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In the past year, Jimmy Carter has been receiving hospice care at his residence in southern Georgia. During this time, the ex-president turned 99 years old, received recognition for his accomplishments, and sadly, his spouse of 77 years passed away.
Rosalynn Carter passed away in November, approximately six months after her family revealed her dementia diagnosis. She spent her final days under hospice care with her husband by her side.
Professionals in the field of end-of-life care note that the Carters’ divergent journeys exemplify the breadth of a frequently misunderstood support. These advocates praise the Carter household for showcasing the inevitabilities of getting older, cognitive decline, and passing away. They communicate their optimism that this publicity prompts more individuals in the United States to seek assistance from services designed to aid patients and their loved ones during the final stages of life.
Angela Novas, the chief medical officer for the Hospice Foundation of America in Washington, acknowledges the significant impact of the Carters’ public support. Their advocacy has brought attention to hospice care and sparked curiosity among individuals to seek out further knowledge.
The Carter family issued a statement in anticipation of Sunday, marking one year since their declaration that the 39th president would no longer be seeking hospitalization and instead receive end-of-life care at home in Plains.
“The statement confirms that President Carter is currently staying at home with his family. The family is happy that his choice to enter hospice care last year has sparked meaningful conversations among families across the nation regarding an important topic.”
To clarify, it has not been confirmed by the family if Jimmy Carter is still in hospice care or if he has been released, which can occur when a fragile patient’s health improves.
Let’s take a closer look at hospice and the situation of the Carters.
Hospice provides care for all individuals, including those who are wealthy and influential.
Mollie Gurian holds the position of vice president at Leading Age, an organization consisting of over 5,000 non-profit agencies that provide care for elderly individuals. She defined hospice as comprehensive care for those who are nearing the end of their life and prioritizing living fully, rather than seeking a cure for a terminal illness.
Hospice provides a variety of healthcare providers for each individual, including nurses, doctors, and social-service experts like chaplains and grief counselors. While home hospice includes in-person visits, it does not offer 24/7 or full-day care.
To be eligible, a doctor must certify that a person has a terminal condition and is not expected to live longer than six months. There are also specific guidelines for different diseases.
Private companies or charitable organizations usually offer services and hire staff to provide care. Medicare compensates these organizations a fixed amount for every day a patient receives care. There are four different levels of care with corresponding daily rates. This idea originated after World War II and has been integrated into the Medicare system since the 1980s. Most private insurance plans also cover hospice services.
According to the federal Medicare Payment Advisory Commission (MedPAC), in 2021, 1.7 million Medicare beneficiaries were enrolled in hospice, resulting in a taxpayer cost of $23.1 billion. Nearly half of the Medicare patients who passed away during that year received hospice care.
The concept of hospice goes beyond the common belief that it only provides morphine.
Gurian explained that the concept of hospice may bring to mind the idea of a person heavily medicated and confined to bed, but it is not simply about administering enough morphine to get through the final days.
Patients often stop taking curative treatments and medications, including radiation and chemotherapy for cancer. Those with advanced Alzheimer’s, Parkinson’s, or other degenerative neurological diseases may also discontinue cholesterol and blood pressure medication, as well as drugs for their acute condition.
Novas and Gurian stated that treatment is tailored to each individual case. Certain agencies may permit individuals with end-stage kidney disease to receive dialysis or take prescribed medication. However, the cost must be covered by the agency, as Medicare typically does not provide separate payment for these treatments.
Additionally, hospice care does not automatically imply giving up on treatments for specific complications that may affect comfort, such as prescribing antibiotics for a urinary tract infection or treating infected bed sores. However, in situations where a patient is in the final stages of a neurological disease, they or their loved ones may choose to forego these treatments.
Chip Carter, one of the four children of Jimmy and Rosalynn Carter, confirmed to The Washington Post that his mother was admitted to hospice due to a severe urinary tract infection and ultimately passed away from it. In such situations, Novas clarified that patients are given medication for pain management.
Jimmy Carter’s resilience is not uncommon.
In 2021, MedPAC determined that the average length of stay for hospice patients who passed away was 92 days. The median stay was 17 days, which is approximately two weeks longer than the period of time between the announcement of the former first lady’s hospice admission and her passing.
Approximately 10% of individuals who were enrolled in hospice care and passed away had a stay of more than 264 days. These longer stays make up the majority of costs. In 2021, $13.6 billion out of the total $23 billion paid was for stays that lasted longer than 180 days before the individual’s death. Out of that amount, $5 billion went towards stays that exceeded one year.
Hospice patients may be released if their health improves, particularly if they have been in the program for six months. In 2021, 17.2% of patients were discharged. The MedPAC report to Congress highlighted that for-profit organizations tend to have longer stays compared to nonprofits. Additionally, the discharge rates of living patients raise concerns about admission criteria.
Novas provided clarifications. She noted that hospice has observed an increase in patients with dementia, where “a patient’s condition can fluctuate for months or even years.” Another reason, according to her, that could account for Jimmy Carter’s resilience is sheer determination.
According to her, it is impossible to quantify the human spirit. However, under certain circumstances, those who truly desire to be present will remain for a considerable amount of time.
Supporters are pushing for revisions and growth.
Leading Age and other advocates argue that the U.S. needs to include a long-term care insurance provision in Medicare, especially with the aging of the Baby Boomer generation.
She stated that this type of care would assist patients and their families in managing the heavy responsibilities that hospitals and hospice do not offer or should not be responsible for. In certain cases of dementia, a long-term care benefit could potentially become a more prevalent form of covered care.
Recent sessions of Congress have seen the proposal of legislation to establish a long-term care program within Medicare. However, this is a challenging and potentially unfeasible task due to the required raise in payroll taxes to fund this additional benefit.
Gurian stated that Leading Age is advocating for Congress to raise hospice payment structures. This would allow more agencies to accept patients while still covering certain treatments that are currently being sacrificed. As an example, she mentioned that cancer patients could potentially reduce their cancer treatments as a form of pain management, rather than completely giving up treatment and quickly progressing to strong drugs like morphine, which greatly impact their quality of life.
Jimmy Carter continues to provide lessons.
According to Gurian, the health care system in the United States and American culture typically only offer two options for individuals facing a serious diagnosis: “battling” or “surrendering.”
She stated that hospice is not about giving up, but rather accepting our mortality.
Novas stated that Jimmy Carter has demonstrated these differences through his public statements and, in November, his resolve to attend the funeral for Rosalynn Carter despite his physical limitations. He was seen in a wheelchair and his legs were covered with a blanket.
Novas expressed the significance of the moment, stating that it was important for the world to witness what being 99 years old looks like, even for a previous president. He believes that there are still lessons to be learned from the former president and that he must be conscious of his actions on some level. Hospice is a supportive ally in his journey, but ultimately it is his own personal journey.
You can visit the Hospice Foundation website at the following URL: https://hospicefoundation.org/Ask-HFA
Source: independent.co.uk
