Hospice Care in The United States - History and Statistics

History and Statistics

The first hospices are believed to have originated in the 11th century when for the first time the incurably ill were permitted into places dedicated to treatment by Crusaders. In the early 14th century, the order of the Knights Hospitaller of St. John of Jerusalem opened the first hospice in Rhodes, meant to provide refuge for travelers and care for the ill and dying. But the hospice practice languished until revived in the 17th century in France by the Daughters of Charity of Saint Vincent de Paul and, later, by the Irish Sisters of Charity, who opened St Joseph's Hospice in London, England in 1902. It was there in the 1950s that Cicely Saunders, who later founded St Christopher's Hospice in London, developed many of the foundational principles of modern hospice care.

In 1971, Hospice, Inc. was founded in the United States, first bringing the principles of modern hospice care to that country. Throughout the 1970s, the philosophies of hospice were being implemented throughout the United States. The hospice movement in the United States soon distinguished itself from that in Britain, according to Stephen Connor's Hospice: Practice, Pitfalls and Promise, by "a greater emphasis on use of volunteers and more focus on psychological preparation for death". Medicare, a social insurance program in the United States, added hospice services to its coverage in 1982. On September 13, 1982, by request of the senate, US President Ronald Reagan proclaimed the week of November 7 through November 14, 1982, as National Hospice Week.

Since then, the hospice industry has rapidly expanded. By 1995, hospices were a $2.8 billion industry, with $1.9 billion from Medicare alone funding patients in 1,857 hospice programs with Medicare certification. In that year, 72% of hospice providers were non-profit. By 1998, there were 3,200 hospices either in operation or under development throughout the United States and Puerto Rico, according to the National Hospice and Palliative Care Organization (NHPCO). According to 2007's Last Rights: Rescuing the End of Life from the Medical System, hospice sites are expanding at a national rate of about 3.5% per year. In 2007, 1.4 million people in the United States utilized hospice, with more than one-third of dying Americans utilizing the service, approximately 39%. In 2008, Medicare alone, which pays for 80% of hospice treatment, paid $10 billion to the 4,000 Medicare-certified providers in the United States.

As the hospice industry has expanded, so, too, has the concept of hospice care. 2003 saw the opening of the first US children's hospice facility, the George Mark Children's House Hospice in San Francisco. In February, 2009, Buffalo News reported that the balance of non-profit and for-profit hospices was shifting, with the latter as "the fastest-growing slice of the industry."