Although the hospice movement does not cater solely for older people, with an ageing population and the fact that deaths are concentrated in the older age groups, its activities are very relevant to the wellbeing of older people and positive ageing[1].
What is hospice?
The focus of the movement is palliative care – defined by the WHO as “the active total care of patients and their families by a multi-professional team when the patient’s disease is no longer responsive to curative treatment”. Palliative care affirms life, but accepts death as inevitable. It provides relief for patients from pain and other distressing symptoms and integrates the psychological, social and spiritual aspects of care, helping patients to come to terms with their own death as constructively as possible. It provides a support system that enables patients to live as actively as they can until death and offers support for families both during the patient’s illness and in bereavement. This differentiates hospice from hospital care, where the focus is to cure and return people to health.
In this context, hospice is a philosophy of care rather than a type of building or service. Its philosophy is that there is always something to be done to help patients. The movement has had a major impact around the world in promoting palliative care and improving care standards.
Hospice history
The roots of the words hospice and hospital are the same and date as far back as the 4th century AD when hospitality was provided for the poor, travellers, hungry, thirsty and sick[2]. They were also the places where the pilgrims on their journeys received food and medical care.
In later periods, hospice programmes emphasised inpatient care of the terminally ill – patients were admitted to a residential facility, where they received comfort and care from a multidisciplinary team of caregivers until they died.
The modern hospice movement started in the mid nineteenth century, mainly by religious orders, and has since spread all over the world. Pioneers in the twentieth century included Cicely Saunders and Elisabeth Kubler-Ross. Saunders used her experiences as a nurse, social worker and doctor, to integrate these skills, and opened the first modern hospice, St. Christopher’s, in London in 1967. In the United States, in the 1960s, Kubler-Ross wrote a book “On death and dying” which brought death to the public awareness. These women accelerated the spread of hospice in the UK, USA and the whole world.
A worldwide movement
Hospice programmes now provide a wide range of residential and home-based services[3]. Although there are different models and systems of palliative care, they have common attributes.
An average voluntary hospice consists of an inpatient unit; a day care centre; home care and outpatient clinics and a bereavement support service. They aim to offer a home-like atmosphere, in contrast to the rush of hospital wards. For example, staff usually do not wear uniforms and the décor and processes are as informal as possible. They may share facilities with hospitals to reduce costs. Palliative home care teams allow patients, who prefer to do so, to remain at home. Although many hospices cater mainly for cancer sufferers, they also cover other chronic and terminal illness such as renal, respiratory or cardiac failure, HIV/AIDS, motor neuron disease, etc.
The Hospice Movement in New Zealand
New Zealand’s first hospice, Mary Potter Hospice, was opened in Wellington in 1979. Later that year, Te Omanga Hospice in Lower Hutt, and Saint Joseph’s Mercy Hospice in Auckland, were also opened. Since then hospices have gained widespread respect in the community. But initially there was tension between the movement’s aims and the medical system that it sought to reform and inspire. For example, in the United States healthcare tended to be dominated by technology and the physical components of care overshadowed emotional and spiritual support.
Why do we need hospices?
Over the past 50 years, treatments have improved dramatically for illnesses which would have led to early deaths for many people in the past. These improvements mean we are living longer. But as we get older, we may have to live with more illnesses and disabilities for longer periods of time than was the case for past generations. Our healthcare system is set up by speciality, when patients are seen by several specialists that deal with one condition each. This means people living with multiple conditions may find it difficult to have a coordinated approach to their care. There has also been greater recognition of the value of holistic approaches to care and treatment. That’s where hospices come in.
In my next blog I will look at the challenges now facing the hospice movement, with examples from the situation of the Wellington Mary Potter Hospice.
[1] These blogs have been prompted by my personal experience of the work of hospice, and the Wellington services in particular, over recent weeks.
[2] Jindrich Polivka (2002) The hospice movement: History and current worldwide situation. Archive of Oncology, Vol.10(1):29-32.
[3] In 2006, the United States-based National Hospice and Palliative Care Organization and the United Kingdom’s Help the Hospices commissioned an independent, international study of worldwide palliative care practices. They found that 15% of countries offered palliative care services with integration into major health care institutions, while an additional 35% offered some form of palliative care services, though these might be localised or limited. In 2009, there were an estimated 10,000 programmes internationally intended to provide palliative care, although the term hospice is not always employed to describe such services (Wikipedia).
On Research 
We are so lucky to have this model of holistic care when health workers run out of options and we need comfort, not cure.
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