Since Jimmy Carter entered hospice care at his home in Georgia, the former U.S. president has celebrated his 99th birthday and enjoyed tributes to his legacy.
. Those advocates commend the Carter family for demonstrating the realities of aging, dementia and death. They express hope that the attention spurs more Americans to seek out services intended to help patients and families in the latter stages of life.
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. 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 . Almost half of Medicare patients who died that year did so under hospice care.Hospice can elicit images of “someone doped up and bedridden,” but it is not “just providing enough morphine to make it through the end,” Gurian said.
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. Legislation has been introduced in Congress in recent sessions to create a long-term care plan under Medicare. But it is politically difficult, if not impossible, because it calls for an increase in payroll taxes to finance a new benefit.Separately, Gurian said Leading Age would like Congress to increase hospice payments structures so more agencies might admit patients and still cover certain treatments they now typically forgo.