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Speaker 1: Welcome to Stuff You Should Know, a production of iHeartRadio.

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Speaker 2: Hey, and welcome to the podcast. I'm Josh, and there's

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Speaker 2: Chuck and Jerry's here too. So this is an old

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Speaker 2: fashioned root and tootin episode of Stuff you Should Know

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Speaker 2: and about something we needed to talk about. Chuck.

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Speaker 1: Okay, okay, you remember back in like.

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Speaker 2: The like about like the two thousand and nine ten

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Speaker 2: eleven era, when like death was all the rage people

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Speaker 2: were having, like death cafes and like creating living wills,

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Speaker 2: and it was just a big thing that everybody talked about.

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Speaker 2: When was this like two thousand and nine to two

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Speaker 2: thousand and maybe eleven.

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Speaker 1: I don't remember that, but I'll take your word for it.

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Speaker 2: It was a real thing, for sure. Unless I've just

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Speaker 2: completely lost my marbles and I just made up a

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Speaker 2: whole era of American culture. I don't think I did.

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Speaker 2: But that has died at so like that it's gone

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Speaker 2: back to death has gone back to being a bit

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Speaker 2: of a taboo topic, an uncomfortable topic, at least at

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Speaker 2: least here in the United States.

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Speaker 1: I didn't know that either.

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Speaker 2: It's true. I guess I'm just speaking for myself anecdotally.

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Speaker 1: Oh okay, that makes a lot more sense.

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Speaker 2: So okay, well let's just cut to the chase here.

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Speaker 2: There's this concept of a good death, yeah right, and

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Speaker 2: you can probably fill in a lot of the blanks

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Speaker 2: of what that means and what it means to you

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Speaker 2: at least, but there's actually like some components to it

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Speaker 2: that studies have found, like kind of bubble up to

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Speaker 2: the top that most people can agree this makes a

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Speaker 2: good death. There are things like getting to say goodbye

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Speaker 2: to friends and family, having those people at your side

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Speaker 2: if you want so. A certain amount of control over

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Speaker 2: the dying process is something being pain free, not suffering, sure,

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Speaker 2: being in an environment, and having a chance to like

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Speaker 2: kind of come to terms with the fact you're about

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Speaker 2: to expire. Those are some of the top things that

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Speaker 2: people say, like, this to me is a good death.

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Speaker 2: And not coincidentally, those are the kind of things that hospices,

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Speaker 2: which we're about to talk about today, are intended to provide.

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Speaker 2: That's the service they provide is to give you, the individual,

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Speaker 2: a good death. And it's not something that's relegated to

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Speaker 2: the rich. It's not something that's relegated to the educated.

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Speaker 2: It's for everybody. Everybody deserves to have a good death,

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Speaker 2: and that's pretty much the motto of hospice, And in fact,

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Speaker 2: I ran across one motto. It said, if you can't

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Speaker 2: add more days to life, add more life to days.

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Speaker 1: That's great. It sounds a little too corporate slogany, but

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Speaker 1: I like the sentiment.

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Speaker 2: Yeah, there's a mascot, Louis the dead guy who's like

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Speaker 2: always saying that slogan, and he did a partnership with

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Speaker 2: home Depot for some reason recently.

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Speaker 1: Oh boy, well that explains the orange bed sheets and things, right,

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Speaker 1: all right, so that's probably the last semi joke we're

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Speaker 1: gonna make. You'll have to forgive us for that. We

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Speaker 1: did a whole episode on dying, and I don't even

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Speaker 1: know if we made one joke in that one, So.

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Speaker 2: Sure we did, you think, yes? I absolutely think.

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Speaker 1: All right, well we'll pair that with this one. And

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Speaker 1: because we've got a lot of great feedback on the

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Speaker 1: dying episode and how that could kind of help people out,

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Speaker 1: so yeah, maybe this will do the same. We should

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Speaker 1: probably go back in time a bit and explain the

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Speaker 1: history of hospice, because it is very recent. If you

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Speaker 1: look at sort of the timeline of people in the

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Speaker 1: world dying hospice has only been around since like the

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Speaker 1: sixties or seventies and the form that we know it

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Speaker 1: because previous to that, for all of time, basically medicine

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Speaker 1: was like, hey, we're here to cure people, and if

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Speaker 1: it turns out that we cannot cure you and that

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Speaker 1: the end is near, for a very very long time

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Speaker 1: until the last like you know, like I said, since

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Speaker 1: the sixties or seventies, very shamefully, hospitals and even doctors

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Speaker 1: would sort of like it was a reminder that they

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Speaker 1: couldn't save you, so they didn't spend a lot of

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Speaker 1: time with you. And there are a lot of you know,

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Speaker 1: well known reports of people kind of like scurrying past

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Speaker 1: rooms where people were in their final days in a

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Speaker 1: hospital and stuff like that.

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Speaker 2: Yeah, they left the dying who were incurable now to

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Speaker 2: basically die alone. They withdrew support. That was just what

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Speaker 2: they did. And like you said, it was a reminder

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Speaker 2: of the failing of medicine. And this was a time

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Speaker 2: when modern medicine was not in any kind of mood

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Speaker 2: to be reminded of failings, because I mean, the twentieth

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Speaker 2: century was pretty triumphant for it. I mean, I saw

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Speaker 2: that infant mortality rate declined by ninety percent over the century.

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Speaker 2: There's like sanitation, clean drinking water, polar vaccine, like science

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Speaker 2: could do anything, and people who were incurable were just

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Speaker 2: a reminder that there were limits to that whole thing.

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Speaker 1: That's right, right, and another thing that was going on.

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Speaker 1: And this is also pretty shameful. Well, I guess not shameful,

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Speaker 1: but they've since revisited how they look at pain management.

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Speaker 1: But yeah, you had to like really be in pain

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Speaker 1: to get pain management, and then that had to like

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Speaker 1: wear off and you had to be really in pain

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Speaker 1: again for them to administer more pain management. They were

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Speaker 1: worried about, you know, opioid addiction and stuff like that,

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Speaker 1: but you know, these days, it's it's definitely more like, hey,

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Speaker 1: you know, we're not worried about you getting addicted to

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Speaker 1: opioids in the final possibly days of your life. We

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Speaker 1: just want to make you feel okay.

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Speaker 2: Yeah, that's definitely the hospice philosophy is you don't have

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Speaker 2: to wait until one pain killer wears off to get

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Speaker 2: another dose. You can you know, stay comfortable. That's the

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Speaker 2: point is to make the person comfortable. That's called palliative care.

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Speaker 2: We'll talk a little more about that, but it's essentially

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Speaker 2: just taking care of symptoms to keep people comfortable.

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Speaker 1: Yeah, for sure, nuns were kind of on the scene

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Speaker 1: early on, providing you know, emotional support. They couldn't dose

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Speaker 1: out pain medication of course, and stuff like that, but

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Speaker 1: they you know, it was a lot of times it

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Speaker 1: was religious organizations that were stepping forward that were kind

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Speaker 1: of doing the hospice type work that would come along

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Speaker 1: in the sixties and seventies, thanks in part to a

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Speaker 1: couple of big landmark books that came out.

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Speaker 2: Yeah, there was this whole thing in the sixties and

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Speaker 2: seventies that was kind of this rebellious streak that went

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Speaker 2: across like against some of the just unquestioned institutions, and

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Speaker 2: one of those was medicine and doctors and hospitals. But

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Speaker 2: there was a psychiatrist name Elizabeth Koubler Ross who very

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Speaker 2: famously came up with the five Stages of grief that

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Speaker 2: was in her nineteen sixty nine book on Death and Dying.

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Speaker 2: And in addition to being famous for coming up with

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Speaker 2: the Five Stages of grief, she also basically interviewed people

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Speaker 2: in the Chicago Hospital's ice you who were dying and

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Speaker 2: just found that they were just being totally neglect and

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Speaker 2: so she definitely lobbied for dying and dying people and

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Speaker 2: their families to be listened to and to be treated

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Speaker 2: rather than just ignored.

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Speaker 1: Yeah, we talked about her and that book in our

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Speaker 1: dying episode. I don't think we talked about the Denial

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Speaker 1: of Death from nineteen seventy three, but that was from

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Speaker 1: an anthropologist named Ernest Becker, and he was writing this

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Speaker 1: as he was dying himself, so he was in a

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Speaker 1: position to really give a good, you know, pretty moving

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Speaker 1: first person account, and he talked about sort of you know,

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Speaker 1: a good death and accepting the inevitability and stuff like that.

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Speaker 1: So these things were sort of happening in the cultural

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Speaker 1: movement when a woman, a hero i think a named

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Speaker 1: Cecily Saunders came along, eventually the founder of medical director

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Speaker 1: of Saint Christopher's Hospice in London, and she really changed

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Speaker 1: the game and kind of birthed the whole sort of

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Speaker 1: modern hospice movement.

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Speaker 2: Yeah, she had a bad back from a young age

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Speaker 2: and apparently it kept her from her desired career of nursing,

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Speaker 2: so she instead became basically a social worker. Uh, at

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Speaker 2: the time they called a lady almoner or distributor of alms, right,

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Speaker 2: So it's pretty old timey, but it does kind of

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Speaker 2: it's a nod back to the original hospice which were

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Speaker 2: founded in the Crusades by the Roman Catholic Church. Ironically,

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Speaker 2: Cicily Saunders was raised an atheist, but she had a

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Speaker 2: conversion to Christianity, evangelical Christianity, even when she went on

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Speaker 2: vacation with a Christian friend and her family. And one

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Speaker 2: of the other big experiences that letter to found the

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Speaker 2: hospice movement essentially was she had like some friendships with

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Speaker 2: some people that she helped essentially as they were dying,

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Speaker 2: and really kind of was moved by these friendships and

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Speaker 2: wanted to make sure that other people had that same experience.

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Speaker 2: So she did something that I mean just kind of

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Speaker 2: I think really gets across kind of person she was.

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Speaker 2: And she went to medical school to make her voice

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Speaker 2: a little more credible.

