Hello, my name is Doctor Sarah Walker, and I'm honored to serve as the 2025 president of the El Paso County Medical Society.

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Presented by the El Paso County Medical Society and hosted by Kathrin Berg.

For many, the word hospice brings fear, uncertainty and confusion.

But the truth is, hospice is not about giving up.

It's about gaining something incredibly meaningful, such as comfort, connection and dignity during one of life's most vulnerable seasons.

We're going to break down what hospice really is, why families choose it, and how starting care early can create a more peaceful and meaningful moment in a person's life.

This program is underwritten by Hospice El Paso and a huge thank you to the El Paso County Medical Society for bringing this program to you.

I'm Kathrin Berg, and this is the El Paso Physician.

Neither the El Paso County Medical Society, its members, nor PBS El Paso shall be responsible for the views, opinions or facts expressed by the panelists on this television program.

Please consult your doctor.

Hello.

Thank you so much for joining us.

Today.

We're going to be talking about understanding hospice.

Usually there's a gasp when somebody hears that word.

What does it mean.

And we're going to break down what hospice actually does, what it does mean to families and to the person who is actually in hospice.

Today with us, we have Dr.

Juan Becerra, who is the chief medical director, and he's the person that oversees patient care and guides clinical decisions.

We have also with this doctor, Jose Burgos, who is the medical director and supports patient care and ensures comfort focused treatment.

And then we have nurse Rosie Bernal who is the director of nursing, and she leads the nursing team and ensures patients receive compassionate, high quality clinical care.

Now all of that was a lot of mouthful and speaking of what you all do.

So, we and to me the golden nuggets are always right before this program starts.

And we have these conversations about what you all do.

So what I'd like to do is have you all tell the audience, so Dr.

Becerra, as the chief medical director, what does that mean to the folks at home?

What do you do all day?

Every day?

I'm going to ask each of you the same question.

Thank you, Kathrin Well, my job is to coordinate the levels of care and hospitals all across from pediatrics to adulthood.

We also supply the medications are supposed to be for the patients on the different stages in their illness, and also coordination with the nursing staff where, well, social workers were chaplains, the whole team that makes hospice, hospice.

Excellent.

And Dr.

Burgos, how about you again?

You are the medical director.

We've got chief medical director, medical director.

And we were talking earlier that you do a lot of inpatient.

You do outpatient.

What does that mean?

Right.

So I take care of the center for Compassionate Care, which is our, inpatient hospice unit.

And basically, this is the type of patient that has severe symptoms that are difficult to control with our typical medications, patients who are, actively symptomatic, and they can only be controlled with intravenous medication.

So rather than get these patients back to the hospital, where unfortunately, hospitals are not necessarily trained to provide comfort, more to treat aggressively.

Then the center for Compassionate Care can provide aggressive treatment for symptom control while preserving that comfort that the patient, family needs.

Because, we not only treat the patient, we're treating the family members at the same time.

So I'd like to expand more on that as this hour goes, because I think that that could be one of the myths that we that we encounter throughout time, because all of us have been in that situation where we know somebody went on hospice, and then I'm just being blunt and it's like, oh, that means they're going to die soon.

And that's not always necessarily the case.

And we're looking at treatment within hospice as well.

So I'm glad that we're bringing that up.

Nurse Rosie, so let's ask you you are often I'd imagine, the first line of the families that come in and you are the nursing director.

So the conversations that you might have with patients and their families.

How would you describe what your what your role is?

Well, I provide support for our nursing staff, our social workers, our chaplains.

Be and, our bereavement counselors, our certified nursing assistants.

And my job is to support them when they go out and see patients.

They have face to face interactions.

And sometimes they need the support that, amongst each other because hospice is a hard job.

So they all need support from each other.

And and I like to say I provide support for them too.

You know what?

Say it out loud and proud because, we're going to talk about caregivers in a while as well, because that is a it's an onus on people.

And you all are very good about navigating that and helping out with the caregivers as well.

Rosie, I'd like to start with you, and this is the million dollar question of the evening.

What is hospice?

Right.

And the reason I'm saying it, I know we talked about a little bit before the program started.

It seems like such an easy thing.

Well, everybody knows that hospices, but there are a lot of different tentacles that, that are involved in different ancillary effects.

Maybe go through some of those.

So the people that are listening, that may go, oh, I didn't know that hospice did that.

So if you can start from there.

So hospice is a program for patients and families, patients that have, terminal diagnosis, life limiting diagnosis.

And basically what it is, we have team members that go out and see the patients and provide care that we want them to feel comfortable at end of life, have dignity, of end of life and manage their symptoms.

There's also we manage clinical symptoms, but there's also spiritual symptoms .

Spiritual symptoms, emotional symptoms.

And sometimes patients are grieving things that could have been families or grieving things that could have been.

