Podcast #141 What Can We Do to Create Gentle, Empowered Endings? – Dr Bob Uslander

How do we support individuals to do death better?

#1 Realize that the medical system isn’t set up to address the gaps for the dying and their families.

#2 Identify for you and yours: what are the gaps we are going to have, and what might possibly fill them?

#3 Look into resources ahead of time.

The bottom line: We aren’t very prepared and there are gaps we really should know about. Take your head out of the sand of denial and have a look around, starting with listening to Dr. Uslander’s naming of “the five gaps people don’t see coming” in this important episode.

⁠https://empoweredendings.com/⁠

⁠https://www.facebook.com/empowerendings⁠

⁠https://www.linkedin.com/in/bobuslander/⁠

⁠https://www.instagram.com/empowered_endings_/⁠

⁠https://www.youtube.com/@Empowered-Endings/⁠

Transcript:

Diane Hullet: Hi, I’m Diane Hullett and welcome to the Best Life, Best Death podcast. Today I’m here with a guest out of California. Welcome to Dr. Bob Uslander. 

Dr. Bob Uslander: Hi, thanks Diane. 

Diane Hullet: How am I saying that right, Bob? Is it Uslander? It’s 

Dr. Bob Uslander: Uslander. 

Diane Hullet: Uslander. Beautiful. So Bob Uslander has co founded the Empowered Endings Organization.

And tell us about Empowered Endings, Bob, because there’s so much to it. 

Dr. Bob Uslander: There is and more every day. So empowered endings is is the creation of myself and my wife, Elizabeth. We came together a number of years ago around our work and our shared passion for helping people have the best possible experience as they’re navigating.

Complex and terminal illnesses. Empowered Endings is a, it’s a collective. We have a medical group, the Empowered Endings medical group, that provides personalized in home care for patients and support for their families as they’re navigating these challenges. Challenges. And we work along with the traditional health care system, collaborating with providers that are already part of the patient’s team, or we help find people who are, who are going to add value to that team as we create a village of support around people.

 And we, we help care for people who are homebound for various reasons, aging, frailty, dementia serious illness, terminal illness, there is no sort of prerequisite or qualification. We like to say we meet people where we, where they’re at, and we engage and provide the kind of support that they, that they want and deserve.

And we help people prepare for and experience the most gentle, dignified end of life journey. We like to say that we help people have a soft landing. And we’ve been, we’ve been doing this practice for a number of years and. Over time, we realized so many of our patients and their families have had a really positive experience.

Granted, somebody is, is dying in many cases. But, but given that reality, The families tend to have a very gentle experience and, and, and after the person is gone, we, we get cards and notes and, and emails and reviews that indicate that whatever we were doing was really valuable for them. And so we look at, we kind of have looked back at what we’ve done in, in this practice, that’s allowed that to take place so consistently.

And we, we kind of. Identify a number of, of areas where we filled these gaps that people were otherwise kind of falling into. And we did it in a way that. That worked for them. So we decided we don’t want to just be able to do this for a small number of people in our community. We want to help others have the, the wherewithal to do with this for people in their communities, because we’re aware that there are many people in health care who want to do better, who want to give people a better experience, but they’re constrained because of the.

The system they work in or what’s available in their, in their community. So we created the Empowered Endings Institute, which is an educational platform, a training platform that is kind of in, in its right now, it’s just unfolding and it’s, and a lot, a lot of content is being added and we’re ready to, we’re getting ready to launch a community and online communities that will be the beginning of the Institute.

And we also have a Empowered Endings Foundation. Which is a non profit of 501c3 that helps provide services. That support people and having this beautiful, gentle experience at end of life and offer some financial support for for people who need additional services that they can’t afford. So that’s the triad at this point. 

And then the other piece of it is a management services organization, which is in time going to help support other medical practices and and end of life doulas, which will touch on partner in providing this kind of support. 

Diane Hullet: That is not an elevator speech. That is a slow elevator speech, isn’t it?

