In Texas’s largest county, people aged 65 or older make up a quarter of the population, compared with 13% statewide, but hospice care hadn’t been available since the 1990s. Since last year, registered nurse Karen Ramirez has been providing care through Angels Care Hospice. Ramirez, who has lived in Brewster County for nearly 30 years, used to deliver babies but switched to hospice care in 2018 after seeing how her mother was cared for at the end of her life. Families say she brings people the dignity of being able to die in their own bed and home, surrounded by their family. On a typical day, she’ll drive anywhere from 25 to 150 miles to visit four to six patients, seeing each one at least twice a week. When asked “how much time do I have left?”, she has learned to say “‘I’m here for you as long as we need. We don’t have a timeline.’ ”

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