What Hospice Really Provides for Families Facing Dementia

Ana Safarian: 0:00

A beautiful lady, and you know she's gorgeous. We talked to her, blonde, blue-eyed, beautiful lady, and I said, "What makes you want to go onto hospital care? Why are you giving up on labs? She goes,"Ah, I done what I needed to do. I feel like I'm a burden on my kids at this point. That she goes, "Auto, and she's in assisted living facility. She goes, "Autumn gonna go down and have dinner at the dining hall, or I want to go out to dollar store with the people at it. She goes, I'm just done because whatever I have to do in my life, I'm done, and I feel like there's no quality for me to stay anymore. Which, when you think about it, is a very smart thing to say, but it's heartbreaking as well.

Barbara Hament: 0:46

Hello and welcome to season four of Dementia Discussions. I would really like to take a moment to thank the guests who were on this past year, and to thank you, the listener. I really could not do this show without you. And over the past couple of years, some of you have called me. So I am encouraging more of you to pick up the phone and call me. I'm accessible, and I'm so eager to hear your story. I'm at 310-362-8232, or you can email me at dementiadiscussions.net. So again, thank you. I'm grateful for you, and so looking forward to another year of us being together. Hello, and welcome to Dementia Discussions, the podcast for and about caregivers. Today on the show, I am so pleased to have Anna Safarian. Anna is the administrator of Olympia Hospice

Care, and spoiler alert: 1:53

we're going to be talking about hospice. So, Anna, welcome to the show. It's great to have you. Good morning, Barbara. Thank you so much. Thanks. It's a pleasure for being here. Thank you. So I thought we would start out with just basic hospice information. What is hospice? Who qualifies for hospice? So I think we all know that hospice is intended to be an end of life service, right? Yes. Yeah. So, what would you say if I were to ask you what's the definition of hospice, or you know, who's the main population that gets onto hospice?

Ana Safarian: 2:30

Okay. Well, I'm just going to start off by saying hospice is a benefit covered under Medicare Part A, which is 100% covered under the Medicare guidelines. Who qualifies for it? It's obviously people that have a terminally illness, but there's so many other umbrellas that fall into it, like COPD, congestive heart failure, advanced Alzheimer's. There's a lot of things. Before hospice was only like six months or less, but now there's a lot of other things to look for when a patient is qualified or not. For example, if a patient has it is living with a caregiver and was eating, I don't know, 100% of the meals six months ago. Now she only eats half 50% That's a trigger. A patient is losing weight. That's another trigger. So it's kind of things to look out for. Patient sleeps more. That might be a indication of a UTI, which you know requires more frequent hospitalizations and more frequent antibiotics. So those are all things that qualifies patients for hospice care. Really, under Medicare, under Medicare. Basically, it's at the concierge level of care at home when the patients or the families don't want to take the patient back to the hospital back and forth. So they rather be at home, comfortable with the caregivers or whoever's taking care, and the medical team coming to the home. Correct. So we have our medical team. We have the doctor that will come home see the patient. RN registered nurses, licensed vocational nurses, certified home health aides to help with bathing or grooming or whatever the needs are. We send a podiatrist home to take care of the podiatry. If they need an ophthalmologist. We send that home. Basically, it's whatever they would need at home. We would cover. We also cover all of the supplies if a patient is incontinent, you know, such as diapers or chuffs, whatever creams, gloves, like so. The family doesn't need to go out and buy them anymore. So it's like a one-fashion.

Barbara Hament: 4:41

So that is interesting. I have not heard that podiatry, ophthalmology, these are all services. So some of the specialists are covered under Medicare, under hospice.

Ana Safarian: 4:52

Yes, they are, and then we also, you know, some agencies prefer not to offer it, but I prefer to offer it because. It's a comfort for the families. The patient wants physical therapy. We also give them some physical therapy, and those are all out-of-pocket expenses to the hospital agencies. We don't build Medicare for anything extra. It's like the service that I provide just for you know the families. Will be they want a patient to try physical therapy or speech therapy. We do all that, really. Yes, yes. Or OT, SP, TT, all those.