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Speaker 1: Yeah, she started medical school at age thirty three. This

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Speaker 1: is in the nineteen fifties, and she finished medical school,

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Speaker 1: she was able to work as a physician. She started

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Speaker 1: writing articles and stuff about this about people, you know,

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Speaker 1: being deserted or feeling like they'd been deserted by their doctors,

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Speaker 1: like the closer they got to death like we were

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Speaker 1: talking about, and said, hey, there's got to be a

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Speaker 1: better way to take care of people, not only physically,

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Speaker 1: but emotionally and spiritually as they as they near death.

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Speaker 1: So she, you know, got that medical degree, got a

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Speaker 1: research job at a hospital, started studying. You know, she

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Speaker 1: wanted to have a legitimate sort of background for this

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Speaker 1: so people didn't think she was just some some wacky

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Speaker 1: impath trying to do good, which you know should be enough.

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Speaker 1: But she figured she was armed with medical training and

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Speaker 1: real data and on like pain management stuff, that she

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Speaker 1: would go a lot further in She did.

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Speaker 2: Yeah, she went and studied pain management firsthand so she

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Speaker 2: could come up with her own protocols. One of those

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Speaker 2: protocols that was really groundbreaking and went against the norm,

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Speaker 2: was to give dying patients not just heavy doses of

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Speaker 2: morphine to make sure that they weren't in pain, but

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Speaker 2: also cocaine to keep them from just being kind of

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Speaker 2: doped up for the rest of their lives. She would

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Speaker 2: find out what liquor they preferred and would make sure

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Speaker 2: that they had their liquor and all of this sounds

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Speaker 2: like just completely reckless and careless, but she had before

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Speaker 2: and after pictures of these people terminal cancer patients who

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Speaker 2: in the before pictures before they had been treated with

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Speaker 2: her new protocol of pain management and I guess mood

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Speaker 2: management too if you think about it. They did not

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Speaker 2: look very good. They looked like terminal cancer patients. And

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Speaker 2: afterward they were sitting up in bed, perked up. Some

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Speaker 2: had taken up hobbies like knitting. And she would show

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Speaker 2: these before and after pictures when she went around the

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Speaker 2: world speaking on behalf of hospice as she was trying

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Speaker 2: to found it, and like she would get converts at

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Speaker 2: every talk she gave just from the before and after

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Speaker 2: pictures alone.

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Speaker 1: Yeah, it was pretty remarkable. This all culminated in nineteen

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Speaker 1: sixty seven when she founded Saint Christopher's Hospice, Like like

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Speaker 1: I mentioned earlier in London and kind of right off

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Speaker 1: the bat, she said, all right, we have a new

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Speaker 1: way to deal with pain management. We're going to get

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Speaker 1: rid of visiting hours and people family can come and

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Speaker 1: go when it's convenient for them, and we're going to

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Speaker 1: not talk about just you know, physical pain. We're going

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Speaker 1: to talk about what I call total pain or what

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Speaker 1: she called that. You know, like we mentioned emotional support,

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Speaker 1: social support, spiritual suffering that happens with people. And one

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Speaker 1: of the people that she worked a lot with was

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Speaker 1: a nurse in the US named Florence Wald who ended

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Speaker 1: up doing the same thing. In the US. She said,

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Speaker 1: I think we need this over here. She started up

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Speaker 1: the very first hospice in Branford, Connecticut and the United States,

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Speaker 1: and that was six years later after the one in

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Speaker 1: London in nineteen seventy three.

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Speaker 2: Yeah, that first American hospice. They tried a few names

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Speaker 2: out before they settled on the final one, Hospice rus

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Speaker 2: MC Dying, and then they just kind of went with

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Speaker 2: the straight name. Well all right, so yeah, so hospice

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Speaker 2: that's spread pretty quickly. I think you said Saint Christopher's

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Speaker 2: opened up in nineteen sixty seven and the one in

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Speaker 2: Branford opened up in nineteen seventy three. That's pretty good

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Speaker 2: traction to create a brand new idea in both the

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Speaker 2: UK and the US and start spreading it around the world.

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Speaker 2: And one of the things I think you said about

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Speaker 2: Saint Christopher's was, even though it was religious or at

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Speaker 2: least spiritual, it was non denominational, and that is a

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Speaker 2: huge point about hospice that is lost on a lot

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Speaker 2: of people. I think a lot of people associated with

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Speaker 2: religious groups still and like, if you're not, say Christian,

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Speaker 2: you wouldn't really want to go to a Christian hospice.

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Speaker 2: That is not at all the way that hospices work.

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Speaker 2: And in fact, there's plenty of people who are atheists.

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Speaker 2: They are humanists and they just are like those empathic

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Speaker 2: do gooders that you were speaking about earlier, and none

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Speaker 2: of these philosophies clash because they all come together to

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Speaker 2: essentially say, one of the big parts of dying is

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Speaker 2: some sort of spirituality or at least some sort of

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Speaker 2: peace that we associate with spirituality, and it doesn't matter how

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Speaker 2: you get there, we're all just kind of coming together

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Speaker 2: to make sure that everybody can experience that. It's a

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Speaker 2: big misunderstanding of hospice sometimes.

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Speaker 1: Yeah, for sure, in the US it's usually, or at

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Speaker 1: least at first, it was done at home. That was

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Speaker 1: a difference from the early ones in the UK they

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Speaker 1: were in patient facilities. But in the US, you know,

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Speaker 1: it was sort of a budget issue at first because

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Speaker 1: they couldn't get these facilities and pay for them. But

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Speaker 1: I think they also realized that people wanted to die

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Speaker 1: at home. And there was also this sort of long

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Speaker 1: running institutional distrust that Americans had, and it was a

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Speaker 1: lot of volunteer work at first, like almost entirely volunteer

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Speaker 1: early on. It was sometime, like we mentioned, people in

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Speaker 1: the clergy still doing this kind of work after centuries

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Speaker 1: of doing so, doctors that were moonlighting that wanted to

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Speaker 1: help out, and a movement was was, you know, clearly growing,

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Speaker 1: and it made government sit up and take notice when

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Speaker 1: they realized that it was saving money on healthcare, because

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Speaker 1: not only was the movement growing and people were just

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Speaker 1: feeling better about it, but it was keeping people out

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Speaker 1: of the hospital sort of off and on, off and on,

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Speaker 1: off and on, and so much though that the US

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Speaker 1: government and the Reagan administration said, you know what we

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Speaker 1: should we should get this covered. And in nineteen eighty two,

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Speaker 1: the hospice Medicare benefit went through, which allowed people all

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Speaker 1: of a sudden to be able to pay from you know,

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Speaker 1: staff run by professionals that were also paid and you know,

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Speaker 1: get it covered through Medicare.

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Speaker 2: Yeah, which opened up the door for people who wanted

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Speaker 2: to help people during the final days or weeks of

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Speaker 2: their life, but there wasn't a career associated with it.

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Speaker 2: Now there was, so you could you could pursue that

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Speaker 2: kind of medicine, end of life medicine. That's pretty cool

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Speaker 2: that that was a huge change. I suspect that the

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Speaker 2: saving money had a lot to do with it, though.

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Speaker 1: Yeah, that's usually the case.

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Speaker 2: And the reason why, we'll just spell it out explicitly.

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Speaker 2: The reason why it saves money is because you're taking

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Speaker 2: a patient off of a very expensive track, which is

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Speaker 2: a lot of different medical procedures and treatments, and saying

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Speaker 2: we're like, you're not going to go for the curative

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Speaker 2: treatment route anymore. We're going to take you out of

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Speaker 2: this crazy nutso medical world and put you in a

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Speaker 2: much more peaceful, tranquil world where you can end your

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Speaker 2: days as a happier person rather than feeling like a

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Speaker 2: guinea pig being experimented on. And it's just much cheaper

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Speaker 2: to do that too, as you can imagine.

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Speaker 1: It feels like a good breakpoint. Yeah, yay, all right,

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Speaker 1: we'll come back and we'll talk about how the modern

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Speaker 1: system works right after this.

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Speaker 2: So here in the United States, Chuck Hospice is usually

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Speaker 2: paid for by Medicare, which is federal insurance coverage for

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Speaker 2: people who are retirees typically or maybe disabled, and then

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Speaker 2: also sometimes Medicaid, which covers lower income Americans. And the

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Speaker 2: upshot of all this is that if you are dying

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Speaker 2: and choose to go on hospice care, you are not

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Speaker 2: charged for this, and that is a wonderful thing that

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Speaker 2: the federal government does. Apparently the UK is very much

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Speaker 2: like that, but a lot of it is donation driven

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Speaker 2: rather than paid for by the government, which does chip in,

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Speaker 2: but the lion's share is paid for by donations in

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Speaker 2: the UK. But there's eligibility requirements that basically say like,

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Speaker 2: if you don't check these boxes or if you stop

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Speaker 2: checking these boxes at any point, you can't be in

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Speaker 2: hospice anymore.

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Speaker 1: Yeah, and those boxes specifically, you have to have two

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Speaker 1: doctors certify that you have and this is for Medicare,

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Speaker 1: you know, to get it covered, not just to get

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Speaker 1: into hospice. Right, you have to have a terminal illness,

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Speaker 1: You have to have six months or less to live,

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Speaker 1: and you cannot be going after curative treatments. And we'll

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Speaker 1: talk about some I don't even know if there are exceptions.

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Speaker 1: But some things that some people might think are curative

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Speaker 1: treatments and a curate of treatments. That doesn't mean like

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Speaker 1: they don't ask for anything at all.

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Speaker 2: You know, you can't have a band aid.

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Speaker 1: Yeah, you're on your own. So we'll get into those.

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Speaker 1: But and this is going to be a sticking point

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Speaker 1: that kind of comes up later and some of the

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Speaker 1: failings of the current system. But Medicare pays hospice companies

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Speaker 1: and agencies a daily rate instead of for specific services

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Speaker 1: they provide like like basically all the other medical treatment

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Speaker 1: you're ever going to get, and there are four levels

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Speaker 1: of that care and there are going to be different

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Speaker 1: rates depending on the level that you're going to get

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Speaker 1: and also where you.

