Father-in-law (85) with multiple health problems - when is enough enough?

I'm so sorry, Sunflo. Thank you for sharing the points to think about. ICU is not a good place to end up, but I'm glad the staff were humane - not always the case in that intense a clinical environment, I gather. Condolences to you and your husband's family, and peace at last to your FIL.

Update. FIL went thru 6 was of medical h*ll, of which each move to rehab, in and out of ERs, ICU and Memory care continued to weaken dad. He passed away last Sat in ICU.

Lessons learned: please know that memory care, AL, etc doesn't mean that they watch over your loved one or administer skilled nursing care. They don't make sure you eat, they don't monitor hygiene, inputs and outputs, etc --for that you need to pay extra for that type of one on one care.
Resident still needs an advocate to visit and monitor and ask questions.
Lastly, DNR doesn't mean all life supports are not given. Dad, even though he had comorbidity conditions, not expected to survive at less than 90 percent, comatose, was still given antibiotics, fluids, vascular meds to sustain blood pressure and oxygen. It was heartbreaking and we had to make decision anyway to remove all supports even with DNR that was very specific. So I learned something new here about what DNRs really mean.
I wish that the dr had insisted on hospice consult immediately. This would have cut dads suffering 24 hrs earlier.

In the end, he had a caring ICU staff but my MIL and family had very difficult time understanding what Dr was really saying.

WELLL... lots of things wrong with this picture. If they won't do palliative care, at least try to find a decent geriatrician or geriatric neurologist who will take a comprehensive look and stamp out the polypharmacy and the whole "whack-a-mole" approach as you so aptly describe it. Some people surprise you with their ultimate recovery from ICU care given a little time, and he may do better with fewer meds too. I've seen it. I've seen people come off hospice or become rehab-ready when a med that was causing them undetected problems finally gets stopped, and more than once!

Have you checked with Social Services to get a Emergency Protection Order for Guardianship. Once they get involved they can and most likely will have an order from the court to do what is in the best interest of the patient. This is what I would do being that you have concerns about his quality of life and care at home. It never hurts to check into that option and they are best qualified in discussing the options with everyone and taking action when its deemed necessary. The hospital social worker may be able to help when/while he is admitted if not check with your local department of social services for help with this issue. Best Wishes and God Bless You.

What a terrible situation for you all :~(
My only advice is that there are times when the most loving gift we can give is release/permission to let go.
I did this with my SO, "it's ok to go my love, you don't have to fight to stay. I'll be ok, I'll miss you but I'll be ok. I love you, go when you're ready."
Minutes later he was gone ~ peacefully.
I've done this with other loved ones with the same result.
Often people fear for their loved ones and so fight against all odds to stay.
Thinking of you all.

My mom has mild dementia. My MIL is fine and competent.

I'm confused since your profile says that MIL suffers from dementia. Why would a person with dementia be in charge of making another's medical decisions and even allowed to be their caregiver? Do FIL's doctors know this about MIL? Would they discharge a person to a spouse when the spouse has dementia and may not be able to provide adequate care?

Are your trying to explain things to MIL that she just can't comprehend due to her dementia?

Well and update to all and thank you for your responses and support! The last month has been a nightmare for FIL -- sepsis, bedsore and bladder infection; move to permanent catheter. He has been in ICU, rehab, back to ICU, having to have night nurse due to him constantly pulling out catheter; discharge from rehab and MIL moved him into nice memory care residence -- but was there less than 24 hrs and now back ER and stay for bladder infection. Dr says he has 25% heart function; in acute renal failure. He is very anxious (who wouldn't -- every time he wakes up there are different caregivers, health workers at his side trying to coax him to eat, move, be mobile), sleeps most of day and has stopped eating/drinking for the most part (lost 25 lbs in one month). MIL is hanging in there and we are supportive -- but as all elders in crisis; she has paperwork but thinks "just cause she told the dr and social workers" that she as AMD that it was ok. Dr. told her to consider moving FIL to hospice back at memory care center. I think she will do this. We advised her to ensure a hard copy of AMD and DNR was in his chart and bedside TODAY. She said she would do this (she doesn't have a DNR currently). Poor man needs palliative care but MIL doesn't really understand the difference between pall and hospice so I hope they explain it to her. She keeps visits short because Dad just wants to sleep (understandably as seems his body is giving out). Hope he doesn't continue to suffer. He is getting fluids and antibiotics in hospital.

