Array ( [0] => {{short description|Organization that cares for the dying or the incurably ill}} [1] => {{About|the type of medical/psychological care}} [2] => [[File:De Greeff Hospice House.jpg|250px|thumb|right|A Hospice House in Missouri]] [3] => '''Hospice''' care is a type of health care that focuses on the [[palliative care|palliation]] of a [[Terminal illness|terminally ill]] patient's pain and symptoms and attending to their emotional and spiritual needs at the end of life. Hospice care prioritizes comfort and quality of life by reducing pain and suffering. Hospice care provides an alternative to therapies focused on life-prolonging measures that may be arduous, likely to cause more symptoms, or are not aligned with a person's goals. [4] => [5] => [[Hospice care in the United States]] is largely defined by the practices of the [[Medicare (United States)|Medicare]] system and other [[health insurance]] providers, which cover inpatient or at-home hospice care for patients with terminal diseases who are estimated to live six months or less. Hospice care under the Medicare Hospice Benefit requires documentation from two physicians estimating a person has less than six months to live if the disease follows its usual course. Hospice benefits include access to a multidisciplinary treatment team specialized in end-of-life care and can be accessed in the home, long-term care facility or the hospital.{{Cite journal|last1=Marshall|first1=Katherine|last2=Hale|first2=Deborah|date=2017|title=Understanding Hospice|journal=Home Healthcare Now|language=en|volume=35|issue=7|pages=396–397|doi=10.1097/NHH.0000000000000572|pmid=28650372|s2cid=36990444|issn=2374-4529}} [6] => [7] => Outside the United States, the term tends to be primarily associated with the particular buildings or institutions that specialize in such care. Such institutions may similarly provide care mostly in an end-of-life setting, but they may also be available for patients with other palliative care needs. Hospice care includes assistance for patients' families to help them cope with what is happening and provide care and support to keep the patient at home.{{cite web |url=https://www.n2information.com/article/ |title=End of Life Care |publisher=N2Information |author=Suzanne Myers |access-date=2017-11-10 |archive-date=2020-01-05 |archive-url=https://web.archive.org/web/20200105162414/https://n2information.com/article/ |url-status=dead }} [8] => [9] => The English word "hospice" is a [[Influence of French on English|borrowing from French]]. In France however, the word "[[wiktionary:fr:hospice|hospice]]" refers more generally to an institution where sick and destitute people are cared for, and does not necessarily have a palliative connotation. [10] => {{Toclimit|3}} [11] => [12] => == Philosophy == [13] => The goal of hospice care is to prioritize comfort, quality of life and individual wishes. How comfort is defined is up to each individual or, if the patient is incapacitated, the patient's family. This can include addressing physical, emotional, spiritual and/or social needs. In hospice care, patient-directed goals are integral and interwoven throughout the care.{{cite book|last=Kilpatrick|first=Anne Osborne|title=Handbook of Health Administration and Policy|author2=James A. Johnson|publisher=CRC Press|year=1999|isbn=978-0-8247-0221-2|page=376}}. Hospices typically do not perform treatments that are meant to diagnose or cure an illness but also do not include treatments that hasten death. Instead, hospices focus on [[palliative care]] to relieve pain and symptoms. [14] => [15] => This philosophy affects how hospice staff treat people and their families. Compared to general healthcare providers, hospice professionals take a different approach to talking to people and their families.{{Cite journal |last1=Menchik |first1=Daniel A. |last2=Giaquinta |first2=Maya |date=January 2024 |title=The words we die by |url=https://linkinghub.elsevier.com/retrieve/pii/S0277953623008274 |journal=Social Science & Medicine |language=en |volume=340 |pages=116470 |doi=10.1016/j.socscimed.2023.116470|pmid=38091852 }} They are more likely to make predictions or express uncertainty around future events (e.g., "He might die this week" or "I think she might live longer") than to issue orders or prescribe actions (e.g., "She needs a nurse" or "He can't go home"). [16] => [17] => ==History overview== [18] => ===Early development=== [19] => The word "hospice" derives from [[Latin]] ''hospitum'', meaning hospitality or place of rest and protection for the ill and weary. Historians believe the first hospices originated in [[Malta]] around 1065, dedicated to caring for the ill and dying en route to and from the Holy Land.{{cite book |last1=Moscrop |first1=Janet |last2=Robbins |first2=Joy |title=Caring for the Dying Patient and the Family |date=2013 |publisher=Springer |isbn=978-1-4899-3376-8 |page=246 |url=https://books.google.com/books?id=gCkDCAAAQBAJ&q=first+hospices+1065&pg=PA246 |access-date=17 January 2020 |language=en}} The rise of the European [[Crusades|Crusading movement]] in the 1090s placed the incurably ill into places dedicated to treatment.{{cite book|last=Robbins|first=Joy|title=Caring for the Dying Patient and the Family|publisher=Taylor & Francis|year=1983|isbn=0-06-318249-1|page=138}}{{cite book | last = Connor | first = Stephen R. | title = Hospice: Practice, Pitfalls, and Promise | publisher = Taylor & Francis | year = 1998 | isbn = 1-56032-513-5 | page = [https://archive.org/details/hospicepracticep0000conn/page/4 4] | url = https://archive.org/details/hospicepracticep0000conn/page/4 }} [20] => In the early 14th century, the order of the [[Knights Hospitaller|Knights Hospitaller of St. John of Jerusalem]] opened the first hospice in [[Rhodes]].Connor, 5. Hospices flourished in the [[Middle Ages]], but languished as religious orders became dispersed. They were revived in the 17th century in [[France]] by the [[Daughters of Charity of Saint Vincent de Paul]]. France continued to see development in the hospice field; the hospice of L'Association des Dames du Calvaire, founded by Jeanne Garnier, opened in 1843.