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The Republic of South Africa (population 44.76 million) is located at the southern tip of the African continent and covers an area of around 1, 220, 000 km². In South Africa, around sixty organizations linked to the national association — the Hospice and Palliative Care Association of South Africa (HPCA) — provide a range of services for patients and their families. Service types include inpatient care, home care, day care, clinics/drop-in centres, hospital support teams, education and training, patient support groups, bereavement care, foster parent support groups, orphan support groups, and hospice care for the homeless. Palliative care services may also be found in hospital settings countrywide. The opportunities for palliative care development in South Africa are considered. Hospices in South Africa are usually registered as not-for-profit organizations. Opioid availability and consumption are shown. Palliative care education and training is provided at different levels by numerous organizations that include the University of Cape Town (UCT), HPCA, and individual hospices. Moreover, some key events of the early hospice movement in South Africa through the lived experience of people involved in them are presented.

This chapter stresses the need to incorporate children in adult hospice care programs. It explains that more than 1 million children suffer from serious and chronic medical conditions in the U.S. and that it is imperative that adult hospice and palliative care programs adapt to including children when planning for today's and tomorrow's patients. The data suggests that many adult hospices are well suited to expand their reach to embrace children and their families.

This chapter discusses social work practice in hospice settings with older people and their families. It begins by providing both historical and current perspectives on hospice care, including a differentiation between end-of-life, palliative, and hospice care, and it integrates current utilization and length-of-stay information from the National Hospice and Palliative Care Organization (NHPCO). The chapter's three main sections discuss (1) regulations and policies that guide hospice social work; (2) hospice care environments; and (3) hospice social work with older adults and their families. Although people of all ages enroll in hospices, the chapter focuses on older patients and their families.

This introductory chapter explains the coverage of this book, which is about pediatric hospice care. The book provides specific information about providing for terminally ill children, including children's age-related understanding of death, the critical elements of pain and symptom control, and the psychosocial aspects of life-threatening illnesses in childhood and adolescence. It addresses the spiritual concerns of the family and sibling bereavement and describes inpatient palliative care practiced at St. Mary's Hospital for Children. The chapter also discusses the Children's Hospice International's (CHI) Program for All-Inclusive Care for Children and their Families (CHI PACC).

This chapter examines the quality of care in long-term care facilities in the U.S. It describes the nursing home as a primary focus of long-term care and reviews relevant literature concerning end-of-life care in nursing homes. It compares hospice and nursing homes care and suggests that the overall cultural and policy milieu in the U.S. seems to be changing slowly towards some increased acceptance of palliative care at the end of life in nursing homes.

This chapter examines the clinical, ethical, and policy challenges of hospice and palliative care in the U.S. It presents the case of two patients who both needed and received palliative care. Both patients benefited from palliative care interventions but they had unequal access to formal hospice programs and each found some limitations to the degree of palliation and support they received during the periods of their illnesses. These cases illustrate the potential effectiveness of palliative care and show that the clinical, ethical, and policy dilemmas are complex and at times vexing, even under the guidance of a skilled team of caregivers.

This chapter presents a sampling of the growing number of pediatric hospice and palliative care programs around the world that are working to meet the needs of children with life-threatening conditions and their families. It describes the history and goals of the program as well as the organizations that organized them. The chapter suggests that these programs will continue to develop and expand around the world because of the efforts of the Children's Hospice International (CHI) in hosting its World Congresses.

Tanzania (population 36.59 million) is a country in Eastern Africa, bordering the Indian Ocean, that covers an area of 945, 087 km². The palliative care is provided by four organizations: Selian Hospital, Muheza Hospice Care, PASADA, and Ocean Road Cancer Institute. Faith-based organizations, particularly the church-related hospitals, provide 50 percent of the health care in the country. The Evangelical Lutheran Church is introducing palliative care into its twenty Lutheran hospitals. Health care is traditionally family and home based due to the low doctor to population ratio. The reimbursement and funding for services of these organizations are shown. The chapter also summarizes their palliative care coverage, education and training, and palliative care workforce capacity. The Tanzanian Palliative Care Association is a national association that provides a voice for palliative care in Tanzania. The history and development of hospice-palliative care in Tanzania is described.

The care of children who are dying of cancer and their bereaved families is a growing concern both in this country and others. This chapter discusses the pediatric hospice movement from a historical perspective and identifies issues that have to be considered when offering palliative care to a child dying of cancer, including the needs of the caregivers. It considers the need to formulate new ways of studying death and dying in order to enhance the quality of living for children dying of cancer and provide greater support for their families. The chapter describes some of the existing programs that provide services to dying children and bereaved families.

