Why won't my dad's physician put him on hospice?

Doctors generally do not like Hospice...and this is not all doctors..
Because Hospice means that they have failed.
Failed to cure
It may also mean that they will no longer be able to bill for services and that is one revenue stream that will be gone from them.

You do not need your Dad's Doctor to refer him to Hospice. You can call any Hospice and ask for an evaluation. Once Hospice evaluates your Father they will let you know if he qualifies or not.

To find a Hospice ask the staff where he is what Hospice organizations they are familiar with and what ones they think do an outstanding job. Then call the ones that they mention and "interview" them. Or if you know of one that has a good reputation call them.
There are Not for Profit Hospice and For profit Hospice not saying one is better than the other. The one I used, and now volunteer with is a Not for Profit.
You can make the call to Hospice it does not have to be the Doctor.

If a doctor treating my loved one made a decision I found puzzling, I would ask the doctor for an explanation. Not people on an internet forum who know nothing about my loved one or his medical history.

I don't mean to sound snippy, apologies if I do. But seriously, don't be afraid to ask - your question is a perfectly reasonable one and should be addressed to the person who can answer it.

TG, I tried to be conservative to respect my Mom's end-of-life wishes. But when she got a bad foot ulcer it was 8 weekly wound clinic visits with debridement and nurse visits to change dressings several times a week. I put her through this because I didn't want her to have to have an amputation. But her skin started to break down in other areas and soon she had a Stage 4 pressure ulcer on her lower back. Please know she had gentle, professional care. This was her transition. They were not going to heal; no way could she consume enough protein, etc. The choice was hospice or SNF. Even hospice tried aggressively to heal the sores. I had to eventually be my Mom's advocate and say "enough"! I demanded morphine before every dressing and diaper change and stayed by her side for her last 6 days. Sometimes the body is done.

Hospice is generally for people who are not expected to live more than 6 months. (Obviously no one can predict that for sure, so it is a judgment based on other patients with similar symptoms.) Perhaps his doctor does not feel he is there at this time.

You can ask for an evaluation by the hospice doctor, also.

Tgibson,

Doctors in general are all about fixing problems and prolonging life. It's crazy and cruel. Has your father talked about wanting to die, given that he doesn't want his foot amputated? How awful for both of you. I'm so sorry.

I am in a somewhat similar position, although it is not as dire. My mom has had breast cancer and a stroke in the past few years. She is now 84 and getting repeated UTIs that have landed her in the hospital 4 times in the last 8 mos. One time she was in septic shock, but came back from the brink. She is wiped out from all of it, but docs are advising surgery on the huge kidney stone at the root of the infections. If you saw her, you'd see that it is totally nuts to put her through surgery. She is not totally with it, so it's my decision.

doctors love money! More often than not elders--especially in nursing homes-- are enormous cash cows for their champagne and caviar lifestyle and in time for Christmas holidays, vacations and expensive presents.  Anybody with a foot that is starting to rot (gangrene) poses dangers such as infection and bleeding to death and it sounds like your dad should be in hospital..or hospice in my opinion.   You may want to tell your dad's doctor you plan to file a complaint against him. Maybe that in itself will save you the trouble of having to actually do it. You definitely are within your rights to file a complaint.   I would like to point out that not all Hospices have to be "Do Not Resuscitate" status but can remain "full-code" if the hospice facility is Medicare approved because it is understood treatment would be palliative.   If you feel your loved one is being mistreated you may file a complaint with your State entities and information is provided by Medicare. See this link. https://www.medicare.gov/NursingHomeCompare/Resources/State-Websites.html ;

It could be that MD does not want dad on hospice as once on hospice it means only palliative care can be done for him at the NH. 

For gangrene, the care plan will likely be debriedement, antibiotics, duoderm adhesives, circulation / movement, etc. and then with amputation surgery as the last resort (my diabetic grandma had gas gangrene started from bad toe nail clipping) but IF he's on hospice & being on hospice means none of these are available (as considered curative not palliative) then hospice placement will be discouraged. This might be why  MD won't do hospice evaluation orders. 

Gangrene if left on it's own will spread rapidly & become beyond painful eventually; and at that point then they agree to surgery only to find out that other organs are too compromised & skin is too necrotic for surgery to be done. It's too late. 

