The Hospice Movement

  • Medicine & Health
  • 1974

Historically, hospices were institutions run by religious charities to offer short-term care to terminally ill patients too poor to afford alternatives. They began to be adapted to modern circumstances in the late-1940s, when British physician Ciceley Saunders, working in the suburbs of London, sought to bring more compassionate care to the dying, with a particular emphasis on relieving suffering. Saunders inspired a grassroots movement in the United States starting in the 1960s. A lecture Saunders delivered at Yale University inspired Florence Wald, dean of the school of nursing, to leave Yale and work at Saunders’s hospice, St. Christopher’s. Upon returning to the United States, Wald asked American foundations to support a feasibility study on opening a U.S. hospice.

An early grant from the Commonwealth Fund, then support from the van Ameringen and Ittleson Foundations, allowed Wald to establish the first such organization, in Branford, Connecticut, in 1974. It offered end-of-life care to 100 patients, in their homes and in its 44-bed facility. Abiding by the philosophy that patients need to be treated emotionally, spiritually, and physically, the hospice focused on providing comfort and dignity. It subsequently became a training facility for other hospices and paved the way for other such organizations to set up operations across the country.

The hospice movement was cemented nationally when the Robert Wood Johnson Foundation poured more than $170 million into efforts to improve end-of-life care. With 337 grants made between 1996 and 2006, the foundation sought to educate health-care professionals, improve institutions, and engage the public, all toward the end of better serving the dying. “Few foundations can say they built a field of medicine, but RWJF…built a very important field of medicine that hadn’t existed before,” summarized one expert observer. Today, there are an estimated 3,200 hospices providing palliative care across the United States.