They don’t have any children and wife is ill. We are the closest living relatives. We don’t know anything about their finances and he doesn’t “meet the criteria” for hospice. How do we begin to plan!!?
This type of cancer quickly moves to death and he is already stage 4 and is 95. Hospice would help with pain nausea vomiting help maintain his skin. He needs to be in hospice. To be kept comfortably. Hospice could be at home but would need 24 hr care givers orthere are hospice places for those who need a place to die that are staffed 24 hrs and you could visit.
Why doesn't he meet the criteria for hospice? I would think his pancreatic cancer would fit the criteria, unless he has told his drs that he wants to do all he can to fight the disease right now.
This would be a good time to go talk with both him and the wife to find out if they need help sorting out finances, helping out to pay bills, inquire about what they both want - maybe get wills done to take care of each other, etc. Then you will know how to move forward in assistance to them.
This is sad I am sorry for you BUT YOU CARE!!!! SO YOU ARE AWESOME! To protect yourself , your family and the person get a lawyer asap for advice then get a 2nd opinion! Dr Jack Grenan
The first step is to understand the financial, including insurance, and the legal situation. You'll need an attorney who understands geriatric law well, a financial advisor, and possibly a CPA. Ask around as this is a growing industry and like any other, includes some who are not so honorable. You will need wills, likely trusts, powers of attorney, medical powers of attorney and living wills for both. This can be relatively inexpensive or run into the thousands. If the attorney does not recommend the trust and tells you that probate is the way to go, run, don't walk to the next group of attorneys. Probate is the way to generate thousands of additional fees for attorneys after the client has passed. A trust allows that process to be avoided.
Hospice is fully covered by Medicare inpatient insurance. That's Medicare A. Other insurance companies also cover it, generally in the medicare managed care product lines. That may be the "criteria" they are talking about. Also, either the hospice organization physician can declare someone eligible for hospice or the patient's physician. I would go directly to the patient's treating physician - either the hospitalist or oncologist in the hospital or his internal medicine physician. There should be no problem. Hospice is often for-profit and they are allowed a certain amount of dollars to take care of each patient in hospice. As a result, they may err on the side of cutting down on expenses (estimated costs for time to end of life) and needs vs. profit. The second thing could be perhaps if the patient is still taking treatments that are not simply for comfort, but are aggressive in trying to "cure" the cancer. Hospice does not treat the disease, but strives to make the last months, weeks, days, or hours of life left more comfortable. What most don't know is that you can opt on or off hospice at any time. It can be intermittent, but each time you go back on, you need to go through the same steps and answer all of the qualifying questions.
This is a hard road, but a rewarding one. You will never look at your own life the same way after you walk through this with a loved one.
By the way, this site is terrific and there is a lot of amazing support and information out here. I just went through this with mom and dad, so it's sadly very fresh in my memory.
I am so sorry for the sadness that this must be causing you. Just know that your involvement can make an enormous difference in how loved and cared for your loved ones feel at the end of life.
This all seems so overwhelming but you have broken it down for me. I think you are right about the “criteria” ,we asked the physician and he did order it so we did not have to dispute it thank God ! its sad but true when they say you have to “walk the walk “ but this seems to also enable us to help others as you are now helping me despite your pain . This site is new to me and has been so helpful the last few days. It’s been a blessing !
"My husband became health POA today. Was not aware of financial POA. I will ask him. But does financial POA make him then responsible for all of his outstanding bills if they have any ?"
Great that he was able to become the health advocate, but to help with the finances, he will need to become financial DPOA. This will give him access to financial information and allow him to manage it, but in no way would you be responsible for paying ANY of the uncle/aunt's bills other than as the advocate using their finances. Always sign your name with DPOA. If aunt is ill, it might be wise to get the health and financial POAs set up for her as well.
