Demystifying Hospice Care: A Conversation with Dr. Andrew Mayo, St. Croix Hospice

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Frank Jaskulke  01:24

Good morning, good afternoon and good evening to everyone out there in Medical Alley. Thank you for joining us on another episode of the Medical Alley Podcast. This is your host Frank Jaskulke, and today we're having a very important conversation, important for health care, but also important, I think, for all of us. We're in November, and it is National Hospice Awareness Month, and we're gonna be talking with Dr. Andrew Mayo, who is the Chief Medical Officer at Medical Alley sustaining partner St. Croix Hospice. Dr. Mayo, thank you for joining us today.

 Dr. Andrew Mayo  01:57

Well, thank you for having me. It's so nice to be here and to be talking about something I'm very passionate about, hospice and hospice care and its role in our health care system.

 Frank Jaskulke  02:09

Indeed, indeed. And maybe that's where we can start. I think, for a lot of us, especially, you know, our listeners work in and around health care and health technology. They they think about the role of medicine and health care and saving lives. And as a society, we sometimes don't like to talk about death and dying. What what do people still get wrong about hospice care and its role in broader health care?

 Dr. Andrew Mayo  02:34

Yeah, that's a very good point. You know, hospice is very much a loaded word. And, you know, you talk hospice, and people are like, oh, yeah, you know, we're not there yet. We're not ready for that yet. And, and yet, it's something that needs to be considered as part of the healthcare continuum. And so often people have misconceptions about what hospice is and what hospice can do, in their own lives, or for the lives of their loved ones. And so, you know, some of the things that people get misled or don't have a great understanding is, is that hospice is not just about end of life care, it's about living. And part of that is trying to live the best life possible with the time that you have remaining. And so that's a very important part of it. You know, obviously, it's associated with death and dying. But so much of it is about living the best life possible with the time that you have remaining. You know, when you look at statistics, hospice is meant as a six month benefit. And yet, the median length of stay for people on hospice is only about 18 days. And so we're not having those conversations about what hospice can do for patients, and just not having a good enough job in the medical field, even. There's physicians that don't understand what the hospice benefit is.

 Frank Jaskulke  04:10

Interesting. I want to come back to the benefit part in just a second. But maybe, can you expand a bit on even the physician side? Have you seen over your career is it getting better awareness? Are we still - do we still have a very large gap we're trying to close? Or has the perception changed or evolved in any way?

 Dr. Andrew Mayo  04:29

Yeah. So you know, in medical school, I was in medical school in the 90s. And we got very little on the end of life care, and we're starting to see that being brought into education now. But there's times when I'm out talking with physicians, and I remember one conversation where a physician said, you know, 'I don't refer to hospice.' And I said, 'Why don't you refer to hospice?' 'Well, every time I refer a patient to hospice, they die.' And I was like, 'Well, yeah. How late are you waiting to refer patients to hospice?' If it's a self fulfilling prophecy, you know, in terms of a patient dying if you're waiting till the last days of a patient's life to refer them to hospice, but hospice can be so much more in working with the not only palliating physical symptoms for patients, but also healing the social relationships, and the spiritual being as well as the physical body starts to dwindle, our spirit spiritual person, our social person needs tending to as well and hospice is able to do that, you know, in terms of providing a multidisciplinary approach to care for the patient, and really, that multidisciplinary care where, you know, hospice, we have a physician, we have a nurse, we have a social worker, we have chaplains, we have different types of therapists, music therapy, massage therapy, all coming together to care for the well being of a person at the end of their life. And it's a very powerful thing. And you know, sometimes, you know, whenever I talk to people about, and they asked me, What do I do? Well, I'm a hospice physician, I work in hospice. And it's always been, Oh, I'm sorry. Well, no, it's a blessing to be able to be involved helping people and one of the most critical times of their lives and for their families as well, and to provide that healing from a spiritual and social aspect. And also to provide palliation of a patient's symptoms so that they can live the best life possible with the time that they have remaining. And really, you know, when I think about hospice, Dame Cicely Saunders, who was the founder of the modern hospice movement, her quote was, 'You matter because you are you, and you matter to the last moment of your life. And we will do all we can not only to help you die peacefully, but also to live until you die.' And for me, those are so important, because that's how we approach the hospice patient. And that's also how we should be approaching life every single day, living the best life possible that we can with the time we have remaining, because none of us know when our time is up. 

