History of Hospice:

1963 – Dame Cicely Saunders introduces the idea of specialized care for the dying to the United
States in a lecture at Yale University
1965 – Florence Wald, Dean of the Yale School of Nursing, invites Dame Cicely Saunders to
become a visiting faculty member
1967 – Dame C. Saunders creates St. Christopher’s Hospice in the United Kingdom
1968- Florence Wald takes a sabbatical from Yale to work at St. Christopher’s Hospice
1969 – On Death and Dying, written by Dr. Elisabeth Kubler-Ross, identifies the 5 stages through
which many terminally ill patients progress

1972- Elisabeth Kubler-Ross testifies at the 1st national hearings on the subject of death with
dignity, conducted by the US Senate Special Committee on Aging.
1974- Florence Wald, along with 2 pediatricians and a chaplain, founds Connecticut Hospice in
Branford, Connecticut.
The 1st hospice legislation is introduced by Senators Franc Church and Frank E. Moss to
provide federal funds for hospice programs. The legislation is not enacted.
1975 – The 1st National Symposium on Hospice Care is convened in New Haven, Connecticut.
1977 – The 2nd National Symposium on Hospice Care is convened in Boonton, New Jersey.
The 3rd Symposium on Hospice Care is convened in Marin County, California.
1978 – National Hospice Organization NHO is established to promote the concept of hospice
care.
The 1st national NHO conference with 1000 participants is help in Washington, DC in
October.
A US Department of Health, Education and Welfare task force reports that “the hospice
movement is a viable concept and one which holds out a means of providing more humane
care for Americans dying of terminal illness while possible reducing costs. It is the proper
subject of federal support.”

1979 – The Health Care Financing Administration (HCFA) initiates demonstration programs at
26 hospices in 16 states to assess the cost effectiveness of hospice care and to help determine
what a hospice is and what is should provide.
 NHO issues the 1st Standards of a Hospice Program of Care,” adopted by the NHO Board
of Directors in February.
Cicely Saunders is made a Dame of the British Empire.
1st hospice program established in Africa: Island Hospice, Harare, Zimbabwe
Hospice is promoted through the film “Hospice: An Alternative Way of Care for the
Dying. “

1980 – Josefina Magno, MD, swerves as the 1st full-time Executive Director/President of NHO.
(1980-1982)
The W.K. Kellogg Foundation awards a grant to the Joint Commission on Accreditation of
Hospitals (JCAHO) to investigate the status of hospice and to develop standards for
accreditation.

1981 – Logo is officially registered as the property of the NHO

The National Hospice Education Project is set up for the sole purpose of passing
Medicare hospice Legislation
1st AIDS case is defined.
1982 – Congress includes a provision to create a Medicare hospice benefit.
Carl Akins serves as Executive Director/ President of NHO 1982-1983
Addition of hospice benefits in many 3rd party payer insurance plans 1982-1985
Proclamation of the 1st National Hospice Week in November.
NHO’s 5th annual meeting is held in Washington, DC.
NHO grows to 12 full-time paid staff.
NHO joins Medicare Initiative.
NHO’s 1st television PSA is aired, featuring actor Jack Klugman.

1983 – Initial Medicare Hospice Regulations are published in the Federal Register.
Regulations establish the 4 levels of care and outline the cost components of the routine
home care rate.
 JCAHO initiates hospice accreditation.
Human Immunodeficiency Virus HIV is isolated
Louise Bracknell serves as Executive Director/President of NHO (1983- 1984)

1984 – John J. Mahoney serves as Executive Director/President of NHO (1984-1998)

Dr. William Lamers is recognized with the NHO founder’s Award
The Joint Commission Hospice Accreditation Program is implemented
The HIV is recognized as the cause of HIV/AIDS and research on zidovudine and other
treatments gets underway.

1985 – Dr. Josefina Magno, dennis Rezendes, and Don Gaetz are recognized with the NHO
Founders Award.
Consolidated Omnibus Budget reconciliation Act of 1985 (COBRA, 85) does the
following:
Medicare Hospice Benefit is made permanent
States are given the option of including hospice in their Medicaid programs.
Permits payment of separate room and board rate for hospice patients residing in nursing
facilities.

