Palliative care in institutions
Jeanne Samson Katz
In the UK, palliative or hospice care is often synonymous with hospice buildings, where people with cancer are believed to go to die in their last weeks of life. However, end-of-life care takes place in many different situations and settings and, indeed, as Chapter 15 has identified, the longest period of the terminal phase is usually spent in one's own home. However, in the twentyfirst century in Western industrialized societies, we have an ageing population and in the UK there are more people over the age of 60 than under 16 years of age (Office of National Statistics 2002). Unlike the nineteenth century, when most people died at home, changes in family and household composition have impacted on the site of care for dying people. In the UK, health and social care policies have resulted in a reduction in long- stay hospital beds for older people, yet hospitals are still the most likely site of death.
The development of palliative care in the UK is described in Chapter 2. Suffice it to note here that, unlike in the USA, palliative care services in the UK developed by focusing on 'buildings with in-patient provision'. With the opening of St Christopher's in 1967, the prototype of palliative care services was established in an 'institutional' base, although the intention was to ensure that the environment was un-institutional in a conventional sense. This meant that 'wards' were to be as home-like as possible, hospice staff would often refrain from wearing uniforms and an informal approach to relationships between hospice personnel and dying people (not patients) and their families would predominate.
Very shortly after the founding of St Christopher's, other palliative care services began in the UK and, partly for funding reasons, many of these services began as home care services, while funding was being sought to create a 'proper hospice' (e.g. North London hospice). So although this chapter focuses primarily on palliative care in institutions, the history, philosophy and practice of the kind of palliative care that takes place in institutions such as hospices and hospitals are intertwined with those in the community. This is less the case in prisons and care homes.