WEBVTT - Everyone Deserves A Good Death 0:00:01.480 --> 0:00:07.720 Welcome to Stuff You Should Know, a production of iHeartRadio. 0:00:11.119 --> 0:00:13.560 Hey, and welcome to the podcast. I'm Josh, and there's 0:00:13.720 --> 0:00:16.360 Chuck and Jerry's here too. So this is an old 0:00:16.360 --> 0:00:18.960 fashioned root and tootin episode of Stuff you Should Know 0:00:20.079 --> 0:00:22.320 and about something we needed to talk about. Chuck. 0:00:22.840 --> 0:00:27.280 Okay, okay, you remember back in like. 0:00:27.440 --> 0:00:31.320 The like about like the two thousand and nine ten 0:00:31.520 --> 0:00:34.880 eleven era, when like death was all the rage people 0:00:34.960 --> 0:00:37.960 were having, like death cafes and like creating living wills, 0:00:38.000 --> 0:00:41.000 and it was just a big thing that everybody talked about. 0:00:41.760 --> 0:00:44.319 When was this like two thousand and nine to two 0:00:44.360 --> 0:00:45.519 thousand and maybe eleven. 0:00:46.000 --> 0:00:48.639 I don't remember that, but I'll take your word for it. 0:00:48.640 --> 0:00:50.879 It was a real thing, for sure. Unless I've just 0:00:50.960 --> 0:00:53.640 completely lost my marbles and I just made up a 0:00:53.640 --> 0:00:57.640 whole era of American culture. I don't think I did. 0:00:58.200 --> 0:01:01.480 But that has died at so like that it's gone 0:01:01.520 --> 0:01:03.800 back to death has gone back to being a bit 0:01:03.840 --> 0:01:07.560 of a taboo topic, an uncomfortable topic, at least at 0:01:07.600 --> 0:01:09.080 least here in the United States. 0:01:11.160 --> 0:01:12.000 I didn't know that either. 0:01:12.560 --> 0:01:16.920 It's true. I guess I'm just speaking for myself anecdotally. 0:01:17.120 --> 0:01:19.160 Oh okay, that makes a lot more sense. 0:01:19.840 --> 0:01:22.640 So okay, well let's just cut to the chase here. 0:01:23.480 --> 0:01:28.200 There's this concept of a good death, yeah right, and 0:01:28.959 --> 0:01:31.000 you can probably fill in a lot of the blanks 0:01:31.040 --> 0:01:32.800 of what that means and what it means to you 0:01:32.840 --> 0:01:35.320 at least, but there's actually like some components to it 0:01:35.400 --> 0:01:38.240 that studies have found, like kind of bubble up to 0:01:38.319 --> 0:01:40.399 the top that most people can agree this makes a 0:01:40.440 --> 0:01:44.480 good death. There are things like getting to say goodbye 0:01:44.720 --> 0:01:47.480 to friends and family, having those people at your side 0:01:47.520 --> 0:01:50.160 if you want so. A certain amount of control over 0:01:50.200 --> 0:01:55.640 the dying process is something being pain free, not suffering, sure, 0:01:56.680 --> 0:01:59.960 being in an environment, and having a chance to like 0:02:00.120 --> 0:02:01.960 kind of come to terms with the fact you're about 0:02:01.960 --> 0:02:05.200 to expire. Those are some of the top things that 0:02:05.240 --> 0:02:07.720 people say, like, this to me is a good death. 0:02:08.320 --> 0:02:13.040 And not coincidentally, those are the kind of things that hospices, 0:02:13.080 --> 0:02:16.080 which we're about to talk about today, are intended to provide. 0:02:16.400 --> 0:02:19.880 That's the service they provide is to give you, the individual, 0:02:19.960 --> 0:02:23.160 a good death. And it's not something that's relegated to 0:02:23.200 --> 0:02:27.720 the rich. It's not something that's relegated to the educated. 0:02:28.160 --> 0:02:31.160 It's for everybody. Everybody deserves to have a good death, 0:02:31.160 --> 0:02:35.760 and that's pretty much the motto of hospice, And in fact, 0:02:35.800 --> 0:02:38.560 I ran across one motto. It said, if you can't 0:02:38.600 --> 0:02:41.919 add more days to life, add more life to days. 0:02:44.919 --> 0:02:47.440 That's great. It sounds a little too corporate slogany, but 0:02:47.600 --> 0:02:48.480 I like the sentiment. 0:02:48.880 --> 0:02:54.080 Yeah, there's a mascot, Louis the dead guy who's like 0:02:54.600 --> 0:02:57.600 always saying that slogan, and he did a partnership with 0:02:57.600 --> 0:02:59.280 home Depot for some reason recently. 