I have cared for 5 elderly people over a career of more than a decade. I cared for several clients until they passed away at home. My current client is 92. He has kidney failure, two large tumors in his bladder, 2 compression fractures in his thoracic spine, and end stage CHF. He is in agony. There is no other word to describe it. He cries out in pain throughout the night. His kidneys and bladder cause such discomfort that he wakes up 4-5 times an hour and slaps his abdomen hard. I asked him why he did this, and he said he wakes so frustrated that slapping helps. I wonder if somehow causing pain on the exterior of his abdomen helps the pain inside. I have reported to the family repeatedly that he is in pain that is no longer addressed by Tylenol. The daughter that he lives with sees the pain, and agrees with me. She contacts the other daughter who is the POA, and also has an associate's degree in nursing. She works in a cardiologists office. The daughter who is POA comes up with reasons that I find incredible for why her father "acts" like he is in pain, but really is not. She is concerned that Daddy will become addicted as well, although it is apparent to me that her father has perhaps 2 months left to live. The best I have been able to do is get Tylenol 3, but only after the bladder tumors were found 3 weeks ago. The POA refused a biopsy, as her father does not want to treat them even if they are carcinomas, so why bother finding out what they are! The home health RN spoke with the urologist about my client's obvious pain, and Hydrocodone was prescribed. However, according to the POA daughter, Daddy is allergic to it. Nothing else has been prescribed. Unfortunately my client is slipping into despair. He won't talk to me about his pain as of last week, because he no longer trusts that I will help him, as I have failed in every attempt. Please help. I can't stand to see him angry and withdrawn. The daughter he lives with will not override her sister.
I'm sure you are, but please document everything - every dose & keep copies. I hope not, but some people can lash out if crossed - the POA daughter may cause legal trouble. Especially if the gentleman declines rapidly & she is still in denial about this or suffering from grief.
Is he having kidney dialysis treatment? If so & he decides to stop, depending on his kidney function, he may have only one to a few weeks.
If this was my client I would be talking to the reasonable daughter about bringing hospice on board.
I would also call APS about the POA withholding comfort care.