My 89 year old father has dementia and Parkinson's. I am POA and MPOA. He is at an AL and this is the second time he refused an ambulance. Any suggestions?

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The calls have been from the AL nursing office. Please don't tell me he has rights, because my dad can't tell what is his health risk...what are my rights to tell the ambulance service to take him? They told me they can't if he refuses. Do I need a doctor's note to state he cannot make medical decisions to show them!?! He does listen to me and my younger sister...but who's to say that we may not be available!!!

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MPOA is either standing or springing. Springing requires incompetence as determined by two doctors that the person can no longer make decisions. Because a person has dementia does not make them incompetent, there are many stages. During early stages a person most certainly can make their own decision.

Standing, on the other hand is in effect always. My mom's was standing but had the requirement for two doc's to find her incapacitated. Doc's hate to make that call when not obvious.
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I echo fantasmagorical: read "On being Mortal" by Atul Gawande.

The kind of dementia associated with Parkinson's usually has wide fluctuations in cognitive ability. Sometime when Dad is in a particularly lucid state, discuss with him what kind of medical care he wants.
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I had the same problem with my father in law that lives with us. He refused and they said he had the right to even with advanced dementia. I said any one can see they both need serious medical attention. I gave them a copy of the POA, but then my husband convinced his dad to go. It was a nightmare. Both him and my husband had a serious case of food poisoning and I was recovering from major surgery. Both were vomiting badly and all I could do was call 911 because of my own condition. My husband was near passing out by the time they got here. When my father in law refused it terrified me. What would I have done with my husband in an ambulance and my father in law if he didnt go, still vomiting and me after major surgery? No one has any idea what care givers go through on a daily bases. Its very frustrating. Thank Goodness they both were loaded in the ambulance and both were admitted for several days. Now my husband thinks twice if his has to feed himself and dad when I am sick or recovering from surgery which has been a lot the last 5 years. Maybe due to caring for my father in law in our home for 10 years. May God give caregivers the strength to continue.
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The facility should have a copy of the POA and MPOA on file. That's what they're there for as the elder can no longer tell if he has a medical emergency.
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My dad too has PD & dementia, and I'm his DPOA. We also have a POST on file with both the MC facility and the hospital. Since I have a letter from his doctor, which states he shouldn't make his own medical and financial decisions, my understanding is that it's my call. There are certain aides there, though, that really have a way of working with Dad and can get more cooperation from him than others. I doubt they would give him an option, but I will be checking into this more when I visit tomorrow.
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When mom got to this point, refusing treatment, we sat down with a nurse who went over her wishes on a MOLST form. She became a DNR, no transport to ER. A few months later she had yet another stroke and died that evening.
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As others said your POA does not kick in until the person gives permission, (or can't verbalize objections) or a court order. Since he is living in an ALF, I conclude that he is capable of self care. Read the book On being Mortal, by Atul Gawande. One thing I have not heard hear is 'what are your Dad's wishes, and this book gives some key questions.
My mother who has Alzheimer made it clear when she still had capacity that she wanted nothing medically done, unless it brought her mind back to it's normal state.' She did end up in the ER, because the ALF policy was if they fall and hit their head they had to go to ER, even if no neurological changes occurred nor the force at which the head struck the object taken into consideration. The ER visit was quite upsetting. I have been questioned about the lack of intervention, as I told them unless it is an event that cause pain or mental anguish I do not want her taken to the hospital. I have been questioned if she made that decision while she was depressed. I took her to a psychologist and reasonable care while she was very functional. But as I told ALF, the reality is inevitable and depressing, so it is difficult to say she was just being realistic or made the decisions under depression.
As someone has mentioned a POLST; it is a great document to have. It will be more likely followed than a living will, although the 2 should match.
Another thing, someone mentioned hospice, when the time comes they are wonderful, but it sounds as though his status would not yet qualify him for hospice. Some hospices, however, have a palliative care component, for those who don't qualify, but do not want life extending care.
It is difficult to manage what could be life altering care for someone you love. In the end you have to make decisions you feel you can live with, and even then you may feel you could have done some things better.
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Hospital and rehab are very confusing for a Dementia patient. Sometimes they cause them to decline even more. I would avoid them when possible. Someone posted he is dying? I didn't see that in ur post. If this is true, do u have hospice for him. If not, maybe you should have him evaluated. No extreme measures will be taken and he will be kept comfortable. Its paid by Medicare.
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If they are calling you, they have concerns, which is good. If they can't be bothered to tell you and things get out of hand, then you SHOULD be concerned. They are trying to work with him and you. The issue of him refusing to go is a very touchy one. I did a lookup and found a website for nurses that discusses not just this, but many topics (rotating someone to avoid bed sores, medication refusal, bathing, changing undergarments for incontinence, etc). They are between a rock and a hard place. If they can't get compliance and something happens, they can be considered liable. If they force the issue, they can ALSO get into trouble. Neglect for bedsores, medical crisis if not medicated, etc., abuse if they try "forcing" the issue.

As others have queried, what is the ambulance for? Our mom has fallen a few times and they sent her to ER in ambulance (she tried to refuse, but she eventually went, and is not currently combative) just to be safe. Would it be better if they call you and have you take him to be checked? There is only so much they can do without worrying about charges of neglect or abuse.

I do not know if it will post, but try this or I will list my query and you can find the site:

allnurses.com

Query: what to do if patient with dementia refuses ambulance

I read through all the posts and it is enlightening. I can understand how difficult this is for the care-gives (nurses, etc). The original poster tried multiple ways to get compliance and then is written up when it fails. Consider this from THEIR perspective!! Again, work with them. If it is a concern to get him checked for whatever the issue is and he refuses to go in the ambulance, you should consider taking him yourself, unless you are not within a reasonable driving distance - then you have to decide how to handle this another way.
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I did not have this problem when Mom was in an AL, she was complient. If ur Dad has Dementia that is when the MPOA kicks in. He is not able to make that decision. I was consulted before Mom was taken eventually. When the Nurse wasn't around the CNAs would send her out and then call me. Now, if she hit her head it was an automatic hospital trip. But the nurse and I agreed if she fell they would wait and see. My Mom suffered from arthritis and would be in pain for a while then everything would be alright. I see no problem in asking his doctor to write a letter saying that with his Dementia he can no longer make informed decisions concerning his health. That with your MPOA should be enough for the AL. Request that before an ambulance is called you r called first. Then from the info the Nurse gives you, you can determine if a hospital visit is warrented. No, the facility cannot force him but u can override him. Thats the whole purpose of a MPOA to make decisions on his behalf when he no longer can.
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