Hospice Care Explained: Eligibility, Comfort Care & Fraud Red Flags

Episode 44 — RC Hospice Care — Cleaned Transcript

Guests: Esther, co-founder and executive leader at RC Hospice Care, and Timothy Henderson, Assistant Director of Patient Care

Note: This transcript has been cleaned for readability. Raw timecodes and placeholder speaker labels were removed, obvious transcription errors involving hospice terminology were corrected, and the substance of the interview was preserved. Medical, billing, regulatory, and fraud-related statements remain attributed to the speakers and should not be treated as individualized medical or legal advice.

Opening & Meet the RC Hospice Care Team

And welcome to the Key Concepts Podcast. Today's episode we're going to talk about hospice care. And specifically we're going to get into some of the

hospice fraud that we've been seeing in California,

especially with some of the stuff that makes sure the is exposed and how it's kind of impacted the Armenian community.

I'm really excited to be joined by my special guest today

is the Chief operating officer and co-founder of

RC Hospice Care, and Timothy Henderson,

the assistant director of Patient Care. Thank you both for joining me today.

Thank you for having us. I am so excited to be here.

before we jump into it, we ask that the last guest leave a question for the next guest and

question left for you guys is what is your favorite quote and why?

going to say it in Armenian first. Is that okay? So I.

Basically in our culture and our in our language, there's no such. When you say lion, there's no lioness.

So my dad used to tell me and my sister growing up,

you're always strong. You're the king of your jungle.

So I'd say my favorite quotes. My dad's

nice. That's awesome. I don't favorite quote. You can say something I've said, Tim, I'm pretty funny. No, I don't really have a favorite quote.

I would say always live. Something that hospice has taught me is always live your life to the fullest.

Yeah, it's actually great because you're never promised tomorrow, so that's awesome.

Oh, that makes you take a deep breath. You're never promised tomorrow.

Oh my gosh. Funny story.

Can I jump in real quick?

I was talking to a patient and she she made me laugh so bad. She

know, one day you'll see him tomorrow.

I sat there and I'm like, what are you saying? She goes, think about it.

One day you'll see him tomorrow, like it'll be tomorrow. And I remember I was thinking, I'm like, God, please let me be 99 wins

tomorrow.

But yeah, it's it's you're not promised. It's real. Yeah. When they will be tomorrow. And hopefully it's of old age.

What Is Hospice Care?

let's go ahead and jump into it. So for, for people that don't know what hospice care is, Esther, could you give us an overview of what is hospice care?

Hospice care. Oh, man. Hospice care. First of all, I want to say it's unlike any care you've ever you'll ever receive. Number one reason, because it's for the death and dying.

It's for those who have basically no more cure for their illness.

It's something that's terminal. And terminal means that there's no cure chronic. So a lot of times we hear two different terms in medical field. You hear chronic, which means you're going to have it for the rest of your life. And then you hear terminal, which means that it's going to be the thing that ends you basically.

And.

I apologize for those of you listening, I'm a little direct and little blunt, but I feel like that's the best way to get things across.

a lot of times when I talk to the families and they're waiting for something they don't, we don't sugarcoat. If you sugarcoat, you're you're prolonging something that shouldn't happen. So hospice care?

Yes. Unfortunately, it's for those who are

getting ready to, you know, their final journey, as we say. So I wouldn't even say just not a cure. Maybe it's a older person who wants to no longer see curative treatment. Maybe it's going to the hospital, maybe is

100 years old and he's diagnosed with cancer. There is a treatment for that cancer, but he doesn't want to fight it and wants to stay comfortable at home.

Absolutely. And we see a lot of different types. So hospice care is for those who have been diagnosed

with a terminal illness. And the statement that we get in hospice, every single patient, they can't get on tosses without this certification of terminal illness by two physicians

that state this patient has six months or less to live

if the disease takes this natural course.

And

that's literally the statement of information. You know, when lawyers have

this statement is true and corrected. Best of my knowledge, the doctors have to do a similar statement in the medical term, which is this patient will basically pass within six months or less if the disease takes its natural course. Now, to add that doesn't mean that they will.

And every physician will say they're not God or the universe or whatever people believe in. Sometimes the disease does prolong like they live so specially like our dementia patients. Sometimes they might be on hospice for longer than six months.

Yeah that's crazy. And that's kind of heavy at the same time I mean you're dealing with people who are at the end of their life.

Why Esther Entered Hospice Care

And so what inspired your family to get into this field. That is actually quite funny. I was 23 years old when I started the company. Well, I mean, when I took over to start the company, my dad came up to me. I was a supervisor at Sutter. I was a Medicare medical subject matter expert. I love insurance, I've always been like a sponge.

And I was a medical assistant before that. I've, co-managed clinics, like, from a very young age. I've just loved patient care and just knowing things. And my dad came up to me, I'll never forget. He's like. And he wasn't even sick at the time to. He's like, I think you could do this. I think you we should do this.

You should. We should start a hospice agency and

like, you should do it. And I'm like, first of all, what is hospice? And, you know, in our culture, it's like an omen touch a dead body like, you know, don't do it. And here I am, 23 years old.

I'm going to help people who are passing away. So I, I prayed about it.

I said, God, I want to see the two greatest miracles in life, the first breath and the last breath.

And if that happens this year, I think I'm going to do this. You know, I'm going to take it on.

And

I remember that year my my little cousin was born. They named her Elizabeth Esther, even though April says it's from the Bible, I know it's me.

Okay. To me.

then that same year, my cousin's grandpa, Michael Bobby, passed away. And that man blessed me every single day of my life. I can't even tell you. Like, every time I would, I would see him. He'd hug me and tell me,

God loves you. I bless you like this guy's bless my marriage, my life, my like he would just go on a whole list and

having someone like that in his presence when he passes and how peaceful he goes.

was like, okay, this is this is this is actually such a rewarding thing. I think I want to do this. So that was the

thing that convinced me to start the

well, to make the job and help out with the family. Yeah. It was. Yeah. And Tim, were you around at that time or were you. That was way before I wasn't even a nurse.

Then when they started RC Tim's our baby, but he's a baby. He's like an old soul. I can't I can't explain everybody jokes around that. I'm a 27 year old, but I have the soul of an 89 year old woman.

That's hilarious. For the rest of the podcast, that's what people are gonna see. Now, listen, I can't explain it. I love Tim so much. He is the best advice giver, the most empathetic, the most compassionate, and he is perfect for hospice. I'm just so grateful that he's a part of our team. Thank you. Know, I love working for C and yeah, I joined probably it was about four years ago that I joined RC.

So when they were hitting their ten year mark, yeah, it was when I joined awesome all the time. Congratulations and excited that you guys are part of the team and making it all happen.

And I want to take a step back a little bit.

Who Qualifies for Hospice?

if RC requires two forms of certification I can't just come and enroll into your service. I can't just

be

like I want hospice care and stuff like that. No. So what happens is a lot of times we've had so many family members who have friends who've had patients like their loved ones on hospice, and that's like the word of mouth is my favorite referral because it's an experience that they're coming from.

And

they'll call us like, hey, I think my mom needs hospice, and they'll tell us what it is and

we'll

do a courtesy consultation or whatever that's needed. But it has to be two physicians who certify the patient. So the main physician is always the patient's primary care doctor, or sometimes it's an ER doctor. Absolutely. Or yeah, there's different avenues that they can come from.

But if the patient's calling us directly and they're not in the hospital, then we would have to explain to them, hey,

can come to consult. We can reach out to your doctor for you and tell them what our findings are.

But

99% of the time their doctor is like, hey, I want you to come see me so I can evaluate you.

They're not just going to trust somebody.

doctor will then send the referral, which is the first form of certification. And then our medical director will then review it to make sure that he also concurs.

and then our directors of patient care services, whether it be Kim or Tim, will look over all the happy, which is the history and physical, to make sure that everything that's on there is accurate and it matches what the patient looks like, because sometimes on paper they look healthy, as healthy as can be. But they're

she looks healthy. She's talking. She's eating great. But she has cancer that she was just diagnosed. So it's the internal that I'm not seeing of the cancer that's eating away or kind of the diagnosis. And I'll tell you, there's some amazing physicians out there. We had one doctor, I will I, I can't I'll never forget this lady.

She's 104 years old.

Her

daughter was 79. I remember I went to go to help with the admission we were doing. I helped with consent. Sometimes

I walked in. This lady, she looks younger than my grandmother, who's like 80, the 104 year old. I'm like, where is the founder? And her daughter, who's 79, looks 45. And I'm like, where is the fountain of youth, you know?

And I remember the doctor's like, no, she's passing away in three weeks. I, I'm like, there is no way there's, there's her diagnosis was constipation. I'm like, how is she passing away in three weeks?

he was telling he should start showing the labs because I was always curious. Like I said, I'm a sponge. I want to understand what you see.

I, I swear it like three weeks is 21 days. Day 19. She passed away. Yep. Oh, no. I've had a similar experience where I go assess the patient, admit her daughter said, I'm moving into a boarding car.

I'm going to pay for two weeks only she's going to die in two weeks. I was the hospice nurse. I was assessing her. Everything was fine.

And sure enough, two weeks at the exact date patient passed away. It's. We see some really interesting stuff. That's crazy.

So it they might look healthy, but it's. You have to look on the champion history and physical.

See what's actually going on inside the body. And if I may add what happens is a lot of times families are so scared to go to the doctor, and even though they know what's happening, it has it takes someone from the side to say, you need this program, you need a call, get some help, you know? But so yeah, to answer your question, we do need two forms a certification.

Sorry. That's crazy. No, because like, what I'm thinking about, it is like when we get into a little bit further down

we get into some of the fraud stuff, that means that there's got to be a whole fraud ring in this thing. Oh, yeah, talk about doctors. You're talking about certifications. And so

now I'm just thinking ahead. You know that's crazy. So

when people are terminally ill it sounds like and the are enrolling into hospice and they're getting through it the proper way. What are the pros and cons of it? Like could I just if I needed to go to 911 or something, can I still call like what am I restricted by doing

and what am I getting by enrolling in the hospice care that my regular medical provider could do versus you guys or a hospice care facility?

What Hospice Covers and When to Call 911

So the best way I explain it to our families when enrolling into our services.

Hospice is your new 911. You have a nurse available 24 hours a day. So

if maybe grandma had a fall at night and she hit her head, you're going to call hospice and not 911.

there are some times where you can send your loved one to the hospital if it has nothing to do with their hospice diagnosis.

our main goal is to take care of your needs in the home. So maybe it was a fall where your mom or loved one hit her head and she needs stitches. We would still send you to the hospital, stitch you up, bring you back on. So those are kind of how I explain.

I absolutely agree with what Tim said,

important thing is for patients to understand or their families to understand that just because they're on hospice doesn't mean that they're not going to get treatment for other things. So

So for me, who did billing for six years, I learned so many ins and outs of it to understand,

can a patient go to the hospital?

Can a patient go to a specialist. So if I have a patient who's on hospice for her, their heart, they have congestive heart failure.

Are they allowed to go to the doctor? Absolutely. Because they're not on for their asthma or their lungs or pulmonary their own for their heart.