This chapter examines the importance of staff support in pediatric hospice care. It suggests that individuals who work in pediatric hospices and palliative care require a commitment from themselves and their organizations to foster a continual sense of renewal, dedication, and respect in their capacity to care for these babies, children, and adolescents whose precious lives are far too short. The chapter discusses a comprehensive approach to maintaining the professional well being of hospice staff and explores ways to help them cope with professional anxiety.

This chapter discusses the provision of age-appropriate end of life care to adolescents and young adults. The particular needs of the age group have been recognized in policy documents and measures are being taken to meet those needs. Individual hospices are responding to the needs of their adolescent and young adult users, both chronic and acute, and are taking steps to ensure that the care setting is age-appropriate. Even if resources are limited, if the philosophy that underpins age-appropriate care can be implemented across the range of hospice provision and coupled with training packages, shared care, and early planning for transition, this will make a significant contribution to meeting the needs of the age group.

This introductory chapter discusses ‘modern’ hospice care, which started in 1967. It describes the evolution of hospices, from those run by religious orders during the Middle Ages, to the 8,000 hospices that now provide hospice care. It also looks at palliative care and its services, the people found inside a hospice centre, and the important job features of a voluntary service manager.

This chapter focuses on Cicely Saunders's conception of a new method that would change the clinical field, particularly care for the dying worldwide. In the summer of 1957, before she acquired her qualifications in medicine, Saunders wrote her first publication, which centred on a new approach to the care of dying people. In her paper, her intention of providing approaches that would centre on caring for dying became prevalent. Saunders' 1958 paper took note of the seeming desertion by the doctors of their patients, leaving them to cope with the remaining days of their lives in isolation. She reiterated that doctors should remain the head of a team that continually works to relieve what cannot be healed, to maintain the patient's struggles within their priorities and to bring hope and consolidation to the very end. Although the British National Health Service was driven by the aim to give services from ‘cradle to grave’, little attention was given to dying people. Saunders was one of the few clinicians who took considerable interest in the welfare of the dying. Her encounter with David Tasma and her experience at St. Joseph's helped her create her methods for hospice care and to establish the St. Christopher's Hospice. With a single goal of creating the first modern hospice, Saunders set a social train that would change the perception of caring for dying throughout the world.

The Republic of Sierra Leone (population 5.88 million) is a country in Western Africa bordering the North Atlantic Ocean. It covers an area of 71, 740 km ² and its boundaries border the countries of Guinea and Liberia. In Sierra Leone, palliative care services are provided by The Shepherd's Hospice (TSH), Freetown. The range of services includes home-based care, inpatient care (24 h symptom control), outpatients' clinics (twice a week), education and training, orphans and vulnerable children's programme, Women's Wellness Project (WWP) and advocacy. As an NGO, TSH relies on fundraising and charitable donations to meet its costs. The national and professional organizations include the Christian Health Association of Sierra Leone (CHASL), and Friends of The Shepherd's Hospice (UK). TSH takes patients from Freetown and parts of the western area of Sierra Leone. The chapter then deals with the history and development of hospice-palliative care in Sierra Leone.

Helen's life provided the spark from which the idea of Helen House was kindled. Helen House opened and was soon to be cited as a shining example of how gravely ill children and their families could be cared for and supported. The disorders and illnesses that Helen House children suffer from cover a wide spectrum, and some of them are extremely rare. Still, many brothers and sisters of ill children enjoy their holidays at Helen House. Their lively, cheerful presence greatly enhances the family atmosphere that pervades it. Generally speaking, GPs devolve the care of a child to the Helen House Medical Director, Roger Burne. Perhaps the most serious problem success has brought to the House stems from the fact that more and more families are now contacting the hospice and making enquiries, in particular about respite care.

This introductory chapter begins an overview of developments in medicine in the twentieth century and a brief look at the evidence that people with chronic conditions have not always been served well by these. It goes on to describe the development of hospice care to meet the needs of another group ill served by modern medicine: terminally ill cancer patients. It summarizes developments in hospice and palliative care, focusing particularly on the UK, and describes the patients currently served by these services. It then introduces the debate about the appropriate provision of palliative care services for non-cancer patients, and outlines the contents of this book.

This chapter examines the role of primary care physicians (PCP) in pediatric hospice care. It suggests that PCP must be able to help in family coping and that they must be cognizant of the data that describe the financial situations of the children they treat. The chapter argues that the role of the PCP is essential in ensuring that a patient with life-threatening or end-of-life issues has a “medical home,” as described by the American Academy of Pediatrics (AAP).

This chapter examines hospice care for children with AIDS and HIV infection. It discusses the historical response of pediatric hospital to AIDS, the social considerations that affect the care of HIV-infected children, and the prevalence of behavioral and psychiatric symptoms in children with HIV infection and AIDS. The chapter also analyzes the so-called illness–wellness continuum and the role of palliative care staff in this type of patients.