As recent as the 1970s, the concept of hospice care was relatively new in the United States.
That began to change in 1975, when the team at Hospice of Marin recognized that quality end-of-life care required a comprehensive approach, addressing not only physical symptoms but also emotional, social and spiritual needs.
But as much as the philosophy of hospice care resonated with families and communities, it faced significant barriers to widespread adoption. Chief among them was the lack of a sustainable funding model. For families already grappling with the emotional and financial challenges of terminal illness, the cost of hospice care was often prohibitive.
As a result, early hospice programs relied heavily on community donations, volunteers and private philanthropy. While these sources were invaluable, they were insufficient for sustaining comprehensive services on a large scale.
Adding to the problem was the fact that Medicare covered treatments aimed at curing illnesses but did not recognize or reimburse for the palliative focus of hospice.

Building the case for a Medicare hospice benefit
Mary Taverna and her colleagues at Hospice of Marin understood that without systemic change, hospice care would remain out of reach for most Americans. So they began to advocate for a new approach that would integrate hospice into the Medicare system.
Taverna and her team were not alone in their efforts. Advocates across the country were pushing for legislative action. And together, they argued that hospice care was not only compassionate but also cost-effective. By prioritizing comfort over curative treatments for terminal patients, they argued, hospice care reduced hospital stays and intensive medical interventions, ultimately lowering healthcare costs.
Not surprisingly, given the entrenched interests and complexities of the American healthcare system, Taverna and other advocates faced skepticism from policymakers and healthcare administrators.
The idea of allocating federal funds to a care model focused on comfort, rather than cure, challenged traditional notions of medical care. Additionally, policymakers worried about the potential for abuse and fraud in a new Medicare benefit.
To combat that, Taverna testified before congressional committees, met with legislators and worked alongside other advocates to build bipartisan support for a Medicare hospice benefit.
A turning point
The advocacy of Taverna and others scored its first victory with the establishment of hospice demonstration projects in the late 1970s. These projects, supported by the federal government, allowed selected hospice programs to provide care under a preliminary funding structure while gathering data on outcomes and costs.
Hospice of Marin was one of the programs selected for the demonstration, and the organization was able to show the viability of hospice care as a Medicare-funded service. The data collected from the demonstration projects revealed that hospice care not only improved quality of life for patients and families, but also backed up the belief that hospice care would reduce overall healthcare expenditures for terminally ill individuals.
Finally, in 1982, after years of advocacy, research and collaboration, Congress passed the Tax Equity and Fiscal Responsibility Act (TEFRA). Included in the act was a Medicare hospice benefit, a carveout within the program that allowed terminally ill patients to receive hospice care while forgoing curative treatments.
It also defined key components of hospice care, including pain management, bereavement support and interdisciplinary care teams. And, importantly, it required that hospice services be provided in alignment with a patient-centered plan of care, ensuring that patients’ values and preferences remained central in the care they received.

Continuing the legacy
Today, more than 1.5 million Medicare beneficiaries receive hospice care annually, making the 1982 hospice carveout a watershed moment in U.S. healthcare.
Mary Taverna’s ability to bridge the worlds of healthcare delivery, policy advocacy and community engagement were instrumental in this achievement, and even as our organization has grown and evolved over the decades, her passion and guidance continues to drive By the Bay Health.
Hospice and palliative care still face challenges, including workforce shortages in healthcare, potential regulatory changes and a growing elderly population. But by continuing to advocate for policies and practices that ensure all individuals have access to compassionate care, we will be able to take these challenges head on and continue to work toward making access to hospice and palliative care more equitable.
Taverna and other trail-blazers believed in empathy and a commitment to dignity for those at the end of their lives or in need of consistent care. We’re honored to continue their work and their legacy.
By the Bay Health is celebrating our 50th anniversary of advocating for hospice and palliative care. You can help us continue our mission by donating. Visit our 50th anniversary page to learn how you can contribute.
