Recently I saw I picture of myself with a group of people. It was shocking. I am short. I dont feel short. When walking and talking with these four other people I thought that I was looking at them on eye level but obliviously I wasnt. My husband stands just a bit over 6 feet and I am 5 foot 3 inches tall. I just dont see the height difference. I guess that is how it is with an elephant in the room. Everyone sees the elephant but the elephant himself. Oh no, Im not ready for hospice yet. What does it mean when someone is ready for hospice care? When there is no hope for a cure left? When death is imminent? When life has been exhausted? They say that there are only two absolutes: death and taxes. That is the elephant in the room. Death will be a reality for all of us. Hospice care, by design, is meant to ease the journey of lifes last six months. The best use of hospice care is experienced over months of care, not days. It is then that the work of life is heightened. Saying good bye and preparing to say good bye takes time both for those speaking the words and those hearing. When is the best time to learn about hospice care? Now, before you need the help. What are some of the signs that you or a family member may be ready for hospice care? It may be time to seek hospice when there is an increase in pain, nausea, breathing distress or other symptoms, when there are repeated hospitalization or trips to the Emergency Room. It may be time to ask for help when the outcomes of treatment for a life limiting illness do not result in a cure. The Latin meaning for the word elephant is huge arch. Death is often symbolized by a butterfly, the human spirit taking flight. Before death is a butterfly it feels like an elephant. It can be a huge arch and sometimes a painful journey. It is a journey that we dont have to take alone. Referrals for hospice care are given by physicians, nurses, friends, neighbors, the patient or family members. Call 1-877-324-1686 to learn more about High Peaks Hospice & Palliative Care or visit our Web site at www.highpeakshospice.com. Jan Demers is the Executive Director of High Peaks Hospice. Her column appears regularly.