 Frank Jaskulke  05:32

Wow. And so I wanna back up then on a practical piece, you had mentioned six month benefit, and I think I'm not even aware of this. So you're providing this great care. How accessible is it for people?

 Dr. Andrew Mayo  07:51

Well, the hospice benefit is available pretty much to everybody. Most private insurances have it. Of course, the majority of the patients that we have on service our Medicare patients, and it's completely provided by the Medicare benefit with no out of pocket costs we cover not only the nursing care and the social worker, chaplains, and therapists, but we also cover medications and all durable medical equipment that are related to that person's terminal diagnosis without any charge for patients. So it's very accessible. I think the things that are limiting accessibility is really talking about it and letting patients know that it's something that's available to them, and we don't do a good enough job in the healthcare industry in conveying that message. Only 50% or less of patients who are actually eligible for the hospice benefit received the hospice benefit. And so we have a lot of work to do yet. I mean, I have to confess, you know, I was in family medicine for 18 years prior to being in hospice, and I delivered babies, I worked in the hospital, I worked in the nursing homes. And now that I've been in hospice, I look back at all the missed opportunities that I had to even suggest the presence and the benefits of hospice and, you know, just think back, you know, let's say you take a patient, Mr. Jones, you know, a random, this is HIPAA compliant. And, you know, 'Mr. Jones, you've been in the hospital three times this last month. You've gone from the nursing home to the emergency room, into the hospital for your congestive heart failure. They've patched you up and sent you back to the nursing home only to go into heart failure once again, go back to the emergency room and back into the hospital. You know, Mr. Jones, how do you feel about that? If I could tell you that I can write you a pill right now that's going to take care of your shortness of breath, it will take care of your pain, it will take care of your anxiety, and you never have to go to the emergency room again, would you want me to write that pill for you?' And I bet nine times out of 10, that patient would say, 'Yeah, Doc, write that pill for me.' Well, that pill is hospice. If hospice was a pill, it would be a multibillion dollar medication, you know. And yet, less than 50% of people are getting that benefit when they're actually eligible for it.

 Frank Jaskulke  10:49

Interesting. As you describe that, right, I hear that, and I think if I put myself in the shoes of a patient, yep, I'd want that pill. So it sounds like the awareness challenge, right, there is a general public awareness challenge. But then there's also a clinical awareness challenge of making sure the you from many years in the past is aware of this, but also it sounds like maybe not hesitant, or is willing to include this as part of their practice and a part of how they care for their patients. Is that fair to describe it?

 Dr. Andrew Mayo  11:30

Well, absolutely. And you know, in medical school, we're trained that death is the enemy, and that we stomp out disease at all cost. And so it's a very difficult thing sometimes to say, you know, first to have a conversation with a patient and to say, hey, how do you want to spend - you have a disease that may be life limiting. How do you want to spend the time that you have remaining? And how can I help you achieve your goals? And so very much important to understand the story of a person and to how they've come to be where they are in their disease process, and where they want to go and how they want to spend their time with the time that they have remaining. And then be able to facilitate that. And some, it may be pursuing aggressive care. But for many, it may be respecting their wishes and saying, Here's what I can do. Here's what I can offer for you to live the best life possible with the time you have remaining. And for many, that answer may be hospice. My great grandfather was one of the mayo brothers who started the Mayo Clinic, and one of their guiding philosophies was the best interest of the patient is the only interest to be considered. And I think that that's very true. But it's a difficult prophecy or difficult thing to follow when we've medicalized the aging and dying process. And so what is in the best interests of a patient? Well, that depends on what their goals are, and having that conversation and understanding. And then being able to say, well, hospice may be part of that care continuum. It may not be pursuing additional chemotherapy; it may not be having an invasive procedure. It may be taking a step back and saying, 'Hey, let's take care of your symptoms. Let's bring in a team of health care providers that are going to work on providing symptom relief and palliation of physical, social and spiritual needs.

 Frank Jaskulke  13:48

Interesting. You've mentioned the social and the spiritual a few times. I would imagine, you know, the people that you end up seeing in St. Croix Hospice come from a wide range of backgrounds and beliefs and practices that have, you know, different views and cultures on how they live and how they die. How does St. Croix Hospice, take that into account or include that in the care that is provided?

 Dr. Andrew Mayo  14:18

Right, so our chaplains are nondenominational chaplains. And so we're providing that support to all patients, regardless of their background. And in many cases, you know, we do deal with people from all walks of life, all spiritual backgrounds, and we're able to connect. Because we're involved in the communities, we're able to connect them with people of their own faith, or, you know, even like with veterans, we have veteran programs where we bring in volunteers who are veterans to be able to spend time with other veterans, and so we can cater to the specific needs of any person. So hospice really is for everybody that wants it and we can connect those community services and the people that they need to feel comfortable speaking to.

