Everyone Deserves A Good Death

26:17Like there's all that stuff that they're doing, bathing you, housekeeping sometimes, you know, helping out with gathering and administering the medications. But, you know, they're doing all kinds of stuff. They might be shopping for you. They might be babysitting for your family to give, you know, the like we mentioned, the people in your family that are caring for you like to give them a break. They may help with fundraising. If you have, like, you know, money you need raised for your treatment, they may bring in music and comedy performances to hospice centers. People that cut hair, like volunteers that will come in and style somebody's hair even.

26:55I remember that was a big deal for Emily's grandmother near the end is, you know, she wanted her hair done and to look like she looked. And that stuff goes a long way to just putting people at ease, you know? Oh, for sure. Another one that volunteers can do is take care of the person's pet to make sure that if the person is opting for in-home hospice, that their pet doesn't have to go live with somebody else because they can't care for it anymore. So you can go and feed somebody's pet, take them for a walk, change the litter box. And then something as simple as just sitting with somebody and watching TV with them is enough.

27:32And this is just a volunteering opportunity in the United States and the UK. A, basically anywhere there's hospice, they would very much like you to volunteer to just basically be there. And just being a human being who can drive a car over to somebody's house is essentially the qualifications. That's basically all you need to do, and they'll tell you what to do from there. But no one would expect you to, like, you know, inject the person. As a matter of fact, you'd probably get in big trouble if you did inject the person with anything. You just need to be there. And in addition to just being there for the person, the patient, like you said, that gives the caregiver some time to just go take a shower, do something, just stop being a caregiver for a couple of hours, too.

28:14Yeah. And, you know, even though a lot of them are professionals, like most of them now, there's still quite a lot of volunteers that do this kind of thing. That Medicare law that I talked about in 1982 that stipulated that hospice facilities have at least 5 % of the patient hours provided for by volunteers. So that's one of the reasons. And also just because there are people in the world, you know, some people have maybe gone through this with a family member and then they want to give back. Some people are just wired this way as empaths to want to help people. And then sometimes it's people that are preparing for a career in health care and, you know, getting in a hospice and kind of going through the worst of the worst situations is, I imagine, pretty good preparation on dealing with any kind of patient.

29:04Yeah, and you would prepare for a career in that because hospices, like you said, they are professionally staffed and not just with nurses, not just with hospice doctors, but social workers, bereavement counselors, some of those clergy and just general aides who can come together and help with that thing that Cicely Saunders started kind of seeing clearly the total pain. where, you know, if you have psychological pain, it's going to make your physical pain exacerbated and vice versa. And the worse off you are, the more hesitant people might be to come visit you because they feel hopeless or they're just freaked out or something like that.

29:43So now you have social pain. So if you have all these people coming together to treat the person's total pain, you have a much calmer, happier, again, good death. And those are called in the hospice industries, interdisciplinary groups. And they do. They form a team for each patient to figure out what to do for each of the patients to help them basically find peace and comfort and calm. Yeah. And this is a, you know, it's a booming industry now in the United States. And we'll sort of get to the downsides of that in a little bit. But statistically, from 2 ,000 hospice centers in 2001 to about 5 ,700 today, 24, 25 years later, it's really grown a lot.

30:32Utilization grew by 32 % between 2013 and 2022. There was a 25 % increase in Medicare beneficiaries, obviously, as the boomer generation is aging. But that doesn't account for all of it, you know, 25 compared to 32%. About half of people now in the United States enroll in a hospice before their death. If you have cancer, you're far more likely to do so, as well as being female and more educated and also older, which at first seemed like, well, of course, but just so far as to say, if you're someone very tragically in your younger life that is stricken with something like this, you're far less likely to enroll in hospice.

31:17Yeah. And there's actually a lot of reasons why people don't enroll in hospice. A good majority of them just don't either aren't really aware of it or don't understand it. And there's stigmas about hospice too. Like there's a whole idea that if you go into hospice, you're giving up on fighting for your life. You're giving up on living. And that's just absolutely not true. Like if you have a terminal illness and it's really no longer treatable, a good doctor will say like, there's nothing more we can do for you. There's plenty of stuff we can do for you, but none of it is going to extend your life.