{{cite book | last = Lewis | first = Milton James | title = Medicine and Care of the Dying: A Modern History | publisher = Oxford University Press US | year = 2007 | isbn = 978-0-19-517548-6 | page = 20}} Six other hospices followed before 1900. [21] => [22] => Meanwhile, hospices developed in other areas. In the [[United Kingdom]] attention was drawn to the needs of the terminally ill in the middle of the 19th century, with ''[[The Lancet|Lancet]]'' and the ''[[British Medical Journal]]'' publishing articles pointing to the need of the impoverished terminally ill for good care and sanitary conditions.Lewis, 21. Steps were taken to remedy inadequate facilities with the opening of the Friedenheim in London, which by 1892 offered 35 beds to patients dying of [[tuberculosis]]. Four more hospices were established in London by 1905, including the [[Royal Trinity Hospice|Hostel of God]] on Clapham Common founded in 1891 by Clara Maria Hole, Mother Superior of Sisterhood of St James' (Anglican) and taken over in 1896 by the [[Society of Saint Margaret]] of East Grinstead. [[Australia]], too, saw active hospice development, with notable hospices including the [[Julia Farr Centre|Home for Incurables]] in [[Adelaide]] (1879), the Home of Peace (1902) and the Anglican House of Peace for the Dying in [[Sydney]] (1907).Lewis, 23-25. In 1899 [[New York City]], the Servants for Relief of Incurable Cancer opened St. Rose's Hospice, which soon expanded to six locations in other cities. [23] => [24] => The more influential early developers of hospice included the Irish [[Religious Sisters of Charity]], who opened [[Our Lady's Hospice]] in [[Harold's Cross]], [[Dublin]], [[Ireland]] in 1879. It served as many as 20,000 people—primarily with tuberculosis and [[cancer]]—dying there between 1845 and 1945. The Sisters of Charity expanded internationally, opening the Sacred Heart Hospice for the Dying in Sydney in 1890, with hospices in [[Melbourne]] and [[New South Wales]] following in the 1930s.Lewis, 22-23. In 1905, they opened St Joseph's Hospice in [[London]].{{cite book | last = Foley | first = Kathleen M. | author2 = Herbert Hendin | title = The Case Against Assisted Suicide: For the Right to End-of-life Care | publisher = JHU Press | year = 2002 | isbn = 0-8018-6792-4 | page = [https://archive.org/details/caseagainstassis2002unse/page/281 281] | url = https://archive.org/details/caseagainstassis2002unse/page/281 }} [25] => [26] => ===Hospice movement=== [27] => [[File:St. Christopher's Hospice.jpg|thumb|right|St Christopher's Hospice in 2005]] [28] => In Western society, the concept of hospice began evolving in Europe in the 11th century. In [[Catholic Church|Roman Catholic]] tradition, hospices were places of hospitality for the sick, wounded, or dying, as well as for travelers and pilgrims. The modern hospice concept includes palliative care for the incurably ill in institutions as [[hospital]]s and [[nursing home]]s, along with at-home care. The first modern hospice care was created by [[Dame]] [[Cicely Saunders]] in 1967. Saunders was a British [[registered nurse]] whose chronic health problems forced her to pursue a career in [[medical social work]]. The relationship she developed with a dying [[Poland|Polish]] refugee helped solidify her ideas that terminally ill patients needed compassionate care to help address their fears and concerns as well as [[palliative]] comfort for physical symptoms.{{cite book | last = Poor | first = Belinda | author2 = Gail P. Poirrier | title = End of Life Nursing Care | isbn = 0-7637-1421-6 | year = 2001 | publisher = Jones and Bartlett | location = Boston; Toronto | page = [https://archive.org/details/endoflifenursing0000poor/page/121 121] | url = https://archive.org/details/endoflifenursing0000poor/page/121 }} After the refugee's death, Saunders began volunteering at St Luke's Home for the Dying Poor, where a physician told her that she could best influence the treatment of the terminally ill as a [[physician]]. Saunders entered [[medical school]] while continuing her volunteer work at St. Joseph's. When she completed her degree in 1957, she took a position there. [29] => [30] => Saunders emphasized focusing on the patient rather than the disease and introduced the notion of 'total pain',{{cite journal|title=Total Pain: The Work of Cicely Saunders and the Hospice Movement|author=David Clark|url=http://www.ampainsoc.org/pub/bulletin/jul00/hist1.htm|journal=APS Bulletin|volume=10|issue=4|date=July–August 2000|access-date=2009-06-22|archive-url=https://web.archive.org/web/20110224021430/http://www.ampainsoc.org/pub/bulletin/jul00/hist1.htm|archive-date=2011-02-24|url-status=dead}} which included psychological and spiritual as well as physical discomfort. She experimented with [[opioid]]s for controlling physical pain. She also considered the needs of the patient's family. She developed many foundational principles of modern hospice care at St Joseph's. [31] => [32] => She disseminated her philosophy internationally in a series of tours of the United States that began in 1963.{{cite book | last = Spratt | first = John Stricklin |author2=Rhonda L. Hawley |author3=Robert E. Hoye | title = Home Health Care: Principles and Practices | publisher = CRC Press | year = 1996 | isbn = 1-884015-93-X | page = 147}}{{cite book | last = Lewenson | first = Sandra B. |author2=Eleanor Krohn Herrman |title=Capturing Nursing History| publisher = Springer Publishing Company | year = 2007 | isbn = 978-0-8261-1566-9 | page = 51}} In 1967, Saunders opened [[St Christopher's Hospice]]. [[Florence Wald]], the dean of [[Yale School of Nursing]], who had heard Saunders speak in America, spent a month working with Saunders there in 1969 before bringing the principles of modern hospice care back to the United States, establishing Hospice, Inc. in 1971.Sullivan, Patricia. [https://www.washingtonpost.com/wp-dyn/content/article/2008/11/12/AR2008111202953.html "Florence S. Wald, 91; U.S. Hospice Pioneer"], ''[[The Washington Post]]'', November 13, 2008. Accessed November 13, 2008. Another early hospice program in the United States, Alive Hospice, was founded in [[Nashville, Tennessee]], on November 14, 1975.{{cite web|url=https://www.newspapers.com/newspage/112643152/|title=The Tennessean from Nashville, Tennessee · Page 80|website=Newspapers.com|date=19 August 2001 |access-date=2016-04-22}} By 1977 the National Hospice Organization had been formed, and by 1979, a president, Ann G. Blues, had been elected and principles of hospice care had been addressed.{{cite book|last1=Blues|first1= Ann G|last2=Zerwekh|first2=Joyce|title=Hospice and Palliative Nursing Care|publisher=Grune and Stratton|year=1984| isbn=0-8089-1577-0|pages=84–85}} At about the same time that Saunders was disseminating her theories and developing her hospice, in 1965, Swiss [[psychiatrist]] [[Elisabeth Kübler-Ross]] began to consider social responses to terminal illness, which she found inadequate at the Chicago hospital where her American physician husband was employed.{{cite news | last = Reed | first = Christopher | title = Elisabeth Kubler-Ross: Psychiatrist who identified five stages of dying - denial, anger, bargaining, depression and acceptance | work = The Guardian | date = 2004-08-31 }} Her 1969 best-seller, ''[[On Death and Dying]]'', influenced the medical profession's response to the terminally ill. Saunders and other [[thanatology]] pioneers helped to focus attention on the types of care available to them. [33] => [34] => In 1984, Josefina Magno, who had been instrumental in forming the [[American Academy of Hospice and Palliative Medicine]] and sat as first executive director of the US National Hospice Organization, founded the International Hospice Institute, which in 1996 became the International Hospice Institute and College and later the International Association for Hospice and Palliative Care (IAHPC).