That’s the 60th floor. I think it’s so powerful, Bob, because what you and Elizabeth have have said is we can impact individuals. And here’s how we’re going to do that. And impacting dying individuals for the better has a massive impact on their families, friends and loved ones who are left behind. So that’s this, this system that we can impact like one at a time.

But then you’ve also said, how can we support other practitioners, other offices in bringing these kinds of things that you’ve found to be helpful into other cities, other regions, other places. And I think there are a lot of people trying to do that. I think, you know, the Empowered Endings Institute is really kind of at the forefront of really trying to make that happen.

Dr. Bob Uslander: Yeah, we’re very excited. We’ve been, we’ve been doing a lot, a lot of we were working on the ground with patients and families and that’s always very satisfying and gratifying and, and impactful. But we, what we were very excited about the, the Institute, because that’s going to help us spread this in a, in a way that we, it’s hard to even imagine because we get so many, People who are letting us know that they’re interested that they like, how do we, how, how can we contribute?

How can we participate? And this is going to be the mechanism. To allow that to happen. And I think you’re right. There are so many, and you know, your, your, your podcast is all about helping, you know, the better, a better debt, helping people experience that. So you’re, you’re meeting people in this world on a daily basis who are also trying to contribute and add value.

And we recognize that we are, we are by far not the only people. Who have this notion, who know that it can be better and it should be better. So we’re, we’re, we’re looking, always looking to figure out how to, how to collaborate. And, you know, and, and partner with the people who are already out there doing great work.

Diane Hullet: Yeah, it’s so it’s so interesting to to work in a field and maybe a lot of fields are like this but end of life feels particularly poignant that there’s the possibility of impacting one And then there’s the possibility of really growing the impact of that on more than just a single situation. Well, you know, I know that one of the things you’re looking at is really what are these gaps in health care?

What are the gaps in health care that families experience, particularly at these end of life situations? Stages, whether that’s from terminal illness, you know, a diagnosis that is a disease process that someone is dying of, or whether it’s simply the frailty and the body, you know, challenges of being old.

Dr. Bob Uslander: Yeah. Well, the gaps are vast . There are many, and they, and they kind of are, are across the board. And, and a lot of it is just because of the, the way the healthcare system has, has been designed and has developed over time. I I, one of the things that I like to, at the beginning of, of my. Talks and presentations and I just I want to make it clear that even though we work kind of outside the traditional healthcare system is a, it’s an additional layer of support.

We’re very appreciative of of the people who are working within the healthcare system. And the fact that there are these, there are programs such as hospice and palliative care and people who are incredible humans who are incredibly caring and, and, but the system itself has, has, you know, A number of areas where it falls short and that, and that’s what we try to help people understand because my, my, my awareness is that a lot of people believe that the health care system is going to show up and meet them where they, when they need more support, but when things get complicated, that the, the, the, the people, the systems, the programs that they need will be there for them, and then they find out that that’s not the case.

Or that it’s very hit and miss and it’s, it’s disorienting and, and frustrating and people find themselves really in many cases, you know, overwhelmed and often angry that they didn’t, that they, they don’t know how they got where they are and they don’t know how to get out of it. They don’t know where to go.

So we find people and then, and I imagine this is not, you know, you’re shaking, you’re, you’re nodding your head. So you’re, so you’re aware that this, so, so the gaps that we’ve identified that caused the most struggle for people and. It’s, it’s in the palliative care and hospice world, but I think primarily in hospice when people make the decision to discontinue curative aggressive treatment.

And and choose comfort care as as it’s been described, and there’s six gaps that we’ve identified first being when people go on hospice care in in most cases, not all, but most cases, they will never see a doctor again. Doctors in general are not part of the hospice experience. Every hospice has medical directors and people who need to sign off on orders and be part of the interdisciplinary meetings, but they’re typically not involved in the actual care of the patient or in meeting the patients and the families.