So

insurance company not going to say, oh, we're not, we're not, we're not taking care of the medication or we're not going to send them to the specialist. They're going to say, okay, we need we need to serve this. This isn't what's killing the patient. And again, I apologize for the bluntness, but this isn't what's taking the patient.

It's

the heart. So the heart's treatment falls all on the hospice. And by treatment,

anything to make it comfortable. So we're not going to stop the medication. We're going to make sure that they get what they need because they're already passing.

So us stopping medication. Yes. Some patients want like I'm just ready. I don't want anything. But others are like, oh my God, are you going to take it away?

Am I going to die faster? Absolutely not. Listen, your body is already going,

giving you the medication or not giving you the medication. A lot like 90% time is not going to change that. So if it's comfortable for you to take that aspirin every single day, take it. Take the aspirin. I think my favorite one that we do, especially at Arc hospice and maybe not other hospices do, is dialysis.

Oh yeah, that's my favorite one of working for Arc hospice. A lot of other hospices will say, well, you're on dialysis, stop it. But that's because they don't understand diagnosis billing. And I think that's where the strong suit comes from, because we have an understanding of what billing is and how dialysis can get covered.

and here's the thing.

We're not going to put a patient who's dying from their kidneys on a different diagnosis and admit them onto hospice and let them get dialysis. That's not how it works. But we've had, I think, 100% of the patients we've actually ever admitted with dialysis. They are dying from something else.

And yeah, they come on for another diagnosis, but because of billing, they can still go to dialysis and seek that comfort and going there.

So why take it away if it's making them comfortable? Exactly.

that's super interesting because I kind of had this misconception of if you get on hospice care, you can't go to the your medical provider anymore. But it sounds like there's a narrow scope of what hospice care is for. It's something that's been diagnosed that's certainly ill.

That's basically going to kill you. So let that be the

hospice provider. So that becomes your first line of defense. Absolutely. You wouldn't go to the hospital or or E.R. you would have hospice come for that specific thing and everything else. You would just go through your routinely medical providers

checkups and so on and so forth.

Yeah. If the hospice care, what would it if it would not be if they wanted.

So what happens is the patients will come. So if they're on hospice and even if they have these problems, their medical providers, again, it's a lack of education in our system unfortunately,

especially the newer doctors. And I respect them and I love them so much.

They went to school for so long and they're great. I love you guys, but they feel like, oh, patients on hospitals. I don't have to take care of them anymore.

That's not the case like there are. So and if I was to talk about some of the modifiers you could use to make it take care of your patients,

you would still be their physician.

You are still their doctor. For everything that's not related to hospice. They got a they got a they broke a finger. They broke their toe. You're still required to take care of them.

so many doctors were like, oh no, you're on hospice now. I don't have to worry about it. Let them figure it out. And what do we do?

We're not going to go suture like we don't suture their fingers back together. You know, we're like, okay, you need to go to the emergency room. There's nothing else we can do for you right now.

Well, so there's there's actually a lot more complexity to it.

And it sounds like if the hospice care actually understands the ins and outs of it, they can provide the best care. What sounds like you guys are going to send the billing. You know what they can get. You know when to refer them. You know when to call the doctor. Be like, hold on, you. You need to do this for this patient.

So on and so forth. So it sounds like that deep experience and knowledge helps you guys provide an extra layer of care for your patients. Then

maybe like a startup or someone who's maybe not as in green as, as you guys are in the hospital. Absolutely.

Now I kind of want to talk about like the elderly and how it is kind of from the provider's perspective.

When you guys go into these homes and you're dealing with the patients for someone who's on medication, you guys talk about dialysis and aspirin or whatever else might might be in there at some point that medicine probably starts fading away and stops working.

Pain Management, Morphine, and Comfort Care

So

do you deal with the patient who's more resistant to the medication? Like what do you do in those situations? Do you just like up the dosage.

So it depends on what medication it is. So if it's pain medication for example, there's times where I've sat with a patient for four hours trying to get symptoms managed because this pain was out of control. So we have access to our doctor 24 hours a day and I'm able to get updated orders lifetime. So this patient, he was taking morphine.

I was giving it every hour, but he was still screaming out in pain. And the pain was not getting controlled. So I would contact our doctor and getting a new order, upping that dose

honestly, the saddest part is when people hear morphine, there's that stigma. Oh, if I take them dying and.

the medication doesn't work correctly or the dosage is not enough, especially with cultural people, for example, different nationalities, actually

they will. No, no, no, you're already giving them too much. We have to explain to them that the liver. There's something called stacking on the liver. So when the liver starts processing the medication in the beginning, guess the first dose of morphine that we give a patient, it might put them to sleep.

And that oh my gosh, we have so many family members. Just start freaking out. Oh my god are they going right now. And listen every panic is we we understand it. We want you to process it. We're here to explain it. And the most important thing about our hospice agency is we don't just give it a bounce. Sorry for my slang, people.

We are there to make sure that, hey, we're going to stay here until you see that this is

short lasting. And then we see, is this enough? Heavier patients need a bigger, bigger dose. And until the liver starts processing the medication, they don't normalize. I've had a patient patient start on a fentanyl patch. They slept for 12 hours, and then they woke up on that same patch.

Completely normal, no pain. They felt amazing. Four days later, they're having pain again. Because guess what they've built a tolerance delivers. Stacking has. Now they need a little bit more. And with some diseases like not all cancer, but cancer is one of the ones we see the most for pain.

It's not stopping, it's still progressing, it's still going to take you.

So obviously your pain is going to get worse.

There's so many things that happen at end of life, whether it's the death moan, the rattle, the breathing, the secretions, where if I can't come there on time and make sure that you don't see who wants to remember that loved one like that?

And we explain this to them at the time of admission. Listen, this medication that we're bringing in

is

not for right now. It's for when we need it to make sure that you're seeing them peaceful. I think one of my, my things that I say is patients don't stay alive because, like, they're fighting for, it's I think that keeps them alive.

The heart stopped beating because they're anxious about death as well. I mean, can you imagine? God forbid. But you're the one dying

You just need that comfort. Why not paying consulting or anxiety? Take something for your anxiety. I've had so many patients at the moment, they take that out of and they're like, I'm ready to go.

Let me go. Leave me alone. I feel calm now. I know where I'm going. And that's the most that's my favorite statement. I know where I'm going

that's funny. I not funny, but I have a close friend of mine who was recently on hospice care, recently passed away and had went over to go see him,

and he said the same thing.

He's like, we know where we're going. We're not. There's no surprises. And he had like a little cup of scotch drinking. I was like, he's like, hey, might as well. My last couple, I was

little bit shocked at first, but at the same time I was like, this is kind of cool, isn't it? To kind of do the last things that that you enjoy.

And I was like, how does that mess up with your medicine?

He's like, actually, this doesn't mess with the medicine. And so I could have the scotch, I could have the whiskey and I could have a medicine. And I was like, man, you're living. You're living it up your best life. I always tell my patients towards end of life,

if you want to drink a scotch, have a shot, do it.

Who am I to tell you what to do?

Enjoy your last moments. Take that shot. Three shots. Whatever you'd like.

If that makes you happy to do it, have a couple a shot of cognac a day until he like it was and his doctors like, hey, it's like an aspirin, you know, it's thinning out your blood. It made me laugh him like you liar.

extended to clear it up for everybody listening. We don't just give you fennel patch because you want one.

You have to literally need it. And the medication itself is if you have pain, we're going to treat it if I can quickly add something to it. We

had a patient who was released from

prison and it was released because of his disease. He had a really bad cancer.

The

patient was an ex addict or probably was still an addict.

I don't remember the story correctly, but the dose he needed for his morphine and listen, we're a newer hospice. Think he's like year seven for me. And I'm like, oh my God, who's going to give that much morphine? And every hospice they went to said no,

and I'm not giving names or whatever. But I remember when they called us.

Do you think you do it? I work with a medical director who, honest to God, I'm so, so blessed and I thank God for every day he's like, listen, these people are dying. If I sit here and judge their past or judge what they're going to be taking to get them comfortable, why am I here? Why are we doing a hospice?

that's what people miss so much of it. They freak out. Yes, it will be your license if you do something the wrong way. But if this patient's paint on is based off of every single medical record that I know, they're taking 20ml of morphine an hour.

That's what they need. Quick story. There is a man. Oh my gosh, my favorite.

He had the same exact diagnosis as my dad, Corey.

He's young. He was 63 or 64 years old, has three daughters,

he's the best freaking grandpa.

I was just I could just imagine that's how my dad would have been with my daughter.

And he's on methadone, 150mg of methadone. That's a huge dose. And he has to go to the methadone clinic. We have to make sure we're coordinating it. Now. This guy, he needs it at home, right? He's he's dying. They just. We're adding him to hospice.

I looked over everything. It's a fast admission. He's declining,

he has, like, swelling, like, listen, everything you can imagine bad is happening to this man.

What do we do, a doc? There's no way I can give him that many milligrams, especially because it's from a methadone clinic and they don't provide that a lot of the pharmacy. So what are we doing? We need to taper it. How are we tapering it? Okay, maybe it's fentanyl we're starting. Maybe it's morphine. We're sorry. Maybe it's a lot of starting.

But imagine if someone's passing away on that high of a dosage. You're not going to be giving them 20ml of morphine liquid for them to swallow, especially if the secretions are happening. And his was lung disease. It's like fish out of water.

I fought tooth and nail. I literally called the methadone clinic maybe

12 times the first day to get the medical records because my doctor like, unless I get that record, I can't start him on anything.

And he has like, I think one day left of his medication at home. I'm not playing. I went down there,

I was like, listen to me. I was like, give me the medical records. All you're supposed to do is give me the records. Look, I mean, I get it, I bring it, I, I give it to my doctor.

And then we have two medical directors. They look over it. Everything's great. All. My gosh, Corey, the man was able to pass as peacefully as possible. And let me tell you,

it's still not as what I wanted. But when it's that high and I have five days to to help calm that, if I can get him down to a four, I know I did good,

those are the types of people like,

you're dying. I'm not going to judge you based off of your past.

I don't care what past is in the past.

Thank you. We don't judge. Yeah, yeah. Who are we to. I mean, that's the thing with internal wounds is, like, you could see someone's arm broken. You could see someone bleeding, but you can't see someone's internal organs. And so you don't know what the lungs are doing. You don't know what the cancer is doing

if the paperwork is there, like, you got to take your emotions out of it. Can I justify this? Do I have the documentation? Do I have policy and paperwork to stand on? And if you can't, and you could always justify it and it's no longer your decision. It's the paperwork kind of leading you to that decision.

Dementia, Agitation, and Family Education

So it's, probably something that sometimes gets overlooked because it's hard to find a balance

paperwork versus your own perspective and your own biases and how it makes them those decisions.

But how do you deal with the patient who then becomes like verbally combative and abusive and

doesn't recognize who you are and is like Tim trying to fight you in the process? That's a lot of our patients, actually.

A lot of patients do sometimes come on for dementia, and it's training families on dementia care is how do you properly approach grandma when she's agitated? Or

maybe it's changing some medications to make grandma a little more comfortable, because she might need a small dose of lorazepam? And how are we going to give it to her when she's super agitated?

