"Most People Think Hospice Means Giving Up" - Rick Russell Proves Them Dead Wrong

[0:16]  Welcome back to another episode here on the Heart and Hustle podcast. Our next guest says most people think hospice means giving up. However, what he sees is families holding hands, laughing, healing, and living right to the end. because it isn't about dying, it's about living well in the final chapter. Welcome, Rick. How you doing, man?

[0:34]  I'm great. How are you?

[0:35]  I'm doing amazing, man. You said 35 years in nursing last time I spoke to you, but only two weeks in hospice told you everything you needed to know. What was it about hospice that felt like home right away? When we talk about our patients and families and when you can see that experience firsthand, the way our interdisiplinary team comes together, the nurses, the aids, the social workers, the physicians and wrap their arms around those patients and families, the way that interaction helps them embrace the journey. We talk about journey all the time because it's not about the destination. And it's about how can we help them every step of the way during whatever time they have left. And we see the joy and we see the reconnection and we see the way that families really kind of embrace that journey and how they are able to not focus on death. Death happens to us all. And when we get them together, we don't want them to focus on that. We want the focus to be on every moment. We talk about moments all the time. So once you experience that moment for the first time, it it tugs on your heart and it creates a sense of fulfillment like I've never experienced in in nursing before. And I worked in the ICU, I worked in oncology, and you you see hope in little bits and pieces and how this families embrace the journey is just different. And it really is the most fulfilling practice I've ever had in nursing. And I within two weeks, like you said, I knew that that was where I needed to be and I've been there ever since.

[2:13]  I want to look at I love what you said, but I then I'm also intrigued by the sign behind you because it clearly means something to you because it's on its wall on its own. Don't mistake God's patient for his absence. His timing is perfect and his presence is constant. He's always with you. What does that mean to you, man? So there's actually a story behind this. Uh I was starting a hospice program. Um this has been about 10 years ago and things never happen as quickly as you want. So my daughter found this saying and uh there's a Bible verse that goes along with that. But she made that for me and it really struck me at the time because no matter what you will do and how fast you want things to happen, they never happen on your time frame. So patience is key

[3:00]  and it doesn't mean that he's not there. It just means that

[3:04]  you're you're not where you need to be yet. So that that journey is defined and we and

[3:09]  it kind of for me brings everything back to round to what we do with hospice and the journey is there. It's not defined by us, but we're along for the ride and he's always with us. So it's it's been something that's followed me uh ever since for the last 10 or 12 years that you made it. And that right there, man, just speaks. It's a gem in its own because a lot of times we're always wanting to see things happen so quick. And I think we're in a time with Amazon and with Chat DBT that gives us instant gratification at times. And we expect that in our lives, you know, and it's like you have to have faith. You got don't give up it. You know, it's going to happen as long as you don't give up. But you got to have the faith. And God, like you said, time is everything, man. Um, and so many people forget that. So, I love it. I love that you have that posted on your wall all on its own and that we could uh talk about it. Is faith something huge that you also kind of live by?

[4:05]  It is. I mean, it's always played an important role in lives of my my life and the lives of our our family. And as I think about where I've gone in nursing, it's really played a part a big part in how I've embraced hospice care because everybody thinks about when they think about hospice care, they want to know how much time is left. And the focus really isn't on how much time is left. And that really speaks to this. It's the journey that is defined by by God. It's not defined by us. And we need to embrace every moment. And when it's meant to be, it'll be. And those are those are the moments that we talk about with our patients, families all the time. And those are the the the tenants we share with our our children and have their entire lives. You know, kids can be impatient. Like you said, in this time with all the technology and instant gratification, it's hard to be patient. You know, we think about nursing 25 years ago or 30 years ago when I started, we were writing everything and you know, handwritten handwritten notes were the thing and now if we can't get documentation done in 30 seconds, we spent too much time on it. We used to spend hours on documentation. So, it's just a different mindset and patience is key.

[5:21]  Yeah. What got you into it, man? You spent so much time in the healthcare space. What made you even get into healthcare? Was it that you seen family doing it? You just always wanted to help and uh and recover people like why healthcare?