To help them understand the trajectory and, and what’s possible. So the lack of physician engagement is a really serious gap. And one that we’re trying, you know, to, to fill and doing it. I think doing it well. Another is that in the, in the traditional healthcare system, there is no mechanism for, for.

For doctors or providers to take care of the family. The patient is the focus. And you always hear about patient centered care. And that’s important that the patient receive the care and support, but in, in most cases, the family and loved ones are very involved and trying their best to meet the needs of the patient and figure things out and, and often overwhelmed and under resourced.

And there is no, no mechanism for the family to be cared for, to have somebody, people who they can reach out to at any moment to get care. Appropriate guidance and, and, you know, reassurance. So that’s a, that’s a huge gap and that has huge long lasting impact. Additionally, there is no one companioning the patient and family.

When you go on hospice, you have a nurse who comes out, you know, intermittently, typically weekly. You have a social worker who can help with certain. Aspects of support and resources and they’re typically, you know, coming out monthly. A spiritual counselor comes out monthly. The people who have the most contact with the patient are the health aides who come out to do bathing and personal care often twice a week But there’s nobody who’s really like they’re day to day, moment to moment, to, to provide that support.

And, and what we’ve recognized is having that kind of a relationship with patients and families has really dramatically improved the experience. So we’re working with doulas. There’s end of life doulas, death doulas, dementia doulas, people who have a, a passion for providing that kind of support, specialized training.

They’re not licensed. There isn’t like a licensure that they go through, but they come from all walks of life, and we’re finding that at the doulas in partnership with the doctors and the team are incredibly valuable for allowing these these journeys end of life journeys to to flow much better.

People are not being given. Choices about they’re not they’re not being informed about their options at end of life. So it’s important for us. It all with all of our patients and families that they understand all the options that are available to them as life is coming to an end. 

Diane Hullet: And that’s, that’s gap number four, right?

And that’s 

Dr. Bob Uslander: gap number four. 

Diane Hullet: It’s a big one. And I was struck as you were talking, I think one of the things about the companioning piece and also this gap number four, the options is that families are often sort of deep in it before they realize what they’re not getting. So they, they sign up with hospice.

They’re feeling okay about these choices, but then perhaps that goes on for four months and People who are working full time, how are they managing the care? It’s a real question of how do you understand what the gaps are before you’re standing in a gap, trying to bridge it yourself, right? Yeah. So, and part of that is then this piece you’re talking about now, which is the fourth gap.

What are my options? And and our medical system is set up to mostly keep us on kind of a treadmill, right? Choosing the next option 

Dr. Bob Uslander: and the options include, you know, they include the type that the levels of care that The places where people are going to refer are going to go to receive the care, but they also refer to people who are terminally ill who live in community in states where where medical aid and dying is legal.

So, giving letting patients know that when they have a terminal illness and a life expectancy of less than 6 months. It’s, it’s a legal option for them to choose to go through the medical aid in dying process and take control over when they die, where they die, how they die, with whom they die. So medical aid in dying is one of the options that is available to people.

In California and Colorado, Washington, Oregon, Hawaii, New Mexico, Maine, a number of states around the country and more every year there are more states that are, that are kind of waking up and realizing that people deserve the right to choose. When they’re dying, how they die voluntarily stopping eating and drinking is another option for people who are competent to make decisions to choose to have a soft landing in a, in a, in a manner that is aligned with their values and who they are.

So giving people an understanding of what their options is really important. The fifth gap that we talk about is life enhancing options. So when, when we started this practice initially eight years ago. It was really one of the focuses was to give people a much more holistic experience. So our patients have access to massage therapy and acupuncture and music therapy.

And enhanced physical therapy, cannabis, you know, therapy there is no, there’s no end to what, what, how, what we look for, we’re very creative and figuring out what is it going to, what is going to make the quality of life better for this person and, and make those services available and encourage them and not just the patient, but the family.

