Mom was diagnosed with stage 3 lung cancer. Our family is devastated, no discharge from hospital or anymore caregiving. Now what?

Does Mom/Grandma have dementia, or is she mentally capable of making decisions with you? About both financial and medical care, almost all answers depend upon this answer, as to moving forward. If she is currently hospitalized contact the Social Worker at once. She or he is going now to be an excellent guide for you, and you may only have access during hospitalization.

First, has your mother been living with you or you with her? If you have been living with her, you will need to keep the possibility of needing to find new living arrangements in mind.

Your profile says Mum has dementia, so if her paperwork, Will/POA documents are not in order, that ship may have sailed. If Mum does not have a Will, you need to find out what happens when someone dies intestate in your Province/State.

Talk to the social worker at the hospital about what services are available to your family.

In your post you say no discharge from the hospital. Do you mean to home, but perhaps to a nursing home, or she will stay in the hospital?

Talk to the doctor about Palliative Care, ask lots of questions and take notes.

Has Mum discussed in the past what she wants for a funeral? Covid-10 has changed how we mourn, but there should be some way to include her wishes and or cultural practices.

You are worried that your family is going to break, do you have a trusted advisor to whom you can speak? There are a great many posts on this site from people whose families have broken over caregiving and the death of a family member. It is a sad situation.

My step father died 6 weeks after getting a cancer diagnosis 2 years ago. He has been diagnosed with dementia a couple years before. For him it was a blessing in disguise. He stayed in the hospital, a couple times he was scheduled for discharge, but the doctor realized that there was no way Mum could manage him at home. He had 24/7 professional care, family had unlimited access to him (before Covid-19), and Mum was able to catch bits of her life at home.

It was not easy for the family to have him go from being healthy other than the dementia, to being deathly ill. But during those weeks, his daughter was able to visit several times. Mum was able to get support from the Minister, Hospice, family and friends. Even the lawyer who prepared David's documents was an incredible help and a true friend to Mum, helping her enact the POA documents, deal with banks that did not want to accept them, and after death he helped to settle the estate.

I am so sorry for your family.

Unfortunately things will happen within the family as they have always happened.

May God grant you all strength and wisdom during this difficult time.

Start by asking about Hospice care. It sounds as though there is no "treating" her cancer, only making her more confortable.

Where is the disension coming from? Are there family members who want a second opinion? It's probably pretty easy to have her CAT scans sent to another hospital, but given the advanced state of your poor mom's dementia, I m not sure I see the point. Cancer treatment is brutal; do you see the point in subjecting her to more suffering?

Im pretty sure that hispice is the correct answer in this situation. You want her to be in no pain and free from anxiety and agitation.

(((((Hugs))))))

Dear "atanimpass06,"

I'm so sorry that your family is going through the devastation of mom/gramma's diagnosis. That alone is hard enough but, to deal with dissension, anger, fear and more on top of it only makes it that much more difficult.

I can't imagine her having to go through radiation treatments for what could just be a couple weeks or months. When my husband's father was diagnosed with cancer, he was only in his 40's. He was a big, strong man but let me tell you my husband, who was 16 had to drive him to a hospital two hours away for his chemotherapy and he would always get extremely sick in the car after each treatment.

In my own case when my dad was diagnosed with Stage 4 Pancreatic Cancer in 2004 at the age of 82 even though surprisingly he told the Oncologist he would try the chemotherapy, it would have only kept him alive for a very short time. I knew my dad well - I just couldn't see him being able to handle it. We had a long talk and I told him I didn't want to see him suffer and that I would like to have hospice come to our home (my parent's home where I grew up) and have them do an assessment. He trusted my judgement and that was the route we took. He remained home until he passed away three weeks later. They took such good care of him. It was my first death of a loved one and to this day, I have never been more grateful and thankful for God's mercy. Honestly, it was meant to be - I never heard of hospice before and while I was desperately trying to figure out what to do I heard a radio commercial for a hospice company. I called right away to have them send me their information packet and everything fell into place from there. The strange thing was I never heard that commercial again until many years after my father had passed away and I had listened to the same station, at the same time everyday.

May God give His strength, wisdom and mercy upon mom/gramma, you and your whole family in the days ahead.

P.S. I just read your reply to someone who commented. I think we live in the same city and I just got a great hospice company for my mom now. I'm sorry you had a bad experience with a previous one here.

Atanimpass, I'm so sorry to learn of this diagnosis, as well as for the sadness you and your family experience.   You have my deepest sympathy; I can read the sadness in your posts.    I hope your family are able to support each other during this stressful time.


Just some comments on your post, and my experience that might offer some insights:

1.   Radiation as stated is hard on a patient, especially one who's older and is already in Stage 3.   With dementia, radiation will be brutal.   She won't understand it and think she's being tortured.  

