Our Roots

A Brief History of the Hospice Movement

From medieval shelters for weary travelers, to Cicely Saunders’ vision of “total pain,” to Florence Wald bringing that vision home to New England — Monadnock Hospice House continues a tradition of compassionate, community-rooted, end-of-life care that is now more than fifty years in the making.

Origins: The Word and The Idea

The word “hospice” comes from the Latin hospes (host, or guest). As far back as the 11th century, places of hospitality called “hospices” appear in recorded history — run by Roman Catholic religious orders to care for travelers, pilgrims, the sick, and the dying. These early institutions were closer to religious shelters than medical facilities, but they established the core idea that would endure for nearly a thousand years: a dedicated place of rest and care for those nearing the end of life.

Dame Cicely Saunders And The Birth Of The Modern Hospice (UK, 1960S)

The modern hospice movement traces directly to Dame Cicely Saunders, an English nurse, medical social worker, and later physician, who believed that a society which avoids the subject of the dying has an incomplete philosophy — and made it her life’s mission to change that.

A pivotal moment came in 1948, when Saunders formed a close friendship with a dying patient, Ela “David” Tasma, a Polish-Jewish refugee who had escaped the Warsaw Ghetto. He left her £500 to be “a window in her home” — a gift that helped germinate the idea for what became St. Christopher’s Hospice. She spent the following years researching pain control at St. Joseph’s Hospice in Hackney, and in 1957 earned her medical degree, giving her a rare combined background in nursing, social work, and medicine.

In 1967, Saunders founded St. Christopher’s Hospice in London, widely regarded as the first modern hospice, combining medical treatment with emotional, spiritual, and psychological support. Her central concept was “total pain” — the idea that suffering in terminally ill patients includes not just physical discomfort but psychological, social, and spiritual distress, requiring a multidisciplinary team of physicians, nurses, social workers, chaplains, and volunteers. St. Christopher’s became a model worldwide because it was the first hospice to link expert pain and symptom control with compassionate care, teaching, and clinical research, all under one roof.

Crossing The Atlantic: Florence Wald And American Hospice (1970S)

The American hospice movement has its own founding figure: Florence Wald, Dean of Yale School of Nursing. Wald’s interest in end-of-life care began in 1963, when she attended a Yale lecture by Cicely Saunders on palliative care or terminally ill cancer patients. Deeply affected, Wald resigned as dean in 1968 and traveled to England to study for a month at St. Christopher’s under Saunders directly.

Back in the U.S., Wald’s husband Henry left his engineering career to study hospital planning at Columbia University; his master’s thesis provided the framework for what became Connecticut Hospice. Wald organized a team of doctors, clergy, and nurses to study the needs of dying patients, leading to the founding of Connecticut Hospice in 1974 in Branford, CT — initially a home-care program, with its first 44-bed inpatient facility opening in 1980. As Wald put it: “In those days, terminally ill patients went through hell, and the family was never involved.”

Wald’s model was built on ten core principles of care, including that the patient and family are regarded as the unit of care, an interdisciplinary team provides services, trained volunteers are integral to that team, care runs 24/7, and patients are accepted based on health needs rather than ability to pay. Many of these principles still shape hospice standards today.

Formal Recognition And Expansion (1980S–Present)

As the model spread, it gained institutional and financial backing. In the U.S., the Medicare Hospice Benefit was established in 1982, funding hospice services and cementing hospice’s place in mainstream healthcare. By 1980, Medicaid also began covering hospice care, driving a sharp rise in the number of hospice facilities nationwide. By the time of Wald’s death in 2008, there were more than 3,000 hospice programs in the United States serving roughly 900,000 patients annually. Today, hospice care is available in over 100 countries, tailored to local cultural and societal needs.

Saunders herself continued to expand the field’s research base: in 2002, she co-founded Cicely Saunders International, which later helped create the world’s first purpose-built institute of palliative care. She died in 2005, fittingly, at St. Christopher’s Hospice — the institution she had founded nearly forty years earlier.