Dr. Ned Stolzberg – The Importance of Quality Hospice Care
Dr. Ned Stolzberg is the Executive Medical Director at Hospice of the Valley (HOV), Arizona’s leading provider of end-of-life care. Dr. Stolzberg has worked with HOV since 2007, overseeing the staff of physicians and nurse practitioners. Previously, he served as a palliative care consultant in hospitals.
Dr. Stolzberg earned his bachelor’s degree from the University of Texas and his medical degree from the University of Massachusetts, where he was awarded the Chancellor’s Award for Outstanding Medical Student. After graduating, he performed his residency at Phoenix Baptist Hospital.
Here’s a glimpse of what you’ll learn:
- Dr. Ned Stolzberg’s journey to hospice care
- The origins of hospice and what makes the field unique
- Assessing the criteria for people who need hospice care
- The correlation between hearing loss, dementia, and hospice
- Some of the overlooked or unknown benefits of hospice
- Why hospice is underutilized and how it can help more people
In this episode…
Hospice is an underappreciated and underutilized branch of the medical world. It’s understandable: the field itself is loaded with difficult topics and memories for many people. However, the subject doesn’t have to be so grim. In fact, hospice is designed to give as much peace and gentleness to the patients — and their families — when they need it most. If anyone knows the good that hospice can provide, it’s Dr. Ned Stolzberg.
Dr. Stolzberg is a medical director for Hospice of the Valley, a not-for-profit organization that works throughout central Arizona. He’s witnessed firsthand, both in his professional and personal life, the benefits of hospice done right. He’s a proponent of the service and is eager to explain why it should be used more.
In this episode of the ListenUp! Podcast, Dr. Mark Syms interviews Dr. Ned Stolzberg, the Executive Medical Director at Hospice of the Valley, to talk about hospice and how it can be better utilized in the medical world. They go over the origins of the field and how it got started in Arizona. They also dive into the correlations between hearing, dementia, and hospice, as well as the criteria for patients. Check out this episode to hear it all for yourself!
Resources mentioned in this episode
- Arizona Hearing Center
- The Listen Up! website
- Listen Up!: A Physician’s Guide to Effectively Treating Your Hearing Loss by Dr. Mark Syms
- Dr. Mark Syms on LinkedIn
- Hospice of the Valley
- Hospice of the Valley’s phone number: 602-530-6900
Sponsor for this episode…
This episode is brought to you by the Arizona Hearing Center.
The Arizona Hearing Center is a cutting-edge hearing care facility providing comprehensive, family-focused care. Approximately 36 million Americans suffer from some sort of hearing loss, more than half of whom are younger than the age of 65. That’s why the team at the Arizona Hearing Center is focused on providing the highest-quality care using innovative technologies and inclusive treatment plans.
As the Founder of the Arizona Hearing Center, Dr. Mark Syms is passionate about helping patients effectively treat their hearing loss so that they can stay connected with their family and friends and remain independent. He knows first-hand how hearing loss can impact social connection and effective communication. By relying on three core values—empathy, education, and excellence—Dr. Syms and his team of hearing loss experts are transforming the lives of patients.
So what are you waiting for? Stop missing out on the conversation and start improving your quality of life today!
Welcome to the ListenUp! Podcast where we explore hearing loss communication connections and help.
