. If you, you're anything like us, I'm sure you don't remember everything that somebody tells you Right. When you know you first hear it for the first time. So that second week is also a little bit of just reiteration of everything that we talked about in the first week. Making sure that you know how to access this after hours, for example, make sure you're clear on what medications are covered and not covered, or what supplies we're gonna be bringing. Making sure that you have everything that you need. After that is when the kind of the real work of hospice begins. So there's a, you know, a kind of a middle phase, right? And it's an adjustment, right? Adjustment. Right? It's

Brandi:

an adjustment. So again, that it's kind of like dating Exactly. Everyone kind of gets to know somebody in the beginning, and then you get your routine. So it's like any other relationship in your life where you meet people, you know what to expect, they know what to expect. We learn your preferences. We learn how to communicate with one another. So for example, if somebody who's really important in your life wants to be updated on your plan of care, because they work, we learn how to communicate with you. If it's best to call you, you know, after three because you get off at two, then we learn that and. So we communicate with you after three because your loved one might be in a skilled nursing facility or have a caregiver who's paid by you and you may not be in the home. So learning everybody's routines, knowing what to expect, and how to communicate with us if we're not present for that visit or if you're not present for that visit.

Nicole:

So how would you describe like a, a more routine type visit? What, what should they expect?

Brandi:

So after everybody kind of knows their team, you know when to expect the nurse. You know when to expect the aide, chaplain, and the other various members of the team. On a routine visit, the nurse will set an appointment with you. We usually give about a two hour window to allow for traffic and emergencies. But you'll know when to expect your nurse. The nurse will come out and do a head to toe assessment. Talk about what happened since the last time we saw you. So if you had any exacerbations in pain if you're just not feeling well or if you have a question about anything, we talk about, anything that's on your mind or what's most important for you that day. And then the nurse typically will go into the head to toe assessments. So that's taking your vital signs, like your blood pressure, your temperature, your pulse. We'll do a skin assessment just to make sure there aren't any changes in your skin. We'll talk about your diet and your intake how you're sleeping, if you're having any anxiety and then if you have any issues with those types of things. Then we talk about the medications that you may or may not need to treat the symptoms that you're having. We'll also review your medications to make sure that you have enough medications to get you along until the next time we see you. And again, we open up the visit for you because it really is your plan of care and try to gear what we do to best suit your needs. Exactly.

Nicole:

The other thing too is I know that when we're talking about nurses, and I mean it sounds very clinical, it's not always clinical. I mean, sometimes there, I mean, there are clinical aspects of every of the nursing visit, for example, but it's not only clinical stuff. As Brandi said, the visit is yours. So you're able to open up and talk about really anything that you'd like to talk about. Any concerns that you may have, any issues that may be going on that are not necessarily related to your health? Right. I mean, so,

Brandi:

so it, I mean. Hospice is for people who have some type of life, life limiting illness, but hospice is really about the living, and so it's about maximizing the moments that matter most to the patient and the family. So sometimes it's really just not about that disease or you know, the pain I may or may not be having. It might just be somebody being there and just talking about whatever that's on their mind. Sometimes people don't really want to talk about. The disease during the visit. Exactly. Or whatever's going on there. So we build relationships with patients and families. And again, we talk about what's important to them.

Nicole:

And also, I mean, it's also, I think, important to note that some of the things that we focus on is, well, not some, we really do focus on making sure that you're prepared, right. For what's coming next. You know, one of the things, and when I was a case manager, I know that we've talked about this before, you know, a hospice nurse, a hospice professional is not gonna. Lie to you about where you're at and about what's coming next and, and is gonna be very honest about, about what to expect. Because again, as Brandy said, to be on hospice, you have to have a life limiting illness. But we, I mean, and we do. I mean, our job is to make sure that you're prepared for what's coming, what we see, what we're expecting.

Brandi:

And so, and everything doesn't read textbook. Every person's disease trajectory looks different. And so we talk about what to expect. That's why we have a conversation with you. We really assess the patient from the moment we open the door. We may see that, you know, our patient was walking independently and maybe they're moving a little bit slower, and that leads us into the conversation about decline. I see you're moving a little bit slower. How is that affecting you? Right. You know, do you have everything you need? Let's talk about what this is looking like for you and how is, how are you coping with that? How is your family coping with that? Are you prepared if you need additional support in the home, if you may need assistance with bathing, maybe you don't have an aid from the onset. Do you need some assistance with somebody helping you get in and outta shower? It may not be the shower, it may just be, I need somebody to help me wash my hair. Right? So again, that care plan is really designated for what's going on with the patient at the time. But as Nicole also mentioned. We would be remiss if we weren't having those open and honest conversations. Oftentimes what we hear from patients and families is, I wish somebody would've told me this sooner.

Nicole:

Be sooner. Yep.

Brandi:

And it's a difficult conversation for most clinicians outside of hospice to have, and I can appreciate that. Doctors go into medicine for the most part, to save people. Mm-hmm. They want to make people better, and it's not a failure to recognize that sometimes we can't make everyone better, right? Mm-hmm. And there is a path in the healthcare arena for people who we can't make better. And that's hospice.

