• Nearly 2.5 million Americans will die this year
  
  
• Polls show 71 percent of Americans would prefer to die at home and 86 percent believe people who have a terminal illness would most like to receive end-of-life care at home. However:
• 20 percent of Americans die in hospital intensive care units and 38 percent in hospitals
• 20-to-25 percent of Americans die in nursing homes
  
  
• Three quarters of Americans believe in having a legal document to spell out how they want to die if they are incapacitated, but less than 20 percent have a living will or medical power of attorney.
  
  
• In a recent study:
• Less than 50% of severely or terminally ill patients had an advance directive in their medical record
• Only 12% of patients with advance directives had received input from their physicians in its development
  
  
• Lack of communication with physicians and other health care providers causes confusion about medical treatments, conditions and prognosis, and choices that need to be made.
  
  
• In 2005 1.2 million people with life-limiting illnesses received care from one of the more than 4000 hospice programs in the United States.
  
  
• Nearly 80 percent of Americans don't realize hospice care is available at home. 90 percent of Americans are unaware that Medicare can cover hospice care costs.

Not fact, but theory.

• Elisabeth Kubler-Ross developed a stage theory of death and dying built on extensive interviews with people who were dying and with those who cared for them:
• Stage 1 – Denial.  Denial comes in several forms.  A patient may flatly reject the diagnosis, simply refusing to believe the news.  In other forms of denial, patients fluctuate between refusing to accept the news and, at other times, confiding that they know they are going to die.  Patients deal with loneliness, internal conflict, guilt and feelings of the meaningless of their lives.  
• Stage 2 – Anger.  A dying person may be angry at everyone – people who are in good health, their spouses and other family members, those who are caring for them, their children.  They may lash out at others, and wonder – out loud – why they are dying and not someone else.
• Stage 3:  Bargaining.  In the bargaining stage, dying people try to negotiate their way out of death.  In some ways, bargaining seems to have positive consequences.  Although death cannot be postponed indefinitely, having a goal of attending a particular event or living until a certain time may in fact delay death until then.  However, there is a gradual realization of the real consequences of their condition.  
• Stage 4:  Depression.  Realizing that the issue is settled and they cannot bargain their way out of death, people are overwhelmed with a deep sense of loss.  They know that they are losing their loved ones and that their lives are coming to an end.  The depression they experience may be of two types.  In reactive depression, the feelings of sadness are based on events that have already occurred:  the loss of dignity that may accompany medical procedures, the end of a job, or the knowledge that one will never return home.  On the other hand, dying people also experience preparatory depression, feeling sadness over future losses.  They know that death will bring an end to their relationships with others, and that they will never see future generations.
• Stage 5:  Acceptance.  In this last stage people are fully aware that they are dying.  Increasingly self-reliant, they have made peace with themselves.