31:49It's going to make your last days pretty miserable. We recommend that you go into hospice and have like good last days, hang out with your friends and family, like be peaceful. That's actually, as far as the American Society of Clinical Oncology is concerned, that's a sign that you've had good cancer care, that toward the end, in the last, you know, few weeks, your cancer team says you've reached the, you know, incurable stage. There's nothing we can do for you anymore, except let's put you into hospice. The problem is, is there are plenty of doctors out there who do see that as quitting, do see that as giving up, and are known to steer people into hospice too late to where essentially they just spend like the last couple or few days in hospice and they don't have a chance to actually develop what again is referred to as a good death.

32:41Yeah, and there's even evidence that going, like trying to cure yourself and sort of ceasing that process and starting up with hospice can actually make people live longer. A lot of reasons, Maybe you're being monitored a little more closely. Maybe your symptoms are being managed a little better. And just everything that goes into the non-physical, you know, sick and dying part that we've been talking about, the emotional part and everything else. Like if all of that is eased, studies show that you can make it a little bit longer. Yeah, that actually happened to Yumi's dad. He was in hospice and given not very, yeah.

33:23Yeah, that was just a pretty raw time. He was given not much time to live at all, I think like days. And he didn't pass. And you started to notice he was actually kind of, he was eating more. His mood was starting to improve. And she convinced the hospice doctor that he was not dying anymore. And one of the things that became really clear that being in hospice at home can do to improve your health is that you're getting better nutrition. You're getting good sleep. You're surrounded by people who don't have to come see you in the hospital setting during visiting hours. And all of those things are terribly managed in the hospital.

34:03So at home, you can just get better and better. And Yumi's dad eventually left hospice, was discharged alive, and went on to live for another three years. Man, I remember all that going down and Jerry and I, all of us being like, oh man, this is like, this seems like it's it. And you were bringing reports, you were like, man, the darndest thing. Yeah. And then I just, I think we all suspected it was just going to happen again right after that. And it was, yeah, it was a few years. It was just, what a story. Yeah, I've never been more proud of anybody than I am of Yumi. She was the only one who saw, like she saw it and she had to convince everybody else, including me, that no, he's not dying.

34:48And she brought him back for sure. So, yeah. What a gift. It really was a gift. Yeah, I'm very proud of her. All right. Shall we take another break? I think we should, man. All right. We'll be right back and we're going to finish up with hospice right after this.

35:15new year new goals and in this economy a better money plan is more necessary than ever i am matt and i'm joel uh we are from the how to money podcast and every week we help you to spend smarter save more and make sense of what's going on out there if you want 2026 to be the year you finally feel in control of your money, we're here to give you the tools and advice to help you make it happen. Listen to How to Money on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Hi, I'm Dr. Priyanka Wally. And I'm Hari Kondabolu. It's a new year, and on the podcast Health Stuff, we're resetting the way we talk about our health.

35:50Which means being honest about what we know, what we don't know, and how messy it can all be. I like to sleep in late and sleep early. Is there a chronotype for that or am I just depressed? We talk to experts who share real experiences and insight. You just really need to find where it is that you can have an impact in your own life and just start doing that. We break down the topics you want to know more about. Sleep, stress, mental health, and how the world around us affects our overall health. We talk about all the ways to keep your body and mind, inside and out healthy. We human beings, all we want is connection.

36:29We just want to connect with each other. Health stuff is about learning, laughing, and feeling a little less alone. Listen on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Hey there, this is Dr. Jesse Mills, director of the men's clinic at UCLA Health and host of the Mailroom Podcast. Each January, guys everywhere make the same resolutions. Get stronger, work harder, fix what's broken. But what if the real work isn't physical at all? To kick off the new year, I sat down with Dr. Steve Poulter, a psychologist with over 30 years experience helping men unpack shame, anxiety, and emotional pain they were never taught to name.

