How do you know when the end is truly near?

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This is my first time posting here but I just need to talk some people That have been through or are going through this.

About 3 months ago my 84 year old grandmother came to live with me while waiting for an assisted living facility. She has COPD with emphysema. She's had a horrible cough pretty much since she came to stay with us. She's been back and forth to the family doctor and the pulmonaligist almost weekly since coming here. I've seen her get slightly better for maybe 2-3 at most and then she gets worse again. The cough is worst at night time and I feel awful that she can't even sleep because of the cough. It just seems like she's doing everything she can and its not even making a difference. She does the nebulizer 3-4x a day, takes all her meds, and sleeps with oxygen. She even had a bronchoscope procedure done last month. I don't know much about this disease and in just trying to see if anyone has been through this and has some input. She seems to have taken a turn for the worse the past few days and I think she'll end up in the hospital soon. I just can't shake this feeling that she's not going to get better and only continue to deteriorate rapidly.

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Steph, it will be easier now, going straight through the hospital instead of going home. So, the social worker may try to pressure you into taking her home. You need to simply refuse telling them that she needs more care than you can provide. Do not give into them, if you did who knows how long you would have to take care of her. Transition from hospital to nursing home to stay will be easier on her too.
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Thank you for all of your help gladimhere - that is exactly what I am hoping for right now. They are doing a bronchoscope procedure on Friday and then I'm sure she'll end up staying in the hospital for a few more days and then possibly rehab after that. I'm really hoping we can get her into a nursing home after this ordeal.
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Steph, one thing to remember is that now may be the time to get her in a nursing home. You can talk to the social worker, discharge planner, to tell them she is too much to care for at home. So many of the elderly become very weak when in the hospital so rehab may be necessary. This is an ideal opportunity for a longer term assessment of her care needs.
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I just wanted to update everyone and thank you all for your input. My grandmother was hospitalized today - finally. She has been coughing literally non stop now. Now everytime she coughs she's having diarrhea, and they've had to put a diaper on her at the hospital. She's so embarrassed and upset and I feel awful for her. I haven't seen her today as my aunt and cousin took her to the doctor this morning and her pulse ox was at 85 so the doctor sent her right to the hospital. It's just all very sad. 😔
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Steph, if her doc thinks nursing home is more appropriate he will write an order. People cannot just decide a nursing home is needed and go.

And you are a caregiver. You help care for grandma. Most of us here are taking care of elders thaf are still ambulatory. As they reach the end of their lives they become bedbound and the large majority needed help long before that. It is wonderful that you have a cousin and aunt to help. While you still have grandma do everything you can to make sure that help continues. The holidays get so busy that people often become distracted from what they should be doing.

Best wishes to you, you are a wonderful granddaughter!
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Thank you for all the input. I don't really consider myself a caregiver, my grandmother is pretty independent really. She can get around on her own and isn't like she is bedridden. My cousin and even my aunt help out a lot. I have 2 uncles also but they aren't much help really. She does still have some funds from selling her home and that will all end up going to assisted living and when that runs out then it will turn into Medicaid. Sometimes I think an actual nursing home would be better for her vs assisted living.
Terry-thanks for the advice about the fluid - I will be asking the pulmanoligist about that myself. I'm just exhausted and my husband and I need our home and privacy back to normal.
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Steph, I agree with Gladimhere. Your grandma's condition at the stage she has reached is too much for you to handle in your busy home. COPD is a progressive disease. Medications can relieve symptoms for a time and temporarily slow the progress of the disease but not cure it. I don't know about where you live, but many NHs and ALs have furnished respite rooms available that she can stay at for short term until final arrangements are made. In my area, just calling around for information had several of them eager to rent a room immediately. I settled my mom in one to give me time to research permanent AL arrangements.
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Steph, if she sold her home last year, does she have the funds to go into an AL right away if there is room? I certainly understand what you're going thru because my own father had COPD when he came to live with me 9 years before he passed away. It wasn't too bad at that time but occasionally, he would get into coughing fits and not be able to breathe. COPD causes fluids to collect in the lungs slowly over time and it's gets harder and harder to lie down flat because they can't breathe. After about 5 years, he started declining rapidly and having attacks where he couldn't breathe. He said it was like his lungs weren't moving at all and he couldn't inhale/exhale because the lungs stayed the same size. Has your grandmother started experiencing this? Once this started, I had to call an ambulance more than once to take him to the hospital which turned out to be a good thing actually. They put him in ICU and had the respiratory nurse suction out the fluids on a regular basis. Not a pretty sight but necessary. After about 2 weeks, he would come home and feel great and able to breathe again. the removal of the fluids allowed his lungs to move again. Talk to the pulmonologist about putting your GM in the hospital to remove the fluids and possibly showing you how to remove it at home. If her condition is such that she needs hospice, they can do the suctioning or an aide or home health care worker can do it. Once she's in the AL they will take care of the fluids. Talk to the doctor about the length of time he thinks she will be in AL. The GM's daughter should be the one doing this work, not you as you have your hands full with your family. Tell him you need some answers as you have some decisions to make. If she is aware that you can't do this, then talk to her about hiring caregivers to come in and help until the bed is available in AL; then she will be transferred to the AL facility and go see her as often as you can. She may feel abandoned by that time. Not everyone can be a caregiver because it takes too much out of them to care for someone who really needs help. Maybe by that time, the daughter will help with sitting with her at the facility and giving you a break. The more she steps in, the more you step out. I don't think your GM have a lot of time left so enjoy the time you have with her, read to her if she wants you to and tell stories about happier times that would put her in a good mood to sleep soundly at night. If you do all you can do while she's alive, you will have no regrets later on. The daughter may if she doesn't step in and help. Good luck with the facility.
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Steph, NO it does not sound awful at all! You are too young with your own family and all the responsibilities that go along with that to also be caring for grandma. No guilt! We all understand and support those sorts of decisions, especially when the carer has their own responsibilities and a life in front of them.
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Thank you all for the responses. I ended up with my grandmother living us about 3 months ago. When my grandfather passed away last year she sold her home and moved In with my aunt (her daughter). They just couldn't get along and somehow she ended up here. I have a husband and a 2 year old daughter. It's really too much for me to have her here and she knows that. I lost my own mother(her daughter) last year suddenly, and that was very difficult for me.

She has another meeting with an assisted living facility next week to go over finances, and I'm just praying that this goes well and she can in soon.

She is actually on meds for the GERD already! I was thinking that too, but nope! I know her COPD is getting worse and I know this might sound awful but I just can't have her here when she's gets much worse or even worse when she passes away.
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