And so we have our bereavement counselors and we have chaplains that provide that spiritual support.

They are non-denominational.

So they can provide care for all patients.

Yeah.

And then we have our social workers that provide emotional support for our patients.

I want to give, kudos really to some of the social workers.

And I'm just going to use my own experience because I think that's what we all do.

We all come from the perspective that we have.

I'm from Germany.

When my grandmother was 80, we brought her from Germany to live with us here in America.

She didn't understand any English, etc.. We, she was at a point where we put her in hospice and a social worker that we had went out of her way to get books in German to get, at that time, VHS tapes in Germany.

It was 30 some odd years ago.

But really made an effort to make her comfortable in an environment that she was completely, I'm trying to think of, a stranger to, you know, in this, in this area.

And it was my first introduction to hospice.

I never knew what hospice was.

I was, you know, a teenager.

And so, kudos to that.

And I've been always a proponent of anything and everything that has to do with hospice.

And I'm going to stop here at this point, cause I think it's super important for the audience to know that this particular hospice, which is Hospice El Paso is the only hospice in town that's a nonprofit.

And it's the only hospice in town.

Dr.

Becerra, that you were talking about that also treats pediatrics, it treats children and so on that note, Dr.

Becerra, I'm just going to ask to go off script a little bit and talk about those two components.

In fact, I'd like you to talk about the pediatric hospice portion of it.

And Dr.

Burgos, if you don't mind, I'd like you to talk about the the fact that it's a nonprofit.

And what does that mean in the space of all the other hospices as well?

Because there are there are many to choose from.

And I just would think would be good for the audience to know that.

So talk about the pediatric portion of this particular hospice.

Yeah, the pediatric program is different from a regular hospice that we all know, right?

Yes.

The patients are, well, close to the end of life.

Right.

But I keep most of the time last longer because it's a younger body that is a reality.

Right.

So for there for bad bility, for good or for bad, they last longer.

They're in their, hospice benefit.

They're able to receive chemotherapy.

In the case of a cancer, they're able to go to the hospital in the case of, or a flare up of asthma or an infection or whatnot.

Whatever it is, they can still go to the hospital and still reenroll in hospice care because our role is to prevent infections, to help them at home with their not only their clinical needs, but also their spiritual needs, the family members and everyone else around them, and also the social needs that sometimes these families encounter from, financial issues to social issues in general, right, that they have a sibling that needs to go to school.

But the mom is always busy at home.

So all those things, as you said, kudos to these people that take care of this, this, this person.

And they ask me like, why do you do that?

Right.

Well, yeah, it's a call that is a calling.

I think God put us there for a reason.

And yeah, everyone runs away from the, house on fire, but we run towards that, right?

Yeah.

Yeah.

Someone's gotta do it.

And believe me, just with knowing that keeps me going.

And again, my experience is over 30 years ago, and it was for maybe a six month period, I'll say it's my my mother, my grandmother died within three months of each other and both were on hospice care.

And so it was it was a very big portion of my life.

But the change and the impact you had on our family was phenomenal, like truly phenomenal.

And I want to say that to people listening because I think there's a hesitancy to sign on the hospice because it means you're giving up, just like we talked about in the opening statement.

And that's a myth we'd like to bust this evening.

Dr.

Burgos to kind of counter on that.

I know I said, let's talk about the, nonprofit arm, but we're also talking about, with pediatric care, but also in adult care.

You were talking about aggressive treatment that can be done within in care hospice, like sometimes, people think, well, after hospice starts, then there's no more treatment or now it's just giving up time again.

Let's bust that myth and talk about some of the treatments that occur while in inpatient care.

That makes sense.

Yes.

I mean, typically people say, well, there's so there is nothing else to do.

And the reality is that there is a lot to do.

The problem is that we just have to change our frame of the situation.

We're now probably not aggressively treating that condition.

Now.

We are aggressively treating the symptoms.

And symptoms are not always physical.

They can be spiritual as well and emotional.

So this is now what hospice does.

We just reframe how we were dealing with the condition.

So there is aggressive treatment in hospice in the sense of the the symptoms that the patient is presenting.

On the inpatient hospice, we aggressively treat pain, we treat agitation, we treat anxiety, we can treat certain type of infections because we do not want our patients who are already, declining because of their primary condition to have an infection.

Just, you know, making them crumble and pass faster.

So actually, we we make sure that we can maintain their status for as long as possible, even if they have a terminal condition.

So that is part of the aggressive treatment on the medical physical part.

But there is aggressive treatment emotionally.

I mean, we we can run on patients who are in the, in the hospice unit.

Then our typical for perspective will be like, okay, the doctor will say yes or no to this medication or the other, but, we get in the middle of, of family feuds, you know, that they're fighting because it's a very tense moment.

We have to do psychotherapy on everybody there, even the nursing staff.

Right.

