Making Cancer Care Decisions for Older Adults

Covered in this guide:

• Understanding Challenges Faced by Older Adults With Cancer
• Senior Living Options for Individuals with Cancer
• Staying at Home vs. Moving to a Facility: Making the Decision
• Choosing an Assisted Living Facility for Cancer Care
• National Assisted Living and Nursing Home Chains That Offer Cancer Care
• Hospice Care for Cancer Patients
• Expert Reviewer

Updated: June 28, 2023 | Reviewed by: Dr. Deidre Sommerer, LPN, MS, CMC, CDP.

A cancer diagnosis is devastating at any age, and older adults are no exception. If your loved one has been diagnosed with cancer, you're not alone. According to Johns Hopkins, the incidence of cancer has increased by 26% in people 65 years of age and older in the last 30 years. Today, the over-65 population accounts for 56% of all cancer diagnoses and 70% of all cancer deaths. Treating cancer in older adults is especially challenging due to socioeconomic barriers and health factors that affect access to care and treatment outcomes. With the 65 and older population set to dramatically increase to more than 95 million by 2060, addressing the inequalities that create poor outcomes in older cancer patients is more important than ever.

While navigating cancer care for your elderly loved one can seem challenging, it's important to have the tough conversations about living arrangements and make a plan for the future. Depending on where your loved one is in their cancer journey, they may resist talking about the obstacles they're facing. But, by having these conversations early and often, you can prepare for what may come next and respect your loved one's wishes when it comes to treatment and long-term care. 

This guide will discuss how a cancer diagnosis can present unique challenges for your loved one when it comes to senior living options and care. You'll come away with a better understanding of the barriers older adults with cancer face and how your loved one's diagnosis will influence their future care needs. This guide will also provide tips and information for finding a nursing home, assisted living facility, or home care provider that can deliver the cancer care and level of personalized attention your loved one needs. 

Understanding Challenges Faced by Older Adults With Cancer 

Health care inequalities disproportionately affect older adults, and a number of social and economic factors can make cancer diagnosis and care challenging. When it comes to cancer treatment, time is of the essence. Studies show that even a four-week delay in treatment can lead to increased mortality in cancer patients. Issues such as lack of transportation and the inability to pay for treatment can keep older adults from getting the care they need after a cancer diagnosis.

Financial Barriers 

In the United States, everyone 65 and older can access Medicare, but many older adults are underinsured. In fact, one-fifth of older Americans spend more than $2,000 on out-of-pocket health care costs. These high costs can keep older adults from getting regular checkups and cancer screenings. One in 12 Americans age 65 and older reported postponing or forgoing health care consultations, treatments and medical tests because of costs. These financial barriers can keep older adults from getting the cancer treatment and care they need. 

Difficulties in Accessing Treatment and Care 

Along with finances, trouble accessing care is another prominent reason why older adults cannot pursue cancer treatment. Older adults living in rural areas without access to public transportation are at an increased disadvantage in this regard. They may be unable to drive themselves to appointments or unable to afford travel expenses to receive care. 

Difficulties During Treatment and Cancer Therapy

Treating cancer in older adults is especially challenging due to the high prevalence of comorbid chronic health conditions in this population, such as heart disease or diabetes. These conditions can affect the way a person with cancer responds to treatment and may increase the risk of serious side effects. Chemotherapy and radiation can negatively impact an older person's overall quality of life and prevent them from living independently or caring for themselves.

Senior Living Options for Individuals with Cancer

A cancer diagnosis greatly impacts the senior living options available for your loved one. However, many facilities can provide the care they need in a safe and secure setting. You and your loved one can evaluate each option and make an informed decision about their care. Here is an overview of the senior living options available for individuals with cancer. 

Assisted Living

If your loved one's cancer treatment and symptoms make it difficult for them to manage tasks such as preparing meals and taking care of themselves, assisted living facilities can provide the help they need to function as independently as possible. Assisted living is a senior care option for individuals who can live semi-independently but require some assistance with activities of daily living. These activities can include bathing, dressing, eating or taking medication. Some communities provide transportation to and from doctor's appointments to help your loved one access their cancer care. 

Skilled Nursing or Nursing Homes

Nursing homes, also known as skilled nursing facilities, provide 24/7 care for individuals with complex medical needs. For older adults who require hands-on care due to advanced cancer, nursing homes offer a safe environment with access to qualified nursing staff. Nursing home stays can be short-term or long-term. After a hospitalization, your loved one may be discharged to a skilled nursing facility if returning home isn't safe for them.

Home Care

Depending on the level of care needed, home care may be an option for your loved one. Home care services can include personal services, such as housekeeping and assistance with day-to-day activities, or home health care provided by licensed professionals such as nurses or physical therapists. Your loved one's health care team can help you determine if home care is appropriate for them and what sorts of services they could benefit from. 

Hospice Care

Hospice care is for individuals with a life expectancy of six months or less. It focuses on reducing pain and managing symptoms to keep the patient comfortable. Hospice care is primarily provided at home or in the nursing home that the senior lives in. Hospice staff and nurses visit periodically and are available by phone 24/7 for patient and caregiver concerns. 

When hospice care cannot manage care in the patient's home environment, short-term inpatient care is available. Short-term respite care is also available to give family caregivers a break.

