CareWorks Health Services
Moulton Parkway STE 103C
Laguna Hills, CA 92653
of Business: 24/7 Service
provide Medical/Non-Medical Home Health Care Helping
Seniors and Disabled Adults live independently and safely,
in the place they want most, Home
24/7. Our caregivers believe in and adopt our
Ten Commandments”, the cornerstone of success
for all our “Compassionate Companions”.
provide the most compassionate care to all individuals
- begining with newborns, hospital outpatient care to
seniors. With our dedicated and committed professionals,
our experienced team of caregivers are supported by our
diligent Support Staff making them the best in the industry.
is a type of care and a philosophy of care that focuses on the
palliation of a terminally
ill patient's symptoms. These symptoms can be physical, emotional,
spiritual or social in nature. The concept of hospice has been
evolving since the 11th century. Then, and for centuries thereafter,
hospices were places of hospitality for the sick, wounded, or
dying, as well as those for travelers and pilgrims. The modern
concept of hospice includes palliative care for the incurably
ill given in such institutions as hospitals
or nursing homes, but also care provided
to those who would rather die in their own homes. It began to
emerge in the 17th century, but many of the foundational principles
by which modern hospice services operate were pioneered in the
1950s by Dame Cicely Saunders. Although the movement has
met with some resistance, hospice has rapidly expanded through
the United Kingdom, the United States and elsewhere.
The first dedicated hospice in Hong Kong.
Linguistically, the word "hospice" is derived from the Latin hospes,
a word which served double-duty in referring both to guests and
hosts. The first hospices are believed to have originated in the
11th century, around 1065, when for the first time the incurably
ill were permitted into places dedicated to treatment by Crusaders.
In the early 14th century, the order of the Knights
Hospitaller of St. John of Jerusalem opened the first hospice
in Rhodes, meant to provide refuge for travelers and care
for the ill and dying. Hospices flourished in the Middle Ages,
but languished as religious orders were dispersed. They were revived
in the 17th century in France by the Daughters of
Charity of Saint Vincent de Paul. France continued to see
development in the hospice field; the hospice of L'Association
des Dames du Calvaire, founded by Jeanne Garnier, opened in 1843.
Six other hospices followed before 1900.
hospices were established as well in other areas. In the United
Kingdom, attention was drawn to the needs of the terminally
ill in the middle of the 19th century, with Lancet
and the British
Medical Journal publishing articles pointing to the need
of the impoverished terminally ill for good care and sanitary
Steps were taken to remedy inadequate facilities with the opening
of the Friedenheim in London, which by 1892 offered 35 beds to
patients dying of tuberculosis.
Four more hospices were established in London by 1905.
Australia, too, was seeing active
hospice development, with notable hospices including the Home
for Incurables in Adelaide (1879),
the Home of Peace (1902) and the Anglican House of Peace for the
Dying in Sydney (1907).
In 1899, New York City saw the
opening of St. Rose's Hospice by the Servants for Relief of Incurable
Cancer, who soon expanded with six locations in other cities.
more influential early developers of Hospice were the Irish Religious
Sisters of Charity, who opened Our Lady's Hospice
in Harold's Cross, Dublin, Ireland in
1879. It proved to be very busy, with as many as 20,000 people—primarily
suffering tuberculosis and cancer—coming to the
hospice to die between 1845 and 1945. The Sisters of Charity expanded
internationally, opening the Sacred Heart Hospice for the Dying
in Sydney in 1890, with hospices in Melbourne and New
South Wales following in the 1930s. In 1905, they opened St
Joseph's Hospice in London. It was there in the 1950s
that Cicely Saunders developed many of the foundational
principles of modern hospice care.
of the modern hospice movement
Hospice in 2005
a British registered nurse whose chronic health problems
had forced her to pursue a career in medical social work.
The relationship she developed with a dying Polish
refugee helped solidify her ideas that terminally ill patients
needed compassionate care to help address their fears and concerns
as well as palliative
comfort for physical symptoms. After the refugee's death, Saunders
began volunteering at St Luke's Home for the Dying Poor, where
a physician told her that she could best influence the treatment
of the terminally ill as a physician. Saunders entered
medical school while continuing her volunteer work at
St. Joseph's. When she achieved her degree in 1957, she took a
focusing on the patient rather than the disease and introduced
the notion of 'total pain',
which included psychological and spiritual as well as the physical
aspects. She experimented with a wide range of opioids
for controlling physical pain but included also the needs of the
her philosophy internationally in a series of tours of the United
States that began in 1963.