So we have to play different roles when we are providing hospice care.

And I tell this to the family like it's not only the patient who is receiving services.

Everybody in the close circle is receiving services because it's everybody's problem at the end.

So we tend to relieve that weight, from the shoulders or make it a little lighter at least.

So they can have a better experience at the end of life.

Because this is unavoidable.

It's right.

Death is going to come.

And a lot of people and I'm sure that for Dr.

Becerra, I said, well, why are you guys doing this is not a glamorous specialty in medicine.

And I actually with years I have to learn to recognize more and more why why we do it.

Everybody's present when we're born and we tend to die alone.

Oh my goodness, that's so spot on.

And to me that is extremely important.

We cannot die alone.

We cannot die in pain.

We cannot die suffering.

So we do so much to celebrate birth.

We do so much to fight death when we are treating, patients in the hospital, when we prevent diseases.

But what about at the end of life?

We have to recognize that the life will come to an end.

Sometimes it is time.

Most times it's unexpected.

And we need to be there.

Yeah, I agree, Rosie, I'd like to, take that a little bit further.

In the mental health field in treating, I know we were talking about social workers and, faith leaders in the world of end of life.

We talked about anxiety.

We talked about depression a little bit.

But I'd like to focus on that for a while because, again, that is what people think of you can't help but just be completely down and depressed when you know that your life is going to end and the people around you and that was, a big part of the treatment with my, my parents.

When you're going through this, talk to the audience a little bit about what is available when someone is in hospice with those issues.

We do have, for example, our chaplains, they try and take care of spiritual pain.

It can be very hard when you're dying and you're asking yourself, why is this happening to me?

And so we have our chaplains that have experience with patients that are dying.

Our social workers are amazing and they provide emotional support.

And sometimes it it's amazing what, venting can do for a patient or a family member.

And so we have patients that have a lot going on in their mind.

And our social workers are there to listen.

They will listen.

They'll take what they hear, and then they'll try and help them that way.

And then it's not always about sadness and anxiety and depression.

Sometimes, or a lot of times we're there to control symptoms so that they can live comfortably at the end of their life.

So we would treat pain so that they're able to enjoy their time with their family.

We treat anxiety for the same reason they can enjoy their hobbies, at the end of life.

So all those services that we provide is for us to be able to give the the patient's life meaning at the end of their life.

That makes sense.

Dr.

Becerra, what I'd like to do is, I know we've kind of answered this here and there, but you are the physician.

You are the physician.

When you talk to a family that is in that that really difficult stage of do we decide to go with hospice?

We decide not to again, kind of discounting myths and what you've heard and what it is, what are.

And I'd love to hear maybe some experiences that you've had, some case studies perhaps of a family that was was kind of fighting, going in like, I'm not sure if we want to do this.

What are those conversations like?

What is it that they ask of you?

And how do you explain how getting into office and why you should be getting into hospice?

It really is an art to convey the message.

It really is something that is very intimate from not only from person to person, but also there's cultures around these things.

Right?

You mentioned later German, the perspective of dead and life.

Obviously in German community will be different from one that is, a Jewish community or Islamic community.

So you have to release a social skill.

You have to read the room, and then you have to talk first to a patient, obviously.

Right.

We have to respect the patient.

Always talk to the patient.

And if not, maybe you have to address yourself.

If the patient is not able to make decisions to the chief of the family may be right.

The, our laws in Texas, they tell us who to talk to, who to address to, if they don't have the decision making.

The patient doesn't have a decision making.

So you have to start there.

And then you have to make a diagnosis based on the prognosis.

You have to tell us what to expect.

Ma'am, the patient is there, right talking to you.

You have this condition is a terminal one, right.

So it means that he doesn't have a cure.

You have this much?

Maybe if you have a good estimate of time, you have to convey the message with all the compassion in the world.

And if they want to write anything and that that's so key.

And if they want to.

I feel like you were saying that, but how how often is that a struggle?

Is that is that often a struggle?

Not often a struggle.

And I guess it depends on, like you said, the chief of the family, so to speak.

Right.

Surprisingly, most of the patients, whenever they they know that they have something terminal, they want to know how long.

They want to know how long, because, hey, you have to be prepared, right?

You have to know how to react to that.

That's the hard thing to write based on their experiences.

Right?

Based on our experiences or previous patients every patient gives you, you know, another lesson to learn as a physician so you can be better prepared, better, more accurate for your, your prognosis.

And to tell them what to expect in, in future cases.

So you can be that message to them with all the compassion if possible with all your social skills.

And then they pick what you write and it's okay, you have to address it.

That is okay to not let go or not to to feel that they're failing.

Right.

I don't like whenever someone say oh you fail chemotherapy, you fail or you're not okay is not fail.

It just I, as I explained in medicine, has two purposes.

The first purpose of medicine is sort of cured, which are to cure.

