In this episode, Dr Kaishauna Guidry and I take a look at some myths about hospice. You’ll hear Dr G’s heart-filled point of view as she busts some common misconceptions, including: hospice is only for the very end of life; all hospices are the same; hospice is a place you go; it’s expensive and only for the privileged; calling hospice means giving up hope. Ever heard any of these or believed them yourself? Join us to hear another point of view from a seasoned physician.

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Transcript:

Diane Hullet: Hi, I’m Diane Hullet and you’re listening to the Best Life, Best Death podcast. Today I’m talking with Dr. G, California based doctor who has so many wonderful things to share. Welcome Dr. G. Hi. 

Dr Kaishauna Guidry: Hi. 

Diane Hullet: And her actual name is Dr. Kaishauna Guidry. Yes. 

Dr Kaishauna Guidry: Gold star. And I’m so 

Diane Hullet: happy to be pronouncing the name right because I keep messing it up.

It’s got all these wonderful vowels in it, but um, welcome Dr. G. Yeah. This is going to be good. She and I connected at the death over drafts and the end will conference in California in late November, 2024. And there’s just a lot of wonderful connections here. One is that you’re a former teacher now a doctor.

We both love conversations about end of life. We’re both here to support families and advocate. And we also kind of have a little passionate streak and a silly streak. So I think the marriage. Yeah. So Dr. G is the host of Dr. G at the heart of healthcare podcast. And that’s in your spare time because most of the time you’re working with your primary medical work, which is morning dove medical.

So with that long winded background for me, um, you know, you tell us about yourself. Give us your introduction. 

Dr Kaishauna Guidry: Yeah, so first of all, don’t worry about mispronouncing my name. I’m not one of those people who gets offended. You, you could imagine I’m probably, I probably dealt with this my whole life. When I go to like a dentist appointment or anything, I’m waiting, I’m waiting for them.

I know when they’re on my name, they go. And I love to see what they come up with. So I’m just happy to be here. And it was so great to meet you at, uh, death overdraft and end well, but yeah, about me, I am just a California girl and I was born and raised there, got married to stay at home mom. And then I decided I wanted to become a doctor and now I’m here with morning of medical and that’s how I serve, um, my community and I guess the world too with, with the work that I do at the end of life.

So, 

Diane Hullet: and you’ve written two books and I want you to just talk sort of briefly about the first one. Cause I think the second one is where we’re really going to dive in. So your first book is Dr. G’s Hospice Pocket Guide and tell us how that one got started. 

Dr Kaishauna Guidry: So I decided to write. That book and I released it on doctor’s day in 2023 as a gift to doctors because many work in hospice care, they come on over here and they they use it as a side gig.

I mean, I welcome them we need more. Come on. And also there are fellows who have to be trained in hospice work and so it was information that I already like had saved in a note in my phone. And one day I decided. to publish it. Uh, you know, it’s easy to self publish these days. And so our industry of hospice didn’t have a pocket guide.

Most specialties, actually all specialties, we have a book for it. Ask any doctor, they’ve probably thrown the books away or they’re on their bookshelf, but there was nothing to tell someone what are the basic duties that I need. To do to be a hospice medical director. And so, uh, I put that together and, and not necessarily a hospice medical director.

Mine is focusing on just hospice physician because there’s a higher level of involvement needed to be a hospice medical director. And we have the hospice medical director board, um, and that certification for that and actually that own book. But my book is just the basics, the very basics of starting day one, helping our industry.

Diane Hullet: What an incredible resource. And as you said, it’s really the seven things hospice doctors or doctors who will be working in hospice need to know. And it’s H O S P I C E. And you’ve created an acronym so they can kind of read the chapters and see what those seven things are. And they correspond to the term hospice.

Hostess. 

Dr Kaishauna Guidry: Yes, yes. You know, it’s I used to be a teacher. So in a tutor. So I like to make things easy for people. And that drives a lot of things that I do. And so having that framework helps them know because you know, when I when I help some of the agencies that I help, they’re surprised that I’ll do a home visit and I’m like, but that’s like the first thing.

Home visits . 