[5:36]  So, there's a story that goes along with that as well. Hopefully, I don't give you too many stories today, but

[5:41]  I love it. Tell these stories. I was uh actually an engineering major and uh I was looking at the Ohio National Guard to help with tuition costs and they had a lot of nice education programs and the unit close to my home was a medical company. So I joined that medical company in in order to pay for my engineering degree and then I got exposed I was a medic 91 Bravo and uh I got exposed to it then and I found that it just rang true with me. So within a seme one more semester of engineering and a semester of computer science I thought you know this medical field I I should try and embrace that and nursing seemed to give the the most opportunity for me to be side by side with the patient with a hands-on and it really struck me and it and I took to it. Um, and I love every aspect of nursing that I've done, both ICU, cardiac oncology. I worked in emergency room for a while. I've done a little bit of everything and I've loved it all. But again, you know, when when I got exposed to hospice, it it was where I truly needed to be. But the journey was uh a torturous one and started with certain certainly somewhere I didn't think I would end up when I was starting. But it seems like it was meant to be.

[7:09]  Wow. You So never went back to the engineering part of it.

[7:13]  No. Calculus and I didn't get along.

[7:17]  That's it, man. You know, remember the times when they said that uh you wouldn't have a calculator in your pocket,

[7:22]  right?

[7:23]  Here we are, man. Calculators in our pocket. We got things like AI that you mentioned a little bit about just the uh the note takingaking aspect of things where it took sometimes um individuals would go home with the work and they're at the dinner table just writing notes. Kids are asleep and they're still trying to get these notes and documentation in and now we don't have to have that problem. Right. I think when people got into the field of healthcare break and probably yourself um could kind of attest to this. It wasn't because you love to do admin. It wasn't because you like to take notes and write all the time. It's because you really wanted to help people. And I think um we've experienced that during the pandemic where people felt that they couldn't help people and they had all these other things to do and got overwhelmed, burnt out, they leave. But the industry is changing. Of course, there's still some more some more work to do when people talk about the health care and just the system that we're in. But what are your thoughts on it, man? When you talked a little bit about just note-taking AI, are you seeing it actually play a huge part in hospice? Are you guys dipping your toes into that part? So let me take you back a little bit. So from the beginning in nursing and then the leadership roles I've been we've always thought about ways to make ourselves our nursing staff more productive and giving them time at the bedside. The caution has always been you know you need to hear the voice of the nurse. You need to hear the voice of the patient in everything that you do. So as we looked at doc electronic documentation it got certainly easier and easier and more detailed to support clinical processes along the way. And that's always been the focus as we look at electronic support for documentation and AI is kind of the next version of that. So when we look at AI and all the things it can bring to the table, there are uh risks to implementation of AI. Right now we are looking at a couple of ways to help support some administrative processes. So, as we process referrals and docu and gather medical record information, I think there's some util utility for AI on that because it can certainly find information a heck of a lot quicker than one of our intake folks. But as we look at streamlining documentation, AI can make some assumptions that will override the voice of the nurse and override the voice of the patient. So my concern is is that we we take that from while it would probably make it make a cleaner documentation from a legitimate from a um legibility standpoint and understanding standpoint it will certainly change the way the the note could be perceived or change the way the clinical picture develops. So we have to be careful. I'll give you an example. So the way the patient makes a statement to one of our caregivers is important. So if you change that statement because the way the chat GPT thinks it should go, you've changed the meaning of that and you could change the clinical interpretation of that. Maybe it they say things a certain way because of uh a little bit of confusion or they didn't understand a statement. Bringing that out in the documentation is important. So the big concern I have with the the AI programs is that we'll override that because you see it right now when it's embedded in emails. It's suggesting words for you as you type.

[10:50]  Yes.

[10:51]  Sometimes it it'll suggest a work and and I think wow that's better than the one I had. And think about if you roll that into a nurse and when they're typing a narrative note, it will it will give them 50% of that note. is that is that we really want in the nurses know or do we want really want to have their picture of it. So those are my concerns and I think there's a way to get around it. I think that AI is going to evolve, continue to evolve, and we need to focus on how we support all of the techy pieces behind the scene to make sure that we're not having clinicians spend time doing mandatory or administrative tasks that are required by billers and regulators. So, we're meeting all of those needs, but don't override that clinical judgment. don't override the the clinical voice as we look at that. Um, you know, more and more you're seeing even AI is going into looking at documentation and generating a diagnosis and they're finding that it can be a lot more accurate than, you know, a physician or from a nursing standpoint, a nursing diagnosis can be generated a lot quicker. But what you don't get with that is the intuition. Human intuition can't be replicated in AI. AI is very logical by nature and it's going to look at facts and data points and it'll come to a conclusion. But sometimes that intuition is way more important and it picks up on all those subtle points that you can't put into an AI program. I'll give you another I'll give you another story before.