But hey, sometimes because of the type of wounds, we cannot cure you.

So you shift your care your efforts to.

The second purpose of medicine, which is prolong the life, may return prolong life with chemo, with the treatments for COPD, for heart failure, for a and then we cannot prolong your life, or prolonging your life means making you suffer.

We shift our care to a third and last purpose in medicine, which is avoiding suffering, which is what hospice is.

Right.

But is not failing or is not, you know, quitting.

There never was it's just directing your medical efforts and your efforts as a patient towards a different purpose.

That's, that's beautifully explained.

Dr.

Burgos, if you can and this is the hard part because it's kind of the clinical question of in a, there's all kinds of different situations and I get it.

But when is it the time that you would tell a patient it's time to go to hospice.

And I would like to not emotionally but clinically.

And maybe you can get some examples.

But you talked about ALS, you talked about, certain types of heart disease, etc., certain types of cancers, oncology.

When is it clinically that you all make the decision amongst yourselves of, like, this patient should be approached or this patient's family should probably be approached to consider hospice care?

Definitely.

Actually that there is one important thing, in the United States, hospice is regulated by CMS.

So everybody follows what CMS makes a standard.

And what is CMS centers for Medicare and Medicaid Services.

Okay.

So it's the federal government, right.

Because obviously most patients in the country, they can they can be insured by, you know, by by the by the federal government with either Medicare or Medicaid.

So they set the rules.

And in a this is a very regulated program.

A lot of people think, oh, you guys want to put me in hospice because it's a business.

And I actually tell them, well, if I actually make the wrong call for secondary gains, I'm going to be in trouble and not just in trouble for, you know, somebody is going to, like, slap my hand.

I'll be in trouble with the federal government because it is a heavily regulated program.

So the rules in the US, they tell us that somebody qualifies for a hospice if the condition they have has a prognosis of six months or less is that if it follows the natural course of the condition.

So this is something that we always have to reinforce when we document how the patient is doing.

So that is the a strict criteria.

Now sometimes we we can see a patient in a certain condition.

And we know.

Well I mean if this continues to go this way we know that it's not six month.

It might be weeks or days.

So hospice is appropriate.

But if the patient recovers and they still have the terminal diagnosis, they may actually outlive the six month.

So they can still be within the realm of receiving hospice services.

And they can actually surpass that expectancy of six months or less.

We have patients in hospice who survive over a year, so we have to always reevaluate if they meet criteria or not.

Do they have evidence of of declining through the past three months, or are they actually getting better?

And you know what?

Sometimes a lot of patients with terminal conditions or with severe chronic conditions, all they need is a little bit of care.

And with the care provided by hospice services, some of them, they tend to do so well that the prognosis is overextended.

So we have to interrupt and stop services because their life expectancy just went went above of what we thought would be initially.

So in that unique case, when someone is in hospice and the expectation was six months or less and it now looks like things are getting better, there's a rallying happening.

And that person looks like it's going to, you know, maybe live quite a bit longer.

How how do you all handle that?

You said sometimes they go out of hospice or into something else.

How is that usually how is that cadence work when that happens we have to do certain processes.

They're called recertification processes.

We do that every 2 to 3 months just to see how the patient is doing.

So it's, on, on a particular recertification period.

We're seeing that, you know, the patient is actually quite stable, pain, not needing pain medications anymore.

It's gaining weight is not falling.

Hasn't needed to go to the hospital accidentally because something, you know, happened in the middle of the night?

So we we we kind of, like, flagged the patient here.

Okay.

For the next couple of months, let's keep a close eye, because once we recertify and again, maybe they might not be criteria.

And then at the same time, we have to let the patient and the family know, because a lot of people, they get so comfortable with the services that we have to drop them, they will they will have a really hard time.

Yeah.

Because it is a it is a net where they are falling and it's holding them and it's holding the entire family at times.

In and we were talking, part of the program to that being in hospice, and this is a great example of that doesn't necessarily mean that you're married to hospice.

If you you on your own want to de-enroll in hospice, that's something you can do as well.

Or if medically things are going well, that can happen as well.

And I would imagine two and was you can speak to this that if and when that does occur, there is still some support obviously.

In in service that might help out on that note.

And I think this is the question that everybody asks.

And Dr.

Becerra, I'll ask you, first on this when it comes to paying for hospice, when it comes to the fact that Hospitable Paso is a nonprofit hospice, does that make a difference in the paying of hospice?

How much do people pay for hospice is a different according to insurances, etc.

it's always the hard question to ask medically, but that's the question everybody's curious about.

Yeah, it's 100% covered with Medicaid and Medicare and most commercial insurances, and I dare to say maybe 99% of them right now cover the hospice benefit because they recognize everyone recognizes the benefit of it.

These types of patients will end up eventually in and out of the hospital, produce and a lot, a lot of, you know, depth in the families.

