On the first anniversary of Rosalynn Carter’s passing, her husband, former U.S. President Jimmy Carter, continues to reflect on the immense loss of his beloved wife. At 100 years old, President Carter has been in hospice care for over a year and a half, facing this difficult period without his life partner, who passed away on November 19, 2023, at the age of 96.

“He’s surrounded by family and friends and love, and he misses Mrs. Carter terribly, every day,” said Paige Alexander, CEO of The Carter Center, in an interview with PEOPLE. Despite the loss, Alexander shares that Carter remains engaged with the world, albeit without the burden of leading his foundation, which now continues its vital work in his stead.

Founded in 1982 by the Carters, The Carter Center has played a significant role in advancing human rights, alleviating human suffering, and improving mental health care. In the wake of Rosalynn’s death, those who carry on her and Jimmy’s legacy feel a renewed commitment to the causes she championed, particularly in mental health and caregiving.

“I think in many ways it lit a fire under us,” Alexander said, noting the Center’s continued global efforts. “Both nationally and globally, we have extended the work that she started. We’ve opened an office for mental health and caregiving in Washington, D.C., we’re moving our mental health program from Liberia to other African countries, and we had a strong mental health presence at the UN General Assembly in September.”

Throughout their careers, the Carters remained deeply involved in the work of The Carter Center, often seen walking the halls together, participating in meetings, and attending events. Alexander recalled, “They would walk the halls here holding hands, going from meeting to meeting, turning off lights if someone left the lights on. They were on the road regularly… they were really working colleagues of ours.”

Although Rosalynn is no longer physically present at The Carter Center, her legacy continues to inspire those who knew her. Alexander shared that it has been heartening to see the recognition of Rosalynn’s contributions, especially her work in mental health advocacy. “I think often first ladies get overlooked, and so we were truly comforted by the fact that she was recognized as much as she was for all of her work that she’s done in mental health and caregiving,” she said.

As The Carter Center moves forward, Alexander emphasized the importance of continuing Rosalynn’s work. “The people who knew and worked with Mrs. Carter feel that they’ve internalized that, and the people who didn’t have that chance to work with her recognize they’re inheriting a legacy that is so incredibly powerful,” Alexander said.

Looking ahead, The Carter Center plans to use modern tools and initiatives, such as the Rosalynn Carter Journalist Fellowship program, to elevate voices in the mental health space. Alexander hopes these efforts will lead to critical conversations that shift how mental health is treated across the United States.

Remembering Rosalynn Carter on the anniversary of her passing brings both gratitude and pride. Alexander fondly described her as “selfless, intentional, astute, she listened and she was very service-oriented.” Rosalynn herself once shared, “I would like to think that people understood that I took advantage of the opportunities I was given and I did the best that I could.”

Her legacy of service continues to shape the work of The Carter Center and inspire future generations.