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DF end of life hospice trauma. Please advise

159 replies

Totallybannanas · 06/07/2025 20:01

My dad is currently in a hospice receiving care for stage 4 oesophageal cancer. He was admitted two weeks ago, and while there have been slight fluctuations in his condition day to day, overall he has deteriorated rapidly.

He is very frail and thin, though still eating, drinking, and mobile — but with increasing fatigue and weakness. He now has incontinence and wears a pad. They attempted to catheterise him recently, but he was too distressed to tolerate it.

One of the hardest parts is the extreme agitation and confusion. He often seems overwhelmed and doesn't know what to do with himself. He barely sleeps at night, gets up frequently, paces the room, and is visibly anxious and restless. He’s often angry, short-tempered, and frightened — especially of the dying process — and he says things like he wants it to be over.

He’s been very demanding with staff, constantly ringing the bell for medication and complaining about things. He’s receiving lorazepam and oxycodone orally. Even though he wants us there often, he sleeps through much of the visit or hardly speaks. I took him for a short drive today — he got out of the car, walked a few steps, and then immediately asked to go back. Once inside, he rang the bell repeatedly until he was given more medication.

This experience has been emotionally traumatic. No one has clearly explained what’s happening, and I feel like I’m guessing what's normal and what isn't. He had a UTI earlier this week, and we hoped that might explain some of the behaviours, but his distress and mental state haven't really improved.

We’ve now been told to begin looking for a nursing home. He hasn’t specifically said he doesn’t want to go, but I honestly think he will find it deeply frustrating and depressing. I don’t think he’s safe to live alone, but I also don’t know how he’ll react if the hospice stay ends and he’s moved. I'm also unsure whether his current behaviour is due to the cancer, the medications, or the general decline in his condition. We're not getting updated scans or clear information on prognosis.

I feel emotionally drained and anxious every time I go to see him. Today, he screamed so loudly the nurses thought something terrible had happened — it terrified my brother, who called me afterwards visibly shaken. My dad told the nurses he wanted to put his head through a window. He also asked my brother to help change his pad. His sense of dignity seems to be gone, and it’s heartbreaking to watch.

I don’t know what to do anymore or how to help him through this. Has anyone been through something similar? I feel like I’m watching him slip away and there’s nothing I can do.

OP posts:
TheOtherRaven · 06/07/2025 21:17

I am so sorry OP. A relative in the last months with cancer a couple of years back had a period of being very distressed and confused, and I think it was the GP who identified a severe missed bladder infection which was causing a lot of it, which he couldn't feel in amongst all the other symptoms, and also that he needed mental health support and medication. There was calmer water beyond this patch, once we got it sorted. We did a few times have to push quite firmly for medical assessment, I think with a chronic patient new things get missed or lost or assumed to just be part of it instead of something that needs checking and helping.

hhtddbkoygv · 06/07/2025 21:18

AluckyEllie · 06/07/2025 20:28

This is why we all should be in favour of assisted dying. It’s horrific. The poor man, knowing he’s dying but he can’t die quick enough. The panic must be unreal. It sounds like he might need more medications to sedate/take the anxiety away. It sounds like anxiety to me, the need to stay close to the hospice, the constant ringing of the bell.

Quite the opposite in fact.

Itsanewnameeveryday · 06/07/2025 21:20

https://en.m.wikipedia.org/wiki/Delirium

Sounds possible that the UTI and/or meditation may have triggered a delirium which can persist after treatment has been completed.

Delirium is common but under recognised by health professionals.

Delirium - Wikipedia

https://en.m.wikipedia.org/wiki/Delirium

Pebbles16 · 06/07/2025 21:23

@Totallybannanas I am so sorry to hear about your Dad and you are in an awful situation.
As much as it seems against your nature, you MUST - for your own wellbeing - refuse to offer care. Yes, you might feel uncomfortable handing over care to the others, but they are professionals. You can advocate for your Dad, but don't get stuck in the quagmire of being capable, because your energy will be depleted very quickly.
I am not a medic but have seen a few similar situations, it sounds like your Dad is towards end of life. It's great that he can still eat and drink, keep encouraging self-hydration.
Sending you my best wishes.

