In December, a stroke-ridden Merle Sauer, 77, came home from the hospital to live out his final months surrounded by his wife and family, his beautiful gardens and the memories that fill their comfortable house overlooking Puget Sound.
Three nurses and a social worker drop by and are on call 24 hours a day to help the Sauers, in what is known as home hospice care (search).
More than a million Americans receive hospice (search) care each year — many of them, like Terri Schiavo, in specialized centers called hospices or in hospice units within hospitals, and 50 percent of them in their own homes, like Sauer, according to theNational Hospice and Palliative Care Organization (search) in Alexandria, Va.
During the last week of Schiavo's life, the hospice organization received more than 6,000 calls and about 3,300 e-mails asking for more information about hospice case and help in drafting living wills. On a typical day, about 100 calls come in.
"Clearly the silver lining in this one family's very difficult struggle is it has brought this issue to the forefront," said Anne Koepsell, executive director of the Washington State Hospice and Palliative Care Organization.
Hospice care seeks to ease the fear, pain and loneliness of dying in a hospital by allowing patients to spend their last days surrounded by loved ones instead of doctors and machinery.
The word "hospice" was first applied to specialized care for dying patients in 1967 by physician Dame Cicely Saunders, who founded the first modern hospice in a suburb of London.
Private hospice care, run by volunteers, slowly took hold in this country in the early 1970s, but did not become widely accepted until Congress decided to experiment with a Medicare hospice benefit in 1982 as a way of saving money. Medicare paid for hospice nurses and social workers to come to people's homes or nursing homes. The benefit became permanent in 1986.
By 1988, a government study found hospice care cost about half as much as having the same patients spend their final days in the hospital. For a patient to be eligible for Medicare reimbursement, a doctor must certify that the person will die within six months if the disease runs its normal course.
"We think it's bringing humane treatment ... to situations where all the interventions in the world aren't going to change the outcome," Koepsell said.
Schiavo, who was in what doctors called a persistent vegetative state, was atypical for a hospice patient, who is usually someone with only a few months to live.
A hospice care team can include doctors, nurses, home health aides, social workers, spiritual counselors, therapists and trained volunteers. They work to alleviate pain and despair.
"If we can support them through their symptoms, then they can focus on what needs to happen at the end of life," including taking stock of their accomplishments, saying goodbye, asking for forgiveness and forgiving others, Koepsell said.
Sauer, a retired real estate salesman, suffered a stroke nearly five years ago and came home from the hospital after several bouts of pneumonia for what doctors said would be the last time.
The Sauer house is filled with laughter, pastries and tea. Hospice workers help his 75-year-old wife, Ruth, keep her spirits up and encourage her and her husband to reminisce about their 58 years together. Sauer shared a passion for baseball with his wife and their three sons.
Last week, his wife smiled and caressed her husband's head as they shared stories about the collection of family photos hanging above his favorite recliner.
"Hospice has lifted a load off my shoulders," she said. "Just knowing I could call someone has helped me a lot."