EPISODE 7 - When and why to execute hospice. An exceptional way to improve your quality of life!

Hospice isn’t about giving up — it’s about maximizing comfort, dignity, and quality of life. Kara Snyder from Riverside Home Health and Hospice joins Jamie Callahan to explain what hospice really is, how it supports families, and why learning about it before you need it is so important.

They cover:

• What services hospice provides (and what it doesn’t)
• The emotional and spiritual care often overlooked
• How hospice is paid for (spoiler: it’s often 100% covered)
• What “graduating” from hospice looks like

This episode gently clears up myths and empowers listeners with knowledge — because every family deserves compassionate care at the right time.

📞 Questions? Call Team Senior at (541) 295-8230.

Transcript

Jamie Callahan: Hi, this is Jamie Callahan with the Team Senior Podcast. Our goal is to simplify aging society, grooms us to plan for retirement, but what about life beyond retirement, where the rubber meets the road? Perhaps you've had a stroke or you've been diagnosed with cancer, or maybe you're forgetting things and now you have dementia.

That's our area of expertise, and we are here to share our insight. And now the Team Senior podcast. Hi, this is Jamie Callahan with Team Senior. I am here today with Kara Snyder from Riverside Home Health and Hospice. Before we dive into the information that she's gonna share today, I want to give her an opportunity to introduce herself and tell us a little bit about what makes her an expert on hospice.

Kara Snyder: Sure. Thank you for having me today, Jamie. I have spent my whole career working in multiple healthcare settings. I started my journey after college in skilled nursing where I worked in social work for many years and until I fell in love with hospice and bedside care I have been a hospice consultant for.

Goodness, over six years now. 

Jamie Callahan: Very nice. That definitely gives us some insight into how you are going to answer some of these questions. So let's start by just having you explain what hospice care is and how it differs from like traditional medical care. 

Kara Snyder: Yeah, of course. So hospice care sometimes. You hear it referred to as palliative care or comfort care.

Sometimes those are gentle, gentler terms for the word hospice. 'cause sometimes it can be a little off-put for people. Hospice is what we consider comfort care as opposed to traditional healthcare. Which is referred to as curative medicine. So the difference between the two is when you somebody elects hospice care or comfort care, we are choosing to move away from going out to the hospital, having to chase specialty care all over the valley, going to primary care.

Pretty much the whole worry of having to get into transportation and go to a visit. Gets eliminated from somebody's plate. When somebody chooses to elect hospice services, all of their care comes right to their home or their home-like setting, and we provide everything we need right there. We become their specialty care, we become their primary care, and we also become their 9 1 1 service.

So anything they are going to need day or night, we will be there for them. They only got an have to know one phone number and they can get ahold of us day and night, holidays, weekends. It truly is a beautiful service. 

Jamie Callahan: I feel like this is a great opportunity to interject a photo that I saw some years ago.

Lots of people in southern Oregon know the name doc. John Forsyth, who's a retired cardiologist and also sits on the board with Celia's House, the Hospice House here in Jackson County. He used to make a presentation actually on navigating the end of life and populating your advanced directive and how to do that.

And in that presentation he shared a photo of what it looks like to be in end of life in a hospital versus what it looks like to be in end of life in your. Home, your bedroom where you're surrounded by all of your loving family and possessions that are very comfortable and familiar to you.

Whereas in a hospital, you have bells going off all the time and doctors coming in and interrupting you, and it feels very cold and like an institution. And I feel like hospice just really, allows a family to eliminate that altogether. So tell me, along those lines, I think folks always want to know what services exactly does hospice provide to patients and families when they do go home and they choose not to be in the hospital?

Kara Snyder: Yeah, of course. There is a team of people that get assigned to someone when they're on hospice services, and that team helps pretty much navigate from the day of admission all the way through the end and beyond what their care is going to look like. They will have, a registered nurse, we refer to them as case managers and that person is there to truly direct their care.

Any medications they're going to need, any medical supplies, medical equipment they are gonna be the one there providing bedside care whenever the patient needs it. So traditionally, you usually see a nurse visit at least twice a week, but that differs depending on what those care needs are and what they're actually providing during each visit.

Other than that, there is hospice aides, they're certified nursing assistants. They come in to help with personal care. So bathing assistance, sometimes that can be a pretty daunting task for a family to have to do. So it's one of those things that we can take off of their plate for them. And again, there's no black and white schedule for that either.

It's truly however often they wanna have those services. Usually we see families request. Bathing two to three times a week. Some people want it every day. Some people don't want it all. So it truly depends on what their preference is. Other folks on the team who are checking in with families, their social work support, social workers on a hospice team is there to provide resources.

So we are looking at, do you need caregivers in place? Let me help you get those services. Do you need help getting your final arrangements set up or burial arrangements, chasing paperwork, helping get food services in place? Social workers are there to provide all of those resources so we can make sure a patient is safe within their home.

The other folks on the team who are in Portman are chaplain services. Chaplains are, it's non-denominational, so they're not coming in to convert anybody's. Faith or anything, they truly are going to meet a patient wherever they are spiritually, and just that can provide a lot of comfort for folks to have someone to pray with or sing songs or just to be a presence holding their hand at the bedside.