{{cite book|title=Cicely Saunders: Founder of the Hospice Movement : Selected Letters 1959-1999|last=Saunders, Cicely M.|author2=David Clark|publisher=Oxford University Press|year=2005|isbn=0-19-856969-6|page=283}}{{cite journal|last=Newman|first=Laura|date=2009-09-27|title=Josefina Bautista Magno|journal=BMJ: British Medical Journal|volume=327|issue=7417|page=753|pmc=200824|quote=That vision, fuelled by her drive and gritty determination, led to the International Hospice Institute, soon to metamorphose into the International Hospice Institute and College as the need for education and training became recognised, and finally into today's International Association for Hospice and Palliative Care.|doi=10.1136/bmj.327.7417.753}} The IAHPC follows the philosophy that each country should develop a palliative care model based on its own resources and conditions.{{cite web|url=http://www.hospicecare.com/History/history.htm|title=IAHPC History|publisher=International Association for Hospice & Palliative Care|access-date=2009-02-21}} IAHPC founding member Derek Doyle told the ''British Medical Journal'' in 2003 that Magno had seen "more than 8000 hospice and palliative services established in more than 100 countries." Standards for Palliative and Hospice Care have been developed in countries including Australia, [[Canada]], [[Hungary]], [[Italy]], [[Japan]], [[Moldova]], [[Norway]], [[Poland]], [[Romania]], [[Spain]], [[Switzerland]], the United Kingdom and the United States.{{cite web|url=http://www.hospicecare.com/standards/|title=Standards for Palliative Care Provision|publisher=International Association for Hospice & Palliative Care|access-date=2009-02-21}}[[File:Mamilla StVincent.jpg|thumb|Hospice Saint Vincent de Paul, [[Jerusalem]]]] [35] => [36] => In 2006, the United States-based National Hospice and Palliative Care Organization (NHPCO) and the United Kingdom's Help the Hospices jointly commissioned an independent, international study of worldwide palliative care practices. Their survey found that 15% of the world's countries offered widespread palliative care services with integration into major health care institutions, while an additional 35% offered some form of palliative care services, in some cases localized or limited.{{cite book | last = Connor | first = Stephen | title = Hospice and Palliative Care: The Essential Guide | edition = 2nd | publisher = CRC Press | year = 2009 | isbn = 978-0-415-99356-2 | page = 202}} As of 2009, an estimated 10,000 programs internationally provided palliative care, although the term hospice is not always employed to describe such services.Connor, 201. [37] => [38] => In hospice care, the main guardians are the family care giver(s) and a hospice nurse/team who make periodic visits. Hospice can be administered in a nursing home, hospice building, or sometimes a hospital; however, it is most commonly practiced in the home.{{cite web|last=Villet-Lagomarsino|first=A|title=Hospice and Palliative Care: A Comparison|publisher=PBS|url=https://www.pbs.org/wnet/onourownterms/articles/versus.html|year=2000|access-date=2017-08-31|archive-date=2015-05-12|archive-url=https://web.archive.org/web/20150512141234/http://www.pbs.org/wnet/onourownterms/articles/versus.html|url-status=dead}} Hospice care targets the terminally ill who are expected to die within six months. [39] => [40] => ===Popular media=== [41] => Hospice was the subject of the [[Netflix]] 2018 Academy Award-nominated{{Cite news|url=https://www.nytimes.com/2019/02/06/movies/2019-oscar-nominated-short-films-review.html|title='The 2019 Oscar Nominated Short Films' Review|date=2019-02-06|work=The New York Times|access-date=2020-04-10|language=en}} short documentary ''[[End Game (2018 film)|End Game]]'',{{Cite news|url=https://decider.com/2018/05/07/end-game-on-netflix-stream-it-or-skip-it/|title=Stream It Or Skip It: 'End Game' On Netflix, A Short Documentary About Dying Gracefully|date=2018-05-07|work=Decider|access-date=2020-04-10|language=en}} about terminally ill patients in a San Francisco hospital and [[Zen Hospice Project]], featuring the work of palliative care physician [[BJ Miller]] and other palliative care clinicians. The film was executive produced by hospice and palliative care activist [[Shoshana R. Ungerleider]].{{Cite news|url=https://www.forbes.com/sites/rimmaboshernitsan/2018/08/29/how-this-doctor-is-bringing-human-connection-back-to-end-of-life-care/#3ad05f6d6208|title=How This Doctor Is Bringing Human Connection Back to End-of-Life Care|date=2018-08-29|work=Forbes|access-date=2020-04-10|language=en}} [42] => [43] => In 2016, an open letter {{Cite web |last=Taubert |first=Mark |date=15 January 2016 |title=Thank you letter to David Bowie from a palliative care doctor |url=https://blogs.bmj.com/spcare/2016/01/15/a-thank-you-letter-to-david-bowie-from-a-palliative-care-doctor/ |access-date=9 February 2024 |website=British Medical Journal Supportive & Palliative Care}} to the singer [[David Bowie]] written by a palliative care doctor, [[Mark Taubert|Professor Mark Taubert]], talked about the importance of good palliative care and hospice provision, especially being able to express wishes about the last months of life, and good education about end of life care generally. The letter went viral after David Bowie's son [[Duncan Jones]] shared it.{{Cite news |last=Leopold |first=Todd |date=18 January 2016 |title=David Bowie's son shares powerful letter |url=https://edition.cnn.com/2016/01/18/entertainment/david-bowie-son-letter-feat/index.html |access-date=9 February 2024 |work=CNN}} The letter was subsequently read out by the actor [[Benedict Cumberbatch]] and the singer [[Jarvis Cocker]] at public events.{{Cite news |last=Wightwick |first=Abbie |date=7 June 2016 |title=Benedict Cumberbatch read out a Welsh doctor's letter about dying |url=https://www.walesonline.co.uk/news/news-opinion/benedict-cumberbatch-read-out-welsh-11424522 |work=Wales Online}}{{Cite news |last=Daly |first=Rhian |date=20 July 2016 |title=Watch as Jarvis Cocker reads a letter to David Bowie |url=https://www.nme.com/news/music/jarvis-cocker-104-1201992 |access-date=9 February 2024 |work=NME}} [44] => [45] => == National variations == [46] => Hospice faced resistance from cultural and professional [[taboo]]s against open communication about death among healthcare providers and the wider population, discomfort with unfamiliar medical techniques and perceived professional callousness towards the terminally ill.