His doctor just referred him for hospice at home. He's 87 with severe COPD. Recently he's much weaker and more short of breath. He lives independently and has always been a "loner" who wants no help except for me doing his shopping and errands. I was relieved he spent a couple of days in the hospital this weekend so I could clean his apartment! He has typically said "no" to anything his doctor or I have suggested. I feel like the doctor and I just wore him down yesterday to the point where he agreed to the hospice referral. It makes me so sad to have to convince him to do something pro-active. He just keeps saying "I'll cross that bridge when I come to it" but as I told him at the doctor's office yesterday - he's at that bridge.
Can anyone tell me what to expect in the way of palliative care for his COPD? I know he won't want social or pastoral services, or even help with daily activities.
Any suggestions on how to deal with a crusty, obstinate but sort of loveable ol' codger?

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Hospice offers so many services and it's like ala carte, you just pick and choose which services are right for the situation.

I'd bet an obstinate, lovable ol' codger would perk up to see a pretty young girl from hospice coming to talk to him about getting some oxygen in the house, if he doesn't have it already. Believe me, in home healthcare (and I've worked hospice many times) we're informed when a patient is resistant and it's nothing we haven't dealt with before. You can also substitute the word 'resistant' for the word 'denial'. It's very common.

Hospice will also offer bath aides. Real live people who will help your dad get cleaned up. Many people on hospice are very resistant to this initially but it's done in such a professional, comforting way. It's getting that first shower/bath out of the way that's the key. Once that's done it's not so scary or embarrassing anymore. When hospice provides bathing it's also done very quickly, before the patient hardly knows it's happening. That's by design. But someone in hospice is receiving palliative care, comfort care, and being bathed and feeling clean falls into that category. The bath aides are usually chatty and very mindful of the person's dignity. Getting your dad to accept the first time is going to be the trick but I'll bet after that it won't be as much of an issue. You'll just have to work him and get hospice involved too. It's more difficult to say no to a stranger than it is to family. Baths can also be done in the bed. This is something hospice has a difficult time explaining to their patients. The patients assume it's going to be a mess and uncomfortable and it's not. It too is also very quick and very comforting.

You can't convince your dad he's at that bridge that he keeps talking about. Take it only one little issue at a time and if you've been his caregiver then you definitely get some say so in what comes next with for him. He can't agree to let you be his caregiver and then shut you out on particular issues, he can't have it both ways. You're either in or your out. He's part of a team and you get a say so as much as he does. We all want our parents to be as independent as they can be for as long as they can be but when we sign on to be a caregiver that doesn't mean we sit idly by while our loved one makes poor choices. We put on our caregiver hat and we get to work. Why have hospice services if your dad isn't going to avail himself of those services? If you need the assistance, get it and worry about what your dad is going to say about it later.
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My FIL actually threw them out of the house the first time they came, in an angry rage that he did not need them. That ol'codger will open up to someone who is not their child. My MIL's mother told me everything she wanted for her wake, what funeral home, which casket. These are things she would never ever discuss with her children due to the emotional reaction it triggers. My FIL finally opened up when Hospice sent a man who was a retired teacher to visit. FIL was also a teacher and their visits were mostly chatter about students. Talk of eventualities was lightly sprinkled in, never the main subject.
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