That service is available for anybody who's having a hard time with the potential loss of their loved one, and that goes for the whole team, but especially spiritual care. We call it bereavement services, and that is grief support. So they start forming that bond with the family from before the passing, and then they continue to follow a family for an additional 13 months afterwards, which is pretty wonderful to know that they have a trusting relationship and somebody they can speak with during care and beyond.

Jamie Callahan: Wow, that's amazing. Even I didn't know that service was available for families after. That's really a blessing. 

Kara Snyder: Yeah, it's just, it's nice to have that trusting relationship. They're going through a lot and obviously there's a multiple stages of grief and as we're anticipating the loss of a loved one, that looks different for every person.

And so it's nice to have somebody they can walk through that journey with. And then I guess the last part of the hospice team is volunteer services, which probably one of the most important things. We consider them the backbone of what we do. And that can look different for every single patient.

We. Connect with multiple people throughout the valley. There are some wonderful people out here who have donated their time for residents out in this area. We have hairdressers, people coming out to do nails. There's pet therapy, massage therapy, aroma therapy, all sorts of things that we are able to bring into the home for patients that end alive.

That's 

Jamie Callahan: awesome. So I'm curious to know when you meet with a family who hasn't decided or doesn't even really know how to navigate what could be available to them with hospice, what is the specific criteria? Is there a set of symptoms that indicate that hospice is the right choice?

How do you help them navigate who will be eligible for hospice care? 

Kara Snyder: Sure. So hospice services this is a Medicare benefit, so we have to follow Medicare guidelines. And so how that looks is different for every diagnosis. Each diagnosis has a different set of criteria that we have to look at in order to qualify them for our services.

We see cancer, obviously a lot at end of life. That's an obvious one, but somebody doesn't have to have cancer in order to qualify for hospice. It's important that we're looking at people as a whole person. Sometimes it's heart failure, sometimes it's end stage renal disease. There are truly so many different things that we can do that helps determine a patient's eligibility generally.

Per Medicare guidelines, somebody does need to have a terminal illness. Their primary care physician has to certify that if their disease were to progress naturally without medical intervention, that they could pass within six months. Obviously, nobody has a crystal ball. Those are just things that we look at.

It's Medicare statistics and data, and we go. As long as we can prove that, yeah, maybe that could happen. We can get somebody on service and provide care for them in their home. 

Jamie Callahan: Yeah. And I've even seen people graduate off of hospice, like they go on hospice because they think that this thing is happening.

And maybe their condition improves. I. 

Kara Snyder: Yeah, we see that all the time and we love that because it just shows that a lot of people perk up when they come onto hospice services. It's amazing when you get those, the extra touch points or just to have somebody coming in multiple times a week managing your symptoms, looking at your medications.

Sometimes we're on so many things at the end of life that a lot of these medications, they interact with each other and they. They impact a patient's condition. So when you have a dedicated nurse coming in, looking at what's going on and able to make, essentially game time decisions in those very moments to help impact your care, we see a lot of positive outcomes for folks.

It's amazing sometimes. People are just lonely and having somebody come in to speak to them and just truly help get 'em through some of those moments you see 'em perk up quite a bit. 

Jamie Callahan: Sure. I feel like one of the biggest benefits with hospice is that it truly does improve the quality of somebody's life.

When we consider end of life one challenge I face when I'm talking with people and I'm sharing that sentiment either on the phone or in person. Person. Is that sometimes we as a healthcare community recognize that hospice might be appropriate for a family, but a family member, especially the loved ones, it's not always the patient.

In fact, it's probably less often the patient. It's more often the family member that feels like by signing up for hospice, they're essentially giving up hope, like they've accepted that this is the end. How do you handle those conversations? 

Kara Snyder: That is a very common thing that I have heard when meeting with families.

I think the most important thing to remember is that hospice is about quality of life. We're not there to hasten death and make it come sooner. We're there to make every day count. What can we do to make your days? The best they can be. We want to make sure that you're living life to the fullest. Just because you're on hospice doesn't mean now you're trapped in your house and you can't do anything.

We want you to go to the beach. We want you to go to the casino. We want you to go out and have fun with your friends and have a good meal if you can. Those are important things that we want you to be able to take advantage of. Yeah, 

Jamie Callahan: absolutely. Hospice is definitely not meant to cause a loved one to pass away sooner.

It's absolutely meant as wraparound services that allow someone to embrace the end in the absolute highest level of confident comfort and just really truly increasing their quality of care and we see that a lot. I'm curious to know why is hospice so important for not just the patient but also the family members?

Kara Snyder: I think that the way I always pitch it to a family is we become your safety net. It's nice to know that if you ever get into a situation, you have somebody to call. You're never alone. We're always there for you. Whenever you need us nights, holidays, weekends, it does not matter. You call us if you have questions and there's no silly questions.

We are here to help you. We're here to be a resource and. Truly we wanna take some of the workload off of your plate. It's important, especially as somebody is looking at the end of the life, that you are able to be their loved one. We want you to be their family member holding their hand and making lasting memories.