So it's teaching family tips and techniques on

how to go about that. It's a lot, of lot of education. Maybe it's going multiple times of Mimas agitated. Well, let me come and show you how to do it. When Mimas agitated, it might take us 2 or 3 times to train family until they're comfortable. But we're going to do it.

there's other, other ways. I love how we said that.

example, if they are combative, if they're like we had we've had multiple

they're scratching their biting or whatever.

the pharmacies will mix medications together to. And whether it be in a cream form, a patch form, or whatever the case may be. And

We can put it on a glove and just, hey, grandma, how are you doing today?

You're doing okay. And because we have thinner skin in specific areas, the nurses, I've learned a lot. You guys, they can they know exactly where to put it on. And then within like 15 minutes, grandma's comer.

And

it's not something to help. Like, everyone thinks that these medications are going to make them fall asleep or just. No, that's not what happens.

It's like a nerve. You just have to find the right dose for them. And it could take a little while till we find that right concoction for these patients. Maybe it's a start. They're falling asleep. Okay,

let's find that right concoction that works for them. Let's do a little bit less next time. And none of these medications are going to do harm to them.

No. Okay. I mean, hold on. I'm not an expert. From the best of our knowledge, they're not going to do ARM. They're going to help calm the patients down. They're going to help the families have a peace of mind because their loved ones not as agitated.

That's awesome. I like that magic trick where you kind of come shake their hand, slip them a patch,

not biting you, fighting you, cursing at you and things of that nature. Get them to calm down so you could administer. They care that you're there to kind of administer. Yeah, that's a good technique.

Yeah. You have to figure it out.

Elder Abuse, Unsafe Homes, and Mandatory Reporting

But on that note of administering care

it. If you're there with that person 24 over seven, at some point you lose your patience.

So does that lead to elder care abuse? And what is your guys's process when you guys identify that, or do you even come across it at all?

I mean, I've never personally come across elder abuse, but there are situations where maybe it's an unsafe living environment where we do have to contact adult Protective services

and we will remain reporters.

And usually we've had patients come on to our service through an APS report.

We had one patient who had 16 wounds and it was draining and oh my God, it was just horrible. This poor woman was suffering and the sun's freaking out because he's like, I don't know what to do. And you can't blame him either. I mean,

what do you do? He doesn't know what to do. It's his mom. And some people are so uncomfortable changing them.

And. But there's home health, there's hospice, there's so many programs that can kind of help them or IHSS. But

if if they don't know Corey, what can benefit them? What can help them? How are they going to get these services for their loved ones? If and especially IHSS says it's one of the most amazing programs out there. Unfortunately, it also has been abused, from what I've heard.

But

on our hospice, like the first thing we do for patients is the medical patient. Obviously low income, they have nothing. The sons home all day, they don't even have money to pay their bills.

you know what? I think you qualify for IHSS. Let's let's go ahead and contact them. Let's fill this form out. And that's what the social workers will do.

reach out. They'll get a caregiver in place, whether it be eight hours, ten hours, 12 hours. I don't know how many hours they can do, but we get that help because why?

Why allow the skin to break down if we don't have to? But unfortunately, the APS cases or the abuse cases, we get them way later. And then now we're chasing symptoms, we're chasing issues and how can we fix it?

And it is extremely sad. Extremely sad. We actually have had a few patients, we've helped quite a few patients actually get out of that situation.

One of my favorite one. Oh my God, grumpy, grumpy old man is an understatement. The cutest grumpy old man he was actually one of our first patients was the second year of hospice.

I think we had like eight patients at that time on average for a monthly.

every time I'd go see him, I was also the volunteer coordinator at the time. I would just go hang out with him because he was a veteran.

How I got him to start talking to me, he's like, I saw this greenhouse outside.

I'm like, oh my gosh. I'm like, were you a gardener? And then he starts talking about his wife who passed away and how she loved roses. So after that, I made every single employee take a rose with him every time they go visit him, and

one time I'll never forget

he calls me. I had my number taped on the wall because he lived by himself. His son lived out of state and I'm not getting a call from him. I haven't heard from him. And I usually go once a week for two hours just to hang out.

See, he's all by himself. He has no family here and he has a paid caregiver. 24 hours we go, I go. No, my social worker calls me. She's like, I think we need to go visit him. Something's off. I'm like, I'm like, what's wrong? I'm kidding me. We're getting ready to discharge him. He's about to graduate. He's not.

He's doing so good.

I go, it's like 2:00 in the afternoon. I knock on the door, I walk in the caregivers. I don't know what. It's 85 degrees inside the house. He's still in his pajamas. And the was like, he doesn't. He didn't want to get out of bed. The man doesn't have dementia at all. I'm like, hey, we're going to call him Mr. Joe.

I'm like, Mr. Joe, how come you're still in bed? He goes,

she refuses to get me out of bed. And there's this smell in the house where I can tell no one's touched him. The first thing I do is I call my nurse. I'm like, you need to get over here. The nurse comes, we take care of him, change him, get him cleaned up.

I see the phone's been disconnected. The caregivers on his cell phone talking to whatever, so he doesn't call one of us.

And then I found out the son had come a week earlier, taking him to the bank, done whatever they needed to do, and left at this point. Now, yes, I've built a relationship with this man. It's been like six months.

I'm like, this is my grandpa, you know? But one thing I love about us is we never crossed the line. That's not my job. It's not my place to do anything to contact in or to problem solve. It's very important that all of our staff and every hospice agency knows what lines not to cross. But what can I do?

I contacted apps, this patient doesn't have dementia. He has no Alzheimer's. There's no recollection of him having any memory issues. Everything he's saying is true and correct. To the best of our knowledge. They came, they contacted everybody. I mean, he he got the help he needed. He ended up moving to buy. His son passed away peacefully there, which was beautiful for me because I'm like, he's not alone,

but I, I'm not like, I have such amazing I love my patients.

I don't know, there's just so cool. But we unfortunately you do see it and it breaks your heart. What do you do? What can you do? I'll call who I need a call.

And then if they tell me to back off, we back off. I mean, there's nothing that we can do anyway, you know?

Yeah. And then you mentioned something really quick, and I don't want to lose that thought.

What Does It Mean to Graduate From Hospice?

Is graduating off hospice care. So

what is that? Can you explain what is graduating off hospice care. So sometimes a doctor might think Meemaw is going to pass away within six months or the period given. Well, those six months have passed. Meemaw is doing great beforehand. When the doctor saw her, she's not eating, she's not drinking, but now she's up 20 pounds.

She's eating, she's drinking, she's getting better. So that's when we would graduate them from hospice and put them on to our palliative care program, so we can continue to monitor them and help them with any doctor's appointments they need. They're no longer as, quote unquote terminally ill, or there's no longer the doctors don't think they're going to pass away.

Within those six months. The diagnosis is no longer terminal. Actually, I love this. I love the US. This question because everything Tim said is completely accurate. But you have to understand the idea and the process behind it.

Hospice care is through certifications. There are you get recertified after a specific number of days. Now the first two certifications are 90 days each.

So if the doctor certified two doctors certified, that covers 90 days. Doctor certifies again 90 days is covered. So that's six months. That's what the original quote unquote hospice care's diagnosis is supposed to be. After that, if they're still alive, it's certified every 60 days. A doctor has to physically see them to make sure or telehealth for a lot of states to make sure that they still qualify.

And the disease will still take its natural course in six months or less at that time, they say on hospice. So when do they graduate? They usually graduate at the end of the term or end of their certification period. So let's say they just started hospice care. I don't know, it's the first period. It's the second month end.

Patients gained like 10 pounds.

We're not going to discharge them right then and there, because we still have that 30 days to figure out what's happening right now. The next 90 days they're up walking. We gave them oh, our hospice covers physical therapy for example.

doing physical therapy and they feel good. And sometimes it's just that extra hands and extra eyes that makes them get better.

I do have a quick story, if that's okay. We had a patient oh my gosh. Doctor calls. She's 55 pounds. Skin and bones.

she's in an assisted living. She 55 pounds, skin and bones in bed. She has the two little cats. So cute.

I don't think this lady is passing. I'm like, what do you mean? She goes, the food comes, she goes. I've noticed that every time I go over there because it's assisted living, technically they don't have to help feed them, right? It's an assisted living.

She goes, I go in, the food is literally sitting on the counter and no one's taking it to her like she doesn't eat because she doesn't have the energy to get out of bed. So we had daily visits at this time.

Our nurse would go every time it was food, give her food, make sure she ate her food, sit next to her.

You know, like, hey, how are you doing? Is there anything else you need? Take care of what they needed to do. Spend that time with them and leave this patient within 4 or 5 months. Gained 32 pounds, healthy pounds.

She was up walking, talking, laughing. Her sons were confused. And a lot of times. And there is that there's a statistic.

I think you lived 28 days longer on hospice just because you do get that extra care, or you live longer because you know, it's that it's a human interaction that makes people want to live like there's so many families who are abandoned and not just abandoned, but people have moved away and they have their own lives. And like you said, there's that guilt of man, I can't be there for them, but the hospice company is there for them.

Guess what? It helps them have a life. Tom, our chaplain, he goes just to hang out and play the harmonica for them sometimes. And then if God comes up, which it's amazing when it does,

it's a benefit. But like, it's just that patient, family or human interaction that helps them live and then they're discharged by, we call it graduating.

Do they come back? Yeah, they do. But sometimes it's a couple years later they come back.

well that's amazing. That reminds me of a statistic. And I'm not sure how true this is, but

is probably during World War one or World War Two time, where they had babies that were left alone and babies that were with their parents and 60% of babies would die without any human interaction.

Palliative Care and Family Support

And the babies that had the human interaction

majority, almost all of them, basically lived.

And so I believe that as you're talking about

elderly people who are in isolation and they don't have their families or communities, that probably is true when an infant is born as well as true is when someone is elderly.

I want to backtrack a little bit back to the people, the parents, we talked about them a little bit, but we didn't really dive into it.

they're taking care of their grandmas and their mothers, and they're frustrated because they don't even recognize their own daughters. Sometimes they don't recognize their grandchildren. And being 24, seven in front of them, trying to take care of them does burn you out. So

What advice would you give caregivers that are trying to take care of their parents or grandparents that are just burnt out?

Like what options and resources do they have?

one of the resources that we provide is respite care. It's a five day period that we give our patients where we give that family that break. The patient would go to a skilled nursing facility for five days. That way the family can get a breather. They can maybe go on that vacation that they wanted to.

I think one time we

had a patient where the wife really wanted to go see her newborn grandbaby, I think, in Texas.

But she's taking care of her husband. Well, she was able to go see her grandbaby because we were able to provide those five days of respite care.

So she got a little refresher, came back refreshed and ready to care for her husband again.

Maybe it's connecting them, as Esther said, with those resources of getting an IHSS worker to come in and help them out. Maybe it's we even coordinate sometimes where

had our volunteer go sit with the patient for four hours so the wife could come out, go see, go to church, be with her friends or even our chaplain Thomas out with patients.

So we always find a way to help give them that break that they need. Maybe it's an hour or two, or maybe it's the respite care.

I think this falls into two things absolutely everything, Tim said. But number one is to validate their feelings.