0:02:59.440 --> 0:03:03.480 Oh boy, well that explains the orange bed sheets and things, right, 0:03:04.480 --> 0:03:06.760 all right, so that's probably the last semi joke we're 0:03:06.760 --> 0:03:09.320 gonna make. You'll have to forgive us for that. We 0:03:09.360 --> 0:03:12.200 did a whole episode on dying, and I don't even 0:03:12.200 --> 0:03:13.639 know if we made one joke in that one, So. 0:03:14.080 --> 0:03:17.760 Sure we did, you think, yes? I absolutely think. 0:03:17.919 --> 0:03:20.400 All right, well we'll pair that with this one. And 0:03:20.440 --> 0:03:22.040 because we've got a lot of great feedback on the 0:03:22.080 --> 0:03:24.359 dying episode and how that could kind of help people out, 0:03:24.440 --> 0:03:27.680 so yeah, maybe this will do the same. We should 0:03:27.680 --> 0:03:29.600 probably go back in time a bit and explain the 0:03:29.639 --> 0:03:33.400 history of hospice, because it is very recent. If you 0:03:33.440 --> 0:03:35.560 look at sort of the timeline of people in the 0:03:35.560 --> 0:03:39.320 world dying hospice has only been around since like the 0:03:39.480 --> 0:03:42.360 sixties or seventies and the form that we know it 0:03:43.360 --> 0:03:48.280 because previous to that, for all of time, basically medicine 0:03:48.360 --> 0:03:52.640 was like, hey, we're here to cure people, and if 0:03:52.680 --> 0:03:55.160 it turns out that we cannot cure you and that 0:03:55.240 --> 0:03:58.480 the end is near, for a very very long time 0:03:58.600 --> 0:04:01.480 until the last like you know, like I said, since 0:04:01.520 --> 0:04:06.720 the sixties or seventies, very shamefully, hospitals and even doctors 0:04:06.720 --> 0:04:10.920 would sort of like it was a reminder that they 0:04:11.120 --> 0:04:13.520 couldn't save you, so they didn't spend a lot of 0:04:13.560 --> 0:04:16.440 time with you. And there are a lot of you know, 0:04:16.760 --> 0:04:20.400 well known reports of people kind of like scurrying past 0:04:20.520 --> 0:04:22.360 rooms where people were in their final days in a 0:04:22.400 --> 0:04:23.560 hospital and stuff like that. 0:04:23.920 --> 0:04:26.960 Yeah, they left the dying who were incurable now to 0:04:27.040 --> 0:04:30.520 basically die alone. They withdrew support. That was just what 0:04:30.560 --> 0:04:32.200 they did. And like you said, it was a reminder 0:04:32.240 --> 0:04:34.920 of the failing of medicine. And this was a time 0:04:34.960 --> 0:04:37.440 when modern medicine was not in any kind of mood 0:04:37.480 --> 0:04:40.359 to be reminded of failings, because I mean, the twentieth 0:04:40.360 --> 0:04:43.440 century was pretty triumphant for it. I mean, I saw 0:04:45.120 --> 0:04:48.960 that infant mortality rate declined by ninety percent over the century. 0:04:49.120 --> 0:04:52.440 There's like sanitation, clean drinking water, polar vaccine, like science 0:04:52.440 --> 0:04:56.080 could do anything, and people who were incurable were just 0:04:56.279 --> 0:04:58.960 a reminder that there were limits to that whole thing. 0:04:59.600 --> 0:05:02.800 That's right, right, and another thing that was going on. 0:05:02.920 --> 0:05:05.960 And this is also pretty shameful. Well, I guess not shameful, 0:05:05.960 --> 0:05:11.120 but they've since revisited how they look at pain management. 0:05:11.200 --> 0:05:15.440 But yeah, you had to like really be in pain 0:05:15.600 --> 0:05:17.960 to get pain management, and then that had to like 0:05:18.080 --> 0:05:20.159 wear off and you had to be really in pain 0:05:20.200 --> 0:05:24.120 again for them to administer more pain management. They were 0:05:24.240 --> 0:05:27.039 worried about, you know, opioid addiction and stuff like that, 0:05:27.279 --> 0:05:30.560 but you know, these days, it's it's definitely more like, hey, 0:05:31.120 --> 0:05:33.880 you know, we're not worried about you getting addicted to 0:05:33.960 --> 0:05:37.279 opioids in the final possibly days of your life. We 0:05:37.360 --> 0:05:38.800 just want to make you feel okay. 0:05:39.360 --> 0:05:42.159 Yeah, that's definitely the hospice philosophy is you don't have 0:05:42.240 --> 0:05:44.600 to wait until one pain killer wears off to get 0:05:44.640 --> 0:05:48.599 another dose. You can you know, stay comfortable. That's the 0:05:48.640 --> 0:05:52.920 point is to make the person comfortable. That's called palliative care. 0:05:53.000 --> 0:05:55.520 We'll talk a little more about that, but it's essentially 0:05:55.600 --> 0:05:58.400 just taking care of symptoms to keep people comfortable. 