It’s amazing what can happen when, you know, a loved one, a woman has been caring for her husband who’s, you know, who’s terminally ill and, and the stress that that goes into that care for her to get a 60 minute massage. And then, you know, in the middle of the day to regenerate her and and give her a sense of of peace and so that so the life enhancing options are something that that are really important that we like to bring into every case where they’re open to it.

And then the final gap. There are more, but the ones that we feel like the biggest gap that we see in many cases is, is what is the planning is people are not doing appropriate planning, they’re not upstream planning for how they would navigate how they what they would want what they would not want. If they got to a certain point, and so doing the planning, having it documented appropriately and then communicating that with their loved ones so that when things do change, it’s not a surprise in that the loved ones have already offered to support them in in the way that was is aligned for them.

Wow, those are the gaps, those are the biggest that, and on the seventh one that we don’t that we don’t put in there because it’s not quite as. There aren’t as the need isn’t quite as as widespread is is nursing care. We had we realized that having nurses who are available to be present with people. When they need it, not just because hospice says it’s okay and that it’s justified and they’re, and they qualify for it, but having caring, committed nurses who can show up to be with people in their final hours of life.

Maybe days of life is really important. And that’s part of what our, we’re hoping the foundation will help to, to be able to help support from a financial standpoint, because we know that that’s relative, that’s, that can be pretty expensive, but not having clinical people there. At certain times with the families as people are transitioning is really, is really value is a huge disservice.

Diane Hullet: I’m struck by how much this ties in with a conversation I had with Dr. Allison Applebaum recently. And Dr. Applebaum and I were talking about navigating modern meaningful caregiving. And one of the things she said just from her personal experience is she said, every time my dad was discharged from the hospital, I was expected as the primary caregiver to give him a level of medical care that I wasn’t really prepared to do.

And so one of her things was, be sure that you ask and that you totally understand as someone is discharged, what is, what does it mean to do what you’ve been asked to do? And are you doing it correctly? And I think that’s just a place where often the conversation is kind of rushed. There’s a handout.

You’re focused on getting the person in the wheelchair and into the car. It’s very difficult as the caregiver to say, I’m going to be the primary caregiver here, and I need to completely understand this thing that I’m managing. So, you know, that’s partly talking about, you know, You know, the idea that could there be more nursing, could there be doctors involved, and could there be doulas who are educating and companioning so that that caregiver doesn’t go home and, and just kind of have a meltdown over the responsibilities that have landed on them that, as you said, they kind of didn’t see coming.

And that’s the really interesting thing. I wonder if that’s sort of the one of the challenges is that people because you don’t really see this until you’re in it. And when you’re in it, it’s such a hot mess. You can’t really get out of it and do anything about it. It just means that it becomes this kind of on the side.

You know, circus that’s happening in homes all over the U. S. And I don’t know how you know how to get in there and shift it. But I think identifying what the problems are is a big piece of it. And you’ve done that. You’re doing that. 

Dr. Bob Uslander: Yeah, we’ve certainly identified a lot of the spaces where those problems you know, exist and and we’re doing what we can to try to To provide the solutions, but it’s going to be a slow process and being able to expand it and for people to recognize that the system isn’t going to provide that and, and they’re going to need to be willing in the, in the short term, they’re going to be, they need to be willing to pay a little.

Extra to have that in. And for those who can’t, then we’re trying to find those additional resources and put a put a process in place for for the financial for that to not to be such a huge financial barrier. And then in time, we anticipate and hope that. Healthcare systems will recognize how, how valuable this is and necessary this is and start and start appropriately paying for it.

 I was just talking to a colleague who, who runs a company that does private nursing and we work with them frequently because it’s hard to find good quality private nursing. It’s a tough business and the scheduling of it is challenging and finding the nurses is challenging. But he was telling me that he has developed relationships with some of the hospitals here in San Diego where when they have patients who they can’t get discharged, meaning they can’t get a hospice to take care of and they can’t find a place for these people to go, they end up staying in the hospital for extended periods of time, which means the hospital is losing money because they can’t.

