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End of Life Care: A History of Hospice

Hospice, or end of life care, is a relatively new development in the United States. Hospice comes from a Latin word for hospitality that dates back to medieval times when hospitality was the care and comfort provided to travelers on a long trip. The first hospice was created in London in 1967 by Dame Cicely Saunders. The idea behind St. Christopher's Hospice was to offer a different and more specialized type of care for terminally ill patients.

End of Life Care in the United States

It was Saunders herself who introduced the hospice model to the medical community in America. A visit by Saunders to Yale University in 1963 included a lecture that showed, in detail, the benefits that hospice care had on dying patients in London. The Dean of the Yale School of Nursing was so moved by the concept of hospice care that she took advantage of a sabbatical to work at St. Christopher's with Saunders.

End of Life Care and Dr. Elisabeth Kubler-Ross

A book by Elizabeth Kubler-Ross, "On Death and Dying," was the final trigger that led to the creation of hospice care in the United States. The book was published in 1969 and was based on interviews with more than 500 dying patients. The book itself was a plea for home care for patients who have been declared terminally ill by their attending physician, as well an argument in favor of a new hospice system that allows patients to participate in end-of-life decisions. Kubler-Ross argued that the system of medicine at the time isolated dying patients when they should be with their families, in a home setting, for an end of life journey that's as comfortable and dignified as possible. By 1979, federal funding creates hospice demonstration programs at 26 locations around the country.

Main Elements of End of Life Care

  • Focus on caring. The idea of end of life care is to provide care to the patient to manage pain and provide both emotional and spiritual support. At the heart of hospice care is the idea that every person should be able to end his or her life without pain and in a dignified way, surrounded by family and loved ones.
  • Hospice team. End of life care involves a team of professionals, from the attending physician to nurses, home health aides, social workers and spiritual advisers. One family member is designated as the main caregiver and decisions are made in the best interest of the patient, always including the patient in the consultations.
  • Family members. Hospice care recognizes that losing a loved one can be a traumatic experience. Counseling and other services are offered for family members and friends of the loved one to help them cope with their grief. This also benefits the patients, who in many cases, are also concerned about the effects of the end of life experience on loved ones.

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