My father-in-law is getting on up there and this past summer has gotten into a deal where he will go to the ER every couple of weeks because he gets dizzy, has a fainting spell, his blood pressure gets low and his eyes roll back or he just doesn't feel well(he wants a lot of attention). Every time they find nothing immediately wrong with him and send him home.
(Right now, these visits are only costing him about $60 but does Medicare have a cap on how many ambulance rides and ER visits they will pay for? Because the bills actually come to a lot more than that, and it would be finanical suicide if we ever had to chip in to see those bills were paid.)
Anyway, regardless of the bills it is getting to a point where we think it is...I don't know, this revolving door is getting out of hand. My father-in-law has always boasted that he is going to live forever and he wants heart transplants and machines and whatever it takes to keep him alive. But my husband is his health care proxy and when he talks to the ER he tells them no heroics. The visits have become so frequent that the last couple of times the hospital did not call, my husband had to call them.
So, the husband and me decided it would not be cruel or unreasonable to suggest a DNR to his father (though we both know he won't sign it) but we at least need to bring some reality to the situation for him. The last time we went to pick him up from the ER my father-in-law was in the car saying he couldn't understand why the doctor wouldn't talk to him because there was sure something wrong, his other arm was starting to get tremors and today he fainted and fell to the floor. My husband (who isn't known for his tact) said, yea, there's something wrong, you're 83 yrs. old!Not 20 yrs. old, 83! These foray's to the emergency room several times a month are getting ridiculous, when you faint they need to put you in the bed and let whatever happens , happen. There's no cure for old age. You need to think about signing a do not resuscitate order.
So, FIL just gets real quiet and won't say anything like he always does when he doesn't agree with you or like what you're saying. I tried to tactfully explain that they don't even think it's generally a good idea to do CPR on people over 80 because first of all CPR is iffy even on healthy people and second when you beat on someone that old it puts the body through so much trauma that is as likely to finish them off as any time it could buy them, which in a lot of cases is only a few days.
Nothing but the sound of crickets from the backseat.
So, we had "the talk" with him. I don't know if it was the right thing to do but we did it. We know him so well we are certain that when we left the boarding home he started running his mouth a mile a minute and telling people we were full of $h*^ (that is his favorite expression).
But my question is...do you know of a tactful yet effective way to suggest a DNR to someone, especially one who is deteriorating? No, we don't want him to die, but we have to be frank about it, the time is coming and why put his body through unneccesary trauma to maybe buy him a few more days of misery?
Other than med reviews to rule out S/E and changes to try to make him more comfortable there is really nothing else that can be done. He has been diagnosed with Lewy Body Disease and fits the s/s like a textbook. My FIL either can't comprehend or refuses to accept the prognosis.
I'll be honest with you. I'm shocked and I've sat with my mouth gapped open reading most of the post.
You aren't describing someone who is near-death...you are describing someone who is very sensitive about his health (and this is NORMAL for older people). The news and internet is bombarded every day of people dropping dead over a headache...that scares senior citizens to death...they wonder to themselves..."It's a little chest pain, maybe it's a heart attack!"
This is EXACTLY why my father refuses to get an advanced directive and put someone else in charge. He is afraid someone will just let him drop dead out of convenience...because that is what you are describing...your husband letting your father-in-law die NOT because he's terminal, but because he has normal health conditions for an aged person, just let him go at the first code? How could your husband live with himself?
Not to sound harsh, but your family seems to be more concerned about the cost of everything, than his well-being. Your family IS NOT going to have to chip-in for healthcare bills...you are not liable. My father could care less if he runs up a $2,000,000 medical bill...what are they going to do? Take his house AFTER he dies? He could care less.
You live ONE life on this earth. Once it's over it's over. I'm all about quality of life, but I'm not about to suggest to someone that they be allowed to pass away over a paper cut, because that is what it sounds like to me.