Nicole:

Awesome. Also, , sometimes you know, as Brandi had mentioned about the psychosocial and this and the spiritual, , aspects of hospice care, sometimes families need help, you know, kind of maneuvering those conversations and they need help. Just preparing. People in general for what's coming. So that, I mean, social workers and chaplains a huge, , benefit for, , a family, right?

Brandi:

Most people don't die alone., There's a community of people who love our patients. Mm-hmm., Sometimes there's a small child in the home, , maybe it's the spouse who's been married to the patient for 60 years. That spouse might have been responsible for doing all of the financial stuff. Mm-hmm. I've never, you know, written a check. I don't know what to do about my mortgage. Right., My husband was the one who took care of me, and so helping them think about all the things that will come. After the loved one is gone, how do I prepare my small child who lives in the home that mom, dad, grandma, grandpa, aunt, uncle is not gonna be here. And so even talking about, you know, maybe doing some type of life review, talking about, you know, what happened to them when they got married or their sweet 16, or how did mom and dad meet? And having those stories recorded in some type of way. So that legacy is able to live on. Exactly. So we, we broach those conversations because sometimes people think about it, but because they may be overwhelmed with other things which are more important at the time, it allows for those types of conversations to affect. Exactly.

Nicole:

So., The part that nobody really wants to talk about, you know, is what happens at the end. And I know, , there's a lot of mystery and, , fear, I think related to absolutely what happens, not necessarily at the end of life per se, but, , how, you know, what do you do, , when your loved one passes away and they're in the home? How would you describe maybe, the last week of what to expect on hospice?

Brandi:

I would say that if we said that it always goes a certain way. We would not be honest, agreed. If we were to say, it's like anything you see in a lifetime movie. We would probably not be very honest. Right, right. What I would say is you should expect to be supported.

Nicole:

Great answer.

Brandi:

At the very least, you should expect to be supported by the people you've entrusted to provide hospice care. Now, typically, a patient will have a gradual decline and there may be some sudden change. Right. And now it looks like the end is near and we can predict days., Till the person may pass or die., So what you should expect is that your hospice team is going to be readily available and accessible to you 24 hours a day, seven days a week. When families ask me how often should we expect a nurse, how often can I have the nurse? My typical response is, our team should be available to you as often as your loved one. Systems require it. Or as often as you need it. So sometimes it is not about doing something physical. It's not about taking the blood pressure, right? It's not about administering a medication. It is about being that gentle presence to be along with you during that journey. So is that daily? Possibly. Is that twice a day? Possibly. Mm-hmm. If there's a symptom out of control, there's a level of care called crisis care that we can place the patient on where there's a nurse at the bedside, , to support and help the palliation of those symptoms or the treatment of those symptoms until the patient's symptoms are relieved or until the patient has a point of comfort. Awesome.

Nicole:

So when we talk about like. The last visit, right? Mm-hmm. Everybody's, I know people get very, very, , nervous about the last visit., How would you describe that last visit? So, I, you know, mom has stopped breathing and what, what do I do? Then?

Brandi:

You should call hospice. The first thing you should do is call hospice, and then you allow us to take the lead from there. The nurse will arrive. There will be an assessment of the patient, , and look for signs of life. If the patient doesn't have any signs of life, the nurse will pronounce the patient. And when we say pronounce, we say that the patient has officially died., And from there we, , verify the funeral home of choice, and we will make all of those calls for you. If you've prearranged or select, not necessarily arranged, selected a funeral home, we'll call the funeral home. We'll make sure that your loved one is,, has final care, so we will make sure the the body is clean and presentable for the family, or any loved ones who wanna see that patient that one last time, and then we stay with you until the funeral home. Picks up your loved one's remains. Sometimes patients would like their clergy to be there, so we'll make the call for either our chaplain to come by. We can call your clergy person to come by., If someone wants any type of prayer, , our clergy or our clergy, clergy, our chaplain can provide that., But it really is a sacred time and it's about how you want to best be supported. There are technical things that the nurse will do like. Again, call the funeral home and prepare your loved one for the last viewing in the home., And then just really be a supportive presence. It is a sacred time and we wanna respect the, that last time that you'll see your loved one in their home environment. Right.

Nicole:

Also, just a side note, , in Houston and surrounding areas, sometimes police departments have to be contacted,, which depending on what county, depending on what county you live in, so. That, that may be a part that, , that we would do., And then we would, you know, just talk with the police department and handle as much as we can. You know, saving you guys the,

Brandi:

it's, it is a responsibility. Yeah. That would be required. But I think most importantly we want patients and families to know that it really is their journey. We are here to support them on that journey in any way that is appropriate for them at that time in their life.

Nicole:

Exactly. So, , just wanted to say thank you so much for joining us today and I also wanted to let everybody know, , it's actually very interesting 'cause you have like the, the two head honchos of Vantage right now. So, , the administrator in the DCS, so like all the decisions that are made advantage are made by the two of us., Brand and I have been working together for a very long time and, , anyway, so thank you so much for joining us today. You're welcome. And welcome. I'm sure you will see her again, , you know, during, during our podcast, , journey. So thank you so much.

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Nicole Knight, FNP

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