Jimmy Carter's Death Highlights Extended Hospice Care and End-of-Life Choices

Former President Jimmy Carter, the 39th president of the United States and a Nobel Peace Prize laureate, passed away on December 29, 2024, at the age of 100. He died peacefully at his home in Plains, Georgia, surrounded by his family, following a prolonged period in hospice care that began in February 2023.

That leaves three living former presidents, excluding Joe Biden, who will leave office in January 2025, and Donald Trump, who will return to the presidency that same month.

• Bill Clinton (born August 19, 1946): Served as the 42nd president from 1993 to 2001.
• George W. Bush (born July 6, 1946): Served as the 43rd president from 2001 to 2009.
• Barack Obama (born August 4, 1961): Served as the 44th president from 2009 to 2017.

Carter's death at age 100 after 16 months in hospice care has drawn attention to the importance of patient-centered end-of-life decisions. His prolonged hospice stay, far exceeding the average duration, underscores the flexibility of care options and the role of Medicare in supporting families during terminal illnesses.

A Legacy of Service and Humanity

Born on October 1, 1924, in Plains, Georgia, James Earl Carter Jr. rose from humble beginnings to the nation’s highest office, serving as president from 1977 to 1981. His administration was marked by significant achievements, including the Camp David Accords, the establishment of the Departments of Energy and Education, and a steadfast commitment to human rights.

After his presidency, Carter's dedication to humanitarian efforts continued through the Carter Center, which he co-founded with his wife, Rosalynn, in 1982. The center has been instrumental in advancing peace, health, and democracy worldwide.

Health Challenges and Resilience

Carter’s later years were marked by a series of health challenges, demonstrating his resilience and determination. In August 2015, he underwent surgery to remove a small mass on his liver, after which he announced that cancer had spread to his brain and liver.

He began treatment with the immunotherapy drug pembrolizumab and radiation therapy, leading to a remarkable recovery by December 2015, when he announced that his medical scans no longer showed any cancer.

In 2019, Carter faced additional health issues, including multiple falls that resulted in a fractured hip, a pelvic fracture, and a forehead injury requiring stitches. Despite these setbacks, he continued to engage in public service, notably returning to teach Sunday school shortly after his injuries.

Transition to Hospice Care

On February 18, 2023, following a series of short hospital stays, Carter chose to receive hospice care at his home in Plains, opting to spend his remaining time with his family rather than undergoing further medical interventions. This decision aligned with his values, emphasizing quality of life and the comfort of being surrounded by loved ones.

Hospice care focuses on providing compassionate care for individuals in the final phases of terminal illness, prioritizing comfort and quality of lifeCarter's's choice brought attention to this aspect of healthcare, highlighting the importance of patient-centered end-of-life care.

According to the National Hospice and Palliative Care Organization, the average length of stay in hospice care is approximately 24 days. However, former President Jimmy Carter far exceeded this average, remaining in hospice care for more than 16 months.

His experience highlighted the flexibility and individualized approach of hospice services, which focus on comfort and quality of life rather than curative treatments. While Medicare covers hospice care for an initial 60-day period, it also allows for unlimited 60-day benefit periods after recertification by a physician, ensuring continued support for patients with terminal illnesses whose conditions may progress unpredictably.

Those with Long-Term Care Insurance usually have hospice benefits, ensuring they can receive necessary hospice benefits whether at home or in a facility.

A Prolonged Period in Hospice Care

Carter’s time in hospice care extended far beyond the typical duration, with patients usually receiving hospice services for a few weeks to months. His 16-month stay was considered a "outlier," shedding light on the variability of end-of-life experiences and the personalized nature of hospice care.

During this period, Carter remained engaged with his family and community. He celebrated his 99th and 100th birthdays, attended a tribute concert in his honor, and, with assistance, participated in public events, including a drive through the Plains Peanut Festival. His resilience during this time challenged common perceptions of hospice care, demonstrating that individuals can experience meaningful moments even in the final stages of life.

Impact on Perceptions of Hospice Care

His extended hospice experience has had a significant impact on public perceptions of end-of-life care. Advocates and healthcare professionals have noted that his journey dispelled myths about hospice, particularly the misconception that it is solely for individuals in their final days. Politico reported that his case highlighted that hospice care can be a supportive option for patients seeking comfort and quality of life over an extended period.

By openly sharing his decision to enter hospice, Carter contributed to a broader understanding and acceptance of this type of care, encouraging conversations about end-of-life choices and the importance of aligning medical care with personal values and preferences.

Family's Journey

Throughout his time in hospice, Carter was supported by his family, who remained by his side, providing emotional and physical care. The Carter’s openness about their experiences brought attention to the role of family in end-of-life care and the significance of support systems for patients and their loved ones.

The passing of his wife, Rosalynn Carter, in November 2023 was a profound moment during this period. Despite his frailty, Carter attended her funeral, exemplifying his enduring commitment to family and the deep bond they shared over 77 years of marriage.

Lasting Legacy

Jimmy Carter's life was characterized by many observers as a steadfast commitment to service, peace, and human rights. His post-presidential years were marked by significant contributions to global health and democracy through the Carter Center, including efforts in disease eradication and election monitoring.

His decision to enter hospice care and the subsequent public attention brought to this choice has had a lasting impact on discussions about end-of-life care, encouraging individuals to consider their own values and preferences in medical decision-making.

The Carter family has requested that, in lieu of flowers, donations be made to the Carter Center to continue supporting the causes to which President Carter dedicated his life.