1986 – Rev. Edward S. Dobihal, Jr. and Shirley Dobihal are recognized with the Founder’s
Award.
Ann Morgan Vickery is recognized with the NHO Woman of the Year award.
First NHO conference on management and interdisciplinary development is held.

1987 – Florence Wald and Zach Morfogen are recognized with the NHO founder’s Award.
1st Anti-retroviral drug (AZT) is approved by the US FDA to treat people with HIV but is
unavailable to most people in Africa.

1988 – Ewart V. Thomas is recognized with the NHO founder’s Award.

 Initiation of Community Health Accreditation Program (CHAP) hospice accreditation
program.
The 10th anniversary of NHO is celebrated at an annual meeting in Orlando.

1989 – Reverend William Manger is recognized with the NHO Founder’s Award.
The Government Accounting Office releases a study stating that only about 35% of
eligible hospices are Medicare-certified.
Congress gives hospices their 1st increase 20% in reimbursement since 1986 and ties
future increases to the annual increase in the hospital market basket through a provision
contained in the Omnibus Budget Reconciliation Act of 1989.
1990 – Dr. Balfour Mount is recognized with the NHO Founder’s Award
Passage of the Omnibus Reconciliation Act (OBRA, 1990) establishes an unlimited 4 th
election period for the Medicare Hospice Benefit
1991 – The Commission on the Future Structure of Veterans Health Care (Mission Commission)
releases a report recommending inclusion of hospice care in the veteran’s benefit package.
Dr. Derek Doyle is recognized with the NHO Founder’s Award
Department of Defense Authorizes coverage of hospice care in military hospitals or
under CHAMPUS
Patient Self Determination Act PSDA becomes effective and requires all health care
providers, including hospices, to discuss advance care planning wishes with patients during the
admission process.

1992 – congress passes the Indian Health Care Improvement Act of 1992, calling for a hospice
feasibility study.
National Hospice Foundation NHF is established.
Dame Cicely Saunders and Dr. Sylvia Anne Lack are recognized with the NHO Founder’s
Award
FDA approval of Combined Therapy for HIV/AIDS
1993 – Hospice is included as a nationally guaranteed benefit under President Clinton’s health
care reform proposal.
Dr. Elisabeth Kubler-Ross is recognized with the NHO Founder’s Award.
 NHO coordinates the display of the AIDS quilt in Salt Lake City.
An estimated 9 million adults in sub-Saharan Africa are infected with HIV with 1.7
million AIDS cases

1994 – HCFA sends memorandum alerting the regions of problems regarding questionable
certifications and recertifications of terminal illnesses, resulting in the 1 st “focused medical
review” for hospices.
Dr. Robert Twycross and Dr. William M. Lamers, Jr. are recognized with the NHO
Founder’s Award.
1995 – HCFA releases an expanded version of the Hospice Interpretive Guidelines, which
provides much needed clarification of the Conditions of Participation.
The Civilian Health and Medical Program of the Uniformed Services (CHAMPUS).
Hospice Benefit is implemented in June.
The Office of Inspector General announces Operation Restore Trust, a special program
to combat waste and abuse in Medicare and Medicaid in 5 targeted states- California, Florida,
Illinois, New York, and Texas- later expanded to include hospice.
Mary Taverna is recognized with the NHO Founders Award.

