How can I better deal with my grandfather (88) who is in the end stages of CHF?


I currently live with my 88 year old grandfather in his home so that he will not have to be put into a nursing home as he is unable to live alone. He can tend to basic hygiene and minimal cooking but the rest I take care of. His doctor has told him that he needs to take it easy and avoid any type of strenous activities as his heart is only functioning at 20%. He down right refuses to accept what the doctor or hospice nurse tell him. The most recent battle that he has choosen is that he wants to start driving again which is completely out of the question according to all health care professionals. He becomes irrate when he is told by anyone that he can no longer drive due to his health problems. I don't know how to handle this situation. He was also given restrictions from his cardiologist to avoid long walks and to stay away from the stairs in our home. He has severe neuropathy in his legs and feet so he is prone to falling. When he over does things his legs swell and he blames me for giving him the wrong medication. After any type of activity he can barely walk and refuses to use his walker, then ends up falling on the floor. I have patched him up numerous times from these falls and he is angry at me when it happens because apparently some how it was my fault. If his son (my father) attempts to discuss anything with him he becomes evil as we put it. He is a very angry and hateful man which makes caring for him incredibly hard and mentally/emotionally exhausting. How can we help him understand that we aren't out to take everything away from him, but we are trying to keep his best interest in mind in regards to his safety? The doctor told him that he has maybe one year to live because of the heart failure and he absolutely refuses to accept this diagnosis. I can understand that no one wants to hear that they are dieing, but he is under the impression that he will be back to tip top shape in 6 months. When anyone even his hospice nurse tries to remind him that strenous activity strains his heart he tells everyone to f off. Many days he is unbearable and has on numerous occasions told me to move out of his house, then retracts the statement because he knows that if I do in fact move out that he will have no choice but to be in a nursing home. I guess overall I just want to understand how to better communicate with him and attempt to find a way to curb the aggressive behaviors as it is getting harder and harder to handle.

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Your granfather is clearly at the end of his life and he has the right to behave exactly as he chooses. He does not however have the right to put others lives at risk. so clearly driving is not allowable under any circumstances. Remove the keys or leave them hanging up and replace the ignition key with one that looks similar but would not work. if the keys are in full view and no one says anything he may know he is not safe and wont actually try.
As far as anything else that he is supposed to do like take medication is concerned forget it. Offer but don't insist. if the pills are ignored just take them away without comment after a few hours and do the same next time. it is not going to make much difference anyway. if his legs are badly swollen and his chest sounds gurgly offer the diuretic and explain ti will help but again it is his choice. It is absolutely correct to explain the purpose of his actions but in the end it is his choice. He will stop going upstaires when his breathlessness gets too bad. if he falls and breaks something so be it call 911. If he becomes violent call the police or in either case the hospice nurse unless you are in physical danger then you call the police for your protection not his and then that is nothing to do with hospice. Hospice nurses are used to dealing with these frustrating patients.
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If he is on hospice then a professional evaluation concluded that he is likely to die within 6 months. If he chooses to die by overexerting himself instead of quietly waiting out the next few months, is that so awful? It is right for the hospice nurse to point out likely consequences of his actions, but then I think he has a right to make his own decisions.

BUT he does not have a right to put others at risk, so, no driving. Absolutely none.

Can you take another six months or perhaps even a year of his aggressive behaviors? You need to protect your own health and self-interest, too. It would be acceptable for you to move out, and let him hire fulltime caregivers or go into a care center or hospice house.

If you really want to stay with him I suggest that you accept his right to take risks for himself.
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You can't change his thinking; you can only change your response to it. You need to make sure that everyone, including his docs, understands that you have no control over his behavior. He very clearly wants to die on his own terms. Do not, under any circumstances , allow him to drive.
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