{{cite journal|last=Kirn|first=Marie|date=June 1, 1998|title=Book review|journal=Journal of Palliative Medicine|volume=1|issue=2|pages=201–202|doi=10.1089/jpm.1998.1.201}} Nevertheless, the movement has spread throughout the world.{{cite book|title=Ethical Issues in Neurology|last=Bernat|first=James L.|publisher=Lippincott Williams & Wilkins|year=2008|isbn=978-0-7817-9060-4|edition=3, revised|page=154}} [47] => [48] => ===Africa=== [49] => A hospice opened in 1980 in [[Harare]] (Salisbury), [[Zimbabwe]], the first in [[Sub-Saharan Africa]].{{cite book | last = Parry | first = Eldryd High Owen |author2=Richard Godfrey |author3=David Mabey |author4=Geoffrey Gill | edition = 3 revised | title = Principles of Medicine in Africa | publisher = Cambridge University Press | year = 2004 | isbn = 0-521-80616-X | page = 1233}} In spite of skepticism in the medical community, the hospice movement spread, and in 1987 the Hospice Palliative Care Association of South Africa formed.{{Cite report|title=Mapping levels of palliative care development: a global view |url=http://www.eolc-observatory.net/global/pdf/world_map.pdf |last=Wright |first=Michael |author2=Justin Wood |author3=Tom Lynch |author4=David Clark |date=November 2006 |publisher=Help the Hospices; National Hospice and Palliative Care Organization |access-date=2010-02-06 |page=14 |url-status=dead |archive-url=https://web.archive.org/web/20110723115836/http://www.eolc-observatory.net/global/pdf/world_map.pdf |archive-date=2011-07-23 }} In 1990, Nairobi Hospice opened in [[Nairobi]], [[Kenya]]. As of 2006, [[Kenya]], [[South Africa]] and [[Uganda]] were among 35 countries offering widespread, well-integrated palliative care. Programs adopted the United Kingdom model, but emphasise home-based assistance.{{cite web|url=http://www.fhssa.org/i4a/pages/index.cfm?pageid=3286 |access-date=2010-02-06 |title=What do Hospice and Palliative Care Programs in Africa Do? |publisher=Foundation for Hospices in Sub-Saharan Africa |url-status=dead |archive-url=https://web.archive.org/web/20091120033010/http://www.fhssa.org/i4a/pages/index.cfm?pageid=3286 |archive-date=2009-11-20 }} [50] => [51] => Following the foundation of hospice in Kenya in the early 1990s, palliative care spread throughout the country. Representatives of Nairobi Hospice sit on the committee to develop a Health Sector Strategic Plan for the [[Ministry of Health (Kenya)|Ministry of Health]] and work with the Ministry of Health to help develop palliative care guidelines for cervical cancer. The [[Politics of Kenya|Government of Kenya]] supported hospice by donating land to Nairobi Hospice and providing funding to several of its nurses. [52] => [53] => In South Africa, hospice services are widespread, focusing on diverse communities (including orphans and homeless) and offered in diverse settings (including in-patient, day care and home care). Over half of hospice patients in South Africa in the 2003–2004 year were diagnosed with [[AIDS]], with the majority of the remaining diagnosed with [[cancer]]. Palliative care is supported by the Hospice Palliative Care Association of South Africa and by national programmes partly funded by the [[President's Emergency Plan for AIDS Relief]]. [54] => [55] => [[Hospice Africa Uganda]] (HAU), founded by [[Anne Merriman]], began offering services in 1993 in a two-bedroom house loaned for the purpose by [[Nsambya Hospital]]. HAU has since expanded to a base of operations at [[Makindye]], [[Kampala]], with hospice services offered at roadside clinics by Mobile Hospice [[Mbarara]] since January 1998. That same year the Little Hospice Hoima opened in June. Hospice care in Uganda is supported by community volunteers and professionals, as [[Makerere University]] offers a distance diploma in palliative care.Wright et al, 15. The government of Uganda published a strategic plan for palliative care that permits nurses and clinical officers from HAU to prescribe [[morphine]]. [56] => [57] => ===North America=== [58] => [59] => ====Canada==== [60] => Canadian physician [[Balfour Mount]], who first coined the term "palliative care", was a pioneer in medical research and in the Canadian hospice movement, which focused primarily on palliative care in a hospital setting.{{cite book | last = Forman | first = Walter B. | author2 = Denice Kopchak Sheehan | author3 = Judith A. Kitzes | title = Hospice and Palliative Care: Concepts and Practice | edition = 2 | publisher = Jones & Bartlett Publishers | year = 2003 | isbn = 0-7637-1566-2 | page = [https://archive.org/details/hospicepalliativ0000unse_h4k9/page/6 6] | url = https://archive.org/details/hospicepalliativ0000unse_h4k9/page/6 }}{{cite book | last = Feldberg | first = Georgina D. |author2=Molly Ladd-Taylor |author3=Alison Li | title = Women, Health and Nation: Canada and the United States Since 1945 | publisher = McGill-Queen's Press - MQUP | year = 2003 | isbn = 0-7735-2501-7 | page = 342}} After meeting Kübler-Ross, Mount studied the experiences of the terminally ill at [[Royal Victoria Hospital, Montreal]]; the "abysmal inadequacy", as he termed it, that he found prompted him to spend a week with Cicely Saunders at St. Christopher's.{{cite web|url=http://www.canada.com/ottawacitizen/story.html?id=896d005a-fedd-4f50-a2d9-83a95fc56464 |title=A Moral Force: The Story of Dr. Balfour Mount |author=Andrew Duffy |work=[[Ottawa Citizen]] |access-date=January 1, 2007 |url-status=dead |archive-url=https://web.archive.org/web/20061215112019/http://www.canada.com/ottawacitizen/story.html?id=896d005a-fedd-4f50-a2d9-83a95fc56464 |archive-date=December 15, 2006 }} Mount decided to adapt Saunders' model for Canada. Given differences in medical funding, he determined that a hospital-based approach would be more affordable, creating a specialized ward at Royal Victoria in January, 1975. Canada's official languages include English and French, leading Mount to propose the term "palliative care ward", as the word ''hospice'' was already used in France to refer to [[nursing home]]s. Hundreds of palliative care programs then followed throughout Canada through the 1970s and 1980s.Feldberg et al., 343. [61] => [62] => However, as of 2004, according to the Canadian Hospice Palliative Care Association (CHPCA), hospice palliative care was only available to 5-15% of Canadians, with government funding declining.