Not all NH are set up for an active infectious disease resident. If your dad is fixed on not accepting MDs care plan & gangrene goes on, ask the NH facility if he will be allowed to continue to stay living there. 

There has been posts in the past on gangrene and the dilemma family finds themselves in. Especially with family member who refuses any thought of amputation. Go up to the search "Q" function type in gangrene and the list of old Q&A will pop up. Lots of solid info with real experience details from BarbBrooklyn, Pamstegman & Vstefans. 

When my husband was very I'll, our doctor did the same thing. The next morning he died.  I have been told you do not need hospice approval from Dr.  Hospice has their own drs.  Ck it out

Alum is NOT a spice, though according to WikiPedia it can sometimes be FOUND in the spice area of a store (it is used mainly for pickling in recipes, hence WHY you might find it there.)

Per WikiPedia:
"The alums are a class of chemical compounds. Alums are double sulfate salts...

Cosmetic
An alum block sold as an astringent in pharmacies in India (where it is widely
known as Fitkari (Hindi) or Phitkari (Urdu)
Styptic pencils containing aluminium sulfate or potassium aluminium sulfate
are used as astringents to prevent bleeding from small shaving cuts.
Alum may be used in depilatory waxes used for the removal of body hair or
applied to freshly waxed skin as a soothing agent.
In the 1950s, men sporting crewcut or flattop hairstyles sometimes applied
alum to their hair as an alternative to pomade. When the hair dried, it would
stay up all day.
Alum's antiperspirant and antibacterial properties contribute to its traditional
use as an underarm deodorant.

Medicine
Alum is used in the treatment of canker sores in the mouth, as it has a significant
drying effect to the area and reduces the irritation felt at the site.
Alum was the major adjuvant used to increase the efficacy of vaccines, and has
been used since the 1920s. But it has been almost completely replaced by
aluminium hydroxide and aluminium phosphate in commercial vaccines.
Alum has been used to stop bleeding in cases of hemorrhagic cystitis."

For canker sores, sure, this was a known treatment. Given that it is a type of salt, even regular old table salt would help canker sores - they've sold canker sore treatments for ages!! Also note that it is used as an astringent to stop bleeding in MINOR wounds, such as shaving cuts - also a well-known remedy. How do you compare a canker sore or a shaving cut to an open ulcerated gangrenous wound???

Stop spreading nonsense. For this man's affliction, this will not cut it. YOU (and you know who you are) are NOT a doctor and should not spew this kind of garbage. The poster would get just as much benefit from a rhino horn or bear balls or hiring a witch doctor...but be out a lot more money! If the man has a open non-healing gangrenous ulcer, all the alum in the world is not likely to do ANYTHING for him.

Your post also does not address the question being posed.

Recommend poster ask doctor directly, as others have suggested, or get another opinion. If his doctor is just a GP, try finding a specialist who deals with this kind of condition specifically. Asking hospice for evaluation might also be an option.

For those suggesting just directly calling a hospice group, for the OP, her dad is in a NH so it's not as simple as this. TGibsons dads is under the care of the existing MD who is the medical director of the NH & whichever MD specialists the NH works with; and in all likihood the NH has a pre-existing relationships with 3 -5 hospice groups that already come into this NH & that residents and their families can choose from for hospice provider.

There are hospice groups at the ready & waiting for medical directors order for a hospice consult for hospice to start. But to me, it's more the case that the MD is reticent to do this cause they know by experience that for a non-compliant patient like dad, the infection will lead to gangrene and then once dads pain gets bad (& it will and be truly awful with gangrene), he's gonna change his mind and now want things (like surgery) done like yesterday..... and if he's on hospice its palliative care only. No surgery, no antibiotics as their "cure".

Hospice can't provide services that cure the Condition or disease. So if I'm correct, any care care that cures his gangrene cannot happen, only comfort care like pain medications. And it's likely to be Schedule 2 black box drug, like fentanyl. A lot of hospice groups do not have staff that carry or administer these for various reasons. Their going to have to work within the hospice groups that already come to this NH. Or she moves her dad into a speciality LTC facility for infectious diseases.

It's difficult situation if her dad is strong willed don't tell me what to do type VS a md who knows pain will eventually cause dad to cave in & allow intervention but could happen too late to remove the infection even with amputations.