>>> AFTER A SERIES OF SHORT HOSPITAL STAYS, FORMER PRESIDENT JIMMY CARTER HAS OPTED FOR HOSPICE CARE IN HIS HOME IN PLAINS GEORGIA.

WHAT DOES THAT MEAN FOR THE 98-YEAR-OLD LONGEST LIVING PRESIDENT?

HERE TO EXPLAIN HOSPICE IS DR. HOUSER, ASSOCIATE PROFESSOR OF MEDICINE AT NORTHWESTERN SCHOOL OF MEDICINE, DIRECTOR OF HOSPICE AND PALLIATIVE MEDICINE FELLOWSHIP THERE AS WELL.

THANKS FOR BEING HERE.

>> THANKS FOR HAVING ME.

>> YOU BET.

THESE DECISIONS ARE DIFFICULT FOR FAMILIES.

PRESIDENT CARTER IS AT PIECE WITH THIS DECISION.

REMIND US WHAT HOSPICE CARE IS.

>> IT IS FOCUSED ON COMFORT, SIMILAR TOLL CONTROL AND QUALITY OF LIFE AND ALSO CARE FOR FAMILIES.

FAMILIES GO THROUGH ILLNESSES WITH PATIENTS.

GO THROUGH THOSE THINGS THAT HAVE A LIMITED PROGNOSIS, LIMITED LIFE EXPECTANCY AND A SERIOUS ILLNESS.

>> IN TERMS OF WHAT THIS MEANS, WE CAN'T REALLY READ THAT INTO IT, WHETHER IT MEANS DAYS OR MONTHS.

>> I DON'T THINK WE CAN.

HOSPICE OFTEN MEANS 6 MONTHS IS THE EXPECTED PROGNOSIS WHEN SOMEONE ENTERS HOSPICE WHAT THAT MEANS IS PATIENTS LIVE LESS THAN THAT AND SOME PATIENTS MORE THAN THAT.

WE DON'T REALLY KNOW.

>> THIS IS A DIFFICULT DECISION FOR FAMILIES.

I HAVE BEEN IN THAT DECISION WITH MY OWN FAMILY.

WHAT ARE THE FACTORS THEY HAVE TO WEIGH HERE?

>> THAT'S A GREAT QUESTION.

I THINK AS WE THINK ABOUT HOSPICE AND THINK ABOUT CARE THAT IS FOCUSED ON QUALITY OF LIFE, WE WANT TO DO THINGS THAT ARE WITHIN THE VALUES OF THE PATIENT AND FAMILY THAT WE ARE TAKING CARE OF.

WE TRY TO WEIGH THE ADVANTAGES OR DISADVANTAGES OF GOING BACK TO THE HOSPITAL MIGHT BE OR NOT GOING BACK TO THE HOSPITAL.

ONE DECISION THAT PATIENTS OFTEN MAKE IS A DECISION -- AND THIS SOUNDS LIKE WHAT PRESIDENT CARTER HAS MADE -- NOT TO RETURN TO THE HOSPITAL FOR FURTHER CARE, TO FOCUS ON CARE AT HOME.

AND THAT COULD BE INTENSIVE, INVOLVING NURSES AND SOCIAL WORKERS, INVOLVE CHAPLAINS WHO ARE ALL PART OF THE TYPICAL HOSPICE.

AND AS I SAID, IT OFTEN HAPPENS AT HOME AS IN THE CASE OF PRESIDENT CARTER.

>> AND PALLIATIVE CARE, HELPING FOLKS DEAL WITH WHATEVER DISCOMFORT THEY ARE IN, AS OPPOSED TO TREATING THE UNDERLYING DISEASE.

>> RIGHT.

SO HOSPICE IS MOST SPECIFICALLY FOCUSED ON COMFORT AND TREATING SYMPTOMS.

PALLIATIVE CARE IS A BROADER TERM WHICH INCLUDES THAT, BUT CAN ALSO INCLUDE HOSPITAL CARE AND THAT TYPE OF CARE.

HOSPICE IS A VERSION OF PALLIATIVE CARE CLOSER TO THE END OF LIFE.

>> AND YOU ARE THE DIRECTOR OF THAT POSITION, PALLIATIVE MEDICINE, AS WE MENTIONED.

DOES THAT MEAN THERE IS ADDITIONAL TRAINING FOR FOLK THAT IS DO PRACTICE IN THIS FIELD?

>> YEAH, FOR PHYSICIANS, HOSPICE IS A MEDICAL SPECIALTY, ACTUALLY A SUBSPECIALTY THAT YOU DO A ONE-YEAR FELLOWSHIP AFTER YOUR PRIMARY RESIDENCY.