{{cite web | url = http://www.chpca.net/public_policy_advocacy/january_2006_policy_alerts/Factsheet-HospicePalliativeCareinCanada-December+2+2004.pdf | title = Fact Sheet: Hospice Palliative Care in Canada | date = December 2004 | publisher = Canadian Hospice Palliative Care Association | access-date = 2009-02-21}} At that time, Canadians were increasingly expressing a desire to die at home, but only two of Canada's ten provinces were provided medication cost coverage for home care. Only four of ten identified palliative care as a core health service. At that time, palliative care was not widely taught at nursing schools or universally certified at medical colleges; only 175 specialized palliative care physicians served all of Canada. [63] => [64] => ====United States==== [65] => {{main|Hospice care in the United States}} [66] => [67] => Hospice in the United States has grown from a volunteer-led movement to improve care for people dying alone, isolated, or in hospitals, to a significant part of the health care system. In 2010, an estimated 1.581 million patients received hospice services. Hospice is the only [[Medicare (United States)|Medicare]] benefit that includes pharmaceuticals, medical equipment, twenty-four-hour/seven-day-a-week access to care, and support for loved ones following a death. Hospice care is covered by [[Medicaid]] and most private insurance plans.{{cite magazine |last1=Kofman |first1=Ava |title=How Hospice Became a For-Profit Hustle |magazine=[[The New Yorker]] |date=28 November 2022 |url=https://www.newyorker.com/magazine/2022/12/05/how-hospice-became-a-for-profit-hustle |access-date=29 November 2022 |publisher=[[Condé Nast]]}} Most hospice care is delivered at home. Hospice care is available to people in home-like hospice residences, nursing homes, assisted living facilities, veterans' facilities, hospitals and prisons. [68] => [69] => Florence Wald, Dean of the Yale School of Nursing, founded one of the first hospices in the United States in [[New Haven, Connecticut]], in 1974.{{Cite web|url=https://dolancollection.uconn.edu/wp-content/uploads/sites/1299/2019/05/Final-Project_aml14022_attempt_2019-05-05-19-13-51_Final-Project-The-History-of-Hospice-Nursing-.pdf|title=Long 2019}} The first hospital-based palliative care consultation service developed in the US was the [[Wayne State University School of Medicine]] in 1985 at [[Detroit Receiving Hospital]].{{cite journal |last1= Carlson |first1= Richard |last2= Devich |first2= Lynn |last3= Frank |first3= Robert |date= 1988 |title= Development of a Comprehensive Supportive Care Team for the Hopelessly Ill on a University Hospital Medical Service |journal= JAMA |volume= 259 |issue= 3 |pages= 378–383 |doi= 10.1001/jama.1988.03720030038030 |pmid= 3336162 }} The first US-based palliative medicine and hospice service program was started in 1987 by Declan Walsh at the [[Cleveland Clinic]] Cancer Center in Cleveland, Ohio.{{cite web|last= Walsh |first= Declan |date= 2000 |title=Pioneer Programs in Palliative Care: Nine Case Studies |url= http://www.milbank.org/publications/milbank-reports/101-reports-pioneer-programs-in-palliative-care-nine-case-studies |publisher= The Milbank Memorial Fund/Robert Wood Johnson Foundation}} The program evolved into The Harry R. Horvitz Center for Palliative Medicine, which was designated as a [[World Health Organization]] international demonstration project and accredited by the European Society of Medical Oncology as an Integrated Center of Oncology and Palliative Care. Other programs followed; some notable ones are: the Palliative Care Program at the Medical College of Wisconsin (1993); Pain and Palliative Care Service, Memorial Sloan-Kettering Cancer Center (1996); and The Lilian and Benjamin Hertzberg Palliative Care Institute, Mount Sinai School of Medicine (1997). [70] => [71] => In 1982, Congress initiated the creation of the Medicare Hospice Benefit, which became permanent in 1986. In 1993, President [[Bill Clinton|Clinton]] installed hospice as a guaranteed benefit and an accepted component of health care provisions.{{cite web|url=http://www.rnceus.com/course_frame.asp?exam_id=98&directory=hospice|title=Interactive Online Continuing Education for Nurse Professionals|publisher=www.rnceus.com|access-date=2018-11-28}} {{as of|2017}}, 1.49 million Medicare beneficiaries were enrolled in hospice care for one day or more, which is a 4.5% increase from the previous year.{{Cite web|title=NHPCO Releases Updated Edition of Hospice Facts and Figures Report|url=https://www.nhpco.org/nhpco-releases-updated-edition-of-hospice-facts-and-figures-report/|date=2019-07-08|website=NHPCO|language=en-US|access-date=2020-05-12|archive-date=2020-05-19|archive-url=https://web.archive.org/web/20200519173613/https://www.nhpco.org/nhpco-releases-updated-edition-of-hospice-facts-and-figures-report/|url-status=dead}} From 2014 to 2019, Asian- and Hispanic-identifying beneficiaries of hospice care increased by 32% and 21% respectively. [72] => [73] => ===United Kingdom=== [74] => [[File:Canterbury 002 St Thomas Hospice.jpg|thumb|200px|St Thomas Hospice, Canterbury]] [75] => The first hospice to open in the United Kingdom was the [[Royal Trinity Hospice|Trinity Hospice]] in [[Clapham]] south London in 1891, on the initiative of the [[Hoare baronets|Hoare banking family]].{{Cite web|url=https://www.cqc.org.uk/location/1-144273944|title=Royal Trinity Hospice|website=www.cqc.org.uk|access-date=2019-12-23}} More than half a century later, a hospice movement developed after Dame [[Cicely Saunders]] opened [[St Christopher's Hospice]] in 1967, widely considered the first modern hospice. According to the UK's Help the Hospices, in 2011 UK hospice services consisted of 220 inpatient units for adults with 3,175 beds, 42 inpatient units for children with 334 beds, 288 home care services, 127 hospice at-home services, 272 day care services, and 343 hospital support services.{{cite web | url = http://www.helpthehospices.org.uk/about-hospice-care/facts-figures/ | title = Facts and figures | publisher = Help the Hospices | access-date = 2012-10-02 | archive-url = https://web.archive.org/web/20120220121846/http://www.helpthehospices.org.uk/about-hospice-care/facts-figures/ | archive-date = 2012-02-20 | url-status = dead }} These services together helped over 250,000 patients in 2003 and 2004. Funding varies from 100% funding by the [[National Health Service]] to almost 100% funding by charities, but the service is always free to patients. The UK's palliative care has been ranked as the best in the world "due to comprehensive national policies, the extensive integration of palliative care into the National Health Service, a strong hospice movement, and deep community engagement on the issue."