Hospice Care: What Families Need to Know About Services, Equipment, and Support

Diane Carbo-RN & Tara Discuss

🎙️ Hospice Care: What Families Need to Know About Services, Equipment, and Support

When families hear the word hospice, it often brings uncertainty, fear, and many questions. What services are provided? What equipment is covered? Can families choose their own equipment provider? What support is available for caregivers?

In this episode of The Medical Equipment World & Healthcare: Get the Scoop!, Tara Slaughter sits down with Diane Carbo, a Registered Nurse who has worked extensively with hospice patients and families, to discuss hospice care, caregiver support, common misconceptions, and the resources available to help families navigate difficult healthcare decisions.

Together, they discuss:

✅ What hospice care really is and what it is not

✅ Common questions families ask about hospice services

✅ Caregiver challenges and available support

✅ Medical equipment considerations during hospice care

✅ Questions families should ask hospice providers

✅ Planning ahead and understanding available resources

At CFS Medical Supplies & Equipment, we work with families every day who are trying to understand healthcare services, equipment options, and available resources. This conversation was created to help patients, families, and caregivers better understand the hospice journey and make informed decisions.

🎧 Listen now and learn how hospice care can support both patients and their loved ones.

📞 CFS Medical Supplies & Equipment & CFS Solutions DBS
(310) 817-5373

🌐 www.cfsmedicalequipment.com

🌐 www.cfssolutionsdbs.com

📱 Download the CFS Medical Supplies & Equipment App
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🎙️ Podcast:
The Medical Equipment World & Healthcare: Get the Scoop!

At CFS Medical Supplies & Equipment and CFS Solutions DBS, our mission is to educate, empower, and support patients, families, caregivers, healthcare professionals, and business owners through practical resources, real-world experience, and meaningful solutions.

#HospiceCare #Caregivers #Healthcare #PatientAdvocacy #MedicalEquipment #SeniorCare #FamilyCaregivers #HospiceSupport #HealthcarePodcast

Transcript

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SPEAKER_00 0:02

Well, hello everyone, and welcome back to the medical equipment world and healthcare get the scoop, the podcast where we break down German medical equipment, patient care, and real world solutions for caregivers, families, and healthcare professionals. I am your host, Tara, with CFS Medical Supplies and Equipment, CFS Solutions. And whether you're new to DE or seasoned provider, this show is here to give you insight, tools, and stories that matter. And of course, we can always read that disclaimer. The information shared in this podcast is for educational and informational purposes only, and it's not intended as medical advice. Always consult with your professional healthcare regarding any medical display for the liability. You know, they got some equipment, but their little one was in the hospice, but now they are no longer in hospice and the equipment's being picked up. Um, I didn't like the hospice. I mean, all these things. I we hear it all, right? And so I said, Diane, I want you to talk to the audience about hospice, the fraud that's going on in hospice, uh, what families should look for with hospice, what questions to ask? Because let me tell you guys, I'm learning today too, because I have no clue. So I'm excited to uh ask Diane some questions, and I'm excited to hear the answers. But for in the beginning, now what I'm gonna do is go ahead and read Diane's um her bio. Diane, welcome! Hi, Tara.

SPEAKER_01 2:05

Thanks for having me. We're gonna have a real hot topic here.

SPEAKER_00 2:09

Yes, we do. Yes, we do, and I am uh, you know, I because I feel for my the families that because they're they don't know or they don't know, you know, if they want to make a decision or make a change, they're uncomfortable, unhappy about how do they go about doing that? What should they look for initially? You know, all these questions. I have questions because I'm like, oh my god, like I, you know, I feel so bad for them because they didn't, you know, didn't know how to go about doing some of the things or whatever, and just kind of sharing information with um, as we do, resources and information, Diane. So welcome and thank you for taking out your busy time because I know Diane, you guys, has Caregiver Relief, a podcast, which is one of the top podcasts in healthcare for caregivers. And so I am excited when she takes out her busy schedule to come and join us on the medical equipment world and the healthcare get the scoop. So thank you again, Diane.

