Whereas nursing homes emerged to serve the needs for long-term care not met by hospitals, hospices emerged out of growing public recognition that neither of these options provided appropriate care for the dying.
Only in the past few decades has institutional care for the dying become a public issue. At the beginning of the 20th century, few individuals experienced a long period during which they were known to be dying. Instead, most succumbed quickly to illnesses such as pneumonia, influenza, tuberculosis, or acute intestinal infections, dying at home and at relatively young ages. Now, however, most Amer- icans live long enough to die from chronic rather than acute illnesses. In addition, as doctors and scientists have developed techniques for detecting illnesses in their earliest stages, they now more often identify individuals as terminally ill long be- fore death occurs. Thus, dealing with the dying is to some extent a uniquely mod- ern problem and certainly has taken on a uniquely modern aspect.
Although modern medical care has proved lifesaving for many people, its ability to extend life can turn from a blessing to a curse for those who are dying.For various reasons, including legal concerns about restricting care, financial incentives for using highly invasive treatments, and a medical culture (described in the next chapter) that emphasizes technological interventions, thousands of Americans each year receive intensive, painful, and tremendously expensive medical care that offers little hope of restoring quality of life or extending lives. In nursing homes, on the other hand, the emphasis on profit making and cost cutting often results in dying persons receiving only minimal and depersonalized custodial care.
This lack of appropriate care for the dying led to the development of the hospice movement. The first modern hospice, St. Christopher’s, was founded in England in 1968 by Dr. Cicely Saunders to address the needs of the dying and to provide an alternative to the alienating and dehumanizing experience of hospi- tal death. The hospice admitted only patients expected to die within six months and offered only palliative care (designed to reduce pain and discomfort) rather than treatment or mechanical life supports. The hospice provided care in both St. Christopher’s and patients’ homes.
The first American hospice, which closely resembled St. Christopher’s, opened in 1974 in New Haven, Connecticut. Other hospices soon followed, emerging from grassroots organizations of religious workers, health care workers, and community ac- tivists seeking alternatives to hospitals and nursing homes. Public support for hospices was so immediate and so great that in 1982, only eight years after the first American hospice opened, Congress approved covering hospice care under Medicare.