And then obviously the insurance companies are going to have to pay a lot for these patients, right?

So, whenever we enroll, the hospice benefit for these patients, it's 100% covered, so they don't have to go to the hospital anymore, which we know that eventually they're going to expire because you have a chronic, life limiting medical condition.

No one escapes that.

You know, just focusing the care on comfort.

Would it's a win win win for everyone.

And, Rosie, let's talk about, we've talked about the idea of when it's that time and now a family comes to you and comes to Hospice of El Paso, and it's time to enroll them, admit them into hospice, etc.. And one of the myths is that, oh, if I'm going to go in hospice, that means it's going to speed up my dying process.

I'd like for you to address that bluntly and, specifically because I think that needs to be addressed.

And again, there's myths out there because it's I heard this and I heard that, well, I remember this and I remember that.

And it's always not always, but often from a second hand or a third hand or something happened 20 years ago, etc.. So tell us really what that that means when you come into hospice, it's not about expediting death.

What we are focusing on is quality of life at the end of life.

It doesn't mean that the patient is going to pass away sooner because they're in hospice care.

What happens is that we treat patients for, say, pain, anxiety with medications.

And a big myth is that those medications cause death.

And it's not the medications that cause death, it's the actual disease that causes death.

But it doesn't mean that they're going to die as soon as they go into hospice.

These, when we admit the patient and they're talking about, do I have to give this medication to my loved one, even though they might not need it?

The answer is no.

You don't have to give them medication if they don't need it.

Sometimes they think, oh, they're in hospice.

I need to give them their medications no matter what.

But that's not the case in.

So expand on that.

So that is the doctor's directive to give a medication.

But then the family can decide not to do that in hospice like expand on that a little bit.

So what happens is that a nurse will do their assessment and then report back to the doctor.

Then the doctor gives us the orders to, incorporate a new medication or, stop a medication.

We get those orders and then we educate the family on the medication.

We'll, or because it may be a brand new medication they've never heard of before or understand how the reaction will be.

Okay.

Yes.

And so we educate the family with the medications for, a lot of the times the medication is used as needed.

And so we educate the family.

You only give this as needed.

So you give us an example.

I know I'm interrupting, but that way we can be specific on that.

So when you say as needed, is that usually a palliative medication meaning of medication for either pain or medication for sleeping.

What what family is the medications or the medications in that you're that you're speaking of?

For example, pain medication.

Okay.

We we provide pain medication.

The doctor's ordered pain medication.

And we teach the family that if the patient has pain, then that's when you get the medication.

If they don't have pain, then we don't give the medication another medication that we may use would be anti-anxiety medications.

As our body start shutting down, we get anxious.

We get scared.

And so during that time, if the patient gets anxious or scared, then we'll use the anxiety medications as needed.

Sometimes we don't get scared, sometimes we're ready to die.

And so we're at peace with that.

And we don't need the anxiety medication.

Another one would be shortness of breath.

That happens at end of life, too.

We will provide oxygen or even something like morphine to help, relax the patients.

Diaphragm and help the lungs breathe better.

And so we'll we'll talk to the family about that, too.

So this is the stuff that I think is so important for the audience to hear and know.

Because when when a family is in that situation and the family is making decisions and I am I'm going to the point again, I'm thinking about my mother in this point.

So she was in a coma ish for the last 4 or 5 days.

So there was not something that she can make a decision on.

So the family had made this initial decisions there, with the help of the nurse that was there.

And again, this is 30 some odd years ago.

It's been a long time.

Have you been in a situation in the past?

And this is again, what we can talk about, real life case studies, where a family was like fighting.

And you were talking earlier, too, that sometimes there's infighting within family members.

Some say, yes, you know, let mom have the medication.

It's going to help her feel better.

The other ones know it's, you know, talk a little bit about that struggle and how you all handle that, because that's, again, a real life situation I imagine happens quite a bit.

It how do you all handle that?

So sometimes we'll have a family and a patient that have been through a lot of struggles.

To get the patient into hospice.

They might all agree, but then we have a daughter or son that lives out of town, and they see the bubble that the patient and the family, the immediate family has been in.

And they say, well, you or you're giving up, why aren't you treating my my mom with more chemotherapy and more radiation?

And so what we do is we encourage the family member to come and visit the patient and see the dynamics of what's going on with the patient, and then we educate.

We educate, on what's going on with the patient, how their body is shutting down and at that point, some time or most of the time, they they understand and then they're ready to accept hospice and to accept the treatment that we are okay.

And, you know, we follow a hierarchy.

You know, there is there is a chain of command patient rules.

Patient is the one who makes a decision.

There you go.

And then if the patient is not able to make the decision because is numb by the condition or the status, or even because of the medications, then we go to whoever has the medical power of attorney.