ALL POAs terminate at time of death. Hopefully they have other important issues already taken care of, such as a will and burial arrangements, getting husband listed as executor. If not, get that done as well. It will still mean time and effort processing everything through probate, but without these in place, it will be a nightmare! Aunt isn't likely going to be able to handle any of that.
"My husband is pretty distraught with the news about his uncle I will ask him again. Is it possible that without financial information they could refuse hospice?"
I would ask whoever informed you that he doesn't qualify what that means. Typically hospice is for ANYONE who is determined to be terminal within 6 months (some people have been on it for years!), which generally pancreatic cancer is, and it is covered by Medicare, so it doesn't make any sense.
IF uncle is requesting treatment, that will have to stop in order to get hospice. Hospice provides palliative/comfort care, not treatment. You will need to ask a lot of questions, because if he goes home and at some point gets taken to the doctor or ER, hospice must be contacted first and possibly terminated until after the visit.
Someone suggested it might be financial if he needs to move to a NH. If you get that financial POA in place, you could have him brought home and either stay there to help him with hospice on board or hire people to provide whatever care he might need when hospice isn't there (hospice isn't 24/7 care, so he might need extra supportive care at his age with his condition.) Checking if he has VA benefits wouldn't hurt either. If he is a veteran, he might qualify for a bed in a facility with hospice (again, no treatment.) His wife would also be eligible for veteran's benefits. Having that financial POA for both would help enable you to process this for her (being government, they do have their own forms that have to be used for you to be the advocate/have access to information. Gov entities such as SS don't honor any other POAs. If he doesn't have direct deposit for SS and for other reasons, you would have to go to local SS office and apply to be rep payee - on death this might help you process payments for the wife.)
Treatment at this point is probably useless. VERY early stages might be treatable in some cases, but with his age and the stage, there really isn't much that can be done. Going home with hospice is likely the best solution.
Talk to the social worker at the hospital. That person can guide you. You are probably looking at getting guardianship over him, or certainly, a POA or Durable POA. Hospice might not be that far down the road at Stage 4.
Why do you say he doesn't meet the criteria for Hospice? Call Hospice and find out why he doesn't meet the criteria. Then ask about getting any help and what you need to do. HomeHealth might be the answer.
He's probably a veteran since he's in the WWII age group and they were drafted. You can contact the VA for assistance if he is a veteran. For that you google for Veteran's Advocate.
Great advice. Veterans have received help even at advanced ages. I know of someone aged 99 that received help. They will speed up the process at his age.
So sorry for you and him. Stage 4 pancreatic cancer is not curable. Make sure he is getting adequate treatment for pain. He probably has been having abdominal pain which can be excruciating. He will also lose a lot of weight as the disease progresses.
While he is still lucid, please make sure all his affairs are in order: will, powers of attorney, living will, DNR... If he has special desires for experiences or to see certain people, now is the time to accomplish those tasks.
My unlce had pancreatic cancer and ended up living for a year or 2.
Something is not right. If his uncle has Medicare, his uncle should qualify for hospice with a diagnosis of stage 4 cancer.
Now that your husband has POA, have him sign a DNR/DNI so that, if his uncle does arrest, they will not resuscitate him, which is a shockingly violent act and, on a 95 year old, likely to break bones, cause organ damage, and land him on a ventilator where he will die from pneumonia in a matter of weeks. And all those days or week of treatment in an ICU bring in big $$$money$$$ for the hospital.
Help your husband advocate for his uncle to be put on comfort measures with hospice so that he gets a good death.
Medicare or not If he is seeking treatment for the cancer he is not eligible for Hospice. He would be eligible for Palliative that would lead into Hospice if he chose to
Who told you he didn't qualify for hospice? That's ridiculous. These days there are often more than one hospice program provider. You're on here so you must be computer savvy enough... to google your town and hospice and see what comes up. Also will probably want to connect with a certified elder law attorney, and I always encourage people to try and find one who does it for a flat fee for each needed task. A good one will give you a list of what you need to get. If things can be handled quickly it will save you a lot of hassle in the long wrong. For now I'm guessing that if your uncle passes first his wife will inherit the estate...and there may be a will that exists already. Holding good thoughts for you...
