My father is in an awkward place. He "performs" for doctors and nurses and fools them with his mental state. He then reverts to his normal which I would characterize as moderate cognitive impairment/dementia. We cannot get a dementia diagnosis... and yet he is unable to remember anything, constant questions, confusion, inability to understand simple processes, repeated information, etc... which then contributes to his demeanor, cranky, mean, bordering on abusive. He uses pity and guilt to manipulate to get what he wants. His underlying condition is COPD. He won't use or take his medications. He sometimes uses his oxygen. Yet complains he can't breathe well... He doesn't want others in the house to care for him. He expects his daughters (me and my sister) to drop everything in our lives to care for him. He has in the past month become weakened to the point of only getting out of his chair to get to the bathroom and often doesn't make it in time and messes his adult diapers. He will eat if someone brings him something to eat, but won't usually go get it himself in the kitchen. He won't bathe or allow others to bathe him. His last shower was New Year's Eve. We cannot give him anything for anxiety because he won't take it. We just got a consult for hospice and they warned us that if he refuses their services, they will have to discharge him from their help. He is in denial about his condition and the need for extra helpers. He is getting to the point of being a fall risk, unsteady on his feet, weak. He is getting to the point of needing 24/7 care. He wants to remain in his home but doesn't want anyone else but family here. He still has "capacity" to make his own descisions. What do you do when he can make his own decisions but the decisions he makes are not in his best interest and he needs more care??? My sister and I are still working and cannot be the 24/7 caregivers. He has two CNAs who split afternoons and come for about 1-2 hours but that is not enough. My sister and I would love to put him in a facility but he will fight that tooth and nail and he has capacity to make his own choices... so what the heck do we do?