While you can let hospice take the work off of you, we'll chase the pharmacy and get your medications. We'll deal with your supplies. You get to be there and be their loved one. That's why it's so important. 

Jamie Callahan: Yeah. That's so awesome. And we. See that over and over again. It is a huge burden to be lifted from the family to have to do all of those things.

Let's talk a little bit about insurance. How does hospice get paid For 

Kara Snyder: sure. Like I mentioned earlier hospice is a Medicare benefit, so anybody with Medicare and doesn't matter if you are a Providence plan, if you are any kind of Medicare advantage plan, that part falls off. Medicare is pays for it with your part A services and it pays for it at a hundred percent that, and that includes all of your supplies, all of your medications, and everything that the team is doing for you.

There are no out-of-pocket expenses. That's awesome. So 

Jamie Callahan: we've talked about Medicare, many folks are Medicaid recipients in Oregon. Does Medicaid also pay for hospice? Yes, it does. It will pay for it a hundred percent as well. So is there ever a time when somebody needs to question their ability to financially afford hospice, or is hospice always covered by insurance?

Kara Snyder: Anybody who is Medicare or Medicaid eligible, it is covered without a doubt, a hundred percent all of the time. Sometimes there are copays or out-of-pocket expenses, but that usually applies to somebody who just has a standard commercial insurance plan. It would be good to have a conversation with your.

Insurance just to see what that looks like. In my experience, I've seen like a 20% out of pocket or something like that. But for the most part, all insurance companies have a carve out for hospice services because you never know when you're gonna need it. I should also mention that the VA and Tri West, they also pay for hospice services at a hundred percent as well.

That's 

Jamie Callahan: fantastic. So one thing that I hear when I'm talking with families is that they fear their ability to have an emergency dealt with when they're on hospice. So let me give you an example. So if I'm working with a family, for example, that we know prognosis says that they have five months to live, hospice would be appropriate in that setting.

A number of things. Will benefit the family in being on hospice, but a fear of theirs might be that if they are mistakenly electrocuted in the kitchen, that has nothing to do with their prognosis. Do they get to go to the emergency room? 

Kara Snyder: That can be a pretty gray area. But the long and the short of it is if there is something that happens when a patient is on hospice and we cannot control their symptoms within the home safely, we will send them to the hospital.

So an 

Jamie Callahan: example of that might be more applicable, because getting electrocuted could lead to a heart problem, obviously, but maybe like a broken bone. So they would go to the emergency room, it would get set, they're not getting admitted to the hospital. They're being discharged the same day that they've shown up, but.

I'm not sure. Can a hospice nurse in the home treat a broken bone or would they too choose to send them to the emergency room so that could get set and then come 

Kara Snyder: back home? Usually we will send them out. If the patient and family is willing, of course we'll send 'em to the hospital just to get the bone set.

Usually there is. Some pain control that needs to happen there as well. And so we'll send 'em out and they'll hold them on observation, generally do the services for us, and then we'll bring 'em right back home and get 'em comfortable again where they're where they wanna be. So what's the most important thing, 

Jamie Callahan: That you want families to know about hospice in terms of not just making an informed decision, also the.

The care that they're gonna get while they're on hospice. 

Kara Snyder: I think it's most important for families to know that it's never too early to start getting information. If you have questions about hospice, please reach out. It's so much easier to make informed decisions before you are. In crisis mode. I see so often people wait too long to reach out for services and at that point there have limited options because they just need something and they need it now, whereas it doesn't hurt.

There's no commitment. If somebody comes out and meets with you and gives you information, that's all it has to be. You don't have to sign up at that time. I should also let you know that. If you do admit onto services and you have a change of heart and you don't wanna do that anymore, now you wanna go to the hospital, you can always revoke services.

Just because you elect to be on hospice now does not mean that you are stuck if you choose not to do it anymore for whatever reason, maybe there's a new treatment you want to pursue or something like that, all you have to do is let us know and there are no hard feelings. We'll have you sign the paper and then you go back to care like you did.

Before you elected to be on hospice services, but please know that we are there to be a resource for you. We are looking out for your best interests and the best interests of your loved one. We want every day to matter and to count, and we want you to be able to be there to be their loving support.

Jamie Callahan: So here we are at the end of our podcast on hospice with Kara Snyder. I wanna say thank you so much for coming in and sharing this information. I just wanna say again that Riverside Home Health and Hospice, they are an absolutely phenomenal company. We've come alongside them with a lot of different patients and I can't say enough good things about not just their timeliness in care, but also their.

Commitment to the family and their hearts are truly in it. We love them. We love working with them. And if you have any questions again, I just wanna say you don't have to remember everything that you heard here today. Our phone number is available to you and we are extremely accessible. I joke all the time that if you call me on Christmas morning, I'm probably gonna answer the phone.

And we're gonna help you get connected to whatever it is that you need. Thank you so much, and we look forward to talking with you again next. Week. Thank you for listening to the Team Senior podcast. We're here every week sharing new and relevant information. Remember that we're just a phone call away.

Team Senior can be reached at 541 295 8230. Again, 5 4 1 2 9 5 82 30. Until next time, this is Jamie Callahan.