Rosalynn and Jimmy Carter bring needed attention to hospice care—and questions

Rosalynn and Jimmy Carter bring needed attention to hospice care—and questions

By Cara L. Wallace, Ph.D.

USA Today

November 29, 2023

The Carters perhaps will join other longtime couples who die within days to months of each other. But the drastic difference in their lengths of hospice care brings attention to this question: Can someone “outlive” their hospice stay? End-of-life care advocates have championed the Carters’ willingness to publicly share their decision to enter hospice because it brings needed education and attention to the extended benefits of hospice care, such as home visits from interprofessional team members, equipment and supplies, and access to on-call support. But what happens when someone enters hospice expecting to live six months or less—a requirement for admission—The simple answer is that hospice patients must be reevaluated for care every 90 days within the first six months, and then every 60 days thereafter, with a physician documenting that the patient remains eligible. However, recertifying patients for care, or removing them from care if their condition is not declining, is anything but simple. ... Ultimately, I wonder whether there are additional questions we should be asking beyond what happens to people if they live “too long.” These concerns include whether hospice is appropriately structured to care for people dying from chronic illnesses—heart disease, cerebrovascular disease and Alzheimer’s disease all fall in the top causes of death for those 65 and older—when it is nearly impossible to predict when they are six months from death. ... Though it has been more than 40 years since hospice was established in health care policy, we still have a long way to go before it is fully embraced by patients, families, clinicians and communities. ... “Hospice” and “death” are not dirty words. Perhaps the more we talk about them, the better off we all will be—in life and in death.

[Editor’s Note: The author is a professor at the Trudy Busch Valentine School of Nursing at Saint Louis University in Missouri.]