SO YOU DO A RESIDENCY -- I DID A RESIDENCY IN PALLIATIVE MEDICINE AND ANOTHER YEAR.

ONE THINGS THAT UNIQUE IS YOU CAN ACTUALLY BE A SURGEON AND GET FURTHER TRAINING IN THAT AND YOU CAN BE A PSYCHIATRIST AND GET FURTHER TRAINING IN HOSPICE AND PALLIATIVE MEDICINE AND THE REASON THAT'S IMPORTANT IS BECAUSE AS A FIELD WE LIKE TO THINK OF THE TYPES OF SUFFERING THE PATIENTS UNDERGO AND IT MIGHT BE PHYSICAL.

IT MIGHT BE PSYCHOLOGICAL.

MIGHT BE SPIRITUAL OR MIGHT BE SOCIAL OR SITUATIONAL.

AND SO WE REALLY TAP ON THE EXPERTISE OF ALL THOSE TYPES OF PHYSICIANS.

>> AND WE MENTIONED YOU ARE A PROFESSOR OF BIO .

>> THERE IS A LOT OF DECISION-MAKING, HOW WE WEIGH THE VALUES OF THE PATIENT AND FAMILY.

THERE IS A LOT OF ISSUES AROUND HOW FAMILIES MEDIATE THINGS AND HOW FAMILIES NEGOTIATE WITH EACH OTHER, HOW WE THINK ABOUT DECISIONS NEAR THE END OF LIFE, WHETHER THAT'S TO GO ON A VENTILATOR OR ON ICU OR STOP THAT.

AGAIN, PRESIDENT CART FRER A PUBLIC REPORTING HAS MADE A DECISION NOT TO RETURN TO THE HOSPITAL.

BUT WHEN THERE IS SOMEONE IN THE HOSPITAL RECEIVING PALLIATIVE OR COMFORT FOCUSED CARE, THERE MIGHT BE DECISIONS MADE TO STOP LIFE SAVING TREATMENTS.

WHICH CALLINGS UNDER ETHICS AND ETHICAL DECISION-MAKING.

>> ONE THING I'M FACING AND A LOT OF PEOPLE FACE, WHEN THEY GO INTO HOSPICE, IT IS LIKE I BETTER SEE THIS PERSON.

IT'S GETTING COMPANY AND GUESTS AND BEING AT PEACE WITH YOUR CLOSEST LOVED ONES.

>> THAT'S SUCH AN INTERESTING QUESTION.

AND I SEE A LOT OF PATIENTS WITH FAMILIES WHO STRUGGLE WITH THAT.

AND THE STRUGGLE IS OF COURSE I WANT TO SEE SO MANY DIFFERENT PEOPLE, BUT IT'S ALSO HARD TO SEE SO MANY DIFFERENT PEOPLE.

SO I THINK WE TRY TO COUNSEL PATIENTS IN THE SAME WAY, TO LIMIT IT IF THEY WANT THAT INTIMACY.

A LOT OF PATIENTS WILL CHOOSE TO SPEND THEIR FINAL DAYS OR WEEKS OR MONTHS IN HOSPICE, WHENEVER THAT MAY BE WITH PEOPLE CLOSE TO THEM.

AND IT CAN BE SAYING TO OTHER PEOPLE THEY MAY NOT HAVE THE ENERGY OR TIME TO SEE THEM.

>> AND THAT'S A HARD THING FOR A LOT OF PEOPLE SO SAY OUT LOUD, EVEN IF YOU ARE AT THE END OF YOUR LIFE.

IS THIS AFFORDABLE TO REGULAR AMERICANS?

IS IT COVERED BY MEDICARE.

>> YEAH.

SO THIS IS AHMED CARE BENEFIT.

IT STARTED IN THE 1970s AS AHMED CARE BENEFIT AND IT IS ALSO COVERED BY PRIVATE INSURANCE.

SO THE SERVICES OF HOSPICE INCLUDE MEDICATIONS FOR SYMPTOMS OR COMFORT FOR PAIN, INCLUDE LABOR, IN OTHER WORDS, NURSES, SOCIAL WORKERS, PHYSICIANS, CHAPLAINS TO SEE THE PATIENT, WHETHER AT HOME OR IN A FACILITY, AND INCLUDE EQUIPMENT.

SO SOMEONE MAY NEED A HOSPITAL BED OR A BEDSIDE COMMODE.

SO ALL OF THAT IS COVERED BY MEDICARE AND PRIVATE INSURANCE.