They can’t give that bed to somebody who’s, you know, whose insurance is going to pay for it. They’ll pay this company to actually help the patient get discharged and provide nursing care so they have the support that they need. And the hospital is paying for it, and which is, which is one way of, of dealing with this problem of not inadequate resources and inadequate support.

So they’re, so they’re starting to see the value and the, and the need for this additional kind of support. You know, I think that part of the problem is people think that the palliative care that people think that hospice and palliative care. Are adequate and they’re, they’re enough and especially you 

Diane Hullet: just, you just said a mouthful people think that they’re going to be adequate and enough.

And then when they get in it deep in it, it’s not really enough to cover, but the needs are 

Dr. Bob Uslander: right for some people. It is. I mean, we meet people all the time who say, Oh, we had a great hospice experience and couldn’t, well, couldn’t have, you know, couldn’t have imagined it going any better. Yeah. And those are, those are, it’s wonderful to hear that, but those are the minority of cases, like doctors, oncologists, cardiologists, primary care doctors, gerontology, geriatric doctors, they refer to hospice.

And then they don’t, and then they assume that everything goes beautifully, because they don’t hear, they don’t hear back, they don’t get feedback. What they don’t understand is that often the patients get admitted to hospice. And from that point forward, the family. is struggling because they, they have a whole new team of people who are showing up for them variably.

They you know, they, they have all these, we recently had a patient who was admitted a younger person in his forties with a brain tumor. And I talked to the wife a couple weeks after he’d been discharged and decided that there was no additional treatment available. So they were referred to hospice.

And I talked to the wife a couple weeks later and she said, What, what I discovered. Was that I’m hospice because the hospice team comes in and they, they have all the, they, you know, they come in with a big flurry and everybody shows up and they sign all the forms and then, and then they’re gone. And then a nurse comes once a week to check in and to make sure they have, you know, enough medications, you know, they’re available if something changes.

But then, you know, they go through a phone tree and they get a triage nurse and somebody who doesn’t know the patient has never met them. They have to go through this whole. And so it was, it was clear to her that hospices, there’s benefit there, but it’s clearly not enough to, to really meet the needs, all the needs that come up during that really emotionally, physically, spiritually challenging time.

Diane Hullet: You said at the beginning, Bob, I loved you said. You know, there’s this sense of how, how do we, we need a village at that time. So how do we create a village that can show up? So that young wife needed more than just herself and her husband, and maybe there were young kids involved and, and more than one or two friends, you know, she needed a team that can really help her.

As you said, on these multiple layers, I think you, you just said it. Amazing thing, too, when you’ve identified a gap being support for families, because what I’ve seen is families that have time to prepare, families that use what, you know, some people call precious time. I think Barbara Carnes has used that phrase and, Jennifer O’Brien, who’s the goes by the hospice doctor’s widow.

She has an amazing, and they talk about this precious time when, you know, it’s finite, the impact and the feeling of time changes a little bit. So when families have time during that time before someone passes to prepare and they emotionally, spiritually, mentally, physically have a team that can help them prepare.

When the person dies, that dying person’s experience is different and the loved ones left behind their experiences different, and that trails forward with them into the rest of their life and impacts their community and impacts how they are able to be functional in the world. So, so it isn’t, you know, I, I love that you kind of identify that because we aren’t really talking just how do we, Improve the experience of the one person who’s transitioning out of this body and out of this world and dying.

We’re talking about that, but we’re also talking about the whole experience of dying in a family system, in a community, in the friend groups. And how do we do it better? 

Dr. Bob Uslander: Yeah, well, I, I, I a hundred percent agree that the term village is really, it’s a beautiful one because I think people get that. And different people have different roles in the village.

And. Everybody’s important and everybody brings something if they’re, if they are willing to give of themselves and, and to be, to participate in a way that is, you know, selfless and focused on everybody wins. I think we’re going to have much more successful outcomes. I, and, and there is no, there is no way to, to really express how critically important it is to, to.

