The History of Hospice

The inspiration for the modern hospice movement came from Dame Cicely Saunders, who as a student of nursing in her native England during World War II, witnessed a great deal of suffering and pain. She came to believe that three things were most important in easing life’s final journey. People needed strong relief from physical pain and troublesome symptoms, they needed to preserve their dignity, and they needed help with the psychological and spiritual pain of death. After some years in the nursing profession, Dame Cicely obtained degrees in medicine and social work, and in 1967 she established St. Christopher’s Hospice in London, over which she presides to this day. Ever since its doors opened, St. Christopher's treatment philosophy has been to help individuals in the final stages of life live in dignity and comfort. Her approach involved a marriage of disciplines: pain management, emotional and spiritual support, and family counseling. The care was delivered by a team of medical and nursing professionals as well as social workers and spiritual counselors.

A few years before Dr. Saunders opened St. Christopher’s, she delivered a lecture at Yale University in New Haven about her ideas. That lecture helped launch hospice care in America, for among those in the audience was Florence Wald, then dean of Yale’s School of Nursing.  According to Wald, Dame Cicely's words changed the direction of her life. Wald left the deanship in 1968 and traveled to London where she worked at St. Christopher’s hospice to learn its approach to patient care and to study the hospice's organization and management. Six years later, in 1974, with the help of two physicians, Florence Wald founded Connecticut Hospice in Branford, on the outskirts of New Haven. As the first hospice in the United States, it was also first to offer home care and today, throughout the country, over 90% of hospice care is delivered at home. 

Since the mid-1970s when hospice care was introduced in America as the most innovative, comprehensive and humane care available for people with limited life expectancies, demand for hospice care has increased every year. 

One of the most important developments in expanding access to quality end-of-life care was the passage of the Medicare Hospice Benefit in 1982, through which hospices receive federal funds for the care they give to eligible patients. With this legislation, the federal government essentially declared that hospice care was so important in relieving suffering and in bringing about a peaceful and meaningful closure to life, that every citizen was entitled to it, regardless of ability to pay. Although federal reimbursements for providing hospice care have fallen behind the real costs of this care, this benefit has nevertheless supported the growth of quality end-of-life care for all Americans.