They're going through so much at that time. It's 24 over seven. You're exhausted. They're calling your name in the middle of the night. You're like, at this point, I want them to die. And you hear those?

I'm going to be as direct as possible.

I have told so many family members, listen, you're not crazy or a bad person for feeling that you are human. You are burned out right now. It is exhausting being a caretaker. 24 over seven.

One girl I love what she wrote. She goes, thank you for allowing me to be a daughter and not a caregiver.

And don't get me wrong, hospice is not there 24 over seven, but we help coordinate it in such a way where the pains control, the symptoms are controlled. He's sleeping or he's up and he's walking and he has his schedule.

Where. Oh my gosh, dad's going to be sleeping through the night. I don't have to wake up. I can sleep or grandma's not going to wander. There's a bed alarm. Or if she falls like there's a floor mat, she's not going to break a hip this time. You know, like there's so many things we put in place where we're going to make sure that

we're we're there to cover all bases for you.

That's what we're there. We're we're there to think because you're

and we're we're there to give you that peace of mind.

and then their loved one passes, they're not crying out of resentment and anger.

Like, why did why did you make me suffer? And then you left.

They're grieving now because they're processing that their loved one is passing. I love what one of the things I started saying in hospice was, if I can help you think of it as a let go versus a loss. Grief is different.

Caregiver Stress, Grief, and End-of-Life Support

It's so different. So we validate them.

You're not crazy.

I think that's honestly super important because it's two sides of the coin. It's not just the person who's terminally ill, it's the whole family that's impacted by it.

And they do get stressed out. They do get burned. They're there 24 over seven. Their grandparents or parents are waking up in the middle of the night. They're not getting sleep. So they're they're having their own anxiety.

Their patience is thinned out over months now of doing this in and out. And they're at their own breaking point, sometimes years,

and then sometimes they don't even know to call for these programs until two days before the patient passes.

You go there, they're like, we would have had you two months ago. I just took a deep breath for the first time, and they were like, why? Why is our system so broken? And then you get into the fraud situation. You understand it.

Well, that's actually a good segue. So I do want to dive into some of the fraud.

Hospice Fraud in California

But I think for the people that are

in that position for hospice care and they're in Sacramento, hopefully they can reach out to you guys. Hopefully you guys have room to take on more

patients always, and then they can get some of the higher quality hospice care.

Now. We're in California. We're in Sacramento and we're not probably as impacted as the the fraud that's happening in Los Angeles. But

want to just start off of asking, like, how has all of that fraud?

I mean, how has all of that fraud impacted hospice? And you guys specifically, you guys kind of fall into that same Lane Armenian in the hospice field just on in LA. It's in Sacramento. So tell me about RC hospice and the impacts from all that fraud.

in hospice. You hear a lot about it.

You always hear about it. And for me I'm the type of person I keep my head down. I do the right thing. I doubt my eyes across my teeth, I keep going. This is not just a job for me.

is my dad's legacy. This is

my daughter's inheritance. One day, I don't know, like I have, I have, I don't know, so many employees.

This is their family's lives and their livelihoods.

and I hate that the Armenian were to stuck to it, but if I was to think like a fraudster, well, let me do this fast. There. Of course there's ways. I mean,

obviously we we see how many hundreds of millions of dollars ways there are.

I mean, the stories I've heard is crazy. I don't I don't even know if I'm allowed to talk about the stories I've heard, but I'm like,

who thought of that? How did they do that? And the thing is, Armenians have a saying, I'm not going to say it because there's a bad word in there, but 40 days, all it takes is 40 days and 40 days to mean literal.

But the parable behind it is it's going to come out one way or another. They're going to get caught.

Now, what sucks is when they're screaming our main in Armenian, Armenian or where Armenians doing it. Absolutely. But there were so many other nationalities doing it too. Corey. And

when the loudest one is your nationality,

you want to keep your head down and go in a corner and be like, oh my God.

Here we go again. Why is this happening?

We're joint commission accredited, okay. We have the highest accreditation. We've passed every audit flying colors. I have the best nursing staff. We dot our eyes, we cross our teeth. And I'm not saying, hey, come check me out. But if you do, I'm not afraid. And one of the reasons is because I love patient care.

I love what I do, I love the program. It brings me closer to my dad. Like

I don't want to get emotional, but my father is a huge, huge pillar in my life. My grandfather was an archbishop of the Pentecostal church. Like, I want to sleep well at night because I my faith will not permit me to do those things.

And granted, yes, our main is the first Christian nationality, blah blah. I'm going to get so much hate by the Armenians.

I agree with you. We are. But why? Why are we with this stigma of you know what? Let me make a quick buck. Make that quick buck. Be in jail. Be away from your families. How do you say be the embarrassment of the community?

And everyone knows everyone. So props initially. Honestly,

When it started happening, I remember somebody called me like, oh my gosh, how do you feel? Like I feel great, like, this is awesome. Like we've been waiting for it. I had such a bad stigma already where people weren't signing up, or

I don't even want to go into the type of conversations I've heard.

No, no, no, no, don't do it. You're going to get caught. So yes, the hospice fraud, we actually the funny thing is I thought it was going to affect us at all and it hasn't affected us. Thank you Jesus. But

we had one patient who moved here from LA patients. Family member. They're still on our service. I hope you're never watching this.

But he asks our social worker, he's like, aren't you guys Armenian? And it's like a little at my social was like, what are you trying to say?

I started laughing so hard and she's telling me she's like, Esther, I didn't. I was, I was like, I explained, that's not us, you know? And we've proved this, not us. It's I think those who are scared or those who are doing something wrong.

But like I said, my conscience is clear. I want to do this for the rest of my life or as much as I can. Like I see the benefit, the reward. I'm actually gonna add a quick story to this. One of my patients sons. One time he called me, he's like, why are you what you do? He's like, I don't understand.

His daughter worked as an N in Redding and we're in Sacramento.

And I said, and again, this is faith based, you guys. We don't talk about Jesus to every single patient, only those who allow. Just so we're clear about that.

he asks me, he's like, why? Why are you doing hospice? At the time I think I was like 32.

And I said, how could this it feel when one of your friends comes from writing and says, I saw your daughter. She took care of me and I feel so much better. You raised her so good. He's like, he feels amazing.

I'm like, I know that when my patient gets to heaven, they're going to see my dad and they're going to say, I met your daughter.

And she was amazing and they're doing great. Gary, you have nothing to worry about.

But the idea that there's still that connection that my dad hears from us, I feel like that makes me want to continue to do hospice and see these patients.

I used to go everyone who was passing, if I knew the patient was passing, I'm like, I want to go see them before they they die, especially if they're a Christian. I'm like, I'll never forget Dolly.

I'm like, Dolly, if you see my dad like you, tell him. And it's it's kind of amazing because in a way it comforts your grief.

And I've said this story to so many patients where now they go to their loved one who's passing, they're like, well, if you see mom, you tell mom. Mr.. And I don't know, like, if you don't have that compassion, that empathy and that of what hospice is, and I believe there's life after death, then you're in the wrong field.

I'm not doing it for that reason.

With with with all the fraud. I mean, that's a good point. Why why do it for a quick buck? I mean, it's not worth it at the end of the day. No, your life is too short. You guys are in the field. You know all about it.

So why spend it in prison when you can spend it with your loved ones?

Have you seen more patients come to see hospice? Have you seen other hospices get shut down then? Has there been the influx of calls?

So great question. No I can't say we've gotten crazy referrals because of the hospices closing or we've gotten transfers. I think we got 1 or 2 that were transferred from us from one of the hospice agencies. And it wasn't a transfer. It had to be a whole new referral because for me, I have to do it the right way.

How Fraud Has Affected Trust in Hospice

I don't know what that doctor did. I don't know why that happened. I don't even want to know. I just want to do it the right way. Does the patient qualify? I will contact their primary care doctor. I will get that referral, and then we will start the certification period from whatever period there on.

I will tell you the growth that's been happening. It's word of mouth. The fraud is happening. I think it's causing a lot of people to do research. Oh

go and they read the reviews they call. I always tell people when they call me and I'm supposed to give them the hospice spiel. I'm like, listen, I don't want you to choose me.

I want you to call every single list that they gave you. Call all of them, ask them this question, this question, this question and this question. And if they can do those things for you, you don't have to go with me. Go with them. We offer something called a catheter. It's an external catheter. No other hospitals was doing it.

I've been doing it for the last, I think four years, maybe, maybe five years, maybe, maybe more recently, another hospice agency started doing it too, which is great. I am, I am so happy because patients need that. But here's the problem they're not offering the ones with it because it's so expensive. They're making the families buy it.

let's say Meemaw needs it.

She's bed bound. They live in a trailer. They're going to have to pay. I think it's like $5 a wand. Yeah, and that's a daily use. Change it every day or when soiled. So it could be

two wands, which is $10 a day, which adds up seven days a week. And in my head I'm like, okay, you're offering it.

You're causing more stress to a lot of these families. We don't do that. We offer it, we cover it. It's there. Of course it's an expense, but your loved ones passing that is a symptom management tool. That is something that, you know, it's also an independence thing. I've seen so many people were if they can

use the restroom themselves still, they still feel independent.

They don't think it's the end of their line. They're still holding on a little bit because they have that dignity of, I can still take care of myself. You stay there, you know, and it's that's what it is. A lot of times they want you at arm's length because they, they still got it, you know.

yeah, I would feel embarrassed if I couldn't do it on my own.

Honestly. I was like, let me go now. I don't want my dad of me. I want to just either be full time in hospice care or full time in some elder care home, and not have my kids worry about me at all. If I get to that point, then, God, take me. Yeah, pretty much. At that point, I don't want to be burden on someone else, you know what I mean?

That's kind of thing is, like,

see some people around me and what they have to go through. And I was like, man, when I'm that age, I don't want to put my kids and grandchildren do the same thing. So for some of the hospitals is getting shut down. It sounds like there's a little bit of an influx coming in.

And

you're saying that there's maybe more questions that are being asked now with who they're choosing with who. Yeah, who they're choosing. But

with all the certifications like, and you're double checked in, triple check in the work, how does that work in the first place? Like if someone was to go through that path,

how would they do it?

So hypothetical again, I'm going to give you from my perspective not what's been done. And maybe it's something that can be looked into, I don't know, but what I can see happening. And one of the articles actually had something similar to this. Doctors are in on it. Or the there was one hospice company I read about. There was no doctor.

How to Choose a Hospice Provider

I don't know how they passed the certification, but this guy and there was another one where it was a clinic. He had a whole clinic. He was prescribing things. No one was checking. But that's what's happening. They know that unfortunately, our government is so behind on catching these people that they'll get away with it for a couple of years, hit a couple million.

From their perspective. You don't do that, people. I want you to know hospice. You're not going to become a millionaire just because you have a hospice agency. That's not how it's supposed to be. The government is not stupid, okay? When they're giving you the money for your patients or whatever the benefit is. And I can't believe I'm even saying this, but I'm glad that I'm saying this.

They understand that it's 99% of it is the overhead, which is your staffing, your patient care, your medical equipment, your medication, your supplies, like hospice has a whole bunch of things that has to has to be covered. And the funny thing is, when you hear about what they're doing with the money, the kickbacks, I'm like, how are they even open?