Dr. Mark Syms 0:15
Dr. Mark Syms, here I am the host of the ListenUp! Podcast where I feature leaders in health care. This episode is brought to you by Arizona Hearing Center. I help patients to remain socially connected and independent by effectively treating their hearing loss. I am passionate about hearing loss because I lost my brother Robbie twice, I lost him first to hearing loss from radiation to his brain tumor and then when he succumbed to complications from the treatment of his brain tumor. I’m an ear, nose and throat doctor who only takes care of ears. I’m the he of EMT, I’ve treated over 10,000 patients with surgery and and many more than that with hearing loss and passionate about treating their hearing loss. Well, I’m also the author of Listen Up: A Physician’s Guide to Effectively Treating Your Hearing Loss. If you want to learn more about that my practice you can go to listenuphearing.com, that’s listenuphearing.com. today I’m really excited about my guests. I have Dr. I’m sorry, my eyes. Dr. Ned Stolzberg. He is the medical director at the Hospice of Valley since 2007, where he oversees clinical care. He has worked with both IT team medical director and as a Palliative Care Consultant in the hospital setting. After growing up in Boston area. Dr. Stolzberg attended the University of Texas where he received a Bachelor of Arts degree. He went on to graduate from medical school at the University of Massachusetts and his residency at Phoenix direct at Phoenix Baptist Hospital. And I’m excited to have him here. Thanks for coming on. Thanks, man. Appreciate your having me. Yeah, tell tell me a little bit about your, your course like I know you were in family medicine and family practice. How did you end up at Hospice of the Valley doing hospice care, which is a wonderful service, it’s really an excellent thing people need,
Dr. Ned Stolzberg 1:56
oh, thank you, it’s a great place to work. I my personal journey started off in family medicine, and I knew nothing of hospice or palliative medicine. Back when I was training, which was in the early 90s. And my residency program, had a community medicine, rotation essentially. And as part of that, I was assigned to spend three days at one of Hospice of the Valley’s inpatient units, which I at the time dreaded, because I thought it was going to be just horrible and sad. And and, and I found it to be quite the opposite. I actually found it to be very refreshing in terms of the approach that was taken to medicine, how happy and and engaged and friendly the staff were, and, and even how patients and families despite the challenges that they were facing, were reacting to the care that they were getting. And so I tucked that away in the back of my mind and launched into my career as a family physician. And then a few years later, had the occasion for my mother to need hospice care. And I got to see all of that from the patient perspective, and exactly what could be done and she was cared for both at home and for a little while in one of the inpatient centers and that that kind of sealed my, my desire that this was the kind of medicine that I wanted to pursue. And so I started working part time in hospice and liked it so much, I decided to go back and get additional board certification with The Hospice and Palliative Medicine, and kept on going and now this is what I do is my career, and it’s taking me a lot of different directions and all wonderful direction.
Dr. Mark Syms 3:50
That’s wonderful. I mean, you know, I’m a board certified in neurotology, which I say is a tongue twister and most people in medicine, don’t know there is a board certification and I didn’t confess, I didn’t know there was a board certification and Hospice and Palliative medicine. How long has that been around?
Dr. Ned Stolzberg 4:07
Well, palliative medicine hospice has been around since the early 70s. In the United States, certification. The hot the certification for palliative medicine is relatively new over the last 15 years or so. Palliative medicine itself is something of a newer field just in the last 20 ish years maybe. So yeah, the the the board certification. And the extra training you can get is, is in the last 15 years.
Dr. Mark Syms 4:38
Are there fellowships or residency?
Dr. Ned Stolzberg 4:40
There are actually in fact, Phoenix is quite fortunate we’ve Hospice of the Valley has been very involved in bringing education to the Phoenix area, and we’ve partnered with a number of the larger hospital systems in town. So we actually have four fellowships In in the Phoenix area for palliative medicine physicians or adults, one pediatric palliative fellowship, and then one fellowship specifically for nurse practitioners who want to get additional certification as well.
Dr. Mark Syms 5:15
That’s great training future leaders and future providers is a really a wonderful thing. I mean, it you know, it’s interesting how it’s regional. I mean, I did my internship in Philadelphia. And so that was a 1989 to 9090. And nope, 1993 to 94. That was those college and medical school 93 to 94. And DNR just came then. So it’s amazing how there’s geographical variability. Hospice was not really an option there. And I know people are catching up, but it sounds like, historically, Phoenix has been on one of the more progressive ends of that type of care.
Dr. Ned Stolzberg 5:49
Yeah, I would, I would say that’s true. You know, it is kind of interesting. We, we are one of the older hospices in the country. And we’re actually one of the largest non nonprofit hospices in the country. And I’d say the the number of educational opportunities for folks wanting to pursue this type of care. I’m not sure it can be matched necessarily by another, another city. It sounds like, given how many opportunities there are here.
