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The opinions and statements expressed by Ann Mitchell, Montgomery Hospice and Prince George’s Hospice reflect their own views and do not necessarily represent the views of Sandy Spring Trust.
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- Hello, everyone. And welcome to Sandy Screen Banks Real Life Matters discussion series. My name's Phil Fish. I'm a certified financial planner, and I'm a state planning specialist with Sandy Spring Trust. I'm the host of this discussion series, as I interview local professionals in the areas of law, tax, finance and healthcare. I'm very honored today to have Ann Mitchell, the President of Montgomery Hospice, and Prince George's Hospice joining us today to talk about a very important topic of how hospice supports families and the community, especially during these difficult times. Ann, thank you so much for taking time out of your busy day to join us. And before we get started, could you give us a little background on yourself, and the organization that you work with?
- I'd be delighted to, and I'm pleased to be here. My name is Ann Mitchell. I am the President and CEO of Montgomery Hospice, and Prince George's Hospice serving both Montgomery County and Prince George's County. I have been the president of this organization for 23 years, but I have been in hospice for 40 years. This is actually my fourth hospice, and have been just thrilled to be here. I love this area. Montgomery Hospice has been serving the terminally ill for 40 years, and this is our 40th anniversary. And we have several services including full service hospice to both of the counties.
- Wonderful. And I know you and I have known each other for many years with my role with the trust division. And can you give, I know there's a lot of misunderstanding about what hospice is, but can you kind of give our audience today kind of your definition of how you view hospice? 'Cause I know if you would to do a survey monkey, and ask 100 people define hospice, you probably get a lot of different answers from a lot of different people. So could you give the audience kind of your definition of what you think of when the word hospice is presented?
- Absolutely. Hospice was created almost a little over 40 years ago in this country to really help people who are terminally ill stay at home with their loved ones and their belongings as they die. And this has been a really important aspect of healthcare. It is true as much as we all would like to think otherwise that each and every one of us will come to a time in our lives when we will be facing the end of our life. And what's so beautiful about hospice is that it looks at each of us as a person, and is part of a family structure, a family system. Does it regard us in terms of what our diagnosis is, and that in and of itself is what makes it so very special that we combine medical expertise with a real caring compassion for the patient, but also for their family. We work very hard to rehabilitate the family. And so that is in a nutshell, it is a holistic approach to the end of one's life.
- And I know you've got quite a substantial staff of both from a care management standpoint, medical expertise, also counselors, grief counselors helping with the family. It's a wonderful support structure and an incredible volunteer organization as well of individuals who volunteer their time just to provide comfort and support during, it might be the last few days or weeks or even months of an individual's life. So how is your staff made up? Obviously you're the president. And so what are some of the different components of Montgomery Hospice and Prince George's Hospice?
- So we have about 250 paid employees, and we have 250 volunteers. And really 500 people working with our patients and families. And with our paid staff, half of them are registered nurses. That's really what we're experts at, making sure that people are comfortable, that they don't have any, that their symptoms that they're experiencing are mitigated. They're ameliorated. We try very hard to make sure that people aren't in pain, that if they're short of breath, that we address that, all sorts of other things that come when you're very, very ill. You clearly might have symptoms. In addition to the registered nurses, we have several doctors who are working with our clinicians, but also seeing patients. They do not replace people's personal physicians. You still keep as a patient, you still keep the physician you wish to have, but our doctors are trained in palliative care, which emphasizes comfort, in palliative hospice and palliative care. Then the other big group are counselors. So we have dozens of counselors. They're social workers, they're chaplains, they're bereavement counselors. It's very important from a holistic point of view that we're looking at the entire patient, and that we're including the family. Finally, we also have nursing assistants. We have quite a few nursing assistants who help with the personal care for patients. And our volunteers are helping the families support their patients.
- Okay. You mentioned at the beginning that this is about an individual coming to the end of their life in the comfort of their home. Does hospice ever get involved with individuals who are at the hospital or does that, do they kind of wait? How does that work? So if an individual is coming to the end of their life, and they're in a hospital, how would that work? Can the hospice be provided in the hospital itself, or would that be handled by the staff that are already there?
- We don't provide hospice directly in the hospital, but we have nurses in hospitals who help with the discharge planning, who help to make sure patients are coming home, that they have the medical equipment, they have medical supplies. And then the nurse who is in charge is the care manager. And it's usually a she. She is working with the patient, with the family, with the attending physician, and our hospice physician to make sure everything is in place so that we can give the care in the home, in their house, in the nursing home, in the assisted living facility, in the group home.