SPEAKER_01 3:03

Okay, Torah, I'm I'm very grateful to be here. Yeah, and and when you wanted to talk about hospice, I just want your listeners to know I've been around as a nurse for 54 years. That's what I'm saying. So when you said hospice, and I I I'll tell you when I'm hearing what about the fraud and stuff, I had to do some research because it was very confusing to me, and I'll tell you why. I I I've worked in hospice, but I've also been a nurse for a long time. And um I, you know, Medicare, the hospice benefit began in the 1980s. So it was just started, and it was a way to support terminally ill patients who had less than six months or less to live. And I want you to know that my father in the mid-80s, I had him I had him put on hospice. And I will tell you, in those days, hospice was very, very different. My dad was told he had a pancreatic cancer after a massive surgery he had. And if you don't mind, I'm gonna share a little personal story with you about if that's okay. My my dad was told he had cancer and that he had less than six months to live. Every my dad was a letter carrier, you know. He he had a timeshare he purchased in Hawaii, and every other year for six weeks he would go. And this was the year the he this was in we were he was diagnosed in uh late uh November. And in January, he was supposed to go to Hawaii for six weeks. And the first thing out of his mouth when the doctor tells him his heart, you could just hear see his heart sink, and he says, I guess I can't go to Hawaii. Well, I'm a smart aleck, and you know, being a nurse, I I was in my 30s at the time, and I just looked at my dad and I said, Well, you're not dead yet. You know, we'll just put you on hospice. You know, and my dad, oh my god, you know how people are about talking about death and dying. You just don't do that. Anyway, I said, if you're if you're feeling well enough, um I'll we'll get you hospice set up over there as well, so that you know, if you die over there, is that going to be a problem for you? He goes, No. I said, that's fine then. So he went over to on to I put uh he went to uh Hawaii, was there for six weeks. The first week he was there, he was doing so well. He came off of hospice, and it was like he he he lived a really good life. He was he just enjoyed himself so much. The day before he was coming home to Pittsburgh, Pennsylvania. That's a long trip, you guys. For and he came home and we put him on hospice right away. And he died a few weeks later. But hospice then was it was different. It was it was there was a lot of volunteers, it was mostly run by non-for-profits, it was designed to be comfort care, nursing support. I think that one of the things that um people don't under don't know and understand is from the beginning, Medicare hospice was not designed to provide 24-hour care at home, it was only designed to supplement the fair family caregiver. And that means the family caregiver burden was already built into the model from the start. And this is uh this is frustrat this frustrates me because we're not prepared, the family caregivers aren't prepared. So it's all about dollars and cents. So that's so let's talk about how this changed from being a system of a lot of not-for-profits to now um uh in the 80s, uh late 80s, early 90s into the uh 20s, two 2000s, uh hospices were closing left and right. And I didn't understand why. And then I learned that hospices were uh the inpatient hospices were closing, the not-for-profits were leaving, and it was because the reimbursement rate was so low in those days, and it still is, for hospice that um the pe the companies couldn't survive. So move forward to the day Medicare thought, oh well, with all we we've got to do something. Our government, oh god, let we need less government, not more, but our government involvement said, Oh, let's solve the problem. We'll give the uh providers, the vendors who provide the hospice services, a daily rate. And they can get a daily rate to make money. Well, that it set us up for terrible, terrible fraud, and that's what's happening. And uh one of the things you're gonna learn is there the bad actors learned about hospice, how it could be profitable if they enrolled people who were not truly terminal. They provided very few services and they targeted people using misleading marketing or signed up people who without clear understanding or consent. So we went from a of this beautiful service to uh a payment system that can underpay high-quality, high-touch hospice care, but can also reward low service, fraudulent hospice operators. So we've got a we've got a uh a big growth in for-profit hospices. In fact, I'm gonna share with you that in California, in one building, there are 89 registered hospices uh registered to that address. 89, Diane? Yes, 89. And and to and get this, there are hospit there are more hospices in a two or three uh uh block area than ever before. It's just incredible. Um in fact, um, according to MedPAC, uh for-profit hospices accounted for about 82 percent of hospice providers in 2024, while hospital-based and the the hospitals uh hospices provided in skilled care declined dramatically. Um and it's really, really sad. And and the the problem with the hospice fraud is not just that it's stealing taxpayer dollars and our healthcare dollars, but it's damn it steals our trust and it's harming dying people, and it's confusing families, and it's also damaging the reputation of good hospice providers. Um the other thing, of course, you know, the government, you know, they meant well, but everybody tells me the the road to hell is paved with good intentions, yeah. And while um uh they you know thought this daily rate, so if the hospice gets paid, whether your hospice provider shows up every day or not.

