"We outright make the patient's family our unit of care, so there's a lot of attention given to the family caregivers, including bereavement care following the death of the patient," she said.
Usually, patients are given hospice care when they are expected to live six months or less. Hospice care can take place at their home or in a hospice center. Seeing the value of the care, hospitals and nursing facilities also are opening hospice units to help the dying.
Part of the difficulty in choosing to use a hospice can be how hard it is to really know how much time a person has left, Spence said.
"It's difficult in general to come up with an accurate picture of disease projections," Spence said. "People are living with chronic illnesses that will have an inevitable downward course, but knowing precisely when death will approach is not an easy thing.
"Bringing hospice in doesn't mean they're going to die tomorrow. It means a better quality of life for whatever amount of time you have left, whether it's a week or a month or six months," she continued.
Another possible reason for people failing to use hospice can be found in American attitudes toward dying -- going to hospice can seem the equivalent of "failing" or "giving up," she said.
"Our American culture is death-averse," Spence said. "The medical community and the general population, the attitude is shown in the metaphors used, whatever the disease you have -- 'I'm going to fight it, I'm going to beat it.' "
There's also some misunderstanding over who can utilize hospice care, with many people believing it's mainly for those dying of cancer. In fact, about 40 percent of U.S. hospice admissions are for patients suffering from some other life-ending diseas
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