Issues with elderly parents and some encouragement for Mr.

[silver]

So, at the risk of upsetting Mr. I'm going to post a little about the issue that we are faced with.

This is difficult for Mr. and he needs a little encouragement.

He is an only child and his parents are in their late 70's. They live in an assisted Living Home that is very near us and I help them with doctors' visits and shopping and any needs.

His father is declining and yesterday the doctor advised me that it may be time to .....well....I don't know how to say this in an appropriate manner.....but think about how to let him go with dignity.

He's still doing OK and may have plenty of time but the doctor has suggested that make arrangements that if he has an emergency that the EMTS and nursing staff at the home NOT initiate CPR/defibulater/intubation. The doctor said that we should still direct that he get IV fluids/nutrition, antibiotics, diabetic care in the case of trouble but that he would be unlikely to come through the trauma of CPR/defibulation with any quality of life. EMT's are obligated to do this unless we take action to request that it not be done.

In order to do that, we must discuss this with him and have him sign a form stating this fact.

I'm willing to discuss this with him but Mr. is not.

Obviously, Mr. is having a trouble with this. Please give him some positive encouragement and ask him to please forgive me if he's upset with me for posting about this.

If would also be helpful if anyone else have experience on how to deal with these issues in a positve manner and with the most dignity possible.

[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!

[Running Mommy]

Mr. Silver... I don't have anything to add. Both sides have been represented quite well here I believe. And really it is YOUR decision on how to handle this. But I just wanted to give you my support and tell you that I am praying for you and your entire family.
Over the past few months I feel like I have gotten to know the Silver family, so it breaks my heart to see you have to deal with this.
I'm sending cyber hugs your way.
Denise

[bikerchick68]

A lot of really great info has been shared here already...

Do you know what Mr Silver Dad's wishes are? If he is unable to make the decision, the time may come when you will have to. This is such a personal thing for people... their reasons why they want DNR orders or don't... and there is no right or wrong. You have to make the decision that is best and healthiest for your loved one. Which typically isn't what is best for you...

Silver and Mr. Silver, I want to share this with you too... I'm sure you already know this, but sometimes reading it can be helpful. Mr. Silver is IN the grieving process... and he may go in and out of the stages, which is totally healthy and OK too. I just think it's useful to understand the process...

http://www.counselingforloss.com/article8.htm

also here is some info that may be helpful about making the decision whether to use or not choose DNR:

http://www.emstar.org/dnr.html

I feel for you Mr. Silver... I dread the day, as we no doubt all do...

[wannaduacentury]

So, at the risk of upsetting Mr. I'm going to post a little about the issue that we are faced with.

This is difficult for Mr. and he needs a little encouragement.

He is an only child and his parents are in their late 70's. They live in an assisted Living Home that is very near us and I help them with doctors' visits and shopping and any needs.

His father is declining and yesterday the doctor advised me that it may be time to .....well....I don't know how to say this in an appropriate manner.....but think about how to let him go with dignity.

He's still doing OK and may have plenty of time but the doctor has suggested that make arrangements that if he has an emergency that the EMTS and nursing staff at the home NOT initiate CPR/defibulater/intubation. The doctor said that we should still direct that he get IV fluids/nutrition, antibiotics, diabetic care in the case of trouble but that he would be unlikely to come through the trauma of CPR/defibulation with any quality of life. EMT's are obligated to do this unless we take action to request that it not be done.

In order to do that, we must discuss this with him and have him sign a form stating this fact.

I'm willing to discuss this with him but Mr. is not.

Obviously, Mr. is having a trouble with this. Please give him some positive encouragement and ask him to please forgive me if he's upset with me for posting about this.

If would also be helpful if anyone else have experience on how to deal with these issues in a positve manner and with the most dignity possible.

Hugs to you both. My dad died of cancer in may and he spent the last 2 days in the hospitall(if he came home- we were doing hospice) and DNR(do not resc) was his request as well w/ power of attorney signed over to my mom. He wasn't as old as Mr.'s parents, but It's hard with parents. We don't want to lose them and when they are ill, it's just that much worse, but you don't want them to suffer either. The only way I know is to break it to him as gently as possible and make sure nothing else stressfull is going on at the time. My heart goes out to you. Jennifer

[solobiker]

Mr. S, as you know from some of my previous posts, I have had several years of experience working with the older population. I have seen this issue happen too many times to count. It is a very hard decision to make and not an easy conversation to have. However, it is actually easier to have this conversation done before something happens. I say this because when, and if a crisis does happen it is hard to make decisions with a clear mind and you may feel rushed and get very frustrated. I only say this with what information I have from your current situation. I do not know what is going on with your parents medically, including declining cognition (if it is). I know you will make it through this rough time as you are a very strong person. Just know that I hope you can find your strength to do what you feel is best for you and your family. My thoughts are with you.