In the past, a hospice was defined as a shelter or refuge - a peaceful place to rest while on a long journey. Today, the word is too often viewed with fear and sorrow: Families contact hospice as a last resort when their loved ones are dying. But returning to the original definition might make more sense, since the services hospice offers are much closer to supporting an individual on their journey instead of helping them end it.

"Hospice is a scary word, associated with death and dying," said Tiffany Jones, marketing director/patient care coordinator at Crest Home Health & Hospice. "It's more about quality of life."

Hospice teams provide spiritual, physical, and emotional support 24 hours a day, 7 days a week for families and individuals living with a terminal diagnosis.

"We already know that they're dying," said Shayla Abernathy, director of nursing at Auburn Crest Hospice. "What we're doing is helping them live to their fullest with that diagnosis."

Patients must have a terminal diagnosis or a life expectancy measured in months instead of years to qualify for hospice services.

"It's not about giving up," said Jonie Anderson, patient care coordinator at Crest. "It's about accepting and shifting focus to make life as good as you can."

Hospice services are free to anyone with Medicare or Medicaid, and most private insurance companies cover them at 100 percent. They provide a broad range of medications and durable medical equipment based on an individual care plan and designed for the patient's physical comfort.

"We are mission-driven," said Cindy Reed, Hospice House director for Hospice of North Idaho. "We look at what is best for the patient first, and what it costs second."

There is no limit on the hospice benefit; if an individual improves enough to stop the service, they can restart it as many times as needed - because some people do graduate from hospice.

"When social and physical stress is placated, it's amazing what the body can do," said Todd Fonda, community outreach coordinator at Auburn Crest.

"Once they get specialized care, they often bounce back," Anderson said.

A team of trained professionals including physicians, nurses, social workers, chaplains, CNAs, and volunteers offers supplemental care to the primary caregiver, in collaboration with the patient's primary care physician.

"We decide what we can do in addition to what the caregiver is already doing," Abernathy said.

Unfortunately, families often wait too long to contact hospice. The earlier they are brought in, the better the patient can be served. That way, the team will have time to build relationships before the patient gets to a full-care state and the family is in crisis mode. They will also have more time to help patients fulfill items on their "bucket list," emphasizing their quality of life.

"The thing we hear most is, 'Why didn't we bring in help sooner?'" Fonda said.

Anyone can request a consultation. If the hospice staff determines that they can help a family, they will help them obtain the required doctor's order.

The spiritual piece of hospice care is enormous, said Dave Roberts, spiritual care coordinator at Auburn Crest. "It's a journey. This work is humbling and powerful. It's not a job. It's an honor."

There are for-profit and nonprofit hospices in North Idaho providing similar services. All are Medicare certified and must meet the criteria for Medicare guidelines. Each one offers slightly different benefits to its clients.

"We suggest that families call each hospice and get a feel for what they offer," said Donna Wilder, alternate administrator at River City Hospice. "There's enough need for all of us. We need to figure out how to serve the community and sharpen care."

The teams will refer patients to other hospices when they feel it's appropriate.

"I always encourage families to ask around to find the one that best fits the needs of their loved one," said Abernathy. "One is not better than the other. They are just distinctive."

Hospice of North Idaho offers its patients hospice inpatient stays or respite care in its Hospice House, the first hospice house in Idaho. Other hospices provide a similar benefit in local skilled nursing facilities.

"When they have a need that can't be met at home, whether it's symptom management or simply caregiver respite, they're welcome here," Reed said.

Crest Home Health offers a palliative and supportive program to help transition its home health patients into hospice with the help of a case manager. Palliative care is directed toward comfort, pain- and symptom-management, not attempting to cure a life-limiting illness.

HONI emphasizes its bereavement program, where it offers counseling and support to both family members and the community at large through group and one-on-one sessions. Its annual memorial service in May and tree-lighting at Christmas are aimed at helping the community celebrate the lives of those they have lost.

"They are very powerful events," said Amanda Miller, director of community development at HONI. "The tree lighting is poignant and sweet, and helps many families get through the holidays."

HONI qualifies as a 501(c)(3) organization. River City has a 501(c)(3) nonprofit foundation that affords it the opportunity to subsidize the cost of services for underinsured patients with limited financial resources. Crest provides similar options through the Rocky Mountain Care Foundation.

Statistics show that patients involved with hospice outlive those not involved with hospice, said John Lundholm, director of clinical services at River City. The team can catch situations before they become emergencies, and help patients avoid trips to the hospital.

"Our emphasis is on keeping patients in their home," said Lundholm, "wherever 'home' might be to them."

In the end, hospice teams help patients and their families through the most difficult time in their lives. It's a loving option that they hope the public will become more comfortable with as they learn the benefits of having hospice involved at the end of their loved ones' lives.

"We build relationships," said Mary Jean Tranfo, a nurse at Auburn Crest. "If they need it, we provide it. I feel blessed to work here. It's an honor for me to be serving at the end of their lives."

Hospice contact information

• River City Hospice - Post Falls (208) 777-2489, Sandpoint (208) 265-8612

• Crest Home Health & Hospice (208) 765-4343

• Auburn Crest Hospice (208) 773-7731

• Hospice of North Idaho - Coeur d'Alene (208) 772-7994, Kellogg (208) 786-6100

• Bonner Community Hospice (208) 265-1179

• Hospice of Benewah County (208) 245-5734