SPEAKER_00 10:47

And that's the qu that is that's really interesting you said that because I had a client actually the a few days ago, and she was complaining to me about um the hospice company that she was with didn't wasn't showing up. I think she said they came up once, and then she called them and they didn't she didn't hear from them. And I was like, Well, I don't know enough about it to even comment on it, you know? And um, so I just said, Well, maybe you should just call them. It's just kind of fine, talk to the manager as director, and just kind of see what they say, you know. But I keep hearing all these different stories of, you know, about hospice. I was like, you know, we need to talk about this. I need to just know. I because I want to know. I don't even know. I want to know too. Yes, yes, yes.

SPEAKER_01 11:32

And you know, there are steps, and we can talk about that. I know we're gonna talk about that later, but um I I want to get into people understanding that um right now um there are uh hospice provides uh it the reimbursement is $200 a day, a little higher, maybe $250 a day to provide care. Okay. And um it, you know, they used to have a lot of volunteers come, you know, to help visit and the chaplain and the social worker. I mean, there was somebody checking on the family. You know, the nurse may come once a week or twice a week or more often. Um the higher acuity level, you know, when you're really, really sick and they need oxygen, they need suction, they they need a special bed. Those kinds of cases are the the hospices lose money on. And that's why they want people that aren't really sick or aren't gonna require a lot of services. You know, when my dad was on hospice, an aide came three times a week to help bathe them. And, you know, initially he didn't have a bed in the ho uh they didn't bring a bed in until two days before he he passed. Um we didn't need it then, you know, he was able to still get up and do things, but uh when he when he went into coma, went into a uh a coma, we had a hospice bed brought in and we cared for him around the clock until he passed. Uh so there's all kinds of uh people die differently, yeah. And some people require a lot of medications. Uh you don't want to give a lot of medications, but there's pain medications, there's medications to dry up secretions. There's, you know, you want to put chapstick on people and lotion their skin to make them feel comfortable and and keep their keep them from breaking down. So you want to make sure you you treat their backs and bottoms and heels and elbows with lotions so that they don't break down. I mean, there's things you can do, and they do uh provide um air mattresses and stuff. That is not happening like it did before. It it's just not happening.

SPEAKER_00 14:05

Wow, I tell you, I know that there is a standard that they normally would bring in, right? So they do, I've seen them like they'll bring in beds and things like that, because I've had some clients where they'll bring they are on hospice and they have uh the bed that they're brought, which is technically the more of the of the basic bed that the insurance normally pays for. Now the difference with the hospice bed is that it it is a lot of times it is full electric, which just which is good. Now it still doesn't go high enough um or low enough and things like that. But you know, it I mean, I guess some families who are okay with that, they that's what they use, right? But I know you've had clients that they're like, well, I need something more advanced because I just need it's because they're doing a lot, they're suctioning their loved one. They're they're doing a lot, so they want something that's more that's the bed is higher, you know, when they elevate all these things, so it's just a little bit that goes into it. So I do see that, but I mean, just understanding the dynamic of it. So you talk about an agency that sets up a hospice, right? And then they bring in and they contract because I've had hospice companies to reach out to us to do some hospice, and we won't do it because it's just um it's just not um there's a lot that goes into it.