{{cite news|title=Quality of Death Index 2015: Ranking palliative care across the world |url=http://www.economistinsights.com/healthcare/analysis/quality-death-index-2015 |access-date=8 October 2015 |work=The Economist Intelligence Unit |date=6 October 2015 |postscript=none |url-status=dead |archive-url=https://web.archive.org/web/20151009031039/http://www.economistinsights.com/healthcare/analysis/quality-death-index-2015 |archive-date=9 October 2015 }}; {{cite news|title=UK end-of-life care 'best in world' |url=https://www.bbc.co.uk/news/health-34415362 |access-date=8 October 2015 |work=BBC |date=6 October 2015 }} [76] => [77] => As of 2006, about 4% of all deaths in England and Wales occurred in a hospice setting (about 20,000 patients);[https://publications.parliament.uk/pa/cm200809/cmselect/cmpubacc/99/9905.htm End of life care: 1. The current place and quality of end of life care], [[House of Commons of the United Kingdom|House of Commons]] [[Public Accounts Committee (United Kingdom)|Public Accounts Committee]], 30 March 2009, paragraphs 1-3. a further number of patients spent time in a hospice, or were helped by hospice-based support services, but died elsewhere. [78] => [79] => Hospices also provide volunteering opportunities for over 100,000 people in the UK, whose economic value to the hospice movement has been estimated at over £112 million.{{cite web |url=http://www.helpthehospices.org.uk/about-hospice-care/facts-figures/ |title=Help The Hospices |access-date=2009-02-19 |archive-url=https://web.archive.org/web/20120220121846/http://www.helpthehospices.org.uk/about-hospice-care/facts-figures/ |archive-date=2012-02-20 |url-status=dead }} [80] => [81] => === Egypt === [82] => According to the ''Global Atlas of Palliative Care at the End of Life'', 78% of adults and 98% of children in need of palliative care at the end of life live in low and middle-income countries. Nevertheless, hospice and palliative care provision in [[Egypt]] is limited and sparsely available relative to the size of the population.{{Cite book|title=Global atlas of palliative care at the end of life|editor-last=Connor|editor-first=Stephen R.|editor-first2=Sepulveda |editor-last2=Bermedo |editor-first3=Maria |editor-last3=Cecilia |year=2014|publisher=Worldwide Hospice Palliative Care Alliance |isbn=978-0-9928277-0-0|oclc=1062190212}} Some of the obstacles to the development of these services have included the lack of public awareness, restricted availability of opioids, and the absence of a national hospice and palliative care development plan.{{Cite book|title=Atlas of Palliative Care in the Eastern Mediterranean Region|last1=Osman |first1=Hibah |last2=Rihan |first2=Alaa |last3=Garralda |first3=Eduardo |last4=Rhee |first4=John Y. |last5=Pons-Izquierdo |first5=Juan José |last6=Lima |first6=Liliana |last7=de Tfayli |first7=Arafat |last8=Centeno-Cortes |first8=Carlos|date=2017-05-17|publisher=IAHPC|oclc=989071454}} Key efforts made in the past 10 years have been initiated by individuals allowing for the emergence of the first non-governmental organisation providing primarily home-based hospice services in 2010,{{Cite web|url=http://www.hospiceegypt.org/?AspxAutoDetectCookieSupport=1|title=Hospice Egypt|website=www.hospiceegypt.org|access-date=2019-12-04}} the opening of one palliative medicine unit at [[Cairo University]] in 2008 and an inpatient palliative care unit in [[Alexandria]]. [83] => [84] => Models of both home-based care and stand-alone hospices exist globally, but with the cultural and societal preferences of patients and their families to die at home in Egypt there is an inclination to focus on the development of home-based hospice and palliative care services.{{Cite journal|last1=Alsirafy|first1=Samy A.|last2=El Mesidy|first2=Salah M.|last3=Abou-Elela|first3=Enas N.|date=August 2010|title=Where Do Egyptian Palliative Care Patients With Cancer Die?|journal=American Journal of Hospice and Palliative Medicine|language=en|volume=27|issue=5|pages=313–315|doi=10.1177/1049909109357613|pmid=20167838|s2cid=2837232|issn=1049-9091}} [85] => [86] => === Israel === [87] => The first hospice unit in [[Israel]] opened in 1983.{{cite web|url=http://mecc.cancer.gov/pallative_care_workshop/ami-palliative_israel.pdf|title=Palliative care services in Israel|last=Ami|first=S. Ben|publisher=Middle East Cancer Consortium|url-status=dead|archive-url=https://web.archive.org/web/20090131095006/http://mecc.cancer.gov/pallative_care_workshop/ami-palliative_israel.pdf|archive-date=2009-01-31|access-date=2009-02-21}} More than two decades later, a 2016 study found that 46% of the general Israeli public had never heard of it, despite the 70% of physicians who reported that they had the skill to treat patients according to palliative principles.Shirli Resnizky, Netta Bentur, Jennifer Shuldiner, Shelly Sternberg, Leah Aharoni, Avinoam Pirogovsky, and Ben Koren. "[https://brookdale.jdc.org.il/en/publication/knowledge-attitudes-community-physicians-general-public-regarding-end-life-palliative-care/ Knowledge and Attitudes of Community Physicians and the General Public regarding End-of-Life and Palliative Care]". Jerusalem: Myers-JDC-Brookdale Institute (2016). [88] => [89] => ===Other nations=== [90] => Hospice care in Australia predated the opening of St Christophers in London by 79 years. The Irish Sisters of Charity opened hospices in Sydney (1889) and in Melbourne (1938). The first hospice in New Zealand opened in 1979.{{Cite book |last=O'Connor |first=Margaret |url=https://doi.org/10.1093/med/9780199332342.003.0073 |title=Oxford Textbook of Palliative Medicine |publisher=OUP |year=2015 |edition=4th |chapter=Palliative care in Australia and New Zealand|pages=1072–1079 |doi=10.1093/med/9780199332342.003.0073 |isbn=978-0-19-933234-2 }} Hospice care entered [[Poland]] in the mid-1970s.{{cite journal |editor1-first= Beata |editor1-last= Roguska |date=October 2009 |title=Hospice and Palliative Care |journal= Polish Public Opinion |page=1 |publisher= [[Centre for Public Opinion Research (Poland)|CBOS]] |issn=1233-7250 }} [[Japan]] opened its first hospice in 1981, officially hosting 160 by July 2006.{{cite web | url = http://www.hospat.org/english/objectives.html | title = Objectives | publisher = Japan Hospice Palliative Care Foundation | access-date = 2009-02-21}} [[India]]'s first hospice, Shanti Avedna Ashram, opened in [[Bombay]] in 1986.{{cite journal | url = http://findarticles.com/p/articles/mi_qa4036/is_200308/ai_n9246448/ | archive-url = https://web.archive.org/web/20080119011430/http://findarticles.com/p/articles/mi_qa4036/is_200308/ai_n9246448 | url-status = dead | archive-date = 2008-01-19 | title = Model of holistic care in hospice set up in India | last = Kapoor | first = Bimla |date=October 2003 | journal = Nursing Journal of India | volume = 94 | issue = 8 | pages = 170–2 | access-date = 2010-02-06| pmid = 15310098 }}{{cite book|title=Clinical Pain Management|url=https://books.google.com/books?id=2pMYQtN4t3AC&pg=PA87|access-date=30 June 2013|year=2008|publisher=CRC Press|isbn=978-0-340-94007-5|page=87|quote=In 1986, Professor D'Souza opened the first Indian hospice, Shanti Avedna Ashram, in Mumbai, Maharashtra, central India.