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My 94-year-old father-in-law resides in assisted living, suffering from congestive heart failure that led to 4 hospitalizations in 2024, severe pain from spinal stenosis (treated for 6+ years with a fentanyl patch), and GI bleeds that land him in the hospital with severe anemia at least once a year. He has just been hospitalized again with blood pressure of 190/114, and I predict the same outcome: medication adjustments that will do the trick for a few weeks, and then more of the same. Meanwhile, his cognition and quality of life seem to diminish by the day. At what point, and how, do loved ones broach the option of hospice, or at least palliative care? He does not like to be "managed" and seriously thinks we should be planning a European river cruise right now, not his funeral.

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My husband's kidneys failed because of the lasix for CHF while in the hospital. When the social worker came in to explain that he was able to go home but it would be on dialysis or hospice, the choice was hospice. He had decided long ago to not do dialysis so choosing hospice was the right thing. But I was not the one who approached him about it. The hospital staff did that.
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Reply to graygrammie
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Dear Sadtowatch,
I am wondering where your husband is on this topic? I, for one, would not advise a DIL initiating the topic of Hospice Care. My guess, just a guess, FIL's whole family is living in denial and you are swimming against a tidal wave. What a challenging and painful time for all involved.

If the above is true, everyone would be better served if you hand this off to someone else, your husband or other sibs. Pressing this issue falls in the category of "shoot the messenger."

When my dad was dying, he called me often asking for relief from his suffering. When I visited him (and his wife) to lend a little support I asked him (age 93, CHF) if he might want to consult with Hospice about stopping meds and receive comfort care. His wife was eaves dropping and swooped in and said I might as well take him out back and shoot him. Then she said, "We don't belive in that."

I scheduled a visit from Hospice for the next day (I returned home and was not present.) and to my surprise they accepted the care. I can only imagine why. I believe my dad told her it was what he wanted. He died in a few weeks mostly unconscious for that time. Wife and I never spoke again. She blamed ME for his death!

I offer my story as food for thought if anything in it might help you discern your role here and a way forward.

How lucky your FIL is to have you for his DIL. I hope you and all will find peace and comfort during his transition.
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Reply to Debmiller
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My dad had a long, slow decline with CHF with many hospitalizations to pull off the fluid that oral Lasix couldn’t touch. It was insidious and beyond tiring to him. His cardiologist was the one to suggest bringing him home on hospice care and dad, after taking a couple of days to think about it, chose it for himself. CHF definitely reaches a point of more frequent issues with less solutions or even temporary helps. My dad was so very tired of it all and ready to leave this world. If your FIL isn’t able to be honest about his health issues and the coming outcome, he may not be ready to hear about hospice care. Discuss this with his doctor first. For my dad, it was a kindness.
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Reply to Daughterof1930
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My MIL had cancer and was receiving immunotherapy treatment. It was making her sick. She was depressed and hospitalized for three weeks on a psych hold. During that time her treatment was stopped. When she came home from the hospital (to our house), the oncologist contacted her about restarting treatment and she said she didn’t want to, which prompted them to suggest hospice. She made the decision herself.

I personally believe that hospice is a decision that should be the choice of the patient, provided they are mentally competent. It’s often easier for all concerned for the medical professionals to make the suggestion. Of course if they don’t do this proactively the family can ask the doctor whether it would be appropriate and if they would discuss with the loved one. The patient wanting to discontinue treatment or expressing a wish to die is an obvious sign. Uncontrollable pain is another one.

I wish you peace at this most difficult time.
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Reply to iameli
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I spoke with my brothers psychiatrist for an Hour and we felt Hospice was right around the Corner . Then I took him to the head doctor at Dana faber and he felt it was time for Hospice . Usually You consult with their doctors about Hospice .
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Reply to KNance72
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Just based on personal experience the answer is never. Generally the patient is already receiving some kind of care. The word hospice is associated with death so why do you want to remind the patient that they are going to die. They can still receive hospice care but just don’t tell them it is hospice. I saw my wife decline rapidly once that word was uttered. She just gave up. If I had to do it over I would just say you got them more care.
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Reply to Sample
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DrBenshir Jan 10, 2025
Hospice care is not about dying. It is for patients who have a condition that is chronic and requires ongoing medical support. In most cases, however it means that the patient is not expected to recover and will benefit from better at home medical management. The nurses come to you and are in constant contact with the doctors so the patient no longer has to travel to medical appointments. That’s a big stress reliever for everyone in the family. Anytime a patient needs permanent medical care and it is a hardship to take them to doctors, Hospice should be considered. When my mother’s doctor suggested we consider hospice, we had already been discussing it within the family. We did not ask Mom, we scheduled the evaluation for the next day. With twice weekly nurse visits Mom actually got back some appetite and some energy and we were able to celebrate her 96th birthday with a family party a few weeks later. Mom was alert and happy. She had three more good months that we would not have had without hospice care.
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the best time for you is to ask for a consult while he is hospitalized. The doctor or someone from the in hospital paliative services will speak to him.
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Reply to MACinCT
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His doctor should be suggesting it if he thinks it's time, I personally think hospice is only needed when they are actively dying. Palliative care might be the way to go for now and you can usually get a referral through the doctor in charge of his care. But, with all this said, why not plan a short excursion river cruise (if he is able) so he can enjoy the last part of his life?
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Reply to Evonne1954
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ShirleyDot Jan 20, 2025
Hospice provides palliative care and the patient can then live more comfortably and often longer. Waiting until they are actively dying is waiting too long.
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Never to early for a topic of Hospice
It probably should have been discussed at the second or third hospitalization in 2024.
Ask for a consult with the Hospice. Most hospitals have a Hospice or an admission nurse for a Hospice they work with is on site.
His ALF may also have a Hospice they work closely with.
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Reply to Grandma1954
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I am so sorry about your dad's terminal condition. I am surprised that no doctor has pulled you aside to recommend Hospice Care. Please have your dad placed in skilled nursing and rehab. If he has Medicare or Medicaid, they will work with Hospice Care. I am afraid your father's days are limited. I have been there. Make sure your dad is reclined and not lying flat. Please have his care team recommend Hospice Care.
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Reply to Onlychild2024
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