#13 - Navigating End-of-Life Care: Insights and Strategies for Women in Retirement with Jeanne Brosseau
“The end of life deserves as much beauty, care, and respect as the beginning.”
- Anonymous
In 2008, Jeanne Brosseau moved her two teenagers to Houston, Texas so that she could better provide for her children's college education. She accepted a position as a Unit Secretary at a small Catholic hospital and shortly thereafter was a student in their first Patient Care Technician training program.
Right after her 40th birthday, she was recruited by a hospice company to be a liaison assistant and promoted two months later to a full marketing position. Although Jeanne didn't know anything about hospice, she researched, asked lots of questions, and started to become educated on all areas of healthcare. She wanted to know the differences between the levels of care, when each was appropriate, and why. She loved the "educational" piece of it. Now, Jeanne brings that education to as many people as possible.
In this conversation, Eric and Jeanne Brosseau, Community Liaison from Ardent Healthcare, tackle the sensitive subject of end-of-life care. This episode is specially crafted to guide you through the complexities of retirement planning, with a focus on hospice and palliative care.
You can learn more about Jeanne’s story by reading a recap of the episode below, on YouTube, or listening on your favorite podcast app!
Wendy McConnell: Welcome to the Simply Retirement Podcast with your host, Eric Blake. I'm Wendy McConnell. Well, that's a thinker, Eric.
Eric Blake: It is. Today, we're just going to get right into it. We have one of those topics that nobody wants to talk about because it forces us to deal with mortality, whether it's ours or, as is the case for many of our clients, parents, or close family members that we're worried about. We're going to talk about end-of-life care today. It's a topic that's always difficult because of the emotions that come with it, but as I’ve said many times, I didn't want this show to just be about the financial aspects of retirement. I wanted it to be about some of these real-life issues that women face on their retirement journey. I wanted to help bring the necessary resources and education to our audience to hopefully take some of the stress out of it.
It's hard enough as it is, but when you add the stress of dealing with family and indecision and lack of knowledge, that's really where I wanted to bring value to our audience.
Wendy McConnell: We have a guest today to help with this topic. Would you like to introduce her?
Eric Blake: Today, we're joined by Jeanne Brosseau, who is the community liaison for Ardent Healthcare. She's primarily responsible for educating patients and families on the benefits of hospice, home health care, palliative care, and private-duty caregivers.
I just have to share that I asked some of our past guests and the groups that I'm a part of who the best person was to speak to about these difficult topics. Jeanne's name came up more than once, so I'm pretty sure we got the right person on to help us understand all this. Jeanne, welcome to the Simply Retirement Podcast.
Jeanne Brosseau: Thank you.
Eric Blake: I want to give you the chance to share a bit about your background, how you got to where you are today, and how you became the go-to person for end-of-life care and helping educate people on that.
Jeanne Brosseau: I’ll try and keep that short and sweet. I moved to Houston in 2008 from Connecticut, where I was in education. When I got to Houston, I ended up getting a job at a little local Catholic hospital as a unit secretary and then joined their first patient care technician training program. I ended up doing patient care and then a hospice liaison tapped me on the shoulder and asked if I wanted to be her assistant.
That was in 2009, and it’s when I started my journey into the healthcare end-of-life field. At the hospital, I had been working in their oncology unit but I didn’t know anything about hospice. I researched and asked a lot of questions. I kind of joke that I was raised by nurses and social workers and physicians in hospice. They’re the ones who trained me, and I fell in love with it. I absolutely fell in love with the concept of bringing care and bringing peace of mind when facing the end-of-life journey.
Eric Blake: I'll be completely honest. This is a selfish inquiry. I’ve started looking into these topics because my grandmother is 88. She's extremely important in my life. If you’ve ever heard my story, you know that she's a big part of my why. She's starting to experience issues as she's gotten older: Her memory is not working quite as well as she’d like, of course. So, you just start thinking that somewhere down the road, it's going to be something that the family is going to have to make some decisions on.
When it comes to comes time for end-of-life care, it's often perceived as a very difficult decision. But knowing more and being well informed on the benefits can be just a huge blessing and can help people make those decisions. One of the things I was not completely sure of myself is the difference between palliative care and hospice care. So, if you wouldn't mind just going into that a bit, maybe give us a brief description of each and how they compare, and the key distinctions that people need to be aware of.
Enhancing Quality of Life with Hospice Care
Jeanne Brosseau: Just for my own curiosity's sake, I Googled ‘palliative’ this morning, and the amount of information that came up that really wasn't about palliative care programming was very interesting to me.
The main difference between hospice and palliative care is that hospice is end-of-life care based on a physician’s determination. Their patient has a terminal illness and a prognosis of six months or less if the disease process follows its natural course. Palliative care is not hospice. It is a supportive care system that helps symptom management and psychosocial issues for the patient in a home setting, wherever home is. The patient can still receive aggressive treatment and continue their care.
Eric Blake: I think that's where some of the confusion comes in. I'm not telling you anything new, but the word ‘hospice’ really scares people, especially if it's the patients themselves. There are some similarities in terms of the care itself, but even the terminology can be confusing. Are there a couple of examples of each that you could give me of when you’d talk to your doctor about hospice care versus the palliative route?
