Has probable pvd, gangrene in toe, pain. Has not seen doctor in several years. Family doing their best but do not want him to suffer. He is 85 and lost wife over five years ago. Just wants to be with her.
Hospice will come to your home and do an assessment free of charge in most situations. Medicare covers hospice care. The initial visit includes a primary care doctor who is necessary to qualify your dad for hospice. The doctor's order is needed and most will come to where your dad is living.
Past medical records are helpful, but not necessary to get hospice care. My mom avoided medical care for decades as best she could barring emergency situations. It's a little embarrassing they avoided medical care for so long, but very common, rest assured. You are not alone in your situation with your dad. A lot of our seniors are VERY stubborn.
My mom began receiving hospice care at her AL just three weeks ago. The folks from hospice have been great at taking care of a bedsore for my mom and a bad foot issue. She is on the lowest dose of morphine now for hairline breaks in her spine that were extremely painful. Taking care of our loved one's pain is a blessing.
I encourage you to call the hospice of your choice in your local area tomorrow. If there are online ratings of them, check them out. You will be glad and relieved that you did. Dealing with gangrene on your own sounds awful, especially with your own dear dad.
Please update us on how things go. You need professional help now to keep dad out of pain and so glad you reached out.
I have been doing this a long, long time. In fact, it feels like forever. Mom was diagnosed with Alzheimer's in 2006 officially, but we had been struggling with this a looooooong time before the official diagnosis finally came. Whatever you can name, we've been there and done that. I have cancelled some appointments when they weren't absolute emergencies, due to emotion reasons on my mom's part, so I know there is some latitude to make discretionary decisions that may be...atypical.
That being said, call 911. The EMS workers have experience with all kinds of medical, physical, mental, and emotional situations. They will get him into an ambulance and into the ER safely, which is where he needs to be. The poster who mentioned caregivers being prosecuted for neglect is 100% right. Take it seriously. If he dies at home without medical documentation, by law, they will have to do an autopsy. When they find the gangrene, as unfair as this may be, the WILL come after you. Please don't put yourself in that position.
Your grandpa is NOT competent to make his own medical decisions, as evidenced by refusing to seek medical help even if you have gangrene!
When EMS gets there, one person will be able to ride along. Another should follow in a car. If he is unbearably fearful, they have meds that will make him feel nice and calm and happy. There is medical management available for his fears; take advantage of it.
The hospital will treat and release him back home, provided adequate care is available. Once he's at the hospital, you should call in hospice for an evaluation. The hospital with all it's resources will facilitate that. He wants to die, that's fine. But he doesn't have to die in pain.
Thank you so much. I knew there had to be a doctor order but I didn't know how to get it when he refused to go. It's out of fear because he doesn't want anything done. I tried to explain he didn't have to have anything he didn't want. I will pass this info to his POA.
This is a troubling issue, for a reason nobody has mentioned yet. I have seen (in the legal literature) cases like this where the individual died and the caregivers were prosecuted for neglect. In some cases, the family caregiver has gone to jail. Yes, elders can be very stubborn. But the gangrenous toe can lead to a system-wide infection that could ultimately prove fatal. Yes I know he doesn't want treatment and he wants to die, but he needs to say that now to somebody other than his family, because once he dies it will be too late to have his desires documented. Get a doctor there or insist that he has to go to one at least once in order to go on record as refusing medical intervention. (You can tell him it's only for pain relief, which may be the case ultimately). You don't want any loving and well-meaning family members to end up paying the price for his decision.
His desire to join his wife is perfectly natural and many elders can only think of this once their partner has passed. Having Hospice involved will make everything easier for all concerned. If he refuses medical care and hospice when he dies the only alternative is to call 911 which will involve the police and the county coroner and probably a post mortum because it is what is called an unattended death. It will be simpler if you can get him to go to the Dr once just to get the recommendation for hospice plus some immediate pain management. The Dr does not have to do any treatment which may be too late in any case. Before an amputation can be attempted a good blood supply to the limb has to be present. So even if amputating the toe is the only thing necessary if he has poor blood supply the amputation will need to be much higher which will be very hard on him and he probably would not agree. Gangrene is extremely painful and the only way to get relief is with a Drs prescription unless you plan to go an illegal route. Once hospice is agreed upon everything for his comfort will be taken care of and he will have no fear of being forced into treatment he does not want. Hopefully the infection will quickly become systemic and he will pass quickly before the infection does engulf his whole leg. I am sure the family wishes he would have treatment but unfortunately it is his decision so all you can do is respect his wishes and keep him as comfortable as possible. If he has a liking for alcohol it may bring him some relief and I do not usually recommend this but if all else fails buy him whatever he wants. Now is not the time to wean him off just make sure he is safe and does not fall. Otherwise let him do whatever he wants. Eat,drink or not. Try and keep him reasonably clean. Let him stay in bed or get up walk around or sit, watch TV all night. Do not let him smoke unsupervised and don't give him free access to the alcohol. Just give him what you consider a reasonable amount and let him drink when he wants. You may want to call 911 just to protect yourselves but don't try and persuade him to get in the ambulance although the EMTs will try very hard and try and over rule the family. Try and get a DNR signed if at all possible and advanced directives. If you can't get a lawyer to come to the house have a non family member witness his signature. Lawyers are usually more willing to visit the home than are Drs. It really depends what you can afford. It is his right to make his own end of life decisions and they should be respected because if they aren't it will cause him unessecary suffering and he will get his wish anyway.Stay strong and help him all you can.