[12:37]  I worked with a nurse in the ICU. So, this goes back 30 something years. I won't give you the exact number. And she could walk into a room and look at a patient and look at the monitors and what was going on and immediately she could tell you that that person was going to have a good night or a bad night. And I will tell you, out of a hundred times seeing her do that, I think she was wrong. Maybe three. It was just that that intuition just pulling all those data points together and your brain compiles it all and you get a gut feeling. Those are the things you can't replace with AI. So while I think there's a lot of utility of it, I think we have to be careful going forward not to think that we can replace human intuition, human judgment or you know kind of the compiling of information with an AI. Okay. I I haven't asked this to another leader, but you've been in the healthc care space for so many years. You do you remember when electronic

[13:44]  Do you remember when uh electronic health records became a thing?

[13:47]  Yeah, I did.

[13:49]  Was it something that people were scared to implement? Was there a fear there? I always feel like anytime there's new technology, new something, there's a little bit people getting uncomfortable. And I think that's where we're at with AI that people are uncomfortable. They're seeing all the negative in it. I love that you called out some of the positive, but is it almost kind of the cycle repeating itself?

[14:08]  It really is. When we first implemented the electronic medical record, the concern was is that, you know, we're going to be checking all these boxes rather than writing a note. And the nurses at the time were very very me. They they held on tight to that note because that was how they did things. And at the end of the day, when we look at it, it's pushing people out of their comfort zone. When we look at the note itself, all the information is there. It's charting by exception for a lot of these electronic medical records. So, you only put it in there if it's a negative assessment finding that was hard for people to grasp. And then you lay it out differently. It becomes another piece. So, I have to remember all the boxes I have to check. So the older nurses, the let's say the seasoned nurses had more difficulty with that because they knew how they laid out their note. The newer nurses, they adapt, they adapted it to it quickly because that next generation is so much more comfortable with electronics than the older generation. And we're seeing the same thing now. younger nurses, nurses just coming out of school, they're more comfortable with technology and they can embrace the the AI function and ch GPT a lot more quickly than some of our seasoned nurses. Now, they'll get there,

[15:30]  but we just have to understand there's a little bit different learning curve to it. So, I think you're right. It is a cycle repeating itself. And anytime we see any kind of meaningful change in an organization, you do see that same resistance. And there are certainly generational differences as you look at it.

[15:46]  If the Heart and Hustle podcast has ever sparked any idea or made you think differently, do us a favor. Make sure to guys share this, post it on LinkedIn, or even text that nonprofit friend that you just have. Whatever works. This is what keeps the conversation going and allows us to just grow this community together. Seriously, we appreciate you.

[16:07]  No, I'm happy that that you see the positive in it. A lot of times people are still in fear of it and which respectfully so, you know, something new. I think anytime that is you're doing something new in life, just personally, it could be a little there's a little fear

[16:21]  played in it, right? But I think that there is a lot of good in what AI has been able to do as well. And I think even from the experience of um the patient like myself that is walking in and feeling now that I can get more eye contact that people now I feel like I'm seen more or heard more and I think that's that was always a bad experience for individuals. I mean, even myself, you know, the last time I went to the doctor, I just thought to myself like, "Wow, this lady didn't really look at me that one time." She sat down, she put a clipboard, she asked a few questions, never looking at me, though, which is almost, I guess, standard questions. And she's just plugging away on the computer. And I think to myself, like, man, this lady doesn't even know me, you know, like, is she really willing to is she really helping me? And I think at sometimes I don't think she intentionally meant to do that. I think she her intentions is I want to help. But for so long, it's been the same thing over and over. You've got to take these notes. These notes is what gets us paid, right? That's where the money is being made and documentation. So, I'm happy that we're finding ways where the experience becomes a little higher for the for the patient. Um, obviously becomes a little bit better for the nurses that are, you know, doing what they love. I mean, hope that we get to see a overload of nurses where now we can't hire because there's too many of them because right now we're in the problem. Is this still a thing, Rick, for even for you guys in the hospice space where not enough people?

[17:39]  Well, we're fortunate enough to be able to have um a good flow of nursing candidates.

[17:46]  Okay.

[17:47]  Uh hospice aid candidates are a little bit tougher to come by, but we've been in the community long enough. We've been very fortunate to have people drawn to our mission and the flow of nurses is pretty good, but the industrywide nursing shortage is significant and healthcare nursing shortage. I saw some numbers a few months ago. They're projecting a shortage of 30 million nurses coming up in the next several years as nurses retire.

[18:13]  Oh my god.

[18:14]  And the nurses that are coming out of school coming up to replace them is still going to be significantly short. So it's we're talking about 30 million not just in the United States but you know worldwide um was one of the numbers I saw. I think local in the United States they're talking about maybe 8 to 10 million shortage.