That's what my sister looked like after every radiation treatment.  It was emotionally painful beyond description, for both of us.  In the long run, it didn't do any good; she died anyway and the last several weeks of her life were nothing that I'd ever want to see someone else endure.   And she was still fighting to live.

So I'd opt out of the radiation and focus more on the end of life comfort.

2.    Are there any religious hospice organizations in your area?   I'm not at all a religious person, but I found that they're far better and more stringent in compliance than any of the several hospices I called when I was selecting one.

Some asked personal questions which I learned when interviewing with the Catholic hospice (first for rehab, but Dad segued quickly into hospice) should NOT have been asked.   The nonreligious ones, including ones recommended by a good home care agency were pushy and demanding wanting to get us signed up quickly.  I really resented that.  There was no compassion at all.

3.    The rehab then hospice facility we chose had very compassionate staff.  As Dad grew closer to the end, the DON arranged for a pot of coffee, pitcher of water, and snacks to be brought to the room when I stayed with him.  One of the chaplains also brought food; another found a tv channel with soothing music. 

I was very, very impressed.
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I'm not entirely clear on the legal issues.   Are you asking for assistance on that aspect as well?   If, so:

4.   Whether or not your Mom needs a will depends on what assets she has to convey, and whether or not they're jointly titled with the heirs.   If everything she has is jointly titled, with rights to the survivor(s), assets will pass directly w/o the necessity of probate.

5.    If she has no transferable assets, she won't need a will. 

6.    If she has assets but isn't able to create a will now, she would be passing "intestate", subject to the intestacy laws of the state in which she resides.   These are statutorily prescribed levels and orders of succession.

As to legal advice, it would depend on the answers to question 3 - 6.    And as to taking over care, you mention paying bills.   Would your family be able to agree on someone to handle this?    As asked above, are her accounts held jointly with another family member who could assume this task now? 

Does Mom have a home?   Where is she living now and where will she stay?   Are there enough family members in the area to provide 24/7 support at her home, or one of the family member's homes?   In terms of meals, is she able to eat anything?   Her desire to do so will begin to wane as time progresses.

You mentioned that dissension, anger and fear are coming fast.    Is this over treatment options, how to get acceptable hospice treatment, asset management?

You should do what your mom wants.

I know I would want to be in my own bed and die at home.

Have her put on Hospice Care where she will be kept as comfortable as possible.

They will send a Nurse to the home, she'll get meds to help relieve her pain and an Aide to come 2-3 times a week to give her a bath.

All of the above, her Insurance will pay for.

Of course, depending on her condition, she'll need someone to come by and check on her daily to someone being with her 24 7, dividing up the time amoung family and friends or paying for a Caregiver to be with her a couple hrs or more a day.

My sister died of Cancer 7 yrs ago and I had her living with me the last 3 months and tho it was sad and hard, I would do it all over again.

My 96 yr old Dad is still in his own home where he wants to be and I have Caregivers 24 7 for him which is expensive but Dad has money to pay for at least 3 yrs and after that I'll hire a Live In to care for him, which will be less than half the price.

Prayers.

So sorry you are having to make these difficult decisions.

Me, not big on Chemo if not guaranteed to cure. Lost an Aunt at 80 to lung cancer. I really think she did the first bout of Chemo for my Mom. She refused the second bout. My sister died from an aggressive breast cancer. She was on chemo 8 months, only to pass about 4 months later because the cancer had spread to her brain. Would she have lived just as long if she hadn't done Chemo?

Chemo does a number on our bodies. It effects the heart. You have no immunity. You are sick and throwing up. Personally, I would not put someone suffering from Dementia through this. They will not understand what is going on.

Sorry that Hospice didn't seem to work for a family member but this is how I look at it. The person on Hospice will eventually pass. Morphine is given to elevate pain and ease breathing. A person on Hospice should not experience pain. Its suppose to keep the person comfortable so they can pass comfortably. Overdose or not, the person passed peacefully. You have to look at the quality of life.

Just something to consider here—what is your moms quality of life now? If it’s not good, why would you consider radiation to maybe buy her a little more time? Radiation won’t improve her quality of life. With dementia and stage 3 lung cancer, focus should be on giving her the best quality of life possible.

If mom/gramma is still mentally competent, please have an attorney visit her bedside. She needs POAs for her financial and medical affairs, a will with a designated executor, and probably a "do not resuscitate" order placed in her charts. Rather than radiation, please consider palliative care through hospice. Hospice care can be arranged for in the home so family can visit her in her last days.

Do estate planning, Will, DPOA and pre-arranged funeral or cremation. share bank account so when she passes it will not have to go through probate. Radiation treatments can cause skin irritation and make her feel sick. Ask for hospice. Focus on comfort. But dying and death is sadly a business too and you have to get her affairs in order.

