Hospice Care: Pioneering Palliative Care and What’s Next


In medieval times the term hospice meant a refuge for ill or tired travellers. In other countries hospices are specific buildings where care is provided only for patients of life limiting illnesses. However in the US hospice care is a term that denotes care to the terminally ill patient at the location of his or her choosing. That location can be the patient’s home, a family member’s home or an institution. The concept of hospice is the recognition of the end of life as part of a natural process. The desire is to help a patient at that stage cope with that progression as positively and with as much dignity and respect as possible. Hospice care also recognizes the importance of the involvement of the patient’s family in the decisions involved in the patient’s care.

In the 20th century the concept of providing compassionate care and relief from suffering of dying patients was first conceived by Dame Cicely Saunders in the UK in the 1960s. Her focus was “to keep the terminally ill patient active alert and in charge of decisions about their care for as long as possible. ” (www.hospicechoice.com) Through the work of Dr. Elizabeth Kubler Ross’s work with the dying, hospice care started in the US in the 1970s. She is quoted as saying: “All of those who have the courage to care for dying patients will be enriched by this experience.” (www.hospicechoice.com) The work of these two pioneering health care professionals was not a coincidence. The first hospice in the US was located in Connecticut in 1974 as an inpatient unit of a hospital. (www.lifeintheusa.com)

The enactment of the Medicare Hospice Benefit in 1982 encouraged the growth of hospice care in the US. Currently, there are 4700 hospices in the nation and about a third of terminally ill patients access hospice care.(www.lifeintheusa.com)
There are about an equal percentages of non profit and for profit hospices.(www.sthospice.com) Most hospice
benefits are covered by Medicare. For hospices to be Medicare certified they must utilize volunteers, thus recognizing their significance in the team approach of hospice care.

Hospice care involves all the disciplines of medical care but most importantly allows both the patient and the patient’s family input into the decision making involved in his or her care. That choice may begin with the patient deciding to discontinue treatment meant to cure the disease or condition, focusing more on quality of life rather than the extension of life. For what use is a long life if it devoid of meaning purpose and happiness?
Hospice care is accomplished through, physician, nursing, and social services, counselling, personal care attendants, and therapists.

The focus on hospice care is not on curing the underlying condition but relief of the suffering the patient undergoes. These could encompass any or all of the following: pain management, mental distress, relief of various symptoms, and also psychological support of the patient and family. The aim of hospice care is to ensure a high quality of life for the terminally ill patient and their family. By entering hospice care the patient and their family have not given up hope, but have given hope for their life a new perspective, by deciding that the time available to them must be made the most of by the creation of

Up to 30% of terminally ill patients access hospice care in the final week of death, however, the average number of days a patient is in hospice care is 67. Cancer accounts for less than half of hospice admissions, with heart disease, dementias, and lung diseases making up a significant part of the other admissions. Slightly more women than men access hospice care.(www.sthospice.org)

If treatment is focused solely on physically curing the disease for example cancer, while ignoring the mental effects of the cure, success may be limited. On the other hand the holistic approach of hospice care has enabled some terminally ill patients to be discharged from hospices, or no longer needing hospice care. Up to 30% of patients entering hospice care in 2005 were able to be discharged, and were still alive one year later. (http://dying.about.com)

The need for compassionate solutions to illnesses has the health care profession continuing to develop viable and empathetic solutions. Demographics will demand that for dying patients, and their families. Over 80% of patients accessing hospice care are over 65 years old. (www.sthospice.org)

Within the next three decades the percentage of the population that is 65 or older in the US will double.(http://dying.about.com) This expanding aging population and the proliferation of life threatening diseases and conditions will create the need for a more efficient health care system as a priority. The examination and acceptance of societal attitudes towards end of life challenges has also progressed. It is now understood that a patient’s mental health will greatly affect their physical prognosis. Hospices are able to be a vital part of the health care system for both patients and health care providers. They can relieve the physical and financial burden on hospitals and at the same time remove much of the stress of the patient and their family.