What is Hospice?

Hospice is a philosophy not a building!
"You matter because you are. You matter until the very last moment of your life. And we will do all we can; not only to help you die peacefully, but to live until you die." Dame Cicely Saunders - Founder of the Modern Day Hospice Movement.

The hospice care philosophy sees death as a normal part of living, instead of something to always struggle against, and seeks to reduce the suffering involved in the dying process for both the dying person and his or her loved ones.

Hospice support (or palliative care) should not only start when the medical profession have given up on curing a patient. It can start at the time of diagnosis of a terminal or life limiting condition while doctors are still trying to cure or prolong life. People living with HIV and taking ART can still benefit from hospice support.

The history of hospice

The Sisters of Charity, an order of Roman Catholic nuns in Ireland, started the first hospice in Dublin in 1879. Hospitals at that time did not accept patients with fevers or contagious illnesses, so Our Lady's Hospice was a refuge for the infectious, the poor, and the dying. The Sisters kept patients well nourished and comfortable in their last days, and lent their comforting presence to people who had no relatives or friends to care for them.

The modern hospice movement began in 1967 when Dame Cicely Saunders opened St. Christopher's Hospice in London. St. Christopher's Hospice emphasized a multidisciplinary approach to care for the dying, and provided social, spiritual, and emotional support in addition to relieving pain and other physical symptoms. This team approach to hospice is still used today, although most hospice patients receive care and services at home instead of inpatient hospice facilities.

The hospice and palliative care movement in Africa started in 1979 with the establishment of the first hospice program, Island Hospice, in Harare, Zimbabwe. This program and others that followed in South Africa, Kenya, and Uganda were modeled on the principles of hospice care from the United Kingdom but focused on the provision of home-based care for patients and not on specialized in-patient facilities. With the advent of the HIV/AIDS epidemic, the programs modified their services to meet the needs of the ever-increasing number of AIDS patients in their communities.

Models of care

Hospices deliver palliative care in three main ways:

1. Hospice Home based care - mobile teams of professionally supervised trained community caregivers travel to people's homes and support and teach families to provide care at home. This is the primary means of service delivery for patients who are home-bound. Not only is this cost effective, but it also allows the patient to be at home where they often prefer to be.
2. Hospice Community centres - many hospices work from established bases within the community. At these bases they will meet with groups of people who have palliative care needs. The type of patient who would attend these meetings is still reasonably well and mobile. Doctors, nurses, social workers and other professionals will attend the centres regularly to assist those with individual needs. These centres provide excellent forums for those facing life-limiting illness to connect meaningfully with others in support groups. At many such centres, a variety of skills are also taught and income generating projects initiated.
3. Hospice In patient units - some hospices have in-patient units. This is a facility that provides 24 hour palliative care. Usually these units have a small number of beds and have specific criteria for admission. A patient who has pain that is difficult to control at home, or a patient whose family need respite, or a patient who has absolutely no support systems at home, are some of those who may be admitted at such an in-patient unit.

Outside of hospice programmes, palliative care can also be delivered by trained specialists across the health care continuum. Some hospitals have palliative care teams or wards. Through HPCA driven initiatives, many doctors, nurses, pastors and social workers from NGO's, the public and private health care sector are receiving training in palliative care and are providing this special brand of care.