Meet the needs of the loved ones. And as you, as you, you know, so articulately pointed out, these people are going to live on sometimes for a few years. Sometimes for many decades and, and what that experience is like, how, how they feel they honored their loved one before they died will allow them to go on with a sense of peace and, and kind of unfettered joy versus living with this feeling of regret and remorse and guilt about what, what could I have done differently?

What should I have done better? What else could we have done when they know because they’re being guided and supported and, and all of the different options are have been laid out and when they know that they’ve that they’ve done everything to make that final journey. Dignified, gentle, it, it gives them a sense of peace going forward in the month, the group, not that they’re not going to grieve the loss, they’ll still grieve the loss, but it’s, it will be a different kind of grief and, and it will be a softer, you know, a softer grieving one of the cool things that in our model as well is that we have grief counselors and, you know, do was who get to know the loved ones and are part of the journey.

Okay. And, and they’re able to stay with them afterwards. So there’s this, there’s this continuity of care and support that extends. You know, the, the full spectrum, it extends beyond so, so that the, the loved ones, if they are desiring it, open to it they have access to people who, who know how everything unfolded and understood where, where they were before and understood how the death was.

To place and are then able to continue to be part of that person’s world, which is really powerful, 

Diane Hullet: really, really powerful. And I’m thinking, you know, our, our, your brain and my brain are all creative about how to generate solutions for these gaps. I mean, there’s so many good ways to do this. And it strikes me that the thing in the way is the money, right?

Like, where the money, like, how, like, Might our system evolve and change so that insurance companies see the value of this so that when somebody is well supported through a death, they are more prepared to go back to work and be part of the workforce. I mean, the fact that our bereavement leave is How, something crazy like a few days, how is someone to integrate a giant loss where they’ve been the primary caregiver?

I mean, the number of days of lost work through caregiving and through bereavement must be an enormous economic toll. So how do we flip it so that we understand that if we support people, that’s actually of economic benefit. 

Dr. Bob Uslander: Yeah, it’s a long, long process. And I think part of part of the way it changes is that the people who are who are at the helm of these of the insurance companies of the hospital systems.

It’s almost like they have to have personal experience until they have. And that’s how it is in a lot of areas, you know, in, in the, in the life but also especially in healthcare. When somebody sees a loved one suffering through a terminal illness, and doesn’t have an option. To do things to maybe hasten their death.

And if they don’t, if they don’t live in an estate that allows medical aid in dying, well, they become advocates for things that will reduce that person’s suffering, give them more control. But, but I think a lot of this has to do with people having personal experience and seeing it for themselves where the system is.

Breakdown and yeah, I mean, I, I, the, the, the money, the money is off is often a, a deterrent to people receiving appropriate care, but not always we, we find there’s a lot of folks who have resources. They just don’t think there’s, they should have to spend them to get healthcare. They believe that they’ve been paying into Medicare, they’ve been paying their insurance premiums.

And that they deserve, and they’re right, they deserve to have really phenomenal supportive care. And they’re, and that’s a part of the reason why they’re frustrated and angry when it turns out that it doesn’t, that it’s not available. So part of our job is to help educate people about what is and isn’t available and, and just to be aware and add, to know how to advocate for themselves, to know how to find the resources before they become terrible, you know, so overwhelmed and they’re in this huge abyss that they, they don’t know how they got there and they cannot, you know, see the light and, and, you know, they don’t know where to turn.

Diane Hullet: Yeah, that’s so, so well put. I think how do we support individuals to do death differently, to do death better? You know, there’s some of these great phrases out there and I think it really begins with, Noticing that the system is not going to give you everything you need, whether you’re the dying person or whether you’re the family member or whether you’re working in this field, helping people understand that the system isn’t set up to fill all the gaps and then identifying for families.

What? What are their gaps? You know, maybe, maybe there’s a big family and everybody’s showing up, but it’s working out fine. Or maybe it all falls on one caregiver who lives four states away and it’s not working out fine. So how, you know, how, where are the gaps for you and what might possibly fill them and looking into those resources before you’re in the hot water of the soup that’s cooking when you’re just really Trying to hold a lot of different things together at that stage.