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Speaker 2: Are right, So if you're running a hospice, you would

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Speaker 2: get a flat fee paid by the government for a

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Speaker 2: patient who's in routine home care, which is you're not

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Speaker 2: in crisis, you're still dying, but you're doing okay. And

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Speaker 2: that usually is just a visit maybe a couple of

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Speaker 2: times a week. They're coming by to make sure that

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Speaker 2: their meds are going down right, they maybe have like

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Speaker 2: their nutrition going there's just essentially just checking on you

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Speaker 2: that's routine home care. There's also continuous home care where

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Speaker 2: if that patient slips into a crisis, like maybe they

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Speaker 2: start vomiting uncontrollably, they start suffering uncontrollable pain, that their

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Speaker 2: meds aren't doing anything for anymore, changes in consciousness all

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Speaker 2: of a sudden, Now they have twenty four to seven

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Speaker 2: hospice access at home.

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Speaker 1: Yeah, there's also there's a couple of more. There's inpatient

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Speaker 1: respite care. That's when a patient goes into like a

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Speaker 1: you know, they have to leave home to go into

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Speaker 1: a physical hospice center for up to five days. A

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Speaker 1: lot of times this is to give their caregiver time off,

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Speaker 1: because that's one of the brutal parts about end of

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Speaker 1: life is and I say burden on the family, not

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Speaker 1: like what a hassle, but you know, it is a

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Speaker 1: burden on the family. Yeah, people have to besides the

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Speaker 1: emotional devastation they're going through a lot of times, have

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Speaker 1: to rearrange their jobs and like even leave jobs sometime

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Speaker 1: to do this kind of thing full time. So it

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Speaker 1: can be quite a heavy burden on a family.

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Speaker 2: Yeah. Actually, chuck that that's a if you look up

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Speaker 2: downsides of hospice that's pretty much the number one issue

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Speaker 2: with it is that it transfers responsibility for caring for

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Speaker 2: the dying patient from say like a hospital to their family.

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Speaker 2: And that's it is. It's a very big deal. Yeah.

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Speaker 1: And then the last one is general and patient care,

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Speaker 1: and that is when you're addressing pain control or any

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Speaker 1: kind of symptom management that you can't that you have

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Speaker 1: to like go in and take care of at a

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Speaker 1: specific place. It's not the kind of thing you can

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Speaker 1: do at home generally. And then you know, palliates of

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Speaker 1: care is a big part of it. That's what we

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Speaker 1: kind of mentioned earlier, is is just making people feel

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Speaker 1: better toward the end. You know, I mentioned things that

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Speaker 1: don't count as curative treatment, like if you're if you

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Speaker 1: have heart like active heart failure, they can try and

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Speaker 1: reverse that. Or if you have some like nasty bedsword

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Speaker 1: that gets an infection, that that's not going to boot

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Speaker 1: you off covered hospice care to get that taken care of.

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Speaker 2: No, the key to being covered for hospice under Medicare

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Speaker 2: is that you are not pursuing treatment to cure the

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Speaker 2: thing that's got you terminally ill. Right, So, like you said,

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Speaker 2: if you have to develop a heart condition, but that's

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Speaker 2: not what's killing you. You have terminal cancer, they can,

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Speaker 2: you know, treat your heart condition. And even if you

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Speaker 2: do have terminal cancer, if you have nausea from cancer,

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Speaker 2: pain from cancer, they're going to treat that because they're

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Speaker 2: not trying to cure the cancer. You have to give

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Speaker 2: up things like radiation or chemotherapy. Those are curative treatments.

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Speaker 2: But there's the idea that they're just like, nope, sorry,

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Speaker 2: we're just going to put you in bed and basically

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Speaker 2: let you lay there. That's not at all what you

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Speaker 2: have to give up in order to enter hospice.

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Speaker 1: Yeah, and you know, the hospice workers are doing a

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Speaker 1: lot of stuff for you that goes above and beyond

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Speaker 1: just making you feel better or maybe sitting with you

395
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Speaker 1: and like you know, brushing your hair, Like there's all

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Speaker 1: that stuff that they're doing, bathing you, housekeeping sometimes you know,

397
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Speaker 1: helping out with gathering and administering the medications. But you

398
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Speaker 1: know they're doing all kinds of stuff. They might be

399
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Speaker 1: shopping for you, they might be babysitting for your family

400
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Speaker 1: to give you know, the like we mentioned the people

401
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Speaker 1: in your family. They're caring for you, like to give

402
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Speaker 1: them a break. They may help with fundraising if you have, like,

403
00:22:37,960 --> 00:22:40,240
Speaker 1: you know, money you need raise for your treatment. They

404
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Speaker 1: may bring in music and comedy performances to hospice centers.

405
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Speaker 1: People that cut hair, like volunteers that will come in

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Speaker 1: and style somebody's hair. Even I remember that was a

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Speaker 1: big deal for Emily's grandmother near the end, is you

408
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Speaker 1: know that she wanted her hair done and to look

409
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Speaker 1: like she looked, And that stuff goes a long way

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Speaker 1: to just putting people at ease, you know.

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Speaker 2: Oh for sure. Another one that volunteers can do is

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Speaker 2: take care of the person's pet to make sure that

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Speaker 2: if the person is opting for in home hospice, that

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Speaker 2: their pet doesn't have to go live with somebody else

415
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Speaker 2: because they can't care for it anymore. So you can

416
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Speaker 2: go and feed somebody's pet, take them for a walk,

417
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Speaker 2: change the litter box, and then something as simple as

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Speaker 2: just sitting with somebody and watching TV with them is enough.

419
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Speaker 2: And like this is just a volunteering opportunity of the

420
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Speaker 2: United States, in the UK, basically anywhere there's hospice, they

421
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Speaker 2: would very much like you to volunteer to just basically

422
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Speaker 2: be there and just being a human being who can

423
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Speaker 2: drive a car over to somebody's house is essentially the qualifications'

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Speaker 2: that's basically all you need to do, and they'll tell

425
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Speaker 2: you what to do from there. But no one would

426
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Speaker 2: expect you to, like, you know, inject the person. As

427
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Speaker 2: a matter of fact, you probably get in big trouble

428
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Speaker 2: if you did inject the person with anything. You just

429
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Speaker 2: need to be there. And in addition to just being

430
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Speaker 2: there for the person, the pay like you said, that

431
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Speaker 2: gives the caregiver some time to just go take a shower,

432
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Speaker 2: do something, just stop being a caregiver for a couple

433
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Speaker 2: of hours too.

434
00:24:10,760 --> 00:24:13,760
Speaker 1: Yeah, you know, even though a lot of them are professionals,

435
00:24:13,800 --> 00:24:16,360
Speaker 1: like most of them now, there's still quite a lot

436
00:24:16,359 --> 00:24:20,120
Speaker 1: of volunteers that do this kind of thing. That Medicare

437
00:24:20,200 --> 00:24:23,640
Speaker 1: law that talked about in nineteen eighty two that stipulated

438
00:24:23,680 --> 00:24:27,600
Speaker 1: that hospice facilities have at least five percent of the

439
00:24:27,640 --> 00:24:31,359
Speaker 1: patient hours provided for by volunteers. So that's one of

440
00:24:31,359 --> 00:24:34,040
Speaker 1: the reasons. And also just because there are people in

441
00:24:34,080 --> 00:24:37,520
Speaker 1: the world. You know, some people have maybe gone through

442
00:24:37,560 --> 00:24:39,600
Speaker 1: this with the family member and then they want to

443
00:24:39,600 --> 00:24:43,000
Speaker 1: give back. Some people are just wired this way as

444
00:24:43,080 --> 00:24:46,680
Speaker 1: impaths to want to help people. And then sometimes it's

445
00:24:46,680 --> 00:24:50,119
Speaker 1: people that are preparing for career in healthcare and you know,

446
00:24:50,160 --> 00:24:52,720
Speaker 1: getting in a hospice and kind of going through the

447
00:24:53,359 --> 00:24:57,840
Speaker 1: worst of the worst situations, is I imagine pretty good preparation

448
00:24:57,920 --> 00:24:59,280
Speaker 1: on dealing with any kind of patient.

449
00:24:59,800 --> 00:25:01,879
Speaker 2: Yeah, yeah, And you would prepare for a career in

450
00:25:01,920 --> 00:25:04,960
Speaker 2: that because hospices, like you said, they are professionally staffed,

451
00:25:05,000 --> 00:25:08,400
Speaker 2: and not just with nurses, not just with hospice doctors,

452
00:25:08,800 --> 00:25:13,720
Speaker 2: but social workers, bereavement counselors, some of those clergy and

453
00:25:13,800 --> 00:25:18,560
Speaker 2: just general aids who can come together and help with

454
00:25:18,680 --> 00:25:23,120
Speaker 2: that thing that Sicily Saunders started kind of seeing clearly

455
00:25:23,160 --> 00:25:27,440
Speaker 2: the total pain, where you know, if you have psychological pain,

456
00:25:27,480 --> 00:25:30,800
Speaker 2: it's going to make your physical pain exacerbated and vice versa.

457
00:25:30,960 --> 00:25:34,120
Speaker 2: And the worse off you are, the more hesitant people

458
00:25:34,200 --> 00:25:36,560
Speaker 2: might be to come visit you because they feel hopeless

459
00:25:36,600 --> 00:25:38,639
Speaker 2: or they're just freaked out or something like that. So

460
00:25:38,680 --> 00:25:40,840
Speaker 2: now you have social pain. So if you have all

461
00:25:40,880 --> 00:25:44,320
Speaker 2: these people coming together to treat the person's total pain,

462
00:25:44,880 --> 00:25:48,919
Speaker 2: you have a much calmer, happier again good death. And

463
00:25:49,000 --> 00:25:52,480
Speaker 2: those are called in the hospice industries interdisciplinary groups and

464
00:25:52,520 --> 00:25:55,000
Speaker 2: they do. They form a team for each patient to

465
00:25:55,040 --> 00:25:57,640
Speaker 2: figure out what to do for each of the patients

466
00:25:57,680 --> 00:26:02,199
Speaker 2: to help them find peace and comfort and calm.

467
00:26:02,920 --> 00:26:05,240
Speaker 1: Yeah, and this is a you know, it's a booming

468
00:26:05,280 --> 00:26:08,240
Speaker 1: industry now in the United States, and we'll sort of

469
00:26:08,240 --> 00:26:11,240
Speaker 1: get to the downsides of that and a little bit.