In 1967, Saunders opened St.
Christopher's Hospice. Florence
Wald, the dean of Yale
School of Nursing who had heard Saunders speak in America,
spent a month working with Saunders there in 1969 before bringing
the principles of modern hospice care back to the United States,
establishing Hospice, Inc. in 1971.
At about the
same time that Saunders was disseminating her theories and developing
her hospice, in 1965, Swiss psychiatrist
also began to consider the social responses to terminal illness,
which she found inadequate at the Chicago hospital where her American
physician husband was employed.
Her 1969 best-seller, On
Death and Dying, was influential on how the medical profession
responded to the terminally ill,
and along with Saunders and other thanatology
pioneers helped to focus attention on the types of care available
faced resistance springing from various factors, including professional
or cultural taboos against
open communication about death among physicians or the wider population,
discomfort with unfamiliar medical techniques, and professional
callousness towards the terminally ill.
Nevertheless, the movement has, with national differences in focus
and application, spread throughout the world.
In 1984, Dr.
Josefina Magno, who had been instrumental in forming the American
Academy of Hospice and Palliative Medicine and sat as first
executive director of the US National Hospice Organization, founded
the International Hospice Institute, which in 1996 became the
International Hospice Institute and College and later the International
Association for Hospice and Palliative Care (IAHPC). The IAHPC,
with a board of directors as of 2008 from such diverse countries
as Scotland, Argentina, Hong Kong and
Uganda, works from the philosophy that each country should
develop a palliative care model based on its own resources and
conditions, evaluating hospice experiences in other countries
but adapting to their own needs. Dr. Derek Doyle, who was a founding
member of IAHPC, told the British Medical Journal in 2003
that through her work the Philippine-born
Magno had seen "more than 8000 hospice and palliative services
established in more than 100 countries." Standards for Palliative
and Hospice Care have been developed in a number of countries
around the world, including Australia, Canada, Hungary,
Italy, Japan, Moldova, Norway,
Poland, Romania, Spain, Switzerland,
the United Kingdom and the United States.
In 2006, the
United States based National Hospice and Palliative Care Organization
(NHPCO) and the United Kingdom's Help the Hospices jointly commissioned
an independent, international study of worldwide palliative care
practices. Their survey found that 15% of the world's countries
offered widespread palliative care services with integration into
major health care institutions, while an additional 35% offered
some form of palliative care services, though these might be localized
or very limited. As of 2009, there were an estimated 10,000 programs
internationally intended to provide palliative care, although
the term hospice is not always employed to describe such services.
1980 saw the
opening of a hospice in Harare, Zimbabwe, the
first in Sub-Saharan Africa. In spite of skepticism in
the medical community, the hospice movement spread, and in 1987
the Hospice Palliative Care Association of South Africa formed.
In 1990, Nairobi Hospice opened in Nairobi, Kenya.
As of 2006, Kenya, South Africa and Uganda
were among the 35 countries of the world offering widespread,
well-integrated palliative care. Programs there are based on the
United Kingdom model, but focus less on in-patient
care, emphasizing home-based assistance.
foundation of hospice in Kenya in the early 1990s, palliative
care has spread through the country. Representatives of Nairobi
Hospice sit on the committee to develop a Health Sector Strategic
Plan for the Ministry of Health and are working with the Ministry
of Health to help develop specific palliative care guidelines
for cervical cancer. The Government
of Kenya has supported hospice by donating land to Nairobi
Hospice and providing funding to several of its nurses.
In South Africa,
hospice services are widespread, focusing on diverse communities
(including orphans and homeless) and offered in diverse settings
(including in-patient, day care and home care).
Over half of hospice patients in South Africa in the 2003-2004
year were diagnosed with AIDS, with the
majority of the remaining having been diagnosed with cancer.
Palliative care in South Africa is supported by the Hospice Palliative
Care Association of South Africa and by national programmes partly
funded by the President's
Emergency Plan for AIDS Relief.
Uganda (HAU) began offering services in 1993 in a two-bedroom
house loaned for the purpose by Nsambya Hospital. HAU
has since expanded to a base of operations at Makindye,
Kampala, with hospice services also offered at roadside
clinics by Mobile Hospice Mbarara since January 1998.
