Will Jimmy Carter, our 39th president, now in home hospice, be a long-stay hospice patient? It’s hard not to consider the possibility as the government continues to hone in on length of stay, putting hospices all over the country on the hot seat.   

Over the last few years, the government has become positively fixated on certain hospice metrics, length of stay being chief among them. Longer lengths of stay — six months to a year — has drawn the scrutiny of the federal government, which argues that such durations are profit-driven and drain Medicare funds.

The hospice community argues that the reasons behind long stay are more complicated than simply malfeasance. Factors such as uncertainty establishing a six-month prognosis add to the complexity. Many disease states, such as chronic obstructive pulmonary disorder (COPD) have “jaggedy” disease trajectories, Judi Lund Person, vice president of regulatory and compliance for the National Hospice and Palliative Care Organization, explained Thursday to McKnight’s Home Care Daily Pulse.

While cancer ensures a pretty steady decline, “for many other non-cancer diagnoses, it’s quite a difference in how you’re looking at disease trajectory,” she said.

The ironic part about the benefit, which began in 1982, shortly after Carter left office, is that longer stays actually save the government money. The recent NORC report released in March found that for patients who spent the last six months of their lives in hospice, Medicare spending was an average 11% lower than it was for patients who did not receive hospice care.

Carter entered home hospice at the end of February, approximately 60 days ago. That makes his stay far below the average lifetime stay of 102 days in fiscal year 2022, according to figures from NHPCO. Therefore, he is still not at the point of long stay.

But if Carter, 98, a human rights activist who arguably helped pave the way for the benefit, continues to stay on hospice, he may be the hospice community’s ideal poster child. After all, how can you argue that he or his physician would remotely consider bilking the system?

Liza Berger is editor of McKnight’s Home Care. Email her at [email protected].