Hospice, A History

Hospice is an old concept only recently adopted into mainstream medical practice.

The History of Hospice

As far back as the 11th century, places of hospitality nicknamed “hospices” appear in recorded history. The first hospices were Roman Catholic run and provided care for travelers, pilgrims, the sick and the dying. It wasn’t until 1967 that the first modern day hospice was established by Dame Cicely Sanders in the U.K and St. Christopher's was the first medical institution to approach care for the dying the way the rest of the medical community approached care for the sick—with a commitment to education, research and clinical excellence.

Dame Cicely Sanders was a trained nurse, medical social worker and later physician. It was while working at Archway Hospital in London that she befriended David Tasma, a dying Polish refugee. Their intense friendship facilitated the birth of modern hospice as they discussed the possibility of creating a dedicated home for the dying. Upon David’s death, he bequeathed her 500 pounds with the promise of becoming, “a window in [her] home,” someday. The gesture was personal confirmation that improving end-of-life care was her life’s mission.

The terminally ill were a severely neglected patient population before the hospice movement. Healthcare providers viewed their incurability with contempt and perceived them as personal failures. Dame Cicely Sanders pushed back against this limited understanding of a healthcare provider’s role and responsibilities. She believed that above all else, they had a duty of care to comfort and reconcile patients to their own mortality.

Dame Cicely Sanders envisioned a patient-centered, clinical environment that cared holistically for the dying by providing for physical, mental and emotional needs. Instead of curative treatments, she submitted palliative care as the answer. Palliative care promotes symptom relief, including from the emotional and mental distress of living with a progressive illness. Comfort, not curing is king.

Before the Dame's inspired painkiller research, cancer sufferers rarely received appropriate medication intervention as opioids were considered too addictive and dangerous for pain management. Her research demonstrated that regular painkiller dosing was not just recommended, but necessary for improving quality of life at the end. She also proved the oral route to be a simpler, yet equally effective method for pain relief. Prior to her research, physicians relied on the more labor-intensive intravenous route for administration.

Hospice and palliative care is so much more than vulgar "pain pill popping". Equally important is disbanding taboos surrounding death and dying by encouraging patients to honestly discuss their fears, concerns and questions with their care team and loved ones. This emotional vulnerability alleviates depression and anxiety among end-stage sufferers by forcing them to reevaluate their priorities and focus on what is most important. Palliative care replaces what is unnecessary, futile and agonizing with what is necessary, effective and soothing.

It’s essential that businesses who cater to the hospice industry understand their unique background and mission to provide superior service. All medicine is personal, but hospice is especially intimate due to its unapologetic acceptance of the often ugly and uncomfortable realities inherent to dying. This isn’t to say that end-of-life care is entirely bleak or devoid of joy. In hospice we often witness sublime displays of human tenderness and spiritual healing. It is unwise to ignore the difficulties patients and their families face as they confront deteriorating bodies and dwindling minds, however. Most hospice participants experience heightened emotions of disappointment, guilt and fear. Business clients must be committed to providing exceptional patient care, simply because there is more at stake than profit loss. When quality of care is compromised, what is meant to be a peaceful passing becomes traumatic for patients and loved ones. Subsequently all business decisions should be weighed against patient benefit before implementation. Speed is an important consideration because of limited life-expectancy. Slow-moving, bureaucratic processes should be cut or eliminated where allowable. Since business clients mostly work with clinical staff and administration it’s crucial that your product or service simplifies rather than complicates workflow. Hospice opts for ease whenever possible because of the gravitas of their work. If your product doesn’t work for staff, it’s unlikely to benefit patients.

In 1963, during a presentation at Yale University to American health care professionals, Dame Cecily Sanders showed pictures of terminally ill cancer patients before-and-after palliative care. The difference was amazing—patient countenances visibly beamed despite wearied faces. Serving the hospice industry impacts patient outcomes, so tread lightly. Hold fast to its founding vision and you can’t go wrong. Patients and their families will be eternally grateful for your commitment to exceptional palliative care during this critical time.

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Works Cited

“A Brief History of Hospice.” Understand Hospice, 1 Dec. 2016, https://understandhospice.org/brief-history-hospice/.

Baines, Mary. “Pioneering Days of Palliative Care.” European Journal of Palliative Care, 2011, 18(5): 223–227, https://www.stchristophers.org.uk/about/history/pioneeringdays.

Fisher, Nicole. “The History Of Hospice: A Different Kind Of Health Care.” Forbes, Forbes Magazine, 28 June 2018, https://www.forbes.com/sites/nicolefisher/2018/06/22/the-history-of-hospice-a-different-kind-of-health-care/#2e3e4dbb660c.

Oliver, Chris. “Short Biography of Dame Cicely Saunders (1918-2005).” Archives of Dame Cicely Saunders (1918-2005): Cataloguing the Papers of the Modern Hospice Pioneer, 10 Feb. 2013, https://cicelysaundersarchive.wordpress.com/tag/david-tasma/.