There are approximately 2,000 active in the United States.

Christian Movement

	Public infirmaries provided care for dying people as well as patients likely to recover
	Julian, a Roman emperor, and opponent to Christianity, acknowledged these "owing to the humanity evinced by Christians toward outsiders"

	Credited with bringing hospice care to western Europe, thereby laying the foundation for current palliative care services.
	Inspired by monasteries in the Holy Land

Cicely Saunders

	Introduced modern hospice care when she founded St. Christopher's Hospice in London in 1967.
	Christian physician

St. Christopher's

	70 beds with 54 for cancer and the remainder by elderly patients who can't function independently
	Cancer patient stays 12 days on average
	Pets and children are welcome
	Long visiting hours
	Smoking and drinking allowed
	Brompton's cocktail for pain relief
	80% cost of hospital, with largest percentage going to salaries
	No IVs, respirators, and related devices
	Death comes quickly
	Family encouraged to participate in death and sitting with body
	Home care program as outpatients
	Philosophy: control of pain and other symptoms, accessibility to medical and nursing care, use of trained volunteers and family members as caregivers, home care component, bereavement program for survivors

International Task Force

	Critical of the type of terminal care provided in most hospitals in the early 1970's.
	The "hidden" or implicit standards included: Few people are on the scene. There is, in effect, no scene. The "successful" death is quiet, slipping with little notice. Attention is focused on the body during the caregiving process. Death at right time, with "happy" staff.

Recommended all of the following standards of care for terminally ill people and their families: Control the pain. Provide a sense of basic security and emotional safety. Respect the patient's intentions as expressed in a living will.

	Reduce pain and other symptoms to protect quality of life.
	Not curative. Condones neither euthanasia or prolonging of dying Active total care of patients whose disease is not responsive to curative treatment To control physical symptoms Goal is healing not curing

The area that is served by a health care agency.

In New Haven, America's first, was established in 1974

Requires that full service hospices have an interdisciplinary team that includes a Nurse Physician Social worker Pastor or Counselor

Must be available 24 hours every day.

	Well acquainted before admission
	A process, not just a place
	Affirmation of human contact
	Family is both a provider and recipient of care

The daughter's response to "a hospice vignette presented in the text, was "It was really right....and she was ready to go."

	At home
	At a medical care facility
	Adult respite care
	Hospice day care programs

The nurse who worked with "Mrs. Doe" in another hospice case Taught Mr. Doe how to give his wife good skin-care. Brought in a physiotherapist to teach Mrs. D. breathing exercises. Listened carefully to Mrs. D's needs and answered her questions.

	Three unsuccessful kidney transplants
	Experiences during her terminal illness demonstrated: the lack of success of traditional medical care in comforting the dying child the lack of active involvement of the family.

A recent survey shows that most hospice programs provide a full range of services to AIDS patients without bias.

In general, people who are not part of the mainstream culture, such as prisoners, the homeless, and the impoverished Die at an earlier age. Receive less medical and social support in their terminal illness.

A study has found that hospital-based nurses and physicians Hold positive attitudes toward hospice but are not well informed about the state of the art in pain relief.

	Still cannot be measured precisely.
	Remains a primary goal for hospice and for palliative care.

Experts suggest all of the following ways to relieve pain in terminally ill patients without surgery or drugs Electrical nerve stimulation to the skin. Guided imagery. Massage.

According to a recent study by Dobratz, uncontrollable pain is experienced by about 10% of terminally ill patients at the time they are admitted into hospice care programs.

	"How would you like your last three days of life to be?"
	Hospice patients answered: "I want to be free from pain." "I want the last three days to be like any other days." "I want (a particular person) to be with me."

Most college students portray themselves as dying without pain or other symptoms.

In qualifying hospice Medicare benefits, a patient must be certified as having a life expectancy of six months or less.

A major study reported in the New England Journal of Medicine finds that most physicians refer patients to hospice programs too late.

	On the international scene, hospice programs are growing rapidly throughout much of the world.
	A high priority for hospice programs around the world is educating the general public and human service professionals.

Contrasting Medical Care

Hospitals

	80% of terminal care is by hospitals and nursing homes
	Short-term, acute care
	Aggressive techniques to diagnose symptoms, provide treatment, and sustain life
	Average stay is now 6 days
	Primary goal: rehabilitation

Nursing homes

	Convalescent care and extended care nursing facilities) less-sophisticated care
	Care for the chronically ill
	Length of stay is longer
	3/4 return to community, 1/4 die in nursing homes
	Skilled nursing facilities have RN on duty 24 hours and skilled paramedical staff
	Intermediate care offer less intensive care with RN or LVN during days

Hospice

	Designed especially for terminally ill
	Free of physical and psychological pain and provide a comfortable, homelike environment
	Friends and family often participate in care
	May be residential care, home care or supplement care in health care institutions
	Goal: pain free and comfortable without dramatic medical interventions when death approaches
	Exchange costly institutional care with less-expensive home care

	Hospice Foundation of America
	American Hospice Foundation - Opening New Doors to Hospice Care
	The National Hospice and Palliative Care Organization