Barbara Hament: 5:30

So occupational speech therapy, physical therapy. They'll send a therapist out there to see if maybe there's anything that a physical therapist could teach a caregiver, let's say, to transfer a patient, maybe learning some range of motion techniques, bathing techniques. Maybe the occupational therapist teaches some. I don't know dressing techniques, or I'm just guessing here. We

Ana Safarian: 5:55

met a patient recently that was having trouble using the toilet at the facility. We tried different types of toilets on top, and he was still having a hard time using it. We were at the mangan having a occupational therapist to go out there to help him, and it really did help him to be able to use his hands. So there's different variations, and we we try to do whatever we can to keep the patient comfortable and away from the hospital. That's our goal.

Barbara Hament: 6:25

So it's interesting because when you think of end of life, you're not really thinking about physical therapy, occupational therapy, you know, ophthalmology. Like these are not services you're really worrying about. I suppose, Barbara.

Ana Safarian: 6:42

You'd be surprised at how much the families ask for these things. They ask, you know, it's a long shot, but they ask if they can get some physical therapy and for mom, and just for to appease their mind, physical therapists can go out there once and say, you know what, it's too late for the patient. We can't do anything, but at least the family knows that they tried to do it.

Barbara Hament: 7:04

Right,

Ana Safarian: 7:05

so it's all about that.

Barbara Hament: 7:06

It's all about that having no regrets. Families having no regrets. Yes, exactly,

Ana Safarian: 7:11

exactly. So we do everything we can to make them see that we try our best.

Barbara Hament: 7:17

Are there rare situations where people don't have Medicare? Are there some instances where a person might not have Medicare Part A?

Ana Safarian: 7:27

There, there are probably there are some patients that have like Blue Cross, Blue Shield, Straight Medi-Cal. We've had patients that have paid out of pocket, which is, I believe, it's 250 a day, which is the Medicare rate. They pay out of pocket if they really need the service at home. I mean, they won't do it for a long term. It's more of that end of life dying that they need a nurse to go home. You know, maybe a week or two, so they'll pay out of pocket. There's different instances, you know. And if you have straight medical straight medical,

Barbara Hament: 8:00

yes, can yes. So hospice is covered under straight medical, correct,

Ana Safarian: 8:04

correct, or Medicaid

Barbara Hament: 8:06

in the rest of the country. Medicaid. So is

Ana Safarian: 8:08

Blue Shield. Blue Shield also, we are contracted with Blue Shield. Even Kaiser, we did a lot of calls for patients that are on dialysis. They did hospice, and their

first question is: 8:22

Can they still continue with dialysis? Absolutely. If you know they're on dialysis, and if they have a heart condition, we use heart as a primary diagnosis, so the patient can go ahead and still do dialysis until they decide.

Barbara Hament: 8:36

So you can still go to dialysis several days a week and on hospice. Interesting. So here's another

question: 8:44

What if your end of life documents? What if people haven't checked the box that says no heroic measures?

Ana Safarian: 8:54

They can be admitted under full code, meaning they can still be on hospice care and still call 911 if their heart stops. They can still do the you know what do you call it the compression. So, but with that being said, what we try to do is every time we're out there, we educate the family into the impacts, the negative impacts of a patient getting those compression things when their heart stops because they can break a rib, or they can, you know, something could happen. So we always try to educate the family to go into do not resuscitate. And 95% time, we talk without into going into DNR, meaning if the heart heart stalls, they just let it be, because the negative impacts of getting those compression. We have life-sustaining treatments. Yeah, are really yeah cause a lot of damage to the. Once we see the patient starting to decline more and more, we'll talk to the family. The social workers will reach out to the family and explain the negatives and the positives. And once they really. Not notice the change, the decline. They'll change to DNR. They being the family. So

Barbara Hament: 10:07

we'll talk about do not resuscitate.

Ana Safarian: 10:09

Correct.

Barbara Hament: 10:11

Really allowing natural death.

Ana Safarian: 10:13

Correct. Which is the right way.