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37:55One thing we should mention kind of briefly, we don't have to get too much into it, but hospice and right to die and assisted dying, these are two things that don't go together, but they obviously kind of do go together in a lot of ways because you've got a group of people that are, it's the same group of people mainly. It's even, I think, legally designated in places where you do have the right to die. You have to have doctors sign off that you're within six months and there is no cure. And it kind of is in lockstep with hospice, but it's not the same thing because it's just not. The World Health Organization very much defines palliative care as something that neither hastens nor postpones death.

38:44It is not the point of hospice to go in and find an empath who will help assist you along a little quicker. If you live in one of those states, I think it's an amazing gift to be able to do that. And there's a track for doing that, but it's not hospice. No, and the reason why it riles up hospice people who are against that is because there are, one of the reasons that people do choose medically assisted dying is to end their suffering. And hospice people are like, no, we know how to end their suffering without them having to die. Yeah. And that's why it really gets under their skin. Although that said, there are plenty of hospice people, probably humanists who are like, it's anybody's inalienable right to choose how or when they die.

39:33So, yeah, it is kind of a tricky thing, but it isn't, I think it is generally unfairly associated with hospice and even palliative care. I don't think we said explicitly that is to treat and manage symptoms, pain, nausea, that kind of stuff, symptoms that come along with terminal illnesses. And that is a part of hospice, but not all palliative care is hospice. You can get that same stuff as you're pursuing like curative treatments, right? So it's not like they're going to be like, you're getting curative treatments for cancer. Sorry, we can't do anything about the nausea then. It makes it, it has a place in both of them.

40:06And it has nothing to do with assisting someone in dying. It has to do with helping them die comfortably when they die naturally. Yeah. Yeah, and you know, you're not going to get, you'll get morphine and you'll get like the good stuff these days. Morphine plus, but you're not going to get the cocaine and the liquor. No, I mean, unless you have a family member who knows somebody. Yeah, I mean, somebody's got a guy, maybe. Yeah. Or if you just have like a, you know, pretty empathic, like really empathic, like on the down low hospice worker. Right. Right. And I mean, even if you do score for them, they might not even want it.

40:44Like I tried to give Yumi's dad a bunch of cocaine. He's like, no, I'm good with with the pain stuff I'm on now. Yeah. And then what to do with it? You know?

40:56So we found another joke. Amazing. Right before the dark side. Yeah, because there is a dark side to this. And again, the one downside to hospice is it puts it's just the burden on the caregivers. We'll talk a little bit more about that in a second. But the kind of generally agreed upon dark side of hospice is that there's such a thing as for-profit hospices. And contrary to our private equity theme in our private equity episode, we should say that there are plenty of for-profit hospices that are perfectly well run. The people who, the family members who have patients and family dying there are totally happy, give them great reviews.

41:36Being for profit as a hospice isn't necessarily a bad thing where they start to get lower marks than other kinds of hospices, specifically nonprofit hospices, is when they are part of a publicly owned corporation. Like a hospice went with the IPO at some point. Yeah, like a chain. Exactly. Or surprisingly or not, private equity owns the hospice. And the reason why it's problematic is because the way that payment is structured has a built-in incentive for for-profit hospices to cut corners and cut costs. Yeah, there was a survey in 2024 that 25 % of hospices in the U.S. are owned by private equity firms now.

42:20So you can refer to that episode as to exactly what goes into that. But, you know, I said earlier to put a pin in the payment structure, which is they don't get paid through Medicare. They don't get paid out per treatment given or for specific treatments given. It's just this flat fee. and obviously if you have a chain, a hospice chain that is for profit and has gone through the IPO process and has shareholders to answer to, very sadly, many times you're going to get hospice centers that get that flat rate, but they're cutting staff and people are getting the bare minimum treatment required by law.

43:03Right. And I saw there's a thing where it's supposedly federal regulations say that you have to visit an in-home hospice patient no less than twice a month. Yeah, just twice a month? Right. And then a lot of for-profit hospices just basically do that minimum. And most people agree, if you are in some sort of crisis, you're getting more visits. But if you're not in a crisis, you're getting fewer visits because they need to balance that out to cut costs, right, or keep costs down. It turns out that's a myth. The federal government doesn't require two visits a month at minimum. The federal government doesn't have any requirements for how often or how little a hospice has to visit a patient at home.