Are they even seeing these patients?

I have patients I see daily, Corey, I have patients I'm negative every single month because of the extra care they have to do. But Medicare understands that some patients you'll see less, some patients you'll see more. And it all makes sense at the end. And then they do listen. There's so many audits that go into it.

If you own a hospice agency and nobody talks about it because in the back end there's a consulting, blah, blah, blah. I don't care about that stuff. If people understood that hospice is not just fun and games, it's not just the patient came on. She's he's passing away. She's passing away. That's what you got your pay day.

That's not how it is.

And

when Nick Shirley paints that picture of, oh, they're driving this, they're doing this, they're doing that. Can someone get there to drive a Bentley one day, maybe like 30 years down the line. And, you know, their company is growing, but any company, a grocery store, you can drive a Bentley. You know what I'm saying?

It's not about.

Oh, the car's there. I hate that stigma. Should I drive a Toyota, people? Okay, because it's great on gas. But what I'm trying to say is like, if we have that stigma of, oh, look at them, they have so much money. Some of the people who've opened the hospice companies come from money. It takes money to open a hospice agency minimum of $250,000.

in my head I'm like,

okay, Nick, I love you. If you're ever watching this, you're great. I love everything you're saying, but I wish you'd ask some facts, especially to those hospice companies who are doing it the right way.

and that's why the remains, the upright.

Oh my God, the frustration from LA. Every time I read these comments on Instagram I'm like, I want to be like,

I want to heart them. Like, I understand your pain, but in my head I'm like, I also don't know who you are and what you do. And I'm steering clear because again, my conscience has to stay clear.

My everything has to stay clear for my patients. Number one. Number one for my

my family, my doctors license, my nurses license, my my staff. Number two, if they're all covered and I care more about the core, right. The patient has nothing to worry about.

And you alluded to kind of like the collusion.

It is. It is it's a whole group of people. They get together and they're like, okay, the doctor will sign the certification forms I remember okay. Something happened a couple of years ago,

where I had heard a story about a hospice agency, unfortunately, in Lausanne.

I hate that I'm saying, you guys, I love you, LA people. But it was in Los Angeles where these patients don't even qualify for hospice.

Nothing like they're 50 years old. Normal grandma and grandpa, you know, their canes. But what they were doing is they're adding them, using a certain period, taking them off, adding them, using a certain period and taking them off.

Because remember, these patients have certification periods you can build for 90 days and then take them off. And.

Their billing per certification period.

So one time I remember a

friend of mine who has a hospice agency. She's like admitting a patient. So she goes,

this patient is now 90.

I opened up, they had 15 certification periods on hospice in the last ten years. She's like, I don't understand it.

I'm like 15 sir periods in ten years. I'm like, what? The flip happened there? And

she goes back, she's looking at the charts and they grabbed one chronic I think it was COPD, chronic obstructive pulmonary disease.

I still remember it was COPD. And they admitted the patient off of the lungs.

But just because it's COPD doesn't mean patients passing. People have bronchitis and live for 4050 years with it or even COPD.

But they use COPD as a diagnosis once. Then they use diabetes for diagnosis second time or whatever. And they're using all these different diagnoses so that Medicare doesn't catch the what's the word the patterns she is at this point, she's like, here's the problem.

Decor. Like when we admit patients who are on later periods. And I love this. I want everyone to understand this, even from a medical perspective. When you admit a patient who has multiple periods, it affects your hospice company because there is something called an average length of stay that Medicare looks at the most. So you take on patients who've been on hospice long or who've had multiple certifications, period, all those days coming to your average.

And that messes everything up, Corey. But here you are. The patient is actually dying. You have to take on this patient. So you admit the patient. You take care of them.

But you want to understand where did this go wrong? I have had patients who stayed on hospice for 2 or 3 years, but their diagnosis permitted it. There's no way I could have discharged it.

They literally looked like they could die any day. But they're not dying.

I'm not going to go back. Hey, buddy, can you go tomorrow? Like my days are going down there? Absolutely not. So you understand how hospice works as the person who's the CEO? Who? I'm the operations officer. I have to know where the ins and outs are.

My directors all know Oaks and my brother, the CEO, Nolan, our CFO. All of us have these monthly meetings where we're like, okay, here's where we are, here's what we're seeing, here's the trend. And then one of the trends were we were getting also in Sacramento, patients who were on their 12th, third period, on their 14th start period on their 16th period.

Now have we done that? Absolutely. We have patients on there. But

we want to understand why are they there, why did they get there, how they allow it to happen. And what happened here okay. So the fraud also happens is they admit them different diagnoses, different periods, different year. And it looks normal because Medicare doesn't know if Meemaw or

people you say p poor is actually deteriorating front of your eyes.

That's where the notes have to match the patient. Another one is they say they're going to see these patients and they're not actually they're not going anywhere. They're just typing up their notes and their billing for the patient doesn't even care to be seen because they're like, oh, I'm fine, but they're telling Medicare we're going and they're collecting the hospice payment.

But there's no they need to put that money into. It's not going to their nurse. It's not going to their DM. Like, you see a bunch of different ways this can happen. So when a person gets onto hospice, you get medical equipment, you get supplies, all types of supplies and content supplies.

give body wash, we give comfort pack.

You get medication, the covered back. We cover, the medications related to your diagnosis. Our hospice company also does what what do we do? Antibiotics, antibiotics for UTIs or any infections. Why do we do it for you? That's a treatment one. I remember one hospice nurse, she argued with me so bad and in my head I'm like, lady, let me just adjust my real quick fighting words.

Hold on. Yeah. All my clothes coming off. She's like, why are you giving antibiotics? Are you trying to make him live longer?

I'm like, this patient is in pain, delirious, foul smell. Can't stop scratching themselves because of this frustration. And there's a rash. And you think that's not comfort to give them an antibiotic. Explain it to me. She shut her mouth so?

Well, I didn't know was that bad. When you're elderly, Corey, when you're. I think after the age. I'm not going to say 60s elderly, but when you're past 60, let's say a UTI, I can even cause dementia.

Billing, Visits, Medication, and Red Flags

Wow. Am I right? Sepsis or confusion?

That's when the infection reaches the blood. Basically. That's the easiest way to put it. So I mean I personally think that giving an antibiotic for you Thais comfort care

it is who wants to see their loved one dying of you tie.

If anybody's had one. It's painful.

Yeah. That's crazy. So there's some medication that's maybe not prescribed. There's some visits that are not being done. They're being skipped. And so there's this extra billing that occurs without the care. And this is how some of the hospice fraud occurs.

You get extra money. The overhead is lower so keep you more in your pocket.

And

I know the Bentleys and the Ferraris are not the really the

a good indicator that someone is doing fraud, but it does optically look bad. Of course, when initially do these investigations and these guys are more and then they they dip out on them.

So what would like we on some of the videos I'm seeing like ghost hospices there's hotels addresses and you're talking about.

So how can so how can Medi-Cal or Medicare bill for something that doesn't exist, like the accreditations are being just

fabricated. So no doctors are being fabricated like just fake notes, plagiarism,

copying something and then just submitting it. Like who's auditing the paperwork? Because if medical provider just gets it, they're going to just approve it most likely.

So they just yellow it and be like, hey, well we'll see what we get. Not necessarily. So what happens is the show okay. For example we just moved office spaces okay. We got a new office. It's still in Rancho Cordova.

And what happens every time you move, you have to submit a change of address and then change of location form to the state and to join commission to everybody.

They have to come to an audit. It was pretty cool. The the guy comes, he checks everything, make sure everything's locked, the door locks, whatever. Everything's into place.

And one of the conversations we had years ago, I don't know if we talked to this guy. I wasn't really at the office when this one happened, but the first time we moved, he said, we have to make sure that this is a working office.

So the shell companies, from my perspective, what's happening is

they're staging it, they're coming, they're giving the certification. Then they're like, okay, we don't we don't need to be here for the next 2 or 3 years until accreditation happens again.

We

can build from home or do whatever save this money to.

But here's the case core can a hospice agency technically work from someone's house? Yes. And here's why.

The nurses and all of the staff are working outside of the office. The office is like a hub where they can come to chart. They can come to have their ID team meetings.

They can come to do their notes, visit with their directors, meet with each other for there's still staff at the office. We have our intake. I mean, there's always ten people in our office, like we have a lot going on. So a lot of these shell companies mean it's probably like a small hospice company and they have like six employees and they're like, why do we need to be in the office 24 over seven

now?

Is that right? No, you should be in the office because that's the correct thing to do. But can you be in your home and still run a hospice agency? Absolutely. My phone is 24 over seven.

So I think what's happening is they're finding another way to save some money.

Yeah, that makes a lot of sense actually.

If they were to work out of the home and they're only going to the hub to get supplies, they could either have the supplies at home or from somewhere else,

whatever the case may be.

Right. It's just a location where people can gather to get there. Like you said, they're doing their charting or they're getting maybe the medicine or whatever, or it's an ID team meeting, which is interdisciplinary team meetings where everybody comes to the office, they sit down there, have their meetings about their patients. That's everyone's all hands on deck for those meetings.

But

that happens once, once every other week, sometimes once a month for smaller companies. So it does make sense to me. But whenever showing it and it's one desk that doesn't make sense to me

I get what he's saying. But again, I wish he would elaborate a little bit more and take the Armenian out. It's not just the Armenians. There's so many fraud happening.

don't want to name hospitals, but a hospital got sued for $144 million. No. You want to know why they weren't in the headline? They got money to cover that.

But our man's are so stupid. I'm going to say it. Yes. So stupid sometimes

What are they thinking? They're getting away with,

you know, and my point for that is

Armenians.

Please do the right thing.

it's a lot of, collusion, a lot of, you know, fabricating of documents. The the office space could be one avenue as well. So it might be maybe a little bit misleading.

They could not be in the office. They could be in the office on a as needed basis. But some of it does look sketchy nonetheless.

What about like the homelessness? Do you think that's integrated into the fraud where

they go and there's actually a person? Yeah, collect their information. Signing up for us. Is there a integration with the fraud there, you think? I think absolutely. There's integration there is there. Have I seen it in Sacramento? Absolutely not.

We actually

have had a few hospital patients who were homeless. Oh my God, I love that man so freaking much. I think I was probably the first person to hug him in ten years because he was homeless.

And I can't explain it. You're not thinking of showering or what he smells like or any of that stuff like. He was the sweetest.

There were two brothers. One was adopted, one got adopted. Then when he turned 18, went and found the other brother. They were both drug addicts. Then one became a pastor. Crazy story. And then

the younger brother became a homeless older brother had a home. The older brother dies on our hospice.

Then the younger brother gets on, but he's homeless and he's so used to being homeless.

Cory,

he still sleeps on the on the sidewalk. He does not want his brother left him his house, but he won't sleep in the home.

It's horrible. We have social workers who some the. There's amazing programs in California sometimes that I mean, not sometimes there are amazing programs when they're working. You're like, yes, this is it. This is what I want my tax dollars to go to.

This is freaking making a difference.