If he is not seeking treatment for the Pancreatic Cancer he DOES meet the criteria for Hospice. I am surprised they were told he doesn't As to "what to do" Ask them Do they need help with anything? Getting Hospice in will help with supplies and equipment. That will make caring for him easier and safer for his wife. And depending on what her medical problems are she may need a lot of help. Is Uncle a Veteran? if so the VA may be able to help out. You might be a great help to the wife making a lot of these calls and "kick starting" any help they will need. Are they in their own home or Assisted Living? If at home they may need more help than if they are in a facility that was built for making it easier for people with walkers and wheelchairs. But just being there and being a support will help a lot. Let Uncle know that you will take care of Auntie so he does not have to worry about her.
Also depending on the wife's medical conditions it is possible that she might also be eligible for Hospice. It is worth a call to several Hospice and talk to each one and see what happens.
Agree about VA if he is a vet. My dad was being sent home from hospital by his horrible doctor saying he was fine so we had him transferred to VA. They found he had cancer put him on hospice and took amazing care of him and he was gone in a week.
Call a hospice provider directly. I had tried to talk to hospital staff about hospice for my mom, and everyone blew it off. When a hospice provider came on directly, my mom was well qualified. Often hospitals won't help with that as they only focus on healing and not palative care. Once hospice came on board it became much easier for us. Also, check with his wife about his continued care. Best of luck and bless you for helping.
The best thing you can do right now is Talk to him about making someone POA so they can Help in his Time of Need. You need to start with his Wife or Him while you can.
He has been accepted into hospice! We are now meeting with his wife to discuss financial stats but we are realizing she may some dementia Drs also said we should begin to “prepare “her for his passing.
It's unfortunate what is going on in this world. Seems to me there is a lack of they give a damn here. Don't you put up with that. He is most likely at the end stage of his life & he needs the right care. You can always look into your health care & report this. Look on your bills, there should be information on how to report lack of care or indifference. The older people are getting the worse they are being treated. Those who loved ones in a home, to keep a good eye on it. What they are doing is criminal. I do agree with hospice is the answer. Tell your husband someone said, "I'm so sorry!!"
Try other hospice providers. If this person doesn’t meet criteria, I don’t know who would. Realize pancreatic cancer will eventually cause his demise and most likely within 6 months.
WTH?? Stage 4 pancreatic cancer and he doesnt meet the criteria?!?! Thats not true....his oncologist can set up a referral to hospice...i used to work in oncology and i lived through this myself, as my husband was diagnosed with same.....he lived less than 3 months after his diagnosis and we had hospice.....they helped tremendously. Is anyone assigned as POA for health and financials? If so, that person should be talking to drs and get this straightened out pronto.....so sorry.....
Being Financial POA does not make one responsible for bills. One must be careful not to sign as oneself but only as POA for the person involved. Can uncle still physically sign documents? If so, he should sign them himself.
Hospice is a Medicare-paid benefit; not having all their financial information shouldn't be a bar to getting hospice. It WOULD be a deterrent to getting him admitted into a hospice facility or nursing home, because unless he has Medicaid, he would be admitted as a private pay patient.
My 62 yo SIL died within 6 weeks of her stage 4 Pancreatic Cancer diagnosis.
Who told you (or told your husband) that uncle is not eligible for hospice? Maybe he's not eligible for REHAB, which would be a whole different kettle of fish.
Someone needs to talk to the discharge planning folks at the hospital. Note that hospice does not cover 24/7 care; if he goes home, someone needs to be with him all the time.
Best case scenario, IMO is that he gets discharged, private pay, to a NH if he's not eligible for Medicaid. And Hospice gets brought in to manage his care there.