Barbara Hament: 10:15

No, that's good to know. That you don't have to start. Your documents don't have to start out as saying allow natural death. No interventions. No heroic measures. You know. I guess what we're saying is that it's a process, right? It's a process for anyone, any family, any patient to accept the idea that they're dying. You know, the effectiveness of the treatments is less and less, perhaps over time, and that we're really kind of facing mortality here. I think it's good to know that your legal documents can say, "Look, you want everything, and you can still go on hospice. Correct, right? You know,

Ana Safarian: 10:56

every family is different. There's different family dynamics. Some families know from the get go what to expect. Some families need some time, need some handholding, which we provide with the social worker. We have a chaplain. We have a rabbi that'll go out and talk to the family or to the patient and kind of explain the the process to them. Yeah, so it's a team effort, I would say, right. It is a team effort. One thing that I did want to mention, Barbara, as I said, like when a patient is an incontinent, they get all the supplies. We also provide all of the equipment at home for the patients, like hospital bed, wheelchair, walker, commode. You know, there's a lot of things that if we don't have, we order through Amazon for the family, so they don't have to get anything like a cushion for the wheelchair. We we provide that. As I said about the toilet a little while ago, but this patient was heavier, so he needed a bigger toilet seat. So we do all that. All the medications that the patient is on gets covered through hospice, so it gets delivered straight to home. They don't need to go to the pharmacy anymore to get the medications. You just want to throw it out there.

Barbara Hament: 12:06

So good thing that you're talking about the medication because my experience with hospices, they go through the medications. Like when you first get on hospice, the nurse will go through your med list side. Like is that a medication that's covered by hospice or not covered. You might come off of some of your medications if it's not covered. Is that is that true?

Ana Safarian: 12:26

That is somewhat true. Some hospice agencies I know will go in and just delete. I mean, DC all of the medications and just put them on comfort meds. We don't think that's the right way. Our doctor does not believe in that, unless the patient is like actively dying, and the family doesn't want any other medications administered except the comfort pack. But when we admit a patient, obviously the nurse calls the doctor, and if the patient is on blood sugar medications, we continue cholesterol medications, we continue blood pressure, we continue all of those medications because those are comfort. You don't want a patient going into a coma because their blood sugar went up to 400. You can't just cut off their medication, correct? So those are all comfort. I know some agencies don't provide antibiotics, but we do because that's comfort.

Barbara Hament: 13:17

So that's okay. So let's talk about that for a minute. So you had mentioned recurrent UTIs. Let's say pneumonia. Like these are things that come up right towards end of life. They're frail. They're not eating. Let's say they're you know less mobile. They're more vulnerable.

Ana Safarian: 13:38

Yes.

Barbara Hament: 13:39

Right to urinary tract infections, yes, urinary infections,

Ana Safarian: 13:44

yes.

Barbara Hament: 13:45

So you're so you guys provide antibiotics for these sorts of things.

Ana Safarian: 13:49

Correct. If we suspect, if we suspect something like in the respiratory, we'll do an X-ray for pneumonia. Yeah, we'll send an X-ray tech out to the home. They will do the X-ray of the chest if we're suspecting something respiratory like pneumonia. So if the res if the X-ray comes back positive, the doctor will always give antibiotics

Barbara Hament: 14:14

if the family wants

Ana Safarian: 14:16

it. If the family wants a Torah, you see they do. If we are suspecting the UTI. We do a urinalysis and obviously, if it comes about positive, we'll do the UTI. We'll do that antibiotic. Some patients are more prone to UTIs because they're in bed more, so we kind of monitor those patients more. Sometimes we'll do a urinalysis maybe every other month, just to like be safe, or put them on a prophylactic, just to make sure that they, you know, it didn't, it doesn't get worse. We also do parasynthesis at home if a patient has cancer and they're filling up with water. As long as the hospital put a port in. We will be able to relieve them of the water, so they don't need to

Barbara Hament: 15:05

talk about like fluid around the heart or fluid around the lungs.

Ana Safarian: 15:09

Yes, the lungs, the stomach. So we do all that. Our nurses are very much trained into, you know, cleaning out the water, fluid retention around the body. As long as the hospital leaves the port in there, we can we can definitely drag them out. We also have a wound company. If a patient has wounds, we have a lot of patients that have wounds. We try to prevent wounds by getting them APT mattress for the hospital guy.

Barbara Hament: 15:37

So you're talking about the alternative mattress? Yes.

Ana Safarian: 15:40

So those are really good at preventing wounds. But sometimes when we get a patient on, like we admitted a patient on Saturday, she had four different wounds. So, besides our nurse doing the wound treatment, we have to have a wound company to go out there and do a wound treatment, which we do. So it's a whole team effort. Hospice doesn't just mean a nurse just goes out. I just want to make this clear: it's a whole team. It's you know you can get a wound company, you can get X-ray, ultrasound, urinalysis blood work. It's a whole team, and home

Barbara Hament: 16:16

could be anywhere. This can be you're talking about you could be at a nursing home, a boarding, or retirement facility.