1996 – Hugh Westbrook is recognized with the NHO Founders Award

Bills are introduced in the US House of Representatives and the US Senate to make
technical changes and improvements to the Medicare Hospice Benefit
National Hospice Organization publishes Medical Guidelines for Determining Prognosis
in Selected Non-Cancer Diseases.
Initiation of ACHC (Accreditation Commission for Home Care) hospice accreditation
program.
Home Box Office and NHF create the air the documentary Letting Go: A Hospice Journey,
which gives viewers an intimate look at hospice care.
Hospice: A Photographic Inquiry- Organized by the Corcoran Gallery of Art and the
National Hospice Foundation, explores the collaborative experience of hospice care through the
eyes of the artists. The Corcoran commissions 5 photographers to create new works about
hospice for this exhibition. The show opens in Washington DC at the Corcoran and then travels
to 18 cities across the country.
1996 – Operation Restore Trust is extended and expanded to target all 50 states and additional
types of health care providers
The Balanced Budget Act of 1997 (BBA 97) includes hospice provisions that restructure
the hospice benefit periods and remove physician services from the employee-only
requirement for the core services requirement. BBA 97 also reinstates a hospice cost report and
report and reduces hospice payment updates by market basket minus one percentage point.
The growing end-of-life movement focuses national attention on quality of life at the
EOL as well as the need for increased public awareness and physician education.
NHF conducts national research to learn more about America’s attitudes regarding EOL
care. That Gallup survey finds that most adults would prefer care at home and would seek a
hospice program if they had 6 months or less to live. The survey also reveals that most
Americans do not realize that hospice care is available at home, and that costs are typically
covered by Medicare or private health insurance.

1998 – Karen Davie serves as Executive Director/President of NHO 1998-2001.

Hospices nationwide report rapidly declining average and median lengths of stay. The
percentage of hospice non-cancer admissions decreases dramatically, reflecting the problems
associated with determining a 6-month prognosis for these patients.
NHO Medical Guidelines for Determining Prognosis in Selected Non-Cancer Diseases
becomes policy through the development of Local Medical Review Policies by Fiscal
Intermediaries.
An Operation Restore Trust report on hospice states, “Overall, the Medicare hospice
program seems to be working as intended.”
Care Beyond Cure: Physician Education in End-Of-Life Care is released by the Annenberg
Center for Health Sciences and the National Hospice Foundation.
The US Postal Service issues the Hospice Care commemorative stamp in February.

1999 – the Health Care Financing Administration (HCFA) releases the Hospice Cost Report
Medicare-certified hospice programs must file cost data for each fiscal year on or after April 1,
1999.
The Office of Inspector General releases the Draft Compliance Program Guidelines for
the Hospice Industry.
 The National Data Set Survey is initiated by NHO with the goal of creating standardized
data collection nationwide.
Foundation for Hospices in Sub-Saharan Africa FHSSA is founded in New York State, with
Bernice Catherine Harper as President, to mobilize a response to the sub-Saharan HIV/AIDS
pandemic and support Africa’s hospice and palliative care programs ability to provide
compassionate care.
AIDS becomes the number one cause of death in Sub-Saharan Africa.

2000 – the National Hospice Foundation launches a public service campaign of TV ads across
the US, one of these ads wins the prestigious ADDY Award.
US Senate holds 2 major hearings on EOL care and discusses barriers to access under
the Medicare hospice benefit.
National hospice community calls for more consistent Medicare surveys.
The Duke Institute on Care at the End-of-Life is established.
PBS Series On Our Own Terms: Moyers on Dying in America is the focus of national
education and engagement programs.
Research from the Department of Health and Human Services demonstrates findings
that support the provision of hospice care for residents of skilled nursing facilities.
NHO changes its name to National Hospice and Palliative Care Organization NHPCO

2001 – The passage of the Benefits Improvement and Protection Act of 2000 brings a 5%
increase in the Medicare hospice reimbursement rate.
A Call for Change: Recommendations to Improve the Care of Children Living with Life-
Threatening Conditions is released by the Children’s Project on Palliative/Hospice Services.
The Health Care Financing Administration HCFA becomes the Centers for Medicare and
Medicaid Services CMS

2002 – J. Donald Schumacher, PsyD becomes Executive Director/President of NHPCO.

25th anniversary of the Medicare Hospice Benefit
 The Department of Veterans Affairs launches a program to increase veterans’ access to
hospice and palliative services while providing educational opportunities for clinicians in
veterans’ healthcare facilities.
Rallying Points, an initiative of Robert Wood Johnson Foundation’s Last Acts campaign,
begins a 3-year initiative to improve care and caring near the end of life.
Claire Tehan is recognized with the NHPCO Founder’s Award.

