Florence S. Wald, the former dean of the Yale University School of Nursing who brought hospice to the United States and in the process revolutionized the care of the terminally ill, died of natural causes Saturday at her home in Branford, Conn. She was 91.
Wald sparked a movement that grew from the first hospice program established in the United States in 1971 to more than 3,200 nationwide now, offering comfort, care and pain relief to patients in their final weeks and months and helping to ease the distress of families faced with the loss of loved ones.
In the process, she made nurses an integral part of the care of patients and forged a new coalition between doctors, nurses and patients -- replacing the long-held tradition that the doctor reigns supreme. The core idea of this new coalition was that, when hope for a cure is gone, attention should shift to a dying patient's physical, emotional and spiritual comfort.
"In some ways, we have to reform our end goals," she said in a recent interview. "We need to cure sometimes but care always."
When Wald was dean of the nursing school in the 1960s, the medical establishment was focused entirely on cures, with little attention given to palliative care and the patients' wishes about their care. In particular, most physicians were loath to prescribe heavy-duty narcotics to ease terminal patients' pain for fear that the patients would become addicted.
Her transformation of the situation had its germ in a 1963 lecture at Yale by Dr. Cicely Saunders, founder of St. Christopher's Hospice in London. Saunders' lecture emphasized minimizing pain in terminal cancer patients so that they could focus on their relationships and prepare for death.
"She blew me away," Wald later said. "Until then, I had thought nurses were the only people troubled by how a terminal illness was treated."
Wald immediately began reshaping the nursing school curriculum to put more focus on patients and their families and to emphasize care of the dying.
But feeling that further effort was required, Wald resigned as dean and went to London to study at St. Christopher's. Upon her return, she organized the first U.S. hospice in Branford in 1971. Connecticut Hospice, which began by offering in-home care but eventually built its own inpatient facility, became a model for hospice care here and abroad.
"Hospice care for the terminally ill is the end piece of how to care for patients from birth on," she wrote. "As more and more people -- families of hospice patients and hospice volunteers -- are exposed to this new model of how to approach end-of-life care, we are taking what was essentially a hidden scene -- death, an unknown -- and making it a reality. We are showing people that there are meaningful ways to cope with this very difficult situation."
In 1982, Congress ordered Medicare to pay for hospice care, which further accelerated the growth of the movement. Today, U.S. hospice programs care for about 900,000 patients every year.
Wald also came out in support of euthanasia. "There are cases in which either the pain or the debilitation the patient is experiencing is more than can be borne, whether it be economically, physically, emotionally or socially," she said. "For this reason, I feel a range of options should be available to the patient, and this should include assisted suicide."
More recently, Wald had been working to bring hospice care to prisons, training inmates to be hospice volunteers.
In an interview with the Journal of the American Medical Assn., she said that the needs of prisoners are different because they face death knowing they have not had successful lives. She found that inmates serving as hospice volunteers gained confidence from the situation.
"It shows that even in this terrible situation, something good can happen, a sense of possibility emerges," she said.
Florence Sophie Schorske was born in New York on April 19, 1917. She received a bachelor's degree from Mount Holyoke College in 1938 and a master's in nursing from Yale in 1941. During World War II, she worked as a research technician with the Army Signal Corps.
After the war, she became a staff nurse with the New York Visiting Nurse Service. She later spent six years as a research assistant at the Columbia University College of Physicians and Surgeons and two years as an instructor at the Rutgers University School of Nursing before obtaining a second master's degree in mental health nursing and joining Yale in 1957. She became dean in 1959.
She received many honors during her life, including induction into the National Women's Hall of Fame in 1998. She was also named an American Academy of Nursing Living Legend.
Her husband of 40 years, Henry Wald, died in 2000. She is survived by a son, Joel, of Bronxville, N.Y.; a daughter, Shari, of Halifax, Canada; and five grandchildren.
Maugh is a Times staff writer.