How can I discuss end of life with an elderly person that doesn’t feel they are at end of life?

First of all you should NEVER pay for the care of an elder; you will have your OWN costs in future and it is crucial you save for them. If the elder no longer has any fiances it is time for them to apply for medical assistance such as is available in their area to them. DO NOT DO THIS.
Secondly, I will preface this comment by saying I am all for Hospice and end of life decisions. I was a nurse. I know the torment of not accepting a decent end. It is literally a physical and mental slow torture of yourself and your family if you cannot recognize that we all live and we all die. BUT, as a nurse, I will ALSO tell you that this is in the hands of the person him or herself, not family, not well meaning friends. This is for the patient and the doctor to discuss together about Palliative care, Hospice and etc. Has the doctor attempted these discussions? Have YOU attempted these discussions??????? And does the elder STILL wish to fight on.
Because this is a PERSONAL decision belonging to each of us as an individual. It is not the decision of our family, friends, or even of our doctors as long as we are competent to make our own decisions. Please NEVER push someone to "accept" an end they do not wish to accept.
If you are personally struggling in care, then you may be facing YOUR OWN limitations, not that of the elder. So you may need now to consider long term facility care. Again, YOU don't pay for this. The elder, and the State if they are broke, pays for this. But THIS is the ONLY decision that is yours to make. I wish you the very best and am so sorry for all the pain now.

Sotired, this is HIS mother right?

Have you given some thought to returning to your home and life, and letting the responsibility for caregiving fall on your husband's shoulders?

Your MIL has the right of self-determination. She can pay for transport to appointments and caregivers.

I don't quite understand why her accepting her decline will make it easier for you. Is it because she supposedly won't be going to doctor appointments any longer?

Hospice comes with a doctor. That's her doctor now, not all these other specialists. I agree with Alva -- you should not be paying for there doctors, and frankly, I think it's unethical for them to be seeing her knowing she's on hospice care. That's just a money grab in my opinion.

Simply tell her that all medical care goes through the hospice doctor from this point on. That's paid by Medicare, so you don't have to break your finances over this.

Keep some compassion there, though. It's got to be tough being one of the last ones of your generation to go, having seen the ends of so many others before you. Death is scary for a lot of people, and merely snapping your fingers doesn't make that fear go away.

Wait, she has a hospice nurse currently. How can she be on hospice with all these appointments?

My dad had the same diagnosis' and would say he is going to live to 140. I would wonder why would you want to live another 65 years being so terribly sick. Then I would say, none of us will get out of here alive. Death and taxes, the only 2 things we can count on. Then we would talk about being with Jesus in a young healthy state. He did come to terms shortly before he died, that's when I rejoiced, because being afraid makes me sad for someone getting ready to die.

I would quietly call and cancel the appointments. Remove any reminder of them and give vague answers if she asks.

Hospice will cancel her if she starts going to doctors, Medicare won't pay for both. Does she know she will lose her in home help if she pursues treatment?

Does she have a pastor or believe? Maybe getting the hospice chaplain to visit could help her come to terms with what she is facing.

I wouldn't try to talk to her about EOL. She's not ready and there is really nothing to gain for you or her by talking about it. Learning to ignore the chatter that she is creating will help you.

My dad said to put him in the back of his truck and haul him to my house. My mom has said just flush her ashes down the toilet. Obviously, I couldn't do either one, so I am doing what I think they would like. My dad got scattered on the farm that held his heart and my mom will probably be scattered in a casino garden, because that's what holds her heart.

This woman is old, scared to death and in denial and she has dementia. Too much for her to face. YOU have to stop tending to her as you have done as you are slowly destroying yourself and those around it. She is NOT going to give in and suddenly see the light. So now you have to set the new rules and enforce them - it is beyond her to do this. If you can't get caretakers to relieve her, just find a way to place her and let them take over. Please don't wait - save yourself while you can.

