Former President Jimmy Carter is in hospice care

Former President Jimmy Carter announced last month that he will stop further treatment for his medical ailments and instead would enter hospice care at his home (Figure 1). The announcement did not offer any specifics on his medical condition, although I have previously written about how President Carter was afflicted with stage 4 (metastatic) melanoma, but received anti-PD-1 immunotherapy that put the melanoma in remission over 7 years ago. 

What is hospice care?

Hospice care is a specialized type of palliative care that focuses on providing comfort and support to patients who are nearing the end of their lives. Hospice care is designed to help patients manage their symptoms, provide emotional support to both the patient and their family, and ensure that the patient's final days are spent in comfort and dignity.

What is palliative care?

Palliative care is a type of medical care that aims to provide relief from symptoms and improve the quality of life for patients facing serious illnesses such as cancer, heart failure, or chronic obstructive pulmonary disease (COPD). The goal of palliative care is to provide comfort, alleviate suffering, and support patients and their families during times of illness and treatment similar to hospice care. Palliative care is often provided alongside curative treatments and can be offered at any stage of an illness, including at the time of diagnosis. It can be provided in hospitals, hospices, nursing homes, and even in the patient's own home.

Curative treatment, also known as "disease-directed treatment," is focused on treating the underlying disease or condition that is causing a patient's symptoms. The goal of curative treatment is to cure or control the disease and restore the patient's health.

Thus, palliative care is focused on managing a patient's symptoms and improving their quality of life, whereas curative treatment attempts to cure the underlying disease. However, the two are compatible and palliative care can be provided alongside curative treatments and may involve a multidisciplinary team of healthcare professionals who work together to address the physical, emotional, and spiritual needs of the patient. 

The distinction between hospice and palliative care centers on whether curative treatment is offered. Palliative care can be provided at any stage of illness, whereas hospice care is a specific type of palliative care that is typically provided in the final stages of life. More specifically, palliative care can be provided alongside curative treatments; hospice care is generally provided when curative treatments are no longer effective or when the patient chooses to stop pursuing curative treatments.

According to Wikipedia, "[o]ver 40% of all dying patients in the United States currently undergo hospice care. Most of the hospice care occurs at a home environment during the last weeks/months of their lives." Finally, "[h]ospice care in the United States is largely defined by the practices of the Medicare system and other health insurance providers, which cover inpatient or at-home hospice care for patients with terminal diseases who are estimated to live six months or less. Hospice care under the Medicare Hospice Benefit requires documentation from two physicians estimating a person has less than six months to live if the disease follows its usual course. Hospice benefits include access to a multidisciplinary treatment team specialized in end-of-life care and can be accessed in the home, long-term care facility or the hospital."

Figure 1. President Jimmy Carter with his wife Rosalind. They have been married for over 75 years (Erin Schaff/The New York Times).