43:50They have no requirements or they're not enforcing anything? They don't have any requirements. And that's another problem, too. They don't enforce a lot of the rules that there are. And there's already a lot of rules that have loopholes. So this is a system that is just set up for abuse. Luckily, most of the people who run hospice companies, they're not in it to abuse the system. They're in it to help people. But there is a place for bad actors to milk the system, overcharge. Like apparently it's extremely complex, but there are ways that you can charge more than the flat rate per day. And I guess a study from, I think, 2021 in the Journal of Geriatric Care, I think, found that for-profit hospices tend to charge Medicare 34 percent more than nonprofit hospices.

44:47There's just a lot of stuff you can do to game the system. Yeah. And, you know, to be clear, hospice in general gets good marks from people. Even for-profit hospices generally get good marks from people. But they've drilled down and they found the ones that get the lowest ratings for care are the ones that are publicly traded corporations and owned and or owned by private equity firms. So, yeah, do your research, you know, if you're getting into this, because there's there are like we said, there's fifty seven hundred of them in the U.S. and hopefully there is one near you that will take care of you a little bit better.

45:30To remain on hospice, there's also, you know, all kinds of rules as far as what's called live discharge. You have to demonstrate ongoing steady decline at recertification intervals every 90 days for the first six months, then every 60 days after until death or discharge. and discharge is basically exactly what it sounds like. You're discharged like you're discharged at a hospital. It may be because you want to try, you know, curative care again, which is great, and you're right. It could be because of an emergency that you have to go to the hospital for, which will boot you off, which really stinks.

46:08But there are guidelines about discharge, and not all of them seem fair. Yeah, and you can imagine if you're dying of a terminal illness, being moved from a hospice to a hospital to continue treatment, maybe home where you have a bunch of emergency room visits ahead of you because your symptoms are going to flare up. It's not a comfortable thing to be discharged from one place to another. It's also a huge burden on the family too, because again, the care is being transferred from medical professionals to the family. But also, the whole premise of it is just faulty, because not all diseases follow the same trajectory in the decline of the person.

46:49And yet, they're all held to the same standard, which is essentially the standard that cancer creates a decline in a patient too. So essentially just saying, if you have a terminal illness that's certified by doctors, that doctors recertify, I say every 60 days, you don't have to face a live discharge. Like you can stay in hospice until you die. Your death doesn't have to cooperate with federal guidelines. That would be a huge change and a really simple one to hospice rules. But apparently that is not that's not happening right now. Yeah. And even if, you know, you aren't moved home, let's say, let's say you move to a different facility because there definitely is a problem with like, you know, not having enough beds at different places.

47:35and the family can get ideally into a routine at least. And, you know, they kind of figure it out. And then with Emily's grandmother, it seemed like once everyone got into the routine and everything had kind of been figured out, then all of a sudden some change would happen where Mary would have to go somewhere else. And then all of a sudden it's new visiting hours. It's in a different place and everyone. And, you know, that's just on the family, of course, just like you mentioned, the move for the patient. is really burdensome. So there's still so much they can do, I think, to clean this whole system up, you know.

48:11For sure. And even, Chuck, if they're not inpatient, just at home, hospice basically overlays this support structure for you, the hospice patient, in your home, right? So you have like medical equipment, you have medications that are like delivered to you at times. If you need a walker, you got a walker. Just all of this support, like you've got bereavement counselors dropping by, you have a social worker you're doing telehealth visits with, like all it just stops. When you're discharged from hospice alive, they come and they take the medical equipment, they take your walker away, you stop getting your medications delivered to you.

48:49You might not even have those prescriptions any longer after that if they were prescribed by the hospice doctor, it's a really bad jam. And the other thing about it, too, that Medicare is often taken to task for is they don't really pay enough for in-home hospice. Like, that's the lowest pay rating, I guess, is in-home non-crisis hospice care. And that means that if you are trying to stay at home, you either have to have a bunch of family members who are willing to commit their lives to taking care of you in your final days, or you have to have a bunch of money to pay somebody to do that same thing.

