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Cancer Supportive and Survivorship Care Programs Improving Quality of Life Logo

Irene Harrison, LCSW

Hospice is derived from the Latin word hospitium, hospitality, an inn for travelers, especially one kept by a religious order. The hospice movement was started by Dr. Cicely Saunders in England in the 1940s, when St. Christopher's Hospice was opened to provide a quiet place where people could die in peace and dignity. It was staffed by nuns who had a sense of commitment to service.

Hospice care was introduced in the United States in 1974 at Yale in New Haven, Connecticut. Since then, the movement has expanded rapidly, with programs based on several organizational models: all-volunteer, hospital-based, integrated with home health agencies or freestanding community hospices. Though diverse, these programs share a philosophy.

Despite all the advances in diagnosis and treatment, a cure is not always possible. Continued treatment, even if available, may compromise a patient's quality of life. After discussion with the physician and consideration of treatment options and the potential outcomes, it may be appropriate to consider palliative (comfort) care. Some patients and families are frightened by the word hospice, believing that all treatment will be discontinued and the patient is being sent home to die. But many kinds of treatment may be continued to provide comfort and relief of pain.

The hospice philosophy embraces a holistic approach that encompasses physical, emotional and spiritual concerns. The patient and family are seen as the unit of care. Care has to be individualized to meet the patient's and the family's needs, as well as being responsive to differences in lifestyles. The hospice philosophy:

- Affirms life
- Promotes self-determination, as patients and families participate in their plan of care
- Provides education to help patients and families provide appropriate care
- Promotes understanding and accepting that the journey of life eventually leads to death, and encourages people to view this experience as an opportunity for growth
- Emphasizes palliation, which includes physical, psychological and spiritual comfort delivered by a multidisciplinary staff

Some hospices are supported by the community with their own fundraising and donations; other programs have a large volunteer component. Hospices may be incorporated with home health agencies or hospitals, or they may receive funds from foundations and grants. Private health insurance and Medicaid are some other forms of reimbursement. In 1982, Medicare began reimbursing certified Medicare hospices, which must adhere to specific guidelines. Part A of Medicare covers most of the costs.

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