2007-2016

posted in Hospice & Palliative Care Today, July 3, 2026

‌1. A Decade We Remember: 2007-2016 in American Life‌

• Between 2007 and 2016, Americans lived through crises, movements, and milestones that reshaped how we understand safety, justice, health, and the work of care.

Historical context: For today’s readers, these events are not abstract history; they are lived memory. Economic insecurity, smartphones and social media, wars and homecomings, health reform, repeated mass violence, racial justice movements, and changing family laws all shape how people suffer, hope, and seek help.

• Financial crisis and Great Recession (2007–2009)
• Introduction of the iPhone (2007)
• Election of Barack Obama, first Black president (2008)
• Launch of the iPad and rise of tablets (2010)
• Wars in Afghanistan and Iraq, with a major Afghanistan surge (2009–2014)
• Affordable Care Act (2010)
• Growth of mass shootings in everyday spaces (Virginia Tech 2007, Aurora 2012, Sandy Hook 2012, Mother Emanuel 2015, Pulse 2016)
• Emergence and growth of Black Lives Matter (from 2013)
• Obergefell v. Hodges: national recognition of same–sex marriage (2015)
• Intensifying political tensions and divisions (2007-2016)

And hospice and palliative care grew within this landscape—asked to respond not only to illness, but also to what it means to offer presence, fairness, and dignity in a country marked by both deep wounds and real efforts to heal.

Today’s hospice and palliative care: Today’s hospice and palliative care teams now serve people whose stories carry the weight of this decade—job loss and recovery, deployments and homecomings, smartphones and social media, health reform, public violence, and changing family and racial realities. Our work is to offer clear communication, steady presence, and fair access to comfort and support, so that families experience reliable care even when the world around us all feels uncertain.

Source: Financial crisis of 2007–08; Apple reinvents the phone with iPhone (2007); Barack Obama inauguration; Apple launches iPad (2010); Great Recession and its aftermath; Obergefell v. Hodges (2015); Black Lives Matter origins; A List of The Deadliest Mass Shootings in Modern U.S. History

‌2. From Movement to System: Hospice and Palliative Care Become a Measured Presence in American Health Care‌

• What began as a small movement for dignity and the promise that “you matter because you are you” has evolved into a nationwide system of care, committed to accompanying people and families through the challenges of dying—helping them live in ways that matter to them, and die as peacefully and comfortably as possible.

Historical context: By 2008, hospice and palliative care had shifted from a small, values-driven movement to a recognized part of the U.S. health care system. That year’s updated Hospice Conditions of Participation formally defined the health and safety requirements every hospice must meet, emphasizing interdisciplinary teams, quality oversight, and core services for the dying. In 2015, the CAHPS Hospice Survey began systematically capturing the experiences of bereaved family caregivers, transforming their narratives of communication, symptom relief, and respect into publicly available quality scores.

Today’s hospice and palliative care: Hospice and palliative care now inhabit a measured, regulated landscape: organizations must comply with federal standards, report experience and quality data, and document care in real time, even as they continue the core work of walking with people and families through the challenges of end-of-life illness. The ongoing task is to ensure that metrics, surveys, and electronic records serve this companionship—supporting relief of total pain and peaceful dying. They must not overshadow the relational, spiritual, and moral heart of the work.

Sources: CMS Hospice Conditions of Participation Overview; CMS CAHPS Hospice Survey;

3. ‌Care Under Pressure: Different Hospice Models, Different Patterns of Care‌

• As hospice care in the United States came to include both community–based nonprofits and rapidly growing for–profit and investor–owned organizations, different ownership models began to show different patterns—who is enrolled, how often teams visit, how long people stay, and how families describe their experience.

Historical context: From the 2000s into the 2010s, hospice expanded and diversified. Long–standing nonprofit programs were joined by a rising number of for–profit and chain hospices, changing the structure of the field. Research found that, on average, nonprofits tended to provide more nursing and social work visits per patient day and had lower rates of live discharge, while for–profit hospices more often served longer–stay, lower–acuity patients and reported higher margins with fewer visits. Caregiver experience scores and recommendation rates also varied, suggesting that ownership models were linked to recognizable differences in how the benefit was used and felt.