- Okay, so hospitals are kind of not your area, but an assisted living, a nursing home, because at that point, the client may have left their home and may have moved permanently to an assisted living, or nursing home. So that really is their home at that point.
- That's correct.
- So then I guess a family might reach out to you depending on the location of the client. They might be at home already. They get in the hospital and they might wish to be moved to somewhere that's less hospitaly, probably not a word. But it's not really the place you wanna spend the last few days of your life, or they might be in an assisted living or skilled nursing. So then they would reach out to hospice and say my spouse, my partner, significant other, father, mother, unfortunately, sometimes son, daughter, brother, sister, friend, is in this situation. They're coming to the end of their life, and I want them to have comfort. And I wanna create the best situation for them. I guess that's the call that comes in. It's that a fair description-
- It is the call, but it's usually not from the family because the family has so much going on. This is truly, almost always a crisis time. It's usually from the medical expert, generally a physician, nurse practitioner who calls us and says we need, and they say, we need to have a hospice consult. We need to have you come out, give an information visit. Or we do that right there at the hospital if they are hospitalized. We do it right then and there with the family present. Because again, what we see is the need to get people home with their family members. So it's a med team then of social worker, chaplain, nursing assistant managed by the nurse, the care manager, they're coming in along with the volunteers.
- And you mentioned, clergy, I think it's important. You and I have spoken before that you are not a religious organization, that you are supportive of all different types of religious beliefs. Is that correct?
- That is correct. So we support any faith institution, any faith that, or no faith that a patient has. We work alongside that faith community. And, but we work with chaplains who are trained in pastoral care, not in a denomination or a kind of religion, but the idea of the emotional feelings that come with knowing that you have a terminal illness.
- Yeah. And not, I guess not just for the client, who's passing away, but at that point, the family will be going through a very difficult time, and they may need support of many different types. I know that the counseling that you provide to families and friends is such an integral part of what you do. And the support that you provide is because it's the before, the during, and the after of losing somebody close to you, even people on firm ground. Both my parents have passed on. I mean, I'm the youngest. I've also lost two brothers before their time. And even if you're on sure ground to begin with, a loss like that, especially at a loss before somebody's time can be incredibly traumatic. And if you're on firm ground, it can shake your ground. But if you're already on shaky ground, because you're struggling and you lose somebody close to you, it can really be a very dangerous time for those individuals.
- And that's why, and I know this from my 40 years of being a hospice administrator, that's why bereavement is so important. The kind of bereavement care services that are offered are crucial. Every single one of us will have feelings of grief when we lose someone close to us. And to have a professional there to listen to us, to help us to answer questions, it's very comforting. I've seen it thousands of times. It is, what you're saying is quite true.
- Now you are a nonprofit. There are some for-profit hospices, but Montgomery Hospice and Prince George's Hospice are non-profit hospices. So I know you received some support from federal funding, but you also receive a huge support from individuals who really value the work you do, and provide donations and gifts to Montgomery Hospice and Prince George's Hospice to help you do, because a lot of the work you do, you could not do it without the support of those donors. I know you and I have talked about that. Unfortunately, the federal funds don't cover all of your expenses for all of the staff that you have, and the work that you do. So can you talk a little bit about funding and, 'cause I believe there is no cost to the client for the hospice services, is that correct?
- And you are correct. When Montgomery Hospice and Prince George's Hospice get involved, we do not bill. We never bill the family. We never bill the patient, Medicare and Medicaid, commercial insurance, including Care First, Federal Blue Cross Blue Shield, Cigna, Aetna, all the clients, all the big commercial insurance companies pay for hospice. But if you're going to give a certain level of service, you're going far above what they cover. And for that, we turn to our community for donations. We have one very precious service that is a treasure here in Montgomery County, and that's Casey House. We have a 14-bed inpatient hospice that cares for people when they're with us. Instead, they don't have to go back to hospitals. They come to Casey House. So it has just been, and Casey House has been functioning for 22 years. It is staffed around the clock with nurses and we have physicians there every day, all day long, we have nursing assistants, the social work, the chaplains, the volunteers, the team is there. And philanthropy is very important for us to maintain the kind of staffing that we have at Casey House and maintain that beautiful setting.
- So Casey House is basically a place, a home for individuals who might not have a home to go to when it comes to that?
- Not exactly. It's in lieu of a hospital.
- Lieu of a hospital.
- It's not in lieu of a nursing home.
- It's not in long, because you don't have long-term stays there, correct? It's generally just for those last, well, how long would normally an individual be there, or does it vary quite-
- It's usually, maybe three to five days, but it's not always at the end of life. We had people who would otherwise have had to manage symptom, let's say pain, and we can bring them into Casey House, and have 24-hour nursing with them, and have physicians all day long looking at them. So it's a way to treat a short term crisis.
