During 1982, seven Chicagoans died from poisoned Tylenol, the first artificial heart was implanted in Barney Clark and end-of-life care was little more than a volunteer movement in America.
Hospice was barely a blip on the healthcare radar screen. In America, hospice got its start in the 70s in response to the work of Dame Cicely Saunders in England and Elisabeth Kubler-Ross theory on death and dying. Virtually a cottage industry, hospice in the United States had no heroes, no resources, no model of care, no reimbursement mechanism.
But in 1979 in Florida, hospice had a small band of allies led by Hugh Westbrook, a United Methodist minister dissatisfied with the way the terminally ill were cared for and committed to changing it. Westbrook had already established a hospice organization he would one day call VITAS.
A handful of enlightened state politicians joined his pioneering legislative efforts; they brought together other small Florida hospices to draft a bill that defined hospice as these idealists thought it should be. Although it didnt provide funding, it was an unusually specific document, establishing the interdisciplinary hospice team; inpatient, respite and continuous care as needed; bereavement support for survivors; a volunteer support requirement; and more.
Despite political maneuvering, the bill passed as written, becoming the first law anywhere in the nation to define hospice care. It also became the model for other states and, eventually, federal hospice legislation and regulations.
Political connections introduced Westbrook to Don Gaetz, a hospital administrator who had far-reaching ideas of his own about how healthcare was provided and paid for in America. Westbrook convinced Gaetz that the hospice model of care represented the best of what healthcare could be, and Gaetz joined the nascent hospice effort. The two became friends as well as lobbying partners. Over the next few years, they would change the way U.S. healthcare addresses death and dying.
Honoring Healthcare Historians
In April of 2007, in honor of the 25th anniversary of the passage of the Medicare Hospice Benefit, these two hospice pioneers, Hugh Westbrook and Don Gaetz, received the Healthcare Architect Award from the National Hospice Foundation. The black-tie gala in Washington, D.C., recognized their history-making efforts to influence legislation and shape hospice programs nationwide.
Westbrook and Gaetz didnt do it alone, of course. With others they founded the National Hospice Education Project, a grassroots effort to encourage Medicare coverage of hospice. With others they participated in the Medicare National Hospice Demonstration Project to show how hospice should work, how it could make a difference in peoples lives and how much it would cost.
And it took a bipartisan group of legislators Congressmen Leon Panetta and Bill Gradison and Senators Bob Dole and John Heinz to get the “Hospice Care Reimbursement Act” passed in 1982. Those four leaders also were honored as Silver Anniversary Honorees by the National Hospice Foundation in April.
Their early and impassioned commitment helped the movement, but the deal sealer was the conclusion by the Congressional Budget Office that a Medicare Hospice Benefit would save taxpayers $110 million. It was passed by the full Congress and signed into law by President Ronald Reagan in September 1982.
It is estimated that in the ensuing 25 years, 10 million Medicare beneficiaries at the end of life have received the compassionate care Hugh Westbrook had in mind when he decided to change the way we care for the dying. Every day, approximately 200,000 people benefit from hospice care in the United States. In 2005, 1.2 million patients received hospice services nationally; 1.6 million families were helped by federally legislated bereavement services following the death of a loved one.
Esther Colliflower, R.N., is another hospice pioneer and co-founder with Westbrook and Gaetz of VITAS Innovative Hospice Care®. While Westbrook and Gaetz were in Washington making history, Colliflower was in Florida making sure the growing VITAS team reflected the companys founding principles and values.
“VITAS was a two-pronged accomplishment,” she once said of those early days. “First, theres the immediate and personal level. We worked every day to preserve and improve the quality of life for those with a limited time to live. Second, on the state and national levels, weve helped define, institute and set the standards for hospice care in the United States.”
All in a days work for these visionary healthcare pioneers.
