- Former President Jimmy Carter has entered hospice care.
- The former president is 98 years old and has had various health issues in recent years including cancer.
- Hospice care is a comprehensive approach to end-of life care that is aimed at maximizing comfort for a person who is terminally ill.
Former President Jimmy Carter entered hospice care at home, the Carter Center announced over the weekend.
The president, who is 98 years old, “decided to spend his remaining time at home with his family and receive hospice care instead of additional medical intervention,” the center said in a statement.
“He has the full support of his family and his medical team,” the statement read. “The Carter family asks for privacy during this time and is grateful for the concern shown by his many admirers.”
Hospice care is a comprehensive approach to end-of life care that is aimed at maximizing comfort for a person who is terminally ill.
Patients with cancer, kidney failure, dementia and other conditions qualify for hospice.
“Hospice, as a Medicare benefit, is specifically for patients who have a serious illness and have a prognosis of six months or less,” Dr. Corey Tapper, an assistant professor of medicine at the Johns Hopkins University School of Medicine in Baltimore, Maryland, told Healthline.
Physicians make the determination of life expectancy based on the disease running its normal course.
This approach to end-of-life care focuses on reducing a person’s pain, as well as addressing their physical, psychological, social and spiritual needs, according to the National Association for Home Care & Hospice (NAHC).
“The goal of hospice care is optimizing someone’s quality of life and reducing their suffering, for however long that patient has to live,” said Tapper.
One misconception about hospice care is that it is intended to hasten a person’s death, but Tapper said that is not the case.
In addition, while patients no longer receive active therapies for their underlying condition while they are in hospice, this is still a medical intervention.
“Often we use medications quite aggressively to manage patients’ symptoms, so that they can be themselves and functional for as long as possible,” said Tapper.
Medicare began covering hospice care in 1983, with some private insurance and Medicaid now also offering hospice benefits.
According to the NAHC, more than 1.6 million Medicare members received hospice services in 2019.
Hospice services are sometimes provided in nursing facilities, assisted living facilities, hospice facilities and hospitals, said the NAHC.
But “for the vast majority of patients in the U.S. who elect hospice services, those services are actually provided in patients’ homes,” said Tapper.
A home hospice team includes a nurse case manager, who runs the day-to-day care for patients, with the rest of the team made up of physicians, nurses, social workers, chaplains, volunteers and others.
Other services offered during hospice include medications to manage pain or other symptoms, home medical equipment, physical and speech therapy, and bereavement services for the patient’s family.
For hospice care in the home, family members and other caregivers — or caregivers paid by the family — provide the day-to-day care, with support from the hospice team.
Tapper said that’s why family members and others need to be included in discussions with the patient and their doctors.
“If patients elect for hospice in the home setting, we rely in a lot of ways on the patient’s support system to participate in their care,” he said. “So it’s really important to make sure the members of that support system are on the same page as the patient.”
Before a patient can receive hospice care, a hospice doctor and a patient’s regular doctor, if they have one, have to certify that they are terminally ill.
The patient also has to accept comfort care instead of treatments to cure their illness, and the patient has to sign a statement choosing hospice care.
While the Medicare benefit is written so patients with a life expectancy of six months or less are eligible, many people spend less than 30 days in hospice care, said Tapper.
This is unfortunate, he said, because research shows that “patients actually benefit more, and report better quality of life and better symptom management, the longer that they’re in hospice.”
Tapper encourages his patients to start thinking about hospice earlier in the progression of their disease, such as when they no longer have additional therapies available to them.
Dr. Michael Trexler, an assistant professor and program director of the Hospice and Palliative Medicine Fellowship at Western Michigan University Homer Stryker M.D. School of Medicine, said the “right time” to enter hospice depends on a patient’s goals for comfort care.
He often asks patients how they would feel about coming back into the hospital to receive additional invasive treatments, such as radiology or surgical procedures.
If that feels like more of a burden than a benefit, and they would rather be at home and comfortable, “then I recommend hospice care as a supportive service to help them be able to stay out of the hospital and meet their comfort needs,” he told Healthline.
Both hospice care and palliative care are about managing patients’ symptoms and relieving their suffering.
In fact, hospice care can be viewed as a type of palliative care.
Where these differ is in the timing of the supportive care and the patient’s goals.
“Palliative care can occur at the start of a serious diagnosis all the way through the death experience,” said Trexler, “and is not limited to just those who are imminently dying or wanting hospice care.”
Unlike hospice care, patients in
If a patient’s medical team believes that the ongoing treatment is no longer helping, the patient may be transitioned to hospice care.
“It is important to note that the palliative care philosophy and approach respects patient and family decisions and choices, and does not coerce people into entering hospice care,” said Trexler.
In addition, when a patient chooses to enter hospice care, it should not be seen as giving up or failing, said Tapper.
“In fact, it can be a very positive thing that patients receive care focused on maximizing their quality of life during one of the most stressful times of their life,” he said.