Hospice care in the United States: a conversation with Florence S. Wald. Interview by M. J. Friedrich.

Abstract

IN THE LAST CENTURY, MEDICAL AND technological advances have provided new and better ways to keep death at bay. But while the ability to prolong life is welcome in many cases, in patients who are terminally ill, it can turn the issue of how and when to die into a technical decision in which the patient and family have little say. To redress this situation, hospice care was introduced to the United States 25 years ago. A hospice team consisting of physicians, nurses, social workers, chaplains, and volunteers helps terminally ill patients and their families come to terms with issues of death and dying. They provide palliative care for the patient and support for the family through the patient’s illness and bereavement counseling for family members after the patient’s death. The modern hospice movement, which was founded by British physician Cicely Saunders, who established St Christopher’s Hospice in London in 1967, was imported to the United States in the early 1970s. Instrumental to this effort was Florence Schorske Wald, MSN. Wald received a master’s degree from Yale School of Nursing in 1941. After serving in the US Army Signal Corps during World War II, she taught psychiatric nursing at Rutgers University and Yale. In 1958, she was named acting dean and, later, dean of the Yale School of Nursing. She stepped down in 1967 to explore the idea of introducing hospice care to this country. With an interdisciplinary group from Yale and New Haven, Conn, she established the first US hospice, the Connecticut Hospice in Branford, which began providing home care in 1974 and in 1980 added an inpatient facility. In 1998, the National Hospice Organization reported that there were more than 3000 working or planned hospice programs in the United States.