For our “Ask Amy” series, we spoke with three women with three different areas of expertise on the end-of-life, grieving and death process – who just all happen to have the same name. They shared with us their unique perspectives on creating a better experience for the dying and their loved ones.
Today’s Q&A is with Dr. Amy Schiffman, a prominent aging in place executive who leads curriculum development surrounding aging in place and provides guidance on supporting resources.
Q. Can you tell me about your background in aging, hospice, and end-of-life care?
A. I am an Emergency Physician by training. While I was an ER doctor, I took an interest in caring for end-of-life patients, and I knew there was more I needed to know. While I was practicing emergency medicine, I also started doing house calls. I found it to be an interesting and challenging dynamic, but also a complex, impactful part of medicine that was underutilized – and a lot of people were underserved.
While learning about caring for people in the home, I also learned more about hospice – because I didn’t know much about it from medical school. It’s a field people have limited knowledge about, because of its various challenges, and because of its complex billing, ethical, and operational service issues.
As a result of my growing interest in the topic, I became a Certified Hospice Medical Director (HMDC®) and a medical director for hospices in my local area. I also became very involved in referral processes and understanding referral streams, within the complexity of post-hospital and post-nursing home care.
While working within my house call practice, I realized there is a real need for physicians and other types of providers to understand hospice. Many specialists and primary care providers are not educated enough about hospice and how to work within hospice agencies. In fact, just 1,110 physicians from across the country currently hold the HMDC® credential.
The reason for this lack of training is because this is not considered to be a primary specialty. Instead, physicians come into this from different specialties. Also, doctors usually go into medicine because they want to make people better. It’s hard to wrap your head around the idea of helping them at their end of life – helping them to die with dignity.
Additionally, there is not a lot of awareness around hospice care in the general population: only about 51 percent of Medicare decedents were enrolled in hospice at the time of death.
Q. What is the biggest challenge you face when working with those nearing end of life? How do you overcome that challenge?
A. Those challenges tend to change year over year. There’s a dynamic nature to those changes. Clinical medicine is the most constant. People die from the same things. What is happening in hospice is a complexity of compliance issues and working with insurance companies. All of this gets harder year over year.
A 2019 study by healthcare data analytics firm Trella Health found that patients who did not elect their hospice benefit incurred as much as $28,000 in additional healthcare costs, compared with patients who received hospice care in their last months of life. Essentially, it costs less to be in hospice care than to be in and out of emergency rooms, doctor’s offices, or hospitals. So there is a real benefit to the healthcare system, in addition to families and patients receiving quality care where they live.
You have to constantly balance the clinical medicine that you know you are doing, along with the fiduciary responsibility that you have, alongside the complexities that the systems put in front of you.
So, to help me overcome challenges, I continue to reassure myself that the clinical medicine is very sound, and that I can help people have a good death. Yes, there are systems-based roadblocks, but the upside of what we do is becoming more obvious too.
Q. How did Covid change the way you work or how you help your patients?
A. Wearing masks definitely impacts the clinical family relationship. And a lot of people died in hospice without anyone holding their hand, because for two years, visitors were not allowed into facilities. It forced us to get more creative about how we access collaborative relationships and provide excellent clinical care. A lot of it is learning how to leverage technology to help our patients.
Q. What does the deathcare industry do right when it comes to end of life? What can it do better?
A. The deathcare industry is very responsive – they know how to make things happen quickly and advocate for families. They provide calm in oftentimes chaotic situations. No matter what you pre-plan for, it’s still difficult to lose a loved one. The industry knows how to respond quickly in the face of rapid change.
What many don’t know well enough is who their community partners are – or how much those upstream of the deathcare industry can benefit the families and provide additional business opportunities.
Data suggest that around 20 percent of people pre-plan for their funeral. People enter hospice with advanced illness, and oftentimes no one has a funeral plan. Those in the industry could work better with hospices in assisting with preplanning.
Q. If you could offer one piece of advice to others in your line of work, what would it be?
A. My advice would be to see yourself as wearing many hats all day long. You are the caring empathetic doctor, the nurse, the clinician. You also have to stay on top of the industry in terms of insurance and required documentation. More importantly, you should be proud of the impact you have on the healthcare system, and know you’re a unique resource.