What Is the History of Hospice?

The term “hospice” dates back to medieval times, when it referred to a place of shelter for weary travelers. It wasn’t until the mid-20th century that the word came to be associated with specialized care for the dying. That is when Dame Cicely Saunders, a British physician, nurse and social worker, began working with terminally ill patients in an effort to bring dignity and comfort to the end of life. At that time, most people in the terminal phase of an illness were simply sent home to die, usually in terrible pain and distress. Morphine was considered dangerous and addictive, so suffering patients rarely received any pain medication, even at the end of life. 

In 1967, Saunders founded the first modern hospice, St. Christopher’s Hospice, in the London suburb of Sydenham. In addition to being the first inpatient facility in London to embrace the philosophy of compassionate end-of-life care, St. Christopher’s pioneered the use of morphine to control dying patients’ pain. But the care provided focused on more than just controlling symptoms. In keeping with Saunders’ philosophy, St. Christopher’s aimed to meet the practical, emotional, social and spiritual needs of the patient and their family, including bereavement care. By 1969, the hospice had begun delivering care to patients in their homes. 

Even before founding St. Christopher’s, however, Saunders was working to spread the word about the need to provide more compassionate care to people at the end of life. In 1963, she traveled to the United States, and while there, gave a lecture at Yale. As she spoke, she showed the doctors, nurses and social workers in attendance photos of dying patients before and after they began receiving appropriate symptom control. This so impressed Florence Wald, then Dean of the Yale School of Nursing, that she invited Saunders to become a visiting faculty member for the spring term. Wald later went to England to study under Saunders at St. Christopher’s Hospice, and in 1974 she joined two physicians and a chaplain to found Connecticut Hospice in Branford, Connecticut, the first modern hospice in the United States. 

Over the next decade, the federal government and private foundations funded a great deal of research on the benefits of hospice care. For example, in 1978, the National Cancer Institute sponsored three hospice demonstration projects in order to evaluate the type of care provided and associated costs. And in 1981, the W.K. Kellogg Foundation awarded a grant to the Joint Commission on Accreditation of Hospitals to develop national standards for hospice care. 

Then, in 1982, Congress enacted the Tax Equity and Fiscal Responsibility Act (TEFRA), which made hospice a Medicare-covered benefit. Their rationale was simple: Years of research demonstrated that hospice would provide substantial cost savings over inpatient hospital care. The initial legislation limited the benefit period to 210 days based on study data that showed that more than 95% of the patients were on hospice for fewer than 210 days. The benefit period was later revised and eventually removed entirely. Instead, Medicare now requires that patients receiving hospice care are recertified as being terminally ill by a doctor after 6 six months and every 90 days thereafter. 

TEFRA also established what is still a hallmark of hospice care — the interdisciplinary care team. Hospice providers were, and to this day still are, required to coordinate patient care with input from a doctor, a nurse, a social worker, a spiritual counselor of some sort and the patient and their family. The legislation also required the involvement of volunteers and the provision of bereavement care to the family after the patient’s death.

Sources

“Dame Cicely Saunders”. St. Christopher’s. https://www.stchristophers.org.uk/about/damecicelysaunders/ 

“Our History”. St. Christopher’s. https://www.stchristophers.org.uk/about/history/ 

The Connecticut Hospice. https://www.hospice.com/ 
“Hospice and Medicare: 20 years of growth”. Relias Media. https://www.reliasmedia.com/articles/79895-hospice-and-medicare-20-years-of-growth