SPEAKER_01 15:25

And so for well, there is, and you know, the logistics are really hard for companies, you know. Um, first of all, I I find it really uh un strange that a hospice company, if a if a patient already has a bed in the house because of the care they're receiving, um, and they go on hospice, they have to change out beds. To me, that's the stupidest thing I ever heard of, you know, because the I'm telling you right now, these hospices are bringing in substandard equipment. I'm I'm just gonna I you may not see it or say say it, but I can because I've seen it and it and it's very frustrating to me when they're not bringing in a comfortable bed, they're not bringing in, I mean, they are still trying to bring in the old crank beds. I didn't even know they still existed.

SPEAKER_00 16:18

Yeah, it's it's it's rough. Well, the reason why they do the exchange is because an example, I'll give you an example. Say for us, if the patient is, um, we just forgot about your bio. Oh, that's okay.

SPEAKER_01 16:33

I'm a caregiver relief.com.

SPEAKER_00 16:35

Look me up. There you are. Okay, then you can just go and check out her her bio right there. You can on here, anyways. Okay. But um, well, normally what happens on I'll explain that part. So you have a patient who may be just an example on on insurance, and they may be on getting their equipment. They may have a bed in there on the home, and now they're switching. So this is an example for us. So we're a provider, we may provide the bed, we're billing insurance direct for it because of the what they're on. Well, now the doctor has put the patient on hospice, maybe a different doctor um for whatever reason. And then we're not a contracting, we're not contracted with that particular hospice company. So that hospice company may have a contract with another supplier that may can get the equipment at a reasonable rate, whatever that rate is, a contract they have, and then that's when we would have to go in and pull our bed out, and then they would bring theirs in because their patient, the patient is with hospice now. Now, for us, we don't do hospice, but what we because logistically it's just not it's not feasible for us. Now, it doesn't say mean for someone else, but for us, we deal with a lot of innovative products, and so because of that, a lot of the patients who families who are on hospice, they call us in to bring in better beds. Now they still remain on hospice, but they just want a better uh bed, right? So they they may say, Oh, you know, I need a better bed, I need a better lower loss. Uh, I need you to bring that in, and they'll pay out of pocket for that.

SPEAKER_01 18:13

Yeah.

SPEAKER_00 18:14

Because their loved one to be comfortable, they want that the best uh product that can do all these different positionings and all that. The regular beds don't do that. Um, so that's what they bring those in for.

SPEAKER_01 18:26

And and you you know, Tara, I think that when you're going actively dying, uh I will tell you right now, families don't know you're supposed to turn a patient every two hours to reposition them and to do skin care and to look for breakdown. And a comfortable bed with the right uh mattress and product products can give a um give some give somebody comfort, their the family, the patient, uh, a comfortable uh end-of-life experience. Yeah. I I'm finding some of these beds, I mean, they're still bringing in the crank beds, the they're not even putting on an air, uh, a low an air mattress on some of these beds, or even a gel foam mattress for their butt. And you know, I'm like, it's it's it frustrates me. And they're not always providing the the chucks and all the things that you need to put under a person to keep them clean and dry um and comfortable. So, you know, there are a lot of issues I have with uh some of these hospice companies. Now, that is the difference between a good hospice company and a um uh uh uh an unsavory or one that is run by bad actors. The bad actors won't provide good beds, they don't want to provide all the um the the tools like the the air mattresses. Um they may be even skimpy on the the amount of chucks you you they provide. I mean, there's a lot of things that go in to um hospice, and you know, one of the things there's I'm s hearing and seeing is how uh people that have a high high need patients cost more. Um and it's more profitable for somebody to take somebody take a patient in that has the bare minimum. And and I think this is what comes uh comes into play is family caregivers don't know what they don't know, Tara. They just don't. And they they don't know that this bed can not only hurt them when they're turning and providing care, but it's hurting their loved one as they go through their dirt death and dying process, their skin's gonna break down. Um, it's hard to keep them clean. Um, there's just a lot of things, and they're not getting the support they need at a time of of uh uh when they really, really need it. Because I I just did a uh podcast yesterday with a death doula, and a lot of hospices are not there talking you through what happens at the end of life. They, you know, patients will call and say, Oh my god, this breathing is going on. What do I do? What do I do? And you know, in in in the olden days, you know, I come from the dark ages, you know, a nurse would come out and sit with you and explain and talk to you. But they don't do that. In fact, spots a lot of them now don't want to send a nurse out until after the patient's died to uh for them to deter, you know, determine that uh the patient has died to to sign the death certificate. And um that's Sad. So we, you know, we really have a situation where families that need support they deserve support. And that's why you and I are doing this because I want people to know you have rights.

