Dad, 86, living alone since mom died a year ago...congestive heart failure, afib. He refuses to cooperate.

Thanks..

Please take a moment and consider your appearances at your father's home and conversations with him. Have you stepped into the role of a nag expressing your displeasure over every non-optimal choice your father makes? Does your father look forward to your visits or dread them? When concerned over an elder's health it's so easy to set the standard of "ideal" choices instead of usually good choices. I watched my mother continue to nag my father over putting mayo on his sandwiches years after TIAs had caused vascular dementia. The damage of Dad's unfortunate choices had already been done. At 80+ whether he put mayo on his sandwiches really wasn't going to have much impact on his life. It was time to let that go. It's so very hard to adjust mentally to palliative care but there comes a time when we need to accept that change.

My father also had CHF and tended to be uncooperative. I discussed with Dad the impact salt would have causing fluid in the lungs and lower legs and how I didn't want him to suffer with the skin splitting or the drowning sensation of fluid in his lungs. I convinced him the low salt diet was for his _comfort_. I tried to be his enabler by giving him as much of what he wanted as possible. When he wanted something high salt, I would comment on the high salt and encourage him to eat a small amount, but I didn't try to tell him he shouldn't eat it at all. He didn't like compression socks because they cut into his legs and hurt, so we switched to wrapping his legs and later a lower compression sock. I cooked meals for him so I could reduce the salt content but he could still have the foods he wanted, even after he entered MC. And I didn't worry about "balanced" meals much either. When he couldn't eat peanut butter anymore, peanut butter milkshakes became a substitute.

Whatever I found, I tried to _never_ start the visit with a criticism. Take time for some normal small talk with each visit. I tried to make sure I included things he enjoyed in my visits, like singing his favorite hymns or a game of checkers. For me, the final years were more about maintaining comfort and embracing what enjoyments remained than trying to extend life with ideal life choices. Dad had always used a layer of mayo on any sandwich and that wasn't going to change just because his health was failing. Make sure the battles you choose to fight will really have an impact. Then fight your battles with cooperative persuasion instead of conflict and realize/accept some battles cannot be won. Do your best and try to let go of the things you cannot change. My experience has been arguments usually make stubborn seniors dig their heels in even more.

My mom had CHF. She was a very compliant patient with HH and therapy. She wanted not one speck of green in anything she ate (warfarin). She got up three and four times a night to pee (Lasix). Not one grain of added salt and all food made to order. She recorded her weight every morning right after peeing.
If her pills weren’t sorted correctly by a new nurse she would tell us. The ends of her fingers were numb so she couldn’t make it right. (But she could work her puzzles. The pills were too small).
If she said the pills were wrong. They were wrong.
I would call HH. They would go sort them correctly and call and let me know that once again she was right. She fell a couple of times. Once lay on her floor for quiet awhile. Didn’t want to use her Medialert. She believed they would take her to the local hospital where she knew she didn’t need to go. Didn’t think they would take her word for it. When I asked why she didn’t just have the dispatcher call one of her children, she said. I was okay. I wasn’t hurting. Why bother everyone.
I always told her we would do whatever she wanted. Which meant live at home or go to a NH. She would have liked me to live with her. That wasn’t an option.
It was a miserable existence the last couple of years. I don’t blame your dad for not caring to prolong it. My mom had aspiration pneumonia when she died. She was in rehab in the hospital after having fluid removed.
No matter what you do, your dad will die. I’m sorry. The human body is fabulous but in the end it is not meant to last. I care for my DH aunt, 93, with dementia. Quiet the contrast. Sometimes I think a little dementia makes life a lot easier for the patient. It’s obvious you love your dad and Im sure he loves but you don’t know what you are asking of him. I second reading the book “Being Mortal”. It will help.

Spounds like its time to let nature take its course assuming hes competant

I bet I'll be like that too - stubborn - but I'll call it independant! 😉 I like to control my own life.

That said, I know your frustration & certainly sympathise.

