Issues with elderly parents and some encouragement for Mr.

[SouthernBelle]

Does he have a living will? Does he need to change anything in his regular will? The easiest time to do this is as a package. Will, living will, durable power of attorney, DNR, funeral arrangements. If you start with the will review it easily segues into the other.

[KnottedYet]

We had to do this with my dad. I agree, do all of it at once. That way nothing gets singled out, and you can discuss all of it in context.

[Blueberry]

Hugs to you all!

Mr. Silver - This is a very difficult issue, but it is *much* better dealt with now than when something happens. When my Grandfather passed away, he did not have the appropriate paperwork for EMS to not attempt to use defib. The county where they lived had recently changed the requirements, and his forms weren't enough. He had been in a decline for weeks, and we all knew it was coming, but they still had to attempt to revive him (even though it was obviously way too late). This is not a way to die with dignity. Please, please talk to him before you mother has to go through what my Grandmother did. Remember that all you're doing is giving him the choice about his life and the quality of life he chooses.

I've been blessed that my elderly relatives have all initiated the conversations themselves, and let us know what they wished (and had the appropriate forms in place) with the exception of my Grandfather. I don't have advice to give on how to start the conversation, except to say that you want to know what he wants so he has the choice.

Good luck - my thoughts are with you!

[Aquila]

Why is the doctor not discussing things directly with the patient? (If I were the patient, I'd be seriously pissed if a doctor went behind my back to a family member UNLESS I were incompetent, in which case, I'd be incompetent. Is that the case here?)

I'd get the family together with the doctor and have the discussion. Yes, it's hard. BUT, a doctor can explain what happens when they start doing all the electronic shocking and stuff, and how very few people (of any age) leave the hospital (even if they were inside already when the code was called).

I've heard about lots of broken ribs, and about a 15% chance of success (=leaving the hospital alive) at best. It doesn't sound like a good way to go at all.

BUT, the doctor can also help you get the directives so there's pain management and so on.

Editing to add: /comfort to Mr. Silver. These discussions are incredibly hard all the way around, and I'm sorry that you have to face this. I'm glad you have Silver's support, though, and wish you all well working together.

[indysteel]

Silver and Mr. Silver. I'm sorry that you're faced with this. My parents are still in decent health so I have not had to deal with this personally, but I feel for you all the same.

Have you thought about talking to someone at your local hospice organization? For one, Mr.'s father may be eligible. For another, they may be able to help Mr. deal with his own feelings, responsibility, fears, etc. and find a way to approach this matter with his father in a loving, respectful and calming way.

Just a thought. In any event, I will keep both you, Mr. and his parents in my thoughts and prayers.

There may be others, but here's a link to a hospice in Evansville. http://www.vistacare.com/locations/site.php?13

[Duck on Wheels]

When Trek's and my mutual Dad was nearing this point, he took the matter up himself. We didn't have to introduce the topic, just listen and respect his wishes. Also, the hospice folks, when things progressed to where our Mom needed their help, took the initiative to discuss what they would and wouldn't be a party to (it happened to be a Catholic hospice, the only one that covered that area). Basically, they said that if he chose to die, they would respect that. They would offer him food and water, but not force feed him. If he made it clear that he was choosing not to eat or drink, they would provide him with mouth moisteners to stave off thirst, pain relief to stave off pain and hunger, and any other comforts they could provide. If he did not eat or drink, he would die within two days. And that was what he did do, although it's unclear whether he chose to do so and quickly slipped into a coma, or whether the coma came on and he therefore didn't have to choose.

My deepest sympathies, Mr. Silver. Losing a parent is painful, even though intellectually we know it must happen eventually and know they've had a long and fulfilling life. Talking about it beforehand is also painful. Our culture tends to prefer denial rather than openly discussing death. Maybe the staff at the care facility can help out? They're used to dealing with the final stages of life. Or maybe just sit quietly, make yourself available, and let your parents bring up the topic? Or take your time, work out the words, and with a good hug from Silver for courage, find a way to ask your Dad if this is a decision he wants to make on his own and, if so, how he might signal his wishes.