Dr. Mark Syms 6:21
What’s the history of like it? who founded the nonprofit? That’s an interesting, you know, I mean, so, yes, you would think like, Hey, I’m going to start this nonprofit, and this is the one.
Dr. Ned Stolzberg 6:33
So hospice actually originated in the United Kingdom in England. And there was a physician by the name of Cicely Saunders, who she started her career as a social worker, actually, then became a nurse, and then went to medical school. And she decided after seeing that folks, were not getting adequate symptom relief, that she would dedicate her career towards trying to change specifically for cancer patients at the time, better care for end of life. And so she started the very first hospice in the late 1960s. And there were a couple of fledgling hospices in the early 70s. I think the first one in the US was in Connecticut somewhere. The story here in Phoenix was there was a local minister, who read a Reader’s Digest article about the hospice in Connecticut, and said, We need that here. And he and two volunteer nurses started Hospice of the Valley in his garage. And now, almost 45 years later, you know, we have 1500 employees, and, and we cover the entire valley and serve as serve. You know, we have probably 2400 hospice patients and another 1000 palliative care patients that we help to care for every day.
Dr. Mark Syms 8:02
I think that, you know, it’s amazing in two places. It’s amazing in just the hospice space. But it’s also amazing that it reaffirms people, like look, if you want to change something, you can start very small, very basic, you know, belts and suspenders, duct tape and put it together, and it can turn into something pretty amazing. That’s an amazing legacy for the founders. That’s pretty amazing.
Dr. Ned Stolzberg 8:21
And the the incredible thing is, I mean, we’re, you know, it’s, I’ve really, I find that the work I’m doing is something of an oasis in medicine, and that, you know, virtually everyone you can run into around here is going to be nice and friendly and helpful. And, you know, unfortunately, it’s not always the case. And, and just, we have wonderful longevity, the first nurse, the two volunteer nurses that helped start the agency are now retired. But when they got a chance to retire, they thought we finally let them retire. But the first nurse that we hired, as a as an employed nurse, in the early 80s, is just about to retire in January, it’s been 42 or so years,
Dr. Mark Syms 9:10
that speaks to the organization, somebody wants to stay there that long. That’s pretty amazing. So you know, one of the areas of interest I have is hearing losses associated with a higher incidence of dementia and memory problems. And so, you know, at the end of that, if, if somebody is unfortunate that they might end up in hospice or those types of things. So, you know, I mean, tell me about what type of criteria people with those particular conditions are what you do to assess them to bring them if they if that is where they are in their stage of life. How does that happen?
Dr. Ned Stolzberg 9:41
Sure. So I’m glad you brought that up because dementia and related illnesses is probably one of the fastest growing areas in hospice right now. So hospice started as a primarily for cancer patients, and obviously large percentages of our patients still have cancer, but probably about a third of our patients at any time that are on our service, have dementia or something related to that, whether it’s Alzheimer’s or Lewy body or something else. And it’s actually one of the more you know, challenging areas to prognosticate People often ask me, you know, how do we know when it’s time and when someone should come on hospice, and there are a number of criteria that if you want to look on the CMS Medicare website, and and, you know, get a little bleary eyed, you can read page after page of detailed criteria. But a reasonable criteria that we tell community physicians to look at is, would you be surprised if this patient passed away in the next year? And it’s called the surprise question? And if the answer to that is No, I wouldn’t be surprised, then you might be getting into the neighborhood where that hospice conversation should go on. And specifically things that, you know, might inform you of that are essentially global decline. And so we look for decline across many realms. What could a patient do six months or a year ago that they can’t do now, in terms of self care, whether that’s bathing or eating or dressing? Are they needing more assistance with those fundamental activities of living? Are they having challenges with continence with ambulation? And, you know, walking and getting around? Have they had recurrent infections or recurrent hospitalizations? Weight loss is a very significant marker, because so many people with dementia will experience weight loss or appetite, wasting and so forth. And so you add up a few of those criteria. And they seem to all be progressing on a steady path, you probably have somebody that is going to qualify or at least potentially qualify for hospice.
Dr. Mark Syms 12:17
Right. So be that that’s part of the kind of the spectrum of dementia where you’re talking about the other health related effects as people get to the latter part of the dementia. Right.
