BRITISH BEGINNINGS
Historically, the word "hospice" was defined as a place of shelter or the offer of rest for weary or ill travelers. In the 1960s, a physician by the name of Dame Cicely Saunders began applying the term to care that was provided for dying patients. Dr. Saunders founded the first modern hospice—St. Christopher’s Hospice, in London, in a residential neighborhood, and began the health care movement toward the licensed hospice care of today. She found that for terminally ill cancer patients and their families, significant improvements in quality of life could be demonstrated with the provision of symptom control – especially pain management in a home or home-like setting. When Dr. Saunders was in the United States in 1963, visiting Yale University, she introduced hospice care to medical students, nurses, social workers and chaplains.
GROWTH OF HOSPICE MOVEMENT IN AMERICA
In 1969, Dr. Elisabeth Kubler-Ross published her classic, international best seller, On Death and Dying, which shared her interviews with dying patients. In her book, Dr. Kubler-Ross identifies five emotional stages through which many terminally ill patients travel. Dr. Kubler-Ross’s book makes a plea for home care vs. institutionalized care. Her work began a "patient advocate" movement --expressing the philosophy that patients have a right to participate in their health care decisions and choose their care even at the end of their life.
In 1972, Dr. Kubler-Ross testified on "death with dignity" at hearings conducted by the U.S. Senate Special Committee on Aging. The first hospice legislation was introduced in 1974 as a Senate bill for the provision of federally funded hospice programs, but the Senate legislation was not enacted at that time. The hospice movement gained force across the United States as a volunteer program with dedicated doctors and nurses and trained volunteers providing care to terminally ill individuals who choose not to die in a hospital but in the comfort of their home.
HOSPICE CARE BECOMES MEDICARE AND MEDICAID BENEFIT
By 1979, the Health Care Financing Administration (HCFA) initiated a demonstration program in 26 hospices in the U.S. to study cost-effectiveness and standards of hospice care. Finally in 1982, Congress created a Medicare hospice benefit in the Tax Equity and Fiscal Responsibility Act of 1982.
The Medicare Hospice Benefit became permanent in 1986, and states were given the option of including hospice in their Medicaid programs. Hospice care is now available to terminally ill nursing home residents.
In 1989, the Government Accounting Office released a study stating that only 35% of eligible hospices were Medicare-certified with several reasons listed. One was the low HCFA payment rates established for hospices. In 1993, President Clinton added hospice services to his health care reform proposal as a guaranteed federal benefit, and today hospice is a familiar health care service around the country.
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