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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]Say an 81-year-old has Stage IV cancer that’s spread to the brain. Can do all physical things, sound lucid over the phone and read a paper, but has no interest in food, cant order food off the rehab center menu for the next day, and, sometimes, in the evening, thinks he’s in a hotel and says he needs cash so he can tip the staff when he leaves the next day.

He’s on two pills per day plus monthly chemo.

He’s pleasant and doesn’t seem unhappy but has no real interest in leaving his room.

The rehab just did an evaluation and says parent just needs a little supervision, but maybe he’s deteriorated in the last week.

In the real world, are there obvious signs that someone like this will have trouble getting into an ALF and will have to go with memory care?

My father still wants to stick with active treatment for now. I haven’t even heard anyone talk about life expectancy. But, if someone like this wanted to shift into hospice, [b]would there be a lot of risk of Medicare refusing hospice care for someone with cancer that’s spread to the brain[/b]? Is that really a case-by-case thing or something where, once the oncologist says it’s time, it’s time?

[/quote]

I'm sorry about your dad.  I've read the bolded and I'm confused.  (asking nicely) why would medicare ever refuse hospice, and what would spread to the brain influence their decision? [/quote]

This could be wrong, but I’d think that a doctor has something like a flow chart to estimate life expectancy. It seems as if multiple metastases to the brain is so dire and so likely to lead to death soon that maybe it’s very easy to classify anyone who has that as someone with a life expectancy of less than six months.

Sort of the way Social Security Disability Insurance classifies anyone with some terrible conditions as automatically being eligible for SSDI.

But, maybe I’m wrong about how metastases to the brain are, or how Medicare hospice eligibility determinations work. [/quote]

I see what you’re asking/thinking now. I don’t think they have a flow chart. I think it’s more squishy than that. When my dad was sick, different doctors gave him different estimates. I was also able to find estimates by googling for medical journal articles. There were lots of articles that tracked how long from diagnosis to death for various types of cancer. I assumed his doctors were using those articles as their baseline and then adjusting upwards or downwards based on his individual factors and their own experience, but I don’t think I ever asked.

I’m sorry you’re going through this.[/quote]

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