Ana Safarian: 16:25

Correct. It can be anywhere.

Barbara Hament: 16:27

It could be home is home. Home is home wherever you are.

Ana Safarian: 16:30

Wherever you are, we go wherever they are. But just with the nursing home, we do need a contract to be able to go in, or any other hospice company, assisted livings. We can go in no problem because it's patients' right to choose which hospice company they would want to go with, and that's about it. So we go everywhere. So you're saying really because most people we used to think of hospice. You know, you bring up the word hospice, and families think, "Oh, you're giving up on my mom. You're really not, not yes. Barbara, we have some families that will call and say, you know what, I want to take my mom for a CT scan, for example, or my dad for another workup. So we tell them once you leave hospice, because with Medicare guidelines now, especially now this past year, everybody knows about all the issues with hospices and all the fraudulent things that have been happening. So, you can't just admit a patient, let them go to the hospital to do a simple workup, and then come back and readmit them. That's like no good anymore. So we tell the families, it's your right to take mom to the hospital to get whatever needs to be done, but you're going to lose the benefit. We will not. Olympia will not take you back. You can go to any other agency; they might take you back. They 95% of the time they'll call back and say, "You know what? We're not going to take mom. We're just going to continue with hospice because they like everything going home to them. Okay, so explain that a little bit. So, what is the regulation? What is well? The regulation, like we had, we had instances where, like for example, we had a daughter that was she was completely in denial denial of her dad passing. So, every other month, she would send dad to the hospital for something. She wouldn't, and the dad was full code, which is her right. Send them back. Maybe, maybe we need medicine four times because once they go out to the hospital, you have to discharge them from hospice, so the hospital can bill Medicare. Can't be double billion. So we got D for that because Medicare's guidelines is if a patient is going back and forth to the hospital, which I agree with, is not really hospice mentality, right? They want to get hospitous, they like the service, but they want to go to the hospital to get whatever workup done. So now Medicare really looks at those agencies or those agencies that have that discharge trend, because Medicare's, which is true, Medicare's philosophy is if a patient comes to hospice, hospice should do whatever they can to take the patient home, unless the patient falls and there's blood dushing out of the head or whatever. Obviously, you want them to go to the hospital, right? Oh, they've broken a bone or something, or they have patients that have fractured a hip, so they have to go to hospital and maybe to sniff to get therapy and then come back. There's like fine lines. We admitting patients back, you know. A lot of the times we tell the families, you know, you can take dad or mom, but we're not going to be able to take him back because it doesn't look good on my numbers, and I don't want to take a chance being dinged for something that I could have controlled over. You know,

Barbara Hament: 19:49

you could have avoided, right?

Ana Safarian: 19:51

So, so with that being said, if a patient is dehydrated, before we didn't give IV. Now the past two years we give them. IV at home just to prevent them from going to the hospital. IV fluids. IV fluids. Yeah, interesting. Yeah, so we give them sodium. I mean, I'm not a clinic. I'm not a nurse, but I know there's sodium in there, just like a tuna, just as if they were going to the hospital to get like an IV. So that really helps the families, and it's a mindset for them that they don't have to take mom back to the hospital, and then usually when a patient goes to the hospital, they come back. Especially if they have a little bit of Alzheimer's, they get more. It gets worse because change of scenery. You probably know that as well,

Barbara Hament: 20:35

of course. Yeah,

Ana Safarian: 20:36

change of scenery, change of people. It kind of plays with their mind. So we try everything we can to keep them at home, you know. Interesting, interesting, right?

Barbara Hament: 20:46

Yes, yes, because it just shows that we have such a difficult time with death, right? Except that death is upon

Ana Safarian: 20:54

us. Yes.

Barbara Hament: 20:55

So we're we're putting it off. As I had one daughter said to me, "Yeah, my mom wants to die, just not today.

Ana Safarian: 21:01

Yes.