0:05:59.279 --> 0:06:01.720 Yeah, for sure, nuns were kind of on the scene 0:06:01.760 --> 0:06:05.760 early on, providing you know, emotional support. They couldn't dose 0:06:05.760 --> 0:06:08.600 out pain medication of course, and stuff like that, but 0:06:08.839 --> 0:06:10.240 they you know, it was a lot of times it 0:06:10.320 --> 0:06:13.400 was religious organizations that were stepping forward that were kind 0:06:13.400 --> 0:06:16.320 of doing the hospice type work that would come along 0:06:16.360 --> 0:06:19.440 in the sixties and seventies, thanks in part to a 0:06:19.480 --> 0:06:21.920 couple of big landmark books that came out. 0:06:22.880 --> 0:06:24.880 Yeah, there was this whole thing in the sixties and 0:06:24.880 --> 0:06:27.400 seventies that was kind of this rebellious streak that went 0:06:27.440 --> 0:06:31.640 across like against some of the just unquestioned institutions, and 0:06:31.680 --> 0:06:34.880 one of those was medicine and doctors and hospitals. But 0:06:34.960 --> 0:06:38.120 there was a psychiatrist name Elizabeth Koubler Ross who very 0:06:38.120 --> 0:06:41.320 famously came up with the five Stages of grief that 0:06:41.400 --> 0:06:43.960 was in her nineteen sixty nine book on Death and Dying. 0:06:45.160 --> 0:06:48.640 And in addition to being famous for coming up with 0:06:48.720 --> 0:06:52.400 the Five Stages of grief, she also basically interviewed people 0:06:52.600 --> 0:06:57.400 in the Chicago Hospital's ice you who were dying and 0:06:57.680 --> 0:07:00.760 just found that they were just being totally neglect and 0:07:00.800 --> 0:07:05.440 so she definitely lobbied for dying and dying people and 0:07:05.480 --> 0:07:07.599 their families to be listened to and to be treated 0:07:08.120 --> 0:07:09.280 rather than just ignored. 0:07:09.840 --> 0:07:12.520 Yeah, we talked about her and that book in our 0:07:12.600 --> 0:07:15.880 dying episode. I don't think we talked about the Denial 0:07:15.920 --> 0:07:18.760 of Death from nineteen seventy three, but that was from 0:07:18.760 --> 0:07:23.760 an anthropologist named Ernest Becker, and he was writing this 0:07:24.040 --> 0:07:27.080 as he was dying himself, so he was in a 0:07:27.080 --> 0:07:29.440 position to really give a good, you know, pretty moving 0:07:29.480 --> 0:07:32.480 first person account, and he talked about sort of you know, 0:07:32.600 --> 0:07:36.280 a good death and accepting the inevitability and stuff like that. 0:07:37.200 --> 0:07:39.440 So these things were sort of happening in the cultural 0:07:39.480 --> 0:07:44.080 movement when a woman, a hero i think a named 0:07:44.080 --> 0:07:47.240 Cecily Saunders came along, eventually the founder of medical director 0:07:47.280 --> 0:07:51.360 of Saint Christopher's Hospice in London, and she really changed 0:07:51.400 --> 0:07:53.440 the game and kind of birthed the whole sort of 0:07:53.480 --> 0:07:54.640 modern hospice movement. 