Janet Stanhope has been told three times now that she’s terminal.

One doctor-in-training looked her in the eye and told her: cancer.

Another hesitated. Even though it was just an act — Stanhope was in on it, so was the mentor watching in the corner to offer pointers — he didn’t want to say the words.

Stanhope, a volunteer greeter and occasional actress at Auburn’s Hospice House, is part of a new venture to ease doctors into breaking bad news and to introduce them to hospice care so the next time, for real, they know what to say. It’s the latest effort by the 5-year-old house to educate doctors and the public on what hospice is and isn’t, along with conveying that death doesn’t have to be a four-letter word.

“We all only have today,” said Director of Hospice Karen Flynn.

Hospice House, the first facility like it in Maine, and only one of two in the state, has seen its 14 beds running at 98 percent capacity since August. Its parent, Androscoggin Home Care & Hospice, is weighing expansion. Over the past 10 years, its patient base has exploded. People staying on-site or receiving nurse and volunteer visits increased from 83 in 1999 to 1,230 in 2009.

Mainers have historically not flocked to that sort of care. In a 2002 state-by-state measure, only one, Alaska, had fewer people dying with some sort of hospice intervention. Officials here have an array of theories: People might not be aware of hospice. Doctors might be reluctant to suggest it, preferring to hold out for the next test, the next treatment.

It could go against Mainers’ grain to ask for help.

“What I’ve always heard people hypothesize about is the independent spirit of people in New England,” said Androscoggin Home Care & Hospice Chief Operating Officer Andrea LeBlanc. “I think they see hospice as relying on others.” There’s inclination, she added, to just “buck up.”

There’s also gloomy perception.

“Hospice does have people think end of life. ‘If I go into Hospice House, I’m going to die’ — well, not necessarily,” said President and CEO Julie Shackley.

Nearly 10 percent of patients who check in check back out, their pain or symptoms, Flynn said, managed to a level that they can comfortably go home. Once a month, staffers gather in a room known as the chapel, a quiet space with four chairs and tissues, to place a beach rock into an over-sized bowl for every person who has died that month. She said it’s to reflect and “make it real for us.”

About half of the patients have cancer, Shackley said. Others have issues such as congestive heart failure. People who move into Hospice House have been under a doctor’s care, either at home, in a hospital, nursing home or assisted living center. Their pain and symptoms have become difficult to manage and they get a doctor’s referral. Sometimes they’ve been receiving hospice care at home; sometimes they haven’t.

Stays can last days or weeks.

Dr. Geoffrey Carden, on the faculty in the family medicine residency program at Central Maine Medical Center, said it’s a different mindset to switch from wanting to cure to making comfortable.

“What (medical residents) say time and time again, when they’re put in that situation they don’t know what to say,” Carden said. Practicing with Stanhope, “this was a safe way to do it.”

He made the change this summer, part of second-year residents’ training that has them spend four half-days in the community.

“I think (hospice) tends to be an urban concept,” Carden said. “Androscoggin covers hundreds of miles. In Manhattan, there’s probably some type of home health care every three blocks. I think there’s kind of a real sea chance occurring in Maine, and the country.”

Maine, he said, is just a bit behind.

‘I wouldn’t have known’

Last Monday, hospice volunteer John Crowley sat with a dying man while the man’s family threw a pizza party for his 3-year-old daughter down the hall. The family wanted to keep things normal, at least a little.

“They had the party; life went on,” said Crowley, 68, from Jay.

Before he retired from International Paper, Crowley began visiting hospice patients in their homes once or twice a week.

“You’re able to be there for somebody else,” he said. “The good thing is to be a good listener, to listen to them and listen through the heart. That’s a skill you have to work on daily.”

After Hospice House opened, he moved to volunteering there Mondays. Crowley offers advice if the look on someone’s face says they need it, and he’ll encourage families, if they have something to say, to get it out.

The work isn’t about steeling your emotions, he said, pulling a folded white square from his back pocket. He always keeps a clean handkerchief on him.

“I never know when it’s going to happen, the waterworks turn on,” he said. “We’re on a journey, and we just don’t know how long that journey is.”

Androscoggin Home Care & Hospice has a roster of 350-plus volunteers, including teens from Edward Little High School and people like Crowley who are at the Hospice House every day.

It opened in 2005 after years of planning and fundraising. One has since opened in Scarborough with 18 beds. A doctor is there daily, with nurses around the clock. Admission takes place 24 hours a day, as do visiting hours. Each room, sized like a hotel suite, has a pullout couch for family to sleep.

Rich Livingston of Auburn stayed around the clock with his wife, Barbara, who died almost two years ago. About six months before she entered hospice, Barbara decided to stop seeking treatment for her long bout with breast cancer.

“The most immediate impact was that as long as she was at home in her own house, she had a sense of responsibility for the home,” Rich Livingston said. Pets had to be taken care of, details put in order. “As she transferred to the Hospice House, all that burden was eliminated. She was much more comfortable, much more serene. She could fully participate in the time she had left.”

Hospice, he said, taught him and their children how to say goodbye.

“They impressed upon us how important that process was for Barbara and for us,” Livingston said. “I wouldn’t have known.”

Full house

During a tour mid-week, Flynn, a hospice nurse since 1990, pointed out the patient spa room — a small sort of beauty salon — a large living room and a comfortable kitchen-meets-cafe with tables and a long counter. That’s a popular spot, she said, for families to gather and catch up.

Well-mannered pets are allowed to stay in patients’ rooms. The windows in each space are low by design for a good view from bed to the outside.

Once, “the entire senior class (stood outside their principal’s window) holding candles and singing vigil for him,” Flynn said. “We had another man from Scotland. He had a bagpiper out his window.”

On this day, 12 of the 14 beds were filled, with one more patient expected and one death already that morning. Despite the full house, the halls were quiet, the sort of silence in a school before it opens for the day.

Shackley said Androscoggin Home Care and Hospice monitors patient demand and waiting lists, and has considered opening a smaller facility in another county.

“At this point, the numbers have not supported the need,” she said. But, looking ahead to the baby-boom generation, “It’s a possibility.”

Stanhope, 62, of Auburn, began volunteering in 2008. Years before, her mother-in-law was dying in a hospital when Hospice House was presented as a choice.

“I had actually never heard of them before,” Stanhope said.

She was impressed with the staff, the atmosphere.

“It is not sad at all,” she said. “Obviously, there are families going through stressful times. You hear a lot of laughter, you smell great things coming out of the kitchen.”

In role-playing with the young doctors, she has a script of emotions. First, she’s stoic. Then quiet. Questioning. Then hopeful.

When her time comes, she jokes about holing up there and having pizza delivered to her suite.

“It’s just a wonderful place,” Stanhope said. “If they take reservations, I’ll give them my name now.”

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Hospice, by the numbers

65: Number of employees at Auburn’s Hospice House (one of two places in Maine for inpatient care)

8.3: Percentage of people who checked into the Hospice House in 2009 and checked back out; they either stabilized or regained some health

$2,843: Average daily cost for hospital inpatient treatment

$190: Average daily cost for routine home hospice care

$690: Average daily cost for Hospice House inpatient care

9.1: Percentage of people in Maine who died with some hospice care (2002 report)

21.5: Percentage of people in U.S. who died with some hospice care (2002 report)

Sources: Androscoggin Home Care & Hospice; the analysis “Means to a Better End: Report on Dying in America Today” by the organization Last Acts.