Hospice Around the World: Different Cultures, Different Views
There is one commonality about hospice around the world: Hospice is synonymous with serious illness and end-of-life care.
Big Ben, Victoria Peak, Gyeongbokgung Palace, Neuschwanstein Castle (aka Crazy Ludwig’s Castle) and the Western Wall are all famous landmarks that people envision when thinking about the United Kingdom, Hong Kong, South Korea, Germany and Israel. But if you were asked to describe how these places across the globe cared for people faced with advancing age or life-limiting illnesses, would you be up for the task? The manner in which countries tackle this type of care vary widely, so today we are taking an in-depth look at hospice around the world.
What is Common About Hospice Around the World?
There is one commonality about hospice around the world: Hospice is synonymous with serious illness and end-of-life care. The differences become apparent when you look at how different cultures view this type of care and whether it is embraced in the country of origin.
Hospice in the United Kingdom
Today’s hospice has its origin in the United Kingdom (UK) due to a free-thinking, trailblazer by the name of Dame Cicely Saunders. In the 1950s, after recognizing the importance of psychosocial and spiritual needs being met during the dying process, Dame Saunders fought diligently for the rights of those faced with life-limiting illnesses because she realized that managing pain was not enough. In order to accomplish her goals, she returned to school to acquire degrees in both medicine and social work.
A decade later, in 1967, Dame Saunders realized a dream when St. Christopher’s Hospice opened in London. Two years later, she established the first home team to care for patients out in the community. Although the first hospice in the UK was founded by a Christian organization, today’s hospice is secular. In fact, the UK has more than 200 hospices with care provided by the National Health Service without charge to all permanent residents of the country.
Here are some additional facts about hospice in the UK:
- Approximately 225,000 people living in the UK receive hospice care for life-limiting illnesses
- More than 72,000 residents of the UK receive bereavement support from hospice
- More than 125,000 individuals volunteer with hospice every year
- Thirty-two percent of individuals receiving care in an inpatient facility returned home
Hospice in Hong Kong
A generation ago, Hong Kong embraced hospice care, and most people died in the comfort of their own homes or in a community setting. However, today in Hong Kong, a different picture must be painted. More than 94 percent of people die in Hong Kong’s public or private hospitals.
Why has this shift occurred? Apparently healthcare providers, as well as patient and families, do not believe that there are many options available for end-of-life care in Hong Kong anymore. There is also a shortage of facilities that can provide comfort measures during a patient’s final days.
For more than 30 years, the Society for the Promotion of Hospice Care has advocated for end-of-life care. This not-for-profit organization is guided by the following principle: “When days cannot be added to life, add life to days.”
Fortunately, due to a governmental land grant and funded by the Hong Kong Jockey Club Charities Trust, the Society for the Promotion of Hospice Care was able to build and open its Jockey Club Home for Hospice (JCHH). With the opening of this 30-bed facility at the end of September 2017, the organization envisions a return back to a multidisciplinary healthcare model that supports comfort at the end of life. The society also provides 24-hour support services to more than 1,000 patients each year, and caregivers can attend its training programs. At the very least, the organization hopes there will be an open dialogue to provide these much-needed services once again across all Hong Kong districts.
Understanding Hospice in South Korea
Since 1963, hospice care in South Korea was only available through religious organizations such as the Gabari Catholic Organization. It has only been in recent years that hospice and palliative care were introduced into the country’s healthcare system because this type of service was not considered “medical” by the public. But a shift in understanding is being introduced into the culture.
In February 2018, a law went into effect in South Korea whereby any adult over the age of 19 who has a serious illness with a life expectancy of six months or less can refuse medical treatment that could potentially extend their lives. Up until now, Koreans were not able to forego possible life-saving treatment, such as cardiopulmonary resuscitation, chemotherapy and dialysis, but instead endured this type of care until death. Koreans wanted hospice care but needed legal protection for this decision to be carried out. Hospice care is mainly available in a hospital setting mainly in hospital setting. Free-stranding hospice houses do not exist in South Korea.
Understanding Hospice in Germany
Ten years ago, Eugen Brysch, chief executive officer of the German Hospice Foundation, traveled to the United States with a goal for his trip ─ to gather information about senior communities. Some of his other objectives were to visit medical facilities and observe how Americans implemented end-of-life care. At the time, he met with LifePath Hospice staff and toured the Sun City Center Hospice House. Brysch saw firsthand how senior lifestyle communities integrate with medical providers. In Germany, these types of senior-exclusive mini-villages did not exist.
“On that trip, I gained insight on how well medical professionals interact with members of the senior community, many who volunteer as a way to stay active,” said Brysch. “In addition, I wanted to learn how we might be able to improve hospice care in Germany.”
Fast forward to fall 2017 when Brysch took another trip across the Atlantic Ocean on behalf of his renamed not-for-profit organization, The German Foundation for Patient Rights. With more than 55,000 donor members, the organization’s mission is to protect patient rights and support people in need of care, specifically those with dementia and terminal illnesses. The foundation acts as a representative for patients and their relatives interacting with insurance companies, physicians, hospitals and nursing homes.
During this journey to the United States, Brysch wanted to learn more about the integration of palliative care for aging adults. After touring the Melech Hospice House, he educated staff about the current situation in Germany.
In 2015, the German Federal Parliament passed a law to strengthen hospice and palliative care in Germany. Important improvements were made in palliative care, specifically with regard to hospitals and hospices. “Unfortunately, nursing home residents do not receive the same level of palliative care. Our foundation lobbied the government on behalf of these patients as they should have the same legal right to hospice care where they live—nursing homes,” shared Brysch.
Germans are forbidden to move from a nursing home to hospice, and unfortunately, palliative care in nursing homes is not on the same level as in hospice. The German Foundation for Patient Rights is committed to putting a stop to what they consider this “second class dying” in nursing homes. With its advocacy efforts, the foundation is once again determined to improve healthcare for those suffering from life-limiting illnesses.
Understanding Hospice in Israel
Located within Sheba Medical Center in Tel Aviv and opened in 1983, Israel witnessed the beginning of its first hospice. Flash forward to the present day where seven community-based hospices offer both in-patient and home hospice care services, and palliative care is not offered in hospitals. With so few hospices available in Israel, the main mission for each is the care of the patient and their family, which can at times be challenging.
In Israel, physicians do not take extreme measures in extending a patient’s life. The country does utilize more complementary and alternative medicine (CAM) in easing the suffering of hospice patients, more than many other countries. Herbs, special diets and vitamins can strengthen the body and spirit of a hospice patient, with the caveat, it is hard to predict side effects and any issues with conventional medication. According to Dr. Dina Ben-Yehuda, dean of the Hadassah Hebrew University School of Medicine School and chief of hematology at HADASSAH EIN Kerem, studies of Israeli cancer patients at three hospitals found that 54 percent had utilized CAM.
Like many countries across the world, there is always room for improvement of end-of-life care in Israel.
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