2003 – National Hospice and Palliative Care Organization celebrates its 25 th anniversary.
NHPCO grant f $100,000 to the Veterans Health Administration to begin the Veterans
Administration Hospice and Palliative Care (VAHPC) initiative.
A Clinical Guide to Supportive and Palliative Care for HIV/AIDS is released by the US
Health Services Resource Administration at The White House Conference on Palliative Care and
the HIV/AIDS Global Pandemic.
The web-based Family Evaluation of Hospice Care FEHC Survey is launched.
The hospice awareness ribbon is unveiled prior to November’s National Hospice Month.

2004- More than 1M Americans with a life-limiting illness are served by the nation’s hospices,
the 1st time the million-person mark has been crossed.
The Clinical Practice Guidelines for Quality Palliative Care are published in May by the
National Consensus Project, a consortium of palliative care and hospice organizations.
The Diana, Princess of Wales Memorial Fund and the Franklin Mint make a $3.35M gift
to NHPCO to promote better EOL care.
2005- Caring Connections, NHPCO’s consumer engagement initiative launches the
comprehensive “It’s About How You LIVE national campaign.
Robert Wood Johnson Foundation continuous its support of NHPCO’s Caring
Connections consumer engagement initiative with an additional $4.9M grant.
The Department of Veterans Affairs releases the report, VA Transforms EOL Care for
Veterans.
National dialog on the importance of advance care planning increases as the case
involving Terri Schiavo- who dies in March- escalates in the media and within public policy
debates.
 The 1st National conference on access to hospice and palliative care is hosted by NHCPO
in St. Louis.
The Society for Nonprofit Association Publishers Awards NHPCO and EXCEL Gold Award
for its hospice education print advertising series.
The number of hospice provider organizations throughout the country tops 4,000 for
st
the 1 time.
J. Donald Schumacher testifies at a Hearing on “Health Care Provided to Non-
Ambulatory Persons” to the Committee on Health, Education. Labor and Pensions, United
States Senate.

2006 – A celebration of Dame Cicely Saunders’ life is held in Westminster Abbey on March 8,
the US hospice community issues a resolution honoring her.
A Guide to Supportive and Palliative Care for HIV/AIDS in Sub-Saharan Africa is released;
the publication is funded by the US Government through the HIV/AIDS Bureau, Health
Resources and Services Administration, and NHPCO.
Quality Partners, developed to build organizational excellence and improve hospice and
palliative care delivery and outcomes, is launched.
Inaugural World Day is held on October 1 to focus global attention on hospice and
palliative care
A National Framework and Preferred Practices for Quality Palliative and Hospice Care is
published by the National Quality Forum.
The African Palliative Care Association APCA is established in Kampala, Uganda and
provided funding by NHPCO.
USAID awards FHSSA a New Partners Initiative grant totaling $ 5,008, 849

2007 – Research published in the Journal of Pain and Symptom Management reports that
hospice patients live an average of 29 days longer than similar patients who did not have
hospice care.
Findings of a major study of Duke University published in the Journal of Pain and
Symptom Management show that hospice services save money for Medicare and bring quality
care to patients and families.
The National Quality Forum releases A National Framework for Palliative and Hospice
Care Quality Measurement and Reporting.
 The Alliance for Care at the End of Life ACEOL, is created to provide the hospice
community with a comprehensive, strategic voice on Capitol Hill.
The Worldwide Palliative Care Alliance is formed to address global care needs at the
EOL. NHPCO becomes a member.
2008 – the Inaugural National Healthcare Decisions Day is held on April 16
NHPCO and its affiliate organizations (National Hospice Foundation, FHSSA, and The
Alliance for Care at the End of Life) move into the National Center for Care at the End of Life in
Virginia.
The 1st revision of Medicare Hospice Conditions of Participation (CoPs) since the
Medicare Hospice Benefit was established is published as a final rule in the June 5, 2008 Federal
Register.
Results of 1st Quality Improvement Organization QIO hospice initiative, the PEACE
project, provide quality measures and develop an instrument to measure quality of care at the
EOL.

