Last night, a farmer died in Georgia, leaving a legacy as long as a comet’s tail.

James Earl Carter Jr., 100-years-old, passed away Sunday evening in his home where he had been receiving hospice care. Carter, a Democrat, served as the 39th president of the United States between 1977 and 1981. Previously, he was governor of Georgia, a state senator, a naval officer and the head of his family’s peanut-growing business.

During his tenure as president, Carter was essential to the establishment of the Medicare Hospice Benefit. His administration launched the U.S. Centers for Medicare & Medicaid Services’ demonstration project to test the model, leading to passage of a law establishing the benefit during the subsequent Reagan presidency.

Prior to these efforts, hospice care was delivered predominantly by volunteers who relied on philanthropy to operate. The scale of these early providers was very limited due to lack of payment, as was access to their services.

“For decades, the Carter family has championed open dialogue about the needs of patients at the end of life,” Dr. Vicki Jackson, board president of the American Academy of Hospice and Palliative Medicine (AAHPM), told Hospice News in an email. “Their vocal support for hospice care over the past year has made an immeasurable impact and brought information about this essential subspeciality of medical care to a national audience.”

After leaving the White House, Carter devoted himself to humanitarian work, perhaps most notably with Habitat for Humanity. In 1982, he founded the Carter Center, a non-governmental nonprofit organization with the mission of advancing human rights and aiding the suffering globally. In honor of these achievements, he was awarded the United Nations Prize in the Field of Human Rights, and, in 2002, the Nobel Peace Prize.

In recent years, Carter battled an aggressive form of cancer, ultimately leading to his family’s February 2023 announcement that he would enter hospice care.

“When President Carter chose to receive hospice care in his hometown of Plains, Georgia, he and his family made the decision that countless others do — to receive care in the comfort and solace of their homes, surrounded by the love and support of family,” Tom Koutsoumpas, CEO of the National Partnership for Healthcare and Hospice Innovation (NPHI), said in a statement. “President Carter’s nearly two-year journey in hospice care highlights its profound value, challenging the misconception that hospice is solely for the final days of life. His experience illustrates how hospice can provide comfort, dignity, and compassion for those navigating life’s final chapter.”

Indeed, at a time when hospices have been battered in the national press, the former president served as a shining example of how hospice care can benefit patients. Many hospices have told Carter’s story to help dispel public misconceptions and fears surrounding end-of-life care.

“President Carter’s choice reflects his commitment to dignity and quality of life, values that Gilchrist upholds for all patients,” Cathy Hamel, president of the hospice provider Gilchrist, said in a statement. “As we remember President Carter, Gilchrist encourages everyone to consider their end-of-life plans and to discuss them openly with loved ones and health care providers.”

Carter’s time in hospice, nearly two years, also illustrated the value of longer hospice stays, which regulators often consider to be a red flag. Long lengths of stay have spurred a rash of government audits and investigations of hospice providers due to suspected fraud, prognostic errors or other issues.

“President Carter’s journey with hospice over the last 22 months has been an inspiration to American households,” said Nick Westfall, VITAS Healthcare’s chairman and CEO, in a statement. “His family’s transparency has sparked dialogue across the country about what hospice is and what it can be, encouraging more families to discuss their care preferences openly and seek earlier referrals to hospice when appropriate.”

His experience dovetails with recent research. Longer hospice stays can reduce health care costs in the last year of life by 11%, according to findings in a 2023 joint report from the National Alliance for Care at Home and NORC at the University of Chicago.

The hospice community was quick to honor Carter upon news of his passing, including the National Alliance for Care at Home.

“On behalf of every member of the Alliance, thank you to the late President Jimmy Carter and the entire Carter family for bringing hospice care into the national conversation and helping everyday Americans become better equipped to think and talk about their end-of-life journeys and wishes,” said Alliance CEO Dr. Steve Landers, in a statement emailed to Hospice News.