Hospice patients can see MDs for care unrelated to their hospice qualifying diagnosis. For example, if the qualifying diagnosis is heart failure - then no cardiology consults to see what more can be done. But endocrinologist for diabetes is permitted - though not clinically useful.
Strategies - Contacting those specialists and explaining that she is now on hospice and that she is homebound (cannot leave home without significant assistance), sleeps 18 hours/day, eats less than 2 full meals daily, and is exhausted by effort of seeing MD in office. Let them know that unless some urgent issue comes up, you would like to discontinue regular checkups but will call if an appt is needed.
Then tell your MIL that the appt. was rescheduled by the MD office, MD on vacation, car had a flat tire yesterday and you didn't think you could get here there this morning..whatever 'little fibs' you need to delay the outing. Reduce any signs that might remind her of what day it is, or names of other MDs, etc.
"Out of sight" more easily becomes "out of mind. "
If she gets really agitated about MD appt, go make a call and tell her you left a message at office...and get focus on something else.
On some level she understands what hospice means, and knows that her body and mind are failing. Struggling to maintain the illusion of improvement by continuing to see specialist MDs (who probably are not making any changes at all when she visits) is a way of holding onto hope.
Helping her let go of this hope can make space to have beauty and hope in some other way at home. Hospice social worker and spiritual care person can help with some life review which focuses on positive experiences.
You need a break. Can you and hubby arrange that you will have 24 hours once a week (so you can go home and stay there overnight), and a couple of half days off? If he can't manage her all by himself, then it is time to hire help, and hospice can suggest local agencies. Use your MILs funds to pay for it. And just tell her it has to be done. she will argue - but if you get exhausted and ill caring for her now...what will happen next?
Good luck. This is a very hard job and you are doing the best you can.

sotired2022: You should NEVER pay for a LO's care. You are going to need the money that you spent on your MIL's care for your own elder years.

This may sound harsh to you, but this is her life, as long as she has her mind, and wants to fight to live, let her. Death is scary to some; I see no reason to tell her to stop wanting to live. Each day is precious to those that are elderly with little time left to live. They need to be shown love, and respect. Far too often people want to rush the death of a family member, sorry but this seems selfish. If you can't handle the care, I do know hospice has nurses, nurse aides that come in and take care of the patient. Even provide ladies that will come and relieve you so you can go shopping to just get away. They provide ministers if the person wants to speak with one. Not sure of all beliefs. Search your heart, how would you feel if you were dying, while this changes when it is your own death. Now, one thing she should not want is new glasses. Saying all this with respect for both you and her.

During the last year of his life my mother noticed that my father was going downhill physically. She warned us all. When I would visit weekly, he seemed his old self except much thinner. But mom, who was living and caring for him, apparently noticed subtle signs. He did indeed die of a massive heart attack 2 weeks before his birthday in the middle of the night while going to the bathroom.

I am sorry you are struggling with your MIL. Based on other comments and replies, it appears you are living in her home with her, and she is considered to be in in-home hospice.

My dear, it is so hard for most people to admit they are dying. I believe the whole point of religions is to help people deal with their death someday. Some people have a hard time accepting it. Other peope know they are dying and get frustrated because it is taking so long to die (my FIL, who was very grumpy about how long it took him to die).

I know you are worn out. When my mother had a hip replacement, I stayed with her a whole month on 24/7 care. She would not follow the care rules layed out upon her release nor let me do the things I was shown how to do with and for her. I love my mom dearly but during that month she drove me nuts. (Very embarassing for me.)

It is now years later and she is still alive. It is much easier to visit her in her home than live 24/7 with her.

It sounds like since your MIL owns her own home and perhaps has other assets, that is the reason you have been unable to move her to a full hospice facilty.

You cannot force someone to come to terms with end of life. This is their choice. So you need assitance of an outside person to help you care for her so you are not so tired and worn out yourself. My cousin who died of a extremely rare brain tumor had someone like that, paid for by her medical insurance, to help her elderly mother care for her in home. It was not easy because the brain tumor both paralyzed her body and altered her personality so that she was raging angry at the whole world all the time. So they in home carer made if easier for her elderly mother (my aunt).

Please check to see if her medical insurance or she herself can afford such assistance for all or part of the day. It is cheaper the a hospice or elderly care home cost but still not free. It will take the stress off you.

My brother in law, whose father had a non-Alzheimers form of dementia and lived in another state, was able to get one of these carers too for his father. The woman hired cared for the father the last two or three years of his life. The father was happy with the arrangement as was my BIL and my sister and BIL's sister.

It could be a life saver for you because you are obviously extremely stressed yourself which is not good for your health.

(I used to have a lot of relatives. Many have died. Many made it into their 90s and two lived to 100.)