0:07:55.840 --> 0:07:59.400 Yeah, she had a bad back from a young age 0:07:59.560 --> 0:08:04.280 and apparently it kept her from her desired career of nursing, 0:08:05.520 --> 0:08:09.600 so she instead became basically a social worker. Uh, at 0:08:09.600 --> 0:08:13.440 the time they called a lady almoner or distributor of alms, right, 0:08:13.560 --> 0:08:16.080 So it's pretty old timey, but it does kind of 0:08:16.160 --> 0:08:18.680 it's a nod back to the original hospice which were 0:08:18.720 --> 0:08:22.640 founded in the Crusades by the Roman Catholic Church. Ironically, 0:08:22.680 --> 0:08:26.400 Cicily Saunders was raised an atheist, but she had a 0:08:26.400 --> 0:08:31.120 conversion to Christianity, evangelical Christianity, even when she went on 0:08:31.240 --> 0:08:34.920 vacation with a Christian friend and her family. And one 0:08:34.960 --> 0:08:38.920 of the other big experiences that letter to found the 0:08:39.000 --> 0:08:44.040 hospice movement essentially was she had like some friendships with 0:08:44.080 --> 0:08:47.520 some people that she helped essentially as they were dying, 0:08:48.200 --> 0:08:51.520 and really kind of was moved by these friendships and 0:08:51.559 --> 0:08:54.559 wanted to make sure that other people had that same experience. 0:08:54.679 --> 0:08:58.199 So she did something that I mean just kind of 0:08:58.240 --> 0:09:00.920 I think really gets across kind of person she was. 0:09:00.960 --> 0:09:03.520 And she went to medical school to make her voice 0:09:03.559 --> 0:09:04.560 a little more credible. 0:09:05.200 --> 0:09:08.760 Yeah, she started medical school at age thirty three. This 0:09:08.840 --> 0:09:12.560 is in the nineteen fifties, and she finished medical school, 0:09:12.640 --> 0:09:16.280 she was able to work as a physician. She started 0:09:16.280 --> 0:09:19.480 writing articles and stuff about this about people, you know, 0:09:19.520 --> 0:09:23.440 being deserted or feeling like they'd been deserted by their doctors, 0:09:23.480 --> 0:09:25.080 like the closer they got to death like we were 0:09:25.120 --> 0:09:28.480 talking about, and said, hey, there's got to be a 0:09:28.520 --> 0:09:32.520 better way to take care of people, not only physically, 0:09:32.559 --> 0:09:36.760 but emotionally and spiritually as they as they near death. 0:09:37.440 --> 0:09:40.080 So she, you know, got that medical degree, got a 0:09:40.280 --> 0:09:43.800 research job at a hospital, started studying. You know, she 0:09:43.880 --> 0:09:46.320 wanted to have a legitimate sort of background for this 0:09:46.400 --> 0:09:49.800 so people didn't think she was just some some wacky 0:09:49.840 --> 0:09:52.920 impath trying to do good, which you know should be enough. 0:09:53.400 --> 0:09:55.680 But she figured she was armed with medical training and 0:09:55.679 --> 0:09:59.480 real data and on like pain management stuff, that she 0:09:59.520 --> 0:10:01.320 would go a lot further in She did. 0:10:01.720 --> 0:10:04.520 Yeah, she went and studied pain management firsthand so she 0:10:04.640 --> 0:10:08.160 could come up with her own protocols. One of those 0:10:08.200 --> 0:10:11.720 protocols that was really groundbreaking and went against the norm, 0:10:12.320 --> 0:10:16.240 was to give dying patients not just heavy doses of 0:10:16.320 --> 0:10:18.760 morphine to make sure that they weren't in pain, but 0:10:18.840 --> 0:10:21.600 also cocaine to keep them from just being kind of 0:10:21.640 --> 0:10:25.360 doped up for the rest of their lives. She would 0:10:25.400 --> 0:10:28.080 find out what liquor they preferred and would make sure 0:10:28.080 --> 0:10:30.480 that they had their liquor and all of this sounds 0:10:30.480 --> 0:10:35.000 like just completely reckless and careless, but she had before 0:10:35.000 --> 0:10:38.320 and after pictures of these people terminal cancer patients who 0:10:39.360 --> 0:10:42.000 in the before pictures before they had been treated with 0:10:42.080 --> 0:10:45.800 her new protocol of pain management and I guess mood 0:10:45.840 --> 0:10:49.400 management too if you think about it. They did not 0:10:49.480 --> 0:10:52.000 look very good. They looked like terminal cancer patients. And 0:10:52.080 --> 0:10:54.880 afterward they were sitting up in bed, perked up. Some 0:10:54.960 --> 0:10:58.200 had taken up hobbies like knitting. And she would show 0:10:58.200 --> 0:11:01.000 these before and after pictures when she went around the 0:11:01.040 --> 0:11:04.480 world speaking on behalf of hospice as she was trying 0:11:04.520 --> 0:11:07.960 to found it, and like she would get converts at 0:11:08.400 --> 0:11:11.360 every talk she gave just from the before and after 0:11:11.400 --> 0:11:12.200 pictures alone. 