Diane Hullet: Yeah. And so that’s your h I’m gonna guess, 

Dr Kaishauna Guidry: yeah, it’s home visits on call. People know about being on call, like they’re gonna call you. Uh, signing stuff is the s and they need to know that things are signing. ’cause there’s levels of accountability to that. You know, with the DEA, with the OIG, with Medicare, you know, uh, we know about a lot of fraud going on and so.

I wanted doctors to understand the things that were being placed in front of them to sign their signature on. P is prognostication, obviously, knowing when someone is dying, um, or when it’s time, when they’re hospice eligible, when they’re not. ’cause some people they don’t die and they graduate. The I is IDT is the interdisciplinary team, and C is a CTI, the certification of terminal illness.

It’s the little paragraph we have to write about. Every single patient admitted to hospice and then E is engagement in the community. If people follow me on social media, they know they see me at a memory care party. I was just, you know, at one last night, they’ll see me over here doing this. And so being involved in the community and being a resource is what they need.

Is important for us to do in hospice as well so that they know that they can refer to us and so that’s what the hospice acronym is. 

Diane Hullet: And this, this hospice pocket guide I think sounds like such a useful tool. Is it relevant outside of California for doctors who don’t live in that state? 

Dr Kaishauna Guidry: Yeah, it’s for anyone.

It’s for anyone who needs to know what you have to do in your role, because each team member has a role. We have the nurse, obviously nurses know what they have to do, the social worker, the chaplain, and the hospice aide, but no one had defined that for us. A lot of people don’t know what doctors do. And so in my journey of the work that I do, I have to define it.

I have to let them know the value of having a doctor involved in your hospice and not just being there on paper, because that’s not the type of hospice you want your family member and or you want to be in. And so this is health care. at the end of life. And so you need to know what doctor is on call 24 seven for that agency.

So that’s what it is. 

Diane Hullet: That’s tremendous. Well, okay. So that moves us into your second book. The other one we wanted to talk about, which is called the real deal about hospice. And I love the title. I think, you know, you and I were kind of kicking around ideas of what we could talk about on the podcast. And really, I think this idea of taking hospice myths and kind of busting them, I think is really good because I’m always surprised how even with the most educated, well meaning people, there’s a lot of misinterpretations out there and misunderstandings out there about what hospice is, who it’s for and when to get involved.

So, um, how’s that sound? Should we break up some myths? Let’s do it. All right. All right. So, you know, a question that always comes up is when should someone reach out to hospice? And I think the myth here is that hospice is only for the very end of life. What do you have to say about that one? 

Dr Kaishauna Guidry: Well, you know, first we have to, you know, understand everyone’s not like you and me going to the death over drafts party or using the D word.

At that, you know, your, this whole podcast is good life, good death, right? So I think just culturally in our society, um, not everyone, cause we’re diverse, right? But most of the time people don’t know that they’re dying or what the end looks like. And so they just avoid it. And so, um, that that’s, The main problem, right?

And it’s the people who have the disease, it’s their family, and sometimes it’s even their doctors, you know, their oncologists, their cardiologists, their nephrologists, um, they’re treating diseases and not necessarily taking ownership of handing over the end stage of that disease. Does that make sense? I want to be careful.

Diane Hullet: It makes total sense because I think, I think doctors and clinicians are doing the best they know how, but often they are stuck in a trap of chasing cures, chasing cures. And if that’s what a family or an individual is pushing for, cure this, do the Hail Mary, make this happen for me. Then kind of nobody in that whole soup pot is saying, well, what about when it is really the end?

What about when there is no more cure to chase? And I think it’s so interesting how, I mean, I think it’s really powerful to exercise the knowing of that time as being full of possibility and potential and preciousness. as opposed to being a terrible message of the end game. It’s a terrible message of the end game when you don’t know it’s coming and you have very little time and suddenly your person is dying and nobody realized it.

That’s the scramble. But if you have a few months, even six months, or a year, or even a month, That’s so much more time than just a few weeks. And it’s incredible what can happen in that time if you really face it. So, is hospice only for the last few days of life? 

