Former President Jimmy Carter lived to 100 with hospice care. Why it may help some live longer

Hospice care is viewed by many people as end-of-life care to help those who need it spend the final weeks or months of life in comfort.

But hospice care may actually help certain patients live longer.

People receiving hospice care for certain cancers or heart failure lived an average of 29 days longer than those who didn't, according to researchers at the National Hospice and Palliative Care Organization (NHPCO).

Many people think hospice is only for the very end of life, i.e., the brink of death," Diana Franchitto, president and CEO of HopeHealth, a company that provides hospice care in Massachusetts and Rhode Island, told ABC News. "Hospice is very appropriate for the last months of life, rather than days of life."

The average lifetime length of time that a person on Medicare spent in hospice care in the U.S. in 2022 before dying was 95 days, according to the NHPCO report.

Former President Jimmy Carter far surpassed this average after receiving nearly two years of home hospice care before his death on Sunday.

Carter was diagnosed with stage IV melanoma in August 2015 and was treated with immunotherapy before transitioning to hospice care in February 2023.

While experts acknowledge the difficulties in choosing to start hospice care, they also note that such services typically provide patients relief from suffering and help facilitate closure for family members.

What is hospice care?

Hospice care focuses on the care, comfort and quality of life for people with serious illnesses who are approaching the end of life, according to the National Institute on Aging. A life expectancy of six months or less and stopping curative medications like chemotherapy are typically required for adults enrolled in Medicare Part A, which covers hospitalization, to qualify.

Experts at the American Society of Clinical Oncology use a stoppage of chemotherapy in the last two weeks of life as a measure of receiving quality cancer care.

"Deciding to stop anti-cancer treatments is difficult and may feel like choosing between quantity or quality of life," Dr. Andrew Lawton, a palliative medicine physician and an assistant professor of medicine at Northwestern University Feinberg School of Medicine, told ABC News.

"When curative treatments no longer help, hospice steps in to fill a person's final days and months (or years for President Carter) with dignity and care," said Franchitto of HopeHealth.

Why do some people live longer with hospice care?

Living longer after stopping cancer treatments and switching to hospice care may seem counterintuitive, experts note.

"I've certainly seen patients live longer than expected with hospice care," Lawton said.

A study published in 2017 in the Journal of Palliative Medicine found that receiving less-aggressive chemotherapy may result in fewer emergency room visits and hospital admissions.

"I think the assumption is often made that more intensive care is always helpful for many patients in the final months and weeks of life," Dr. Edward W. Martin, chief of palliative medicine at Brown University and chief medical officer of HopeHealth, told ABC News.

Like other medications, the benefits of chemotherapy come with risks of side effects, which can include fatigue, nausea, vomiting, hair loss, and decreased appetite. Toward the end of life, "these interventions may do more harm than good," Martin added.

The same 2017 study suggests that hospice care's closer monitoring, symptoms management and social support may explain why some hospice patients live longer.

Lawton often sees that patients feel better and have more energy "once disease-targeted treatments like chemotherapy are stopped, and instead pain control and other symptoms are prioritized in hospice care."

Hospice care misconceptions

Over the past five years, only 50% of Medicare beneficiaries died while receiving hospice care, according to a report from the Centers for Medicare & Medicaid Services. While hospice utilization increased during that time frame, according to the NHPCO, experts say misconceptions about hospice may deter some patients from receiving valuable end-of-life care.

"Even though a patient is in hospice, we often do address readily reversible problems such as an infection and for heart failure, we will continue their cardiac medications," said Martin.

Hospice agencies typically also support families after their loved one passes with up to 13 months of free grief counseling services, the NHPCO said.

"People often don't realize that hospice services are for the patient and their family," Franchitto said.

Palliative care is similar to hospice in that it addresses symptoms of a serious illness, but with an important difference: Patients can continue curative treatment while receiving palliative care, according to the American Cancer Society.

"Many hospice programs also have palliative care services while a patient is still seeking curative treatment and then they can help with hospice at the appropriate time," said Franchitto.

Lindsey Ulin, MD, is a palliative care fellow at Massachusetts General Hospital and the Dana-Farber Cancer Institute, and a member of the ABC News Medical Unit.