0:11:12.679 --> 0:11:16.480 Yeah, it was pretty remarkable. This all culminated in nineteen 0:11:16.520 --> 0:11:19.920 sixty seven when she founded Saint Christopher's Hospice, Like like 0:11:19.960 --> 0:11:23.079 I mentioned earlier in London and kind of right off 0:11:23.080 --> 0:11:24.320 the bat, she said, all right, we have a new 0:11:24.320 --> 0:11:26.720 way to deal with pain management. We're going to get 0:11:26.800 --> 0:11:29.560 rid of visiting hours and people family can come and 0:11:29.600 --> 0:11:33.319 go when it's convenient for them, and we're going to 0:11:33.559 --> 0:11:35.640 not talk about just you know, physical pain. We're going 0:11:35.679 --> 0:11:37.720 to talk about what I call total pain or what 0:11:37.800 --> 0:11:41.960 she called that. You know, like we mentioned emotional support, 0:11:42.880 --> 0:11:47.280 social support, spiritual suffering that happens with people. And one 0:11:47.320 --> 0:11:49.320 of the people that she worked a lot with was 0:11:49.600 --> 0:11:52.920 a nurse in the US named Florence Wald who ended 0:11:53.000 --> 0:11:55.240 up doing the same thing. In the US. She said, 0:11:55.320 --> 0:11:58.360 I think we need this over here. She started up 0:11:58.360 --> 0:12:02.000 the very first hospice in Branford, Connecticut and the United States, 0:12:02.480 --> 0:12:04.920 and that was six years later after the one in 0:12:04.920 --> 0:12:06.360 London in nineteen seventy three. 0:12:06.720 --> 0:12:09.640 Yeah, that first American hospice. They tried a few names 0:12:09.760 --> 0:12:13.439 out before they settled on the final one, Hospice rus 0:12:14.520 --> 0:12:17.440 MC Dying, and then they just kind of went with 0:12:17.440 --> 0:12:22.680 the straight name. Well all right, so yeah, so hospice 0:12:22.720 --> 0:12:25.360 that's spread pretty quickly. I think you said Saint Christopher's 0:12:25.400 --> 0:12:29.240 opened up in nineteen sixty seven and the one in 0:12:29.240 --> 0:12:32.560 Branford opened up in nineteen seventy three. That's pretty good 0:12:32.600 --> 0:12:37.320 traction to create a brand new idea in both the 0:12:37.400 --> 0:12:40.040 UK and the US and start spreading it around the world. 0:12:40.800 --> 0:12:42.880 And one of the things I think you said about 0:12:42.920 --> 0:12:46.240 Saint Christopher's was, even though it was religious or at 0:12:46.320 --> 0:12:50.280 least spiritual, it was non denominational, and that is a 0:12:50.480 --> 0:12:53.600 huge point about hospice that is lost on a lot 0:12:53.640 --> 0:12:55.480 of people. I think a lot of people associated with 0:12:55.559 --> 0:12:59.880 religious groups still and like, if you're not, say Christian, 0:13:00.440 --> 0:13:03.439 you wouldn't really want to go to a Christian hospice. 0:13:03.800 --> 0:13:06.160 That is not at all the way that hospices work. 0:13:06.480 --> 0:13:08.880 And in fact, there's plenty of people who are atheists. 0:13:08.880 --> 0:13:13.520 They are humanists and they just are like those empathic 0:13:13.800 --> 0:13:18.760 do gooders that you were speaking about earlier, and none 0:13:18.800 --> 0:13:21.240 of these philosophies clash because they all come together to 0:13:21.320 --> 0:13:25.400 essentially say, one of the big parts of dying is 0:13:25.520 --> 0:13:29.120 some sort of spirituality or at least some sort of 0:13:29.200 --> 0:13:33.040 peace that we associate with spirituality, and it doesn't matter how 0:13:33.080 --> 0:13:35.520 you get there, we're all just kind of coming together 0:13:35.559 --> 0:13:38.280 to make sure that everybody can experience that. It's a 0:13:38.280 --> 0:13:41.080 big misunderstanding of hospice sometimes. 