95 and stage 4 (as bad as it gets) pancreatic and he doesn't meet criteria for hospice? That makes utterly ZERO sense, and am wondering who told you that. That is unimaginable. It is very likely he will be able to go home with an ailing wife. If he makes it out of the hospital (he may not) then he will require placement. With the lack of children and a wife who cannot function social services may well go for guardianship; that may be a very good thing, indeed. I would not attempt to intervene in any of this except to visit if you are nearby. I caution you not to do the POA thing on a couple you do not really know much about at all or have contact with unless you are experienced and capable. I am currently doing this for my brother who has a simple life, simple estate, simple everything and IT IS NOT IN THE SLIGHTEST SIMPLE. Courts can appoint Fiduciaries in cases like this who function very very well. Social Services will be well aware by now that there is no family involved. If the wife lives close to you you may want to be a support to her in future; her husband has a very short time left to live.
My husband is pretty distraught with the news about his uncle I will ask him again. Is it possible that without financial information they could refuse hospice?
Talk to the social worker at the hospital. I don't understand how a 95 yo, cancer patient does not meet the criteria, there is some misunderstanding here. Does he have a durable POA, if so who holds the POA? Time to investigate this more closely.
I'm wondering if Jaym is right - could it possibly be that hospice is not able to get the information needed? Or similar misunderstanding/hold up? Is there a POA who would be competent (NOT a sick wife) or is this a situation where there is no planning ahead, no POA named, maybe not even an will/executor? Maybe emergency guardianship by the state is the way to go and what family this elder has can concentrate on visiting and helping elder. Placement on hospice in a facility sounds the wisest, since elderly, sick wife could certainly not cope.
I'd like to know how a 95 year old with stage 4 cancer can not be eligible for hospice 😠, IMO there is no way that is correct, something got lost or misunderstood somewhere along the way - I think your first priority should be to get that corrected.
So sorry to hear about your husbands uncle. Is he still mentally ok? If so you could try and get him to sign a POA. But the average time after such a diagnosis is 3-6 months - some longer some less -
However, a financial power of attorney (POA) is a useful tool that can be created at almost any point in the cancer experience to reduce worry and stress. The health one is so another can make decisions that they know would be that persons wishes regarding medical treatment or not.
A POA can also be completed during “moments of lucidity.” Sometimes a person who often lacks decision-making ability may be able to complete the POA documents during windows of time where they are more aware. For example, a person on severe pain medication may be too sedated or groggy to follow a conversation or remember facts at certain times of day, but in the morning, before their first dose of medication, they may be able to. Having witnesses to the signing of a POA is the state’s way of ensuring that the principal is competent.
Once that is implemented you will have access to his financial affairs and if necessary, be able to speak on his behalf re treatment.
My husband became health POA today. Was not aware of financial POA. I will ask him. But does financial POA make him then responsible for all of his outstanding bills if they have any ?
I'm so sorry to hear this news. My FIL had it. It will go fast for your uncle.
Have you spoken to the wife? They may have nieces and nephews who could advocate for them. Things will need to move fast and someone should speak to him about a Medical Directive/DNR/etc. FYI hospitals usually have notaries on the premises, so you could come with paperwork (assuming he and she have their full mental capacities still). Bless you for being willing to help them.
(((((Hugs)))))). We are here to support you.
This would be a good time to go talk with both him and the wife to find out if they need help sorting out finances, helping out to pay bills, inquire about what they both want - maybe get wills done to take care of each other, etc. Then you will know how to move forward in assistance to them.