Barbara Hament: 21:02

So no one wants to die today, right? Maybe tomorrow, and probably not even tomorrow. Like none of us want to die. So that whole idea of accepting that death is coming-it's

Ana Safarian: 21:13

hard. It's hard. Yeah, it is hard. It's very hard. But I think hospice has evolved. I've been doing hospice since 2011. I think hospice has really evolved. It's a little bit harder, but once, like for example, for me now, if I see a patient without even reading their history and physical, and I'm not even a nurse, I can tell you if that patient is appropriate or not just by looking at them, because I look at different things. I look at different different areas. You don't have to look at a paper to see what a patient looks like. It's you know the way they look, the way they look in your eyes, their body, their everything kind of like sets the story up for them. So hospice has really evolved, and I want I wanted to say that we also provide insure for patients. I know we talked about nutrition and wounds. You know, some patients don't get enough protein or you know nutrition in their body. They don't want to eat, so we'll provide them with ensure of their liking whatever flavor they like. And families love that because they don't have to go out and buy it, or we provide them with boosters. You know, booster drinks is drinks. right? Those, yeah. So, I mean, depending on different hospice agencies, every agency is different. I believe in doing whatever we can in our scope to at least try our best to maybe give them whatever they, you know. Everybody needs to die with dignity.

Barbara Hament: 22:40

I mean, that's so here again, like boost an insurer, right? Yes. Meal supplements, meal replacements.

Ana Safarian: 22:46

Yes.

Barbara Hament: 22:47

Again, like you're. It's difficult to accept the fact that your loved one is not taking nutritionally, not taking in what they need, but it's declining over time. And you know, I worked in hospice years ago for a short period of time, and we used to talk about how the body doesn't metabolize the way it used to. It doesn't need, it can't metabolize. You know, like when we were younger. So it's okay that people people naturally eat less. They're not as hungry, and you know, sometimes I don't. You've probably had families say like,"We don't want to starve my mom, kind of thing.

Ana Safarian: 23:25

We don't want them to starve either. But I do believe in not force feeding them because then they could aspirate, and that's not a good thing for them when they're aspirating and they're choking, because that's obviously not comfort. So if they can, you know, take something in and keep it in, that's fine. If not, then maybe the insurer is just a better option for them.

Barbara Hament: 23:49

Okay, so that's another good question about swallowing. The nurses or the speech therapists, do they educate families? Yes,

Ana Safarian: 23:57

and we do. We can. We can also do a swallow test to see how capable they are of swallowing, and if and if it comes back negative, then we'll just move on to like giving them things that they don't need to swallow. We'll crush the medications for them because they're talking

Barbara Hament: 24:13

about like a bedside swallow test. Are you talking about a video swallow test? No,

Ana Safarian: 24:17

no, bedside,

Barbara Hament: 24:18

bedside,

Ana Safarian: 24:19

bedside swallow test. Yeah, everything is bedside.

Barbara Hament: 24:21

So bedside swallow test, and then the the speech therapist can tell them, okay, these are the consistencies that your loved one can swallow. This

Ana Safarian: 24:30

yes,

Barbara Hament: 24:30

avoid this. Use thickener.

Ana Safarian: 24:32

Yes, that thickener is really good. I think I'm glad you brought it up. We use thickener a lot to put it in the food to make the food thicker. We use puree diet, soft mechanical chop diet, or just so we have patients that just dip off of insure. They take three bottles of insure a day, and they're happy. They they don't want the food, and you really can't force feed them either because then they'll start pocketing them, pocketing the food, and then they'll. Aspirate, you don't want that, right? So we try everything we can. You know, every stage is different. I think the hardest for me as an administrator is to see families, patients that have small kids or young kids. That's a whole different family dynamic that we have to deal with. We have to be so careful, and we deal with them quite a lot. But then that's when your team comes in, your social worker, your chaplain, every everybody's on their toes, you know, just to make sure that the family's tucked in properly, to make sure that every question is answered.

Barbara Hament: 25:38

Absolutely, those are hard cases, certainly. So you touched on the comfort pack. Maybe talk about that a little bit. What is what's the comfort pack? Yeah. So

Ana Safarian: 25:48

every patient, depending on their allergies, but we have patients that are allergic to morphine. So obviously, we don't give them morphine. The comfort pack usually has morphine in there, has iodine in there, has acetaminophen. suppository, as bisectodol suppository, and a dolphinax. So it's for pain, constipation, fever, agitation. It's like a comfort kit. It's in a box that comes home. You put it in the fridge. By the way, every patient gets an oxygen pack just in case they need oxygen at any time of the day. So let's say they call at two a.m. in the morning, and by the way, we don't have an answering service. Our nurses are on call full full time. Nurses are on call 24 hours a day, after hours, and on weekends. So if they call and say, you know, mom is agitated, she's not doing well. The nurse, before going out there, will say, okay, open up the comfort kit and give them half the tab of the Ativan. That'll calm down the patient. And there's always orders. There's standing orders on the kit, so every patient has that at home or at the facility, just in case if something were to happen at any time, they have something to fall back on.

