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Six Illustrative Innovations in Community-Based Long-Term Care

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Hospice is an ancient provision of community care for dying persons and their families that reemerged in the modern era with establishment of St. Christopher's Hospice outside London in 1967. The idea migrated to the United States in the 1970s but with a difference (Mor and Allen 2001). Whereas the English hospice was a community of caring for the dying within institutional walls, the American version has emphasized home care, or "hospice without walls." Hospice facilities did not receive federal financial support until the 1980s. The inadequacy of care at the end of life has been widely documented, particularly in hospital and nursing home settings (Field and Cassel 1997; Meier and Morrison 1999). The Institute of Medicine review reported by Field and Cassel documents widespread neglect of dying patients and their families in hospital wards, in nursing homes, and in medical education. The perceived inadequacy of care at the end of life in hospital settings, disenchantment with the unfulfilled promise of curative medicine, and a new sensitivity to the possibility of better care at the end of life have combined to promote the implementation in hospice of a new philosophy about care at the end of life in the community. This philosophy emphasizes the importance of developing and maintaining a homelike environment for terminal care, pain control, absence of high-technology medical and surgical interventions characteristic of hospitals, and emotional support for the dying patients and their families.

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