Today’s hospice and palliative care: Today, most families do not focus on whether a hospice is nonprofit or for–profit; they notice how present the team is, how well symptoms are controlled, and whether they feel supported and heard. For leaders and staff, the challenge is to face the data honestly—visits, live discharges, margins, caregiver experience—and use it to align business realities with hospice’s core promise of reliable, whole–person care. The invitation is not to defend one model over another, but to ask, in every boardroom and team meeting: Are our patterns of care worthy of the trust people place in us at the end of life?

Sources: Nearly Half Of All Medicare Hospice Enrollees Received Care From Agencies Owned By Regional Or National Chains (2016); Differences Between For-profit and Non-profit Hospice Agencies in the US Medicare Population (2021); Private Equity-Owned Hospices; Hospice Medicare Margins: Analysis of Patient and Hospice Characteristics, Utilization, and Cost (2019 analysis using data from this 2007-2016 timeframe)

‌4. Rewriting the Rules of Access: The Affordable Care Act, Aging, and Serious Illness‌

• The Affordable Care Act changed more than coverage. It changed when and how some families could receive serious-illness care.

Historical context: The ACA affected end-of-life care in specific ways. It created pediatric concurrent care, allowing children under 21 in Medicaid and CHIP to receive hospice while continuing disease-directed treatment, and it authorized hospice payment reform and demonstration projects tied to quality and accountability. Just as important, the ACA era helped shift palliative care from late rescue to earlier support in serious illness, by widening coverage, encouraging quality reform, and aligning care more closely with what patients and families needed over time.

Today’s hospice and palliative care: The ACA era shifted the central question from whether hospice and palliative care exist to whether people can reach them early enough to matter. Coverage expansion, concurrent care, and broader reform helped open the door to palliative care alongside treatment, earlier in the disease trajectory and closer to the realities patients and families were living. The enduring challenge is to make that earlier, fairer, better-informed access a lived reality across diagnoses, ages, and communities—not just a policy promise.

Sources: The Patient Protection and Affordable Care Act and Its Impact on Hospice (2010); 10 FAQs: Medicare’s Role in End-of-Life Care (2016); Variation in state Medicaid implementation of ACA: The case of Concurrent Care for Children; The Affordable Care Act and End-of-Life Care for Patients with Cancer; Medicare’s Hospice Benefit: Revising the Payment System to Better Reflect Visit Intensity

‌5. Healing in an Age of Trauma: Repeated Violence, Black Lives, and the Work of Care‌

• In a new era marked by mass shootings in the everyday spaces of schools, places of worship, grocery stores, movie theaters, music concerts, and LGBTQ+ and racial communities, and by the cry that Black lives matter, Americans were forced to ask what care looks like when safety itself is shattered.

Historical context: From 2007 to 2016, mass violence became a recurring feature of American life. Key tragedies included Virginia Tech (2007), Aurora (2012), Sandy Hook (2012), Mother Emanuel AME Church (2015), and Pulse nightclub (2016); soon after came Las Vegas (2017) and Parkland (2018), showing the pattern continuing beyond the decade. In this same arc, Black Lives Matter arose after Trayvon Martin (2012) and grew through names like Michael Brown (2014) and Eric Garner (2014), highlighting how Black communities had long carried disproportionate risks and grief. These events widened awareness of racial injustice and, at times, widened visible gaps between communities, even as many people and institutions began working to bridge those divides in workplaces, health care, education, and culture.

Today’s hospice and palliative care: For hospice and palliative care, this period clarifies that serious–illness and end–of–life care unfold within a nation still wrestling with racial wounds and unequal safety. Many patients and families—especially Black families and other marginalized groups—bring histories of harm and mistrust into their encounters with care. Trauma–informed and equity–focused practice seek not only to avoid re–traumatization, but to help bridge long–standing divides by treating trust, fairness, and dignity as essential parts of the clinical work. The hope is that, at the end of life, care can become one place where the gaps between races are narrowed rather than deepened—where those who have been least protected in public life experience unmistakable respect and belonging as they die.

