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?

If he has not been declared incompetent he can make his own decisions.
If you wish to declare him incompetent you would have to go to court and become his Guardian.
Does he have a DNR or a POLST? The POLST is more detailed than a DNR (Physicians Order for Life Sustaining Treatment).
If he truly wants no more treatment and does not want to go to the hospital you might want to contact Hospice and see if he would qualify. The good thing is he would get a Nurse that would come in every week to check on him, he would get a CNA that would come in a few times a week to bathe him and help get him dressed. Even though the facility where hi is does this it is a good thing to get an extra set of eyes on him to make sure all is well.

I agree with the others in that if your dad refuses to get in the ambulance, they can't take him. I was faced with this myself and refused to get in the ambulance and I had to sign a waiver. (I was passing out but I knew it was from recently donating blood - a day's rest and I was ok. My blood pressure drops and I had been standing - a double no-no for me.)

Anyway, the ambulance can be sued for not listening to his wishes. Perhaps a NH would be in his immediate future.

It would also depend on why the ambulance was called? My dad used to fall and he would have refused an ambulance if called just because he fell. My DH would do the same thing. You can spend up to 12 hours in the ER room and that really bites.

He has rights and can refuse. How often does this happen? Maybe a nursing home is a better solution?

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.

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.

How could you force your dad to go where he doesn't want to go? If you understand that dying at home is what he wants.. Why are you stopping him. Be kind and accept that hospitals are not always the best choice,.. loads of strangers coming and going whenever they need blood measurements or temperature or this or that (he needs familiar faces), feeding him what they think not what he needs (homely cooked meals) . Your dad won't rest in peace. There is a risk to catch bacteria from other pacients....

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.

Your ALF should have a copy of the Medical POA on file. You should also have a HIPPA release within that document as well so you can get results, diagnosis etc. If you have that you can make medical decisions for him. However, it depends on how it was worded. You might need to consult with an attorney. They can’t force him onto a stretcher but are you not able to talk to him on the phone to explain why it’s necessary? Is it a true emergency??

My experience has always been if the person can answer a few basic questions correctly the paramedics determine that they are lucid enough to make the decision of whether to go to the hospital or not.

But I have witnessed paramedics asking these basic questions to someone who can't answer them and the paramedics took the person to the ER over their objection.

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.