Barbara Hament: 27:06

And the morphine is that how is sublingual?

Ana Safarian: 27:10

It's sublingual.

Barbara Hament: 27:11

Is it a it's a pill or it's a liquid?

Ana Safarian: 27:14

It's a I believe no. I it's a sublingual pill that goes under the tongue. That kind of like how you saying just like a Zofran

Barbara Hament: 27:23

dissolves right away? It

Ana Safarian: 27:24

dissolves right away. Yeah. So I think the orders are 0.25 every four hours as needed, and then that could change as you know if the patient's getting worse, then the doctor will change the orders. We also do continuous care, which is a level of care close to like an ICU level of care at the hospital, where there's always a nurse present. As long as there's a skilled nursing need for the patient, we can do continuous care. And if the patient is actively dying, so so if a patient is actively dying and their symptoms are not being controlled by the current medications that they're on, we'll put a nurse there 24 hours a day to kind of give them the medications as needed, and we change orders as we go along. So let's say if one tab of morphine every four hours isn't working, then the doctor will change it to one tab every two hours. If that still doesn't work, then we'll go to one tab every four hours.

Barbara Hament: 28:20

Okay, so this is really at end of life when breathing patterns are changing. Very hard to watch, right? As people are not breathing normally at chain stop breathing is very difficult to see as a family member. So you're saying that hospice provides a nurse, continuous care nurse for 24 hours to kind of get a patient through that, get help a family, like reassure them that this is normal. Everything that you're seeing is normal with dying. These are the stages that people go through.

Ana Safarian: 28:56

So when a patient, like for example, the symptoms are like gurgling, agitation, remissing, that means they're in pain. Often, like a child, like a newborn child, they're grimacing, and they're you know that they're in pain. So it's the same thing, opposite, right? So one's coming into the world, one's leaving the world. So it's the same thing. So those are all signs and symptoms of pain, discomfort, agitation. So that's when hospice will come in, but we have to prove to Medicare that there is a skilled nursing need bedside for us to be able to change the level of care because that's a different payment already to hospice care. So as long as there is a need, we will do continuous care. So skilled nursing need could be like the condition is needs constant monitoring, like yes, actively transitioning, actively transitioning, dying. Especially if a patient is in a assisted living facility, like for example Brookdale, for example, they are not allowed to. Of liquid morphine, it's their guideline. So that's when, and if a patient's transitioning and after the dying, hospice needs to have somebody there to be giving that liquid morphine. It's on hospice because that's our patient. We have to. We're we're in charge of that patient.

Barbara Hament: 30:16

Do you find that sometimes people are they don't really need hospice, but they're on it just so that the family doesn't need or the facility doesn't need to call 911 in those situations.

Ana Safarian: 30:26

What there are some situations where patients do their own hospice prematurely, which is not a good thing, and I think hospices or nurses should be able to be able to evaluate to see if the patient really qualifies for hospice, so if they are ready, yes, it's a great thing because then they don't have to go out to the hospital if they're short of breath. They don't have to call 911911. doesn't have to come out, take them to the ER, have them wait in the hallway of a hospital because there's so many people there. Those are all issues for the families and to the patient, but if the patient qualifies, I think it's great because the patient can stay there. Hospice will go out, evaluate, and if there's a need for continuous care, then they can start continuous care and kind of monitor the patient.

Barbara Hament: 31:16

And I guess the hard part when with families caring for someone with dementia is that it really. This is all on the family. All of these decisions around the family. This is not a joint decision with the patient. Your spouse, your mother, your parent-they're not helping with this decision. Cognitively, they have not been able to help with the decision in a long time, so it's really on you and maybe gaining this support of your children, the support of your siblings to go on to hospice. I think that's sometimes a a big deal. It is 100%

Ana Safarian: 31:57

but there's that one person family that is more open for the conversation, like if there's three sisters and three brothers, or there's always this one person that will bring everyone together and say,"Look, this is what we gotta do for mom, because obviously what we're doing all this time is really not helping her. It's getting worse, so it's time to really sit down and face this issue.

