Nikki Patton

I'm going to pivot just slightly, and it's actually been as a caregiver to hospice patients. That is my why, and that's the reason I do what I do every day. I've been able to sit at the bedside of people that I love and hold sacred space with them until they took their last breath. Without those moments, I would not have the desire to do what I do. When I found this field and was able to share really intimate moments with families who were in pain, I knew that's where I was supposed to be. It fit my soul.

It breaks everything open. Every time. I knew what was happening medically. I knew the trajectory. I knew what each decline meant. And I still lay awake wondering if it was enough. The clinical knowledge does not protect you from the grief. In some ways it makes the grief more specific — you know too much to pretend. What I discovered is that there is a particular loneliness in being a healthcare professional who becomes the family member, and almost no support structure for it. That is a gap I talk about in everything I do now.

"LEAN IN"

It means: 70 percent of Americans say they want to talk about end-of-life care with their doctor. Less than 30 percent ever do. Why is that gap so persistent?

It is not a knowledge problem. It is a courage problem — and it belongs to the system, not the patient. We built a healthcare system so focused on treatment, on fighting, on the next intervention, that we forgot to make room for the truth. Patients are waiting for someone to give them permission to ask the real question. When nobody does, they carry it alone. That grief — the grief of the things left unsaid — is preventable. That is what I spend my time trying to change. It is why i wrote a Sacred Conversation. A Sacred Conversation is not about death. It is about not leaving the people you love guessing. It is the conversation where someone finally asks what you actually want — not what the treatment plan says, not what the family hopes, but what you want. And someone stays to hear the answer without flinching. I call them sacred because they happen in the fullest space of a human life — the space between diagnosis and death that most of us leave empty. And because the people who receive them never forget them.

I have sat with families in the hardest moments of their lives and helped them figure out what came next. I also trained other professionals to do it. The sales part was about building trust with physicians, discharge planners, and social workers — showing up consistently, asking real questions, and being the person they could call when a situation got complicated. The work was relational at its core. The census numbers followed the relationships. If you are looking to enter the hospice industry, lead with integrity, develop your humanity and be consistent. It isn't rocket science, but it is human science.

What is the most urgent thing you want policymakers to understand about hospice and end-of-life care right now?

Two things. First: Medicaid cuts to end-of-life care are not a budget line. They are a nurse who does not show up. They are a family left alone in a crisis they were not prepared for. Second: there is an entire population of healthcare professionals who are simultaneously serving as family caregivers — carrying clinical knowledge that does not protect them from grief, and with no institutional support structure for what it costs them. We have 63 million family caregivers in this country. We have no data on how many of them are also the professionals delivering care. We have never asked.

What do you want family caregivers to know right now?

Nobody is asking how you are doing. Not really. They ask how your loved one is doing and they mean the patient. You are allowed to be afraid and tired and grieving and present all at the same time. You are allowed to want this to be over and to never want it to end, sometimes in the same hour. And you do not have to manage. Sacred Conversations was written for you — not to give you more to do, but to give you language for what you are already carrying.

The caregiving crisis:

• 63 million Americans currently provide ongoing, complex care to adults or children with a medical condition or disability — up 45% since 2015. (NAC and AARP, 2025)

• By 2030, roughly 25% of the U.S. population will be over 65. (U.S. Census Bureau)

I'm building a platform and a community where people who are very passionate about end-of-life care can spend their careers doing work that is meaningful and helpful, but also do it with integrity and deep passion. My greatest accomplishment has been as a caregiver to hospice patients - that is my why. I've been able to sit at the bedside of people that I love and hold sacred space with them until they took their last breath. When I was able to share really intimate moments with families who were in pain, I knew that's where I was supposed to be. It fit my soul.

You have also been a family caregiver to five hospice patients. What does it feel like to be on that side of it?

It breaks everything open. Every time. I knew what was happening medically. I knew the trajectory. I knew what each decline meant. And I still lay awake wondering if it was enough. The clinical knowledge does not protect you from the grief. In some ways it makes the grief more specific — you know too much to pretend. What I discovered is that there is a particular loneliness in being a healthcare professional who becomes the family member, and almost no support structure for it. That is a gap I talk about in everything I do now.