All About Nursing · Hospice & Palliative Care

Origins and a Bit of History of Hospice

Concept antedates 475 AD

  • The term hospes, a Latin word, from which the term hospice is derived, means to be both host and guest and implies interaction and mutual caring between the patient, family, and hospice staff.
  • Self-sustained communities evolved after 335 AD where ill, weary, homeless, and dying persons received care
  • During the early middle ages, the words hospice, hospital, and hostel were used interchangeably
  • Also during the middle ages, hospitia or travelers’ rest at monasteries and convents provided food, shelter, as well as care for those sick or dying.
  • The care and support of the whole person (the body, soul, mind, and spirit) evolved in these early hospices

In the 1800s, hospice evolved to care for the sick and incurables. The first hospice were opened in Dublin (Our Lady’s Hospice) and in London (St. Joseph’s Hospice):

  • The word hospice became synonymous with care of the terminally ill late in the 1800s with the founding of Our Lady’s Hospice in Dublin by Sister Mary Aikenhead of the Irish Sisters of Charity, who was a colleague of Florence Nightingale.
  • St. Joseph’s Hospice was established in 1900 in London, England.

Dame Cicely Saunders, MD, began refining the ideas and protocols that formed the cornerstone of modern hospice care in the 1950s and 1960s – Development of current concepts of palliative care are, in large part, through the work of Dame Cicely Saunders, including the use of scheduled oral opioids for pain management.

  • By the 1960s, Dame Cicely Saunders opened St. Christopher’s Hospice in suburban London, marking the beginning of the modern hospice movement.
  • Dame Cicely Saunders visited the United States in 1963 and spoke to medical and nursing students and interested others at Yale University.
  • Florence Wald, Dean of Yale School of Nursing, resigned to plan and found the Connecticut Hospice.

The first hospital palliative care service at the Royal Victoria Hospital, Montreal, Canada, was started by Balfour Mount, MD and opened in 1975; first use of the term palliative care to refer to a program of care for terminally ill persons and their families; this became the first hospice palliative care program in North America.

In the United States, hospice programmes began in the 1970s and Medicare funding was secured in 1982 (providing reimbursement of costs through insurance but requiring relinquishment of curative treatments.)

  • The first hospice in the United States was the Connecticut Hospice, incorporated in 1971. The began seeing home care patients in 1974, and opened a 44-bed inpatient facility in 1979.
  • In 1983, the Tax Equity Fiscal Responsibility Act created the Medicare Hospice Benefit and defined hospice care in the United States as legitimate medical care but with a 1986 sunset provision.
  • In 1986, the Medicare Hospice Benefit is made permanent by Congress and hospices are given a 10% increase in reimbursement rates. States are given the option of including hospice in their medicaid programs. Hospice care is now available to terminally ill nursing home residents.

In 1988, the European Association for Palliative Care (EAPC) was formed, and in the mid 1990s, the International Association of Hospice and Palliative Care (IAHPC) was established in the United States.

In 1993, hospice is included as a nationally guaranteed benefit under President Clinton’s health care reform proposal. Hospice is now an accepted part of the healthcare continuum.

In 1995, the physician-assisted suicide movement results of the Study to Understand Prognosis and Preferences for Outcomes and Risks of Treatment (SUPPORT) study, showing high incidence of uncontrolled pain (from 74% to 95%) in very ill and dying adults in site of planned interventions from nurses, encouraged physicians to attend to pain control.

In 1996, major grant-makers began to fund research, program initiatives, public forums, and conferences to transform the culture of dying and improve care at the end of life.

In 1997, the Institute of Medicine (IOM) published the report Approaching Death: Improving Care at the End of Life; and the National Hospice Organization (NHO) published A Pathway for Patients and Families Facing Terminal Illness.

In 2000, the National Hospice and Palliative Care Organization (NHPCO) developed Hospice Standards of Practice for Hospice Programs.

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