TwinklyMoose · 06/07/2025 21:25

my Dear dad was in and out of a hospice for last few months of his life. He was then taken in for the last two weeks of his life. They urged me to find a nursing home for him as they didn’t think he was going to be imminently dying so i did. He was transferred sat upright waving in the ambulance and he died the next day. I still feel terrible for moving him. I am sorry you are going through this it’s so hard. My dad displayed strange behaviour in the few months before he died too. Including making my sister drive with him at 40mph on the motorway 100 miles to see a souped up range Range Rover. He was not a car man at all x

Moonlightfrog · 06/07/2025 21:29

Sorry you are going through this OP. I went through similar with my grandad, he refused to go into a nursing home (he just wanted to go home to die), eventually he returned home and had a live in carer and McMillan popping in. It was hard work up until the point he was bed bound and days away from the end. It’s awful for the family having to see them suffer, seeing them lose their dignity. My grandad eventually stopped eating but despite him being a tiny man he still lasted another few weeks on just fluids. The day before he died he was just sleeping and looked relaxed, in a way it was a relief to see him calm and settled.

zeibesaffron · 06/07/2025 21:29

I am sorry you are going through this with your DF.

The poster that said hospices are usually for end of life care isn’t correct - hospices can be used for symptom control and specialist palliative medicine e.g., blood transfusions etc. However in this instance your DF’s symptoms are not being controlled properly and he is distressed plus you are also not getting the support you need.

Call the ward ask for an urgent meeting with the Ward Manager or Matron - you want a full understanding of what is going on and what next steps are. Draw up a list of questions you and your brother have and so not leave until they have been answered.

You can also ask for a meeting with the team Drs, OTs the lot - they should be having ward rounds - ask for an invite. I would want to understand why his symptoms are not being controlled, what is happening with the UTI and medically what are they going to try next - a syringe driver, different anti - anxiety medication??? I would want a pain review too it maybe that the oxycodine is not enough or is not at the right dose.

Unfortunately they cannot keep your DF in their for long - the pressure on beds will be immense- many care homes now are funded via CHC funding for palliative or end of life patients. They will be supported by a local GP and will have training in supporting end of life situations. Make sure the care home is one that has the specialist training in palliation.

Overall take care of yourself this will be a difficult, distressing and painful
time for you too xx

MarySueSaidBoo · 06/07/2025 21:29

My Dad spent 5 weeks in a hospice (liver cancer) and was then discharged to a nursing home as they thought he had another 3 to 6 months. The reality was that he died 4 weeks later, and it was awful. Even in a nursing home, the drugs rounds didn't tie in with Dad's needs and we ended up having to get the district palliative team in on top (the hospice Consultant ended up weighing in too). He was agitated, distressed and difficult for those entire 4 weeks apart from the last 2 days as his liver wasn't metabolising any of the drugs they were giving him. It was incredibly tough. This isn't your Dad, it's his body slowly shutting down.

If they are talking a nursing home (You can't manage this at home in all seriousness) then you want to know that they can manage EOL care and that he can be dosed every 4 hours night and day or as necessary, and not when their drug rounds dictate. I can't emphasise how important this is. And I'm sorry you're going through this, I'm barely recovered 2 years on.

cumbriaisbest · 06/07/2025 21:31

We are being told nothing

This is key, I'm afraid I learnt ( too late) I needed somebody with medical knowledge to navigate the system and advocate for me.

Mischance · 06/07/2025 21:32

It is very concerning that you are not being kept in the loop as regards the medical situation. You need to know exactly what is happening. You need to know the likely cause of his symptoms ... especially the mental ones... and what the options are to deal with these.

There will be a consultant at the hospice. Ask to speak with him/her and take with you a list of what you need to know in order to make the right decisions for husband care going forward. You also need to know if their palliative care expertise will be available to him when he moves on to the nursing home.

When my late OH was in a hospice communication was seen as vital and I had free access to the consultants, who took care of me too. He too moved on to a nursing home before the end, the hospice having fulfilled their role to assess, advise and prescribe ... and they stayed in touch with me there.
I hope someone competent is helping you with finding a nursing home and funding matters.
I had power of attorney for my OH and, having been given all the facts, was able to make the decision for his pneumonia not to be treated and to allow him to die in peace.
You are his next of kin and should be kept properly informed. It sounds as though you may need to fight for this, which is very unfortunate. I am sending you a hand hold and a hug.

Rosscameasdoody · 06/07/2025 21:34

Totallybannanas · 06/07/2025 20:26

I did that before hospice stay. I only only had one carer per day and I went down after lunch until late evening. Those periods alone he was anxious and constantly ringing the nurse and hospice. He is now alot worse. It's like he has dementia.