[18:33]  That's a lot.

[18:34]  That's still significant. And you think about how many nurses there are in the United States. I mean right here at Hospice in Northwest Ohio we have a couple hundred nurses. So for us to turn over a half a dozen nurses doesn't impact us as much as a smaller hospice program or home health program when they turn over a nurse significant. Now when we turn over nurses significant too because we we want people to be drawn to our mission and once they're here we want them to embrace embrace it. But turnover in healthc care is significant in hospice programs nationwide turnover is 40 to 50%. and we're significantly lower that and we're grateful. But nurses are trying to find their niche as well. So that shortage is going to make things worse, especially as the baby boomers start to hit the health care system in a big big way. And that's what's generating those shortage numbers. It's not raw numbers. It's based on the expectation of the volumes as well.

[19:31]  Yeah. That that's the next couple of years, right? I've heard that um what is it in the next five years or something like that? Is that what it is?

[19:37]  Yeah. next five to 10 years are going to be

[19:40]  significant increases in utilization across everything in postaccute and acute care.

[19:47]  To just even hear that, I feel like I get old. What? The baby boomers are are now like going to be a majority like this is crazy. What do you mean?

[19:54]  Baby boomers. Yeah, they've they've been driving everything for years and now we're going to start to see the healthcare utilization because baby boomers um have a lot of chronic disease as well. So that's that's going to play a big part in how we see them impact healthcare. So it's going to be a little crazy for the next 5 to 10 years.

[20:18]  So you that means you're ready for the next 5 10 years.

[20:21]  We're ready.

[20:23]  Rick, man, what do you bring? What do you think you bring different? Um, a lot of people sit in the CEO seat, but probably've never been at the front line. But you've been at the front line. You you understood what that looked like for years and years and then you got into the space of being a CEO kind of um working a little bit more behind the scenes. What do you think you brought to the table as a CEO that has been able to practice nursing for so many years? Well, the one thing I've tried to do from the beginning is bring a servant leadership model to this leadership role in our leadership team. And where wherever I've been in leadership, I've taken that mentality. It was taught to me in graduate school by Dr. Pat Donahghue years and years ago. And it really stuck with me. We are here to serve. Our only purpose is to serve our employees so they can serve our patients. And if we don't have barriers to knock down, processes to fix, resources to provide, then what are we really doing for our staff? So that servant leadership mentality feeds out through everything we do and through everything I've done and being consistent with the patients and our staff and how we treat them and how we support them and having them understand that we're there for them in a supportive way makes their job easier. Makes them feel a little more fulfilled. Makes them feel supported. And that shows as they provide care to the patients. So, you know, the old mentality is that leadership kind of flows downhill. And there's some truth to that because that that feeling of support and guidance and mission driven down from the leadership level helps create a higher quality of care which will create a successful organization. So patient satisfaction's up, employee satisfaction's up. All of our quality metrics are better when the staff feel like they're supported. All of our patient satisfaction data is better because our employees feel better. So you see how that support mentality kind of flows throughout the organization. And that's the way we have to treat everything. And I've I've embraced that from the beginning. And it's been one of the reasons that um you know I'm I'm not on this to try and pat myself on the back but no matter where I've met went that mentality has driven success at every organization I've been and it really has

[22:55]  no pat yourself on the back. Okay, that is good leadership. That's what that means. All right. I always say a good leader can go anywhere and everywhere. Hell, you could leave healthcare and go somewhere else and you still have that same mentality, right? The same leadership still is still true to it. And I I've seen it myself. I've started my career in when I was working for the corporate world that I was in the in the food industry. But the same leadership in the food industry and the same way I t treated people in food, I also took it to retail. And it it works. When you're a good leader, you're just a good leader. And no man, pat yourself on the back cuz I'm pretty sure it's years of of learning. Another thing I did want to ask though, Rick, is you talked about just people being happy. Um, and I think what makes you very happy in the space that you're doing is that you're really chasing purpose. It wasn't so much about the money. Do you feel that that you tell healthc carees the same healthcare workers the same thing when you see them chasing money that it's actually purpose more in the long run?

[23:49]  When we bring um new employees in or we're interviewing employees, one of the things we look for is their the passion they bring to the role. Are they coming to hospice for the right reason? Because no matter what you look at any of our frontline positions or administrative support positions or our clinicians, they can go anywhere and make the same buck.

