Elder Care

A Short History of Hospice and Palliative Care

By John F. Tomczak

Hospice is a philosophy of caring that respects and values the dignity and worth of each person and good hospice care is the practical expression of that personal and professional commitment.

Hospices are for people approaching death, but hospices cherish and emphasize life, by helping patients (and those who love and care for them) to live each day to the fullest.

My book “Shared Knowledge” is focused on the bereaved. However the care of the bereaved, as we know it, comes from the hospice movement.

Middle Ages

Religious orders establish “hospices” at key crossroads on the way to religious shrines like Santiago de Compostela, Chartes and Rome. These shelters helped pilgrims, many of whom were traveling to these shrines seeking miraculous cure of chronic and fatal illnesses.

Many died in these shelters while on their pilgrimages.

During the Crusades, hospices were established in many places in Europe and the near East to care for the wounded and sick.

16th – 18th Centuries

Religious orders offer care of the sick and dying in locally or regionally based institutions. Most people died at home, cared for by the women in the family.


Madame Garnier of Lyon, France opens a “calvaire” to care for the dying. In 1879 Mother Mary Aikenhead of the Irish Sisters of Charity opens Our Lady’s Hospice in Dublin caring only for the dying. By the late 19th century the increase in municipal or charitably-financed infirmaries, almshouses and hospitals, and the expansion of medical knowledge, begins the process of “medicalizing” dying. By the mid-20th century, almost 80% of people die in a hospital or nursing home.


The Irish Sisters of Charity open St. Joseph’s Hospice in East London, to care for the sick and the dying.

Early 1900s

In London, St. Luke’s Hospice and the Hospice of God open to serve the destitute dying.


Interest grows in the psychosocial aspects of dying and bereavement, sparked by the work of Worcester, Bowlby, Lindemann, Hinton, Kuber-Ross, Raphael, Worden and others.

1957 – 1967

Cicely Saunders, a young physician previously trained as a nurse and a social worker, works at St. Joseph’s Hospice, studying pain control in advanced cancer. Here Dr. Saunders pioneered in the regular use of opioid analgesics “given by the clock” instead of waiting for the pain to return before giving drugs. This is now standard practice in good hospice and palliative care.


Dr. Saunders opens St. Christopher’s Hospice in London, emphasizing the multi-disciplinary approach to caring for the dying, the regular use of opioids to control physical pain, and careful attention to social, spiritual and psychological suffering to patients and families.


Many hospice and palliative care programs open in Great Britain in the years following, adapting the St. Christopher’s model to meet local needs, offering in-patient and home care.


The first hospices in Canada opened at the St Boniface General Hospital in November 1974 under the direction of David Skelton, followed a short time later at the Royal Victoria Hospital in Montreal.

New Haven Hospice (now Connecticut Hospice) begins hospice home care in the United States, caring for people with cancer ALS and other fatal illnesses.

1975 – 1978

Hospices and Palliative care units are opened across North America. These include hospices in California, the palliative care unit at the Royal Victoria in Montreal, the support team at St.Luke’s in New York City, and Church Hospice in Baltimore.


Hospice care, usually emphasizing home care, expands throughout the United States and Canada. In the United States, Medicare adds a hospice benefit in 1984. Hospices began to care for people with advanced AIDS.

Almost 3000 hospices and palliative care programs serve the United States. There are well established hospices and palliative care in Canada, Australia, New Zealand, and much of Asia and Western Europe. Hospices and palliative care is now available in over 40 countries worldwide, including many less-developed Nations.

The World Heath Organization sets standards for palliative care and pain control, calling it a “priority.” But studies show that most patients still receive little or no effective palliative care, and pain is often very poorly controlled, primarily due to lack of medical knowledge, to unfounded fears of addiction, and (in less developed nations) to shortage of opioids.

The principles of good hospice and palliative care are understood and accepted and all patients who choose to accept hospice palliative care can be assured of competent and compassionate care in their home, in nursing homes, hospitals and hospices.

Copyright John F. Tomczak. All rights reserved