Dr. Ned Stolzberg 12:27
Absolutely. And I think one of the things that, you know, a lot of times with dementia are actually any, either, you know, end stage chronic disease and terminal disease is that you don’t really need to wait until the last week of life, for someone to enter hospice care. We can certainly do wonderful work in those last few days. But patients will often miss out on a lot of good quality and family support. By waiting, you know, waiting till the very end.
Dr. Mark Syms 13:03
I think the foster you’re trying to say is maybe we do less at the beginning, but it is an escalating care model where as the need escalate, so you don’t have to wait till it’s a desperate time where, you know, you kind of calling in the proverbial fire company to come in and put out the fire. It’s like when there’s a low smolder and you can help get to when you know, the fires coming, I guess.
Dr. Ned Stolzberg 13:26
Absolutely. That’s a that’s a great analogy. And you know, I mentioned my mom earlier, she, she was a cancer patient, she she succumbed to lymphoma. But my father ended up as a hospice patient a few years later, and his disease progression. He had Parkinson’s disease and had cognitive decline as part of that, as well as a potpourri of other other ailments, only medical problems, right? Absolutely. And, you know, he, my mom was on our hospice team was on hospice team for six weeks at the end of her life. My father was on hospice for nine months. And it was a godsend
Dr. Mark Syms 14:14
because it brings you great peace of mind. Right? So that’s the other thing people don’t realize that hospice is not always just for the patient. It’s also for the family to help them have some peace of mind with that transition that’s coming by and you’re supporting them as well.
Dr. Ned Stolzberg 14:29
Oh, yeah. 100% And I’ll tell you that, you know, as a as a physician, you know, when you have a loved one who’s sick, the pressures kind of on and I so much wanted to not really be my dad’s doctor. He wanted to kind of be his son. And it was such a relief when when when he went on hospice, he actually improved a little bit more immediate care. He had more care that was coming to his home. The hospice position sort of took over some things he was D prescribed a lot. In other words, he was on 25 medicines before that got cut down to the eight or so that were really making a difference for him. And it was a tremendous relief to me to be able to sort of back away from from that aspect of his care, and, you know, just be able to be with them and spend time and know that help was, you know, a phone call away if need be.
Dr. Mark Syms 15:32
I know that that’s a really great lesson. And how a large percentage of your patients have hearing loss, or is that part of the situation usually are?
Dr. Ned Stolzberg 15:41
Yeah, absolutely. I mean, especially in the, you know, a larger proportion of our patients are elderly. So just sort of with the natural progression of aging, many have hearing loss, but we do see that as a complicating factor with many of our patients, especially with dementia. And then even with patients where it’s not clear, you know, how bad their dementia is, but they may have some challenges that are milder, but then, but then they show you know, behaviors, which are troubling to their caregivers, and family. And quite often, it’s related to, you know, distorted sensory input, whether that’s poor vision, or hearing, one of the things that we put together is a dementia team. And so we have some specialists when folks are struggling with an eye with what we call distressed behaviors, essentially. And so many times it’s chalked up to, you know, their sundowning are there some that and it’s not uncommon for our team to go in and discover, you know, they need a new hearing aid battery. And, and now they can hear you and understand better, or they need maybe they need a hearing aid or some kind of assistive device or their glasses are broken, simple things like that can make such a profound difference in someone’s quality of life, even if they have just a few months, you know, of life to live, being able to hear, see and understand the people and the world around them makes a huge difference.
Dr. Mark Syms 17:27
Yeah, you know, the way I think about it is, is they’re treading water just to get through the day, right? They’re using every extra capacity, and they’re right, operating at the margin. And so one of those little things seemingly insignificant, can really push them kind of over the edge in terms of, frankly, if you can’t communicate with people, certainly people are typically combative when they can’t express themselves or receive information to understand what’s going on.
Dr. Ned Stolzberg 17:53
Absolutely. So and it’s fortunate that we have folks that were able to send in and evaluate people who are struggling with dementia, and sort of get a sense in their home of what’s the environment like, what are the sensory triggers that might be causing the difficulty? Are folks in pain? Are they having trouble hearing? Are they having trouble with you know, constipation, or relieving themselves in any way? Are they under are overstimulated and making impacts in their environment can really help impact how they do more globally?