- Okay, wonderful. So as you look at a client's situation, so a client or a member of the nursing community may reach out to you, they might state that Mr. Smith is coming to, what is the criteria of when would hospice normally be called upon? Because I think there's some confusion about that is when would be a good time for somebody to reach out to hospice?
- It's often when, and families know it usually that you wouldn't be surprised if someone were to die within say six months. And two doctors have to sign off on this prognosis. One of the doctors must be a hospice physician, but the other doctor is normally the personal doctor for the patient. And you know after you've had multiple trips to the hospital, that the medicines aren't working the way they were working, say a year ago or six months ago. There's a change in what is happening with the patient. And so the emphasis at that point comes on comfort because no, there isn't a cure anymore. And that is very, we're guided by doctors throughout the counties who do understand when the time is right for hospice.
- So from that then it might not be a true end of life the next couple of days next week or so. It could well be weeks if not months.
- And that is usually very important that it is weeks or months, because that allows us to get in. Our expertise is taking care of symptoms. So that allows our clinicians who are trained in hospice and palliative care to come in and get everything, all the physical ailments under control. And then that gives the patient and the family a chance to be together and to be in their home, and not to be dashing back and forth to the hospital.
- Yeah. I mentioned just if the client had a month or two to live, and the doctors state, we're at that time, there would be a huge difference between that one to two months being in a hospital, and one to two months being at home. That would be a big difference I would think.
- Right. And our focus is comfort, physical comfort, emotional comfort, spiritual comfort.
- No, that would make a big difference. I know you and I have talked in the past about a very sad topic, but it's hospice for younger individuals, for children or for young adults, teenagers. Can you talk a little bit about your work there 'cause I think it's not, everyone thinks of hospice, 80 year olds, 90 year olds, but especially I guess with COVID and just generally speaking, it's not always a person in their 80s and 90s that are utilizing hospice or families of individuals who are much younger, which can be even more traumatic to lose a younger individual well before their time.
- We've had a service called Montgomery Kids. We've had our service for years, and we have a special team who are pediatric nurses, social workers, chaplains, physicians who work with terminally ill children, teenagers, and very young adults. One of the things we know is that you usually have an entire family involved here. You have siblings who their needs need to be attended to. So it's a sacred surface for us. I not only meant in a religious way, I mean it in an overall loving way that we are caring for these precious people who are here on earth, a shorter period of time than the rest of us. And it's been a very welcome service from many, many families.
- Yeah, I know my parents had to, they lost one of our like Jamie passed away in a car accident and it was a sudden loss. So it was a little different than with hospice. But for parents to lose a child is so difficult, and also the siblings. It affected all of us. And I don't know whether it's not harder to lose somebody quickly through an accident, or slowly through a longer-term illness. They're both terrible. And so, but I know your group does some wonderful work. So I guess with bereavement counseling, there's kind of the before, the during, or at the event of the passing, and then after. Could you talk a little bit about the different stages of bereavement 'cause it is a journey, and how long after the death of an individual are you still connected to some of the family members do you find?
- For our adult patients, we are with the families for 13 months. It's very important for us to go through that day, that anniversary, the death anniversary. So we're there for 13 months with trained counselors. They're trained to work with grief. And grief is a journey, and it's very individualized. People grieve in a healthy way, in many, many different ways. So our counselors are trained to work with them. When the patient's a child or a teenager or a young adult, we stay with the family for 25 months. So we're with you a longer time. It's a much harder grief journey. And again, you've got those siblings. So you're very involved with the children who might feel so might be living in the home.
- And again, is that counseling service provided, is there a cost to the individuals?
- No. We are a 501 . We are a what I like to call a charity. We give our services, we do not ask for money in return. And it is from our point of view the mission of what we do. It doesn't end with someone dying. You've got the family, you must take care of them emotionally.
- And I don't imagine Medicare, Medicaid paying for that type of bereavement counseling unfortunately.
- No.
- Which they should, because it's all part of health and trying to deal. So thank you on behalf of the community for the support that you provide. So we've talked about Casey House, we've talked about the role of hospice, we've talked about hospice for kids which is such a sad, but an important role. Are there any other topics that you would like to cover?
