History of hospice care

¶ … history of hospice care and where the idea originated. Hospice care is common in the United States and the world today, but it is a relatively new health care innovation. Fifty years ago, the notion of hospice care was just beginning, and the first American hospice would not open until the 1970s. The hospice is a place where dying people can die with dignity and in as much comfort as possible, as compared to a traditional hospital, where health care, and not comfort, is the mode of care. In a hospice, the terminally ill patient can be surrounded with friends and loved ones, and die in peace, rather than in an intensive care unit surrounded by strangers.

Hospice care is often known as palliative care, as this author notes, "By contrast, the hospice offers palliative care, which focuses on maximizing comfort and controlling symptoms when health restoration is no longer possible" (Munley 20). This type of care recognizes the futility of treating a terminally ill patient who has reached a certain point where active treatment is no longer a reality, and there is no hope of cure. Rather than allowing the patient to die alone in a hospital room where visits and interaction is discouraged, the hospice movement supports interaction, warmth, and emotional encouragement to make the patient's last days as comfortable and positive as possible.

In reality, the idea of hospice care actually dates back to medieval times, when monks in monasteries would open their doors to help nurse ill travelers (Editors). Author Munley continues, "The typical medieval hospice was a blend of guest house and infirmary where all comers were given food, shelter, and care until they died or set out again, refreshed and renewed, on their journeys" (Munley 28). This idea expanded in the 1960s, when several authors and health care experts began to promote the idea of "death with dignity." Their ideas included a way for terminally ill patients to end their days in a nurturing and caring environment that would manage their pain and other symptoms while allowing them to interact with their family and friends. This environment included caring for the mind and spirit as well as the physical aspects of any disease. Eventually, these early hospices evolved into the earliest hospitals, and the hospice notion all but disappeared.

The idea revived in the 1960s, when health care experts in Great Britain revived the idea of an environment where people could end their days outside the realm of the hospital and medical domain. The editors of the National Hospice and Palliative Care Organization note, "The name was first applied to specialized care for dying patients in 1967 by physician Dame Cicely Saunders, who founded the first modern hospice -- St. Christopher's Hospice -- in a residential suburb of London" (Editors). Saunders is known as the "mother" of the modern hospice, and she traveled to America in 1963 to share her ideas with scholars and health care professionals at Yale University (Editors). Later, Saunders was invited to spend time at Yale at a visiting professor, and in return, the dean of nursing at the school, Florence Wald, took a sabbatical from the school and traveled to Saunders' London hospice to learn all she could about hospice care and philosophy. Eventually, Wald helped found the first American hospice in her home state of Connecticut.

Initially, hospice care was created to help cancer patients deal with the ravages of terminal cancer and cancer treatment. Another writer states, "More or less self-consciously, hospice care was initially designed for people who were dying of cancer, and who had a functional family support system and a home where they could be cared for away from the high-tech hospital environment" ("What Is Hospice Care?"). However, the idea quickly spread to encompass any type of terminal illness.

Another milestone in the development of hospice care in America was the book "On Death and Dying" by Elizabeth Kubler-Ross. Published in 1969, it became a bestseller the world over, and it helped create understanding and support for the "death with dignity" movement. Kubler-Ross became an advocate of the hospice concept, and testified before Congress in 1972, where she advocated patient care at home for those with terminal illnesses. This helped lend support to the growing call for hospice care in America. After her testimony, hospice legislation was introduced in Congress in 1974, but it did not pass. It did however, bring the idea to light, and the movement began to spread across the country.

The first American hospice was Hospice of Connecticut, which opened in 1973. It began as strictly a home-care program that provided visiting nurses to help care for terminally ill patients in their own homes. Many early home-care hospice units, like the Hospice of Connecticut, turned into full-fledged freestanding facilities that could take care of dozens of patients in their facilities at once, but they still offered home-care alternatives for patients, as well. As the hospice concept has developed, so has the way hospice services are offered. Author Munley notes,

Currently, although individual programs vary, there are at least five identifiable types of hospice program in the United States: (1) the free-standing hospice that provides inpatient service along with home care; (2) the home? health agency hospice; (3) hospice beds or a hospice or palliative-care unit within a hospital; (4) the roving hospice team working with dying patients wherever they are located; and (5) the hospice program with hospital and medical school affiliation (Munley 32)

As the hospice notion began to gain support in America, several avenues of support opened up, in both the government and private sectors. In 1982, Congress approved a hospice benefit as part of Medicare benefits, and in 1990, the World Health Organization drafted a statement supporting and defining hospice care. In 1991, the Veterans Administration began offering hospice care to the nation's veterans. The largest organization supporting hospices in the United States is the "National Hospice and Palliative Care Organization, founded in 1978 as the National Hospice Organization, changed its name in February 2000" (Editors). The group supports hospice care around the country, and one of its goals is to educate the public on how to use and support the hospice movement.

It is important to note that the hospice philosophy supports the terminally ill patient, but hospice staff also work to support the family and friends of the terminally ill patient. They realize the grief and loss that results from losing a loved one, and so, they offer family members information on caregiving, dealing with grief, emotional support, and even help with dealing with affairs after the death of a loved one ("What Is Hospice Care?"). Thus, hospice care serves the entire family and support group of a dying patient, which makes the patient's last days easier, but also allows them to realize that their family will receive support and guidance even after they are gone.