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I’m getting input from the facility, from hospice, from insurance - all from their own perspectives of course. I understand as POA the decision about how to proceed is mine but could use some advice from people with experience and no agenda. Please (heart failure; hx of stroke, bypass).

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What are the doctors telling you Peasuep? I think your goal now is to keep him as comfortable as possible for whatever time he has left, I would rely on them helping me to understand what is necessary for that.
(I want to add that I know how hard it is to choose do nothing, even when you know there is nothing else you can do)
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Well on Hospice if you do decide that he should have surgery Hospice will discharge him while he is under the care of the doctor.
With advanced dementia he probably will not do well with anesthesia.
(Do his doctors even think he is a candidate for surgery given his medical history?)
With advanced dementia he probably will not be able to participate in rehab.
He probably, even with surgery to repair the fracture not walk again.
He will be at higher risk for pressure wounds.

Once he has surgery (if this is your decision) he can then qualify for Hospice.

Without surgery he will probably survive not much more than 6 to 9 months. Honestly with surgery it would probably be about the same since he would be very limited in his activities and would probably be in wheelchair or bed. (due to the fact that he probably would not do well in rehab)

I said for years when I had to make tough decisions for my Husband I was ruled by 2 major organs.
My head
My heart.
I could only hope that my head would rule on the important decisions like the one you have to make.
I can tell you in your situation I would opt NOT to have the surgery done.
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I agree with cwillie, Pea. The goal now is his comfort.
Do you have any specific question for us.
For the most part I will refer you to your hospice. They are paid enormous amounts of money to have on hand social workers, clergy, RN. MAKE USE OD THEM. Keep a small notebook with your daily questions. Call with your questions.
I am glad you've made this decision.
I hope you'll keep updating us.
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Two years ago my almost 101-yr old Aunt with advanced dementia got out of bed at night and broke her hip. As her MPoA I was not in favor of a surgery but her in-home, hands-on long time caregiver nieces wanted to bring her back to the house and continue to care for her. The problem was as she was in the rehab facility she was still attempting to get out of bed. It would be no different back at home. I finally decided to not put her through the surgery. PT was going to work with her to get her to be able to pivot on that hip so she would be able to stand and transfer from bed to chair, etc. I was actually in the process of having her assessed for MC or LTC when she passed away in rehab, cause unknown but possibly from a clot that can be a risk related to large bone breaks. My Aunt did not seem to be in pain unless she attempted to stand and walk (which she wasn't able to do well prior, hence her falling when unsupported). She was not going to die imminently from any other health issue. She probably would have gone back home where she'd continue to fall. If I were in your situation I would not have the surgery (because there are risks with the anesthesia, risks from infections, risks that he won't keep the IVs in, etc) and he probably wouldn't cooperate with the rehab. I take it that without the surgery he will be bedbound. I agree that comfort and pain control is what now needs to be the priority, not his mobility. Is he even considered a candidate for the surgery with heart failure? FYI my Aunt's surgeon told me bluntly that they only like to take on patients with best chances of good outcomes because it impacts their own ratings. I wish you clarity, wisdom and peace in your heart no matter what you decide for him.
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P, if it were my husband, I wouldn’t put him through surgery. If he manages to survive the operation, the recovery is so difficult. With advanced dementia there is nothing to be gained. Even if he does manage to walk again, he has an increased probability of falls due to a brain that cannot instruct his body. So then he falls a lot, injures his brain even more, and becomes wheelchair or bedbound anyway. This would be very difficult for you as well as him.

I am sorry.
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I would be talking to the orthopedic surgeon , especially if your DH is otherwise expected to live for awhile , like he’s still eating , drinking etc .

I only say this because I have had a few patients with unstable fractures so bad , the surgeon said it would have been impossible to keep them comfortable even bedbound with turning them for incontinence care etc . The goal was comfort, not walking.

Otherwise , I would say no surgery and keep him comfortable .
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waytomisery Apr 11, 2025
To clarify, if the break is bad , having surgery will keep him more comfortable in the long run.
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Psue, I am so sorry for all you are facing.

I can't imagine how challenging this all has been for you.

May The Lord give you strength, guidance and wisdom for this time.

