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My father who is 88 years old and has Congestive Heart failure and renal failure now has anemia. The nurse wants to start him on an iron supplement and I have read that it can help to prolong his life. He is living in memory care and his quality of life had diminished greatly. When do we stop trying to improve his medical conditions and let nature take its coarse? I'm constantly struggling with honoring his health directive and/or taking the medical advisement given by his healthcare team.

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The congestive heart failure combined with kidney failure leads to an increase in blood volume through fluid retention. So the low haemoglobin count reflects not so much an iron deficiency as a water surplus - your father's blood is dilute. All the iron will do is make him constipated.

If, on top of that, you have your father's clear instruction that he wishes only to receive palliative care then the decision is easier for you. Tell the nurse that her suggestion while kindly meant is not compliant with your father's directive. You don't have to add that it wouldn't make a ha'porth of useful difference anyway.

This might be a good time to call a meeting about your father's care plan overall. Just to make sure that everybody's on the same page.
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I would agree with the others. Iron at this stage will serve no useful purpose.
Time to stop all unecessary medications not add others. Someone with an MD after their name prescribed some liquid iron for me. I told them in no uncertain terms what to do with that.
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Dear caretaker,

I know you love your dad. I too would have done anything to keep my dad going a little longer even with heart failure. Like you, I wanted to keep trying and trying but the side effects of the meds ended up being too much. Its not an easy decision, but I would have to agree with the others.

Thinking of you and your dad.
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Your body needs iron to make red blood cells but often iron is poorly absorbed in the GI tract and more trouble than it is worth as far as upset stomach and constipation. With CKD 4 @ 88 years old, it's not going to solve the problem. Let nature take its course. It's ok.
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That is a good question. 
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I think I would contact Hospice and consider that, or perhaps Palliative Care.
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Caretaker, that is a good question.   I think I would skip the iron supplement and let nature take its course.

Plus I never heard where iron would prolong life.   If it did, for how long?   Another month or two?   Also, the supplement would cause his bowel movements to turn black, which is normal.   That might become scary to him.
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