2009 – The Accreditation Council for Graduate Medical Education , a private, non-profit
organization responsible for the accreditation of post MD medical training programs within the
US, adds hospice and palliative medicine to its list of accredited programs.
The number of hospice volunteers continues to grow with a record 550,000 serving as
volunteers
The NHPCO Standards of Practice for Pediatric Palliative Care and Hospice, along with
the companion publication Facts and Figures on Pediatric Palliative and Hospice Care in
America, are released.
Hospice leaders from the US meet HRM Queen Elizabeth II at the Silver Jubilee
Celebration for the UK-based Help the Hospices.
Research published in the Archives of Internal Medicine suggests benefits of advance
care planning discussions with physicians include lower costs and reduced utilization of
aggressive care at the EOL.
Quality Guidelines for Hospice and EOL Care in Correctional Settings is published by
NHPCO
FHSSA celebrates its 10th year Anniversary with fundraiser in Denver as part of NHPCO’s
Clinical Team Conference.
2010 – We Honor Veterans, a pioneering campaign to help improve the care Veterans receive
from hospice and palliative care providers is launched by NHPCO in collaboration with the
Department of Veterans Affairs.
2011 – NHPCO publishes the report, Private Conservations and Public Discourse: the
Importance of Consumer Engagement in the EOL Care.
The Concurrent Care for Children: Implementation Toolkit is released by NHPCO
Ethical Marketing Practices position statement and commentary are released by NHPCO
2012 – The Hospice Action Network hosts its 1st Advocacy Intensive to educate clinical frontline
caregivers about hospice policy and how to advocate for hospice on Capitol Hill and at home.

2013 – e-hospice is launched as a globally run online news and information resource committed
to offering the latest news, commentary and analysis from the world of hospice and palliative
care. e-hospice USA is powered by NHPCO.
NHPCO and HAN host “Conversations Before the Crisis”, a symposium focused on
Advance Care Planning.

2014 – 40 years after the creation of Connecticut Hospice, NHPCO and its affiliates celebrate 40
years of hospice care in the US
Moments of Life: Made Possible by Hospice public engagement campaign is launched at
the NHPCO Management and Leadership Conference.
At the HAN Advocacy Intensive, participants secure signatures from 202 US
Representatives and 75 US Senators on letters urging CMS to halt implementation of Part D
guidance that negatively impacted hospice providers, patients and families.
Congress passes the Improving Medicare Post-Acute Care Transformation Act, or
IMPACT Act, and President Obama signs it into law.

2015 – We Honor Veterans initiative is awarded the prestigious Summit Award by the American
Society of Association Executives. ASAE
Moments of Life: Made Possible by Hospice public engagement campaign is recognized
with the eHealthcare Leadership Gold Award, and Bulldog Reporter’s Gold Award for Best Non-
Profil Campaign.
2016 – CMS launches hospice payment reform- the 1st change to the Medicare hospice
payment system since the benefit was established.
Don Schumacher retires as CEO/President of NHPCO
Edo Banach, JD, is hired as CEO/President of NHPCO

2017 – for the 10th anniversary of National Healthcare Decisions Day, NHPCO and HAN hosted a
Capitol Hill briefing on advance care planning
We Honor Veterans reached more than 4,500 partners since the program launch
The exhibit “Hospice: A Historical Perspective” went on permanent display at NHPCO

2018 – The Medicare Patient Access to Hospice Act was signed by the President in February.
Launched the national My Hospice Campaign in April designed to reinforce the value of
the Medicare hospice benefit among policy and health care decision makers.
The Hospice Compliance Certificate Program was launched at the Interdisciplinary Team
Conference in New Orleans in November.
Legislation was passed to address the opioid crisis that included a safe disposal provision
for qualified hospice staff.

NHPCO National Hospice and Palliative Care Organization

National Hospice Foundation