Jeanne Brosseau: To be very honest, once you receive a terminal diagnosis. That's the time to start asking questions and having this discussion with your family on what your goals are because everybody has a different goal and there's not a right or wrong answer.
Once you have a life-limiting illness is when to have that conversation with your physician, saying, ‘Please let’s have this open dialogue to let me know when you think we should start considering hospice.’ A lot of patients start hospice too late. What I mean by that is that if it's been determined that no more aggressive treatment's going to improve the quality of your life and this disease process is causing you to decline quicker and quicker, why not start getting supportive care?
Let’s talk about that 6-month prognosis. That represents a physician asking, “Would I be surprised if my patient is not with us in 6 months?” There's no solid answer to that question. If we're focused more on quality of care and symptom management rather than curative care, that is the time to start looking at hospice services. The earlier you begin actually gives you more time. There are studies that show that people on hospice service live longer than people who aren’t, for terminal illnesses. Getting on hospice services when you qualify, when that clinical criteria allows you to get to know your team and your team gets to know you, makes a big difference. They can identify changes and decline and adjust your plan of care to meet your goals and your needs, rather than coming on when there's only one or two weeks of life left. At that point, the only thing we can do is to help our patients get comfortable rather than utilizing services like counseling and spiritual advice, social work needs, or community needs. There’s a lot involved with hospice that not only benefits the patient but also the family and the primary caregivers.
Initiating End-of-Life Conversations
Eric Blake: What you just said is that you really need to try to start hospice care as soon as possible. Are there any suggestions that you feel could help get past the stigma? It may be the family members that we're talking about helping in this case, where they're going to the individual and saying, “Here's why we think you ought to consider hospice.” It's almost like it's a four-letter word. I'm kind of using my family as an example: It's the “H-word.” You don't say hospice around my grandmother because she hears that and she immediately thinks, “You're going to put me in a facility or something.” She really struggles with that because she's in her home but she's very immobile, so that's kind of the way it is now.
How would you go about talking about hospice with a family member who may really need the benefits of that type of care?
Jeanne Brosseau: I would start with a conversation about advanced directives. What do you want? What are your goals? What have you thought of? You know, we're all going to be at this point in our life no matter what, so what are your concerns about dying? Are there spiritual concerns? Are there physical concerns?
The biggest topic is pain and being able to have it managed. I think that showing the respect to your family members of listening to them and having them write down what they think and really sitting down with somebody who is an expert in hospice and can discuss everything that's involved, everything that's covered by Medicare when it’s time, how long can you stay on it, and can you get off because you can revoke services at any time. You can transfer to another company if you're not happy. Can your physician be involved? Yes, your physician can be involved.
A lot of people have the misconception that hospice comes in and takes you off all your medication and you can't talk to any of your doctors, you can't go back to the hospital. That's just not the case. Our goal is to keep our patients out of the hospital and make sure to control their symptoms and keep them comfortable at home, but it’s still their right to make that decision. Hospice covers medications that are directly related to the diagnosis, but most home medications can still be continued. They can be ordered by the medical director and the patient gets them through their prescription drug plan. The point is coming up with a plan of care that's going to best fit the needs of that patient.
Integrating Medical and Financial Planning
Eric Blake: You mentioned advanced directives, and as a financial planner, I talk about estate planning with every client. When most people think about estate planning, the first things they think of are wills or trusts or those types of documents. But if we're talking about a complete estate plan, it's going to include a medical power of attorney. It's going to include all those additional HIPAA documents. It's going to include all those important documents that we don't want to think about but, at some point, are going to be applicable.
From a timing perspective on advanced directives, your mind might change between when you're 65 and you're getting your wills and advanced directives done and when you're 95 or 90. All of a sudden, you're in that situation.
Does it make sense to guess at age 65 what your thoughts might be down the road, or to revisit those documents and create new ones in the future?
Jeanne Brosseau: You can change your documents at any time. I think the most important part of advanced directives is a medical power of attorney. You want to choose a medical power of attorney who is going to honor your wishes and follow through with what you’ve written down for your goals. That isn't always a family member. You want to choose the person who is going to best represent your interests. A living will is also really important. It sets down on paper how you want your medical treatment to go.
Understanding Care Services
Eric Blake: You mentioned having care in your own home. That's what most people like to do, to stay in their homes as long as possible. Can you talk through where people typically receive hospice care or palliative care? Is it in the home or a facility? I know it's going to be both, but maybe some decision points around that. And how does homecare tie into it?
Jeanne Brosseau: There's a big difference between home health and home care. A lot of people get those two confused or use them interchangeably, and they are two completely different programs. Home health is a skilled service. You have nurses, therapists, and dieticians coming in to help you improve or treat your illness to get you to a better quality of life or to maintain the quality of life that you have. The keywords there are treat and skilled need.
Home care is nonmedical, and there are two different types. There are companion services and there are caregivers. Think of caregivers as being trained to] provide nonmedical care, while companions are there to sit with you, and make sure you're not getting out of bed. They're engaging you mentally. Home care is private pay, while home health is billed through insurance. There are three ways to pay for home care: private pay, long-term care insurance, or VA benefits.