0:13:40.760 --> 0:13:45.120 Yeah, for sure, in the US it's usually, or at 0:13:45.200 --> 0:13:47.719 least at first, it was done at home. That was 0:13:47.760 --> 0:13:49.800 a difference from the early ones in the UK they 0:13:49.800 --> 0:13:52.720 were in patient facilities. But in the US, you know, 0:13:53.040 --> 0:13:56.360 it was sort of a budget issue at first because 0:13:56.400 --> 0:13:58.360 they couldn't get these facilities and pay for them. But 0:13:58.800 --> 0:14:01.920 I think they also realized that people wanted to die 0:14:01.960 --> 0:14:04.600 at home. And there was also this sort of long 0:14:04.679 --> 0:14:09.400 running institutional distrust that Americans had, and it was a 0:14:09.400 --> 0:14:12.640 lot of volunteer work at first, like almost entirely volunteer 0:14:12.760 --> 0:14:15.880 early on. It was sometime, like we mentioned, people in 0:14:15.880 --> 0:14:19.120 the clergy still doing this kind of work after centuries 0:14:19.120 --> 0:14:22.320 of doing so, doctors that were moonlighting that wanted to 0:14:22.360 --> 0:14:27.440 help out, and a movement was was, you know, clearly growing, 0:14:28.600 --> 0:14:31.880 and it made government sit up and take notice when 0:14:31.920 --> 0:14:35.360 they realized that it was saving money on healthcare, because 0:14:35.400 --> 0:14:37.600 not only was the movement growing and people were just 0:14:37.600 --> 0:14:40.680 feeling better about it, but it was keeping people out 0:14:40.680 --> 0:14:42.680 of the hospital sort of off and on, off and on, 0:14:42.840 --> 0:14:45.480 off and on, and so much though that the US 0:14:45.560 --> 0:14:47.680 government and the Reagan administration said, you know what we 0:14:47.680 --> 0:14:50.800 should we should get this covered. And in nineteen eighty two, 0:14:50.880 --> 0:14:56.120 the hospice Medicare benefit went through, which allowed people all 0:14:56.160 --> 0:14:59.240 of a sudden to be able to pay from you know, 0:14:59.600 --> 0:15:04.160 staff run by professionals that were also paid and you know, 0:15:04.280 --> 0:15:05.640 get it covered through Medicare. 0:15:06.840 --> 0:15:10.040 Yeah, which opened up the door for people who wanted 0:15:10.040 --> 0:15:13.800 to help people during the final days or weeks of 0:15:13.840 --> 0:15:17.280 their life, but there wasn't a career associated with it. 0:15:17.360 --> 0:15:19.480 Now there was, so you could you could pursue that 0:15:19.600 --> 0:15:23.080 kind of medicine, end of life medicine. That's pretty cool 0:15:23.120 --> 0:15:27.640 that that was a huge change. I suspect that the 0:15:27.680 --> 0:15:29.760 saving money had a lot to do with it, though. 0:15:30.200 --> 0:15:31.720 Yeah, that's usually the case. 0:15:31.920 --> 0:15:34.360 And the reason why, we'll just spell it out explicitly. 0:15:34.800 --> 0:15:36.960 The reason why it saves money is because you're taking 0:15:36.960 --> 0:15:39.440 a patient off of a very expensive track, which is 0:15:39.480 --> 0:15:42.840 a lot of different medical procedures and treatments, and saying 0:15:43.480 --> 0:15:46.600 we're like, you're not going to go for the curative 0:15:46.640 --> 0:15:48.760 treatment route anymore. We're going to take you out of 0:15:48.800 --> 0:15:53.880 this crazy nutso medical world and put you in a 0:15:53.920 --> 0:15:57.200 much more peaceful, tranquil world where you can end your 0:15:57.280 --> 0:16:00.880 days as a happier person rather than feeling like a 0:16:00.920 --> 0:16:04.280 guinea pig being experimented on. And it's just much cheaper 0:16:04.320 --> 0:16:06.119 to do that too, as you can imagine. 0:16:07.360 --> 0:16:10.640 It feels like a good breakpoint. Yeah, yay, all right, 0:16:10.720 --> 0:16:12.920 we'll come back and we'll talk about how the modern 0:16:12.960 --> 0:16:14.160 system works right after this. 0:16:42.440 --> 0:16:47.360 So here in the United States, Chuck Hospice is usually 0:16:47.360 --> 0:16:53.000 paid for by Medicare, which is federal insurance coverage for 0:16:53.280 --> 0:16:56.600 people who are retirees typically or maybe disabled, and then 0:16:56.960 --> 0:17:00.480 also sometimes Medicaid, which covers lower income Americans. And the 0:17:00.560 --> 0:17:03.040 upshot of all this is that if you are dying 