Hospice is fully covered by Medicare inpatient insurance. That's Medicare A. Other insurance companies also cover it, generally in the medicare managed care product lines. That may be the "criteria" they are talking about. Also, either the hospice organization physician can declare someone eligible for hospice or the patient's physician. I would go directly to the patient's treating physician - either the hospitalist or oncologist in the hospital or his internal medicine physician. There should be no problem. Hospice is often for-profit and they are allowed a certain amount of dollars to take care of each patient in hospice. As a result, they may err on the side of cutting down on expenses (estimated costs for time to end of life) and needs vs. profit. The second thing could be perhaps if the patient is still taking treatments that are not simply for comfort, but are aggressive in trying to "cure" the cancer. Hospice does not treat the disease, but strives to make the last months, weeks, days, or hours of life left more comfortable. What most don't know is that you can opt on or off hospice at any time. It can be intermittent, but each time you go back on, you need to go through the same steps and answer all of the qualifying questions.
This is a hard road, but a rewarding one. You will never look at your own life the same way after you walk through this with a loved one.
By the way, this site is terrific and there is a lot of amazing support and information out here. I just went through this with mom and dad, so it's sadly very fresh in my memory.
I am so sorry for the sadness that this must be causing you. Just know that your involvement can make an enormous difference in how loved and cared for your loved ones feel at the end of life.
its sad but true when they say you have to “walk the walk “ but this seems to also enable us to help others as you are now helping me despite your pain .
This site is new to me and has been so helpful the last few days. It’s been a blessing !
Great that he was able to become the health advocate, but to help with the finances, he will need to become financial DPOA. This will give him access to financial information and allow him to manage it, but in no way would you be responsible for paying ANY of the uncle/aunt's bills other than as the advocate using their finances. Always sign your name with DPOA. If aunt is ill, it might be wise to get the health and financial POAs set up for her as well.
ALL POAs terminate at time of death. Hopefully they have other important issues already taken care of, such as a will and burial arrangements, getting husband listed as executor. If not, get that done as well. It will still mean time and effort processing everything through probate, but without these in place, it will be a nightmare! Aunt isn't likely going to be able to handle any of that.
"My husband is pretty distraught with the news about his uncle I will ask him again. Is it possible that without financial information they could refuse hospice?"
I would ask whoever informed you that he doesn't qualify what that means. Typically hospice is for ANYONE who is determined to be terminal within 6 months (some people have been on it for years!), which generally pancreatic cancer is, and it is covered by Medicare, so it doesn't make any sense.
IF uncle is requesting treatment, that will have to stop in order to get hospice. Hospice provides palliative/comfort care, not treatment. You will need to ask a lot of questions, because if he goes home and at some point gets taken to the doctor or ER, hospice must be contacted first and possibly terminated until after the visit.
Someone suggested it might be financial if he needs to move to a NH. If you get that financial POA in place, you could have him brought home and either stay there to help him with hospice on board or hire people to provide whatever care he might need when hospice isn't there (hospice isn't 24/7 care, so he might need extra supportive care at his age with his condition.) Checking if he has VA benefits wouldn't hurt either. If he is a veteran, he might qualify for a bed in a facility with hospice (again, no treatment.) His wife would also be eligible for veteran's benefits. Having that financial POA for both would help enable you to process this for her (being government, they do have their own forms that have to be used for you to be the advocate/have access to information. Gov entities such as SS don't honor any other POAs. If he doesn't have direct deposit for SS and for other reasons, you would have to go to local SS office and apply to be rep payee - on death this might help you process payments for the wife.)
Treatment at this point is probably useless. VERY early stages might be treatable in some cases, but with his age and the stage, there really isn't much that can be done. Going home with hospice is likely the best solution.
He's probably a veteran since he's in the WWII age group and they were drafted. You can contact the VA for assistance if he is a veteran. For that you google for Veteran's Advocate.
While he is still lucid, please make sure all his affairs are in order: will, powers of attorney, living will, DNR... If he has special desires for experiences or to see certain people, now is the time to accomplish those tasks.
My unlce had pancreatic cancer and ended up living for a year or 2.
Also, make it very clear in every conversation with everyone that there is no one to care for him in his current living situation.
He needs in patient hospice snd that’s how he’ll get it.
If anyone shows any sign of being willing to take him home, the hospital will stop right there and that will NOT be the best care for him.