(((Great big warn hug!!)))
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I had a hip replacement in October. The operation was to have been done under local anesthesia but rapidly progressed to a general. The first two days were very painful.
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Oh peasuep, I am so so sorry, my heart hurts for you. You have been through so much. 💕💕🙏🫂🫂
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Peasuep, I wanted to also say to you that you know your husband, when he had a healthy mind, what would he want you to do ?? 🫂🫂
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(((((Psue))))) I am so sorry that both of you have to contend with this also.

What are his doctors saying?

I really agree with those who say his comfort is the first consideration.

With advanced Alz. and his health history, his (and his body's) ability to cope with major surgery is limited. What challenges are there with surgery vs without surgery?

Everyone has their own axe to grind, including I am sure, his relatives. What, in his best mind would he have wanted? Which decision can YOU best live with?

What a rough time you have had and are having. My heart goes out to you. Prayers for the best outcome all things considered. Please keep us updated.
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Pea, I would have the repair done if MD suggests it.
There is nothing to lose in mentation, really, is there? And nothing to lose otherwise. Let us say that he were "to pass" while under anesthesia. Is there any better way than that to go? Truthfully, his life is now burden to him, and to all who must stand helpless witness.

He would be in pain without surgery and the necessity of heavy medication for this pain would affect body, mind as well. And he would surely very quickly get orthostatic pneumonia.

Falls are often the beginning of the end. It was so for my mom even though she didn't "break" anything with hers. Weeks later she was gone.

I wish you good luck. Be guided by the medical team. There is nothing risk free now for him or for you. Good luck.
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What does Memory care say. I would think they do not have the ability to care for him now. They are not a SNF. I would not put him thru surgery and as said, he would have to go off hospice.

If the Memory care cannot care for him, then you may need to transfer him to LTC.
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A broken hip is supposed to cause brutal pain and it is considered a mercy to fix it. Just be aware that a person with dementia put under anesthesia will likely come out of the anesthesia even more confused. They will not go back to where they were mentally.
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My dear husband passed away last night. His sisters and my daughter were with us every second, through his last breath. Most of the people dearest to him were able to say good bye either in person or on the phone. The facility staff and even a couple of the residents were sweet and caring. Hospice was invaluable.

I am so grateful for all of you who have listened to me through this and given me the benefit of your experience, comfort and strength. You’ve set me back on course when I was veering and encouraged me when I was feeling defeated. Most important, you helped me to prepare for his decline and set up my life without my provider and protector. I made a few mistakes along the way but, oh, they would have been so much worse without you!

I have some questions about my husband’s last couple of days as well as his actual passing and I know I can come to you when I’m ready to ask them.

Thank you with all of my broken heart.
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casole Apr 12, 2025
This is incredibly sad news. So terribly sorry for your loss. Thinking of you 🫂🫂🫂
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So sorry for your loss .
Your husband is at peace now.
I’m sure he would say that you did a great job , your best in such a heartbreaking journey . He was grateful for your love and care , even if he could not tell you so . Cherish good memories.
((((Hugs)))
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I'm so sorry for your loss ((hugs))
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Oh honey I am sorry for your loss. Something to be aware of: if he was on hospice and his hospice was through Original Medicare coverage, it has a bereavement counseling benefit for his immediate family. You don’t need to sign up right away. But it’s there for you to utilize even if it’s 5 weeks from now. It’s billed to his Medicare even tho he has passed. It’s usually outsourced to a licensed SW or therapist who does this as a part of their regular practice.

I don’t know how Medicare Advantage Plan work for bereavement counseling.
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I'm so sorry to hear of your husband's passing, though glad those who were near and dear got to be with him and say their goodbyes.
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Dear Psue (((((((hugs))))) my deepest condolences on your loss. I think your hubby was a special man as he earned such devotion from you. So glad he was surrounded by family when he passed. May he truly rest in peace. Loo after yourself as you go through these next days and weeks dealing with the necessities. Grief counselling can be very helpful when/if you are ready for it. Do come here for support as you need it. My heart is breaking for you.💔
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Peasuep, May The Lord give you grieving mercies, strength and comfort during this new season in life.
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Peasuep: My deepest condolences , I am so sorry! 😥 My thoughts and prayers 🙏 are with you.
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I'm so sorry at this loss but happy to know he was surrounded by loving family that mattered to him. May you all receive comfort from sweet memories and receive peace in your hearts as you grieve.
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Heartfelt condolences. 🙏
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You are an example of a true loving heart. Wishing you comfort and peace to help you heal from this loss.
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