49:31And if you don't, and you want to die at home, you're SOL because you have nobody to take care of you at home because there's not enough pay to pay people in hospice to come by and not enough volunteers to take care of you, take care of your needs on a regular basis. You know, Grandma Mary, former foremost general in the Stuff You Should Know Army, had a t-shirt that says, you can take my walker when you pry it from my cold dead hands. That's all. I would love that, dude. Oh, my God. That would be such a great t-shirt. We got to get that one up there. Can you imagine taking a walker from somebody?

50:07No. That's your job? You're the person? You're like, yeah, go over to Grandma Mary's house and take her stuff. I know. No, it couldn't even be the person who also delivers it because it's such a mean job that there has to just be one specialist who doesn't like anybody who just goes around to houses and takes the medical equipment back. Yeah. It's in Ronnie. You got anything else? No, I have nothing else. Hopefully this serves some people. And, you know, just look around and do your homework and see if you can find a place that works for you and your family. Yeah, and another good piece of advice is to do that sooner than later.

50:44like share your wishes with your family. Maybe even go so far as to create a living will or some sort of medical document saying like, I do want to go into hospice. I want to stop curative treatment at some point. And then yeah, do like read reviews, like just find out who you would go to if it starts to seem like that might be a possibility coming down the pike. Yeah. Oh man. My God, get a living will. I don't care how old you are. That's, it's very easy thing to do. And it's that and a will are the two biggest gifts you can give your family as you grow old. That's right. You want to impress your parents and you're seven?

51:21Start thinking about a living will. Start talking about a living will to your parents. Yeah. And they will just be blown away. Totally. That seems like something in a TV show about a precocious kid. Yeah, for sure. Like Alex P. Keaton, he would do that. Yeah, exactly. Oh, you know he had one. So before we finish, I just also want to give a huge shout out to Yumi's dad's hospice doctor, Dr. Pajari. Awesome. Who did not have any sort of ego and was totally willing to listen to Yumi and helped get her dad out of hospice, too. I love it. So shout out, Dr. Pajari. And since I shouted out Dr. Pajari, as was foretold by the runes in 2008, I've just unlocked listener mail.

52:04This is Gen Z Stare Speaks Back. I have three emails I'm going to try and sort of hit the highlights of because we got what I felt like was three really sort of legitimate answers as to what the Gen Z Stare is all about that now I understand. It may not be my jam, but it doesn't need to be my jam because I don't have to put my Gen X stuff onto Gen Z. That's true. Hey, guys, 22 years old, Gen Z, very much in the Gen Z stare era. I work in customer service, which is where I use it the most. But we were raised with, if you have nothing nice to say, don't say anything at all. So hence staring. So I guess they took that very much literally.

52:49It's not something just done to adults either. And this person points out that they do it for their friends. As far as the phone call, no one calls us. When they do, it's a spam call, which I was always told the double hello people. I didn't know that was a thing. When they answer the phone, it cues the robot. Did you know that? Yes. Okay, I didn't know that. So I just answer and sit in silence until the awkward is this Josie follows. And that is from Josie Boozer. This is another one. Hey, guys, Gen Z person. I think the explanation you're probably looking for is a lot of Gen Z are used to being interrupted, not taken seriously, or have our responses to stories be given a weird look.

53:32The example of where someone finishes a story and the person to stand there can either be one, I don't have anything interesting to say about that story, and I don't want to make something up. Two, I'm so used to having my opinions not taken seriously that I'm just not even going to bother responding. Many of us are socially awkward and have trouble creating small talk with people that aren't close to us. Another reason may be because most of our conversations are online and have been online as we aged. And many people give an emoji reaction to a long story or just get a smile. And that's cool in response.

54:07That is from Sam. Okay. So it's kind of tracking along the same lines. Right. And then this is from Catherine, who's been listening for five years as a 23-year-old. I've heard people blame the pandemic, but I don't think it fully explains the generational trend since we all live through the same period. I think there are two main causes. First, my generation has spent much more time in front of a screen than any previous generations did. We've grown used to one-sided content consumption. You would look crazy if you responded to a YouTube video the way you would a phone call or an in-person conversation.

