In 2000, there were 54 hospice beds in the Las Vegas area. Eight years later that number has remained unchanged.

Meanwhile, Clark County's population jumped from 1.4 million in 2000 to an estimated 2 million in 2007.

Hospice care, which provides palliative care to people diagnosed as having six months or less to live, was first granted federal funding in 1982.

Nationwide, the number of patients receiving hospice care increased 27 percent from 1998 to 2000, and 63 percent from 2000 to 2005.

During fiscal year 2008, Medicare reimburses hospices $601 for every day a patient receives inpatient care. At-home care is reimbursed at $135 and Medicare requires 80 percent of a hospice program's reimbursements be for at-home care, according to the Centers for Medicare and Medicaid Services (CMS).

Medicare hospice expenditures have increased from $2.9 billion in fiscal 2000 to $8.2 billion in fiscal 2005.

In 1983, nonprofit Nathan Adelson Hospice opened Southern Nevada's first inpatient facility and it's believed to be the third such facility in the country.

In 1996, Dallas-based Odyssey HealthCare, opened its 20-bed inpatient facility at 4011 McLeod Drive, Las Vegas.

Since 2000, when there were 908 Medicare-participating hospices across the country, the number of inpatient hospices almost doubled to 1,810 by 2006, according to a June 2007 report from the Medicare Payment Advisory Commission.

There has been an increased use of covered hospice services by Medicare beneficiaries from 2000 to 2005, increasing 11 percent annually, according to CMS.

So just how underserved is Las Vegas in terms of inpatient hospice care?

Hospice advocate Tim Ryan said he and his 57-year-old wife, Karen, were faced with the lack of hospice beds when Karen was diagnosed with a terminal illness five years ago.

She wanted to die at home, he said, but she didn't want to die in pain.

Ryan lacked the skills to efficiently manage his wife's pain, so the couple decided to admit her into inpatient hospice care.

But when the Ryans started looking for a hospice bed, they discovered the 54 beds in the valley were all occupied. While she waited for a bed, she was admitted to a hospital.

She eventually got a hospice bed, but Karen died at Nathan Adelson just days after being admitted.

Patients are staying longer in hospice. Ten years ago, in 1998, the national average length of stay was 51 days. In 2005, the average increased to 69 days, according to CMS data.

Tim Ryan decided to advocate for more inpatient hospice beds, so no one else would be placed in the Ryans' predicament. Five years after her death, he still has a hard time talking about it.

"This problem isn't going away," he said. "If they can't find a place for you, you stay in the hospital" where the purpose there is to cure the disease.

"Hospice is interested in maintaining dignity," he said.

Connor said hospice care will probably grow by extending care to underused beds in hospitals.

Hospice care has been slowly growing.

"We know that generally speaking, inpatient hospice care is less than three percent of the inpatient days, so you don't need a lot of beds, because basically hospice patients are being kept at home, or a place they call home (nursing homes, assisted living)."

But, he added, not everybody wants to die at home.

The cost for hospice is a bit difficult to sort out, he said, because it's basically hospice is getting paid, not what it costs.

Some of the costs of hospice are buried in capital campaigns to cover the cost of the building.

"As hospice gets further into the population that needs end-of-life care, the easy-to-keep at-home patients mostly have already been reached," Connor said. "We've (as an industry) expanded a lot in nursing facilities, but the patients in hospitals and dying in hospitals are the ones we want to try and reach."

Nathan Adelson Hospice has announced plans to build a 16-bed inpatient facility in Henderson, and even hosted a groundbreaking, but will only build the facility after $6.5 million is raised. Friends for Henderson Hospice, an outside foundation, is leading that charge. In the meantime, an adult day care facility will be built, since it is already funded.

As people move to the Las Vegas area to retire, often they are moving away from family. Should a debilitating illness hit and they are deemed terminal, sometimes the only option for them is inpatient hospice care.

Family Home Hospice, a wholly owned subsidiary of Sierra Health Services, provides care to about 1,000 patients a year, said Lynn Rosenbach, the company's president administrator.

Although the company does not operate a freestanding inpatient facility, it has half a dozen contracts with a hospital and several skilled nursing facilities to lease out inpatient beds.

Since it started operations in 1988, Family Home's 50 employees care for people in their homes and also at long-term care and assisted care facilities, she said.

Most of their patients are senior citizens, and while hospice patients used to be primarily dying from cancer, these days they see more end-stage lung and heart disease, and dementia, she said.

"There certainly is a need for inpatient care," Rosenbach said. But since inpatient care is reimbursed three times more than at-home care, it is also an area that's been under a great deal of scrutiny, although not necessarily in Las Vegas, she said.

Medicare reimbursement is 80 percent of Nathan Adelson's income, said Bryan Cox, the hospice's spokesman. It covers the cost of caring for the patients, he said.

The hospice also provided $1 million in indigent care last year, he said.

The hospice's inpatient beds are almost always full, he said.

"As the valley grows, it's hard to keep up," Cox said.