A Brief History of Hospice Care

Hospice care has been a form of end-of-life care since the 11th century, but the modern approach has only existed since the late 1960s.

What is hospice care?

Hospice care is comfort care. It provides nurturing support to alleviate the pain and symptoms of people with a terminal, life-limiting illness. Hospice care takes into account physical, emotional, spiritual and social needs to enhance quality of life. It does not focus on curative, life-prolonging treatments. The term “hospice” comes from the Latin word hospitum, meaning hospitality, or a retreat for the ill and weary.

The pioneering work of Dr. Cicely Saunders in revolutionizing hospice care

The birth of the modern hospice facility as a place dedicated solely to end-of-life care began with the work of British physician Dame Cicely Saunders. Born in 1918, Saunders became a nurse and later trained and earned qualifications as a doctor. She suffered from chronic health issues, which helped instill a strong compassion for her patients.

“Total pain” management approach

Saunders adopted a "total pain” management approach, taking into account the psychological, spiritual and physical needs of the patient, as well as considering the needs of the patient’s family and caregivers. She continued to adapt and improve her philosophy during her time, volunteering at a hospice facility during the 1950s while she furthered her studies to become a doctor.

In 1967, Saunders established St. Christopher’s Hospice in south London, the first modern hospice program.

‍Resistance and challenges

Although Saunders transformed the care offered to the terminally ill, it was not without some controversy. Saunders and other important figures in the hospice movement had to contend with a number of issues, including the cultural taboos against discussing death and terminal illness. Many doctors were resistant to implementing new approaches, while there were many patients and families who struggled with the prospect of moving away from curative treatments toward comfort care.

‍Motivating talk at Yale University

‍Despite these challenges, Saunders continued to work tirelessly on behalf of the terminally ill. In 1963, she gave a talk at Yale University to an audience of doctors, nurses, medical students and chaplains. She discussed the notion of specialist care for the dying with a focus on comfort care and showed images of cancer patients before and after they had received hospice care. The differences in their appearance and well-being was undeniable, and Saunders’ talk prompted the American medical professionals d to consider how they could improve end-of-life care.

America’s first hospice

Florence Wald, a nurse and former dean of Yale School of Nursing, founded the Connecticut Hospice, America’s first hospice program, in 1974. Wald had attended Saunders’ talk at Yale and been inspired by what she’d heard. She found much to consider in the approach of providing support and comfort to the terminally ill and their families rather than carrying out procedures that did little to alleviate suffering. In her words, at the time, “Terminally ill patients went through hell, and the family was never involved.”

The rise in support for hospice care

Dr. Elisabeth Kubler-Ross was another leader in the hospice movement. A psychiatrist and the author of On Death and Dying, Dr. Kubler-Ross highlighted the benefits of home care over institutionalized treatment and argued that everyone should have a say in their end-of life care. She also testified in front of a 1972 US Senate Special Committee on the matter. However, it wasn’t until 1986 that the Medicare Hospice Benefit was introduced with the option for states to include hospice care in their Medicaid programs.

Since that time, funding has improved for hospice care and the number of providers has risen to over 5,500. In 2017, more than 1.49 million Medicare beneficiaries received hospice care for a day or more. ■