}}{{cite book|last=(Singapore)|first=Academy of Medicine|title=Annals of the Academy of Medicine, Singapore|url=https://books.google.com/books?id=eO9NAQAAIAAJ|access-date=30 June 2013|year=1994|publisher=Academy of Medicine.|page=257}}{{cite news | url = http://articles.timesofindia.indiatimes.com/2011-03-08/mumbai/28667751_1_first-hospice-patients-biggest-endorsement | archive-url = https://web.archive.org/web/20130924115700/http://articles.timesofindia.indiatimes.com/2011-03-08/mumbai/28667751_1_first-hospice-patients-biggest-endorsement | url-status = dead | archive-date = September 24, 2013 | title = At India's first hospice, every life is important | first = Malathy | last = Iyer | date = Mar 8, 2011 | access-date = 2013-06-30| work = [[The Times of India]] |quote=The pin drop silence gives no indication that there are 60 patients admitted at the moment in Shanti Avedna Sadan-the country's first hospice that is located on the quiet incline leading to the Mount Mary Church in Bandra. }} The first hospice in the Nordics opened in [[Tampere, Finland]] in 1988.{{cite web|url=https://www.pirkanmaanhoitokoti.fi/in-english/|title=Welcome to Pirkanmaa Hospice - Pirkanmaan Hoitokoti|website= pirkanmaanhoitokoti.fi|access-date=2018-11-28|archive-date=2018-08-13|archive-url=https://web.archive.org/web/20180813144034/https://www.pirkanmaanhoitokoti.fi/in-english/|url-status=dead}} The first modern free-standing hospice in [[China]] opened in [[Shanghai]] in 1988.{{cite book | last = Pang | first = Samantha Mei-che | title = Nursing Ethics in Modern China: Conflicting Values and Competing Role | publisher = Rodopi | year = 2003 | isbn = 90-420-0944-6 | page = 80}} The first hospice unit in Taiwan, where the term for hospice translates as "peaceful care", opened in 1990.{{cite journal|last=Lai|first=Yuen-Liang|author2=Wen Hao Su|date=September 1997|title=Palliative medicine and the hospice movement in Taiwan|journal=Supportive Care in Cancer|volume=5|issue=5|pages=348–350|doi=10.1007/s005200050090|pmid=9322344|s2cid=25702519|issn=0941-4355}} The first free-standing hospice in [[Hong Kong]], where the term for hospice translates as "well-ending service", opened in 1992.{{cite web | url = http://www.ha.org.hk/haho/ho/hesd/100170e.htm | title = Bradbury Hospice | publisher = Hospital Authority, Hong Kong | access-date = 2009-02-21 | quote = Established by the [[Society for the Promotion of Hospice Care]] in 1992, Bradbury Hospice was the first institution in Hong Kong to provide specialist hospice care.}} [91] => [92] => The International Hospice Institute was founded in 1984. [93] => [94] => ==== World Hospice and Palliative Care Day ==== [95] => In 2006, the first World Hospice and Palliative Care Day was organised by the Worldwide Palliative Care Alliance, a network of hospice and palliative care national and regional organisations that support the development of hospice and palliative care worldwide. The event takes place on the second Saturday of October every year.[http://www.worldday.org/about/ About] {{Webarchive|url=https://web.archive.org/web/20140714221522/http://www.worldday.org/about/ |date=2014-07-14 }} World Hospice and Palliative Care Day (visited 24. July 2014 [96] => [97] => === Hospice home health === [98] => Nurses that work in hospice in the home healthcare setting aim to relieve pain and holistically support their patient and the patient's family. Patients can receive hospice care when they have less than six months to live or would like to shift the focus of care from curative to comfort care. The goal of hospice care is to meet the needs of both the patient and family, knowing that a home death is not always the best outcome. Medicare covers all costs of hospice treatment.{{Cite book|url=https://www.worldcat.org/oclc/1019995724|title=Community/public health nursing : promoting the health of populations|others=Nies, Mary A. (Mary Albrecht),, McEwen, Melanie|date=October 2018|isbn=978-0-323-52894-8|edition=Edition 7|location=St. Louis, Missouri|oclc=1019995724}} [99] => [100] => The hospice home health nurse must be skilled in both physical care and psychosocial care. Most nurses will work with a team that includes a physician, social worker and possibly a spiritual care counselor. Some of the nurse's duties will include reassuring family members, and ensuring adequate pain control. The nurse will need to explain to the patient and family that a pain-free death is possible, and scheduled opioid pain medications are appropriate in this case. The nurse will need to work closely with the medical provider to ensure that dosing is appropriate, and in the case of tolerance, the dose is raised. The nurse should be aware of cultural differences and needs and should aim to meet them. The nurse will also support the family after death and connect the family to bereavement services. [101] => [102] => ==See also== [103] => {{Portal|Medicine}} [104] => *[[Ann Robertson (nurse)|Ann Robertson]] [105] => *[[Children's hospice]] [106] => *[[Deathbed phenomena]] [107] => *[[Death midwife]] [108] => * [[Hospice care in the United States]] [109] => *[[Hospice chaplain]] [110] => *[[Life support]] [111] => *[[Opioid]] [112] => *[[Pain management]] [113] => *[[Robert Twycross]] [114] => *[[Worldwide Hospice and Palliative Care Alliance]] [115] => [116] => ==References== [117] => {{reflist}} [118] => [119] => ==Further reading== [120] => * "A Dignified Death: Hospices in the U.S. are increasingly run by for-profit providers, and a lack of regulation allows them to deliver abysmal end-of-life care", by the editors, ''[[Scientific American]]'', vol. 330, no. 2 (February 2024), pp. 68–69. "Today [in the U.S.] nearly three quarters of hospice agencies operate on a [[for-profit]] basis. The sector has become so lucrative that in recent years [[private equity firms]] and [[publicly traded corporations]] have been snapping up previously [[nonprofit]] hospices at record rates. This... has had pernicious effects on hospice care in the U.S." (p. 68.) [121] => *{{cite book | last = Saunders | first = Cicely M. |author2=Robert Kastenbaum | title = Hospice Care on the International Scene | publisher = Springer Pub. Co. | year = 1997 | isbn = 0-8261-9580-6}} [122] => *Szeloch Henryk, Hospice as a place of pastoral and palliative care over a badly ill person, Wyd. UKSW Warszawa 2012, {{ISSN|1895-3204}} [123] => *Worpole, Ken, Modern Hospice Design: the architecture of palliative care, Routledge, {{ISBN|978-0-415-45179-6}} [124] => [125] => ==External links== [126] => {{commons category-inline|Hospice}} [127] => [128] => {{Care navbox}} [129] => {{Health care}} [130] => [131] => {{Authority control}} [132] => [133] => [[Category:Hospice| ]] [134] => [[Category:Caregiving]] [135] => [[Category:Types of health care facilities]] [] => )
good wiki

