Hospice

Hospice care was introduced in the United States in 1974 in response to the growing concern about the medicalization of dying. The first hospice in the United States was the Connecticut Hospice in New Haven. At that time, within health care, the emphasis was on curing illnesses and prolonging life, often at tremendous cost and with limited input from the seriously ill person. Patients typically viewed physicians as "experts" and deferred to their judgment.

The lay community, and some health care professionals, were growing increasingly concerned about their family members, friends, and neighbors dying in hospitals across the United States. There was general consensus that there had to be a better way to assure that persons at the end of life did not die alone and in pain.

Hospice emerged as an alternative to traditional health care, with the majority of care being provided by volunteers. The services provided by hospice programs were typically free, since health care insurers did not recognize hospice as part of the larger health care system. In order to be eligible for hospice, a patient's physician had to specify that the person was expected to live a year or less and that the focus of care would shift away from cure to palliation of symptoms. During the early years of the movement, it was emphasized that hospice was a concept, not a place.

Initially, the expectation was that, in order to receive hospice care, a terminally ill person would have at least one family member or friend who was willing to assume responsibility for his or her personal care. This criterion has evolved over time to provide greater flexibility for persons who are single, providing an option for such individuals to hire a caregiver or to move into a more structured environment when personal-care needs warrant additional assistance.