Sources: A List Of The Deadliest Mass Shootings In Modern U.S. History (2016); Sandy Hook Elementary School Shooting (2012); Black Lives Matter: Our History; 10 years after the deadly church shooting, a new history of ‘Mother Emanuel’; NAACP: Racial Disparities in Hospice Care (2025)

2017-2026

posted in Hospice & Palliative Care Today, July 4, 2026

‌1. COVID-19: Distance, Disparity, and the Demand for Presence‌

• We are not all in the same boat. We are all in the same storm.
  Some are super-yachts.
  Some have just one oar.
  ~ Damian Barr

Historical context: In 2020, COVID-19 drove the largest spike in U.S. deaths in modern memory. Every person in the country lived through its disruptions: fear of contagion, lockdowns, visitor bans, masks, and daily counts of deaths. Visitor bans and infection-control rules meant many patients died without the people who mattered most at the bedside; families and friends kept vigil through phones and video screens as entire networks absorbed multiple losses and generations were cut off from one another. Workplaces and livelihoods were shaken, children and schools pivoted to remote learning, and conflicts over masks and vaccination widened already sharp political divides. The virus struck hardest in nursing homes, communities of color, low-wage essential workers, and people with serious illness, revealing long-standing inequities in exposure, employment, housing, and access to care. 

Vaccines, developed with historically rapid science, brought real hope and protection, yet not evenly shared. Earlier epidemics in this series—the 1793 yellow fever, 1800s puerperal fever, and the 1918 influenza pandemic—likewise showed that place and injustice shape who suffers most and whose vigils and mourning are protected or cut off.

Today’s hospice and palliative care: COVID-19 forced hospice and palliative teams to rethink what it means to “be there” when people are dying. Previously feared technologies brought new ways to connect and accompany. The intersections of science, need, service, ethics, and core humanity continue on. Our call to action is that pandemic readiness and these lessons about isolation, fear, and disruption must become shared hospice work—so that in the next crisis, all of us, especially those at highest risk, can count on connection, relief, and unmistakable dignity.

Sources: “We are not all in the same boat.”; Pandemic Disrupted Historical Mortality Patterns, Caused Largest Jump in Deaths in 100 Years; Racial and ethnic inequities in occupational exposure across and between US cities; How COVID-19 is straining hospice care; Hospice, Hospice Partners, and Telehealth in the Time of COVID-19; COVID-19 Vaccine Equity for Racial and Ethnic Minority Groups

2. ‌“I Can’t Breathe”: Racism, Suffering, and the Work of Care‌

• “George Floyd’s pleas awakened this world that has been rendered comatose by fear of contagion and all of a sudden nothing mattered but justice.” ~ Aysha Taryam

Historical context: On May 25, 2020, the murder of George Floyd, recorded on a phone by a teenage bystander, ignited global protests against police violence and systemic racism. In the months that followed, leaders across public health and healthcare named racism as a public-health crisis, tying it to disparities in chronic disease, mental health, maternal mortality, and premature death. In this series’ long timeline, his cry “I can’t breathe” stands alongside the voices of Absalom Jones, Frederick Douglass, and the Cherokee Memorial—an unbroken line of testimony that bodies, communities, and grief have long been shaped by racialized injustice.

Today’s hospice and palliative care: This moment widened “suffering” from private pain to harm created by unjust systems, including health settings where Black patients and other marginalized groups can face barriers to hospice use, undertreated pain, and fewer chances to die at home on their own terms. A decade of research using the NIMHD health–disparities framework has traced how structural racism, neighborhood risk, financial strain, communication gaps, and mistrust drive inequities in serious–illness and end–of–life care for Black Americans. Continuing this series’ themes of Dignity, Recognition, and “Equity as Outcome,” hospice and palliative care must treat anti–racism as clinical work: tracking disparities, earning trust, embedding cultural humility, and partnering with communities. Our call to action is that, at life’s end, people least protected in public life will encounter unmistakable dignity and presence, not one more chapter of neglect. The graphic created for this 2017-2026 does not indicate “arrival” from past errors, but rather progress on our ongoing journeys: for systems, communities of care, families, and individuals.