Hospice

Hospice is a specialized form of healthcare that focuses on providing holistic and compassionate care for individuals who have a terminal illness or are facing the end of their lives. The main goal of hospice is to improve the quality of life for patients by addressing their physical, emotional, and spiritual needs, while also supporting their families and loved ones.

More about us

About

The main goal of hospice is to improve the quality of life for patients by addressing their physical, emotional, and spiritual needs, while also supporting their families and loved ones. The Wikipedia page on hospice provides comprehensive information about the origins, history, philosophy, and services offered by hospice care. It traces the roots of modern hospice back to the 1960s when Dame Cicely Saunders, a British physician, pioneered the concept of specialized care for the dying. The page also discusses the evolution of hospice from a grassroots movement to a widely recognized and regulated form of healthcare in many countries. The page delves into the principles that underpin hospice care, including the emphasis on pain management, symptom control, and palliative care. It highlights the multidisciplinary approach taken by hospice teams, which often consist of doctors, nurses, social workers, chaplains, and volunteers. The page also explores the role of hospice in supporting patients and their families through emotional and spiritual counseling, respite care, and bereavement support. Furthermore, the Wikipedia entry delves into the different types of hospice care settings, such as inpatient hospices, home-based care, and residential care facilities. It provides information on the eligibility criteria for hospice care, the process of admission, and the reimbursement systems in various countries, including the United States. The page also addresses common misconceptions about hospice and clarifies its distinction from palliative care and other end-of-life options. It explores the challenges and criticisms faced by hospice, such as the perception that it hastens death and the complex ethical concerns involved in decision-making for patients who are unable to communicate their preferences. In conclusion, the Wikipedia page on hospice provides a comprehensive overview of this specialized form of care. It covers the historical context, principles, services, and various aspects of hospice, offering readers a solid foundation of knowledge about this important aspect of end-of-life care.

Expert Team

Vivamus eget neque lacus. Pellentesque egauris ex.

Award winning agency

Lorem ipsum, dolor sit amet consectetur elitorceat .

10 Year Exp.

Pellen tesque eget, mauris lorem iupsum neque lacus.

You might be interested in

Cancer

Cancer is a broad term used to describe a group of diseases characterized by the uncontrolled growth and spread of abnormal cells in the body.

France

France is a country located in Western Europe.

Hospital

A hospital is a healthcare institution that provides medical and surgical treatment to patients.

Medicaid

Medicaid is a joint federal and state program in the United States that aims to provide healthcare coverage to low-income individuals and families.

Nonprofit

Physician

A physician, medical doctor, or doctor, is a professional who practices medicine, which is concerned with promoting, maintaining, or restoring health through the study, diagnosis, and treatment of disease, injury, and other physical and mental impairments.

Spain

The Wikipedia page for Spain provides an extensive summary of the country's history, culture, geography, politics, economy, and more.