WASHINGTON — Florence Wald, a former Yale University nursing school dean who brought the hospice movement to the United States and started the first American hospice unit in 1971, died Nov. 8 at her home in Branford, Conn. No cause of death was reported. She was 91.

Her interest in end-of-life issues was sparked in 1963. Cicely Saunders, an English physician who was a pioneer in the field, gave a lecture at Yale describing her approach to treating terminally ill cancer patients by easing pain and suffering in the final stages of life so they could concentrate on their relationships and prepare for death.

“She made an indelible impression on me, for until then I had thought nurses were the only people troubled by how a terminal illness was treated,” wrote Wald, who informally retained the title of dean after she left the Yale post in 1966.

After hearing Saunders’ lecture, Wald immediately sought to revamp nursing education to focus on patients and their families and involve them in the patients’ care.

She resigned from the deanship to educate herself about the hospice movement. In 1969, she spent a month at St. Christopher’s Hospice in London, the hospice founded by Saunders. When she returned to the United States, she formed an interdisciplinary team of doctors, clergy and nurses to study the needs of dying patients. In 1974, that team founded the first U.S. hospice, Connecticut Hospice in Branford. At first it provided only home care; by 1980, it had an inpatient facility.

The hospice movement took off, with programs sprouting by the dozens, then hundreds. In 1982, Congress required Medicare to pay for hospice care, which put the treatment in mainstream medical practice.

Today, about 3,200 hospice programs serve about 900,000 patients a year in the United States.