Sue Bland often thinks of herself as a "midwife for the soul."

"Midwives bring people into the world gently, and I help bring them out gently," says the Cranberry Township hospice nurse. "The dying process can be satisfying and even joyful; it can bring people together. That's kind of my goal."

Hospice is a program that provides physical, psychological, social and spiritual care for terminally ill persons and their families. It is not simply the "last resort" that most people think of when they hear the word, according to Mary Ann Rupert, senior provider relations manager for Bland's employer, AseraCare Hospice of Forest Hills, which serves patients in several counties throughout western Pennsylvania.

"Hospice is not just about dying; it's about living the best life you can until the end," says Rupert. "It may be a last resort, but it's a gift, a journey with the patient and the patient's family."

Mary Tobin, executive director of North Hills-based Gateway Hospice, which also serves patients throughout western Pennsylvania, describes hospice as a "very natural process."

"It does not hasten death, nor does it sustain life," Tobin says. "Hospice allows death to happen naturally while keeping a patient as comfortable and symptom-free as possible.

Comfort and symptom management are the two biggest things we can do for a patient."

Contrary to what most people believe, hospice is not just for the very last hours of a person's life.

"Earlier identification really allows hospice to do the miracle that it does," Tobin says. "A proactive approach can prevent a lot of unnecessary pain and discomfort, not just for the patient, but also for the family."

Bland says people who begin receiving hospice care early on are more familiar with their options for care and can plan ahead.

"That gives them a lot of control," she says. "I think that's so important for many patients, particularly those who are alert and oriented."

Rupert notes that hospice care is most effective if it begins at least six months before a disease is expected to take a person's life.

"You don't have to be literally in bed dying," she says. "A person could still be living a relatively normal life and be perfectly appropriate for hospice care.

"That's one of things we hear all the time from families: ‘We wish we would have known about you sooner.' We just wish everybody knew that."

"Six months to live" is a general guideline for hospice care, but one that has been misunderstood by both healthcare professionals and the community for years, according to Tobin.

Most or all of hospice care is covered by Medicare and most private insurance carriers, and they use a six-month prognosis as an eligibility guideline, she explains.

"Hospice patients can and do live past six months," Tobin says. "You don't get kicked off hospice if you live."

"Hospice is not a death sentence," adds Rupert. "We're always evaluating a patient to make sure that patient is appropriate for hospice services."

Another common misconception about hospice is that it is only for cancer patients. In reality, hospice care is appropriate for people diagnosed with a wide range of ailments, including cancer, liver or kidney disease, multiple sclerosis and dementia, according to Rupert. She notes hospice is intended for those who are not seeking aggressive treatments such as dialysis or chemotherapy.

Hospice teams might include doctors, nurses, nurse's aides, medical social workers, spiritual coordinators and volunteers who perform a variety of duties. They work together to provide medical, emotional and spiritual support to patients and their families. Services can be provided in patients' homes, hospitals, assisted living or other similar facilities or in-patient hospice centers.

While medical care is a key part of hospice, teams can also help in a variety of other areas.

"It's not just about relieving physical pain, but emotional pain and discomfort as well, plus things that are going on with the patient and their family," Rupert notes.

Hospice teams can offer assistance with financial issues; sit and talk with patients and caregivers; help with bathing and other personal hygiene; provide massage and other relaxation techniques; offer support to children living in the home; help to mediate conflicts over care; and just provide a break for in-home caregivers.

"For the caregivers, we are there to take some of the burden away from them," Rupert says.

For Bruce Piker of McKeesport, hospice care has helped to ease some of the pain of watching his mother, Marjorie, lie in a coma at Baldwin Health Center. Following treatment for cancer, she had a massive stroke in January 2007, and a team from Gateway Hospice began coordinating her care in February.

"I couldn't have written a better ending to the story," says Piker, whose mother passed away in early March. "We all need somebody else to help us get through things like this, and that's what hospice did for me," Piker says. "They not only took care of my mother's needs, but there's a social service side of hospice that is just as important for those of us who are dealing with it. The social service person checked on me every few days, just to make sure that I was getting through this all right. For those of us in the family, they did the same thing -- try to make us feel comfortable."

Bland, who has been a nurse for more than 30 years but only three years ago began working in hospice care, says part of her role is helping to relieve anxiety for not only patients, but their caregiver and family as well.

"We can advocate with doctors, and help patients and their families deal with what's going to happen next," she says. "We teach caregivers about medication and equipment, and about death and dying. We're also an ear; we've heard it all. Most people are very comfortable talking with a nurse.

"That's one of the things I love about hospice; I can really do the art of nursing, not just the science. I make a huge difference in people's lives. When they need somebody, I'm there. I'm a hand-holder."

Bland has also served as a manicurist and makeup artist for patients, and once hosted a candlelight tea party for some of her patients in a local skilled nursing facility.

"Things like that are a distraction - it's something pretty, something special just for you. It's therapeutic," she says.

"That's part of my role as a nurse."

Common Misconceptions About Hospice

• In order to qualify for hospice services, a patient must have only six months left to live.
• Hospice is only for patients who "only have a few days left."
• When a patient or family elects hospice, the attending physician is no longer involved in the patient's plan of care and medical treatment. (Hospice teams work with physicians to meet patients' individual needs and desires.)
• Hospice is a place where patients are sent. (Hospice is a service, not a place, with services provided wherever a patient calls home.)
• Patients on intravenous or feeding tubes cannot be considered for hospice services.
• A person must have a "do not resuscitate" order or a living will.
• Only patients with cancer can qualify, or really need, hospice services.
• Hospice does not medically treat or take care of a patient when medically needed.
  (Hospice is focused on comfort, not care, but teams assist physicians and patients in managing symptoms.)

Source: Gateway Hospice

When Hospice Can Help...

A person may be eligible for hospice services if he or she has:

• Progressive decline in status despite curative measures
• Frequent hospitalizations in the past six months
• Repeat multiple infections
• Increased or uncontrolled pain
• Progressive or profound weakness and fatigue
• Shortness of breath
• Difficulty swallowing
• Continued weight loss
• Changes in mental status
• Uncontrolled nausea and vomiting
• Other uncontrolled symptoms

Source: AseraCare Hospice