In my previous column entitled "Life's Final Journey Nothing to Worry About," I described the process of dying.  In it I quoted the great 16th century essayist Michel de Montaigne who was once on the verge of expiring after an accident and found himself gasping for air, and pounding on his chest to breathe. Fortunately, he recovered. 

He later reflected that despite the trauma, he began to grow languid while feeling like he was being carried aloft on a magic carpet.  From this he found that learning to die is not necessary. 

He noted, "If you don't know how to die, don't worry; nature will tell you what to do on the spot, fully and adequately.  She will do the job perfectly for you; don't bother your head about it." 

Montaigne was partly correct in that we may know how to die but we generally need somebody else around to help either during the process or thereafter. Birth itself actually begins with a cry for help. Fortunately, we have hospice and while most people die in a hospital, many families choose hospice for end-of-life care.


The website for the National Hospice and Palliative Care Organization, states that the term "hospice" can be traced back to medieval times when it referred to a place of shelter and rest for weary or ill travelers on a long journey. 

The name was first applied to specialized care for dying patients by physician Dame Cicely Saunders, who began her work with the terminally ill in 1948 and eventually went on to create the first modern hospice – St. Christopher's Hospital – in a residential suburb of London. 

Saunders introduced the idea of specialized care for the dying to the United States during a 1963 visit when she presented a lecture at Yale University. It was given to medical students, nurses, social workers and chaplains and discussed the concept of holistic (treating mind and body) hospice care, and included photographs of terminally ill cancer patients and their families, showing the dramatic differences before and after the symptom control care. 

Hospice care is designed to give supportive treatment to people in the final phases of a terminal illness and focus on comfort and quality of life, rather than cure.  The goal is to enable patients to be comfortable and free of pain so that they live each day as fully as possible.


According to Heidi Telpner in her book “One Foot in Heaven,” hospice affirms life and does not hasten or postpone death. It highlights quality rather than length of life. She contends that death can be beautiful, peaceful, humorous, touching, tragic, disturbing and even otherworldly. 

Hospice care treats the person rather than the disease and provides family centered care involving the patient and family in making decisions. Care is provided for the patient 24 hours a day, seven days a week.  Care can be given in a patient's home, a hospital, nursing home or in a private hospice facility.  Most hospice care in the United States is given at home with a family member or members serving as the main hands-on caregiver.

Local Service

In Warsaw

We are indeed fortunate having local hospice services.  The original organization was started by eight nurses and numerous community leaders 46 years ago and continues today through the passion of a new generation of nurses,  a physician, medical social workers, therapists and support staff. 

According to their brochure, the group of nurses met at one of the member's home. They had no money, no office space and no supplies.  Several community leaders volunteered to serve on their board of directors, as advisers and help with donations.  Kosciusko REMC provided the office space. Hospice services have flourished and beginning next year palliative care will be added. 

Palliative Care

Unlike hospice, palliative care is specialized medical care that focuses on providing patients relief from pain and other symptoms of a serious illness, no matter the diagnosis or stage of disease. Palliative care teams aim to improve the quality of life for both patients and their families. This form of care is offered alongside curative or other treatments you may be receiving.

Palliative care is provided by doctors, nurses and other specially trained people. They work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care.

Jennifer Riley, the director of operations, reported that her organization will be the first agency in Kosciusko County to provide palliative care services in home settings. The care can be provided in a patient’s residence whether it is a private home, apartment, group home or facility setting. Palliative care programs have proven to reduce hospitalizations and health care costs around the country.

The palliative care program will focus on symptom management and work in collaboration with the patient’s physician. Patients with chronic and progressive conditions will receive visits from the palliative care staff to address the patient’s physical, emotional and spiritual needs. Staff will also focus on facilitating discussions regarding advance directives and medical goals of care.

The organization plans to begin accepting palliative care referrals effective Saturday. The agency name, however, is not changing and will continue to be Kosciusko Home Care & Hospice. Their address  is 1515 Provident Drive, Suite 250, Warsaw, IN 46580. For more information, call 574 372-3401 or fax 574 372-3415.  Glenn Hall is the executive director.

Max Sherman is a medical writer and pharmacist retired from the medical device industry.  His new book “Science Snippets” is available from Amazon and other book sellers. It contains a number of previously published columns.  He can be reached by email at