Jimmy Carter, America's longest living president, is marking 1 year in hospice care

Sunday marks one year since former President Jimmy Carter, now 99, entered hospice care.

The 39th president was diagnosed with cancer that had spread to his brain back in 2015. After a series of short hospital stays, Carter opted last year “to spend his remaining time at home with his family and receive hospice care instead of additional medical intervention, according to a statement by the Carter Center at the time.

A year later, the former president continues to be at home with his family, the Carter family said in a statement to USA TODAY.

"The Carter family is grateful for the many expressions of love they have received and the continued respect for their privacy during this time. The family is pleased that his decision last year to enter hospice care has sparked so many family discussions across the country on an important subject," the family said.

In recent years, 3 out of 4 hospice patients spent less than three months in end-of-life care, according to the National Hospice and Palliative Care Organization.

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And while just the top 10% of those patients spent over 264 days in hospice, Dr. Tammie Quest, Director of Emory University’s Palliative Care Center in Georgia, said Carter’s situation is not actually out of the norm.

“While the public may find this unusual, those of us who do hospice and palliative care don't find this as unusual,” Quest said.

Patients often see better outcomes – living longer as well as better quality of life – with earlier referrals for hospice care, Quest said.

"Suffering kills," she said. "And so when people don't have good pain management, they're feeling short of breath, their depression or anxiety are not met, their care needs are not met, it takes a toll on someone's heart, mind, spirit, body and soul."

"We find that when we can mitigate suffering and support family caregivers who are taking care of patients, that when you add all of those factors together that patients do far better," Quest added.

Already the longest living president, Carter turned 99 on Oct. 1, celebrating that weekend in his hometown of Plains, Georgia. He and his wife of 77 years, Rosalynn Carter, also made a rare public appearance then at the Plains Peanut Festival.

Grandson Jason Carter had told USA TODAY just weeks prior that Jimmy Carter and Rosalynn Carter were “coming to the end.”  While his grandfather faces "really significant physical challenges," Jason Carter said the former president would spend time watching baseball games and seeing family "almost every day."

“He’s been in hospice now for several months, but they are happy,” Jason Carter, chairman of the Carter Center’s Board of Trustees, said then. “They are together. They are at home. They’re in love, and I don’t think anyone gets more than that."

Rosalynn Carter died months later in November, just days after entering hospice care herself. She was 96.

The former first lady, known for her advocacy work around mental health, had been diagnosed in May with dementia.

Carter attended the second day of tribute services for his wife. He joined President Joe Biden, Vice President Kamala Harris, former first ladies and others at Glenn Memorial Church in Atlanta.

This article originally appeared on USA TODAY: Former president Jimmy Carter is marking 1 year in hospice care