[mimitabby]

gee, don't wait. We tried to have this conversation with Raleighdon's mother a number of times. she always responds that she has lots of time to do that later. Now her alzheimers is so bad she doesn't know what house she's in. It's too late to get her to do anything.
She absolutely refuses. But when we had the conversations, neither RD or his brother were able to even bring it up. I had to (they were cool with that)
so it's sort of like good cop bad cop, if you possess the wherewithal to discuss this with your father in law, go ahead and do it (with Mr's blessing of course)

[SouthernBelle]

Hospice is a great thing, but doesn't appear to apply here. He isn't suffering from a terminal disease except old age.

Second the point that the doctor should be more involved here.

[salsabike]

These are exactly the conversations I had to have with my mom in the last year, who, many of you know, died about a month ago.

I talked to lots of nurses who said if they could, they would have "DNR" tattooed on their foreheads, for exactly the reasons described in other posts above--resuscitation can break ribs, and only about 10% of people leave the hospital in the shape they came in. Finally, my best friend from 4th grade, who is an ICU nurse, came to talk with my mom. She's known Susie for 40 years, so was comfortable discussing it with her, and after that she signed a DNR/DNI order. Basically what Susie said was that at her age, resuscitation or intubation would be done only when everything medically possible had been tried, and that neither would change the effectiveness, or lack thereof, of the medical treatments.

These are conversations that really need to be had. That same friend Susie has told me many stories about ICU patients whose families insist on keeping them going far past their bodies' capacity to really live. Once a tube is in, it's a lot harder to take it out, than to never have it placed in the first place.

I spent many hours in the last year talking with my mom about this stuff. It's major emotional heavy lifting, but if you don't do it, your parent may end up in a much worse situation. You have my TOTAL sympathy here. If, Mr. S., Silver is willing to help here, I hope you consider allowing her to do so.

[BleeckerSt_Girl]

I know what I am about to say may not be the popular view here, but....
My mother died last year at 83. Four years before that she was not sick yet but named me in her living will as the person to make decisions for her in the event of her being unable to. She did NOT want to be DNR status, and made it clear to me that she wanted all possible chances pursued. This was not my preference but I was following her instructions.
Then she had a major heart/lung crisis. She was put on a ventilator and resusitated and many other things done. She seems likely to die, but she pulled through. After 4 months(!) in the hospital and rehab, I moved her to a nursing home near me. She continued to improve, and a year later she and I were able to have an entire year together where I could take her to restaurants in a wheelchair, we could tell stories and laugh and listen to music together, sit and read out loud under the trees in the courtyard. Yes she was forgetful and sometimes not happy, but that year was a precious gift we never would have had together if she had been DNR.

Later on she had more crisis, a stroke, and deteriorated again. In the end she was permanently on a ventilator and her quality of life was no longer good- she was not super aware anymore.
At that point I was told that I could supercede her DNR orders at any time, since she legally designated me to make her medical decisions. I still waited, and I rescinded her DNA orders only when her kidneys began to fail and she would need dialysis to survive in addition to the ventilator. We did not request the dialysis because we felt it would be too disturbing and unpleasant for her...and she was peacefully gone within 10 days of that, with me by her side.

I guess my point is that one can be on a ventilator longterm and still have some decent quality of life, even recover to an extent that one could enjoy good times with loving family for a while again. Being on a ventilator is not necessarily a permenant thing- vents can get you through a crisis- my mother went on and off one several times during her last 4 years. Plus, if someone is on a ventilator they can still request that their heart not be restarted if it ceases to beat. One can even feed oneself and talk while on a portable vent, which was amazing to me.
Of course there are degrees of all these things and nothing is ever as simple as we think when we head into it. I learned an awful lot that surprised me during my mothers' last 4 years and while I spent time observing others in that nursing home.
I was glad I got that extra time with her- it was difficult, but it helped me as well as her deal with her passage into her next journey.