SPEAKER_00 22:14

We're gonna get killed too. My gosh. Like, oh my goodness. Like, yeah. So I I'm gonna ask you some questions, Diana. I'm gonna have um, yeah, because I we want to know. Inquiring minds wants to know. And the big thing is we want families to not feel like they're alone and we don't want them because I I'm telling you, I don't even know what to do. Like, what should I call them? Is it okay? You think it's okay? You know, all these things. So, yeah, so I'm gonna just jump right on in. So Okay. Um, I'm one of the questions why is hospice such an important topic for family caregivers right now. Well, you know what?

SPEAKER_01 22:49

First of all, we are have a system uh where uh Medicare has changed the reimbursement rate for everything. We're moving to a cost-sharing plan, and one of the things I'm seeing is um I I shouldn't say it this way, I'm gonna say it in a more appropriate way. Um family caregivers are have are the largest pillar of the long-term care industry. They are unpaid, uneducated, and provide $1.1 trillion in unpaid care. And the um I'm gonna just say shit rolls downhill. And I'm sorry, but you know what? The the hospitals aren't doing the care, this the therapists aren't providing the services needed because of the reimbursement, and everything is falling onto the lap of the family caregiver. So we are really at a really critical time. There's many things going on, and the next few years are going to be awful for us, and it's going, and this is gonna and it's gonna impact the future of health care. We really need health care reform because in the next five years, the baby boomers are going to the end of the baby boomers, the youngest are going to be retiring, the oldest are turning 80 soon, and uh so we're going to see death and dying a lot more, and we need support. Uh, with all the low birth rates, every generation since before the after the baby boomers has not replaced themselves in numbers, in population. So we have a situation where we don't have enough youth to take care of our our elderly, and every generation after us is going to deal with this because um there's just not enough, you know, and we also have more solo agers and childless couples than ever before, and that's going to impact us. We also are going to have a we have a situation where our youth is our tax base and they're our workforce. So things are going to be costing more and more as we move into a system. And there's one other dynamic nobody else is talking about that's really going to dramatically impact health care is the baby boomer nurses my age are retiring in the next few years. And um there that's like one-third of the nursing population in hospitals. And the young nurses, we do not have a shortage of nurses. We have a shortage of nurses who do not want to work in stressful uh situations that they're placed in. They don't want to work there, they're at the younger nurses are saying, hey, I'm interested in a quality of life. I'm getting beaten up by patients, and management blames everything on me. And one of the things that's frustrating, nurses don't make, I know people think, oh, they make great money. Yeah, yeah, yeah. Well, let me tell you, I'm in South Carolina. I have intensive care nurses that are only making 30 to 35 bucks an hour. And I came from Pennsylvania where nurses were were making that kind of money. Uh bigger the cities like New York and maybe in California, you may make it, but your patient care ratio is so bad, it's unsustainable and it's unsafe. So this is we're in a we're in a public health crisis right now that nobody's talking about. And hospice is such a beautiful uh thing, and it's meant to be um to be comfort-focused care for those with terminal illness. Um, and it's generally uh give you know provided uh or ordered when a physician believes life expectancy is six months or less, and if then if the illness follows a normal course. Um and it can be provided at home where they prefer because it's cheaper, but it can be provided in assisted living in a nursing facility or in some inpatient hospice settings or hospice homes, but those are going by the wayside because the reimbursement rate is so low that people don't the the facilities don't want that to provide that level of care.

SPEAKER_00 27:40

So you're saying that the facilities themselves are going away, but the hospice, but people providing hospice services is not though.

