International History of Hospice
The Word Hospice comes from the Latin word ‘hospis” meaning host and guest. In forth-century Rome the concept of hospice, as a place to care for the sick and dying, first came into being under the direction of Fabiola, a member of the Roman patrician class, who was well known in her day as a generous provider of the care and comfort of the sick and dying. Over the next several centuries the Catholic Church continued to provide care to the poor and sick.In 1842, the term “hospice” was used for the first time to identify a place to care for the chronically ill and dying in France, where Mme. Jeanne Gamier is credited with establishing an institution dedicated to the care of the dying. Soon after this, an order of nuns known as the Irish Sisters of Charity cared for the terminally ill. They started a hospice in Ireland in 1879.
The creation of the “modern day Hospice” is credited to Dame Cicely Saunders who in the 1950’s in England realized that managing pain was not enough. She recognized that there were psycho/social and spiritual aspects of the dying process that needed to be addressed. She was told that if she wanted to do something about it she would have to become a physician and so she did. She obtained degrees in medicine and social work. In 1967 she founded St. Christopher’s Hospice in London. The focus was on individuals in the final stages of life living in dignity and comfort. Her approach involved a marriage of disciplines: pain management, emotional and spiritual support, and family counselling. The care was delivered by a team of medical and nursing professionals as well as social workers and spiritual counsellors. In 1969 Dame Cicely pioneered the first home care team taking St Christopher’s care and philosophy out into the community.
In the United States, the Dean of the Yale School of Nursing, Florence Wald, was strongly influenced by a speech that Saunders gave in the US. In 1968 Wald left Yale to work at St. Christopher’s and learn the Hospice model. In 1974 Wald along with 2 physicians, founded Connecticut Hospice in Branford (just outside New Haven). One of the most important developments in expanding access to quality end-of-life care in the US was the passage of the Medicare Hospice Benefit in 1982, through which hospices receives 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.
In Canada the approach has been slightly different. In 1975, a palliative care unit was opened at the St. Boniface Hospital in Winnipeg and weeks later a similar palliative care unit was opened at the Royal Victoria Hospital in Montreal. Dr. Balfour Mount, a pioneer in hospice/palliative care in Canada, used the words “palliative care” rather than the word “hospice” because from the history of early lower Canada the word “hospice” in Quebec was commonly considered a place of last resort for the poor or derelict. The word “palliative” comes from the latin meaning “to cover or cloak, as in to care for”. As a result, the terms have been used interchangeably across Canada. This can be particularly confusing when we speak of the “Palliative Team” referring to the medical professionals, there may be an assumption that Hospice is involved or when we refer to a palliative unit or room in a hospice which may or may not be associated with Hospice.
The Palliative Care Foundation in Toronto released an official definition of hospice palliative care in 1981, stating that “Palliative care is active compassionate care of the terminally ill at a time when there is no longer responsive to traditional treatment aimed at cure and prolongation of life and when the control of symptoms, physical and emotional is paramount. It is multidisciplinary in its approach and encompasses the patient, the family and the community in its scope.” Two years later, the University of Ottawa created Canada’s first University Institute for research and education in palliative care. The Canadian Palliative Care Association was established in November, 1991 and opened its first office in Ottawa in February 1994. The organization later changed its name to the Canadian Hospice Palliative Care Association (CHPCA) due to hospice care and palliative care no longer being recognized as separate entities.While in theory they are one and the same, in British Columbia there has been a separation in the delivery of these programs requiring us to once again be clear about our terminology. Since 1981, the B.C. Ministry of Health has supported a community palliative care project, starting with an inpatient unit at the Royal Jubilee Hospital in Victoria and the second unit at Vancouver General Hospital. The Ministry of Health has also provided home care support to enable terminally ill patients to remain in the comfort of their own homes. However in general hospice programs in communities throughout BC must raise their own funds to financially support their individual programs.In BC as is elsewhere there are five different organizational structures.
- Community based hospice palliative care: This program does not have a facility of its own, other than an office. The program centers around the client, whether he/she is in the home or in a health facility ; using a multidiscipline team approach to provide physical, emotional and spiritual support for the client and the family. Hospice Society of the Columbia Valley will begin using this model.
- Hospital based: This is a unit, floor or wing within the hospital specifically allocated for the terminally ill patient to die in, if he/she so chooses; for symptom management and for respite. It may have a totally independent staff or have staff members who rotate from the main floor. In Invermere we have a single palliative care room attached to a regular hospital room (rooms 6&7) at the end of the urgent care hallway.
- Hospital –based team. This team has no designated place in the hospital but there will be a specific number of designated beds scattered throughout the hospital to be used for palliative patients. Patient care is given by the regular staff on that area, and the team sees the patient on a daily basis, making suggestions for care as they assess the need. This is how the palliative room is attended in Invermere.
- Hospice Bed: This is a bed designated in a location outside of a hospital. The multidisciplinary team used for the community base is utilized here as well. Hospice Society of the Columbia Valley is working to secure a Hospice Bed in the coming year.
Free-standing hospice: The free-standing hospice is housed in its own building and served by a multidisciplinary team. A 6-12 bed hospice is a long term goal for the Hospice Society of the Columbia Valley.