They're able to catch these homeless people, get them to help they need, because sometimes it is that they have a mental illness. We can give them that many, not hospitals, but many doctors can give them that medication, help them get on their feet. What are the case may be or if they need hospice.

Hey, this patient needs hospice. They're living in a

what is that thing called like the homeless pods, houses, homeless shelter or a tent or shelter there? Yeah, they're living in a whatever. Yeah. The guy oh my God.

He's like, my tent is on the corner of this and this. And I'm like, you're what? You built himself out. And it was the cutest thing I want one time.

This was like an eight years ago. Okay. I don't think we've had another homeless patient since then. Maybe. Maybe like a I think they maybe lived in a hotel. Hotel? Yeah, they jumped from hotel to hotel,

I remember I went to the, to this tent and because I would never leave my nurses. Oh, it's another thing about our,

our staff is never alone.

If something's going on, we're going with them. I've had oaks and even go drive. Just stay outside, you know, until the nurse leaves or whatever the case may be, because I care. I know these people need hospice, but God forbid we're in a sketchy neighborhood and still Sacramento. There's neighborhoods out there that are a little difficult.

So we go I go to this tent and he's like, why don't you come in and have a seat?

I was like, where do you want me to sit? And he's totally laughing because he knows it's funny. He's like the same place I'm sitting on the floor and I'm like, I sound the floor with him. I'm like, okay, let's do this. Let's do the consent forms. And it was, I think it was for I think it was for him.

If I remember again, it was so long ago, but it was so funny. My nurse was like, we're really doing this. I'm like, don't worry, someone's coming with you every single time. But what can you do? You know, I mean, that's where they live. Yeah. I mean that's actually a homeless that actually needed it was on it was going through the right thing.

I'm sorry to add. They were actually a homeless living on the. So in the corner I just remember it. It's a property of their friends. So they're homeless. They're living outside, but it's on the property of a friend. So I think that's why we felt comfortable to admit this patient. Otherwise, I don't think I've ever had one where they're on the sidewalk.

Ever. Never. Yeah. No. Yeah. What's your address? Oh, on the sidewalk of the street. Yeah. No.

What's your opinion on that? Tim, do you think that the homelessness is also part of a integration point where a lot of fraud happens, where

people just go collect information and sign them up for us?

Switching Hospice Providers

I would say yes. One of the things I heard, I don't know if it's true, it's obviously TikTok rumors. I go ahead and TikTok that

mortuaries were involved in it too, that they were getting patients who had passed and backdating when they had passed and saying as if they're on hospice. That's one

theory that I heard the same one.

Who knows if that one's true, but that can we dive deep into this real quick? That's interesting, because now you got the doctors that are in on it. You have the hospice care, that's it. And now you have the morgue, you know, on it this into this. So this is what I, we we shared this TikTok video with each other.

I don't know where it is. It was a couple of years ago. But. So nobody come after me asking me where it is. But it was there. And he talks about how

patient building is always at the end of the month. So if they get on hospice, we don't bill until let's say, either they pass in that month or the end of the month.

So people were dying on the 29th of that month, and they were seeing that there was no hospice ever done because they have access.

They were backdating for that full month, getting that payment for it, putting in those fake notes or visits or whatever, collecting the money. And no one was catching them. I heard it went on for almost a year and a half, until one of the family members gets an EOB,

And she's like hospice. She's like, my dad was never on. She was like, why am I getting this? And an explanation of benefits is like a receipt like of what was billed. This is what Medicare paid for, blah, blah, blah, blah, blah. She contacts Medicare and says this never happened. Bam. Ripple effect investigation opens up. I think it was like 16 people went to jail.

Wow. A year and a half, though, Corey, think of how many people they built. And again, I'm so analytical. I sit there, I'm like, what the flip. How did this happen? It's mind blowing to me.

They probably had a friend that was in the hospice was like, hey, let's if we do it, we'll split it. I mean, how many people are dying in a morgue daily like you have?

So many. Yeah, you have maybe 2 or 3 funerals coming a day.

You're maybe doing your, you know, autopsies and you're collecting all this information. And if you're at the end of the month, 90, let's say three day, 90 a month.

Yeah. Times a year and a half times all the billing. Maybe. Maybe they are driving the bellies the first because of this, I could see that portion.

Absolutely. They probably are, but not everybody. And that's what I don't give it a don't give it a name like these are more of the edge cases. But it's like now it's like the prominent thing happening in California. So we're or say there's 52% Armenians. Okay, I like that. Odd because I'm in the 48 where I'm like, Praise God, that's not me.

But in my head I'm like, I'm giving because it's so loud. That's what they're just saying, right? Whatever is loudest gets the most attention.

The Armenian name was so loud for a minute. I'm like, man, that sucks to be in Los Angeles, to be in our main. What about the hospices that got I heard about hospitals that got shut down, that they didn't get a chance like they got shut down there, like, okay, appeal it.

I don't care how many hundreds of thousands you're going to spend to appeal it, appeal it and prove me wrong now because we don't care.

Wow, wow. I didn't even think about the backlash on the hospice side. People would just get shut down for, and I don't know if that's accurate. Government didn't come after me, but I've heard that too.

That's like, what did we do wrong? And they're like, prove that you didn't.

That's actually a good point. That's kind of messed up, actually, like, innocent until proven guilty, right?

Nick Shirley is going after nationality, a culture. It's not just a fraud. He's going after he he he's making the name of the cultural Armenian name louder than the fraud.

To me,

it's maybe a lopsided way of reporting. You're kind of painting a group of people with a broad brush rather than a fraud. So you're highlighting the wrong thing. Yeah. Letting

the nationality rather than the fraud. And it's mixing the two.

If there is fraud, there's a way of processing fraud. Contact the government. Make listen I on my binders when you whenever I admit a patient when I go to their bill of rights, you have the right to complain. You have the right to choose in their house because you have the right to participate.

And there's three phone numbers on there. California Department of Public Health number for the complaint line, joint Commission grievance line. And then there's the R.C. Hospice Grievance line, which means you can even call us to report whatever is needed. But the Ford is there's a way of reporting it. Yeah. Go out there, do the news. That's great. Get the fame.

I'm not talking crap, I swear. But

that's what it looks like. Did you contact the government agencies, Nick? Shirley, did you give them this information? Say, hey, these are shell companies? Because I promise you, Corey, if someone does it that way, the government is not stupid. They're going out there. They're like, okay, thank you for telling me the red flag.

I'm going to come.

I would agree with you in that sense of like the nationality sometimes, sometimes has a negative stigma around it. And

you do catch a lot of friendly fire and reporting things that way. So just report the fraud as the fraud, not the not the people.

Exactly. And you being adopted Armenian. Tim, how do you feel about this?

I think there's also other cultures that are involved in the fraud and they're not being as highlighted as well.

I know,

I mean, I'm part of Filipino. Filipinos were

doing the fraud to.

Oh yeah, because a lot of Filipinos are nurses, right? Yeah. That's like, why do you think I'm a nurse? I had to follow the Filipino way. I love my out

I'm going to plug into you of on here for a second, because I just kept on mind about Filipinos and nurses.

But if you haven't seen this skit with Theo Van, he's like, I love Filipinos. They're like the first people that welcome you, and they're the nicest people when they see you pass.

And it's a whole skit, but it's hilarious. So I'm gonna watch it. Check out the Theo if you want to do a podcast with it. No, this is awesome. But he talks about Filipinos being the happiest people. They. And so they are. That's awesome. Is there anything else about fraud in general that we want to highlight or mention?

I mean, I wanted to maybe ask about have you guys seen anything with pets and animals? Like, do we see people just signing up parrots and blue jays and pigeons and stuff? I wouldn't know, I haven't. Have you? The only thing that I've heard is that there's palliative care for dogs, and

I'd be the crazy pet parent that would absolutely sign my dog up for palliative care.

Hospice.

Yeah, I have heard there is a dog hospice, but I don't know if the billing works the same way. I mean, I think Medicare would cover it. No it's not, it's not I don't know I like care credit might cover it, but that's like a whole different avenue. No I haven't heard of that. Okay. So maybe not so much fraud.

I think that more of the homeless aspect you're saying. But not not really pets because there's not you need a social security number. You need a dress. That's what I was going to say. Or Medicare. You need some form of insurance. You do that. You're human. And granted, we've taken care of patients pro bono just to put it on there.

Like there's a lot of we've had immigrant patients who come, they have no insurance. I mean, granted, will try to get them emergency medical. That doesn't always happen.

our agency is not one to say, oh, you don't have insurance, we can't take you. I mean, again, my conscience is I'm here to make sure that I can take care of all patients.

What would my dad want me? My grandpa. Like I want to make sure I'm doing the right thing. What would God want me to do?

Yeah, I mean, I mean, you you you could do your best. Obviously, you're not gonna put yourself out of business, but. No, no, of course, but for sure, wherever you can, pro bono in the sense

to add that, though, California is amazing about that. You really don't have to do it for that long. They have emergency medical for anybody.

Yeah. So there's ways you could get them the forms and walk them through the process.

Hospice Oversight, Audits, and Compliance

Get a social worker involved so you can see if they can qualify. Then you can hand them off to the right programs that they can kind of get that support and help. Absolutely.

we touch the base. We touch base on this earlier. But I want to circle back to it because it's kind of relative to the fraud stuff, is

if you have a loved one who qualifies for hospice care, what can caregivers, parents, things of that nature, what questions should they ask a hospice provider to make sure that they're not getting a hospice?

That maybe cutting the corners or doing some fraud?

of the ones that I love to ask is after hours. How long will it take for nurse to come out? If I need someone, what's going to be the answer for that?

a lot of other agencies, it might be 3 to 4 hours with us. I tell patients will be out there within an hour,

maybe two, but 99% of the time, within an hour, you will have a nurse at your doorstep.

How long will it take to get medications? I tell them with RC, I've seen it as quick as 45 minutes. I get the order from the doctor. The medications come within an hour,

time is of the essence of other things is how often is the bathroom going to come out? How often is the nurse going to come out?

How is your continuity of care? A lot of other agencies, you might see 5 or 6 different nurses.

We just had a patient that they transferred from us from the agency to us, and they were shocked that they're seeing the same two nurses their whole time of care. They said last time I was on hospice with the other agency, we weren't happy with them. I saw ten different nurses in a span of two weeks.

some people, some organizations will use different nurses just to make sure every time is accounted for. Our agency is not that not like that. We give our nurses their cases to manage. They create their schedules, they know their families, and they make sure that they're seeing them in the correct, timely manner.

A lot of times we'll give two nurses those cases because if one one is off, God forbid they're sick or they're on vacation, the other nurse will handle it

on call.

Granted, are different nurses because it's on call, it's after hours, but usually it'll be a nurse that they've already seen or they visited or they've talked to on the phone.

when I call on call, am I going to be pressing numbers to get to a live agent? Hours is no.

You will literally get a live person every single time, not

only just a live person, but after just talking to an actual registered nurse. Always a lot of the third party agencies. Oh, let me connect you to the nurse. No, you're talking to the nurse. That would be making the visit

for the questions that you had to him, like, what would be the answers to that? How long am I going to? Is this going to come out? How long or am I going to get my prescriptions like what should be the right length of time?