Where can you get each of those levels of care? You can get hospice anywhere. You can be in your residential home, a residential care home, assisted living, independent living, nursing home, or wherever you call home.
You can get home health anywhere but a nursing home because that's skilled nursing. At-home care you can get in any situation because it's a private pay situation. If your loved one is in the hospital and you're not able to be there with them and you want someone there advocating for them, you can hire a private duty caregiver to stay with them. They may need a caregiver for a week to make sure they’re transitioning appropriately back home and not bouncing back to the hospital.
Eric Blake: How do you pay for palliative care and how do you pay for hospice care?
Jeanne Brosseau: Hospice care is paid 100 percent by Medicare. You have a Medicare Advantage Plan right and hospice is billed through the traditional Medicare part of that. Anything that's not related to that terminal diagnosis will still go through copays. For hospice, you don't need to meet a deductible. Most private insurance companies pay for hospice, but if you have a commercial insurance policy, you’re still responsible for those copays and deductibles. It’s also covered under Tricare for home health. They’re going to be running the insurance benefits, seeing who’s in-network, which home health company is in-network with your insurance, and what it’s going to cover. Each plan has a different minimum of visits, maximum of visits, and what it's going to pay for.
Palliative care is paid for by Medicare, most PPO plans, and HMOs. Those are a little trickier, so we want people to be very aware of where are they in their health journey. When open enrollment comes around, what are you going to need? Do you have a very serious illness that is going to need more care in the next year? Maybe you should be looking at some different plans.
Eric Blake: How specifically does Arden Healthcare help people with these decisions? What role can they play? What role do you play within that? What do you guys do?
Jeanne Brosseau: That's community liaisons. We do the education. We go out and make sure that we’re explaining each level of care completely appropriately, making sure all questions are answered, even the ones they haven't thought of yet to help guide them when they’re speaking with their physicians. What level of care is right here? What is appropriate here? We encourage them to have that conversation with their physicians as well.
Ardent health care is locally owned and operated. We've been in business for almost 17 years. We were actually just voted number 10 in the country by Fortune magazine for Best Senior Services and Place to Work in the entire country. That was pretty big for us. Very proud to be part of this team. We really do the continuum of care, the palliative supportive care, we'll oversee those. Patients who have a serious illness and are not ready for hospice yet, are still seeking aggressive treatment. There's no time frame for how long somebody can be on palliative care.
It's not two weeks, it's not six months. It's however long you want that care and you still have that serious illness and need that support system. The nurse practitioner and the social worker are there to guide the family and the patient and their support system on when it’s appropriate to transition to hospice so they're not falling through the cracks and being brought on two weeks ahead of the end. They're getting the benefits that are right for them at that time. With our private duty caregivers and our home health, we cover all those services for our patients.
Proactive End-of-Life Planning
Eric Blake: Can you give me an example of that scenario? A family member or the patient has questions. What would the typical process look like? Do they just schedule a call? Do they contact you? What would be the best way for them to start gathering information on trying to make some of these decisions?
Jeanne Brosseau: They can either contact me or our office at (469) 293-1515). Or they can go to our website, where there’s an area that says, “Please contact me. I have questions.” Those inquiries are sent to a community liaison who covers that territory because we cover all of the DFW area, including up to Gainesville and Decatur and Wiley. We come out and discuss what the needs are and answer those questions. We take appropriate steps to gather information on what’s needed for the level of care they’re seeking.
Eric Blake: Excellent. Is there anything I didn't ask you that you feel like we need to make the audience aware of when it comes to end-of-life care?
Jeanne Brosseau: Have the discussion early. I know we covered that, but I can’t stress it enough. Start having the conversation. Probably six or seven years ago I had to have this discussion with my father, and he didn't want to talk about it. And I said, “Dad, this is what I do. I need to know what your wishes are.” It did spur him on to contact his elder care attorney and get his plans in place. That's all it did, but I'm happy. That was my goal. Also, make sure that you’re speaking with your physicians and letting them know what your goals of care are. The other big one is that the company you want to have care for you is your choice. There isn’t one hospice and there isn’t one home health. Do your research. Look at Medicare.gov. Look at the reviews. Interview a couple of companies and make sure you’re choosing the one you feel most comfortable with and
Eric Blake: Excellent. Jeanne, this has been so valuable. We clearly picked the right person to educate the audience on end-of-life care, hospice care, and palliative care. We'll definitely be sharing your contact information in the show notes and the episode summary to make sure people know how to find you and reach out. I really appreciate your time
Jeanne Brosseau: Thank you so much.
Wendy McConnell: Eric, how do people get in touch with you if they have some questions?
Eric Blake: To learn more about our firm, Blake Wealth Management, visit our website at www.blakewealthmanagement.com.That’s where you can learn about our team, learn more about my story and my background and my family, and why this is all so important to me. You can also sign up for our Simply Retirement Newsletter and connect to our YouTube page, our blog, and all that fun stuff.
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