The Carter family released a statement ahead of Sunday, the one-year anniversary of their announcement that the 39th president would forgo future hospital stays and enter end-of-life care at home in Plains.
“President Carter continues to be at home with his family,” the statement said. “The family is pleased that his decision last year to enter hospice care has sparked so many family discussions across the country on an important subject.”
To be clear, the family has not confirmed whether Jimmy Carter remains in hospice care or has been discharged, as sometimes happens when even a frail patient’s health stabilizes.
HOSPICE SERVES EVERYONE, EVEN THE RICH AND POWERFUL
Mollie Gurian is vice president of Leading Age, a national network of more than 5,000 nonprofit elder-care agencies. She described hospice as “holistic care … for someone who is trying to live the end of their life as fully as possible” but no longer seeks a cure for a terminal condition.
Hospice offers multiple practitioners for each patient: nurses, physicians and social-service professionals like chaplains and secular grief counselors. Home hospice features in-home visits but not round-the-clock or even full-shift care.
Initial eligibility requires a physician’s certification of a terminal condition, with the expectation that a person will not live longer than six months; there are also disease-specific parameters.
For-profit businesses or nonprofit agencies typically provide the care and employ the providers. Medicare pays those agencies a per-day rate for each patient. There are four levels of care and daily rates. The concept was developed after World War II and has been part of the Medicare program since the early 1980s. Private insurance plans also typically cover hospice.
In 2021, 1.7 million Medicare beneficiaries enrolled in hospice at a taxpayer cost of $23.1 billion, according to the federal Medicare Payment Advisory Commission (MedPAC). Almost half of Medicare patients who died that year did so under hospice care.
JIMMY CARTER’S ENDURANCE IS NOT UNUSUAL
In 2021, the average stay of hospice patients who died was 92 days, MedPAC calculated. The median was 17 days — about two weeks longer than the time between when the Carters’ announced the former first lady had entered hospice and when she died.
About 10% of enrollees who die in hospice care stayed more than 264 days. Extended cases drive a majority of costs. In 2021, $13.6 billion of the overall $23 billion paid was for stays exceeding 180 days before death. Of that, $5 billion was for stays longer than a year.
Patients are sometimes discharged from hospice if their condition stabilizes, especially if they have reached the six-month mark in the program. In 2021, 17.2% of the patients were discharged. The MedPAC report to Congress noted that for-profit agencies have higher average length of stays than nonprofits and added that living patients’ discharge rates raise questions about admission standards.
Novas offered explanations. She said hospice has seen an uptick in patients with dementia, conditions in which “a patient can wax and wane for months or even years.” Another factor — one she said could explain Jimmy Carter’s endurance — is sheer grit.
“We cannot measure the human spirit,” she said. With many conditions, “somebody who wants to be here is going to stick around for a while.”Culled from Flipboard