And is that just kind of identifying the better hospice providers, or how am I going to make sure that they're not going to do fraud, essentially, or mismanage the care for my loved ones? Is this just a timing thing that I should be worried about, or is there more to it?

a lot of hospitals is what they would tell you is they'll give you the right answer that you want to hear.

They'll say for sure because it's a business, their marketing. So I'd say it's

I mean, you do. They practice what they preach. Yeah. When they say they're going to come out once a week, are they coming out? Are you seeing the supplies? Are you seeing the medication when you're asking for something are you getting it?

Another thing is the EOB, as I mentioned earlier, the explanation of benefits.

You get that every single month Medicare medical insurance you have is going to set it to and they're gonna say, hey, this was billed for for hospice care.

so that's a good point. I mean, sometimes it may be asking the questions up front and trying to find out how is the hospice responding? Am I getting a life person?

Am I getting the information that I'm asking about? But then the proof is in the pudding. Once you are on that hospice, if they aren't following through as they said they are, then they're probably building for some of the services. They're probably cutting corners, or they're probably in that hospice that you want to go with. So how how do you switch?

Is it easy to switch for same day I've seen it. What we've done one at 1 a.m. in the morning. That's my favorite story that you have is we have a patient. Hospice isn't coming out. They've called the hospice. We'll take this. What's the medications? Not working.

The nurse. They don't want to send a nurse out because it was 1:00 in the morning.

They call Esther and they said, what should we do? Well, there's nothing we can really do at that time because they're not our patient.

So what was the result? But I did I want to actually elaborate. This is actually such a, such a touching story, to the point where

this one spread like wildfire for the word of mouth in that community.

It's a friend of mine who calls me. It's we went out at like 1245. I love how you say 1:00 1245, but I get a call around like 1130. I'm going to sleep. I had the craziest day of my life that day. Okay? Like from a birthday to graduation to an admission to a drop off. Like I was so exhausted and it was just crazy.

So I'm getting ready to go to sleep. Finally, I put my head down. I get this call and I'm like, she never calls me this time. I won't lie, I ignored the first call.

She calls me again and she knows she's calling me a second time. I pick up a mic.

Hey, what's going on? She

goes, I need you, I need your help. And she's like, she goes panicking for her. One of her best friend's mom's on hospice. She's like, she's been screaming in pain for hours. I don't know what to do. I'm like, okay, I'm not about to say, oh, this transfer, I'm coming over there.

That's not my job. I don't want to steal patients. I've never stolen patients. I'm like, get me on the line. Let's throw away with the patient's daughter and let's call the hospice agency. We'll make them come out. They're supposed to come out. That's what it is.

three way the hospice agency and the daughter is like. And I'm just listening for now because I'm like, I told her what to ask.

I'm like, tell them that the pain is not controlled. She's screaming. You can hear her in the background. I think that was the saddest part from him. Like she's screaming.

She goes, well, we educated you on the medication you should give it to. She goes, I did give it to her. It's not working.

Well, you can you can technically go up on this. She goes, I'm not comfortable going up on the dose. Like, and they're they're a different nationality. They don't believe in medication. The fact they even gave a little doses amazing to me. And I'm sitting there just listening and she goes, why can't you come out? I want a nurse to come out, please.

I'm really freaked out. My mom's in pain. I don't want her suffering. She's screaming.

Well, you know, we can probably get a nurse out there and, like, maybe 2 or 3 or four hours, literally. What's what she's saying? I'm listening to this. I'm like, is this a joke? And this is a freaking hospice agency.

I chime in, I'm like, hi, my name is Esther.

I'm the CEO of RC Hospice Care. I'm like, I'm over here because they contacted a family friend. I'm like, why aren't you sending a nurse out right now? I'm like, isn't that the protocol? Well, I can try, but like, they have the medication there and she her, her whole thing is during the house

I'm like, so you're not sending a nurse out? She's like, no.

At that point, the daughter is like, please, Esther, help me. I'm like, okay. I'm like, this is how do you have to initiate a transfer? She's like, we're initiating transfer right now. It's 11. At this point, it's no, it's 1215.

At this point, we're going to change transfer. As of this day, we're letting you know. Daughter's saying it. I'm. We're consenting it. I'm getting the form signed. All that stuff. I need to come. I was at their house. She lives luckily, like 15 minutes away from me. I threw on scrubs like you can't imagine. It's real when you see these hospice nurses and their hair is, like, up in the bun, and it's like, just.

It's real. They they run.

contacted Kimmy, I'm like Kimmy. And she was on call that night. I was like, this was going on this blah blah, blah, blah blah. We need this, this, this, this, this.

called and opened my pharmacy. I was like, hey, I don't know what comfort medication they have out there, but it sounds like she's extremely anxious, extremely agitated.

She's reaching and she's screaming in pain. So pharmacy, I love it. I said, somebody go get the medications. They opened the pharmacy at 1230 for me. Pharmacy is 12 minutes from this patient's house. So we have gotten it there faster.

I get there, the nurse gets there, we go in, I get the consensus on first thing I had to get the transfer form sign the consent sign.

I made sure they understood everything that was going on. We I faxed that so fast to the hospice agency. Then I had Kimmie over there, medication, came in, contacted. We called, woke up our doctor

because she's on a dose. This is what she's been taking. It's been three days. Here's the documentation. Here's the chart that they've written. This is where we're at.

What do you what do you suggest? He gave the recommendation within. Like I want to say 40 minutes. She was she wasn't even asleep. Of course she was so calm. And she keeps blessing me. She goes, God bless you. She goes, I haven't had this much relief in so long. And to me, I'm like, if this isn't what hospice care, what is it for?

Like, are you guys freaking serious right now?

doesn't matter what time it is. Hospice is 24 over seven, and if you're not 24 over seven, you're not a hospice. I don't know what you are.

Yeah, that's a good point. Especially for people that are getting the treatment that delays the runaround.

you call, you feel like you're talking to someone that's out of the country and you're like, don't know what's going on. Then

are all signals to be like, yeah, this is probably not the hospice one either some fraud or two, just not good service, good customer service or

someone who's going to provide the hospice care in the first place.

So that's a good sign to dip out

guys also have the Joint Commission gold seal. So what is the Joint Commission gold seal and what does that mean for our hospice?

joint commission is the gold standard. It's the highest accreditation nationally for your quality of care. And their standards are like

higher than the states. Like you have to have things in place.

I will never forget I was 23 years old when we fast passed our first survey. And that surveyor I heard heard some scary stories about him.

Like, he doesn't pass people

and he comes in, he's asking me questions and he's looking me. He's like, who's this kid? I swear, I used to get looked at like, who is this kid and what is she doing here? I slighted people like, oh, I'm the volunteer person, not the CEO.

And every question he asked me, I answered.

And I remember when he was leaving, he turned around to Oaks and he goes, because obviously our CEO, he turns out and he goes, as long as you have her here, you have nothing to worry about. And I was like, oh my God, what an affirmation. Like, that's crazy to me.

What Families Should Ask Before Enrolling

he said that to me, all I could think about is, God, I am not going to lose this.

Like I'm going to keep the quality. I'm going to make sure that it's always the best standard, best practice. Listen, have we made mistakes? Yes we have. Have we fixed them? Yes we have. And that's the difference. It's not about oh, we'll catch it later. I'm not about to go chasing something. And that's what joint Commission teaches. Even though they're coming in three years.

Right. Or two and a half years to three years Mark, they can walk in any minute. They can literally be like, hey, I know we just this happens all the time. We just surveyed you, but I'm in I'm in town doing a survey for another hospice agency. I'm going to pop in and see what you're up to. And that does happen.

Guess what? Hey, come on. I remember one time I think it was our third survey. No, our second survey. Oh, my God, this lady.

Her face was always like, mean. And she would go.

The entire time. She's like going through our policy stuff and I'm like, Jesus, we're going to lose this and feel it like it's the end. Okay? I can't believe we're about to close. And we go and we're like, in the yellow. She's like, I'm shocked. You did really good. And I'm like. And I told her, I'm like, do you know scared?

I've been for three days with all the noises you've been making. And she starts laughing. She goes, you know, no one never talks to me this way.

I think that's the difference. I'm treating them like human. Yes, they are very important. But if I look at them as someone who can shut me down, I'm going to have a panic attack that way through versus logically thinking, should I be this scared?

Which is no. So my thing, my perspective from there. And the first surveyor taught me this.

He's like, I'm not here to shut you down or tell you you can't do it. I'm here to help you be the best because we need this care in the community, I want you. I want to point out what you're doing wrong so that you can fix it.

Joint Commission has an early survey thing where you can pay them to come out, do a survey that's called a I think it's called a blind survey or a like an undercover survey type of thing where it's not reported to your original survey. If they do find things, it's between you and them, and they're like, this is obviously something crazy, illegal.

They're going to report it. But it's about what am I not doing correctly? Where am I lacking? Can you help me? And we even did that because I'm like, hey, I'm still young. I'm I was 28 years old. I'm like, I am doing it's called a mock survey. I am doing this mock survey. I need to figure out what I need to figure out.

Like, I, I want to be the best. I want to keep the gold seal. There's so many hospitals, agencies, including is that going to lose their gold seal. And they go to a different accreditation because it doesn't require as much. So that's our joint commission. Well, so the Joint Commission is the highest commission gold seal. You can get my understanding from what I've read, from what I've seen.

Absolutely. And if there was fraud, would that joint commission find it? Oh, absolutely. Oh, absolutely. Within seconds,

course, they let's say you have a census hypothetical. I'm going to go really, really low. Let's see your new houses. You have 16 patients. They choose a percentage of those and they don't tell you which patients they're choosing. So something is and they will the missed one.

You don't even understand why they pick that diagnosis. Or they pick two of the same diagnosis. They'll pick out a 6 or 7 or anything at the beginning. It's like ten patients they have to do. They take the ten patients and they

they are nursing. No. It's like this made they start entering. Okay. If I go here, this is a dead end.

This is fine. I'm going to go back out. I'm going to go here. And it's like and then the way they describe it, and this is for anybody who's going to go through a survey, they want your plans of care to tell a story, not just, say patients find patients on this patient's going through this. What? Paint me a picture.

Tell me a story. Read me a book

Yeah. So the accreditation is one of the highest. And you were talking about the mock survey. So you could get that. What needs to be done to prevent some of the stuff from the actual survey?

So it's essentially one of the highest, gold seal standards.

It would catch the fraud if there was fraud. When they come to their audits, they're going to look through your paperwork, they can look through your notes. And so you're kind of telling the story. So but Tim, as a nurse, you're the one that's doing some of the the casework stuff then. Right. That's making sure especially since I here lot of the nurses

are there narratives is they're charting painting that picture of that joint commission wants reviewing each and every note the nurse submits and making sure that we have that right standard.

So you're treating the nurses as well. And how did you how to do the documentation so that it comes in. Oh they're here okay. Read my notes. I'm not worried.

It's as if a normal day is as if I'm adding the notes. I want them to feel just as comfortable as if joint commission audited them.

Nice. So you guys can have your own internal audit process as well, so that you can keep your joint commission if they were to pop in or do a blind audit.