Sorry for your current problems and for anyone judging you or yours in this post. You've always made posts that were sensitive and heartfelt and seem like someone I'd like to know.
Anyway, I agree that unless your Father in law is not of sound mind-your husband's proxy isn't worth anything. As far as, a DNR even with such paperwork, if a patient is aware, or conscious during an MI or respiratory distress and they are fearful and sucking air...a doctor will ask the patient if they want to be resuscitated or tubed and ventilated. Their answer or will to live will take precedence over all written documents and proxies.
My father in law is 92 and I moved him in with us in NJ-so far he has been fairly healthy. There is no doubt in my mind he would have died if he stayed in Florida. Sometimes it is very difficult, he has Alzheimers'(short term memory) so is like a little kid if he is sick, or hungry, or constipated or anything else. But he always has a smile and is easy compared to so many others.
I think it is a big shock when people realize that LTC is not covered by Medicare. Personally, I think it's disgusting. What people don't realize, especially young, unmarried, unmortgaged, no children people.....how can you make choices between young and old? My husband is the youngest of 5, when my FIT condition was deteriorating-I volunteered to take him,(not the only nurse in family)-we have two kids in college and expenses. We have put our lives on hold to care for him, are footing the bill for private home health aide to come in a few times a week, paying all of his bills-even creating an apartment in our downstairs for him. It is a lot of responsibility and a lot of work. God help me, I am now starting to dread my own mother needing me next!
I have told my kids if I am given a bad diagnosis, or maybe even while I am young enough to do what I want. I will have a last hurrah in Vegas, then walk to my maker like the Native Americans out into the desert. I don't want to be like those coming into my ER be coded with cracked ribs and slow painful death, lonely, crazy or existing and waiting to die. I'll make my own choices, not wait on my kids or some doctor.
Good luck to you and may he die peacefully in his sleep while enjoying good health until that point.
As a nurse and a family member, I don't really think that it's ethical to suggest a DNR for anyone, especially your father in law. The best thing you can do is to have a family meeting and discuss your concerns with him-- his increasing age and deteriorating health, and talk about the pros and the cons of a DNR should that time arise. You need to ask him what HE wants to be done if he becomes incapable of making his own decisions.
Right now he is a lucid adult who is perfectly capable of making his own legal decisions. I understand that he is a burden, financially and emotionally, however there are other ways of dealing with these problems then letting him die. Have you talked with social services at the hospital? Perhaps they can help you with any financial options that may be available to you. Certainly you're not responsible for your father-in-law financially, however, as his proxy, you will be responsible for him legally should he become incapacitated.
As you mentioned, he is 83, and he won't be around forever. You have a limited time with him, and he is your husband's father-- if you don't take good care of him, if you talk him into something that he doesn't really want to do (i.e. die), are you going to regret that decision for the rest of your life? Remember that you may not get a chance to reconcile any mistakes that you may make in the future.
My father-in-law is getting on up there and this past summer has gotten into a deal where he will go to the ER every couple of weeks because he gets dizzy, has a fainting spell, his blood pressure gets low and his eyes roll back or he just doesn't feel well(he wants a lot of attention). Every time they find nothing immediately wrong with him and send him home.
(Right now, these visits are only costing him about $60 but does Medicare have a cap on how many ambulance rides and ER visits they will pay for? Because the bills actually come to a lot more than that, and it would be finanical suicide if we ever had to chip in to see those bills were paid.)
Anyway, regardless of the bills it is getting to a point where we think it is...I don't know, this revolving door is getting out of hand. My father-in-law has always boasted that he is going to live forever and he wants heart transplants and machines and whatever it takes to keep him alive. But my husband is his health care proxy and when he talks to the ER he tells them no heroics. The visits have become so frequent that the last couple of times the hospital did not call, my husband had to call them.