Dr Kaishauna Guidry: The answer is no. And even though we have a median length of stay of 17 days, um, meaning half of the people who come on a hospice, Are there less than 17 days and the other half is more than 17 days.

That’s insane. I think knowing even sooner than those months are what’s important. So something that I’m working on is actually, um, for people to have a healthcare roadmap because if someone has, I have an example of, uh, let’s see in stage renal disease, you know, someone may be on dialysis. They know that their kidneys are done, right?

And even the nephrologist knows the length of time that people benefit from dialysis. It should not be a surprise two, three, four years later when they’re getting the hospice talk, right? They should already be prepared, but there’s many times that. Me and my team, we’ll have to have a meeting to convince them that it’s time.

And that’s, that’s not fair actually for anyone. Um, we do it, we do the magic, but I think we can do better upstream instead of. waiting. You know, if you have C. O. P. D. Again, we know people have C. O. P. D. or they have heart failure. Okay. After so many years after you’re seeing this many hospitalizations, you should go ahead and do hospice care.

It’s not You know, like you got kicked off the, the football team. It’s just the level of care that’s most appropriate for that stage of disease. 

Diane Hullet: I love that you say it. It’s a, it’s a roadmap. Like if we had that roadmap for our disease process, or even for the frailty of old age, it might give us more of a framework that we wouldn’t be so surprised.

And we could call in hospice sooner and receive the benefit of hospice, the, the companionship of hospice, the knowledge that hospice brings to end of life, that is a different kind of care. And often people do quite well under hospice care, but if you only have 17 days or 14 days or 10 days or six days, you’re really just in the scramble of setting it up.

You, you don’t have the benefit. It really, the benefit, you know, the, Benefit seems like such the wrong word, but like, cause I don’t mean that as a technical word, I mean the positive, compassionate care that comes with hospice, you derive more benefit from that if you get involved with it sooner. 

Dr Kaishauna Guidry: Yeah, to make a relationship with your hospice team, you know, and you also don’t have time to research the best agency, right?

If you’re in a place like California, um, I could put a zip code on it. Yeah. into the Hospice Compare website, the Medicare website. And there may be 500 hospice agencies that service this area. How do you even choose it? I created a podcast to help people do that, but you cannot decide that if you If your, your parent, for instance, has been in the ICU for three weeks and they’re trying to discharge them tomorrow, and the the case manager just talked to your family and said, you’re leaving tomorrow.

Here’s a list. How do you even pick a good one? Yeah. 

Diane Hullet: You call the first one and you kind of panic, and if they’re nice to you, you take it. 

Dr Kaishauna Guidry: Yeah. You pick their friend. Yeah. The one they like the most. 

Diane Hullet: Yeah. Yeah. So speaking of that, here’s another myth, I think when someone is involved with hospice. Where do they go?

Because I think a myth here is that hospice is a place. 

Dr Kaishauna Guidry: That’s a good one. I’m so glad you did that because if you translate the word hospice in Spanish, we learned about this at NWEL. It’s like a place for the unwanted. And that’s why I created that Spanish podcast to hospice one on one. Um, so for everyone’s knowledge, hospice It comes to you in your home, wherever you call home.

And so the various places as a private residence, obviously I’ve taken care of people in a trailer in the desert and an ocean front home, you know, in California. So even wherever the home is, that’s where you get your care. Uh, if you live in a skilled nursing facility, some people do, or they’re there. For the end, uh, sometimes people live in an independent living or an assisted living or a memory care.

Those are what we call residential care facilities for the elderly. Um, and so that’s where it is. I know some, some programs are even um, tackling, you know, hospice, uh, for the unhoused. And so, uh, there’s a lot of that work going on too. So we go wherever you are. Sometimes people don’t make it out of the hospital.

And so they’re having the hospice care there. And some hospice agencies have actual homes where people can, can go if that’s what’s best for them. But typically it’s in a private home and it’s not there 24 hours a day. Like you, your family takes care of you. We just are intermittent come in, right? And so, um, anyway, that’s another conversation about the levels of care.