SPEAKER_01 27:50

Oh, that's rampant right now. We like I said, because of all the fraud.

SPEAKER_00 27:54

Right, right, right. Because the two they're getting $200 per day. So basically, you have a facil a company that owns a hospice, and they have um they're providing services in home for families whose loved one is on hospice, yes, and in doing so, that particular agency is charging $200 per day for that patient, your loved one on hospice, and then that's how they do it. But they may not show up, they might show up. Uh, this the equipment that you're getting, you might get it, you got you know, whatever you're getting, yeah, whatever is comfortable, compliment, whatever all that is, but that's pretty much how it works. So let me ask you the cut next question. What is hospice supposed to provide when it's done correctly? So, what should families be looking for? You like, hey, loved ones of hospice, what should I be looking for?

SPEAKER_01 28:48

Well, the hospice used to provide everything from a nurse going in to educate and assess once or twice a week, depending on the patient. They had uh services where an aide would go in and help bathe the patient maybe once, twice or three times a week, depending on the level of care needed. There were social services, you know, social workers would go in and see if there were resources. Um, they also would provide um care to the family caregiver and give them, you know, you know, talk with them and and work with them in a lot of ways. Like a perfect example, when my mom, my my dad was passing, my stepmother didn't even want me to change a band-aid on him. You know, she didn't want me to help, she didn't want me, and and it was really hard. Um, you know, she married my dad right after my mom died, and she just didn't care for me. I'm okay with that. Um, but we were all also never allowed to talk about my mom, and we had to act like she never existed. Well, a social worker came in and intervened because I asked for uh a consultation because I wanted to be able to provide a level of care that I knew my dad deserved, and she was not a health care provider, she knew nothing, so they intervened. But there also are chaplain services, and there are uh chaplain services that to meet the spiritual needs of a client and uh the patient and the family if that is something they want, and that's really important as well. Um, and then there's um I had one I worked for one hospice that had music therapy, and they would send in uh people that played guitars or their portable organs or pianos and and and entertain and provide comfort in that way, and it was just lovely. Um today's hospice is very different because um it is it's hard to do um to do provide those kinds of services. You have to pay for travel uh mileage, you have to pay for benefits for patient or the staff, you have to pay for so much um that it's if you get a nurse once a week, I I think that's a good thing. You know, they need for medication support. Um, I think the equipment is always um uh is is is always going to be an issue now because the uh the hospices really are struggling. And um to have good equipment, you're better off to privately pay for out-of-pocket. And that's one thing our our our listeners have to know, Tara, is we are moving to uh Medicare has moved and is continuing to move to a cost-sharing platform. So don't think that you're going to get away with uh if you want good quality care and good quality equipment and services, you're going to have to pay for it. There's going to be a growth in concierge nurse services, and there'll be a growth in uh PT services, all concierge doctors as well. We're already seeing that because the reimbursement has changed so much.

SPEAKER_00 32:20

Yeah. Well, I see that a lot. I see a lot of uh concierge doctors, um, and PTs, wound therapy, I mean, you name it, there's it's across the board now to have um concierge doctors, concierge services. And we kind of are like that, that concierge type of thing, because we're more personable. We're not just a traditional medical equipment company, if that makes sense. So, you know, we actually go physically into the home, analyze the situation. It's more personable, it's more of a concierge type of service, and that's what families want. And they want that, you know, that more of that consultated type of service where you know you kind of cover everything that they pretty much need, if that makes sense. Because even for us, resources for a lot of families too, like not just equipment, but I recommend like home health agencies and people I know, and oh, they call this guy, and that could be anywhere in the United States, like we because that ecosystem that we have, like even for my me and yourself, talking and communicating, and we've talked to so many different people, you kind of put these systems together, and now you're able to recommend, or you know, hey, call this company, call this person, and get those done and stuff. So the next question, Diane, why do you say good hospice can be a gift, but fraudulent hospice can be dangerous?

