The word “hospice” derives from the Latin word hospes, which means both “guest” and “host.” Since the 11th century, the concept of hospice was adopted by the Roman Catholic tradition to refer to a place of hospitality for travelers and pilgrims.

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District Nurses

The root of home care, found in the practice of visiting nursing, had its beginning in England in mid-1800s when William Rathbone, a wealthy businessman and philanthropist, with the help of Florence Nightingale, established a school to train visiting nurses in helping the “sick poor” in their homes. Soon, the concept of community health nursing expanded to other countries, including the United States.

The early visiting nurses in America were called “district nurses,” a term introduced by Nightingale for nurses who visited the sick and provided health teaching in the community. The first “home-visiting” programs in the United States appeared in the 1880s. At that time, home health nursing was inseparable from community health nursing, as each nurse provided the full continuum of nursing care, including health promotion and disease prevention, hands-on care to restore health, or palliative care.

During the first half of the twentieth century, home health nursing in the United States was largely provided by visiting nurse associations and nursing divisions of governmental health agencies. These organizational structures mostly remained stable until the mid-1960s, when Medicare legislation was passed. Then, home care services, as a benefit provided by Medicare to elderly clients, were used more frequently, especially after reductions of in-hospital lengths of stay.

A Brief History

“Hospice” first began being used in the mid-1800s to describe caring for dying patients by Mrs. Jeanne Garnier, the Founder of the Dames de Calaire in Lyon France. The Irish Sisters of Charity adopted it when they opened Our Lady’s Hospice in Dublin, Ireland in 1879 and then again when they opened St. Joseph’s Hospice in Hackney, London, England in 1905.

Hospice did not become more widely known until Dame Cicely Saunders founded St. Christopher’s House in 1967. Dame Cicely had been a nurse, but was currently working as a medical social worker when she came upon a patient by the name of David Tasma in 1948. David was suffering from inoperable cancer and together, they discussed her hopes for one day opening up a place that was more of a home environment to care for the terminally ill that did a better job of focusing on pain management and preparing the patient for death. When David passed away, he left her and told her, “I will be a window in your home.” This was all the inspiration she needed to open St. Christopher’s Hospice and since then, her ideals have been adopted by those all over the world and she is known as the founder of the modern hospice movement.

Two years after the opening of St. Christopher’s Hospice in England, Dr. Elisabeth Kubler-Ross wrote a book based on over 500 interviews with dying patients. On Death and Dying became a best seller and gave people a first hand insight into the emotions and stages that people face when they are terminally ill. In her book, Dr. Kubler-Ross pleaded for better home care as opposed to an institutional or hospital setting. She argued that patients should have a choice when it came to their healthcare and promoted their ability to participate as much as possible in the decisions that affected them.

Also inspired by Dame Saunders’ ideals, students at Yale University in New Haven, Connecticut invited her to speak and were so inspired, that they created and launched the United States’ hospice movement. In 1974, a Hospice nurse in Connecticut and an accompanying volunteer made their first Hospice Home Care visit to a hospice patient in their own home.

In 1981, Nancy Hinds in Fresno, California began caring for terminally ill patients in her own home. This inpatient hospice home allowed patients a place to die with dignity in a home setting when their family or caregivers were not able to care for them in their own homes.

In 1986, Congress made permanent the Medicare Hospice Benefit and the various States were allowed to decide whether they wanted to include hospice in their Medicaid programs.

Estimates show that there are approximately 3,200 different hospice programs in the United States, Puerto Rico and Guam. This includes both inpatient (hospice home) programs and outpatient (in the patient’s own home) programs.