470
00:26:12,160 --> 00:26:18,200
Speaker 1: But statistically, from two thousand hospice centers in two thousand

471
00:26:18,200 --> 00:26:23,240
Speaker 1: and one to about fifty seven hundred today twenty you know,

472
00:26:23,480 --> 00:26:26,320
Speaker 1: twenty four to twenty five years later, it's really grown

473
00:26:26,359 --> 00:26:29,880
Speaker 1: a lot. Utilization grew by thirty two percent between twenty

474
00:26:30,000 --> 00:26:33,400
Speaker 1: thirteen and twenty twenty two. There was a twenty five

475
00:26:33,440 --> 00:26:38,880
Speaker 1: percent increase in Medicare beneficiaries. Obviously is the boomer generation

476
00:26:39,080 --> 00:26:42,320
Speaker 1: is aging, but that doesn't account for all of it,

477
00:26:42,359 --> 00:26:45,840
Speaker 1: you know, twenty five compared to thirty two percent. About

478
00:26:45,880 --> 00:26:48,879
Speaker 1: half of people now in the United States and roll

479
00:26:48,960 --> 00:26:52,240
Speaker 1: in a hospice before their death. If you have cancer,

480
00:26:52,280 --> 00:26:55,560
Speaker 1: you're far more likely to do so. As well as

481
00:26:55,600 --> 00:27:01,159
Speaker 1: being female and more educated and also older, which it

482
00:27:01,240 --> 00:27:03,359
Speaker 1: first seemed like a like a well of course, but

483
00:27:04,600 --> 00:27:06,600
Speaker 1: just so far as to say, if you're someone very

484
00:27:06,640 --> 00:27:09,879
Speaker 1: tragically in your younger life, that is stricken with something

485
00:27:09,920 --> 00:27:12,280
Speaker 1: like this, you're far less likely to enroll in hospice.

486
00:27:12,720 --> 00:27:15,240
Speaker 2: Yeah, and there's actually a lot of reasons why people

487
00:27:15,359 --> 00:27:18,840
Speaker 2: don't enroll in hospice. A good majority of them just

488
00:27:18,960 --> 00:27:22,200
Speaker 2: don't either aren't really aware of it or don't understand it.

489
00:27:22,880 --> 00:27:25,520
Speaker 2: And there's stigmas about hospice too, Like there's a whole

490
00:27:25,520 --> 00:27:28,280
Speaker 2: idea that if you go into hospice, you're giving up

491
00:27:28,320 --> 00:27:30,800
Speaker 2: on fighting for your life, you're giving up on living,

492
00:27:31,240 --> 00:27:33,159
Speaker 2: and that's just absolutely not true. Like, if you have

493
00:27:33,200 --> 00:27:37,000
Speaker 2: a terminal illness and it's really no longer treatable, a

494
00:27:37,040 --> 00:27:39,560
Speaker 2: good doctor will say, like, there's nothing more we can

495
00:27:39,600 --> 00:27:41,359
Speaker 2: do for you. There's plenty of stuff we can do

496
00:27:41,440 --> 00:27:43,600
Speaker 2: for you, but none of it is going to extend

497
00:27:43,600 --> 00:27:47,359
Speaker 2: your life. It's going to make your last days pretty miserable.

498
00:27:47,840 --> 00:27:50,520
Speaker 2: We recommend that you go into hospice and have like

499
00:27:50,960 --> 00:27:53,359
Speaker 2: good last days, hang out with your friends and family,

500
00:27:53,400 --> 00:27:57,400
Speaker 2: like be peaceful. That's actually, as far as the American

501
00:27:57,440 --> 00:28:01,239
Speaker 2: Society of Clinical Oncology is concerned, that's a sign that

502
00:28:01,280 --> 00:28:04,879
Speaker 2: you've had good cancer care that toward the end, in

503
00:28:04,920 --> 00:28:09,480
Speaker 2: the last few weeks, your cancer team says you've reached

504
00:28:09,520 --> 00:28:11,959
Speaker 2: the you know, incurable stage. There's nothing we can do

505
00:28:12,000 --> 00:28:16,280
Speaker 2: for you anymore except let's put you into hospice. The

506
00:28:16,320 --> 00:28:18,600
Speaker 2: problem is is there are plenty of doctors out there

507
00:28:18,680 --> 00:28:20,560
Speaker 2: who do see that as quitting, do see that it

508
00:28:20,640 --> 00:28:24,360
Speaker 2: is giving up, and are known to steer people into

509
00:28:24,359 --> 00:28:27,119
Speaker 2: hospice too late, to where essentially they just spend like

510
00:28:27,160 --> 00:28:30,119
Speaker 2: the last couple or few days in hospice and they

511
00:28:30,119 --> 00:28:34,600
Speaker 2: don't have a chance to actually develop what again is

512
00:28:35,520 --> 00:28:36,760
Speaker 2: referred to as a good death.

513
00:28:37,359 --> 00:28:41,520
Speaker 1: Yeah, and there's even evidence that going like trying to

514
00:28:41,600 --> 00:28:45,920
Speaker 1: cure yourself and sort of ceasing that process and starting

515
00:28:46,000 --> 00:28:50,160
Speaker 1: up with hospice can actually make people live longer a

516
00:28:50,200 --> 00:28:53,160
Speaker 1: lot of reasons. Maybe you're being monitored a little more closely,

517
00:28:53,640 --> 00:28:56,800
Speaker 1: Maybe maybe your symptoms are being managed a little little better,

518
00:28:57,600 --> 00:29:01,600
Speaker 1: and just everything that goes into the non physical you know,

519
00:29:01,840 --> 00:29:04,480
Speaker 1: sick and dying part that we've been talking about, the

520
00:29:04,600 --> 00:29:07,440
Speaker 1: emotional part and everything else, Like if all of that

521
00:29:07,600 --> 00:29:11,120
Speaker 1: is eased, studies show that you can you can make

522
00:29:11,160 --> 00:29:12,160
Speaker 1: it a little bit longer.

523
00:29:12,680 --> 00:29:15,640
Speaker 2: Yeah, that actually happened to Umi's dead. He was in

524
00:29:15,760 --> 00:29:18,920
Speaker 2: hospice and given I remember not very Yeah, there was

525
00:29:19,520 --> 00:29:23,080
Speaker 2: just a just a pretty raw time. He was given

526
00:29:23,160 --> 00:29:25,400
Speaker 2: not much time to live at all, I think like days,

527
00:29:26,400 --> 00:29:29,880
Speaker 2: and he didn't didn't pass, and you started to notice

528
00:29:29,920 --> 00:29:32,760
Speaker 2: he was actually kind of he was eating more, he

529
00:29:32,800 --> 00:29:35,800
Speaker 2: was his mood was starting to improve, and she convinced

530
00:29:35,840 --> 00:29:39,200
Speaker 2: the hospice doctor that he was not dying anymore. And

531
00:29:39,480 --> 00:29:42,800
Speaker 2: one of the things that became really clear that being

532
00:29:42,920 --> 00:29:46,400
Speaker 2: in hospice at home can do to improve your health

533
00:29:47,040 --> 00:29:50,240
Speaker 2: is that you're getting better nutrition, you're getting good sleep,

534
00:29:50,680 --> 00:29:52,960
Speaker 2: you're surrounded by people who don't have to come see

535
00:29:53,000 --> 00:29:56,120
Speaker 2: you in the hospital setting during visiting hours, and all

536
00:29:56,160 --> 00:29:58,520
Speaker 2: of those things are terribly managed in the hospital, so

537
00:29:58,560 --> 00:30:02,680
Speaker 2: at home you can just get better and better. And

538
00:30:02,880 --> 00:30:07,360
Speaker 2: Human's dad eventually left hospice, was discharged alive, and went

539
00:30:07,400 --> 00:30:09,120
Speaker 2: on to live for another three years.

540
00:30:09,920 --> 00:30:14,160
Speaker 1: Man, I remember all that going down and Jerry and

541
00:30:14,160 --> 00:30:16,480
Speaker 1: I all of us being like, oh man, this is like,

542
00:30:17,040 --> 00:30:20,520
Speaker 1: this seems like it's it, and you were bringing reports

543
00:30:20,520 --> 00:30:24,400
Speaker 1: You're like, man, the darnedest thing. Yeah, and then I

544
00:30:24,480 --> 00:30:26,479
Speaker 1: just I think we all suspected it was just going

545
00:30:26,560 --> 00:30:29,120
Speaker 1: to happen again right after that, and it was, Yeah,

546
00:30:29,200 --> 00:30:31,680
Speaker 1: it was a few years. It was just what a story.

547
00:30:31,880 --> 00:30:35,560
Speaker 2: Yeah, I've never been more proud of anybody than I'm

548
00:30:35,560 --> 00:30:38,800
Speaker 2: of Vium. She was the only one who saw, like, yeah,

549
00:30:38,840 --> 00:30:41,160
Speaker 2: she saw it, and she had to convince everybody else,

550
00:30:41,200 --> 00:30:44,280
Speaker 2: including me, that he's not dying, and she brought him

551
00:30:44,320 --> 00:30:44,960
Speaker 2: back for sure.

552
00:30:45,400 --> 00:30:46,480
Speaker 1: So yeah, what a gift.

553
00:30:46,680 --> 00:30:49,280
Speaker 2: It really was a gift. Yeah, I'm very proud of her.

554
00:30:50,840 --> 00:30:52,680
Speaker 1: All right, shall we take another break?

555
00:30:53,080 --> 00:30:53,800
Speaker 2: I think we should.