So, the husband and me decided it would not be cruel or unreasonable to suggest a DNR to his father (though we both know he won't sign it) but we at least need to bring some reality to the situation for him. The last time we went to pick him up from the ER my father-in-law was in the car saying he couldn't understand why the doctor wouldn't talk to him because there was sure something wrong, his other arm was starting to get tremors and today he fainted and fell to the floor. My husband (who isn't known for his tact) said, yea, there's something wrong, you're 83 yrs. old!Not 20 yrs. old, 83! These foray's to the emergency room several times a month are getting ridiculous, when you faint they need to put you in the bed and let whatever happens , happen. There's no cure for old age. You need to think about signing a do not resuscitate order.
So, FIL just gets real quiet and won't say anything like he always does when he doesn't agree with you or like what you're saying. I tried to tactfully explain that they don't even think it's generally a good idea to do CPR on people over 80 because first of all CPR is iffy even on healthy people and second when you beat on someone that old it puts the body through so much trauma that is as likely to finish them off as any time it could buy them, which in a lot of cases is only a few days.
Nothing but the sound of crickets from the backseat.
So, we had "the talk" with him. I don't know if it was the right thing to do but we did it. We know him so well we are certain that when we left the boarding home he started running his mouth a mile a minute and telling people we were full of $h*^ (that is his favorite expression).
But my question is...do you know of a tactful yet effective way to suggest a DNR to someone, especially one who is deteriorating? No, we don't want him to die, but we have to be frank about it, the time is coming and why put his body through unneccesary trauma to maybe buy him a few more days of misery?
Other than med reviews to rule out S/E and changes to try to make him more comfortable there is really nothing else that can be done. He has been diagnosed with Lewy Body Disease and fits the s/s like a textbook. My FIL either can't comprehend or refuses to accept the prognosis.
I'll be honest with you. I'm shocked and I've sat with my mouth gapped open reading most of the post.
You aren't describing someone who is near-death...you are describing someone who is very sensitive about his health (and this is NORMAL for older people). The news and internet is bombarded every day of people dropping dead over a headache...that scares senior citizens to death...they wonder to themselves..."It's a little chest pain, maybe it's a heart attack!"
This is EXACTLY why my father refuses to get an advanced directive and put someone else in charge. He is afraid someone will just let him drop dead out of convenience...because that is what you are describing...your husband letting your father-in-law die NOT because he's terminal, but because he has normal health conditions for an aged person, just let him go at the first code? How could your husband live with himself?
Not to sound harsh, but your family seems to be more concerned about the cost of everything, than his well-being. Your family IS NOT going to have to chip-in for healthcare bills...you are not liable. My father could care less if he runs up a $2,000,000 medical bill...what are they going to do? Take his house AFTER he dies? He could care less.
You live ONE life on this earth. Once it's over it's over. I'm all about quality of life, but I'm not about to suggest to someone that they be allowed to pass away over a paper cut, because that is what it sounds like to me.
I've got two things to say about this:
1. Look up filial responsibility law. Children ARE responsible for the debts of their elderly parents.
2. It's easy to make assumptions and pass judgement on others when you are not in their situation. Funny how it feels when it's real.
You are damn right finances are a concern, because he is nearing the end of his life, those who would most be affected (my children) are just starting theirs and furthermore, I am not about to lose my property (being married to my husband I'm essentially responsible for his debts even though I'm not a blood relative) and everything I've sacrificed and saved to have to see he is kept up in a nursing home.
And that is the situation the government puts families in. And see how easy it is to make the ones most vulnerable look bad?
Look at those greedy heartless people. They don't want to lose their life savings so that poor old man can live out his final incontinent invalid days(or years) in a nursing home.
No, I think people need to look at the government for shunning its citizens who have paid their whole lives into a system and then be told they will not benefit.
Anyway, I agree that unless your Father in law is not of sound mind-your husband's proxy isn't worth anything. As far as, a DNR even with such paperwork, if a patient is aware, or conscious during an MI or respiratory distress and they are fearful and sucking air...a doctor will ask the patient if they want to be resuscitated or tubed and ventilated. Their answer or will to live will take precedence over all written documents and proxies.