Now that your husband has POA, have him sign a DNR/DNI so that, if his uncle does arrest, they will not resuscitate him, which is a shockingly violent act and, on a 95 year old, likely to break bones, cause organ damage, and land him on a ventilator where he will die from pneumonia in a matter of weeks. And all those days or week of treatment in an ICU bring in big $$$money$$$ for the hospital.
Help your husband advocate for his uncle to be put on comfort measures with hospice so that he gets a good death.
attorney. Thanks!
As to "what to do" Ask them
Do they need help with anything?
Getting Hospice in will help with supplies and equipment. That will make caring for him easier and safer for his wife.
And depending on what her medical problems are she may need a lot of help.
Is Uncle a Veteran? if so the VA may be able to help out.
You might be a great help to the wife making a lot of these calls and "kick starting" any help they will need. Are they in their own home or Assisted Living? If at home they may need more help than if they are in a facility that was built for making it easier for people with walkers and wheelchairs.
But just being there and being a support will help a lot.
Let Uncle know that you will take care of Auntie so he does not have to worry about her.
Also depending on the wife's medical conditions it is possible that she might also be eligible for Hospice. It is worth a call to several Hospice and talk to each one and see what happens.
I can't fathom that he doesn't qualify for hospice.
Get someone to explain what the problem is, did a sloppy doctor code something wrong? What needs to happen to get this man care?
I am very sorry that your family is going through this difficult time.
May God grant you strength and wisdom to deal with this situation. Hugs!
Hospice is a Medicare-paid benefit; not having all their financial information shouldn't be a bar to getting hospice. It WOULD be a deterrent to getting him admitted into a hospice facility or nursing home, because unless he has Medicaid, he would be admitted as a private pay patient.
Who told you (or told your husband) that uncle is not eligible for hospice? Maybe he's not eligible for REHAB, which would be a whole different kettle of fish.
Someone needs to talk to the discharge planning folks at the hospital. Note that hospice does not cover 24/7 care; if he goes home, someone needs to be with him all the time.
Best case scenario, IMO is that he gets discharged, private pay, to a NH if he's not eligible for Medicaid. And Hospice gets brought in to manage his care there.
It is very likely he will be able to go home with an ailing wife. If he makes it out of the hospital (he may not) then he will require placement. With the lack of children and a wife who cannot function social services may well go for guardianship; that may be a very good thing, indeed. I would not attempt to intervene in any of this except to visit if you are nearby.
I caution you not to do the POA thing on a couple you do not really know much about at all or have contact with unless you are experienced and capable. I am currently doing this for my brother who has a simple life, simple estate, simple everything and IT IS NOT IN THE SLIGHTEST SIMPLE.
Courts can appoint Fiduciaries in cases like this who function very very well. Social Services will be well aware by now that there is no family involved. If the wife lives close to you you may want to be a support to her in future; her husband has a very short time left to live.
However, a financial power of attorney (POA) is a useful tool that can be created at almost any point in the cancer experience to reduce worry and stress. The health one is so another can make decisions that they know would be that persons wishes regarding medical treatment or not.
A POA can also be completed during “moments of lucidity.” Sometimes a person who often lacks decision-making ability may be able to complete the POA documents during windows of time where they are more aware. For example, a person on severe pain medication may be too sedated or groggy to follow a conversation or remember facts at certain times of day, but in the morning, before their first dose of medication, they may be able to. Having witnesses to the signing of a POA is the state’s way of ensuring that the principal is competent.
Once that is implemented you will have access to his financial affairs and if necessary, be able to speak on his behalf re treatment.
It must be hard with his wife ill too.
Have you spoken to the wife? They may have nieces and nephews who could advocate for them. Things will need to move fast and someone should speak to him about a Medical Directive/DNR/etc. FYI hospitals usually have notaries on the premises, so you could come with paperwork (assuming he and she have their full mental capacities still). Bless you for being willing to help them.