556
00:30:53,840 --> 00:30:55,760
Speaker 1: Man, all right, we'll be right back, and we're going

557
00:30:55,800 --> 00:31:25,680
Speaker 1: to finish up with hospice right after this one thing

558
00:31:25,680 --> 00:31:28,200
Speaker 1: we should mention kind of briefly. We don't have to

559
00:31:28,200 --> 00:31:33,440
Speaker 1: get too much into it, but hospice and right to

560
00:31:33,480 --> 00:31:37,000
Speaker 1: die and assisted dying, these are two things that you

561
00:31:37,040 --> 00:31:39,680
Speaker 1: know don't go together, but they obviously kind of do

562
00:31:39,760 --> 00:31:41,720
Speaker 1: go together in a lot of ways because you've got

563
00:31:41,720 --> 00:31:45,720
Speaker 1: a group of people that are it's the same group

564
00:31:45,760 --> 00:31:51,440
Speaker 1: of people. Mainly. It's even i think legally designated in

565
00:31:51,520 --> 00:31:54,640
Speaker 1: places where you do have the right to die, you

566
00:31:54,760 --> 00:31:57,320
Speaker 1: have to have doctor sign off that you're within six

567
00:31:57,400 --> 00:31:59,680
Speaker 1: months and there is no cure, and it kind of

568
00:31:59,720 --> 00:32:02,600
Speaker 1: is in locksed up with hospice. But it's not the

569
00:32:02,640 --> 00:32:06,240
Speaker 1: same thing because the you know, it's just not the

570
00:32:06,280 --> 00:32:11,080
Speaker 1: World Health Organization very much defines palliative care as something

571
00:32:11,080 --> 00:32:14,280
Speaker 1: that neither hastens nor postpones death. It is not the

572
00:32:14,320 --> 00:32:19,480
Speaker 1: point of hospice to go in and you know, find

573
00:32:19,480 --> 00:32:22,240
Speaker 1: an impath who will help assist you along a little

574
00:32:22,280 --> 00:32:25,120
Speaker 1: quicker if you live in one of those states. I

575
00:32:25,120 --> 00:32:27,400
Speaker 1: think it's an amazing gift to be able to do that,

576
00:32:27,480 --> 00:32:29,880
Speaker 1: and there are there's a track for doing that, but

577
00:32:29,960 --> 00:32:32,000
Speaker 1: it's not hospice. No.

578
00:32:32,200 --> 00:32:35,680
Speaker 2: And the reason why it riles up hospice people who

579
00:32:35,720 --> 00:32:39,160
Speaker 2: are against that is because there are one of the

580
00:32:39,200 --> 00:32:43,360
Speaker 2: reasons that people do choose medically assisted dying is to

581
00:32:43,520 --> 00:32:46,320
Speaker 2: end their suffering, and hospice people are like, no, we

582
00:32:46,440 --> 00:32:49,720
Speaker 2: know how to end their suffering without them having to die. Yeah,

583
00:32:49,760 --> 00:32:51,920
Speaker 2: And that's why it really gets under their skin. Although

584
00:32:51,960 --> 00:32:55,600
Speaker 2: that said, there are plenty of hospice people, probably humanists,

585
00:32:55,680 --> 00:33:00,600
Speaker 2: who are like, it's anybody's inalienable right to choose how

586
00:33:00,680 --> 00:33:01,720
Speaker 2: or when they die.

587
00:33:02,080 --> 00:33:02,880
Speaker 1: Yeah.

588
00:33:03,080 --> 00:33:05,200
Speaker 2: So, yeah, it is kind of a tricky thing, but

589
00:33:05,680 --> 00:33:09,160
Speaker 2: it isn't. I think it is generally unfairly associated with

590
00:33:09,200 --> 00:33:11,560
Speaker 2: hospice and even palliative care. I don't think we said

591
00:33:11,600 --> 00:33:15,600
Speaker 2: explicitly that is to treat and manage symptoms, pain, nausea,

592
00:33:15,680 --> 00:33:18,480
Speaker 2: that kind of stuff, symptoms that come along with terminal illnesses,

593
00:33:19,280 --> 00:33:21,600
Speaker 2: and that is a part of hospice, but not all

594
00:33:22,000 --> 00:33:24,680
Speaker 2: palliative care is hospice. You can get that same stuff

595
00:33:25,000 --> 00:33:28,080
Speaker 2: as you're pursuing like curative treatments, right, So it's not

596
00:33:28,120 --> 00:33:30,480
Speaker 2: like they're going to be like you're getting curative treatments

597
00:33:30,480 --> 00:33:32,840
Speaker 2: for cancer. Sorry, we can't do anything about the nausea.

598
00:33:32,880 --> 00:33:35,240
Speaker 2: Then it makes it. It has a place in both

599
00:33:35,240 --> 00:33:37,920
Speaker 2: of them. And it has nothing to do with assisting

600
00:33:37,920 --> 00:33:39,880
Speaker 2: someone and dying. It has to do with helping them

601
00:33:39,920 --> 00:33:42,160
Speaker 2: die comfortably when they die naturally.

602
00:33:42,760 --> 00:33:46,160
Speaker 1: Yeah, and you know you're not going to get you'll

603
00:33:46,200 --> 00:33:50,320
Speaker 1: get morphine and you'll get like the good stuff these days,

604
00:33:50,320 --> 00:33:52,280
Speaker 1: morphine plus. But you're not going to get the cocaine

605
00:33:52,280 --> 00:33:52,760
Speaker 1: and the liquor.

606
00:33:53,800 --> 00:33:56,160
Speaker 2: No. I mean unless you have a family member who

607
00:33:56,240 --> 00:33:56,920
Speaker 2: knows somebody.

608
00:33:57,160 --> 00:34:00,680
Speaker 1: I mean there's somebody's got a guy maybe, yeah, or

609
00:34:00,720 --> 00:34:05,400
Speaker 1: if you just have like a you know, pretty empathic,

610
00:34:05,520 --> 00:34:09,680
Speaker 1: like really empathic, like on the downlow hospice worker, right.

611
00:34:10,200 --> 00:34:12,239
Speaker 2: And I mean even if you do score for them,

612
00:34:12,360 --> 00:34:14,200
Speaker 2: they might not even want it. Like I tried to

613
00:34:14,200 --> 00:34:15,840
Speaker 2: give you and he's dad a bunch of cocaine and

614
00:34:15,880 --> 00:34:18,239
Speaker 2: he's like, no, I'm good with the pain stuff. I'm

615
00:34:18,280 --> 00:34:18,800
Speaker 2: on now.

616
00:34:20,120 --> 00:34:22,560
Speaker 1: Yeah, and then what to do with it? You know?

617
00:34:23,200 --> 00:34:29,440
Speaker 1: Uh so look we found another joke. Amazing, so right

618
00:34:29,520 --> 00:34:30,640
Speaker 1: right before the dark side.

619
00:34:30,760 --> 00:34:32,840
Speaker 2: Yeah, because there is a dark side to this, and again,

620
00:34:33,080 --> 00:34:36,160
Speaker 2: the one downside to hospices it puts it's just the

621
00:34:36,160 --> 00:34:38,120
Speaker 2: burden on the caregivers. We'll talk a little bit more

622
00:34:38,120 --> 00:34:41,200
Speaker 2: about that in a second. But the kind of generally

623
00:34:41,239 --> 00:34:43,759
Speaker 2: agreed upon dark side of hospice is that there's such

624
00:34:43,760 --> 00:34:48,480
Speaker 2: a thing as for profit hospices. And contrary to our

625
00:34:48,520 --> 00:34:53,400
Speaker 2: private equity theme in our private equity episode, we should

626
00:34:53,400 --> 00:34:57,200
Speaker 2: say that there are plenty of for profit hospitals hospices

627
00:34:57,239 --> 00:34:58,480
Speaker 2: that are perfectly well run.

628
00:34:58,840 --> 00:34:59,040
Speaker 1: Yeah.

629
00:34:59,200 --> 00:35:02,200
Speaker 2: The people who who the family members who have patients

630
00:35:02,239 --> 00:35:05,880
Speaker 2: and family dying there are totally happy give them great reviews.

631
00:35:06,280 --> 00:35:09,680
Speaker 2: Being for profit as a hospice isn't necessarily a bad thing.

632
00:35:10,400 --> 00:35:13,719
Speaker 2: Where they start to get lower marks than other kinds

633
00:35:13,760 --> 00:35:17,560
Speaker 2: of hospices, specifically nonprofit hospices is when they are part

634
00:35:17,560 --> 00:35:21,880
Speaker 2: of a publicly owned corporation, like a hospice went with

635
00:35:21,960 --> 00:35:23,120
Speaker 2: the IPO at some.

636
00:35:23,160 --> 00:35:24,760
Speaker 1: Point, Yeah, like a chain.

637
00:35:24,880 --> 00:35:31,040
Speaker 2: Exactly or surprisingly or not, private equity owns the hospice.

638
00:35:31,080 --> 00:35:34,160
Speaker 2: And the reason why it's problematic is because the way

639
00:35:34,200 --> 00:35:38,319
Speaker 2: that payment is structured has a built in incentive for

640
00:35:38,320 --> 00:35:42,160
Speaker 2: for profit hospices to cut corners and cut costs.

641
00:35:42,560 --> 00:35:44,680
Speaker 1: Yeah, there was a survey in twenty twenty four that

642
00:35:44,920 --> 00:35:47,520
Speaker 1: twenty five percent of hospices in the US are owned

643
00:35:47,560 --> 00:35:50,600
Speaker 1: by private equity firms. Now, so you can refer to

644
00:35:50,640 --> 00:35:53,880
Speaker 1: that episode as to exactly what goes into that. But

645
00:35:54,480 --> 00:35:56,239
Speaker 1: you know, I said earlier to put a pin in

646
00:35:56,280 --> 00:36:01,440
Speaker 1: the payment structure, which is they don't get paid through Medicare,

647
00:36:02,239 --> 00:36:04,680
Speaker 1: they don't get paid out per treatment given or for

648
00:36:04,800 --> 00:36:10,080
Speaker 1: specific treatments given. It's just this flat fee. Uh. And obviously,

649
00:36:10,120 --> 00:36:13,799
Speaker 1: if you have a chain, a hospice chain that is

650
00:36:14,080 --> 00:36:17,759
Speaker 1: for profit and has gone through the IPO process and

651
00:36:17,760 --> 00:36:22,680
Speaker 1: has shareholders to answer to, very sadly, many times you're

652
00:36:22,719 --> 00:36:27,520
Speaker 1: going to get hospice centers that that get that flat rate,

653
00:36:27,880 --> 00:36:30,640
Speaker 1: but they're cutting staff and people are getting the bare

654
00:36:30,760 --> 00:36:32,680
Speaker 1: minimum treatment required by law.