So even if you have 10,000 family members fighting, you just tunnel vision to go to the person who makes the decision and you tell them, this is a legal situation, and this person is the only one who has the capacity to communicate anything, so they have the right to communicate with all the other family members, or they can make decisions on their own.

But legally, that's the only opinion that we will take.

And then when we have when we don't have a paper telling us who makes a decision, then we go to the next of kin, and then that's when we have to play referee among brothers and sisters.

And even if there is one person legally, capable to make decisions, it's always good to try to get everybody, bring everybody together so we can all be on the same page just because, you know, it's a tough time and you want people to feel at ease.

Right.

I will interject here.

I was in a difficult situation.

My my birth father, who I was completely estranged from, I was next of kin.

There was no, no paperwork about who to call, etc., etc.

and I just got a phone call one day.

It's Hello?

Kathrin Berg, are you the daughter?

Are you related to this individual?

I was like, he's my biological father.

Yes, but I there's no.

So I was put into that situation, and all of a sudden had to make decisions and had to I had no idea.

Again, hospice was a it was a different hospice was a different city and a different area.

But I do have to say at that time, too, that I'm a proponent of saying that this is something that they help you out with all kinds of different steps.

Doctor Becerra, I would like to ask you on again, this is not a myth, but just understanding there is end of life care.

We hear the word hospice, and then there's also palliative care.

Palliative care.

Just basically means taking care of the pain, so to speak, the lessen the agony.

And you said the earlier it's medication or medicine is for cure for long life and then avoid suffering.

If you can explain to the audience within the hospice, hospice, hospice of hospice, the the way those two compare and contrast with each other.

Yeah.

So the word palliative means to cover with a piece of cloak is to cover to make you feel better.

Right.

That's what our linguistic word come from.

So what that means is that every person, not only a clinician, a physician or a nurse or anyone else, but any person that puts a Band-Aid on someone is is doing a sort of palliative act or someone helping feel better.

Yeah.

So us in the in medicine, every time that we give, for example, someone that has a cancer, pain medication because are in pain that you give our pain medication or every time that, lung doctor gives an inhaler to someone that has, COPD, for example, they're doing an act of palliative.

Right.

But as those conditions continue, maybe that cancer, instead of being, stage one cancer became a stage three.

So as a tumor grow, for example, or the COPD got worse, or that heart failure is worsening as well, that is causing the patient to have a lot of liquid in the lungs or in the legs.

You find yourself as, as a clinician giving more and more and more medicines or interventions to cope with symptoms.

Yeah, right.

So more palliative, more palliative approaches.

But then at some point because these conditions might become terminal, that's stage three maybe stage four which by definition doesn't have a cure in the Or in the case of a cancer, then you find yourself doing only palliative approaches because the patient is so symptomatic that there's nothing that I can do as a clinician to prolong this patient's life or to cure him.

Right.

So whenever you encounter yourself in that area, as we discussed before, we have to have that conversation with a family.

And that is when hospice will start, when all interventions are with the are exhausted, to prolong life or to cure you.

So all our efforts are merely with the intention of keeping you comfortable.

That is a distinction between palliative and hospice care.

So you can see us.

Palliative is what comes before right when you're trying to prolong your life or cure yourself.

And then hospice is merely palliative measures without anything to prolong your life.

Right.

We don't we don't accelerate death.

That is illegal in the state of Texas.

It's legal in other states.

Right.

That is a topic that will be, you know, for hours and hours since we border New Mexico, Arizona and Mexico.

Because, again, this is kind of our community.

Where does Mexico sit on that and where does New Mexico sit on that?

There's eight states in the nation that allow physician assisted suicide, and New Mexico is one of them.

Right.

So yeah, it is legal.

So is there.

And and I'm going off topic just because we brought it up and I'll just spend a second on this because we've got people in, in Las Cruces and in El Paso.

So if someone was going to choose a hospice in Las Cruces or in El Paso, is there a fundamental difference in policies because of that law or or is it not?

Well, even a hospice in New Mexico does not provide physician assisted suicide.

Hospice does not do that because, as I said, the hospice philosophy is not to hasten nor prolong that what those states do especially well and and especially but also in New Mexico is that a physician that is okay, that is treating the patient, and the patient expresses twice that he wants to terminate his life in the best way possible for the physician could, if he's okay with it, prescribe a medication that it's lethal at that dosage.

But the physician does not give a medication to the patient.

The patient has to give them medication to themselves.

Okay?

That is what it's legal.

Yeah, right.

If I, as a physician, give the medicine to the daughter or to the husband of a patient, and that family member provides it to the patient, that is illegal.

That the patient themselves has to administer the medication.

The medication otherwise will be manslaughter okay.

Otherwise it would be manslaughter.

Yes.

Yeah.

Okay.

I would love to one day do a program that again because it's, it's a part of the conversation often when there is a terminal illness.