Barbara Hament: 32:20

Yeah, and oftentimes that's us, right? Saying, "Let's look at quality of life over quantity. Really, it's a quality of life issue at this point. You know, does your mom have any quality of life? Let's talk about who she used to be and what she used to be able to do. If if many of those things are not happening anymore, you know.

Ana Safarian: 32:43

I I was with a patient last Thursday afternoon. A beautiful lady, and you know she's gorgeous. We talked to her, blonde, blue-eyed, beautiful lady, and I said,"What makes you want to go onto hospital care? Why are you giving up on labs? She goes, "I done what I needed to do. I I feel like I'm a burden on my kids at this point. That she goes, she's in assisted living facility. She goes, I don't want to go down and have dinner at the dining hall, or I want to go out to dollar store with the people at the. She goes, I'm just done because whatever I have to do in my life, I'm done, and I feel like there's no quality for me to stay anymore, which, when you think about it, is a very smart thing to say, but it's heartbreaking as well, right?

Barbara Hament: 33:30

Yeah, yeah.

Ana Safarian: 33:31

It's sad and it's heartbreaking. We're all aging, you know. Aging is a hard process. No matter if you look, your age or your dad, you know, we're all aging.

Barbara Hament: 33:40

Absolutely, every day. Yes, that sounds like a woman who is cognitively intact and can reflect. Yeah, can reflect back on her life. And I, I do want to have you back because I know your agency in particular does medical aid in dying, and I would really like to talk about that. Yeah, you are unique in that service that you provide.

Ana Safarian: 34:02

Anytime, anytime, we can set it up. This has been a true pleasure.

Barbara Hament: 34:07

Yes, this has been a true pleasure. I really appreciate because even as a professional, it's surprising how much hospice can do.

Ana Safarian: 34:16

Yes, and you know, if you have any family members or any caregivers that need more in services or anything, Alvin Morton to come out and explain and to prove that we do all these things that we say we did.

Barbara Hament: 34:32

That's great.

Ana Safarian: 34:33

You know, I know sometimes I and I just want to say this before we close out. I know when families have caregivers, caregivers kind of hesitant about bringing in a new team. They think that we're there to kill the patient, so you know they're worried about their job, correct? Because their kids are that person. We always explain to them that this we are a team. This is a team effort. We do the best for our mutual patient, and one. They understand that and they trust us. It's a green light moving forward. So yeah,

Barbara Hament: 35:05

really important point. You're not taking over.

Ana Safarian: 35:08

We're not taking over. And you know what? That kind of we've had instances where caregivers have intercepted hospice coming in by telling the families, "No, we don't want hospice. Hospice is going to kill mom? That's not true. We're here, there. We're there to facilitate both ends. I mean, we work with each other. You know the way we work. It's a team effort. We need the caregivers there as well, right? It makes our job easier.

Barbara Hament: 35:36

Yes, yes.

Ana Safarian: 35:37

It's a it's a it's a two way street.

Barbara Hament: 35:40

Yeah, it's a two-way street. They're there day in, day out, hour in, hour out, and your team coming in to help to help them. Yes, help everyone. Really,

Ana Safarian: 35:52

yes, it's our pleasure.

Barbara Hament: 35:53

Anna, thank you.

Ana Safarian: 35:55

My pleasure, Barbara. Anytime, and I think this was a great topic. And again, if you think of anything else, I'll be more than happy to do another one. We can do the next one on medical aid and dying because that's a whole different topic.

Barbara Hament: 36:07

Great.

Ana Safarian: 36:08

All right.

Barbara Hament: 36:09

So much.

Ana Safarian: 36:10

Thank you, Barbara. Have a wonderful week.

Barbara Hament: 36:12

You too.

Ana Safarian: 36:13

Bye

Barbara Hament: 36:14

bye. Bye. Thank you for joining us today on another episode of Dementia Discussions. If you're a caregiver or know someone who's a caregiver that would like to be a guest on the show, please call me at 310-362-8232, or go to dementiadiscussions.net forward slash contact and let me know. I would love to have you. Remember that you can follow Dementia Discussions on Apple Podcasts, Spotify, Google Podcasts, and many more. If you listen on Apple Podcasts, it would mean a lot if you would leave me a review. For any other information about this podcast, please visit me at dementiadiscussions.net, and please share this podcast with someone you know if you think it may help. Thanks again for listening, and I'll see you here again next time on Dementia Discussions.