Hospice can be a difficult word for families to hear. We often think it means giving up, but what if hospice is really about comfort, dignity, quality of life, and bringing more support to both the person who is dying and the people caring for them? In this episode, I’m joined by Ana Safarian, administrator of Olympia Hospice Care, for a conversation about what hospice actually looks like and how much support can be available to families. We talk about who may qualify for hospice, Medicare coverage, medications, physical and occupational therapy, medical equipment, nutrition and swallowing concerns, continuous care, and the difficult decisions families face as a loved one approaches the end of life. If you’re caring for someone with dementia or wondering whether it may be time to consider hospice, I hope this conversation gives you information that makes the process a little less frightening and a lot more understandable. Episode Highlights [0:46] - Welcoming you back to Season 4 of Dementia Discussions and sharing my gratitude for our guests, listeners, and caregivers. [1:21] - Introducing Ana Safarian of Olympia Hospice Care and starting with the basics: What exactly is hospice, and who qualifies? [2:30] - Understanding hospice as a Medicare Part A benefit and looking at some of the changes—such as weight loss, decreased eating, increased sleeping, and repeated infections—that may indicate someone could qualify. [4:41] - Discovering just how many services hospice may be able to bring into the home, including podiatry, physical therapy, occupational therapy, and speech therapy. [7:17] - Looking at hospice coverage beyond Medicare Part A, including Medicaid/Medi-Cal, private insurance, and situations where families may pay out of pocket. [8:36] - Can someone receive hospice and still be a full code? We discuss DNR decisions, life-sustaining treatment, and why accepting the end of life is often a process for the entire family. [10:56] - The hospice team approach: how social workers, chaplains, medical professionals, equipment, supplies, and medication support can all come together around the patient and family. [12:06] - What happens to a person’s medications after entering hospice—and why comfort care doesn’t necessarily mean immediately stopping medications. [13:17] - Treating UTIs, pneumonia, wounds, fluid retention, and other medical concerns while keeping a patient comfortable and, whenever possible, out of the hospital. [16:16] - Where can someone receive hospice? We talk about receiving services at home, in assisted living, and in other care settings. [16:30] - What happens when a family wants to return to the hospital for additional testing or treatment after choosing hospice? [19:51] - Providing IV fluids at home and why avoiding unnecessary hospital trips can be especially important for people living with Alzheimer’s disease or dementia. [20:45] - Facing one of the hardest parts of hospice: accepting that death is coming while still wanting more time with someone we love. [22:40] - Nutrition at the end of life, including supplements, declining appetite, force-feeding concerns, aspiration, and recognizing how the body’s needs change. [23:48] - Swallowing difficulties, bedside swallow evaluations, food consistency, thickener, and ways families can help reduce aspiration risks. [25:38] - What is a hospice comfort pack? Ana explains how medications and oxygen can be kept available in the home when symptoms arise. [27:24] - Understanding continuous care and when a hospice patient may need around-the-clock skilled nursing support during the active dying process. [30:16] - Why hospice needs to be appropriate for the patient—and how having support at home can reduce stressful trips to the emergency room. [31:16] - The unique burden dementia caregivers face when their loved one can no longer participate in end-of-life decisions. [32:20] - Shifting the conversation from quantity of life to quality of life and asking what truly matters for the person we love. [32:43] - Ana shares a moving example of a woman who was able to reflect on her own life and make a deeply personal decision about hospice care. [33:40] - Looking ahead to another important conversation about medical aid in dying. [34:32] - Why caregivers and hospice professionals need to work together rather than viewing hospice as a team that comes in to “take over.” [36:14] - Closing the episode and inviting caregivers to share their own stories with Dementia Discussions. Do you have a caregiving story to share? Barbara would love to hear from you! Please leave her a message at 310-362-8232 or send her an email through DementiaDiscussions.net. If you found value in today's episode, please don't forget to rate, follow, share, and leave a review. Your feedback helps us reach more listeners and continue producing this content.