I do agree that it is imperative to talk with the ailing person AND to get a living will and perhaps Power of Attorney drawn up legally and signed.
I think it helps to tell them that you want to be sure you can enforce THEIR wishes for them when no longer can speak for themselves. That you will speak FOR them and carry out their wishes. Tell them the "state" will make decisions for them if they don't designate you to. True, and scary!

[KnottedYet]

Basically, they said that if he chose to die, they would respect that. They would offer him food and water, but not force feed him. If he made it clear that he was choosing not to eat or drink, they would provide him with mouth moisteners to stave off thirst, pain relief to stave off pain and hunger, and any other comforts they could provide. If he did not eat or drink, he would die within two days. And that was what he did do, although it's unclear whether he chose to do so and quickly slipped into a coma, or whether the coma came on and he therefore didn't have to choose.

When my dad was at that point, Hospice very clearly explained to us how much morphine was an overdose and what would happend if my dad was accidentally given that much morphine. (he had a push-button morphine pump)

"accidentally"

I love Hospice. Truly, they are wonderful caring and generous people. They understand. Don't be afraid to ask them for help if you have trouble or can't bring something up. And they are very good about handling paperwork and legal forms and bringing them up to the clients.

[Mr. Bloom]

We had the conversation. Without hesitation, both parents affirmed that they want NO effort made in prolonging their life.

Here's a challenge to each of you who may face this issue going forward. We spent a small fortune getting my parents affairs "in order" a few years ago. BUT, now so many questions remain unaddressed in all the documents that were signed.

Starfish kindly found and sent me copies of a document that her mother executed before her death. Here are specific questions that you might consider if you face this problem:

• do you want cpr?
• do you want any mechanical breathing assistance?
• do you want artificial nutrician and hydration?
• do you want major surgery?
• do you want dialysis?
• do you want chemotherapy?
• do you want minor surgery?
• do you want invasive diagnostic tests?
• do you want transfusions?
• do you want antibiotics?
• do you want simple diagnostic tests?
• do you want pain medication?

Some of these have easy answers, some are complex. While I think the consensus of all the posts here are in support of "having the talk", the devil's in the details...and I may have not even thought of some of these issues.

At the end of the day, my parents said to "keep them comfortable, but let them go..."

It's a tough day when the kids and the parents swap roles

[Starfish]

It's a tough day when the kids and the parents swap roles

Oh Mr. Silver, this is so very true. I'm so sorry.

[Tuckervill]

Just want to pass my warm thoughts in your direction, Mr. This is not easy, but you are handling it very eloquently.

Karen

[Mr. Bloom]

Oh Mr. Silver, this is so very true. I'm so sorry.

Well, I'll add a little levity to the whole debate about the night that we swapped roles about 4 years ago:

They go to church on Saturday evenings. We made plans to pick them up at their house after church to go to dinner.

When we picked them up, Mom was upset - indicating that she 'nearly had a wreck' in the parking lot at church.

At dinner I inquired more...here's the story:

• She was backing out of her space
• Her foot was 'stuck' so she couldn't stop
• She 'may have hit' this car, but there was no damage
• Dad said: "she was saying she couldn't stop, but I couldn't GET OUT OF THE CAR TO STOP IT because of the the automatic door locks!"

Later, I inspected her car, saw another car's paint. Called the church, called the sheriff, but no complaints. Phew

So, that night, I had to counsel:

• my mother on the virtue of not leaving the scene of an accident , and
• my father on the prudence of not getting out of a moving car (at least not without his walker!!)

The next night, the police called to report a "hit and run"...there was $11,000 in damage done to the other car that mom "may have hit".

This is why I favor regular renewal of elderly licenses!