“Hospice” (from the same linguistic root as “hospitality”) can be traced to medieval times—a place of shelter and rest for weary or ill travelers on a long journey.

1963: Physician Dame Cicely Saunders visited the US and Yale University. She lectured to medical students, nurses, social workers, and chaplains, about the concept of holistic hospice care—included photos of terminally ill cancer patients and their families, showing dramatic differences before and after the symptom control care. This lecture… resulted in the development of hospice care as we know it today.

1965: Florence Wald, then Dean of the Yale School of Nursing, invited Saunders to become a visiting faculty member of the school for the spring term.

1967: Saunders founded the first modern hospice—St. Christopher’s Hospice—in a residential suburb of London, in 1967.

1968: Wald took a sabbatical from Yale to work at St. Christopher’s and learn about hospice.

1969: On Death and Dying, by Dr. Elisabeth Kübler-Ross, identified the five stages through which many terminally ill patients progress and becomes an internationally known best seller. Within it, Kübler-Ross made a plea for home care as opposed to treatment in an institutional setting and argues that patients should have a choice and the ability to participate in the decisions that affect their destiny.

1972: Kubler-Ross testified at the first national hearings on death with dignity, conducted by the US Senate Special Cmte on Aging. Kubler-Ross: “We live in a very particular death-denying society. We isolate both the dying and the old, and it serves a purpose. They are reminders of our own mortality. We should not institutionalize people. We can give families more help with home care and visiting nurses, giving the families and the patients the spiritual, emotional, and financial help in order to facilitate the final care at home.”

1974: The first hospice legislation, introduced by Sen. Frank Church and Sen. Frank E. Moss to provide federal funds for hospice programs, was not enacted.

1978: Four years later, a US Dept. of HEW task force reported that “the hospice movement as a concept for the care of the terminally ill and their families is a viable concept and one which holds out a means of providing more humane care for Americans dying of terminal illness while possibly reducing costs. As such, it is the proper subject of federal support.”

1979: The Health Care Financing Admin. (HCFA) initiated demonstration programs at 26 hospices across the country to assess the cost-effectiveness of hospice care and to help determine what a hospice is and what it should provide.

1980: The W.K. Kellogg Foundation awarded a grant to the Joint Commission on Accreditation of Hospitals (JCAHO) to investigate the status of hospice and to develop standards for hospice accreditation.

1982: Congress included a provision to create a Medicare hospice benefit in the Tax Equity and Fiscal Responsibility Act of 1982.

1984: The Joint Commission on Accreditation of Hospitals (JCAHO) initiated hospice accreditation.

1986: The Medicare Hospice Benefit was made permanent by Congress, so states gained the option of including hospice in their Medicaid programs. Hospice care was made available to terminally ill nursing home residents.

1991: The Commission on the Future Structure of Veterans Health Care (Mission Commission) released a report, recommending inclusion of hospice care in the veteran’s benefit package.
1992: Congress passed the Indian Health Care Improvement Act of 1992, calling for a hospice feasibility study.

1993: Hospice was included as a nationally guaranteed benefit under President Clinton’s health care reform proposal, showing Hospice to be an accepted part of the health care continuum.

1994: HCFA’s questions about certifications and re-certifications of terminal illnesses resulted in the first “focused medical review” for hospices and a wake-up call to the industry to improve documentation and certification procedures or be denied payments.

1995: The Office of Inspector General (OIG) announced that the Operation Restore Trust (ORT), a special program to combat waste and abuse in Medicare and Medicaid in five targeted states—California, Florida, Illinois, New York, and Texas—would be expanded to include hospice.

1996: The Ninth U.S. Circuit Court of Appeals in San Francisco overrules a Washington State Law against physician-assisted suicide. The Second US Circuit Court of Appeals strikes down New York’s law against physician-assisted suicide. Both rulings are appealed to the US Supreme Court.

1996: Bills are introduced in the US House of Representatives and the US Senate to improve the Medicare Hospice Benefit. The hospice industry provides full support for both bills.

1997: Operation Restore Trust was extended and expanded to target all 50 states and additional types of health care providers.

1997: Congress passed legislation, barring taxpayer dollars from financing physician-assisted suicide. The US Supreme Court ruled that mentally competent terminally ill people do not have a constitutional right to physician-assisted suicide, leaving the issue up to the states. Oregon voters favored the right to physician-assisted suicide, passing for the second time its “Death with Dignity Act.” The growing end-of-life movement focused national attention on quality of life at the end of life, as well as the need for increased public awareness and physician education. The hospice philosophy and concept of care are central to models for palliative and end-of-life care. The Accreditation Commission for Home Care implemented hospice accreditation program that year, as well.

2004: Dr. Elisabeth Kübler-Ross died on August 24.

2005: Dame Cicely Saunders died at St. Christopher’s Hospice in London, the hospice she founded.

(Source: History: Part II courtesy of the National Hospice and Palliative Care Organization.)