655
00:36:33,520 --> 00:36:37,000
Speaker 2: Right, and I saw there's a there's a thing where

656
00:36:37,120 --> 00:36:40,479
Speaker 2: it's supposedly federal regulations say that you have to visit

657
00:36:40,840 --> 00:36:45,480
Speaker 2: an in home hospice patient no less than twice a month. Yeah,

658
00:36:45,960 --> 00:36:48,120
Speaker 2: just twice a month, right, And then a lot of

659
00:36:48,160 --> 00:36:53,560
Speaker 2: for profit hospices like just basically do that minimum. And

660
00:36:53,680 --> 00:36:56,520
Speaker 2: if you most people agree, if you are in some

661
00:36:56,560 --> 00:36:59,560
Speaker 2: sort of crisis, you're getting more visits. But if you're

662
00:36:59,560 --> 00:37:02,399
Speaker 2: not in a since, you're getting fewer visits because they

663
00:37:02,440 --> 00:37:04,840
Speaker 2: need to balance that out to cut costs, right or

664
00:37:05,000 --> 00:37:07,800
Speaker 2: keep costs down. It turns out that's a myth. The

665
00:37:07,880 --> 00:37:12,600
Speaker 2: federal government doesn't require two visits a month at minimum.

666
00:37:12,680 --> 00:37:15,880
Speaker 2: The federal government doesn't have any requirements for how often

667
00:37:15,920 --> 00:37:18,920
Speaker 2: or how little a hospice has to visit a patient

668
00:37:18,960 --> 00:37:19,360
Speaker 2: at home.

669
00:37:19,880 --> 00:37:22,280
Speaker 1: They have no requirements or they're not enforcing anything.

670
00:37:22,360 --> 00:37:25,120
Speaker 2: They don't have any requirements. And that's another problem too.

671
00:37:26,280 --> 00:37:29,759
Speaker 2: They don't enforce a lot of the rules that there are,

672
00:37:29,960 --> 00:37:33,560
Speaker 2: and there's already a lot of rules that have loopholes.

673
00:37:34,000 --> 00:37:36,640
Speaker 2: So this is a system that is just set up

674
00:37:36,719 --> 00:37:40,400
Speaker 2: for abuse. Luckily, most of the people who run hospice

675
00:37:40,440 --> 00:37:45,319
Speaker 2: companies they're not in it to abuse the system. They're

676
00:37:45,320 --> 00:37:49,320
Speaker 2: in it to help people. But there is a place

677
00:37:49,440 --> 00:37:54,800
Speaker 2: for bad actors to milk the system overcharge. Like apparently

678
00:37:54,800 --> 00:37:57,759
Speaker 2: there's it's extremely complex, but there are ways that you

679
00:37:57,800 --> 00:38:01,600
Speaker 2: can charge more than the flat ray per day. And

680
00:38:01,840 --> 00:38:04,239
Speaker 2: I guess a study from I THINK twenty twenty one

681
00:38:04,600 --> 00:38:08,520
Speaker 2: in the Journal of Geriatric Care. I THINK found that

682
00:38:08,840 --> 00:38:13,920
Speaker 2: for profit hospices tend to charge medicare thirty four percent

683
00:38:14,040 --> 00:38:18,160
Speaker 2: more than nonprofit hospices. There's just a lot of stuff

684
00:38:18,160 --> 00:38:19,960
Speaker 2: you can do to gain the system.

685
00:38:20,160 --> 00:38:23,880
Speaker 1: Yeah, and you know, to be clear, hospice in general

686
00:38:24,000 --> 00:38:29,480
Speaker 1: gets good marks from people. Even for profit hospices generally

687
00:38:29,520 --> 00:38:32,520
Speaker 1: get good marks from people. But they've drilled down and

688
00:38:32,560 --> 00:38:36,719
Speaker 1: they found the ones that get the lowest ratings for

689
00:38:36,880 --> 00:38:42,160
Speaker 1: care are the ones that are publicly traded corporations and

690
00:38:42,320 --> 00:38:47,239
Speaker 1: owned and or owned by private equity firms. So do

691
00:38:47,360 --> 00:38:49,680
Speaker 1: your research, you know, if you're getting into this, because

692
00:38:49,719 --> 00:38:51,799
Speaker 1: there's there are all Like we said, there's fifty seven

693
00:38:51,880 --> 00:38:56,000
Speaker 1: hundred of them in the US, and hopefully there's one

694
00:38:56,040 --> 00:38:58,319
Speaker 1: near you that will take care of you a little

695
00:38:58,320 --> 00:39:01,880
Speaker 1: bit better to remain on hospice. There's also you know,

696
00:39:01,920 --> 00:39:04,759
Speaker 1: all kinds of rules as far as what's called live discharge, right,

697
00:39:05,680 --> 00:39:12,000
Speaker 1: you have to demonstrate ongoing steady decline at recertification inuals

698
00:39:12,280 --> 00:39:14,560
Speaker 1: every ninety days for the first six months, then every

699
00:39:14,600 --> 00:39:20,400
Speaker 1: sixty days after until death or discharge, and discharges is

700
00:39:21,000 --> 00:39:24,040
Speaker 1: basically exactly what it sounds like. You're discharged, like you're

701
00:39:24,080 --> 00:39:27,239
Speaker 1: discharge at a hospital. It may be because you want

702
00:39:27,239 --> 00:39:29,560
Speaker 1: to try, you know, curative care again, which is which

703
00:39:29,600 --> 00:39:32,440
Speaker 1: is great, and you're right, it could because of an

704
00:39:32,480 --> 00:39:34,520
Speaker 1: emergency that you have to go to the hospital for

705
00:39:34,600 --> 00:39:38,279
Speaker 1: which will boot you off, which really stinks. But there

706
00:39:38,320 --> 00:39:41,920
Speaker 1: are guidelines about discharge and not all of them seem fair.

707
00:39:42,120 --> 00:39:43,719
Speaker 2: Yeah, And you can imagine if you're dying of a

708
00:39:43,800 --> 00:39:48,520
Speaker 2: terminal illness being moved from a hospice to a hospital

709
00:39:48,920 --> 00:39:52,080
Speaker 2: to continue treatment maybe home, where you have a bunch

710
00:39:52,080 --> 00:39:56,040
Speaker 2: of emergency room visits ahead of you because your symptoms

711
00:39:56,040 --> 00:39:58,040
Speaker 2: are going to flare up. It's not a comfortable thing

712
00:39:58,080 --> 00:40:01,279
Speaker 2: to be discharged from one place to another. It's also

713
00:40:01,280 --> 00:40:04,000
Speaker 2: a huge burden on the family too, because again the

714
00:40:04,280 --> 00:40:08,240
Speaker 2: care is being transferred from medical professionals to the family.

715
00:40:09,400 --> 00:40:13,000
Speaker 2: But also the whole premise of it is just faulty

716
00:40:13,080 --> 00:40:17,480
Speaker 2: because not all diseases follow the same trajectory in the

717
00:40:17,520 --> 00:40:20,360
Speaker 2: decline of the person, and yet they're all held to

718
00:40:20,400 --> 00:40:24,200
Speaker 2: the same standard, which is essentially the standard that cancer

719
00:40:24,400 --> 00:40:27,680
Speaker 2: creates a decline and a patient too, So essentially just saying,

720
00:40:27,960 --> 00:40:31,160
Speaker 2: if you have a terminal illness that's certified by doctors,

721
00:40:31,560 --> 00:40:36,239
Speaker 2: that doctors recertify, say every sixty days, you don't have

722
00:40:36,360 --> 00:40:38,799
Speaker 2: to face a live discharge, like you can stay in

723
00:40:38,840 --> 00:40:41,840
Speaker 2: hospice until you die. Your death doesn't have to cooperate

724
00:40:41,840 --> 00:40:45,200
Speaker 2: with federal guidelines. That would be a huge change and

725
00:40:45,280 --> 00:40:50,520
Speaker 2: a really simple one to hospice rules, but apparently that's

726
00:40:50,560 --> 00:40:51,680
Speaker 2: not happening right now.

727
00:40:52,160 --> 00:40:55,279
Speaker 1: Yeah, and even if you know you aren't moved home,

728
00:40:55,360 --> 00:40:57,520
Speaker 1: let's say, let's say you move to a different facility,

729
00:40:58,000 --> 00:41:00,480
Speaker 1: because there definitely is a problem with like you know,

730
00:41:00,520 --> 00:41:05,440
Speaker 1: not having enough beds at different places, and the family

731
00:41:05,480 --> 00:41:10,440
Speaker 1: gets can get ideally into a routine at least, and

732
00:41:10,800 --> 00:41:12,279
Speaker 1: you know, they kind of figure it out. And then

733
00:41:13,120 --> 00:41:16,279
Speaker 1: with Emily's grandmother, it seemed like once we everyone got

734
00:41:16,320 --> 00:41:18,640
Speaker 1: into the routine and everything had kind of been figured out,

735
00:41:18,680 --> 00:41:20,879
Speaker 1: then all of a sudden some change would happen where

736
00:41:21,000 --> 00:41:22,719
Speaker 1: Mary would have to go somewhere else, and then all

737
00:41:22,719 --> 00:41:26,239
Speaker 1: of a sudden, it's new visiting hours, it's in a

738
00:41:26,239 --> 00:41:29,080
Speaker 1: different place and everyone and you know, that's just on

739
00:41:29,120 --> 00:41:31,319
Speaker 1: the family of course, just like you mentioned, the move

740
00:41:31,400 --> 00:41:36,600
Speaker 1: for the patient is really burdensome. So there's still so

741
00:41:36,760 --> 00:41:39,600
Speaker 1: much they can do, I think, to clean this whole

742
00:41:39,640 --> 00:41:40,560
Speaker 1: system up, you know.

