An older man holding a ball and working on physical therapy


Written by Jacob Terranova


While the idea of hospice itself dates to the medieval ages, our idea of hospice today is still a fairly new concept.


Back in the medieval ages, hospice was simply a lodging for weary or ill travelers on long journeys. And these hospice houses were owned and operated by religious institutions, primarily the Roman Catholic Church.


But our modern concept of hospice is only about 70 years old. In terms of the deathcare and funeral profession, that means it’s still relatively young. Let’s explore how hospice began and how it might someday look.


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Hospice and Its Early History

According to the National Hospice and Palliative Care Organization (NHPCO), modern hospice began around 1948. It started in a London suburb with the physician Dame Cicely Mary Saunders.


Saunders had grown attached to one of her patients, David Tasma. Tasma was dying of cancer, and upon his death, he gifted Saunders a large donation. That money would be used to help establish the St. Christopher’s Hospice in 1968.


During her time caring for the terminally ill, Saunders wanted to share what she had learned to create a better way of dying. Before founding St. Christopher’s, she presented several lectures and wrote many articles and books about caring for the dying.


According to the St. Christopher’s Hospice website, Saunders founded the first hospice “linking expert pain and symptom control, compassionate care, teaching and clinical research… Through her single-minded vision, and the clinical practice and dissemination of her work through St Christopher’s teaching and outreach, Dame Cicely [revolutionized] the way in which society cares for the ill, the dying and the bereaved.”


Timeline of Modern Hospice Movement

The lectures and work of Dame Cicely Mary Saunders helped set in motion the modern hospice movement. Here’s a brief timeline of some of the important events in the evolution of modern hospice in the United States:

  • 1969: Elisabeth Kubler-Ross published On Death and Dying. The book would go on to influence both the hospice and funeral profession. Its focus was on a more personal treatment for a person’s death, as opposed to a clinical setting.
  • 1971: Hospice Inc. was founded in the United States, helping to usher in the practices of modern hospice and palliative care.
  • 1974: The first modern hospice, the Connecticut Hospice, opened in the United States. One of the founders was Florence Wald, who became known as the mother of the American hospice movement.
  • 1979: The Health Care Financing Administration (HCFA) launched 26 hospice programs around the country to help learn more about hospice and what it should provide patients.
  • 1982: Medicare began to cover hospice services. President Ronald Reagan also declared November 7th-14th as National Hospice Week.

Hospice Today

In the U.S. today, there are an estimated 6,100 hospice programs located in all 50 states. That’s a lot of growth since the first U.S. hospice opened back in 1974. According to a report by the NHPCO, close to 30% of hospices in the U.S. are not-for-profit organizations.


The primary reason people enter hospice care is for terminal cases of cancer. Around 36% of all patients are cancer cases. The next top three reasons are for dementia, heart disease, and lung disease.


Hospice today still practices much of the same principles instilled by Florence Ward and Dame Cicely Mary Saunders.


The Hospice Philosophy Statement of the NHCPO states that:


“Hospice provides support and care for persons in the last phases of an incurable disease so that they may live as fully and as comfortably as possible. Hospice recognizes that the dying process is a part of the normal process of living and focuses on enhancing the quality of remaining life… [It] exists in the hope and belief that through appropriate care, and the promotion of a caring community sensitive to their needs that individuals and their families may be free to attain a degree of satisfaction in preparation for death.”


The Future of Hospice

Because modern hospice is still relatively new, there are some pioneers pushing the field in hopes of expanding and improving hospice care.


For example, there is BJ Miller, a palliative care specialist. Miller aimed to redefine death and how we approach it in modern society. It led him to create the Guest House, a volunteer-run hospice house that offers patients spiritual and communal support, including things like meditation, therapy, and even home-cooked comfort food.


In the future, experts expect to see more of this approach. Everyone knows that they will die. But for the most part, very little time is spent on how they die.


As modern hospice continues to evolve, it won’t simply be about preventing pain. It will include a well-rounded and humanistic approach that focuses on comfort, spirituality, relationships, and personal development right up until the final moments.


Why Funeral Homes and Hospice Should Work Together

Funeral directors can help play an important role when it comes to shaping the future of hospice. It comes down to the continuum of care. Funeral directors should seek to build relationships with hospice patients and their families long before the death.


By getting to know hospice patients, funeral directors can directly learn about them, their experiences, and how they want to be remembered. This can help shape the funeral service to create a personal experience that thoughtfully captures the personality and life of the deceased. And it also creates a powerful healing experience for the bereaved families.