OP it does sound as though the cancer has spread to his brain if his behaviour is suggestive of dementia. Do you have access to his GP ? That might be a starting point for finding out what to expect and when. I also think you need to look into NHS continuing healthcare. If he has a terminal diagnosis and needs medical care, not just nursing care, then I’d suggest starting to look into that now because the process takes a while and starts with an assessment which can be done before he leaves the hospice. Speak to someone there and they should be able to refer you to the appropriate service. I’m so sorry you’re going through this.

DisabledDemon · 06/07/2025 21:34

It used to be that the GP would help people to slip away. This happened with my uncle in the 1970s. He had severe emphysema and was never going to recover. The doctor went up to see him and then came back down, saying he had gone. We all knew what had happened and were grateful.

Mischance · 06/07/2025 21:38

Just to say there are some excellent nursing homes and we did find one for my OH. They are not all awful. But you need the time to do your research and find what is suitable for him, and proper support for you in this process and in the funding issues.
Go to AGE UK website where you will find masses if info in this and also a helpline.
My OH's nursing home was finally funded by the NHS under the Continuing Health care Funding rules, and if you need any advice on that please feel free yo message me.

Shetlands · 06/07/2025 21:43

DisabledDemon · 06/07/2025 21:34

It used to be that the GP would help people to slip away. This happened with my uncle in the 1970s. He had severe emphysema and was never going to recover. The doctor went up to see him and then came back down, saying he had gone. We all knew what had happened and were grateful.

Same happened with my darling Granny in 1972. The hospital doctor told my Mum he could make Granny comfortable but she wouldn't last the night if he did. Mum said she didn't want Granny to suffer so the doctor gave her a shot of something, which sedated her and within a few hours she was gone.

Itsnotallaboutyoulikeyouthink · 06/07/2025 21:43

Don’t you think his behaviour is understandable- death isn’t nice is it. If I was in that situation I’d want to be doing all the things he’s doing. My late husband summed it up “it isn’t very nice knowing your about to be put in a coffin”

Zanatdy · 06/07/2025 21:46

one of my closest friends died of cancer in March, only 9wks after diagnosis. When you say it feels like dementia, I wonder if the cancer has spread to the brain. My friend had several tumours, one in frontal lobe and it was just like dementia. She was only 57 but had to go into a care home. It felt very much like a brain injury. She was eating and drinking until maybe 3wks prior to her death. She went onto soft food only, then stopped eating completely 3-4 days before she died. The care home was the best place for her, her needs were too great for family. She was having seizures and needed constant monitoring. It was all so very hard. My heart goes out to you. Bringing him to your home would be so hard, look into a care home

Eaglemom · 06/07/2025 21:46

uncomfortablydumb60 · 06/07/2025 20:55

Oh gosh that brought tears to my eyes
My DF had stage 4 bowel cancer, which spread to his liver and he died 9 weeks after diagnosis.
it is unusual for a patient to be admitted to a hospice without an imminent terminal prognosis. My DF passed in the hospice .2 days later( personally I think the journey hastened the end)
firstly I would ask for his urine to be (re) tested.. assuming they did
Sounds to me like he still has symptoms and needs repeat or different antibiotics
If clear then I would guess it’s his cancer spreading to his brain and I would mention to the staff he needs sedation, Lorazepam is not enough! Poor man, he must be terrified.
They usually give Midazolam in this situation and a morphine syringe driver

Patients get admitted to hospices for symtom control, a stay woth the aim to get on top of symptoms amd tp return to their place of care. The other reason is for end of life care.
If they have done what they can re his symptoms and he is not in last days of life then moving to another place of care is the norm.
OP you need to write all your questions down and request a meeting with the hospice doctor to get everything ironed out in your mind.
I think the crux of it is that he can't be cared for at home so a nursing home is the only place where he can relieve the 24 hour care his medical.needs are dictating.
Sounds like there is not much of a choice, the need to go to.a nursing home is being led by where his needs will be best met.
I do think you should discuss better symptom management of his agitation and psychological distress with the hospice doctor though as from what you say this sounds like more could potentially be done.

Wonderfulstuff · 06/07/2025 21:49

Nobody tells you how harrowing end of life care can be when you're watching a loved one shrink and slip away - so sorry you're going through this OP.