Dr. Mark Syms 18:36
And primary care doctor? I’m sorry, I get them as my primary care doctor. Because, you know, that’s what people want all the time. Right, those types?
Dr. Ned Stolzberg 18:44
That’s right, absolutely. We’ll send the team right over now.
Dr. Mark Syms 18:48
But I mean, it’s hard, like you’re talking about that kind of comprehensive assessment that, you know, is very challenging in a medical environment, right, on a day to day basis when people are kinda, you know, hustling through clinic, if you will. And so it’s really taking the time to assess, which is really wonderful.
Dr. Ned Stolzberg 19:05
Yeah, and that’s been a really rewarding aspect of this practice is it does give you time, you know, the, the cases are challenging, but we do have the time typically to be able to really sit down and work through the cases. And the other really gratifying aspect is the team aspect of things. Where you know, so many times when I was in private practice, I would think, only I had a social worker right here to help me figure this out. Because you yeah, now I do and, and a nurse who’s good at wounds, which I’m not good at, and a chaplain to help when someone has spiritual needs. And it’s really nice to be able to go in and see someone in their home, which is where really 95% of our care is done. And go in with all these other folks where I know I’m not on an island I can I can do the part that I hopefully know how to do reasonably well and make my contribution and know that these other folks and other disciplines are there to to do their part as well and and patch the holes that I can’t.
Dr. Mark Syms 20:15
So is hospice Valley denominational or nondenominational.
Dr. Ned Stolzberg 20:19
nondenominational will take care of anyone from you know, any background, any creed, whether you, you know, have ability to pay, not ability to pay. all comers are welcome. We have taken care of people from, you know, on top of Camelback Mountain to people who live underneath the bridge. And we try to meet them wherever they are as best as we can. So
Dr. Mark Syms 20:44
really wonderful organization. I’m hoping I don’t need it in the near future, though,
Dr. Ned Stolzberg 20:49
hopefully, hopefully. Hopefully, it’s not. I wish it was something that none of us would ever need. But it’s an inevitability for inevitably when when it is needed.
Dr. Mark Syms 21:00
So yeah, no, I and I and I, you know, having lost both of my parents, I think that, you know, just circumstance didn’t allow it for me personally. But having that softer landing, where you have people around you supporting you, is really wonderful.
Dr. Ned Stolzberg 21:16
Dr. Mark Syms 21:18
This has been really great. Is there anything else you would want our viewers to know about hospice? Valley? I mean, we’ve covered a lot?
Dr. Ned Stolzberg 21:25
Well, I would think I would just tell you that, you know, we have a number of programs outside of hospice, including palliative care, which is for patients that are, you know, their disease hasn’t progressed to the point where they may qualify, or they may be appropriately still pursuing some aggressive treatment. We also have called supportive care for dementia, which is for folks with, and caregivers who are helping their loved ones with earlier stages of dementia. So you know, if they may not be in the hospice realm yet, but there are still difficulties, we have our dementia educators and their dementia team, and help folks with earlier and moderate stage dimensions as well.
Dr. Mark Syms 22:09
Do you guys do this evaluations? Or is that a referral off of evaluation from others?
Dr. Ned Stolzberg 22:14
It can be a referral from the community. So we accept referrals from community physicians, and we accept referrals from family members who call it and say, help. And we’ll go out and sort of assess, you know, is this going to be the right program for you? It’s free of charge. We have wonderful community support through some grants to be able to offer that. And so access is very easy and very simple.
Dr. Mark Syms 22:39
Yeah, it’s fascinating when you look at the spectrum of hearing loss. So I was just asking about, you know, when it as it gets worse, you know, the fundamental threat, that hearing losses to people with a progressive hearing loss is a threat to their independence, right? And so their real mindset of it all is is oh, you know, I went to see mom or dad, and they’re just not quite with it. Right? It is interesting how hearing plays such a role, right? Like, if you if you can’t act, if you can’t hear the question, or you are, you’re answering the wrong question. Even if you’re actually with it, people don’t think you’re worth it. So it must be that’s kind of right, where you guys are on the edge of the hearing loss, causing these types of social disconnections that lead to loss of independence.