So I, I appreciate us bringing that up.

Doctor Becerra, I'm going to ask this of you originally Rosie's question, but it's your turn.

So, when we're talking about a hospice plan of care, like a care plan, and hospice, describe what that might be.

And again, I know it's different with everyone.

Want to use a case study?

Great.

But in general, someone is newly enrolled in the hospice, and now we have a plan.

Describe what that could look like.

So the plan of care is a multidisciplinary approach.

And actually we it's between the doctor, the nurses, the CNA, the social workers, the chaplain, the volunteers, everything coordinator.

So it's it involves so many people, so obviously from the medical part.

And we assess what needs they have.

Right.

Based on the diagnosis.

Maybe it is to improve the respiratory status.

So then we tend to prescribe medication that will help the patient breathe better, dealing directly with their condition, maybe treating pain, maybe through nausea, vomiting anxiety agitation.

And then at the same time is addressing what other social and spiritual needs the patient have.

For example, a something as simple as has has the patient is everybody who he cares about around.

Are they here?

You know what?

There is a sign that he hasn't seen or spoken to in 15 years.

So you know what I think is time to kind of, like, connect this and see if there's something we can do to mend that relationship at the end.

Are there any spiritual needs?

Is there any guilt, being carried?

So even those simple things, they are extremely meaningful in the process of, of of death and the end of life.

So we address all of those things.

And that's part of the plan of care.

Or it could be something as simple as how many, how many volunteers do we need to, you know, to keep the patient company because there are no relatives around, right.

So we want to make sure somebody and you will be surprised how many people actually volunteer for hospice.

I'm not surprised at all.

Actually, I, I, I understand it and I get it right, you know.

Yeah.

So that is part of plan.

So what are the needs and how can we make this process the least, you know, anguish for, for the patient or the family.

And I like how you're talking about sure.

It is physical comfort, but it's also emotional comfort and mental comfort.

And that's something that is is highly focused on.

I think that's great.

And on that note, Rosie, I'd like to talk a little bit about the caregivers and how you all implement caring for the caregivers as well, which I think is highly important because they're the people that are they are 24/7 and, you know, do it the hard stuff.

Hard stuff.

Talk a little bit about how your hospice deals with that.

We provide support to the caregivers by, of course, education, how to take care of the patient.

We encourage them.

We, when they're doing a good job, we let them know you're doing a good job.

You're taking care of your family member.

We also teach them to take care of themselves because if they don't take care of themselves, then who's going to take care of the patient?

We do provide respite care for our patients and their families, which is describe what respite care is for those who don't know.

Right.

What we do is we send the patient to our inpatient unit so that the caregivers can get a break, because taking care of a dying patient is hard.

It's very hard.

And so the patient can go to the inpatient unit for, I like to say, five nights and six days.

And they go so that the caregiver can get some rest.

And the patient receives 24 hour nursing care, which includes the CNA, be a registered nurse or a licensed vocational nurse.

Okay.

And that's a perfect transition.

And Doctor Borgus, I'm going to ask of you, the question comes up.

Well, now they're in hospice.

On hospice.

I don't know if there's one that is is in place of the other, but where does hospice take place?

There's inpatient.

There's outpatient you could do at home, could be an in facility, etc.. How is that decided upon?

And just expand a little bit on that.

So ideally hospice should happen at home because we want the patient to be as comfortable as possible.

But sometimes it can happen for different reasons.

Maybe they need, 24 hour care.

They they cannot be independent on their normal living activities and they need more support.

So that's when we do hospice either in a foster home, which is a private pay home, or it could be in a nursing home.

But if the patient, has severe symptoms that can only be treated with intravenous medication, since that's when we provide care in our inpatient unit.

But, you know, certain hospitals they have they can provide that care inside of the hospital for a brief period of time to treat these aggressive symptoms.

So hospice can happen pretty much anywhere that the patient and the families decide.

We will have patients in jail, correctional facilities and hospice.

Everyone has the right.

So this is actually that time in the program where I just ask about the unique things, the new things happening, stuff that we haven't talked about yet and that that's something we haven't talked about yet.

How how is that carried out?

If someone's in jail and they're on hospice care, if someone has a life limiting medical condition, even if they are in a correctional facility, they have the right to to receive these type of approaches, right?

So if the need be, we we will do it.

Okay.

We will do it.

Interesting.

Someone has to.

So we are at this point now we have a whopping seven minutes left in the program.

So this is usually when I like to pull back the questions that I have and see if there's anything that you all wanted to talk about this evening that maybe you thought about on the way over here, that I didn't talk about or ask you.

And whoever raises their hand first gets to go first?

Yes, Dr.

Becerra.

So I know your audience includes physicians.

And this is my my mission, I feel, to convey the message of the beauty of palliative and hospice care to our medical community as well.