Any other advice to support MIL and FIL -- to help him be as comfortable and peaceful as possible?

It isn't that I don't agree that heroic measures might not be appropriate. But the caregiver who came to help me with my mother had her gall bladder removed last year and was told to take four weeks off work *minimum* to recover from it. And she was around about forty, and - apart from her chronic gall bladder problems - in pretty good shape. So if your FIL only had this done one week ago I wouldn't write him off just yet.

But the constant chopping and changing of medical staff sounds disastrous - can you get just one of them to take ownership and start again with a full evaluation?

You totally have my sympathy. It is precisely this sort of situation which caused me today to lodge not only a DNR but also an Advanced Decision on end of life treatment with my Dr & solicitor.
Now I'm assured that in a case like your FIL I will get fluid and pain killers but nothing else. No feeding, no treatment I will then slip away or rally.
I wish that everyone would make a decision and let it be known. If someone wants treatment at all costs and bringing back over & over. OK but let that be known!
Bless you all in this terrible situation, do keep posting.

MIL just can't have it every which way. She can't care for him at home but doesn't want help......Its so tough dealing with old folks and bad reasoning. I think you view of the situation is correct...Why are we doing this?......does he have a DNR? End of life Directives? Can your husband apply a little firm pressure on Mom or does he still think Dads going to get better?

Thank you. He does have a will of iron and even this week in hospital he has been one day good; one day not feeling good up and down. He complains he doesn't feel good but wants to come home. My issue is more with the medical community - they will continue to play "whack a mole" and "treat" whatever is the condition of the day...that is their job--to treat the patient, stabilize them and get them discharged asap before anything else happens or patient dies on their watch..i know they mean well; but in some circumstances particularly with very ill and dying or elderly, they just keep at it thinking this is what family wants. Its not what dad wants, but he will agree to keep going if no one advocates for an alternative. I'm trying to convince my husband to request a Palliative consult when he visits -- I tell him, no obligation -- but a chance for them to talk with FIL privately to understand what he really wants and then consult with the family to explore options and next steps. I'm frustrated because MIL has not asked for a prognosis for drs. With all the swelling, meds, dilirium and CHF diagnosis -- that is what I wish she'd ask. I tell my husband, if you don't ask flat out, the dr will not tell you and will just keep going and treating acute flareups without regard for dad's quality of life.

I think the issue is not only what we may think or suggest, or what you feel, but the fact that your MIL is in denial, by your own terms and apparently doesn't want to care for your FIL is he comes home to recuperate.

Your FIL has really had a rough time; he may just be worn out and may recover or at least stabilize, gradually, especially since he had some major medical issues hit him all at one time. But he won't if he doesn't get proper care and emotional support, unless he has a will of iron.

I would try to talk to his doctors to get their individual opinions before he leaves the hospital, to determine whether palliative or rehabilitative care is appropriate. It doesn't seem likely that he'll be able to come home when your MIL is tired of caregiving.

My experiences are different; had I really recognized when my sister was in a terminal state, I would have brought in hospice earlier. With my father, it was a completely different situation. One pulmonary doctor and an ICU nurse were insistent he would not survive a multiple issue acute health crisis back in 2003. The nagged me to consider final arrangements.

Today my father walks down to the beach to sit and watch the geese, ducks, swimmers and boaters. He'll be 97 this year.

But everyone is different.

Oh, Lord. I completely agree with you. Palliative Care leading to Hospice. He should definitely be evaluated. Poor guy.

I don't suppose one of his sons or daughters has healthcare power of attorney? I assume his wife is close in age to him. Probably not thinking that clearly if she is.