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Hospice: End-of-Life Care for Your Loved Ones

Hospice care is a program that assists with end-of-life care. Dr. Dale Zaruba, Medical Director for Columbus Community Hospital Home Health and Hospice, discusses hospice care.
Hospice: End-of-Life Care for Your Loved Ones
Dale Zaruba, MD
Dale Zaruba, MD is the Medical Director for Columbus Community Hospital Home Health and Hospice. 

Learn more about Dale Zaruba, MD

Introduction: It's another edition of our podcast series, Columbus Community Hospital Healthcasts.

Bill Klaproth: Talking about end of life care can be hard. However, when that time in life comes for you or your loved one, it helps to be prepared. And hospice care is a valid consideration for many families. Joining us now to talk more about hospice care is Dr. Dale Zaruba, Medical Director for Columbus Community Hospital, Home Health and Hospice. Thanks for joining us today, Doctor Zaruba. So let's start with this, in general terms, can you tell us what is hospice?

Dr. Zaruba: Hospice is a program that was developed several years ago to kind of help with the end of life care. So often is people reset into life care, physicians just don't really know what to do for that person. We've been trained our whole lives to be, you know, people that cure and we're not so good when it comes time to, that we're no longer able to you know, treat something. But in reality, hospice, we are still treating the patient, we're just taking a different approach to it.

Host: Right? So end of life care. So who generally is on a hospice team?

Dr. Zaruba: Our hospice team is primarily made up of nurses. They carry the bulk of the workforce, but we also have a social worker who's very important in helping out families in the financial burdens of this and working through the systems and finding all the resources that are available to them. We also have pastoral care to help with the religious needs. And then I serve as a Medical Director and give my input into how can we do this better. The patient's physician also remains part of our team, although they're not directly involved on a day to day basis, maybe like our team is, but they still serve an important role that we look to them for questions and ask them, you know, where we make some adjustments. If there's something here that, you know, that could help us with the patient's end of life care.

Host: How do you know when someone is ready for hospice care?

Dr. Zaruba: Well, the typical standard that is applied is you think somebody has life expectancy of six months or less. That's kind of what insurance has always used. That's kind of the application that we use in deciding whether somebody's ready for hospice care. It's not always easy to judge whether somebodies got six months to live. We, none of us have a crystal ball. But if you see somebody who's kind of actively progressing in their illness and they actually look like they're sort of heading towards their final days, that's when we need to get involved with them.

Host: And then where does hospice care generally take place?

Dr. Zaruba: It can take place wherever that patient is. That patient is still at home, we do great going in the home and providing those cares that they need. They're in a nursing home. We also bring in, you know, our staff there. Some people wonder why, why would you need hospice care in a nursing home? Well, they don't offer all the social work aspects. They don't offer all the religious aspects and again, they're not necessarily trained in the end of life care. So, we can do it there. We can do it at assisted living facilities. It's really where the patient's home is, that's where we're going to provide that care.

Host: And then how will care providers keep the patient comfortable and control pain?

Dr. Zaruba: Oh, we'll use anything we can. You know, probably the first thing that comes to mind is people are going to think about, narcotics or opiates and use of those more powerful pain medicines. But really what it comes down to is, you know, sometimes we're using kind of talk therapy where we're using kind of nontraditional medicines. It's a combination of multiple things that we do to help control pain. It's not always just going straight to the, you know, traditional morphine's and those types of medications.

Host: Right. And I know this is a touchy question, but how long can someone survive on hospice?

Dr. Zaruba: Well, that's a really interesting question because a lot, we get that a lot when, when somebody comes on and we talk about that six months life expectancy and what happens at six months? Do I just get kicked off if I haven't asked away by that time. And it's always been a standard of just if the patient has a life expectancy of six months, whether six months has already went by, you still feel like, you know, in the next six months this person could pass away from their disease, that we continue to treat. And we've had people that have been on hospice with us for two and a half years sometimes just because they're very ill, but they've been able to kind of hold on. And sometimes when hospice comes in, that extra support makes it easier for those patients to sort of survive with such severe illness. And so our typical days can be from one day to sometimes a couple of years.