And I train students and I tell them, you know, if you don't learn anything from here and you got to be a surgeon, if you get to be a, radiologist, whatever you decide to go in this beautiful world of medicine, just know that we as clinicians, as a nurse, as a doctor, we have to recognize when to stop, when to stop offering things that probably won't benefit a patient anymore.

It is.

It is out of the kindness of someone's heart to recognize that, so that for me and for your audience, I think we all should do that introspection and and recognize and compared with a lot of, you know, as I told you, a lot of empathy and a lot of caring for patients.

And I like the way you said that to, and I've heard this over and over again that often people will keep someone viable for themselves, but not for the patient.

And so to kind of step into the idea of what the patient might want versus what the family is fighting for at the end, that might be that's the way I described it, you know, again, I had three parents that were on hospice, and it's, I get it.

I really do.

Doctor Burgos, anything on your end that you to talk?

Several things.

We have a lot of, from, you know, experiences and information, but something important, in the community, we have several hospice companies.

And actually everybody can potentially, from time to time, take a little break and say, well, we can do a charity case.

But the difference with Hospice El Paso being the only, non-for-profit, hospice agency is that we can take on any, funded patients, absolutely no cost at any time.

So that is definitely something that differentiates, the company with everybody else.

Again, in the community.

A lot of people, they, they do tend to, you know, lend a hand whenever is needed.

But is this is the mission for Hospice El Paso.

Okay.

So we talked about if there is an insurance Medicare Medicaid does cover it.

Most insurances does cover it.

But in case to someone that does not have, the insurance that you all are the ones that that cover that.

And again, as a nonprofit, I'd be, remiss not in not saying, hey, if you want to help out the situation, by all means do.

Exactly.

And then another thing, whenever the insurance pays for hospice, just to make it very clear for the audience, there is no copay.

For the patients or the family.

Okay.

This is extremely important to to remind, you know, our our public because, I mean, we do not know if at some point in time they encounter, an agency that might be charging and that is just wrong is illegal.

I mean, that's not supposed to happen.

There shouldn't be any exchange of money between a patient and a hospice agency.

Okay.

Clear enough?

Anything you want to add in your whopping two minutes?

Can I tell you a love story?

Yes.

You can tell me a little story.

Absolutely.

You can go, Rosie.

Go.

I had a patient that she had Alzheimer's, and the patient's husband loved her so much.

And the patient's husband was not in our services, but he did suffer a fall.

And he broke his hip, and he had complications due to the fracture of the hip.

And he, ended up in the hospital, of course.

And then he was transferred back home and he was placed in hospice.

And so their caregiver, would tell the patient's husband, you have to be strong.

You have to keep going because the patient, his wife needed him to be there for her.

And she he said, no, don't worry about that.

I'm going to take her with me.

Oh, and so that the husband passed away.

And then the following day, the our patient passed away too.

Oh my goodness.

Those are the stories that that movies are made out of, you know.

And those are the stories that that again, this is what it's all about, right?

Making sure that people have dignity and care and warmth in the end of their days.

Thank you for sharing that.

Really, really, I want to say yes, that I think people are going to like you have to do it quick.

So when we do interdisciplinary meetings, which happens weekly with, we tend to learn about every single patient in the agency, right?

Yes.

So something that is very typical that happens with patients who are really at the very end is that they start having visions of people who they actually love.

Yes.

So some of them is a parent, some of them is a kid, some of them is actually a brother who pass.

But it's not a random.

It's not a random thought of like a random family member is people who meant something very particular for that person.

So obviously we believe that that person, well, that's they start having visions.

We know that is very, very close because obviously our we want to believe that that person is coming to pick them up.

So it happens every single day.

What a beautiful note to end on.

Really.

I hope that happens when it's my time.

Yes, I would like someone to welcome me, and I told my dog before he passed that he needs to pick me up.

Oh, I love that goodness.

And I'm glad that we all smile at the end of this, this episode.

If you are just now, catching a part of this episode and would like to watch it again, or any of the programs that we have done here with the El Paso physician, this particular program was Understanding hospice, and it was Hospice of El Paso.

But you can go to several places to do that.

You can go to PBS El paso.org and just look up on that website, the El Paso physician.

You can also go to the El Paso County Medical Society website.

And that is EPCMS.COM and then YouTube.

Everybody always just thinks YouTube.

Go to YouTube and just type in the words the El Paso physician.

You won't have to use that anymore.

You can just put el paso physician.

This one will come up first because it's the latest episode.

But you can also research other episodes of this program that you'd like to see.

Thank you so much for joining us.

I'm Kathrin Berg, and this has been the El Paso physician.

The El Paso County Medical Society is a nonprofit organization established in 1898, that unites physicians to elevate the health of the El Paso community.

We have been bringing the El Paso Physician Television program to your home for the last 27 years on PBS El Paso.

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