Palliative care decision.

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SusanHeart Asked September 2023

Palliative care decision.

At what point in time or how the discussion / decision for palliative care comes into play? My father refuses showers and meds; this is causing severe infections. He is at a recovery center now after a 1 month stay at the hospital, which means they cannot force him to do anything. He has cognitive challenges which has increased his push back as his timeline of events are askew and he states he just got this medication or just took a shower. Nursing staff and I have talked to him multiple times, attempted redirect and nothing works.
Any insight would be extremally appreciated.

Alzheimer's & Dementia Cognitive Decline Hospital Discharge Palliative Care Refusing Care

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score 1 · Answer 1

Why was your father hospitalized? (I may have missed this point, but I am not able to find it!) Thank you!

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score 1 · Answer 2

Sounds like it is a good time to move him to a nursing home. If he is refusing all care, I would have him evaluated for hospice. I would stop taking him to all these specialists. What are they and what is the point? As you say, he won't cooperate anyhow. Slow things down. I don't think there's anything wrong with letting nature take it's course. Your dad has a lot of issues and they may or may not be able to be resolved. I would focus on comfort care and stop doing everything to try to get him better when he has no apparent interest in that. With AZ, he probably doesn't really understand it all anyhow so you'll have to go by what you know from past experience. Best of luck.

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score 3 · Answer 3

Your father sounds far from eligible for end of life or hospice care so my question is - what exactly do you mean by palliative care?
Other than a specific program (that as far I've been able to ascertain has zero actual benefits) palliative care is a philosophy of accepting that the time for life extending treatments is over, so any medical interventions are focused on symptom management and the best quality of life possible within that framework. In my opinion there is no need to take any steps to formalize this, you simply make it your priority when making medical decisions.

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cwillie, palliative care is not quite the same as hospice/end-of-life care. Palliative care, like hospice, focuses on comfort measures. But in palliative care, a person may at the same time continue to seek curative treatment. I would agree, though, that it's not clear exactly what the OP means by palliative care,

(1)

score 2 · Answer 4

While in recovery, have him evaluated for 24/7 care. If found he needs it, this is the time to have him placed. Seems to me some Dementia is going on. If so, Memory care if he has the money or Long-term care if he doesn't with Medicaid paying and his SS and any pension he has.

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He was diagnosed with Alzheimers according to OP🙂

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score 2 · Answer 5

You are not in a position to make this decision unless you are POA or guardian for your father. But if you are next of kin, and the person that medical personnel are discussing his case with, it is more than time to get a GOOD diagnosis for your father. If he is judged incompetent in managing his own affairs a social worker can likely help you get temporary guardianship. At that time you can discuss palliative care with your father's primary doctor. It is time when you believe, if you represent his BEST INTERESTS that it is time, that further diagnostics and intervention would place an undue burden on him at end of life.

Time to discuss with the doctor and do enlist the help of social workers soon as you can.

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Thank you AlvaDeer. Yes I have guardianship and conservatorship for him. He has been diagnosed with Alzheimer’s. He just spent 24 days in hospital with sepsis of the blood and in ICU intubated for 10 of the 24 days. After discharge and acceptance to recovery center back to ER (decided he wanted to exercise) and face plant on floor, forgot he could not walk. While in ER they identified blood clots on his legs so he is supposed to get 2 shots a day lovanex to try to dissolve to blood clots. After discharge from hospital back to recovery center. We finally were able to remove the catheter and a UTI with antibiotics resistant bacteria. Because of the 24 days in hospital his cognitive abilities declined alarmingly. He is on purée food trying to upgrade to soft or ground food. He is refusing PT/OT/SP, refusing meds and showers. Although complaining a lot about the terrible food he eats everything. I met with social worker at the recovery center and they recommended skilled nursing facility. I still taking him to at least 1 Dr appt specialist every week and am currently on FMLA. Not to sound cruel or cold but why am I taking time off from work to take him to all these DRs if he refuses meds?
right now I am trying to figure out what I can do to help him one way or another, this fighting for everything is draining when all we are trying to do is help him.

(3)

Palliative care decision.

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