[24:12]  So, they have to be aligned with our mission. Now, we're certainly going to always be competitive when we look at those roles and to make sure that compensation isn't a factor, but what's more important to us and as we interview, we look for what's called we call the hospice heart. So, do they have that right purpose? Are they here for the right reason? Do they really want to provide the care and support that our patients and families need? And do they understand what that means? A lot of people come into hospice and they don't really understand what hospice is all about. So we start talking about things like quality of life and journey in an interdisciplinary team and how all the thing all these things play together to create that safety net that that really that blanket of comfort that surrounds patient and family. So we want them to embrace that mentality. We want them to embrace our mission and vision and in order to be a fit for the organization they have to do that. Now some people will come in and within the first 6 months they they just don't feel the same and they don't they won't really embrace it the same way.

[25:20]  Not that they're bad nurses. there are just nurses and and aids and social workers and chaplain and other staff that it's just not a good fit for. So we we will help them understand and sometimes they will self- select and they'll decide that their their talents are better utilized elsewhere. So when we look at our staff you think about retention for us is anyone who stays for a year. So when we look at retention for a year, 99% over 99% of our employees if they stay a year, they stay. All of our turnover essentially is in that first year. And these are people that are trying to figure out, does it fit my does it fit my own personal sense of purpose? Do I really have a passion for this role? Does it really align with what I'm being expected to do? So those things some people are working out along the way and they'll determine that it's not right for them. But alignment is key.

[26:18]  That makes sense. And and and I can only imagine with your background that you could really help somebody, as you said, navigate them to what may be the best fit for them because you're able to see based off their performance or what is the conversation they're having, what they love. There's so much experience and that's another thing that you bring to the leadership as the CEO to this organization is that you've been there. You you've been out in the field, but you're in the hospice. And I think that people also when you think about hospice and kind of keep it on that that topic is that people get things dead wrong when it comes to hospice. What is that thing that you think people get dead wrong when it comes to hospice?

[26:48]  Well, there are many, but the most common one they get is people think when hospice comes in that their loved one only has a few days left.

[26:56]  And the purpose of the hospice benefit is to support that patient and family their entire journey up to six months or more. There's no hard and fast limit to hospice care. We've had folks on our hospice program for over a year and it's still okay. But the most common misperception we see is that it's going to be a day or two or that our nurses going to come in and bring the shot. So, we're not Korian. Kavorinian does not work here. It is against the law in the state of Ohio and Michigan. Um, and that is not what we're all about. We're about certainly about comfort. We're certainly about quality of a life. But the most common misperception is that that it's going to be a few days. So a lot of times we're we're fighting that because for all intents and purposes when we get a hospital referral it's because someone is gravely ill and they will go to one of our impatient centers and their family surrounds them and guess what they are only there for a few days before they pass on. So that's a mentality that we've got people to understand is that it does happen like that for someone, but on average patients are with us around two months. We can have them up to 6 months or more, but we need them to embrace that mentality a little sooner. Non impatient centers are certainly a big um draw and people recognize those more than anything else in our market because they think of hospice as being the place that my mother went to and she passed away. So the mentality for us is that it's different because most of our patients are in the community. I can imagine you have a lot of stories, Rick. Those hospice stories, those people that come in here that have two months, five months, six months, but still they have life. Still there's things that they want to get done, right? Um because as you mentioned, it's just not the end of life. Is where we come together to really just appreciate life and and enjoy those last moments. Do you recall a story that someone wanted to do something and they were able to get it done before they pass away that you guys were able to help them with?

[29:04]  Well, I'll give you a story. One of our patients was actually located in our Purisburg impatient center. Um, big-time fisherman and he just couldn't get out and fish anymore. And more than anything, he wanted to be able to fish bass fish one last time. So, we're fortunate enough is right out behind our building, we have two large ponds and they are they are um stocked with bass. So, we were able to set up him and his son and our vice president of clinical services, Rich Blue, went out with him. He's big- time fisher guy, fisherman, too. And he was able to go out and bass fish one last time from our bridge out here. And the the joy you saw in him just from that little act and that little thing that was so important to him was incredibly fulfilling to our entire team and to his entire family. And that moment is something that family will hang on to for the rest of their lives. And it was so simple for us to do. And a lot of times people think you want to do these elaborate trips like Disney World. And you know, for us it's simple as simple as taking them to a Mudhens game. They love baseball. They want to go to a game. We take them to a game. Some of them, you know, we've had weddings. We've had uh graduation parties. We've had you name it. We define those patients and families define what moment is special to them and we do whatever we can to make that moment happen because those memories are what will help that patient live on in their loved ones minds.