Yeah, absolutely.

I think it's important to be ready at all times. So you should be auditing you. You don't know what you don't know unless you're paying attention to it.

And if you have that seal, most likely the people who are doing the investigations are probably going to leave you guys alone because they probably have all your information already.

Anyways, at this point, with all the I sure they do, especially with my last name. I

the the Goldfield, is that something that you could lose? You said they could be 2 to 3 years.

And so like what would be some signals that would cause you to lose that seal.

Well whenever you for example there are the nursing audits. Okay. A nurse has to go out once every 14 days. They have to do a you could talk about this supervisory visit where it's an RN that has to see them every

14 days and doing a full head to do assessment, making sure that all the symptoms are well managed.

And if that's not done, the supervisors aren't done. The checks on the home health aide supervisor is not done. They can they have to make sure that the quality control, which is what's supposed to be done if they'll catch it, and if they catch it and it's in the there's. So they have this it's called a safer matrix.

You can actually Google it and check it out. It's pretty amazing. And it's like when I said yellow, it's yellow, orange, red. And then each one has a category where if let's say there's white there's low widespread and then there's

Pattern is the red. That's the problem. No. Widespread I'm sorry. Widespread is the problem patterns in the middle.

Don't don't quote me. Look it up. But

if you're in the red, especially in the last red where it's high and you're widespread, that's like a resurvey, which means that sometimes they'll revoke you or they'll say, I'm giving you 30 days and I'm coming back, and I'm not telling you when I'm coming back, but I'm coming back. And technically, it's something you could technically fix tomorrow, right?

They might come back tomorrow. You don't know that. So when that safer matrix in their system generates it. And this whole code, these codes zero point, one point, 0.1 point, 0.2, 0.3, you have to look up these codes to understand what it is or the EPs and the ICS and the IPS. Anyone who knows hospitals who does surveys, they know exactly what I'm saying.

There's a code for everything.

Well that's an intense audit essentially. So you get your recertification. If you lose that seal, that means like you're going

that could be the starting of the downfall essentially with that accreditation and RC Hospice Care has this and has had it since 2015.

Basically what I've looked at.

beyond the seal, what makes Orsi Hospice stand out?

amongst the other hospice care providers? I always crack this joke. It's me. People. Yeah, but it's one of our big things is our continuity of care.

Continuity 100%. But I will tell you, it's the people. If Kimi is not there. Kimi has been with me for ten years. Our comfort care, our treatment plans, our plan of care. She has been the mind behind it. It's not. Listen. What? What I come for is I'm the person who makes the call. We're not jumping hoops to figure out.

How are we going to make this change? No, it makes sense. That's the smartest thing. We're not going to go through 50 different people to get approval. It's going to happen.

Tim, is the difference. I've had Tim come up to me like, hey, I really think we need to get a wound vac for this patient. And hospices don't cover wound back.

I'm like, tell me why he gives me the explanation. You're absolutely correct. I am going negative now because a wound vac is a very hard thing to have on us. No problem. We're doing it because Tim said so.

The difference is the care that we provide. We care about you. You said we're treating you like you're army man people I love.

That word is cracking me up. But that's the difference. You have a team who's treating you like they would their own. We've gone through hospice ourselves. My dad didn't have hospice, but he died. I understand that from the grief perspective. I understand the loss and let go perspective.

My grandfather was on hospice. My grandmothers were both on hospice.

God, we lost four people and Mike spent four years. It was it was very hard. But when you have someone who's gone through it or someone who's been in it for so long, we're the difference. We're going to make sure you understand it, you know it, and we're going to talk to you. The way you talk, it's people like you taking care of people like you.

I love saying that, too. It's the truth. No, no, I think it's there's not a price limit with our company. If I want something because I believe it's going to benefit our patient for comfort, and it might be expensive, I can go to the owner and say, I think this is going to benefit them for their comfort, so they can have a peaceful passing.

It'll be done.

sounds like it's the the founders that are running the organization.

Not like just some person has hired to run it. That's running it more like, I don't really care. It's the business. You know, most corporations don't have hearts. They have bottom lines. And so when you have the founders that know the ins and outs of the company, they are going to treat it as

like there's they have more skin in it.

They built it. They want to make sure it succeed. And they care about the quality versus someone that's just hired to run it. Absolutely. Someone who comes after the founder is not going to treat it the same way. So

What are the areas that you guys serve? How far do you guys drive out to you? You go pretty much anywhere. The best way to say it is an hour away from our office. So we go to El Dorado Hills, Placerville, woodland.

I think we have Sutter counties in there. I think Yolo. I think we've done Yuba, Galt, Galt. So it all. It all depends. You give us a call, we'll let you know.

It's a phone call. You know, it doesn't hurt to find out, but you can also check it on our website.

can check on the government website.

It tells you the zip codes that are covered under there. But, yeah, it's usually an hour from the office, and we're located in Rancho Cordova.

People think it's just for. It's not for just Rancho Cordova. It's for everywhere. So

yeah, the greater Sacramento. Yeah. Yeah. The greater Sacramento area.

That's awesome. So if people want to find out, they could reach out and get a better hospice provided than the one that they're on.

Not to say that we're stealing anybody

else's, patients or anything like that. They're doing a great job. Stay, you guys. That's amazing. I'm glad they are. It's. There's a saying you either love hospice or you don't. We want you to love it. It should be the right way. Is there anything else about hospice care that we didn't touch based on that you kind of want to bring up?

Sometimes your doctor doesn't know you need it. Okay. And we. This is my favorite story. Actually. It's a patient who kept seeing Kimmie at this assisted living. Such a cute old man. Oh, my gosh. And he's like, tell me what you do. And Kim, he's like, oh, I'm a hospice nurse.

And like, tell me what hospice is. And she starts explaining it to me. I think he was like in his 90s.

he calls his doctor who was a younger doctor. I think he was like in his 30s, early 30s. I will never forget. I'm like, what did he say to this patient? And the patient calls him and he's like, I, I want you to sign me up for hospice.

I know he's been hospitalized six times in the last month.

I think he's had multiple ties at the time. He's like, I think I'm I'm getting ready. And the doctor goes, young dude, very handsome doctor, mind you. But still, I don't know. What was he thinking? He's like, why don't even the towel in my head when a patient calls you and says, I think I'm dying based off of all this stuff that I just, I just got, instead of him doing the education and stuff or trying to see, hey, was I taught this in medical school or have I ever heard these things?

Patient Choice, End-of-Life Decisions, and Education

Or maybe I should talk to that nurse who's been doing it for 20 something years. I'm going to tell my patient, you're giving up on life. I think that's a really messed up. And

the patient had. Have grace and educate the doctor. And I love you too.

We've had a great relationship, but I really want to be on hospice. It took us, I think it was like six days to go back and forth. Explain. And the good thing is he was receptive. This physician, we educated him. There's this amazing form that they have on on the websites where it tells you, based off of each disease, what to look out for, what they are, what projections, all that stuff,

not?

We admitted the patient, he passed away three months later. And and this this is like I can't believe he knew and I didn't. And I think that's humility right there. But I would say

sometimes your doctor doesn't know. And sometimes it is you who are saying, I'm advocating for myself. I'm advocating for my loved

one. So

advocate, get educated.

you don't know what you don't know unless you ask questions or figure it out. Which is why I'm glad that we're doing the podcast so people can't get more educated and find out more so that that is actually,

a good insight that sometimes the doctors themselves may not know.

And sometimes you as a patient have to for that if you or feeling a certain way, thinking a certain way, and you're getting the runaround by the doctor, maybe you do got to call a social worker or a hospice to kind of advocate for you so you know the right terms, the right terminology to say they kind of put you in a position to get it.

Now, we're not talking about abusing the system or anything and getting it for the sake of getting it, but sometimes you know your body and you know what, you're feeling the best because again, the internal wounds no one can see.

Besides you. So. Oh. Assistant assisted. What's it called when you when they take the the cocktail. Right to die.

The right to die. That's way newer

there's so many assessments that go into it, but

you have the right to die. It's what it's called the right to die.

Our hospitals agency will help

get you with those resources.

Absolutely. So if you are on hospice and you want to do the right to die, hospice should and can get you that information.

Now,

religious people don't come after me. I believe in God too. But it is a person's choice is what they're doing and how they're doing it.

Is it something that I would do or don't do? It's no one's business. It's a personal decision that they make. Go with the hospice agency that understands it. I think what's happened is so many people will shame them into not doing it, but convincing someone not to do something or

going against someone's wishes is not your job. Your job as a hospice provider is to do what the patient's wishes are.

All right. RC Hospice Care

if you do want to do that will connect you with the resources. And I myself have been with a patient. They chose to do it and it's not my place to judge. I will be at your bedside, be your nurse there and help you through that time.

That's crazy. I know that's crazy. The right to die.

That, I definitely has a negative stigma to it.

I know for sure. But at the same time, it's like, to your point, who am I, the judge? If someone is living through chronic pain, chronic illness, like, do you want to just suffer for the next six months or do you want to die? And I guess that's everybody's personal choice.

I don't want to open up that kind of worms, because I can see people advocating for both sides of it.

again, we're talking about education.

People should know what services are out there. And again, we're doing this podcast so we could bring about the awareness and elevate that information. So people just understand that options. And they could just be more informed in how they make their decisions. Now, if someone does want to reach out to RC Hospice Care work and find your socials, your phone numbers, your websites and contact information,

How to Contact RC Hospice Care

we just started a page called RC Talks.

That's where our we started this kind of like a podcasting thing to where

giving tidbits, information. It's really fun. That's where you would go for information and a lot of questions will be answered there. RC Hospice Care, just like that is our main Instagram page. We post information, events, contact, how to contact us, but that's more for you.

Could follow us until God forbid. But if you don't need us sooner. But if you do need us,

there's information there. But the main, main way is you call us at (916) 858-1440 or go to our website wwwrchcinc.org.

That will then take you. There's an agent you could talk to on there if you don't want to call in, but you can even fill out a form.

It'll come to an email. And with the live leads we get back to you within 24 hours. A lot of times within like 2 to 3 hours. But the biggest thing is reach out to us, call us.

It's about being available, and we are available for you if you need us.

go back and put the website information in the description below. So for the audio listeners and even for the video listeners, they'll see it on the screen, but always pop into the description to find those links to the website and to the phone numbers and the emails relatively quickly.

Esther and Tim. Thank you guys so much for coming out here and spending some time and sharing your expertise with us and diving deeper into hospice care in general.

Closing Takeaways

Corey, I want to say, I mean, you are freaking awesome. The questions you had, I am blown away. This is an amazing thing. I am so excited to see this podcast grow.

So God bless you. Thank you for having us and thank you for being so awesome. So

well, I appreciate you guys both as well. And I can have done it without special guests like you guys. And so thank you for even coming on and spending a few hours with me to kind of dive deeper into this.

I think it's a important topic. And we're in California, so this impacts us specifically so

want to thank the RC House for joining us today for sharing that not only their expertise, but also their heart behind the work that they do.

Hopefully, today's conversation helped answer some questions for those that are out there that are in need of hospice care and cleared up a few misconceptions.

So

thank you for watching the podcast and we'll catch you on the next

one.