Host: Wow. I didn't know that. I always thought it was a shorter time frame. So as you're talking about services being offered, can you tell us about the hospice services offered in Columbus?

Dr. Zaruba: So the Columbus Community Hospital Hospice is a nonprofit hospice. We offer all the services we've talked about before with pain management, with grief counseling. We're there for the family in addition to the patient. We have the social workers who can come in and help people with, you know, some of the complex forms that go with time off from work, ranging for the insurance payments. Sometimes it's hard to navigate those things. Again, we have the religious component where we have pastors that come in, we have volunteers that will come and spend time with patients. So there's a multitude of things, I'm just touching on. Another thing comes to mind is we offer a bath aid to come in and assist with bathing. You know, simple things that you would, you wouldn't normally think of. Hospice can, a lot of times help and alleviate some of that burden that gets placed on these caregivers.

Host: Yeah. There's so many pieces to the puzzle. I would imagine things that most people don't even think about. Is it true that many people don't consider hospice care because there's some about how it can help?

Dr. Zaruba: Yeah. I think a lot of people don't necessarily understand what hospice is. In fact, a lot of people have kind of over the years said, well, will they pay for my nursing home stay? And I have to stop them and say, you know, that's, that's not what hospice is here for. We're not there to sort of be a resource for your living expenses. We're there to help with these end of life symptoms and decisions that have to be made. And we're trying to kind of be a coach almost at the end of the light to help them through these most difficult times. Because fortunately most of us haven't experienced a lot of death in our families or if we have, it's only been maybe once or twice and it gives people some support and information and really kind of helps them at that time when you know, there's just, it's difficult to know what to do.

Host: Right. You were just mentioning people may think that this will pay for living expenses. So that seems to be confusion around payment for the services. So what is typically covered by insurance or Medicare?

Dr. Zaruba: So Medicare has a benefit that they will pay for hospice. So if you have your Medicare, that's an easy one for us to work with. Many private insurances also have a hospice benefit. And each one of those is a little bit different. And again, that's where kind of having a social worker involved in our team is able to navigate those policies and go in and say, okay, here's what your benefits are. And we try to guide people when we get them, when we first start getting involved with them and say, okay, here's what your benefits are going to pay for. But most insurance companies have that benefit in place. Medicare is, you know, that's probably who we deal with the most because fortunately most of the people are elderly and they're beyond that 65 years where they're going to be on Medicare.

Host: So with the eventual passing of a loved one, can you tell us how hospice can help families cope with the loss of their loved one?

Dr. Zaruba: So again, you know, we have the religious aspect of our services we have, who provides some of the counseling. Our social worker, again, she's a mental health provider so she can help with that. So it's just again, a resource for us to be able to answer questions and try to be a coach, and to kind of guide them through these end of life decisions. And you know, even just with helping to make funeral arrangements and pretty much anything that comes up, we can be their go to resource.

Host: Which can be very comforting to a family. That's for sure. So Doctor Zaruba as we wrap up, thank you for your time. Is there anything else important about hospice care that people should know about?

Dr. Zaruba: You know, the thing I would say is that if you're at all considering it, don't wait too long. I think that's the thing that we see the most is people wait till it's the last days. And hospice services are there to give people that to make the adjustments. It's really providing some dignity at the end of the life to help them to be at home. Most people, if you ask them, they say they'd rather die in their own home than to be in a hospital bed with a bunch of tubes sticking out of them. And so getting hospice involved earlier is what I would encourage people to look at. Don't wait till the last minute when you know things are imminent.

Host: Well, that's really good advice from an expert. Doctor Zaruba, thank you so much for your time today in talking with us about hospice care. We really appreciate it. Thank you.

Dr. Zaruba: You're welcome. Thanks for having me.

Host: That's Dr. Dale Zaruba, Medical Director for Columbus Community Hospital, Home Health and Hospice. For more information about the hospice services offered at Columbus Community Hospital, please visit Columbus that's Columbus H O S P .org. And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Columbus Community Hospital Healthcasts from Columbus Community Hospital. I'm Bill Klaproth, thanks for listening.