Absolutely do a pre-arranged funeral or cremation because funeral homes will gouge you while you are grieving -- with pre-arranged funeral/cremation you are in better control and also have discounts.

My prayers to all. My thoughts; Take care of all legal issues; POA,Will, Right to Die, everything. Then, thank the Lord for all the time you've had her, & for the time he's given now. Have Hospice in place, & take her home. As a family, & one on one, share time with her. Make a point to tell her how much she's loved, how thankful ya'll are to have shared a lifetime together. The Lord has generously given a few extra days - make the most of them. Have no guilt, no regrets, about letting her go home when her journey ends - she's lived life her way, made her own choices - and she chose to spend her life with her loved ones. She has also chosen to share her last days with all of you. Be Thankful. Ya'll are beyond blessed to have this time. Sara

Radiation can also shrink masses that may cause pain or discomfort, so leave that option on the table if she wants to do it. It may not eradicate the disease, rather a comfort option.

Does she have a will? If not, is she the type of person who would want to have this conversation right now after learning she has cancer - would she think you all have thrown in the towel while her mind is still set on getting well? If the conversation would just add to her fear and anxiety, leave it alone. Probate can sort things out later according to the rules in your state. I would suggest that you talk to her to determine what her wishes are at this point and see if she wants someone to carry the medical wishes out by having her designate a person to do that. Then get the paperwork done. Many people are agreeable when you put it to them as - what if you couldn't tell the doctor that you want this procedure or that one, who would you want to speak for you.

I want to word my response carefully here: Hospice may not have overdosed your brother, their purpose is to alleviate pain and ease breathing and allow their patient to pass away unburdened by those things. That usually takes higher doses of medicine than a doctor would prescribe. That’s the entire reason doctors refer patients to Hospice - they can’t ease the patient through death.

My birth father had Alzheimer’s, then suffered a massive stroke that left him brain dead but very much alive. Hospice helped him pass within two days, when he may have stayed there, in that condition for months or even years.

Since your Mother has terminal cancer, and the aorta is involved, she cannot survive, I’m sorry to say. You’re time left with her may be very very short. Hospice may be a blessing to her. It would save her unnecessary pain and breathing difficulties, and a possible painful demise.

I hope I have explained the purpose of Hospice a bit better. I’m sorry that this terrible situation has happened to your family. I wish you the strength and courage to help your Mom and your entire family to the end of her road, and the recovery that comes after.

"antanimpass06," -

Just in case you didn't see my answer to your question underneath my original post, I sent you a private message with all the information you requested - names, phone number etc. along with their background. I've already called them as well this morning letting them know about your situation and that you might be calling them. Just remember, there's no harm in just seeing what they have to say. I hope all goes well!

So sorry your mom and her loved ones are going through this. But, we all know when our candle gets to the bottom, we don't know long it will take for it to go out. At this stage and your description, I would opt for hospice now. Which one. There are like zillions, exaggerated, yeah. But Hospice of the Valley is supposed to be a really good, compassionate one. My husband fell in AL, cracked the bone just under his eye and the emergency doc asked if I wanted to have surgery to fix it. He left it that a plastic surgeon would talk with me. After 5 days in the hospital, giving him diabetic food which he couldn't eat due to chronic IBS, the plastic surgeon visited me. He right away asked me if I really wanted my husband to have this type surgery. I didn't even think. We all knew he was on his last since he had 3 falls within a few weeks. The doctor highly stated, don't do it. The AL arranged for hospice at the AL, took him there, they set up a different bed, and other safety measures. Explained that he would have a caregiver with him at all times. Gave me all the information that I needed to know. Sadly, while they were fixing his room for his safety, he had a stroke, and another a few minutes later, and passed before he could get anymore hospice care. They notified Neptune Society for me and arranged for transfer to a funeral home of Neptune's choice.
I had a neighbor whose mother kept falling, had stroke, heart problems, and she had hospice in her home for 5 years. A daughter was full time caregiver, but hospice was there every day till she had to be hospitalized due to a stroke.
You are bettr off getting hospice now and be sure all the papers are executed in case she gets worse. There is nothing worse than watching your loved one struggle with eating (mine refused all food the last month), or do anything other than lay there. Consider hospice as soon as you can-for everyone's sake, not just yours or your loved one's. Your loved one will be comforted by very nice people.

I am so sorry for your mother's diagnosis. I offer you many prayers.

So sad to hear not only the bad news for your mother, but that family has to make things worse by not working together.

I've not had experience with hospice, but being on this forum, I've read about the experiences of others. Like any business, and even employees within the business, these can vary widely. My understanding is that if you are not having a good experience/relationship with one selected, you can terminate them and switch to another. Try the one sent to you privately (if you don't know how to access that, ask!)