Diane Hullet: Yes. No, I think that’s another really good myth. It’s somehow hospice is 24 hour care. As you said, no, it’s not. It’s support and it’s set up and it’s guidance and it’s information, but it’s still the family that’s taking care of the person who’s dying or who’s, who’s at a state of calling in hospice. They may not be Anywhere close to active dying, but their disease process is such that they’ve called in hospice.

Yeah, I think that one’s really interesting. And so, so it’s mixed, right? There are places that are hospice houses, but the vast majority of hospice is, as you said, In the place you call home. 

Dr Kaishauna Guidry: Yes. 

Diane Hullet: Well, I think that we touched on this, but what kinds of things should I ask when I first call a hospice provider?

And the myth I want to bust up here is that all hospices are the same. 

Dr Kaishauna Guidry: No, they’re not. Um, I’m not going to attempt to give the history of hospice again. I have, you know, experts that have been on my podcast to talk about it. You know, there’s one that talks about the nonprofit hospice world and he, um, this particular CEO of a nonprofit hospice in California talks about it and how it developed over the years.

I think now we’re at a stage where it’s privately owned 75 percent of them. And, um, I think that’s true for even hospitals. So it’s not necessarily a bad thing because the workers on the ground like me and you, I mean, we’re, we’re still the same, uh, people who care about the patients. Um, but Medicare has created measures.

Like a website for people to follow. There is a survey that sent out to the family caregiver and they give feedback about the care that was provided. And that’s on the hospice compare website. Now, when you’re in a place where there’s so many new agencies, they may not have data there, but there’s ways that you can find out how they’re doing.

There’s Yelp. Um, and people actually have information on there about their experience. Um, but you want to look for a place that, first of all, has a, a, a medical director that’s involved. Um, I’ve seen, uh, agencies where, you know, there are limit, limit, Available, if that’s a word. Um, and not that the doctor’s everything, but again, how can the quality of care and the integrity of the care be managed if the doctor’s not involved with the team?

Um, but the nurses, the nurses are the ones that are champions. If you have an agency that has a lot of turnover in the nurses, that’s a red flag because you want to keep your nurses happy. So if the nurses are quitting or not, Staying or they’re overworked, maybe, uh, too much burden of documentation. Maybe maybe all those things are happening in the background and that can affect care.

Um, or, or they have to drive 50 miles to this patient. Maybe that’s not a good agency. So look for agency that has three stars and above. That’s a simple way to do it. And then kind of look at their website and ask them about, you know, their, if you can get a visit from the doctor, that’s what I would do. I would want to visit from the doctor.

within the first week or so, and then that will let me know how things are going to roll. 

Diane Hullet: Interesting. Yes. And also something about caseload, right? Like our nurses overseeing how many people, how many caseloads and what’s the geographic range that they’re trying to cover. That seems important. 

Dr Kaishauna Guidry: Yep. Yep.

That’s good. So yeah, you do your research. And again, you can’t do your research if you don’t know that you’re have a limited prognosis. So that’s why it’s all tied together. 

Diane Hullet: Right, right. This acknowledgement, this awareness and clarity that there’s a limited prognosis gives you time to then do some research before you need it.

Yeah. Kind of got that in your back pocket. Maybe you’re not calling that day or that week to line it all up, but you’re ready to. 

Dr Kaishauna Guidry: And 

Diane Hullet: I think this, um, this may be just my impression. I don’t know that this is based on reality, but my impression is that the hospice field keeps changing a lot. So like in Denver, they’re getting bought by different companies and shifting and moving and um, chaplains are leaving and nurses are leaving.

So if you land on a hospice that you think you like in May and then you call them in December, you may want to ask all the same questions again because maybe they were your top choice in May. But when you call them in December, it’s now kind of shifted. I don’t know. That’s just a little thing I’m noticing.

Dr Kaishauna Guidry: Yeah. Just know, know about the team because they’re again, things change. And so, um, know your hospice team. That’s what I will say. Know your hospice team. 

Diane Hullet: There’s something too about just friend to friend referrals. Like, what have you heard? Who had a great experience? What was great about it? And just being open to those conversations again.