743
00:41:40,960 --> 00:41:44,080
Speaker 2: For sure, and even chuck if they're not impatient. Just

744
00:41:44,120 --> 00:41:49,640
Speaker 2: at home hospice basically overlays this support structure for you,

745
00:41:49,760 --> 00:41:52,239
Speaker 2: the hospice patient in your home right, so you have

746
00:41:52,320 --> 00:41:57,120
Speaker 2: like medical equipment, you have medications that are like delivered

747
00:41:57,160 --> 00:41:59,480
Speaker 2: to you at times. If you need a walker, you

748
00:41:59,480 --> 00:42:02,799
Speaker 2: got to walk. Just all of this support like you've

749
00:42:02,800 --> 00:42:05,480
Speaker 2: got bereavema counselors dropping by, if a social worker, you're

750
00:42:05,480 --> 00:42:08,640
Speaker 2: doing telehealth visits with a well like all it just

751
00:42:08,680 --> 00:42:12,440
Speaker 2: stops when you're discharged from hospice alive. They come and

752
00:42:12,560 --> 00:42:15,280
Speaker 2: they take the medical equipment, they take your walker away,

753
00:42:15,640 --> 00:42:19,439
Speaker 2: You stop getting your medications delivered to you. You might

754
00:42:19,480 --> 00:42:22,560
Speaker 2: not even have those prescriptions any longer after that, if

755
00:42:22,560 --> 00:42:25,600
Speaker 2: they were prescribed by the hospice doctor. It's a really

756
00:42:25,600 --> 00:42:29,160
Speaker 2: bad jam. And the other thing about it too, that

757
00:42:29,239 --> 00:42:32,760
Speaker 2: Medicare has often taken to task for is they don't

758
00:42:32,800 --> 00:42:36,960
Speaker 2: really pay enough for in home hospice, Like that's the

759
00:42:37,000 --> 00:42:42,640
Speaker 2: lowest pay rating I guess is in home non crisis

760
00:42:42,680 --> 00:42:49,240
Speaker 2: hospice care, and that means that if you are trying

761
00:42:49,280 --> 00:42:51,440
Speaker 2: to stay at home, you either have to have a

762
00:42:51,480 --> 00:42:53,759
Speaker 2: bunch of family members who are willing to commit their

763
00:42:53,760 --> 00:42:56,320
Speaker 2: lives to taking care of you in your final days,

764
00:42:57,239 --> 00:42:58,880
Speaker 2: or you have to have a bunch of money to

765
00:42:58,920 --> 00:43:01,600
Speaker 2: pay somebody to do that same thing. And if you

766
00:43:01,680 --> 00:43:04,680
Speaker 2: don't and you want to die at home, you're sol

767
00:43:04,880 --> 00:43:06,839
Speaker 2: because you have nobody to take care of you at home,

768
00:43:07,000 --> 00:43:10,360
Speaker 2: because there's not enough pay to pay people in hospice

769
00:43:10,400 --> 00:43:13,440
Speaker 2: to come by, and not enough volunteers to take care

770
00:43:13,440 --> 00:43:16,720
Speaker 2: of you take care of your needs on a regular basis.

771
00:43:17,560 --> 00:43:23,080
Speaker 1: You know, Grandma Mary, former foremost general in the stuff

772
00:43:23,080 --> 00:43:25,520
Speaker 1: you should know Army, had a T shirt that says

773
00:43:25,560 --> 00:43:27,200
Speaker 1: you can take my walker when you pry it for

774
00:43:27,280 --> 00:43:27,920
Speaker 1: my cold dead hand.

775
00:43:28,040 --> 00:43:32,040
Speaker 2: That's all, Oh my god, that would be such a

776
00:43:32,040 --> 00:43:33,480
Speaker 2: great T shirt. We got to get that one.

777
00:43:33,640 --> 00:43:37,839
Speaker 1: You imagine taking a walker from somebody for that that's

778
00:43:37,880 --> 00:43:39,960
Speaker 1: your job. Like you're the person they're like, yeah, go

779
00:43:40,000 --> 00:43:43,040
Speaker 1: over to go over to Grandma Mary's house and take

780
00:43:43,040 --> 00:43:43,520
Speaker 1: her stuff.

781
00:43:43,760 --> 00:43:45,920
Speaker 2: I know it couldn't even be the person who also

782
00:43:46,040 --> 00:43:48,600
Speaker 2: delivers it, because it's such a mean job that there

783
00:43:48,600 --> 00:43:51,160
Speaker 2: has to just be one specialist who doesn't like anybody

784
00:43:51,400 --> 00:43:53,920
Speaker 2: who just goes around the houses and takes the medical

785
00:43:53,960 --> 00:43:54,680
Speaker 2: equipment back.

786
00:43:54,760 --> 00:44:00,560
Speaker 1: Yeah, sin Ronnie, uh, you got anything else? No, I

787
00:44:00,600 --> 00:44:04,880
Speaker 1: have nothing else. Hopefully this serves some people, and you know,

788
00:44:05,080 --> 00:44:07,399
Speaker 1: just just look around and do your homework and see

789
00:44:07,400 --> 00:44:08,759
Speaker 1: if you can find a place that works for you

790
00:44:08,800 --> 00:44:09,360
Speaker 1: and your family.

791
00:44:09,480 --> 00:44:11,359
Speaker 2: Yeah. And another good piece of advice is to do

792
00:44:11,400 --> 00:44:15,560
Speaker 2: that sooner than later, like to share your wishes with

793
00:44:15,600 --> 00:44:17,680
Speaker 2: your family. Maybe if you go so far as to

794
00:44:17,719 --> 00:44:20,360
Speaker 2: create a living will or some sort of medical documents

795
00:44:20,360 --> 00:44:22,200
Speaker 2: saying like I do want to go into hospice, I

796
00:44:22,200 --> 00:44:26,120
Speaker 2: want to stop curative treatment at some point. And then yeah,

797
00:44:26,239 --> 00:44:29,480
Speaker 2: do like read reviews, like just find out who you

798
00:44:29,520 --> 00:44:31,640
Speaker 2: would go to if it starts to seem like that

799
00:44:31,760 --> 00:44:34,120
Speaker 2: might be a possibility coming down the pike.

800
00:44:34,800 --> 00:44:38,040
Speaker 1: Yeah, oh man, my god, get a living will. No,

801
00:44:38,080 --> 00:44:39,839
Speaker 1: I don't care how old you are. That's it's very

802
00:44:39,880 --> 00:44:43,239
Speaker 1: easy thing to do. And it's that and a will

803
00:44:43,320 --> 00:44:45,160
Speaker 1: or the two biggest gifts you can give your family

804
00:44:45,239 --> 00:44:46,759
Speaker 1: as you grow old.

805
00:44:46,920 --> 00:44:49,160
Speaker 2: That's right, you want to impress your parents in your

806
00:44:49,200 --> 00:44:52,640
Speaker 2: seven start thinking about a living will, Start talking about

807
00:44:52,680 --> 00:44:54,920
Speaker 2: a living will to your parents. Yeah, and they will

808
00:44:55,000 --> 00:44:56,680
Speaker 2: just be blown away totally.

809
00:44:56,680 --> 00:44:58,839
Speaker 1: That seems like something in like a TV show about

810
00:44:58,880 --> 00:44:59,680
Speaker 1: a precocious kid.

811
00:44:59,760 --> 00:45:02,440
Speaker 2: Yeah, for sure, like Alex p.

812
00:45:02,600 --> 00:45:04,920
Speaker 1: Keaton, he would do that, Yeah, exactly. How you know

813
00:45:04,960 --> 00:45:05,439
Speaker 1: he had one.

814
00:45:06,160 --> 00:45:08,200
Speaker 2: So before we finished, I just also wanted to give

815
00:45:08,200 --> 00:45:12,160
Speaker 2: a huge shout out to Yumi's dad's hospice doctor, doctor Pijari,

816
00:45:12,920 --> 00:45:15,560
Speaker 2: who did not have any sort of ego and was

817
00:45:15,600 --> 00:45:19,319
Speaker 2: totally willing to listen to Yumi and helped get her

818
00:45:19,400 --> 00:45:20,640
Speaker 2: dad out of hospice too.

819
00:45:20,680 --> 00:45:21,480
Speaker 1: So I love it.

820
00:45:21,440 --> 00:45:24,960
Speaker 2: Shout out doctor Pajari. And since I shouted out doctor Pejari,

821
00:45:25,320 --> 00:45:27,920
Speaker 2: as was foretold by the Ruins in two thousand and eight,

822
00:45:28,200 --> 00:45:29,759
Speaker 2: I've just unlocked the listener mail.

823
00:45:33,640 --> 00:45:37,879
Speaker 1: This is gen z Stare speaks back. I have three

824
00:45:37,960 --> 00:45:40,880
Speaker 1: emails I'm going to try and sort of hit the

825
00:45:40,920 --> 00:45:44,120
Speaker 1: highlights of because we got what I felt like was

826
00:45:44,160 --> 00:45:48,320
Speaker 1: three really sort of legitimate answers as to what the

827
00:45:48,440 --> 00:45:52,719
Speaker 1: gen z Stare is all about. That now I understand,

828
00:45:52,760 --> 00:45:54,600
Speaker 1: you know, it may not be my jam, but like

829
00:45:55,040 --> 00:45:56,919
Speaker 1: it doesn't need to be my jam because I don't

830
00:45:56,960 --> 00:45:59,160
Speaker 1: have to put my gen X stuff onto gen Z.

831
00:45:59,760 --> 00:46:02,120
Speaker 1: That's that's true, Hey guys, twenty two years old gen

832
00:46:02,200 --> 00:46:05,480
Speaker 1: Z very much in the gen Z stare era. I

833
00:46:05,560 --> 00:46:07,719
Speaker 1: work in customer service, which is where I use it

834
00:46:07,760 --> 00:46:11,400
Speaker 1: the most. But we were raised with if you have

835
00:46:11,480 --> 00:46:13,200
Speaker 1: nothing nice to say, don't say thing at all, so

836
00:46:13,400 --> 00:46:17,160
Speaker 1: hence staring. So I guess they took that very much literally. Yeah,

837
00:46:18,280 --> 00:46:20,359
Speaker 1: it's not something just done to adults either, and this

838
00:46:20,400 --> 00:46:22,560
Speaker 1: person points out that they do it for their friends.

839
00:46:22,719 --> 00:46:24,719
Speaker 1: As far as the phone call, no one calls us

840
00:46:25,239 --> 00:46:27,080
Speaker 1: when they do, it's a spam call, which I was

841
00:46:27,120 --> 00:46:31,799
Speaker 1: always told the double hello people, I didn't know that

842
00:46:31,840 --> 00:46:34,000
Speaker 1: was a thing. When they answered the phone accused the robot.

843
00:46:34,200 --> 00:46:34,759
Speaker 2: Did you know that?