- We do have another program that I think is incredibly helpful. And it's a physician office practice called palliative medicine consultants. And we have doctors, nurses, a social worker, a chaplain who can visit with patients who don't want hospice or aren't at that point in their disease yet they have needs, they have symptom management needs, they have emotional needs. They wanna talk about advanced care planning. They want to make sure, especially for the frail elderly that we are helping out in their homes. And we can do this remotely. We can do this. And COVID has shown us about the importance of telehealth. We can do this with nurse practitioners, with physicians coming and helping via this, WebEx that's not quite what we use, but it's the same idea. And it's been a wonderful service for people to have this physician office practice.
- Wow, so it's kind of for individuals who aren't at the hospice stage yet, but they have questions or they might be preparing for hospice or preparing for end of life. So they certainly have some serious health issues, but they're kind of caught in that, they might not be quite there yet, but they might need help.
- Correct, absolutely, yeah.
- Well, I know that you and I have done some projects in the past talking to the community about, like you said, as a charity, as a nonprofit, doing all of this work, Casey House and the counseling, unfortunately you don't have an ATM machine in the back just spitting out cash to cover all these expenses. So it really is through the generous support of your community, of your donors. I know there's lots of different ways people can help Montgomery Hospice or any other non-profit hospice that you can make, so that you could volunteer, and we'll be providing contact information at the end of today's program. So if you have any questions about hospice, you can reach out to Ann and the team, and whether it's making a donation, volunteering time, naming hospice in documents, lots of different ways to help, because I know so many people who've been touched. When I've done speaking events with you at Montgomery Hospice events, many people in the audience will talk about how you were there to help them with their spouse, with their father, with their mother, with their child, with their brother, their sister, and you made it so much easier for them. Easier is probably isn't the right term 'cause this is never easy, but you're able to support them, support individual and support them through that difficult time. And they are passionate about how valued that help was. So on behalf of the community, I've been with Sandy Spring Bank now for 21 years. And the work you do is so important and so valuable. And so on behalf of the bank and the community and personally, I just wanted to thank you and the will of your staff for what you do out there. It's amazing work. And you have some amazing employees there. I know many of them have lasted over, I've been with you for many years, correct?
- That's correct, yes. And there is, it's not a calling. We are professionals. But we really believe in what we do.
- Well, I think in my experiences, I've worked with many senior health professionals. It is a calling, whether you're a care manager or a nurse, or you work at assisted living or a nursing home, or with hospice, there's a reason you're there, is that you want to help and you want to provide comfort. And it is an incredibly challenging position. And very emotionally draining at times, but also incredibly rewarding I'm sure as you are able to help families through these difficult times.
- You're absolutely right. And even for an administrator who, and I'm not a clinician, I have in my 40 years, my career has been in hospice and it has been so rewarding.
- Wonderful. Well, are there any final words you'd like to state, Ann? We've covered a lot about hospice. We will provide contact information, Montgomery Hospice's website and an email address. And Crystal Smith is a contact at your organization who can fill of any inquiries. And if she's not the right person, she'll direct the inquiry to the right person. I know you have a foundation that is established to help, talk to potential donors and to receive donations and then direct those funds to Casey House, and Hospice for Kids, and counseling and all the other areas that are not covered through federal and state programs, obviously. And that's how you keep, are able to keep doing what you do is through the generous support of the residents in this area.
- Right, right. I think the one thing I would like to say to people is that it is a time of life that can be made easier by hospice. And to consider it as an option, when you get to a point where you realize things aren't getting better, they're getting worse, and that we're there to help. We have people who have incredible educational backgrounds who can help you and help your family. So I wanna underscore that because denial is an issue for all of us, for me too. But remember there is help out there.
- Yeah, and I know for the caregivers, it might be family trying to help an individual. It can be incredibly draining on them. It can be very negative from a health standpoint, and it's very hard, but those individuals providing the support need to know that there is help out there. And even if it's just being able to have half a day, to be able to unwind because many spouses or partners or significant others, or the 24/7 caregiver, and it can be very detrimental to their health, unfortunately. So there is help out there, whether it's if you're grieving of the loss of a loved one, if you're dealing with a recent loss, or you're dealing with a pending loss, know that there is help available. Well, Ann, thank you so much for your time today, and audience, thank you for joining us. Ann Mitchell is with Montgomery Hospice and Prince George's Hospice. And if you have any questions about hospices services, reach out to the information provided at the end of today, or just go to Montgomeryhospice.org, and there'll be contact information there. I've worked with Sandy Spring Bank for over 20 years. If you have any questions about our services, providing financial investment and estate planning support to individuals serving as trustee, as personal representative, and helping individuals navigate through different stages of life. My contact information is provided, and you can always reach out to me. I'd be happy to answer your questions. On behalf of Sandy Spring Bank. Thank you for joining us today. I hope you're safe and have a wonderful day.
