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Most of the time he acts ok. How do I approach the topic. Do I lie and say it's just home care? I don't think he's there yet but maybe I am reacting to times when he is "normal."

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Also to add, as far as dialysis goes....I drive mom to and from the hospital, where she does dialysis, 3x per week. I don't have to find a parking spot - I just pull up into the drop off area.  I phone up to the renal unit when we arrive. They send a porter down to wheel mom up to dialysis. She manages to stay still at dialysis quite fine. She has so far not required a caregiver to stay with her - there are always many nurses on staff while she is there, as well as the renal social worker.  I am always back at the hospital at a certain time, and they send her back down to me in the care of a porter.  Usually she is ravenously hungry afterwards, so I have a snack ready for her.  It's fine. 

I imagine if she were trying to get out of the chair or unhook herself, that would put me in the position of making the decision for her, but it doesn't go that way.  Mom just thumbs through magazines and enjoys "people watching" the nurses and other patients.  The only real complain she has is that she wishes she could fall asleep, like some of the other patients. 

My mom is 79 by the way. She will be 80 in July.
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My mom has end stage renal failure and dementia. With the dementia - sometimes she is cognitively aware, a lot of the time she is confused, sometimes she is really quite nasty. Dialysis was really hard on her for awhile, especially when we switched her over from peritoneal dialysis to hemodiaylsis, but she seems to be stable now.

The renal team has spoken to us about the choice to end dialysis. They have clearly said that any time she wants to end it, she can. The renal social worker also spoke to me about making the decision for her at some point, which may be necessary.  Several health care workers have mentioned home hospice as an option, when the time comes.  Ending dialysis means ending her life, within weeks to a month or two. That's a huge decision.

So basically what I've been doing is, every once in awhile, I wait for my mom to have a cognitively aware moment and ask her how she feels about continuing dialysis. She has stated very clearly that she's not ready to give up the fight. And I think as long as she is able to make the choice, it should be hers to make. She is the one who has to suffer through dialysis, not me. And even though it seems to me she doesn't have much of a life - she sleeps a lot, has a poor appetite, and doesn't do much except watch TV - she doesn't seem to be suffering a great deal either.  

I share POA with my brother. If/when it reaches the point where my mom has no cognitive awareness - where she is not even able to enjoy the few things she still enjoys now - then we will probably make the decision for her. But until then, I don't think it's for us to determine what her quality of life is or whether it's time for her to die.

This is just how I've approached it personally, within my belief system. It's not a judgment call on anyone who might do things differently.
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Yes start with what jjariz recommended. Dialysis is so hard on elderly people.
It’s such a private issue but if your dad has End Stage Renal Disease he will decline physically & quickly.
Good luck to you!
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The problem with renal failure is if a person with dementia can safely sit still for 3 hours with each treatment 3 times a week and who would ensure that he will get there. Would a family member stay or would there be a paid caregiver who would sit and stay. That part will not be in the dialysis staff scope of practice
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"Dad, the doctor thinks we should talk to hospice and consider their services. "
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Could you call the hospice that was suggested (or any other one) and ask a nurse or social worker for advice?
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