Sources: Aysha Taryam’s quote; George Floyd: ‘Pandemic of racism’ led to his death, memorial told; Understanding African Americans’ experience with palliative and hospice care; A Decade of Studying Drivers of Disparities in End-of-Life Care for Black Americans: Using the NIMHD Framework for Health Disparities Research to Map the Path Ahead

‌3. Workforce, Moral Distress, and Business Models: Who Stays, Who Leaves, and Who Decides?‌

• The injury isn’t just workload—it’s values under pressure.

Historical context: In the 2020s, COVID–19 exposed how exhausted and morally distressed many health workers, even as Baby Boomers aged into higher need. Clinicians described the strain of caring with too few staff, scarce PPE, inequitable access, and rules that kept families away, echoing earlier chapters on Rights & Responsibility and “Business Models Shaping Moral Experience.” At the same time, hospice consolidation, private–equity investment, fraud crackdowns, program closures, and expanding debates over Medical Aid in Dying reshaped who controlled resources and rules—and what counted as relief.

Today’s hospice and palliative care: For hospice and palliative teams, capacity now clearly means supported people, not just licensed beds. Moral distress often arises when pressures to meet metrics conflict with what staff believe patients and families deserve, and when inequities, work–life imbalance, or MAiD requests collide with conscience. Younger workforce members name flexibility, psychological safety, and meaningful support as non–negotiable. Our call to action is to build real career ladders, mentoring, ethics consultation, and trauma–aware teams, while cultivating leaders whose business acumen protects the field’s ethical center—even when mergers, acquisitions, or fraud pressures push the other way. When boards and executives design models that prioritize presence and integrity over volume alone, we help ensure that “all are created equal” is felt by patients and by the people who care for them, together.

Sources: Moral Distress Experienced by US Nurses on the Frontlines During the COVID-19 Pandemic: Implications for Nursing Policy and Practice; Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce; Compassion fatigue, watching patients suffering and emotional display rules among hospice professionals: a daily diary study; Hospice and Medical Aid-in-Dying: Addressing an Unethical Disconnect; The Seismic Shift in End-of-Life Care: Palliative Care Challenges in the Era of Medical Assistance in Dying; Does private equity acquisition impact the quality of care provided in US hospices?; California’s hospice fraud crisis is flourishing in plain sight. Regulation needs to catch up

4. ‌#MeToo and Hidden Caregivers‌

• “We hold these truths to be self-evident; that all men and women are created equal.” ~ Elizabeth Cady Stanton and delegates of the Seneca Falls Convention, “Declaration of Sentiments” in July 1848

Historical context: Across this timeline, women’s caregiving—watchers at the deathbed, enslaved midwives, settlement–house nurses—has been essential and often unpaid, performed without status or protection. Beginning in 2017, #MeToo and movements like Time’s Up Healthcare exposed pervasive sexual harassment and abuse throughout workplaces and revealed the vulnerability of home–care workers, many women of color and immigrants, laboring alone in private homes.

Today’s hospice and palliative care: In modern hospice, as in the wider direct–care workforce where nearly nine in ten workers are women, most frontline roles are held by women; their safety, pay, and voice directly shape the quality of care patients receive. We carry forward the catalysts for change ignited by Elizabeth Cady Stanton, Clara Barton, Lillian Wald, Cicely Saunders, Elisabeth Kübler–Ross, and Florence Wald, even as unequal and unfair treatment of women can persist. Our call to action is to make trauma–informed, dignity–centered practice cover staff as well as patients: robust policies against harassment, real reporting protections, schedules and wages that honor caregiving at home, and leadership that reflects the workforce’s diversity—because the promise that every life possesses worth must include the lives of those who show up, day after day, at the bedside.