[30:44]  I tell you what, I speak to leaders in the hospice world and I never understood what the hospice was, right? I think I had the same thought as everybody else. U you go there as you're dying and you're the end of days and you're laid up in a bed and that's it. But when I hear these stories of no, we're we're we're making sure these people are enjoying their last days, months of life and and helping them do whatever. And I've heard someone go from shooting a bear, okay, and being able to have those moments with their kids and then, you know, end up passing away a month after, but having the ability to do something that he never probably thought he was going to be doing. You hear the fishing stories. I hear people um wanting to go skydiving, but can't go skydiving. they're too old, you know, the body's not doing well. Well, let's put VR goggles on it, right?

[31:29]  And I think it's cool when we think about a hospice and we hear these stories because I don't know that we have these stories enough until someone's in it. So, I love that we were able to to share what it looks like from Rick's perspective on, you know, taking someone to do one last thing as they've requested because it does it makes them feel you just die peaceful knowing that. I think about um just recently um

[31:52]  oh man, Aussie Osborne that he got one last to do that one last concert like literally just died doing what he loved, you know? How cool is it that he he fought through it through fought through the pain and it just seems that that's what you guys are doing, Rick, is that you guys are making sure that families get to enjoy those last times together that whatever that that outcome needs to be that you're going to do everything in your in your power to do so. Is that correct?

[32:16]  That is right on target. And you know, Aussie is a perfect example that big Aussie fan by the way. um two weeks before he passed on, he was sitting on the stage with Black Sabbath doing what he loved his entire life with his family watching him.

[32:31]  And can you imagine the moment and what that family took with them to see him one last time up there belting out Iron Man or belting out, you know, War Dogs, whatever it is.

[32:42]  Can you can you imagine

[32:43]  that? That is that is what we strive for every single day. And there are thousands of these stories and some of them are very simple, some of them are pretty complex. Weddings are not easy to pull together, but we've had several of those. But it's what matters to the patient and family. And that's that's what's key is for us to connect with those patients and families and listen to them, understand what those stories and what's important to them. We build our care around that and we strive to figure out what it is that would make their day meaningful today. And every single day we strive to do that.

[33:19]  I let you get your cup filled every day, man. What a great place to

[33:22]  every single day.

[33:23]  Every single day. There's amazing things happening here. Uh every now and then I'll spend time with the staff and in our inatient centers or go out and do community visits and it is amazing to see our staff in action. They are the most compassionate, understanding, supportive, I'm running out of adjectives team that I've ever worked with. and we are certainly grateful for every single one of them.

[33:49]  You mentioned how you're a fan of Aussie. You've been to one of his concerts.

[33:52]  Uh, you know, I never did. Never made it Aussie or Black Sabbath and it's one of my it's one of my lifelong regrets. You know, I

[34:00]  I just found while we're on a rock concert um topic, I just saw AC/DC for the first time in the last time they're appearing in the United States. So, that was a bucket list thing for me. But, I missed I missed Aussie and Black Sabbath. You know, I um I'm an Eminem fan. Big Eminem fan. And they a lot of these just ODA artists do not tour in the United States. You got to catch him outside the country

[34:25]  for whatever reason. I guess they get more respect and love over there.

[34:28]  But uh I tell myself, man, one day cuz he's also getting older. One day whenever he's doing another world tour, I got to go fly cuz when is he coming to America? I have no idea. Right. But to just, you know, like people that went to that concert of Aussie Osborne would never forget that moment. And how the crowd that he had, man, I can imagine he would just so happy. He literally died peacefully. And when I when I seen that, I'm like, "Wow."

[34:52]  I love to hear when people die doing what they love the most. That something that made them happiness, you know, it brought them happiness. I mean, and Rick, you guys are doing that over at at your organization. So, that is super cool to to think about. Um, but one day someone you love will need hospice. The question is, will we be ready? Well, how do we prepare for these conversations?

[35:12]  So, the easiest or the biggest thing we tell people to prepare for is to talk about what you want your care to look like as your health changes or as your health begins to decline. So, advanced care planning is something we talk about all the time. And there are a lot of different tools out there. There's a five wishes book. There are other tools that talk about what do you want your care to look like as you get older or as your health changes. And it talks about things like that people talk about like life support, medications, ventilating ventilator support, but also things like, you know, where do where do you want to live? Who do you want to support you? Who is your current support? What do you want your care to look like? So as you as people enter the hospital, that's the most common reason they get engaged with any post-accute service, whether it's home health, hospice, long-term care, or skilled nursing care. You have to think about as you exit the hospital, what do you want your care to look like? So those goals of care conversations are critically important and we support that through our pallet of care program, which part of hospice in Northwest Ohio. It's a separate line of service for lack of a better term, but they really help patients and families understand those goals of care conversations. But it's best to have those conversations with your family early on and then when the time comes to make a decision, it won't be, well, I don't know what they want. Well, I don't know what we should do. There's a lot of conflict we see with patients and families because they've never had that conversation. And so have the conversation with your loved ones early and often.