0:17:03.120 --> 0:17:05.800 and choose to go on hospice care, you are not 0:17:06.040 --> 0:17:10.520 charged for this, and that is a wonderful thing that 0:17:10.560 --> 0:17:13.200 the federal government does. Apparently the UK is very much 0:17:13.320 --> 0:17:16.080 like that, but a lot of it is donation driven 0:17:16.480 --> 0:17:19.040 rather than paid for by the government, which does chip in, 0:17:19.119 --> 0:17:22.040 but the lion's share is paid for by donations in 0:17:22.080 --> 0:17:26.000 the UK. But there's eligibility requirements that basically say like, 0:17:26.359 --> 0:17:29.280 if you don't check these boxes or if you stop 0:17:29.359 --> 0:17:31.919 checking these boxes at any point, you can't be in 0:17:32.000 --> 0:17:32.920 hospice anymore. 0:17:33.480 --> 0:17:37.160 Yeah, and those boxes specifically, you have to have two 0:17:37.359 --> 0:17:40.560 doctors certify that you have and this is for Medicare, 0:17:41.000 --> 0:17:42.840 you know, to get it covered, not just to get 0:17:42.840 --> 0:17:46.159 into hospice. Right, you have to have a terminal illness, 0:17:46.880 --> 0:17:49.440 You have to have six months or less to live, 0:17:50.280 --> 0:17:54.360 and you cannot be going after curative treatments. And we'll 0:17:54.359 --> 0:17:57.280 talk about some I don't even know if there are exceptions. 0:17:57.280 --> 0:17:59.480 But some things that some people might think are curative 0:17:59.480 --> 0:18:01.679 treatments and a curate of treatments. That doesn't mean like 0:18:02.200 --> 0:18:04.119 they don't ask for anything at all. 0:18:05.760 --> 0:18:07.000 You know, you can't have a band aid. 0:18:07.160 --> 0:18:09.880 Yeah, you're on your own. So we'll get into those. 0:18:09.960 --> 0:18:13.160 But and this is going to be a sticking point 0:18:13.200 --> 0:18:15.040 that kind of comes up later and some of the 0:18:15.040 --> 0:18:20.760 failings of the current system. But Medicare pays hospice companies 0:18:20.800 --> 0:18:25.120 and agencies a daily rate instead of for specific services 0:18:25.160 --> 0:18:29.520 they provide like like basically all the other medical treatment 0:18:29.520 --> 0:18:32.720 you're ever going to get, and there are four levels 0:18:32.960 --> 0:18:35.320 of that care and there are going to be different 0:18:35.400 --> 0:18:38.280 rates depending on the level that you're going to get 0:18:39.040 --> 0:18:40.080 and also where you. 0:18:40.040 --> 0:18:45.359 Are right, So if you're running a hospice, you would 0:18:45.359 --> 0:18:47.960 get a flat fee paid by the government for a 0:18:48.000 --> 0:18:51.600 patient who's in routine home care, which is you're not 0:18:51.640 --> 0:18:55.600 in crisis, you're still dying, but you're doing okay. And 0:18:55.720 --> 0:18:59.480 that usually is just a visit maybe a couple of 0:18:59.520 --> 0:19:01.600 times a week. They're coming by to make sure that 0:19:01.680 --> 0:19:04.320 their meds are going down right, they maybe have like 0:19:04.560 --> 0:19:07.479 their nutrition going there's just essentially just checking on you 0:19:07.960 --> 0:19:11.200 that's routine home care. There's also continuous home care where 0:19:11.320 --> 0:19:14.439 if that patient slips into a crisis, like maybe they 0:19:14.480 --> 0:19:19.000 start vomiting uncontrollably, they start suffering uncontrollable pain, that their 0:19:19.040 --> 0:19:23.160 meds aren't doing anything for anymore, changes in consciousness all 0:19:23.160 --> 0:19:26.439 of a sudden, Now they have twenty four to seven 0:19:27.520 --> 0:19:29.200 hospice access at home. 0:19:30.280 --> 0:19:32.760 Yeah, there's also there's a couple of more. There's inpatient 0:19:32.840 --> 0:19:36.679 respite care. That's when a patient goes into like a 0:19:36.800 --> 0:19:38.680 you know, they have to leave home to go into 0:19:38.720 --> 0:19:42.600 a physical hospice center for up to five days. A 0:19:42.600 --> 0:19:45.440 lot of times this is to give their caregiver time off, 0:19:45.480 --> 0:19:48.239 because that's one of the brutal parts about end of 0:19:48.240 --> 0:19:51.800 life is and I say burden on the family, not 0:19:51.920 --> 0:19:54.240 like what a hassle, but you know, it is a 0:19:54.240 --> 0:19:58.520 burden on the family. Yeah, people have to besides the 0:19:58.560 --> 0:20:01.119 emotional devastation they're going through a lot of times, have 0:20:01.160 --> 0:20:06.600 to rearrange their jobs and like even leave jobs sometime 0:20:06.800 --> 0:20:08.520 to do this kind of thing full time. So it 0:20:08.560 --> 0:20:10.520 can be quite a heavy burden on a family. 