That same year saw the opening of Little Hospice Hoima in June.
Hospice care in Uganda is supported by community volunteers and
professionals, as Makerere University offers a distance
diploma in palliative care. The government of Uganda has a strategic
plan for palliative care and permits nurses and clinical officers
from HAU to prescribe morphine.
Balfour Mount, who first coined
the term "palliative care", was a pioneer in the Canadian hospice
movement, which focuses primarily on palliative care in a hospital
Having read the work of Kubler-Ross, Mount set out to study the
experiences of the terminally ill at Royal
Victoria Hospital, Montreal; the "abysmal inadequacy", as
he termed it, that he found prompted him to spend a week with
Saunders at St. Christopher's.
Inspired, Mount decided to adapt Saunders' model for Canada. Given
differences in medical funding in Canada, he determined that a
hospital-based approach would be more affordable, creating a specialized
ward at Royal Victoria in January, 1975.
For Canada, whose official languages include English and French,
Mount felt the term "palliative care ward" would be more appropriate,
as the word hospice was already used in France to refer
to nursing homes.
Hundreds of palliative care programs followed throughout Canada
through the 1970s and 1980s.
of 2004, according to the Canadian Hospice Palliative Care Association
(CHPCA), hospice palliative care was only available to 5-15% of
Canadians, with available services having decreased with reduced
At that time, Canadians were increasingly expressing a desire
to die at home, but only two of Canada's ten provinces were provided
medication cost coverage for care provided at home.
Only four of the ten identified palliative care as a core health
At that time, palliative care was not widely taught at nursing
schools or universally certified at medical colleges; there were
only 175 specialized palliative care physicians in all of Canada.
the United States has grown from a volunteer-led movement to improve
care for people dying alone, isolated, or in hospitals, to a significant
part of the health care system. In 2008, 1.45 million individuals
and their families received hospice care. Hospice is the only
Medicare benefit that includes pharmaceuticals, medical equipment,
twenty-four hour/seven day a week access to care and support for
loved ones following a death. Hospice care is also covered by
Medicaid and most private insurance plans. Most hospice care is
delivered at home. Hospice care is also available to people in
home-like hospice residences, nursing homes, assisted living facilities,
veterans' facilities, hospitals, and prisons.
United States hospital-based palliative care programs began in
the late 1980s at a handful of institutions such as the Cleveland
Clinic and Medical College of Wisconsin. By 1995, hospices were
a $2.8 billion industry in the United States, with $1.9 billion
from Medicare alone funding patients in 1,857 hospice programs
with Medicare certification.
In that year, 72% of hospice providers were non-profit.
By 1998, there were 3,200 hospices either in operation or under
development throughout the United States and Puerto
Rico, according to the NHPCO.
According to 2007's Last Rights: Rescuing the End of Life from
the Medical System, hospice sites are expanding at a national
rate of about 3.5% per year.
As of 2008, approximately 900,000 people in the United States
were utilizing hospice every year,
with more than one-third of dying Americans utilizing the service.
movement has grown dramatically in the United Kingdom since Saunders
opened St. Christopher's. According to the UK's Help the Hospices
in 2009, UK hospice services consisted of 220 inpatient units
for adults with 3,203 beds, 39 inpatient units for children with
298 beds, 314 home care services, 106 hospice at home services,
280 day care services, and 346 hospital support services. These
services together helped over 250,000 patients in 2003 & 2004.
Funding varies from 100% funding by the National Health Service
to almost 100% funding by charities, but the service is always
free to patients.
As of 2006
about 4% of all deaths in England and Wales occurred in a hospice
setting (about 20,000 patients);
a further number of patients spent time in a hospice, or were
helped by hospice-based support services, but died elsewhere.
entered Poland in the middle of the 1970s. Japan
opened its first hospice in 1981, officially hosting 160 by July
2006. The first hospice unit in Israel was opened in 1983.
India's first hospice, Shanti Avedna Ashram, opened in
Bombay in 1986. The
first modern free-standing hospice in China opened in
Shanghai in 1988. The first hospice unit in Taiwan, where
the term for hospice translates "peaceful care", was opened in
1990. The first free-standing hospice in Hong Kong, where
the term for hospice translates "well-ending service", opened
in 1992. The first hospice in Russia was established in