But again, this means we have to say the D word and the H word, right? So it doesn’t always happen. 

Dr Kaishauna Guidry: Yes. 

Diane Hullet: What about, what about this myth about what do the services of hospice provide for a patient and the family? Because I feel like the myth is that hospice means giving up hope. And I see hospice provide so many things for families.

What, in your experience, if someone were to say to you, Oh, we can’t call hospice because, you know, mom or grandpa or my sister doesn’t want to give up hope. What would you say? 

Dr Kaishauna Guidry: So it’s so funny. It’s like you stalked all my episodes. I’m joking. But that’s, that’s what we covered in the season finale, season two finale of the podcast on World Hospice Day.

Um, Hospice, The Hope of Hospice Care was the title because I hear it all the time. I even hear it from healthcare workers. One, one of the things I said, I, I, the quotes that I mentioned there is where a nurse said, I think the doctor is giving them too much hope. And it was just like, Oh my gosh, we’re even using that language.

Um, so hope is not lost with hospice, right? Like your hope is preserved in hospice, the hope of having the type of ending that you want of your life and not it being traumatic and a surprise. Right. Cause it’s coming, it’s coming. And so, um, I, I, I don’t, I don’t even know how to tackle that fully because people, you know, people put meaning on words in their own way.

You know, the battle language that’s used to when they’re getting chemotherapy, that is to me, oppressive to folks and, and I think can make people feel shame when their chemo is not working. Like something’s wrong with them. It’s just so awful. It’s the pressure that’s put on them. 

Diane Hullet: It’s so difficult. It’s so difficult.

We don’t, and you’re right, we don’t have good language for it. And this, this word hope, as, as you said, sort of, well, what, what is the hope about what are we hoping for at this point? And is there acknowledgement about the ending? And therefore, can the hope be shifted to what do you hope for at the end of your life?

And that’s just a different kind of hope. What do you hope for out of relationships? What do you hope for out of loose ends? What do you hope for out of the manner in which you go? Is it in a hospital? Is it at home? They’re very different things. 

Dr Kaishauna Guidry: Yes. Your legacy. What do you hope for? Because we’re here. Um, yeah.

Yeah. It’s big. I think it’s fear. Um, and so again, that’s I know, you know, we, we have to get to the bottom of the emotion that’s going on. And a lot of the items I create or the services and the products, the books, the podcast is to address the fear that people have the fear of the H word. That’s why that was my first podcast, because people get anxious.

You know, if I run into someone, Into someone at the grocery store. I don’t tell people I’m a doctor. Trust me. I don’t go around looking like this. But when they find out they’re like, Oh, it’s just like this whole like, Ooh, you know, I’m sure you get it too. 

Diane Hullet: Oh, hospice doctor. That must be so difficult. Yeah.

Dr Kaishauna Guidry: Yeah. Yeah. And it’s like, well, should we just ignore people when they’re going through this or not? 

Diane Hullet: I was so moved at the end. Well, conference, um, Roshi, Joan, Halifax, Facts was the first speaker and she’s one of the great Buddhist teachers of our time. And she said so beautifully, she said, you know, when she worked in a hospital early on in her career, that the most, uh, what was the word she used?

The most ignored people were those who were dying, and it kind of broke her heart because she just saw that they were really shunted aside, and people did not know what to do with them, and she felt like there was a real lost opportunity there, and she said, you know, and she said to this room of 800 people, she said, you know, death is sacred.

And it sounds sort of trite when I repeat it, but boy, the, the gravitas with which she said those words, I just thought was so lovely that there’s the possibility of death being sacred, and there’s the possibility of it being not as difficult as we layer on top of it when we layer this. Um, denial and fear and and lack of conversation with doctors and lack of willingness for family members to get on board when it’s time for someone to call in hospice.

And so there’s these layers and complexities that we add to what is. a very difficult and sad time, but it does not have to be the hot mess of a cluster that we sometimes make it 

Dr Kaishauna Guidry: right. But it is. So how, how do we help them navigate? And here we are, that’s what we’re trying our best to do. 