 Frank Jaskulke  15:18

Interesting. And you had mentioned earlier the modern hospice movement. How has, in the time you've been doing this work, and I think we sometimes in the other work we've done with St. Croix Hospice, think of you all as being an innovator in this area. How has the kind of care you provided changed, or maybe I'd ask even like, what does innovation mean in this space that maybe is different from, you know, other parts of the healthcare continuum?

 Dr. Andrew Mayo  15:47

Yeah, you know, I think that, you know, innovation can come in many forms. And I think sometimes it can be very, very simple. Sometimes it's just a matter of being accessible. We're available at St. Croix Hospice on weekends, on holidays, and after hours. So just by being there, that's something different that not all hospices have done traditionally, being that available. And so I think that that in and of itself, even though it's not like technological or anything, it's very simple. Showing up when you say you're going to show up and communicating with not only patients and their families but with facilities to let them know that you have been there, to let them know that you've provided care, are very simple and basic things, but are significant in how people perceive hospice and how people are able to receive hospice. And of course, we've certainly embraced the technology side of medicine, and how can one not when there's a lot of things being developed that can really enhance patient care. And not only enhance patient care, but also facilitate our nurses and our clinicians in being able to do what really matters, and that's spend time with patients and their families and to be able to ease the burden of documentation and information. And so we use things like home care home base, which is is our electronic medical record that helps ensure accurate documentation, but things like text to speech we've incorporated so that it eliminates that barrier to input of information into the system, which is, you know, sort of necessary burden of modern health care. Also very interesting, we use a technology called Muse, and it's machine learning. And it allows us to identify patients who are going to be transitioning in the next seven to 10 days, so that we in the real world can increase visits and adjust that patient's care plan so that so that we can be present more often in the most critical times. Nearing the end of life. And so, technology like that enhances the care that we can provide by providing timely and wonderful care at the end of life when it's needed most.

 Frank Jaskulke  18:26

Yeah, it sounds like a great marriage of the arts and the sciences in medicine brought for the benefit of the patient.

 Dr. Andrew Mayo  18:34

Yes. We've also developed a lot of different programs, you know, programs like the North Star Dementia Program, which focuses on Alzheimer's care. All of our clinicians get additional training in addressing Alzheimer's. We have a voyage vigil program, which kind of enmeshes with that Muse program where we increase the presence at the bedside and try and be there when a person actually is taking their last breath. And so providing those types of programs is part of the thing that we continue to develop and continue to raise the bar in terms of hospice delivery care.

 Frank Jaskulke  19:16

Oh, that's fascinating. Okay, last question then, slight repeat, but I want to make sure our listeners, you know, get the message. For all those who are listening out there, if you were to leave them with one thing, what would you want them to remember or understand about the role of hospice care?

 Dr. Andrew Mayo  19:34

Well, I would always go back to that quote that we talked about: 'You matter because you are you and you matter to the last moment of your life.' And hospice does all that we can do to ensure that you have a peaceful death, but also that you live until you die. And that that last part of it, I think is just so important to remember about hospice, that hospice is about living the best life possible with the time that you have remaining. And that, you know, as a culture, I think we're becoming much more comfortable. It's a slow process, of course, because death is a difficult thing to talk about. But we're starting to see it in, you know, mainstream media now. Jimmy Carter, former president, I think he has been on hospice now for nearly eight months. And so I think that that brings hospice into a good light, and allows the awareness that it's there, and that it's accessible, and that it is about living the best life possible.

 Frank Jaskulke  20:44

I think that is the perfect place to wrap it up. Dr. Mayo, thank you so much for joining us today.

 Dr. Andrew Mayo  20:50

Well, thank you very much, and thank you for all that you do.

 Frank Jaskulke  20:54

Indeed. And folks, our thanks to St. Croix Hospice and Dr. Andrew Mayo for joining us today. That's been another episode of the Medical Alley Podcast. If you're not already a subscriber, you can find us on medicalalleypodcast.org or wherever you get your podcasts like Apple, Spotify, and now on our YouTube channel as well. And do me a favor. Would you share this episode with at least one other person this is a critically important topic. We want more people to be aware and to understand the options that are out there. If you did that, I'd really appreciate it. Until next time, have a great day.