Sources: A Declaration for the Rights of Women; Time’s Up For Inequality And Harassment In Healthcare; Workplace Violence Prevalence and Reporting in Home Health Care; Verbal Abuse Against Home Care Aides: Another Shot Across the Bow in Violence Against Health Care and Other Workers; PHI Launches Institute to Address Inequities in the Direct Care Workforce; Lillian Wald; Study: Over 50% Of Home Health Workers Surveyed Experienced Workplace Violence

‌5. Emergency Disasters: Climate Change and Community Violence‌

• “Please take care of yourself and each other.” ~ Lester Holt, anchor NBC Nightly News sign-off

Historical context: In the late 2010s and 2020s, emergency disasters—climate–driven and human–made—upended communities, families, and people already dependent on others for help. Hurricane Helene’s winds and flooding devastated vast regions and cut power to millions, leaving medically fragile people at acute risk. In California, wildfires destroyed homes and businesses and displaced entire neighborhoods, including families with loved ones in hospice or reliant on fragile support systems. In Texas, children were killed in the Uvalde school shooting, and other children and counselors later died in flash flooding at Camp Mystic—layers of communal trauma and grief that show how “place” now includes storms, fires, and violence. These unretrievable losses change lives forever.

Today’s hospice and palliative care: Serious–illness and end–of–life care can no longer assume stability; continuity must be planned across outages, evacuations, and sudden loss of safety. Hospice and palliative teams identify highest–risk patients, arrange backup power and oxygen, rehearse communication plans, and work with emergency management, schools, congregations, and local leaders so patients and caregivers are not forgotten when crises hit. Social media can fuel panic, yet it can also carry rapid check–ins, mutual aid, and virtual grief circles. Our call to action is to treat emergency readiness, trauma–aware support, and careful public communication as acts of dignity—so that even when disasters and violence shatter what felt secure, we still do all we can to keep people safe, comforted, and not alone.

Sources: Media Mondays / The Great Good-Byes; One Year After Hurricane Helene: Lessons in Resilience, Recovery, and Renewal; Seeking A Peaceful Death Amid The Flames; Uvalde school shooting; Texas floods: Camp Mystic says 27 children and staff dead; The impact of climate change on hospice and palliative medicine: A scoping and narrative review; Beyond place-based: the role of virtual communities via social media in young adult recovery

‌6. Technology, Data, and the Meaning of Presence: Moving Faster Than Meaning‌

• “I’m in favor of progress; it’s change I don’t like.” ~ Mark Twain

Historical context: Across this series, technology and data have repeatedly reshaped presence. Mortality tables and public health records made hidden suffering visible, yet could also reduce lives to categories. Electric light, telephones, cars, computers, and later telehealth changed how care reached the bedside, extending vigilance, speeding response, and connecting people across distance and time. From 2017–2026, COVID–era payment changes pushed telehealth, remote monitoring, and AI toward the center of serious–illness care, while cybersecurity, privacy, and algorithmic bias exposed new fault lines of trust. Across that long arc, the question remains the same: whether technology and data deepen human presence or distract from it.

Today’s hospice and palliative care: For hospice and palliative teams, technology and data now shape presence itself. Telehealth, electronic records, and real–time monitoring can widen the room—bringing care to rural patients and far–away family—yet they can also flatten nuance, widen digital inequities, and tempt clinicians to mistake dashboards for reality. Data can reveal inequity, symptoms, and unmet need, or turn people into scores if clinical judgment and listening fall away. The task is not to resist innovation, but to guide it with ethics and compassion, so that every new tool helps clinicians notice sooner, respond more wisely, and remain more faithfully present to the whole person.

Sources: Mark Twain, “I’m in favor of progress …”; Payment and Coverage Parity for Virtual Care and In-Person Care: How Do We Get There?; Changes in Medicaid Telehealth Policies Due to COVID-19: Catalog Overview and Findings; National Death Index; Exploring Artificial Intelligence in Hospice and Palliative Care: An Integrative Review of Technological and Clinical Approaches; The HIPAA risks of remote work in hospice administration; Telehealth Group Interactions in the Hospice Setting: Assessing Technical Quality Across Platforms