844
00:46:35,360 --> 00:46:39,160
Speaker 1: Yes, okay, I didn't know that, so I just answer

845
00:46:39,239 --> 00:46:43,920
Speaker 1: and sit in silence until the awkward is this Josie

846
00:46:43,960 --> 00:46:48,879
Speaker 1: follows and that is from Josie Boozer. This is another one,

847
00:46:48,920 --> 00:46:51,960
Speaker 1: Hey guys, gen Z person. I think the explanation you're

848
00:46:51,960 --> 00:46:53,719
Speaker 1: probably looking for is a lot of gen Z are

849
00:46:53,840 --> 00:46:58,880
Speaker 1: using it. Are used to being interrupted, not taking taken seriously,

850
00:46:59,040 --> 00:47:01,400
Speaker 1: or have our responses to stories be given a weird look.

851
00:47:02,000 --> 00:47:04,319
Speaker 1: The example for someone finishes the story and the person

852
00:47:04,400 --> 00:47:06,520
Speaker 1: just stand there can either be one. I don't have

853
00:47:06,560 --> 00:47:09,960
Speaker 1: anything interesting to say about that story, and I don't

854
00:47:09,960 --> 00:47:12,560
Speaker 1: want to make something up. Two, I'm so used to

855
00:47:12,560 --> 00:47:15,480
Speaker 1: having my opinions not taken seriously that I'm just not

856
00:47:15,520 --> 00:47:18,280
Speaker 1: even going to bother responding. Many of us are socially

857
00:47:18,280 --> 00:47:20,360
Speaker 1: awkward and have trouble creating small talk with people that

858
00:47:20,400 --> 00:47:23,279
Speaker 1: aren't close to us. Another reason maybe because most of

859
00:47:23,320 --> 00:47:28,160
Speaker 1: our conversations are online and have been online as we aged,

860
00:47:28,600 --> 00:47:30,680
Speaker 1: and many people will give an emoji reaction to it

861
00:47:30,719 --> 00:47:34,880
Speaker 1: a long story or just get a smile and that's cool.

862
00:47:35,000 --> 00:47:40,080
Speaker 1: In response. That is from Sam Okay, so it's kind

863
00:47:40,080 --> 00:47:42,239
Speaker 1: of tracking along the same lines. And then this is

864
00:47:42,280 --> 00:47:45,360
Speaker 1: from Catherine, who's been listening for five years as a

865
00:47:45,400 --> 00:47:48,400
Speaker 1: twenty three year old. I've heard people blame the pandemic,

866
00:47:48,440 --> 00:47:50,520
Speaker 1: but I don't think it fully explains a generational trend

867
00:47:50,560 --> 00:47:52,640
Speaker 1: since we all live through the same period. I think

868
00:47:52,640 --> 00:47:55,439
Speaker 1: there are two main causes. First, my generation has spent

869
00:47:55,520 --> 00:47:57,799
Speaker 1: much more time in front of a screen than any

870
00:47:57,800 --> 00:48:01,400
Speaker 1: previous generations did. We've grown used to one content consumption.

871
00:48:01,920 --> 00:48:03,880
Speaker 1: You would look crazy if you responded to a YouTube

872
00:48:03,920 --> 00:48:05,920
Speaker 1: video the way you would a phone call or an

873
00:48:05,960 --> 00:48:09,240
Speaker 1: in person conversation. So we're a little out of practice

874
00:48:09,320 --> 00:48:12,759
Speaker 1: with responding to prompts instead of just watching something. This

875
00:48:12,800 --> 00:48:13,840
Speaker 1: is all makes total.

876
00:48:13,600 --> 00:48:14,680
Speaker 2: Sense, It totally does.

877
00:48:15,600 --> 00:48:18,399
Speaker 1: And then secondly, gen Z seems to be more likely

878
00:48:18,440 --> 00:48:21,960
Speaker 1: than previous generations to forego the fake politeness that used

879
00:48:22,000 --> 00:48:24,480
Speaker 1: to be expected in conversations. I think this is partially

880
00:48:24,480 --> 00:48:29,680
Speaker 1: because we're constantly inundated with advertisements. We've become highly sensitive

881
00:48:29,680 --> 00:48:32,120
Speaker 1: to fake niceness because someone is trying to manipulate our

882
00:48:32,120 --> 00:48:35,600
Speaker 1: emotions at every turn and sell us something. My generation

883
00:48:35,840 --> 00:48:38,480
Speaker 1: seems much more likely to prefer genuine reactions, even if

884
00:48:38,520 --> 00:48:42,920
Speaker 1: they're negative, because when we're online, it's the only way

885
00:48:43,040 --> 00:48:47,920
Speaker 1: to note something is not an ad wo man, this

886
00:48:48,040 --> 00:48:49,560
Speaker 1: is something else? Huh.

887
00:48:49,640 --> 00:48:53,279
Speaker 2: Yeah. Those are deep from Josie, Sam and Catherine right.

888
00:48:54,000 --> 00:48:56,520
Speaker 1: Yeah, And I think they all sort of track along

889
00:48:56,560 --> 00:49:00,759
Speaker 1: the same lines, and that explains a lot. So, Yeah,

890
00:49:00,840 --> 00:49:03,520
Speaker 1: if a gen Z person is just staring at you,

891
00:49:03,560 --> 00:49:06,280
Speaker 1: maybe you think maybe they think you're a real jerk

892
00:49:06,480 --> 00:49:08,000
Speaker 1: and just don't want to say anything.

893
00:49:07,760 --> 00:49:10,319
Speaker 2: Right, they assume you're manipulating them, right then?

894
00:49:10,680 --> 00:49:13,200
Speaker 1: Yeah, or the other reasons mentioned, I think they're all

895
00:49:13,320 --> 00:49:15,239
Speaker 1: valid in their own generational way.

896
00:49:15,400 --> 00:49:18,320
Speaker 2: I feel like that really explains the discomfort that people

897
00:49:18,440 --> 00:49:21,080
Speaker 2: like say from gen X get when we're treated like

898
00:49:21,120 --> 00:49:24,360
Speaker 2: that because we are used to fake niceness I know,

899
00:49:24,560 --> 00:49:26,719
Speaker 2: you know, and like we're willing to go along with

900
00:49:26,760 --> 00:49:29,040
Speaker 2: that kind of thing just to keep from a situation

901
00:49:29,160 --> 00:49:30,160
Speaker 2: being uncomfortable.

902
00:49:30,640 --> 00:49:33,560
Speaker 1: Yeah. Also, though, quick tip the if you don't have

903
00:49:33,560 --> 00:49:36,200
Speaker 1: anything nice to say, don't say anything at all. I

904
00:49:36,280 --> 00:49:40,000
Speaker 1: recently went through an experience with a TO two artist

905
00:49:41,239 --> 00:49:46,120
Speaker 1: getting my tattoo covered up with my dogs and it's

906
00:49:46,160 --> 00:49:48,600
Speaker 1: a great I he'd I appreciate it. He did a

907
00:49:48,640 --> 00:49:52,719
Speaker 1: great job, but he, let's just say, we weren't the

908
00:49:52,760 --> 00:49:55,880
Speaker 1: same kind of person. He had a lot of interesting

909
00:49:55,920 --> 00:49:59,920
Speaker 1: theories on things. And here's a little tip to my

910
00:50:00,080 --> 00:50:02,440
Speaker 1: gen Z friends. You don't have to not say anything.

911
00:50:02,680 --> 00:50:04,920
Speaker 1: Just keep nodding and go interesting.

912
00:50:05,520 --> 00:50:07,000
Speaker 2: Oh yeah, I.

913
00:50:07,080 --> 00:50:09,720
Speaker 1: Did that over and over and over for hours.

914
00:50:09,840 --> 00:50:10,759
Speaker 2: It goes a long way.

915
00:50:11,280 --> 00:50:14,640
Speaker 1: Yeah interesting and sure, well no, I don't even know

916
00:50:14,640 --> 00:50:18,560
Speaker 1: if I am lying. It was interesting, yeah, just not

917
00:50:19,120 --> 00:50:19,440
Speaker 1: for me.

918
00:50:19,719 --> 00:50:23,120
Speaker 2: Right exactly. Maybe the tone was a lie.

919
00:50:23,400 --> 00:50:23,720
Speaker 1: Maybe.

920
00:50:23,760 --> 00:50:27,520
Speaker 2: So the guy did you an amazing job? You said

921
00:50:27,520 --> 00:50:28,839
Speaker 2: he did it like freehand too.

922
00:50:28,920 --> 00:50:33,160
Speaker 1: Right. Oh yeah, I'll put pictures up at Chuck the podcaster.

923
00:50:34,000 --> 00:50:39,759
Speaker 1: He's a sort of amazing artistic dude. Yep, just like

924
00:50:39,840 --> 00:50:42,799
Speaker 1: looking at pictures of dogs and drawing them on my arm.

925
00:50:43,360 --> 00:50:45,280
Speaker 1: It wasn't like stenciled out of my arm first.

926
00:50:45,400 --> 00:50:49,160
Speaker 2: It's nuts man. Well, thanks a lot again to Josie,

927
00:50:49,160 --> 00:50:52,719
Speaker 2: Sam and Catherine for explaining that to us. You guys

928
00:50:52,719 --> 00:50:55,879
Speaker 2: did a knockout job and we appreciate it. And I'm

929
00:50:55,880 --> 00:50:58,400
Speaker 2: not being fake nice right now. I'm being quite legitimate

930
00:50:58,400 --> 00:51:01,880
Speaker 2: and serious and genuine. If you want to get in

931
00:51:01,880 --> 00:51:05,440
Speaker 2: touch with us and tell us about your generation, we

932
00:51:05,560 --> 00:51:07,680
Speaker 2: love hearing that kind of stuff, you can send it

933
00:51:07,680 --> 00:51:13,160
Speaker 2: off to stuff Podcasts at iHeartRadio dot com.

934
00:51:13,239 --> 00:51:16,120
Speaker 1: Stuff you Should Know is a production of iHeartRadio. For

935
00:51:16,239 --> 00:51:20,400
Speaker 1: more podcasts myheart Radio, visit the iHeartRadio app, Apple Podcasts,

936
00:51:20,520 --> 00:51:22,360
Speaker 1: or wherever you listen to your favorite shows,