Hospice: A Very Old Concept
Most people today know of hospice and what it means within our health care system. Basically, it is a system and philosophy of health care that ensures comfort, not cure, when someone has been deemed to be terminal. Medicare provides a model for developing hospice programs throughout America, and all hospices that wish to be reimbursed by Medicare operate in accord with that prototype. But, the hospice philosophy is not new by any means.
One of the historical facts that I find fascinating is that Western Europe created a system of end-of-life care that dates as far back as 1000 A.D. Much of the care was provided by physician-monks and nuns, and patients often came to these hospices for comfort when they knew they were dying. And furthermore, finding unique ways to relieve a person’s struggles and fears prior to death was considered a caregiver’s art. Such techniques as prayer, visualization, music, chant, and reflection, just to name a few, were used to relieve spiritual pain so that the person could cross over more peacefully.
I own an artist’s rendering of a large hospice that was conceived in the mid-fifteenth century by Nicholas of Rolin, founder of God’s Hotel in Beaune, France. Nicholas is quoted as saying, “The only measure of a society’s greatness depends upon how it cares for the poorest of its poor at the end of life.” This magnificent structure housed men and women who were too ill to care for themselves and the caregivers there provided the finest in comfort care that one could receive at that time. This hospice did not serve the privileged nobility of that time but rather it was dedicated as a hotel for social outcasts. The building itself is an architectural wonder in many respects. For example, it is built over a river with a glass floor underneath the beds, which allowed patients to hear the soothing sound of running water.
Hospices in Western Europe were usually built along trade routes, which allowed more people to access them. A core belief of their hospice model was that care of someone’s soul was every bit as important as care of the body. I have learned that a caregiver was required to apprentice for 20 years before he or she was allowed to attend their first death.
Learning about the roots of the hospice movement in Western Europe has energized and renewed my interest in end-of-life care. I am tantalized by the fact that caregivers of that time recognized, as I do, that the dying are our teachers. As I go through my daily activities at the bedside of those who are making ready to cross the river, I listen and I learn—about life, relationships, ways to do things better to relieve my own suffering as well as others’, pain (physical and emotional and spiritual), joy, love, and remembering. It is heartening to me to see how many family members today are stepping up to the plate to care for their loved one in the final hours, and I know, without a doubt, that the blessings they receive will ultimately far outweigh the burdens of caring for someone who is extremely ill.
About the Author
Paula Schneider, a Dialogue on Death & Dying facilitator, graduated with a nursing degree from the University of Texas in 1976 and later received a master’s degree in public health from the University of Texas in the early 1990’s. Ultimately, she worked as a Registered Nurse for 40 years, and her career included various nursing positions in Public Health and Hospice.
