A hospice nurse and social worker have been keeping Smith comfortable and talking with her children and grandchildren, telling them what to expect as their matriarch slips away. As of Friday, Smith's nurse said she wasn't expected to live another week.

A hospice nurse and social worker have been keeping Smith comfortable and talking with her children and grandchildren, telling them what to expect as their matriarch slips away. As of Friday, Smith's nurse said she wasn't expected to live another week.

"Having their point of reference has been incredibly valuable," said Ken Smith, one of her grandsons. "They can tell us what's normal and what's not, what they can treat and what they can't.

"This is a family that's familiar with death," the grandson said, noting that many Smiths have worked in funeral homes, "but it's very different when it's somebody you know and love."

Hospice care isn't just for the dying. The nurses, social workers, aides and volunteers who ease our final days also help family members and loved ones come to terms with the end of a life.

"There's so much more than nursing involved in preparing people for what's going to happen," said Kris Earl, a nurse for Asante Hospice who's been working with the Smith family.

In large families, the nurse and social worker may have to talk to many different people, explaining the dying process in language they can understand.

"So many people want so much information," Earl said. "A visit that's supposed to last 30 minutes can take an hour and a half."

Social workers visit dying patients to make sure their emotional and spiritual needs are being served along with their medical requirements.

"Sometimes the physical pain is the least of it," said Katie Ortlip, a medical social worker at Asante Hospice who's been helping the Smith family. "When someone's suffering emotionally or spiritually, their physical symptoms will be worse.

"Facing loss gives you time to reflect," Ortlip said. "Part of what we do is listen to people's stories, and every one is different."

Every family is different, too. The Smiths' deep, multigenerational bonds and strong emotional support system are increasingly rare. Hospice nurses and social workers sometimes have to navigate strained family relationships — or broken ones.

"If there's any unfinished business, that's when it's going to surface," Earl said. "It's amazing what comes out of the woodwork in those last six months."

Nurses and social workers have to assess each patient's family dynamics and develop a strategy for helping the living let go of the dying. Some family members may accept a loved one's imminent demise, but others may be in denial about the inevitable.

"You have to be mutable enough to walk in and go with the flow," Earl said. "You have to get in character with that patient."

"We support them in the process as it unfolds," said Debbie Walper, another Asante Hospice nurse.

Like the nurses and social workers, hospice volunteers hear thoughts and emotions that are rarely expressed in ordinary conversations.

"People get very real," says Amy Navine, an Ashland hospice volunteer for Asante. "You don't get that in a lot of other aspects of life."

Navine has been visiting Lewis Austad, 86, who's dying of chronic obstructive pulmonary disease. She does his laundry, runs store errands, and listens to the stories he tells about his life as a psychologist working with brain-damaged children.

"It's a very special, sacred time to be invited into someone's life," Navine said.

Austad's daughter, Mari Austad Bourque, said the hospice team was a godsend when her father's needs became overwhelming.

"For me it was like suddenly out of nowhere I got an extended family," Austad Bourque said.

"They just eased my sense of responsibility because I couldn't be here enough," she said. "They've eased my tendency to feel sort of guilty. Having them here is like having a huge weight lifted from me."

Hospice workers get an unusually broad view of life because they spend time in the homes of patients from every social and economic tier. They can see a patient who lives in a mansion in the morning and one who lives in a squalid trailer in the afternoon.

"Death is the great equalizer," Ortlip said. "It strips you to your bare essence. We meet a lot of people at a time in life when they're very open. You're dealing with the real person."

Earl said her work has made her think long and hard about how the prospect of dying changes the way we live.

"Sometimes I wonder why we all don't live the rest of our lives like we do the last six months of our lives," she said. "Why don't we live every day being nonjudgmental, and caring and loving each other?"

Reach reporter Bill Kettler at 776-4492 or e-mail bkettler@mailtribune.com.