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Janine2020 Asked November 2020

What happens if transferred from psych. facility to skilled nursing facility still refuses treatment -help w/walking, eating, fluids, meds?

JoAnn29 Nov 2020
Dad is young. If he is eventually placed in LTC, they will not be allowed to force him to do anything. Even with a Dementia diagnosis. The law says he is an adult and as such cannot be made to do what he does not want to. They can coax but they cannot force. With having other patients, they can't spend too much time on one person. Hospice could probably be called in if he was actively dying.

AlvaDeer Nov 2020
Is there any family that agrees with his decision now to wish to pass peacefully? If so, can they take him home if hospice care is found? Truth is that Hospice often cannot be used in this case, as even IF there are right to die laws in your state, the truth is that no doctor can sign for his having 6 months or less to live, as suicide is not in, in our own country, a legitimate reason to die, an accepted diagnosis.
I am hoping this changes. We are an aging population and I have long been a member of advocacy groups for our right to die.
As there are no advanced directives and doctors are NOW saying he is demented (is that based on his wish to die?) it is harder to get them to withdraw treatment.
I am so sorry you all are going through this. To me, when we no longer wish to live life we should not be forced to do so.
If there is any psychiatrist who can be found who will say he is competent to make this decision, an advanced directive would help. Good luck going forward with all this heartbreak. If any family can help to take him home to die, that could be done, but it would be grueling without support. Even with sips of water this can go on easily a month, and there is often in last days, due to changes in electrolytes in body, some delushional thinking that is disturbing if there are not comfort medications.

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BarbBrooklyn Nov 2020
This happened with my MIL after surgery for an aortic aneurysm which advanced her dementia. She was determined to starve herself to death.

She was examined by a psychiatrist and determined to be competent to make her own medical decisions. The hospital threatened to take my BIL, her POA to court to get guardianship and he told them "my mother has a right to die if she wants to".

Hospice was brought in (or maybe it was palliative care, I don't really recall), she went into a NH with good comfort care and passed away after many weeks.

If you are POA, you need someone to tell you if your dad has the capacity to make this decision.

Also, please read Atul Gawande's On Being Mortal.
Janine2020 Nov 2020
I am so sorry to hear about your MIL. Thank you so much for the helpful information and will be sure to read that book. I wish I had POA but he refused to talk to an attorney when we tried before his condition got worse and he doesn't have a written advanced directive although he previously verbally expressed before all this happened that he would want to be saved, if there is anything else I can try please let me know
Janine2020 Nov 2020
He was recovering at home from a fall and had in home nurse visits, home health aide, physical therapy to help him walk again all of which he gradually refused treatment from as well as food, liquids, and meds so his doctor recommended ER visit for Psych. Evaluation where he has been transferred to a psych facility for not being able to care for himself. He had a sudden cognitive decline which they think might be dementia related. He is still refusing meds at the Psych. Facility and they plan to do a court order to inject meds. If the meds work, they plan to transfer him to a Skilled Nursing Facility but I think it will be the same pattern all over again with him refusing treatment? He has gotten dehydrated at home before from not drinking enough fluids to the point of not urinating and would end up back at the ER for fluids/catheter. The psych. facility is saying the failure to thrive is medical related yet his medical doctors say it is psych. related so we are stuck in the middle? He is saying at the Psych. Facility that he wants to be left alone and die in peace yet there is nothing medically wrong except not being able to walk without some assistance which he refuses to learn to use a walker. We asked about hospice before with the in home nursing and they said he wouldn't qualify since they are there to get him back on his feet but I agree hospice would be helpful although the Psych. Facility is insisting on the Skilled Nursing Facility to try to get him to do everything he is supposed to (eating, drinking, meds, walking).

BarbBrooklyn Nov 2020
I agree that we need to know more, but on the face of it, this seems like a situation tailor made for hospice.

NYDaughterInLaw Nov 2020
We need more information. I'm assuming you are asking about your father, whom you mention on your profile. Let's start with why was your father in a psych facility?

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