Dr. Ned Stolzberg 23:20
Hmm, absolutely. And then the other thing that I’m, you know, I like to How about our services, it’s 24/7. And that, you know, if you call us at two in the morning, because you know, you’re on service and you’re in pain, you will get a nurse on the line at two in the morning. And if you need a visit at your home, someone’s going to come out and see you. And so it’s a wonderful safety net, for folks where they don’t have to keep going to the emergency room or, you know, when they don’t want to, and they but they can still have their needs addressed, you know, quickly where they are and when they need it.
Dr. Mark Syms 24:02
So yeah, as you’re saying this, is there any estimate of like, so utilization, in other words, what percentage of patients? But, I mean, some people have sudden death. So they don’t need hospice, right, obviously, right. He can’t call hospice and so he’s having a heart attack. But, you know, what is the percentage of utilization of hospice versus the potential patient population that could benefit from hospice? That’s kind of an interesting question.
Dr. Ned Stolzberg 24:27
Yeah, it is underutilized. And I don’t have the exact statistics. You’re out there, man. Yeah, I will, I would tell you that we could probably, we could probably take almost 40 or 50% More of folks with late stage chronic illness, heart failure patients, COPD patients and so forth to you know, that that we could actually help out and when you look at national trends You know, adoption of hospice has gradually ramped up over the last, you know, 20 or 30 years, but probably is still at about half capacity of really what could be reasonable. And some of its education. And some of it is, you know, just different philosophies of care. And, you know, some of it is the medical system is challenging and can get disjointed. And I think hospice has to be a, a is something where if you have, you know, good ongoing care, from your your primary care team and your specialty care team, that’s consistent, you know, and it gets recognized that, oh, yeah, this is someone who could benefit. But you know, sometimes people are in different hospitals and seen by different doctors, and they move from plan to plan or whatever, and I think jointed care is a big, that becomes challenging in terms of people, you know, becoming aware of, sort of the trajectory of their care and the bigger picture.
Dr. Mark Syms 26:02
Yeah, unfortunately, as you know, as well as I do, that resonates everywhere in the care model, right. And so, people showing up, you know, you don’t have the records, or the, you know, and, and just any search results, so, well, I, you know, I have to say this is really wonderful work, and I appreciate you doing this work for on behalf of patients who really need and you’re really hitting a need and, you know, a time of life where it’s super beneficial. It must be great to go to work every day.
Dr. Ned Stolzberg 26:28
Yeah, no, it’s a it’s a, it’s a great job. And I still feel the same way from that first day in 1993. When I had the wild, this isn’t depressing at all. This is actually bringing people a lot of hope.
Dr. Mark Syms 26:41
I mean, you know, it’s an inevitability it might just be done with dignity and comfort and some sense of perhaps celebration, right. I mean, that’s, that’s really what you want is not celebrating the end result, but the celebration of the process and the life that is being brought to a kind end. Absolutely. So there’s a question I asked everybody, I always ask everybody, since it is listen up, I ask people, what’s your favorite sound?
Dr. Ned Stolzberg 27:08
Favorite sound. I’m a fan of the band, They Might Be Giants. So They Might Be Giants song would be my favorite song.
Dr. Mark Syms 27:19
Well, this has been a great conversation. And then if people want to get a hold of you, how do they get hold of you? You can call Hospice of the Valley at 602-530-6900. And if someone asks for me, they I will be tracked down and they’ll they’ll get me a message and I’ll get back to whomever needs information. This has been great. This is for everybody. It’s Dr. Ned Stolzberg. He’s the medical director of Hospice in the Valley. Thank you so much for coming on the show. This has been a great episode. I really appreciate your knowledge and your compassion for our patients in this stage of life. Thank you so much for having me have great holidays.
Thanks for tuning in to the ListenUp! podcast. We’ll see you again next time and be sure to click subscribe to get updates on future episodes.