[36:54]  It will be here before you know it. And many times it surprises you.

[36:59]  So it's and you'll find it's not a hard topic to to to broach. It's not

[37:05]  it's not difficult. It's just a little awkward to bring it up

[37:10]  because nobody likes talking about death. But if you bring it from the perspective, I'm not talking about death. I'm talking about life. Let's talk about what we want it to look like. And that makes that conversation a little easier.

[37:22]  Yeah, Rick, it happened with me, my family. So, there's seven of us. My mom um

[37:27]  decided that she was going to call us all together for a bingo and family night, but she said she had something very important to tell us.

[37:34]  Yeah.

[37:34]  Where did our minds go at that moment, right? She's got us holding off for a week or so. And I'm like, what the hell? So, as soon as she, you know, we get seated, all the kids are there, grandkids, and she's like, I just want to talk about what happens when the time comes, right? and we're all looking like, what does she have to tell us? But it was just that. It was just, hey, nothing's happening. I'm great. You know, I've recently went to the hospital. But she's also seeing and noticing she's in her 60s. She's seeing friends that are passing away. She's seeing families fighting families. And I think that's what happens a lot of the time because someone wants to make the decision and and you know, maybe that individual didn't make the decision who's going to actually

[38:11]  um have those final wishes, you know. So my mom already, hey, this is who's going to play out the final wishes. this is what I want anyway, but this is who's going to make sure this happens. And then everyone had their role. And I'm like, you know what? We're prepared. So, at the end of it, all that, it's not seven of us bickering and fighting on what mom should do and how she should be treated and all that. Mom already told us what she wanted. She wanted to be, you know, put in a home if if it becomes too much. You know, some of us probably would have thought, no, she has to stay with us. Mom made the decision. We have to just make sure that we live by it. So, I love that you kind of do bring that. And it's a very tough conversation. Now I'm talking more about death Rick just to me my friends and they're like why do you do that? And I'm like we're all going to die. I'm just trying to tell you.

[38:54]  I applaud her for doing that. That is exactly what we need to see. We need to have those conversations. And the point you brought up I want to emphasize find someone who understands what you want and they should be designated as your healthcare power of attorney. They need to be the ones that help make decisions when you cannot. And those those decisions have to be aligned. So many times we see the healthcare power of attorney come in and act completely and disregard with what the patients wishes were. Patients made it very clear they didn't want any aggressive treatment. They didn't want aggressive therapy or anything like that. They wanted to be comfort. And the healthcare power attorney comes in and says, "Oh no, it's my decision. I want everything done." that certainly doesn't respect the wishes of that patient. So, make sure you have those conversations and those those goals align between those two individuals. That's critical.

[39:53]  No, I like it. I love that we're having this conversation, man. I ask you, what legacy do you hope Hospice of Northwest Ohio leaves behind and how can others carry it forward? Well, the legacy of the hospice in Northwest Ohio has been going on for 44 years and we've shown again and again that we here we are here to support the community with whatever the community needs around end of life care. So, our pallet of care program was developed because there was a community need. Our hospice centers were open because there was a community need. So the legacy that I want this organization to continue is that we will be there for the community when they need us. And that de that's demonstrated for the last 44 years. And I'd love to see that last for another 44 years. And when I leave and when I retire, whenever that is, that is the legacy that we'll leave behind no matter what. One question we always ask for um any decision we make is this the right thing for our patients and families in the community? And if it is, the answer is that we are always going to do it. And that's the legacy we will leave behind from community support, community engagement. Our relationship with the community has been phenomenal for 44 years, and I don't expect that to change.

[41:09]  All right, man. Well, it's time for the hot seat. Are you ready, Rick? I got a question just for you. All right. Now, okay.

[41:13]  Hope you're ready for this one. So, it says,

[41:15]  "You've helped thousands die with peace and dignity, but what's one goodbye you still wrestle with? the one you wish had gone differently.