54:38So we're a little out of practice with responding to prompts instead of just watching something. This all makes total sense. It totally does. And then secondly, Gen Z seems to be more likely than previous generations to forego the fake politeness that used to be expected in conversations. I think this is partially because we're constantly inundated with advertisements. We become highly sensitive to fake niceness because someone is trying to manipulate our emotions at every turn and sell us something. My generation seems much more likely to prefer genuine reactions, even if they're negative, because when we're online, it's the only way to know something is not an ad.

55:16Woo! Man, this is something else, huh? Yeah, those are deep. From Josie, Sam, and Catherine, right? Yeah, and I think they all sort of track along the same lines, and that explains a lot. So, yeah, if a Gen Z person is just staring at you, maybe they think you're a real jerk and just don't want to say anything. Right. They assume you're manipulating them right then. Yeah. Or the other reasons mentioned. I think they're all valid in their own generational way. I feel like that really explains the discomfort that people, like, say, from Gen X get when we're treated like that because we are used to fake niceness.

55:54I know. You know, and like we're willing to go along with that kind of thing just to keep from a situation being uncomfortable. Yeah. Also, though, quick tip. If you don't have anything nice to say, don't say anything at all. I recently went through an experience with a tattoo artist getting a tattoo covered up with my dogs. It's a great tattoo. I appreciate it. He did a great job. But let's just say we weren't the same kind of person. He had a lot of interesting theories on things. And here's a little tip to my Gen Z friends. You don't have to not say anything. Just keep nodding and go, interesting.

56:36Oh, yeah. I did that over and over and over for hours. It goes a long way. Yeah. Interesting and sure. Well, no, I don't even know if I am lying. It was interesting. Yeah, okay. Just not for me. Right, exactly. Maybe the tone was a lie. Maybe so. The guy did do an amazing job. You said he did it like freehand too, right? Oh, yeah. I'll put pictures up at Chuck the Podcaster. He's a sort of amazing artistic dude. Yeah. Just like looking at pictures of dogs and drawing them on my arm. It wasn't like stenciled out on my arm first. It's nuts, man. Well, thanks a lot again to Josie, Sam, and Catherine for explaining that to us.

57:23You guys did a knockout job and we appreciate it. And I'm not being fake nice right now. I'm being quite legitimate and serious and genuine. If you want to get in touch with us and tell us about your generation, we love hearing that kind of stuff. You can send it off to stuffpodcasts at iheartradio.com. Stuff You Should Know is a production of iHeartRadio. For more podcasts from iHeartRadio, visit the iHeartRadio app. Apple Podcasts are wherever you listen to your favorite shows.

57:59Hey, it's Joel and Matt from HowToMoney. If your New Year's resolution is to finally get your finances in shape, we've got your back. Prices, they're still high, and the economy is all over the place. But 2026 is the year for you to get intentional and make real progress. That's right. Yeah, each week we break down what's happening with your money, the most important issues to focus on, and the small moves that make a big difference. Kick off the year with confidence. Listen to How to Money on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Hi, I'm Dr. Priyanka Wally. And I'm Hari Kondabolu.

58:33It's a new year, and on the podcast Health Stuff, we're resetting the way we talk about our health. Which means being honest about what we know, what we don't know, and how messy it can all be. I like to sleep in late and sleep early. Is there a chronotype for that, or am I just depressed? health stuff is about learning laughing and feeling a little less alone listen on the iHeart radio app apple podcasts or wherever you get your podcasts i'm john polk for years i was the poster boy of the conversion therapy movement the ex-gay who married an ex-lesbian and traveled the world telling my story of how i changed my sexuality from gay to straight you might have heard my story but you've never heard the real story.

59:20John has never been anything but gay but he really tried hard not to be. Listen to Atonement, the John Palk story on the iHeartRadio app, Apple Podcasts or wherever you get your podcasts. This is an iHeart Podcast. Guaranteed human.