Staying at Home vs. Moving to a Facility: Making the Decision

As you navigate your loved one's cancer journey, you may face the difficult decision of whether moving to an assisted living or nursing facility is appropriate. It's natural that your loved one will want to remain at home, but there may come a time when their home is no longer the safest place for them. You and your loved one can make an informed decision on what living situation is best for them based on the following factors:

Age, Cancer Diagnosis and Prognosis

Your loved one's age, cancer diagnosis and prognosis will greatly influence their living options. Older adults with early-stage cancer or cancer that's in remission may be able to remain at home with only minor supportive services. However, if their disease has progressed far enough to impact their ability to complete activities of daily living safely, an assisted living facility is a safer option. 

For older adults with late-stage or advanced cancers, nursing homes can provide 24/7 care and access to complex medical treatments that may be too difficult to manage at home, such as tube feedings. If your loved one's physician gives them a life expectancy of six months or less, hospice care can provide compassionate end-of-life care. 

Safety of Their Home Environment

It may be possible for your loved one to remain at home if their home is a safe and secure environment. Create an emergency plan with your loved one and ensure they can access a phone or personal emergency response system at all times. It's important to consider not only home safety renovations and accommodations such as wheelchair ramps and grab bars but also logistic factors such as time and distance from a hospital. 

Caregiving Concerns

You and your loved one will need to decide who will care for them and where that care will come from. In-home care can be expensive, and moving to a facility may be a more economical solution. Family caregiving is an option, but if you or a family member will act as your loved one's primary caregiver, you'll need to account for your own needs as well. Caregiver burnout is common in those who care for family members with a chronic condition such as cancer. Respite care services can help you get a temporary break while your loved one is safe and cared for.

Frequent Re-evaluation

Circumstances can change quickly during cancer care. For example, your loved one may be able to live at home for some time following their diagnosis, but their health could worsen as their disease progresses, leading to them requiring more hands-on care. It's important to re-evaluate your loved one's living situation often to ensure that you always account for their best interests. 

Choosing an Assisted Living Facility for Cancer Care

When it's time to choose an assisted living facility for your loved one, it's important to evaluate prospective communities for the resources necessary to provide appropriate care for older adults with cancer. By asking the right questions and knowing what to look for, you can make the best decision for your loved one's needs. 

You may encounter difficulties approaching the subject of assisted living with your loved one. They may be hesitant to move or view moving to an assisted living facility as giving up their freedom and independence. If they're able to, have your loved one join you on tours or visits to different facilities. Seeing the facility firsthand and speaking with staff members and current residents can help them feel more comfortable with the decision. 

Downloadable Resource: Checklist for Choosing an Assisted Living Facility for Cancer Care

National Assisted Living and Nursing Home Chains That Offer Cancer Care

Many national assisted living and nursing home chains provide services and care for older adults with cancer. The table below can help you evaluate several large chains and the services they provide.

We understand that choosing the right assisted living or nursing home facility for your loved one is a delicate decision. We’re here to help you evaluate options in your area and find the right fit for your family member. Call 1-800-334-9427 for free assistance from our experts. 

Hospice Care for Cancer Patients

If the time should come when your loved one experiences a significant decline in their physical or cognitive status despite ongoing medical treatment, and their physician gives them a life expectancy of six months or less, hospice care can provide comfort and care in their final days. 

While the decision to pursue hospice care is often an emotional one, it's important to remember that choosing hospice does not mean that you've "given up" on your loved one's care. Instead, hospice provides the opportunity to improve their quality of life for the time they have left in a caring and dignified environment. Here's what you need to know about hospice care for cancer patients. 

What Is Hospice?

Hospice is medical care for people with an anticipated life expectancy of six months or less when curing or treating their illness is no longer an option. In hospice care, it focuses on managing symptoms and keeping the patient comfortable during the end of their life. Hospice involves an interdisciplinary team working to provide specialty care that's compassionate and person-centered, supporting the patient's physical, spiritual, and psychosocial needs. 

Hospice care also supports family members, close friends and other unpaid caregivers. Hospice provides bereavement care for family members and loved ones during the patient's illness and for up to a year following their death. 

What Services Does Hospice Provide?

Most hospices participate in Medicare and therefore provide the same set of services to meet Medicare regulations. These services include the following:

• Medication for symptom control and pain relief
• Medical equipment such as a hospital bed, wheelchair or walker
• Medical supplies such as oxygen and catheters
• Services needed to manage pain and symptoms as recommended by the hospice team
• Short-term inpatient and respite care
• Grief and loss counseling for the patient and loved ones

Hospice provides additional services such as physical therapy, speech-language pathology services and dietary counseling on a case-by-case basis depending on your loved one's disease progression and symptom burden as evaluated by the hospice team. 

Resources for Choosing a Hospice Provider 

Your loved one's physician can recommend local providers and help you navigate the referral process. You can also ask family and friends about their experiences with choosing a hospice provider for their loved ones. For additional comprehensive resources and information, use the table below to learn about finding a hospice provider in your area.

Expert Reviewer

Deidre Sommerer, LPN, MS, CMC, CDP.

Deidre has worked in the healthcare field for over 35 years and specializes in Geriatrics. Deidre is a nurse who holds a certification from the National Academy of Certified Care Managers and is a Certified Dementia Practitioner. She has worked across all healthcare settings, with a concentration on the community and helping older and disabled adults age in place. She has worked on NIH grant-funded program evaluation projects and considers herself a life-long learner. Deidre is a valued team member at The Hartford HealthCare Center for Healthy Aging in Hartford, CT.