Yea, we understood that unless he is incapaciated he is still in charge of his own decisions regarding his care and even if he had a DNR order he could verbally refute (is that the right word?) it. But someone here mentioned the proxy is only intended to carry out his wishes should he become incapacitated. I mentioned this to my husband and he showed me where the proxy said he was appointed to carry out decisions regarding health care when my FIL was no longer able and it says nowhere that it is to be in accordance with my FIL's wishes, it only mentions that actions are to be taken to ensure as little suffering as possible.
Sometimes it is very difficult, he has Alzheimers'(short term memory) so is like a little kid if he is sick, or hungry, or constipated or anything else. But he always has a smile and is easy compared to so many others.
This is the issue with my FIL, and while it should not be relevant I can't help but mention my FIL has a personality disorder and has always been a very nasty, condescending, arrogant and vindictive person. Perhaps this should not be used to help us decide that he should be a DNR, but in a roundabout way it is one of the reasons, because we have done all we could do to help care for him to no avail. We tried to bring him here to live with us and it took ten years off my life, I even had a mental break down. He made life hell. He was nasty to the chidlren. He wasn't a smiling happy person (what person with half a heart could resist a smile?)So, we realize we can't care for him here, what else can we do with him?
I think it is a big shock when people realize that LTC is not covered by Medicare. Personally, I think it's disgusting. What people don't realize, especially young, unmarried, unmortgaged, no children people.....how can you make choices between young and old? My husband is the youngest of 5, when my FIT condition was deteriorating-I volunteered to take him,(not the only nurse in family)-we have two kids in college and expenses. We have put our lives on hold to care for him, are footing the bill for private home health aide to come in a few times a week, paying all of his bills-even creating an apartment in our downstairs for him. It is a lot of responsibility and a lot of work. God help me, I am now starting to dread my own mother needing me next!
Yes, when my FIL was here we did without seeing our own needs were met to keep up with what he needed. I didn't even see a doctor until after I was five months pregnant, I let a decaying tooth get to the point it was too late for a filling and since I couldn't afford a root canal I had to get it pulled and turn into Snag the Hag. Our whole lives revolved around caring for him and his needs. Preparing his meals, washing his clothes, he would go through episodes where he would purposefully urinate on himself - yes, it was on purpose! He admitted it felt good! - so someone would have to clean him up. I ran the wheels off my car running him to the doctor...I didn't expect to be revered or put on a pedestal for this, but he showed his thanks by slandering and lying to anyone who would listen until someone called APS on us, and all it takes is one fruitcake social worker who doesn't have the sense God gave a goose (can I give her name and location here?) to come into the picture and add more stress to an already overwhelming situation.
I have told my kids if I am given a bad diagnosis, or maybe even while I am young enough to do what I want. I will have a last hurrah in Vegas, then walk to my maker like the Native Americans out into the desert. I don't want to be like those coming into my ER be coded with cracked ribs and slow painful death, lonely, crazy or existing and waiting to die. I'll make my own choices, not wait on my kids or some doctor.
Good luck to you and may he die peacefully in his sleep while enjoying good health until that point.
Maisy;)
We must be kindred spirits because I feel exactly the same way.
and he wants heart transplants and machines and whatever it takes to keep him alive. But my husband is his health care proxy and when he talks to the ER he tells them no heroics. The visits have become so frequent that the last couple of times the hospital did not call, my husband had to call them.
.thumb.jpg.755b83f43c9f3860c778e2fcb2022ecb.jpg){kind=small}
CHATSDALE
4,177 Posts
i think that it would be better if a dnr discussion come from his doctor or other health professional..
with kids the parents will always see themselves as the one making decisions and their children needing the advise
the sandwich generation always has it rough...good luck