So I think, I think this is great, Bob. I think I just, I really admire the work that you’re doing and how you are trying to not just impact people in your community, but then say, how can we take what we’ve learned? How can we share with others? You know, just to say again, I, I encourage people to go to the empowered endings website because there’s just some real clarity there.

And I, I like one thing on your website. You said, look, there’s, there’s four choices at the end of life, just simplifying things, right? There’s do everything possible. And for some people, that’s really what they want to do. They want to engage medically and do everything possible to keep death away. Second option is to stop aggressive treatment.

Maybe you actually don’t want to be in that medical treadmill of aggressive treatment, in which case you are going to have to face mortality. You’re going to have to say, I’m actually at my end game here, and it’s a very personal decision. And then a third option, as you’ve said, in many states and growing is medical aid in dying and a fourth option, which I think people forget about, which is a whole other podcast is voluntary stopping of eating and drinking.

And there are good resources out there for people to learn more, and Empowered Endings is one place to start. So, well, Bob, I thank you so much for your time, and can you just tell us again your website? 

Dr. Bob Uslander: Yeah, it’s empoweredendings. com and that’s it. And on the, at empoweredendings. com, you can, people can, Learn about the medical practice and the offerings, and there’s a lot of a lot of educational resources.

They can learn about the Institute and the online community that is so check, check the website, but check back in a week and check back in 2 weeks because we’re adding additional really important content and information, especially about the Institute. In the next few weeks, I’m not, I’m not sure when this podcast is airing, so it’s possible that it will already have happened.

Good question. 

Diane Hullet: I think this is going up in May of 24. So maybe by 

Dr. Bob Uslander: that time, a lot, a lot, there will be more so, but continue checking back. And then you can learn about the foundation and what the foundation is doing and ways to donate. If you’re interested in helping to provide for a larger community.

A larger group of people having access to the kinds of resources and support that we’re talking about. 

Diane Hullet: Yeah, so wonderful. I love that. That’s the tripod of the work. I think that’s really important. And, you know, really, I’ll just put in a plug for people to consider as part of your end of life planning.

Think about making large gifts to things like this that matter to you. Things like a foundation that is supporting access to healthcare. This is enormous. So those kinds of bigger gifts that sometimes only come when someone has died, you really have to do that planning and thinking ahead of time to impact this, but there’s a way that this work can be supported to be taken out even bigger.

Dr. Bob Uslander: Yeah, well, it’s beautiful. Thank you for that plug. I appreciate it. And I’ll just put it out there that anybody who has a real interest in any of our work, whether it’s bringing this, this work to your community, learning about how it could affect impact you personally, getting more information about the foundation and the vision and the mission and how donations are being used.

Just reach out on the website and connect with us and either my Elizabeth or I will, we’ll reach out to you in person. Cause we love talking to people. We are, we love being engaged and engaging people and a lot of our time to spend just having conversations. About what’s possible. Thank you for that. 

Diane Hullet: I love that.

I think of Bob and Elizabeth as real you know, like ambassadors in this field. I mean, there’s a lot of people working to coalesce around this movement of doing this in a way that really supports people. Because it is always going to be sad. It’s always going to be hard. It doesn’t have to be miserable.

It doesn’t have to be just the kind of struggle that you see people when they show up on your door and say, Bob, help us do this. 

Dr. Bob Uslander: Yeah. Well, thank you, Diane. And, and, and feel free, please, because you’re connecting with people every day who are part of this. If there are people who you feel would be especially good connections for us to have and co collaborators, and we would welcome those introductions and and connections.

So, 

Diane Hullet: yeah, I like to think there’s a lot of connecting of the dots happening right now. So let’s, let’s do that. Well, thanks so much for listening and thanks so much for being part of this movement, and you can always find out more about the work I do at Best Life. Best death.com. Thanks so much.