My Mom also wouldn't go to a doctor. Hospice needed her doctor to order their service. There are mobile doctors who come to you who will evaluate him and do an order for Hospice. This is paid for by Medicare as well. I wish you the best!
Past medical records are helpful, but not necessary to get hospice care. My mom avoided medical care for decades as best she could barring emergency situations. It's a little embarrassing they avoided medical care for so long, but very common, rest assured. You are not alone in your situation with your dad. A lot of our seniors are VERY stubborn.
My mom began receiving hospice care at her AL just three weeks ago. The folks from hospice have been great at taking care of a bedsore for my mom and a bad foot issue. She is on the lowest dose of morphine now for hairline breaks in her spine that were extremely painful. Taking care of our loved one's pain is a blessing.
I encourage you to call the hospice of your choice in your local area tomorrow. If there are online ratings of them, check them out. You will be glad and relieved that you did. Dealing with gangrene on your own sounds awful, especially with your own dear dad.
Please update us on how things go. You need professional help now to keep dad out of pain and so glad you reached out.
Call Hospice and they will evaluate. I strongly disagree with calling 911 (and anyone here can tell you, I'm the first to recommend calling them).
My grandmother developed gangrene secondary to vascular issues. The choice, put to my mom, was, amputate the leg or let nature take its course.
With grandma's input, we let her pass peacefully. It would have been a lot more pleasant had there been hospice.
That being said, call 911. The EMS workers have experience with all kinds of medical, physical, mental, and emotional situations. They will get him into an ambulance and into the ER safely, which is where he needs to be. The poster who mentioned caregivers being prosecuted for neglect is 100% right. Take it seriously. If he dies at home without medical documentation, by law, they will have to do an autopsy. When they find the gangrene, as unfair as this may be, the WILL come after you. Please don't put yourself in that position.
Your grandpa is NOT competent to make his own medical decisions, as evidenced by refusing to seek medical help even if you have gangrene!
When EMS gets there, one person will be able to ride along. Another should follow in a car. If he is unbearably fearful, they have meds that will make him feel nice and calm and happy. There is medical management available for his fears; take advantage of it.
The hospital will treat and release him back home, provided adequate care is available. Once he's at the hospital, you should call in hospice for an evaluation. The hospital with all it's resources will facilitate that. He wants to die, that's fine. But he doesn't have to die in pain.
Having Hospice involved will make everything easier for all concerned.
If he refuses medical care and hospice when he dies the only alternative is to call 911 which will involve the police and the county coroner and probably a post mortum because it is what is called an unattended death.
It will be simpler if you can get him to go to the Dr once just to get the recommendation for hospice plus some immediate pain management. The Dr does not have to do any treatment which may be too late in any case. Before an amputation can be attempted a good blood supply to the limb has to be present. So even if amputating the toe is the only thing necessary if he has poor blood supply the amputation will need to be much higher which will be very hard on him and he probably would not agree.
Gangrene is extremely painful and the only way to get relief is with a Drs prescription unless you plan to go an illegal route.
Once hospice is agreed upon everything for his comfort will be taken care of and he will have no fear of being forced into treatment he does not want. Hopefully the infection will quickly become systemic and he will pass quickly before the infection does engulf his whole leg. I am sure the family wishes he would have treatment but unfortunately it is his decision so all you can do is respect his wishes and keep him as comfortable as possible.
If he has a liking for alcohol it may bring him some relief and I do not usually recommend this but if all else fails buy him whatever he wants. Now is not the time to wean him off just make sure he is safe and does not fall. Otherwise let him do whatever he wants. Eat,drink or not. Try and keep him reasonably clean. Let him stay in bed or get up walk around or sit, watch TV all night. Do not let him smoke unsupervised and don't give him free access to the alcohol. Just give him what you consider a reasonable amount and let him drink when he wants.
You may want to call 911 just to protect yourselves but don't try and persuade him to get in the ambulance although the EMTs will try very hard and try and over rule the family. Try and get a DNR signed if at all possible and advanced directives. If you can't get a lawyer to come to the house have a non family member witness his signature. Lawyers are usually more willing to visit the home than are Drs. It really depends what you can afford.
It is his right to make his own end of life decisions and they should be respected because if they aren't it will cause him unessecary suffering and he will get his wish anyway.Stay strong and help him all you can.
I wish you the best!
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