[41:28]  Thought it was going to be a good question. [Laughter]

[41:33]  So the response is actually going to go back to my oncology days. So we saw a lot of patients. Obviously that was early on in the hospice movement. I'm not going to tell you when because it dates me a little bit, but hospice wasn't as widely utilized. and hospice was pretty usually pretty well accepted for some cancer patients. But regret I the one regret I had was a patient that was gravely ill and we were still working hard to help him recover and it was someone who you know unfortunately was right around my age and that I had to develop a relationship with in oncology develop relationship with patients families because they come back again and again and again for treatment and complications and my one regret is that we never had a conversation ation to prepare him for the inevitable. All the conversations were about hope and he had a a drast you know dramatic disease that most of the time didn't have a strong outcome along with the complications and went along with treatment and everything else. So we never had that conversation and his family wasn't prepared and then he passed away suddenly during a simple procedure unprepared and if and that impacted me dramatically and changed the way that I thought about those communications and the way that I thought about supporting my patients and families where I I was a younger nurse so I was projecting my feelings and how I felt about my longevity and life onto him because of that relationship. But I came to understand that the therapeutic relationship is just as important about being honest with them about things that could happen or things that they need to be prepared for. And as clinicians in oncology or now in hospice, we need to be honest and straightforward. Patient families want the truth. They don't want us sugar coating. The one thing that bothers me in hospice is that patients and patients or family members will say, "We want you to come out and admit mom, but don't tell them you're from hospice." We are not going to do that because it's it's their loved ones right to understand where they're at, to understand the care that's being provided to them. So, we are never going to be dishonest. We are always going to be open and straightforward and honest with them about prognosis about what we know. And that mentality carries forward back from that those early days in oncology for me. And my one regret is that I did not have that open honest conversation with him.

[44:22]  That was good, man. I actually uh appreciate that story and I think it it really resonates with how we've been conversating the whole time, right? Really on par with that. So, I definitely appreciate that. Um, where can people find you? are you on LinkedIn if they want to connect? What is the website for for your organization so people can tap into that as well if they need to see more what's going on at in Ohio space of hospice? Um so we can get some people going and researching you, man, because you got gems.

[44:47]  Yeah. Well, Hospice of Northwest Ohio is hospice nwo.org. We serve all of Northwest Ohio and Southeast Michigan. And I'm certainly on LinkedIn, Richard Russell. um been on LinkedIn for years. So happy to connect with any of your uh viewers and if they reach out I'm happy to answer any questions. I've got a lot of leadership experience and you know I might come up with the right answer from time to time. So uh happy to connect and see how we can uh support the listeners.

[45:17]  Are you are you a wrestling fan by chance or ever watch wrestling back in the days? Maybe attitude era. Hulk Hogan days.

[45:24]  Am I a wrestling fan? No. No. You said hospice nwo and automatically made me think right Hulk Hogan and the nwo. So that's why I just wanted to ask that question. Another person man that made me feel a little old and realize time is ticking. Hulk Hogan,

[45:38]  right? 75.

[45:39]  71 years old.

[45:40]  71 years old. Yeah.

[45:42]  Yeah.

[45:42]  He was one of those guys you saw he just kept coming back and you thought he was going to live forever with his 24inch pythons.

[45:48]  Yeah, man. And you know I'm a big wrestling fan. obviously hit the wrestling industry huge, but to think about the legacy that he's left behind and you know and hope that he was having these conversations, you know, um as well. I think he passed of cardiac cardiac arrest, I think is what it was that he and his home.

[46:04]  But yeah, man, when we talk about life, we're seeing some of the greats right before our eyes, you know, pass on by. We have to start having these conversations because we're we're aging just like them, right? And if we're not having these conversations, we're kind of kind of left behind as well cuz we never know when our time will will show up. Especially when you you have a family. I think when you have family, you have kids. These are conversations we should be having. So I appreciate you, Rick, for just kind of helping us with all the stigma. Did you want to see Did you want to say something else before we this part?

[46:34]  No. And I I just want to So Azie was a perfect example. One of the things we hope for and we all dream about is is when we do leave this world is that we're surrounded by our family. So you saw it with Ryan Sandberg who passed away over the weekend and Azie who passed away last week is that he died at his home surrounded by his family and that's how we all would all prefer for things to go. So your listeners take the time to talk to your loved ones about what you want your care to look like.

[47:01]  I love it. Well Rick, we thank you for being here on the Heart and Hustle podcast and hope that you guys are still listening with us. Make sure that you guys do like, subscribe, and comment. And don't forget, you can also connect with Rick right on LinkedIn or visit their website so you can get some more information on how to possibly get into the organization if you're in the Ohio area. You guys are only right now there's not branches, right? Just Ohio area. Is that correct?

[47:20]  Yeah. Northwest Ohio, Southeast Michigan. Yep.

[47:23]  All right. All right. Well, guys, this has been Ephrain. This is Rick. We'll catch you guys on the next episode. biters.