Given she has dementia as well as the lung cancer, forgoing treatment might be the best path. As much as we don't want to give up on our LOs, we also don't want to see them suffer. My mother just turned 97 and is past halfway through year 4 in MC. The only treated condition she has, besides the dementia, is high BP, which she's had for a very long time (has taken medication for years.) While I'm doing everything I can to manage her affairs and see to her needs in MC, if she were to get a terminal Dx I would'nt want to put her through any extraordinary measures. She did request DNR during the first round of EC atty documents and specified what she would and wouldn't want for treatment too. She's had UTIs in MC, but those are easily treated and treatment is'nt invasive. She had knee pain about 2 years ago (knew, and said many times, she should've had knee replacement done.) Rather than continue with large doses of ibuprofen and Tylenol, as suggested by her doc at the time, I took her to orthopedic. They did xrays and confirmed that she should've had it done. He said if she were 20 years younger, we'd be talking surgery. There was no way, even if he suggested it, that I'd put her through that, given her age and condition. What I requested he did - injection in the knee to help reduce any pain. So far, it hasn't come back.

As to finances, whether she can sign any documents is highly dependent on her dementia status. Mom was deemed capable by our EC atty although she was in the early stages. He was used before, to set up everything for mom when dad wasn't well, so we knew and trusted him. He chatted with her alone and was satisfied she could sign. If your mother has assets AND can be determined competent enough to sign documents, you should try to pursue that. IF she is willing to do this, I would include at least one other family member to witness the decisions and signing. Select from those who are most opposed - it might ward off any contention later that she was coerced or incompetent.

Signing over the house to a trust or those she'd want to have it would be good. Getting access to her account so that you can process any bills/payments she needs to make would be good too. The bank may insist you use their forms, but obviously she can't go to the bank! I had no problem with ours when using the POA to assume control of mom's finances (YB and I were also on her primary acct, which likely helped - I brought her with me, but she said nothing and just rifled through her purse and wallet, at both banks!) A good EC atty, if you can afford one (with her assets hopefully) can usually push the bank to work with you.

Technically in order to use her SS funds to make payments, you should sign up as Rep Payee (their rules!) However, that process can take some time, first to get appt to file and then waiting for it to complete review. I wouldn't stress over that at this time.

If no atty considers her competent, guardianship is the next step, but it's often expensive and time-consuming - sometimes they can process it as emergency, given the situation, but at least start with getting atty to work with you and her. It's much easier and quicker to honor her wishes if it's managed before. Certainly it can be done via probate, but that takes time, and with some contention within the family, it could get dragged out longer!

All the best to you, your mom and family in this difficult time. :-(

Please don't push radiation unless she strongly wants it. Even if it gives her a few more days, they won't be happy ones.

One more thought - while there aren't family members to provide full time care at home, are there enough assets that you could hire help, so that she could at least return home and not be stuck in the hospital?

Hospice (maybe Medicare too and Medicaid if she qualifies) can provide some equipment. If she qualifies for Medicaid, they often can cover limited hours of care (Medicare, I believe, can also help with covering some cost of outside help, if the person qualifies.) The SW at the hospital might be able to answer these questions, and perhaps help you to get the help you need. Hospice at home generally isn't a full time coverage.

If anyone can provide part-time care for her, it would reduce the amount needed to hire outside help. Just thinking she might prefer to be in her own home, with family, than stuck in a hospital.

I will just say that we used hospice twice, once for my mother and once for my father. In both cases, we waited too long to take full advantage of their services which did help my mother - they washed her hair for her - and would have helped my father - I think he would have liked music as a distraction. They think of things I was too distressed and overwhelmed to think of. I was reluctant to have them dispense medication and could have refused it. They told me it was less than a surgical patient would receive and would ease their breathing. Of course, if your body is already shutting down, the medication will facilitate that. It is a very hard decision to accept that your parent isn't coming back from this.

Who has medical power of attorney and who has financial power of attorney.
Hospice has 24 hour supervision and empathy for the patient as well as the family.

Atanimpass, I hope that this is a good turn for your whole family. Getting my brothers on board with hospice was certainly a blessing.

Hold on! My daughter in laws mother was diagnosed with STAGE 4 Lung Cancer. That was 5 years ago and her last 3 scans show no cancer. I don’t know where you live but there are great cancer hospitals in this country. Don’t just give up!

Go get second opinion. there are all kinds/types of lung cancer and new treatments that weren't around a few years back-depending on the type. Family member-non smoker-4 years ago stage 4 lung cancer-spreading to his brain. Receiving targeted radiation and oral chemo. Loads of fear, crying and uncertainty for sure-unavoidable. We got a second opinion to make sure we had made the right/best choice of treatment.