SPEAKER_01 33:45

Oh, that's you know, that's that's a a good question. And I have to tell you that um good hospices um struggle with bad actors. You have perfect examples right now of a good hospice cares about you, they're going to provide you with the best possible care they can, and they're willing to work with you. There's flexibility within them, and they show up, they they have a schedule, they they educate you, they support you, they provide you. You know, one of the things that a hospice also does is provide 18 months of bereavement services after for free. Wow. And and I can I can tell you that very few hospices even talk about having that. But I can I can also so who is uh the who are the bad actors? Um the bad actors in hospice are the ones they're they're the ones that are uh having you sign up, they you know, they they don't um they well you had an example the other day. You called me about about uh uh your one of your clients wanted to see the nurse's license or uh and the nurse wouldn't show her. And I'm like, oh my gosh, you know, I've done home care, I've done hospice, I you know, I have I you carry around your nurse's license with you all the time. It's just a little card. But you know, I can tell you that I have had family members, and I have no problems with this, that want to take my see my driver's license as well, and take my driving's license information down. I don't have problems with that. Maybe some nurses do, but having the nurse showing a license or at least you know providing them with a uh copy or whatever shouldn't be an issue. But um so and there are steps that you can take, but the the shoddy nursing um companies uh or the hospice companies uh just aren't going to provide you with a lot of care. They're not going to show, like I said, they're gonna show up or they're going to send uh substandard uh equipment, and you do have a right to refuse those things, and people don't understand it. And the other thing that patients uh families don't understand is you can fire a hospice and have another one come in. You have that right. Yeah, and I have done that myself as a care manager. I've had my clients call me and say, Oh my god, this is awful. And I'm saying that's easy. I call them up and say, You're out, get your stuff out of there, and we have another one come in. And you do have that right to what they have to do though.

SPEAKER_00 36:45

So like you're just you got one and you want to get rid of that one and you want to go to another one. How is it how you know how do you go about doing that?

SPEAKER_01 36:52

Well, you you first you would call um the the hospice company and and and here's the thing there's what you have to to deal with now, especially in California, Kaiser Permanente is I think your biggest managed care provider. Uh you have more managed care in that state for a longer period of time than the rest of us have had. So um, your situation is uh first, uh uh in reality, uh a managed care or ha or a social worker in a hospital should provide you with three hospice companies they can refer you to. That's really important. You should be able to have them come to your home, talk to you, and uh you interview them, and you go with the best company that fits right for you. And we'll provide you with a list of questions and stuff that you can have at the end of this. Um, we can do that. But um the other thing is um you have and and the thing is you can actually self-refer yourself to a hospice. People don't understand that as well. How does that work? Well, you know, let's say your your family member is not feeling well and they start talking about palliative care hospice, and you want to look around. You can actually contact different hospice companies, they can come in, meet you, and evaluate you, and if they feel you're appropriate for their services at this time, they will call your doctor, your PCP, and ask for a hospice referral. So you can do self-referral. So if you have a hospice that you're not happy with, um again, you know, if you're managed care, you've got to go through the um Medicare or Medi-Cal system. You have to go through your managed care company to see what it what companies are in your network.

SPEAKER_00 39:04

Okay. When you have an advantage plan, pretty much.

SPEAKER_01 39:07

When you have an advantage plan. Yes. Or I know you have Medi-Cal, and that is another big thing is you know, they have to be willing to take your insurance, Medi-Cal, if that's your only insurance.

SPEAKER_00 39:22

Right, right.

SPEAKER_01 39:23

And that's a tough one too, because you know, nobody nobody in in in reality, I will tell you right now, the providers of of services don't want to take Medicare advantage, and they don't want to take uh uh Medi-Cal or Medicaid. They just don't want because the reimbursement is so awful and they don't make much money. That's why they like the traditional Medicare with a supplement plan. That's the reality of it.

SPEAKER_00 39:53

That's true. That's so we see a lot of that too. That is so true. Yeah. What should families understand before they sign the hospice paperwork, Diane?

SPEAKER_01 40:03

Um, well, I think that they they really need to uh understand that there are uh things that they can ask and um