In my experience being highly agitated in those last weeks/days is very normal and the nurses will be very experienced in handling - please turn to them and don't feel that you need to be doing things that you are not comfortable with. Also have a discussion about what meds can be given to ensure your DF is neither in pain or distressed. It helped us a lot knowing that my DM wasn't in pain towards the end.

Totallybannanas · 06/07/2025 21:49

We have funding for chc. Trying to find a nursing home that is suitable is proving hard. You tend to get shown around by the receptionist and so any questions don't seem to get answered properly with regards to end of life care. The only one that I like was a care home but they don't have a nurse on site and work with district nurse. I don't think they would cope with him though. Are nursing homes able to give him all the drugs a hospice can?

OP posts:
MikeRafone · 06/07/2025 21:49

Totallybannanas · 06/07/2025 21:15

I think they brought him in but he rallied up. He is still eating and drinking, so guessing not end of life.

my dad was eating and drinking until 36 hours prior he had a small fish super and glass of red wine. He did swear a lot in the last 24 hours which was out of character the words coming out and hated the catheter - but apparently men fail to cope with this such more often the females.

I would suggest that as he is ready to go he may go sooner, though his anxiety may hold him back

one thing that my father found was oramorph (sp?) made him sleep peacefully all day - so he refused it as he didn't want his days wasted and wanted to be fully aware and chat to is family - but would this help your dad relax?

Radionowhere · 06/07/2025 21:51

Feel for you OP.
My MIL is receiving palliative care. She's refused a syringe driver as she wants to be aware of her family around her at the end. At home. I'm bricking it.

BellissimoGecko · 06/07/2025 21:51

TooBigForMyBoots · 06/07/2025 20:13

Would he be more comfortable at home with carers and a family member?

That’s not always possible or practical. Don’t make op feel guilty.

RedRock41 · 06/07/2025 21:52

OP my heart goes out to you, your DF and your family. This is a really sad situation. Resist calls for a nursing home. Also do not agree to care at home. It’ll only get worse and as a grieving daughter you’ll have enough on your plate trying to get your head and heart round everything without having to be a psychiatric/palliative care nurse on top. The hospice sound like they are passing the buck. Nursing homes often are extremely short staffed, have less resources than hospices and 9/10 care he will get will be conveyor belt. Not the staff’s fault, that’s thanks to Thatcher et al who introduced care for profit. Speak to the family and put a letter into the hospice (in writing - email fine) to outline your concerns that your DF behaviour is out of character and is causing distress, highlight that from an adult safeguarding perspective you do not consent to nursing home who are not specialist in complex end of life care and family not able to care for him at home.
All deaths are different. There are some similarities in a lot of cases. Him still being mobile, would suggest not at the end end yet. Typically people can lose functions in stages, when bed bound, sleeping a lot, not eating/drinking, not engaging, it can be getting near. For want of a better phrase, when it feels a bit like they have one foot in this life and one in the next. Even then can take a few days or weeks.
As a loving daughter, best you can do is fight for him to get the best care. Imho, that be )given he’s end of life) at the hospice. Also recognise guilt is a given so be extra kind to yourself. How would you want him or your family to act if it was you? The guilt often so misplaced so keep it in check. Know if it was my DC I wouldn’t want them burdened. For them to have the time/space to get ready to say goodbye and to enjoy as best they could time left.
It’s one of hardest times so thinking of you and your Clan.

Totallybannanas · 06/07/2025 21:54

MikeRafone · 06/07/2025 21:49

my dad was eating and drinking until 36 hours prior he had a small fish super and glass of red wine. He did swear a lot in the last 24 hours which was out of character the words coming out and hated the catheter - but apparently men fail to cope with this such more often the females.

I would suggest that as he is ready to go he may go sooner, though his anxiety may hold him back

one thing that my father found was oramorph (sp?) made him sleep peacefully all day - so he refused it as he didn't want his days wasted and wanted to be fully aware and chat to is family - but would this help your dad relax?

He has had oramorph. I think they gave him something stronger today oxycodin I think it was, which may have caused the outburst earlier. He wants us with him but he doesn't want to chat. He's not interested in anything really. It's becoming harder to distract him and engage him. He says he is exhausted and having broken sleep. I dread seeing him now he isn't the same person.

OP posts:
TheBroonOneAndTheWhiteOne · 06/07/2025 21:54

I think you should let them give as much sedation as possible.
It seems awful that medication is available but is not being given.

Can you talk to the doctor who deals with his care and ask for decent medication to be prescribed?