Our views on dying have changed in the last half century. In the past, most people died quickly from infectious diseases or at birth with little time to prepare. Our life expectancy has improved through advances in public health and technology such as antibiotics, life support systems, advanced surgical techniques and effective medical treatments for cardiovascular disease and cancer. Death is still inevitable, but it can sometimes be a lonely, lengthy and uncomfortable process.

In 1969 Dr. Elizabeth Kübler-Ross published On Death and Dying, a book to raise awareness of Americans to the emotional needs of dying patients and their families. She turned the spotlight to the work of Dame Cicely Saunders of the United Kingdom and Florence Wald, Dean of the Yale University School of Nursing in the 1960's. Their work led to the establishment of the first hospice in Connecticut in 1974. Apparently the hospice concept filled a void, as evidenced by the establishment of roughly 2,300 hospices since in the decades since then.

Hospice care provides supportive social, emotional and spiritual treatment of terminally ill people. Hospice medical treatments center on palliative care to reduce or control pain, anxiety and other troubling symptoms. Hospice caregivers view death as the final stage of life which should be lived to the fullest and shared by a circle of family and friends.

Hospice care professionals and volunteers work to keep families together and provide care and support in the home if possible. Short term care in a skilled nursing facility or hospital is also available. Many services are offered including nursing and physician services, emotional and pastoral care, and home health aides. Hospice organizations can include volunteers who help with daily tasks such as shopping, driving and companionship.

Many people think hospice care is for those dying of cancer. In fact, many who receive hospice services have cardiovascular and lung diseases, Alzheimer's disease, Parkinson's disease or have failure of multiple organ systems. Some think that once one enters hospice care they will no longer receive medical treatment. To the contrary, treatment is ongoing in hospice. The difference is that it is directed to treatment of pain, difficulty breathing, anxiety, depression and other symptoms so that the final weeks or months of life are more comfortable. Treatment is not aimed at cure but at palliation.

Hospice workers will tell you that hospice care is not the same as "giving up." Once a person has reached the point where improvement or cure is not possible, the goal changes from living longer to dying well. This positive approach to death helps to remove the anger, depression and guilt that can accompany the dying process. The dying person and his or her survivors can find serenity in a peaceful death.

Sometimes doctors will suggest hospice care when there is no further treatment for a condition but formal referral by a physician is not necessary. Anyone can initiate a request. In order to receive hospice care, however, a doctor must certify that a patient is not likely to live more than six months. The hospice care team will work out a plan of care with the doctor aimed at providing only those treatments that relieve symptoms. There is no time limit for hospice services. If the person's condition improves, hospice can be discontinued and begun again later if needed or extended as long as the person is considered to be terminally ill, that is, not likely to be cured or improved.

Hospice care is paid by Medicare and Medicaid and most managed care organizations. It is available to people of all ages, not just the elderly. Medicare and Medicaid pay for all aspects of hospice care with a $5.00 co-pay for medications. If a respite is needed for the family, Medicare also covers short stays in a nursing facility or hospital.

Hospice is available almost everywhere. Many hospitals have hospice organizations and private hospice services may also be available. You can find most listed in the Yellow Pages. Don't wait until the last days to seek hospice care. It's best to make arrangements as soon as it becomes apparent that a medical problem is likely to cause death. Since that can be difficult to judge, even for doctors, it pays to discuss hospice care with a physician early.

We need no longer fear dying alone or in pain. When the time comes hospice can help us through life's final passage with peace and dignity.

For information on hospice services, payment and choosing a hospice, go to http://www.hospice-america.org/ or http://www.nhpco.org/

Information on Medicare and hospice services is available at http://www.medicare.gov/publications/pubs/pdf/02154.pdf