Lay the options in front of him with the facts & the consequences. Let him choose. It is hard.

I need to repeat CM's paragraph over & over too! (Not even asking what my Dad has been up to over the weekend - instead of isolating at home).

Thank you daughterof1930, I feel the exact same way. To let it all go is liberating!!! Now when I see my mother once a week it is to see her as her daughter NOT as her caregiver.

I agree with countrymouse, all three times. Her advice helps me too!! You can’t help someone who doesn’t want help. If he is competent, let it go. My 95 1/2 year old mother lives alone in her hoarded house all by herself. I haven’t been to her house in one whole week. My son went to check on her last Tuesday, Wednesday, and Friday. I said to her today let’s soak your feet so they don’t get infected again and keep you out of the hospital. She said no, she was too tired. I let it go because she’s not going to give in and then we just end up arguing. Just let it go. I did, and it works!! I refuse to argue with her anymore. It hurts my own mental health when we argue. I stopped arguing. If she doesn’t want to bathe, then don’t. If she doesn’t want to wash her hair, then don’t.,I finally have some peace of mind.

It’s okay to let go. My relationship with my dad has become much better since I stopped bothering him to do what he won’t. 

It’s okay to let go. My relationship with my dad has become much better since I stopped bothering him to do what he won’t. 

It’s okay to let go. My relationship with my dad has become much better since I stopped bothering him to do what he won’t. 

I've cut and pasted three times because... EXACTLY! God bless you, Dof1930.

Tiredandsad, we really do understand how desperately worried you and your sister must be. But this is all about choices - some still your father's to make, some yours and your sister's. Some of it's complicated but some of it really isn't, and not wasting your time and temper on anything that won't *help* should be Rule #1.

Read "Being Mortal, Medicine and What Matters In the End."

Practical tip - the usual reason for refusing diuretics is that they make you pee HUGELY and in a hurry. It's uncomfortable, as well as panic-striking, and when you're overloaded with fluids you can't get anywhere in a hurry. So people who aren't expecting that and prepared for it avoid the diuretics, either not realising or not caring that the consequences are worse.

The answer is: 1. explain that this is indeed what's supposed to happen. 2. Get him several urine bottles. 3. Make sure he's taking his diuretic at a convenient time and in a convenient location where he can pee comfortably for as long as he needs to.

I agree with Daughter. Even though his decisions are wrong, ther're his decisions. He must understand by not following a diet and taking meds means he will die. So be it. Tell him you would love to have him around longer and you will miss him when he is gone. Reverse psychology like u would use on a child.

I hope you have POAs in place to be able to make decisions for him when he can't.

If he doesn't like homecare, he probably will not like Hospice. In home Hospice means someone has to be there with him 24/7.

My dad has end stage congestive heart failure, which can last a long time. He also lives alone, eats salty junk food, and periodically falls. He insists on living alone and we accept that it’s his decision as he has a sound mind. Even his lawyer told me that though I have POA I have no rights to make him do anything. If your dad needs to go to the hospital, it’s fine for him to go. My dad goes every few months for fluid to be pulled off. The risk of coronavirus and fluid overload are both serious, but the fluid overload will make him so uncomfortable and gasping for each breath, it’s cruel to deny draining it. Bottom line, unless your dad has dementia, he’s free to make his own decisions and he has to be respected in it even when they are bad and you disagree. Spend the time left with him enjoying his company, not lecturing him and begging him to do what he doesn’t want. It’s okay to let go. My relationship with my dad has become much better since I stopped bothering him to do what he won’t. He’ll leave this world the way he wishes. And I wish you the best

If your father is competent and if he is determined not to cooperate with care, you should probably contact hospice and get an evaluation.

You can't force a person to care about himself.

I remember after mom's second thoracic procedure, her pulmonologist said to me "stop poking holes in your mom. Let the NH manage this and let her die peacefully". She did, 2 years later, with palliative care and finally hospice.

Make a bargain with dad. If he allows home health to check on him, no more trips to the hospital.