Diane Hullet: Let’s, let’s do one more myth.

Sometimes people feel like, well, how much does hospice care cost? And the myth is that hospice is expensive and not covered by insurance. And maybe it’s only for privileged folks. 

Dr Kaishauna Guidry: No, it’s your Medicare hospice benefit. So, uh, that is. available to Medicare beneficiaries. And, um, I know there may be various insurance programs like Medicare Advantage that have, have different variable ways of doing it.

You know, I don’t, I don’t claim to know insurance. That is a whole thing in itself, but it is covered. And the services that you get is everything, you know, when you sign those consents or Your person, your health care, uh, power of attorney signs that for you. If you’re not able to do it yourself, it’s all of your health care.

So we become responsible for that. Whatever you need, your medications, your durable medical equipment, we call that DME. So sometimes people get a hospital bed, you know, oxygen, this and that, all those things, everything you need. And, and the folks that. Come to your home and help take care of you. You have us available 24 hours a day.

There’s always a doctor on call. There’s always a nurse to triage and we’re there to respond to whatever you need at home. And many people, again, just don’t know that. So you have folks that they come on and then they, what we call revoke meeting, they take back their benefit and they go back to the hospital or to their doctors because they didn’t know that they had a limited prognosis.

Like, it’s just, It’s it’s tough. It’s tough. You know, people just, they don’t know. And you know, I want to go back to something you said about having conversations with their doctors. You know, if, if a doctor is willing to prescribe a treatment or a regimen, why wouldn’t someone say yes to it? Even if they’re frail or it’s not the best thing, your doctor has an idea, so why not go with it?

So again, I think it goes back to just understanding disease processes. I had a great, um, teacher in med school, uh, in my internal medicine clerkship. He said, you know, the treatments are always going to change, but the diseases don’t change. The chronic diseases. So know the diseases. That’s what we went to medical school for.

So we don’t have to take away their hope, which I hate saying that, or do any have any uncomfortable conversations or whatever you want to call it. We are telling them what it looks like at the end stage of the liver or organ that is failing the kidney. That’s failing the heart. That’s failing the brain.

That’s deteriorating. That’s our responsibility as physicians, what that looks like and how we can support you as that organ fails. 

Diane Hullet: That’s so well put. Well, I, I look forward to seeing how you develop these roadmaps and I would encourage listeners, you know, um, Dr. G has touched on so many things here. And as she said, she’s got so much more on her podcast.

So again, Dr. G. At the heart of health care, and you can follow her on all kinds of social media. She’s got great posts and she’s interesting and funny and joyful. And just, you know, one of the real heartfelt doctors out there working in this field, I think. So 

Dr Kaishauna Guidry: I was 

Diane Hullet: delighted to, you know, have conversations with you and be together at end.

Well, and, um, yeah, the real deal about hospice. Here it is. 

Dr Kaishauna Guidry: Here it is. And I believe hospice is the heart of health care. And that’s why the podcast has that name, but I’m here to support all the, all the folks out there. Everything I do is to help everyone have a better ending. So I hope I can keep doing that as long as I can.

Diane Hullet: Tell us your website, where can people find out more about you? 

Dr Kaishauna Guidry: Yeah, they can find out more about me on Morning Dove Medical, uh, website. And then most of the social media platforms out there, I’m on there with Morning Dove Medical and I post the same thing. So, uh, I’m available, um, and, and happy to help our industry 

Diane Hullet: thrive.

And that’s morning. M-O-U-R-N-I-N-G Dove, DOVE. Morning dove medical.com. 

Dr Kaishauna Guidry: Yes. And this is the Morning Dove in my background, the logo, I love the morning dove. There’s a story about a morning dove visiting me and so gold starter, anyone who finds that, I’ll send you a free book. 

Diane Hullet: Oh, nice. Okay. I like it. Who finds the background story?

Dr Kaishauna Guidry: Mm-hmm . 

Diane Hullet: All right. Well, thank you so much for your time, Dr. G. As always, you can find out more about the work I do at Best Life. Best death.com. Thanks so much for joining me, and thanks so much for listening.