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Hospices

Hospice care is care for the terminally ill and their loved ones. Hospices allow families, friends, and the dying themselves to maximize the quality of their relationships and lives as they come to a close. With emphasis on providing comfort, easing fears and difficulties, and “help[ing] to make the best of a hard situation” (Beresford 1993, p. 3), hospices provide the opportunity to die in an environment that focuses on the individual and his or her needs rather than on the medical aspects of illness and death. On an ever increasing basis, patients dying of cancer, AIDS, and various other grave ailments are turning to hospices for palliative care that gives them more control over their treatment and lifestyle than they would have in most conventional hospital settings.

History of Hospice

Hospis, the Latin word for host, is at the root of the hospice movement. Hospice care is most frequently traced back to the fourth century CE, when the Roman noblewoman Fabiola, a convert to Christianity, financed refuge for and provided care to sick and dying Christian pilgrims. In the medieval period, the Knights Hospitaller similarly welcomed returning Crusaders. In the mid-1800s, Jeanne Garnier founded the Women of Calvary and its houses for caring for impoverished and dying patients around France, while the Irish Sisters of Charity performed similar service in both Ireland and England at the beginning of the twentieth century. The modern hospice movement is largely credited to Cicely Saunders, who in 1967 founded St. Christopher's Hospice in London. There she catalyzed the movement to provide preventative symptom and pain relief rather than just a place for the dying to gather. Saunders once said, “Hospice is not a place to go to die, but rather a concept of care based on the promise that when medical science can no longer add days to life, more life will be added to each day” (Clemens 1998, p. 9).

According to the U.S. National Hospice Organization, between the 1974 establishment of the first U.S. hospice in New Haven, Connecticut, and 1997, more than 3,000 additional hospices have opened in the United States. According to the National Hospice and Palliative Care Organization (NHPCO), of 2.4 million Americans who died in 2000, 700,000 received hospice care. Fifty-five percent of hospice patients in 2000 were female, 82 percent were Caucasian or white, and 57 percent were diagnosed with cancer. The NHPCO also reports that less than 50 percent of American deaths occur in the hospital setting, while around 25 percent occur at home and another 25 percent at nursing facilities such as hospices.

Hospice Purposes and Services

The general purpose of most hospice facilities is to achieve some combination of the following objectives: designate the terminally ill as such, involve them and their families and caregivers in planning the care they will receive, provide the necessary staff to provide hospicerelated services at all hours of all days, maintain administration and record keeping, supply in-home care if appropriate, provide counsel, relieve symptoms, coordinate all services, and establish “open, direct, and honest communication with the terminally ill person and his or her family” (Sendor with O'Connor 1997, p. 11).

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