0:20:10.800 --> 0:20:13.399 Yeah. Actually, chuck that that's a if you look up 0:20:13.480 --> 0:20:17.520 downsides of hospice that's pretty much the number one issue 0:20:17.520 --> 0:20:22.160 with it is that it transfers responsibility for caring for 0:20:22.240 --> 0:20:25.640 the dying patient from say like a hospital to their family. 0:20:26.119 --> 0:20:29.560 And that's it is. It's a very big deal. Yeah. 0:20:29.600 --> 0:20:31.920 And then the last one is general and patient care, 0:20:32.119 --> 0:20:35.800 and that is when you're addressing pain control or any 0:20:35.880 --> 0:20:38.840 kind of symptom management that you can't that you have 0:20:38.920 --> 0:20:40.440 to like go in and take care of at a 0:20:40.440 --> 0:20:42.159 specific place. It's not the kind of thing you can 0:20:42.200 --> 0:20:45.760 do at home generally. And then you know, palliates of 0:20:45.840 --> 0:20:47.119 care is a big part of it. That's what we 0:20:47.200 --> 0:20:50.680 kind of mentioned earlier, is is just making people feel 0:20:50.760 --> 0:20:54.720 better toward the end. You know, I mentioned things that 0:20:54.800 --> 0:20:59.320 don't count as curative treatment, like if you're if you 0:20:59.320 --> 0:21:01.560 have heart like active heart failure, they can try and 0:21:01.600 --> 0:21:04.720 reverse that. Or if you have some like nasty bedsword 0:21:04.800 --> 0:21:08.280 that gets an infection, that that's not going to boot 0:21:08.320 --> 0:21:12.840 you off covered hospice care to get that taken care of. 0:21:13.560 --> 0:21:17.320 No, the key to being covered for hospice under Medicare 0:21:17.440 --> 0:21:20.840 is that you are not pursuing treatment to cure the 0:21:21.280 --> 0:21:25.359 thing that's got you terminally ill. Right, So, like you said, 0:21:25.400 --> 0:21:27.960 if you have to develop a heart condition, but that's 0:21:28.000 --> 0:21:30.960 not what's killing you. You have terminal cancer, they can, 0:21:31.160 --> 0:21:33.720 you know, treat your heart condition. And even if you 0:21:33.760 --> 0:21:37.359 do have terminal cancer, if you have nausea from cancer, 0:21:37.480 --> 0:21:40.400 pain from cancer, they're going to treat that because they're 0:21:40.400 --> 0:21:42.640 not trying to cure the cancer. You have to give 0:21:42.680 --> 0:21:47.000 up things like radiation or chemotherapy. Those are curative treatments. 0:21:47.280 --> 0:21:51.160 But there's the idea that they're just like, nope, sorry, 0:21:51.160 --> 0:21:52.880 we're just going to put you in bed and basically 0:21:52.960 --> 0:21:55.679 let you lay there. That's not at all what you 0:21:55.800 --> 0:21:58.280 have to give up in order to enter hospice. 0:21:58.840 --> 0:22:03.119 Yeah, and you know, the hospice workers are doing a 0:22:04.160 --> 0:22:07.199 lot of stuff for you that goes above and beyond 0:22:07.440 --> 0:22:10.800 just making you feel better or maybe sitting with you 0:22:10.880 --> 0:22:13.360 and like you know, brushing your hair, Like there's all 0:22:13.440 --> 0:22:18.280 that stuff that they're doing, bathing you, housekeeping sometimes you know, 0:22:18.320 --> 0:22:23.359 helping out with gathering and administering the medications. But you 0:22:23.400 --> 0:22:25.639 know they're doing all kinds of stuff. They might be 0:22:25.720 --> 0:22:28.320 shopping for you, they might be babysitting for your family 0:22:28.680 --> 0:22:31.320 to give you know, the like we mentioned the people 0:22:31.320 --> 0:22:33.600