Reference no: EM133444555

Background - Ting is an 88-year-old widow with four grown sons and eight grandchildren. She has been living alone for the past 20 years since her husband died. Ting continues to make her own meals, engages in self-care and other activities of daily living (ADLs), pays her own bills, enjoys visits from her family and tends to her garden every day. Last month she developed mild abdominal pain. She thought it was related to something she ate, however she decided to go to her family doctor when the pain persisted. Lab tests and a CT scan confirmed that Ting had stage 4 ovarian cancer. Since a cure was unlikely, Ting decided not to follow an aggressive treatment plan. Wishing to remain at home, a visiting nurse was assigned to Ting to assess her needs every week and to manage her pain. Ting was a strong independent woman, but now she was facing an unexpected diagnosis of cancer. Two months following her diagnosis, Ting woke up feeling lightheaded and nauseous. A second CT scan revealed that the cancer had metastasized (spread) to her brain. An inter-professional team meeting was held to discuss Ting's unwillingness to be transferred to a long-term care facility. It was decided that Ting's youngest son Bao and his wife Linda would move back home to support his mother. Ting was becoming forgetful and having trouble managing her medication for pain, high blood pressure and nausea, and was showing early signs of depression as assessed by her physician. This came at a time when Bao and Linda were experiencing financial difficulties. Bao had just recently lost his job due to COVID-19, and Linda was about to go on maternity leave. Regardless of these concerns, their priority was Ting's health and well-being during this difficult time in her life.

Current Context - Ting wanted nothing more than to live her final days at home, however as her health declined and her pain increased, Ting understood that she would be more comfortable in a hospice care setting. She secretly hoped that she would be able to return home, but knew that this was unlikely. Ting slowly began to withdraw from social activities, however her mood always lightened when her grandchildren visited. Bao made a point of visiting his mother every day and often brought the grandchildren in for a visit in the evening. He continued to look for work, often staying up late to search for opportunities and submit applications. As Linda's pregnancy progressed and she experienced more discomfort, Bao took over most household responsibilities, such as grocery shopping, vacuuming, and cleaning the bathrooms. He also maintained his mother's house and attended to financial matters such as paying her bills. He also tended her garden and provided updates to Ting about how things were growing. One evening after the children left, Ting placed her call light on for assistance to use the restroom. She waited for 20 minutes, and then exerted her independence by getting up and ambulating on her own. Her lightheadedness caused her to fall. She was not injured however Ting became more socially isolated, not only withdrawing from Bao and Linda but her grandchildren as well. Linda confided in one of the nurses that Bao was worried about this change in his mother and that the grandchildren missed being with her. Ting's nurses were quick to respond to this change in behaviour and her primary nurse spoke with Ting about her disinterest in spending time with family. Ting spoke of how she missed being with her grandchildren but worried that she might get dizzy and fall during a visit. She feared this would scare her grandchildren, and that it would leave them with bad memories of her. She also worried about the ever-present dark circles under Bao's eyes and thought she was becoming a burden to him. She started to cry when she spoke of the possibility that she wouldn't meet her newest grandchild. Ting's nurses called a team meeting to discuss how her formal and informal caregivers could best support Ting.