Abiding by Fathers wishes

[johnhenry76]

What is the name of your state?Kansas
My father recently had a stroke which left him without the capacity to swallow. He was placed in a nursing home with the families understanding that he would be fed "solid" foods with some or most of the food going to his lungs and would bring about his death. We thought that we had explained this to the nursing home before sending him there, now the nursing home is concerned about his calorie intake and wants to meet with us about this at 10am this morning. My question is would they be in violation of any federal or state laws if we wish to stay this course? We are trying to abide by my fathers wishes and we the family are not able to take him into our homes to do this. It could be that he may pass from starvation before any other complications arise, but he has been adamant in the past that he did NOT want feeding tubes or machinery to keep him alive. We have no problem with this and want to make sure the nursing home cannot force us too or could they force us to find another place to take him? He is a Medicare/Medicaid patient not self-pay and has no other assets. Any help or thoughts are appreciated.

 

[BelizeBreeze]

Where is his doctor in all of this?

 

[BlondiePB]

Also, does your father have a living will with someone nominated as medical power of attorney and are there doctor orders for a soft, mechanical diet that includes the use of Thick-It?

 

[johnhenry76]

After meeting with the rehab team this morning they are going to stay the course. The rehab team wanted to update us that they were going to have to move him to long-term care. There is a soft mechanical diet with Thick-it but his appetite is very much diminished from what it used to be. The doctor issue is kinda cloudy, to me anyway, he was in the process of changing doctors and the day after his stroke he was to go see a new doctor for the first time. That doctor did not have admit privelage to the hospital that he was taken to which was one of only 2 here that had stroke intervention certification. He was sent to the nursing home from the hospital, so I am assuming that the home's staff doctor is now his doctor. There is no living will but we are operating under the precedent of no spouse, so eldest child has DPOA. I am consulting with the rest of the family about all issues before I sign or order anything and the family and I were all very aware of his wishes before this stroke. Sorry this is so lengthy but I wanted you to have as much info as I thought you would need to let me know of any issues that I might need to be aware of.

 

[BlondiePB]

...let me know of any issues that I might need to be aware of.

There are other issues that you need to be aware. First, the legal issues. Not all DPOAs include medical decisions. You must look at this and discuss the following with an Elder Law attorney. Should the DPOA, indeed, include medical decisions but NOT include directives such as one would put in a Living Will regarding life-sustaining measures, the DPOA could face criminal charges should the DPOA not allow tube feeding, etc. (this can be overcome) You did not state whether or not dad was competent to make such decisions and whether he is able competent to make a decision regarding advanced medical directives. Just because he had a stroke does not necessarily mean he cannot make such decisions.

Someone in the family needs to observe dad at meal times. Dad does need help with eating his limited diet. Usually, thick-it is started at a honey consistency. This may not be enough and may need to be changed to a pudding consistency. All liquids, including water, soup, nutritional supplemental milkshakes require adding thick-it. Dad may also benefit from anti-depressants. Discuss this with his physician. If your dad is also having problems with balance, body position and speaking, pressure sore (bed sore) prevention measures need to begin (red spots are the first sign), and dad will develop his own sign language. When dad becomes (or if he is) terminal, enroll him in Hospice. Should you have further concerns, post back. Sorry for my delay in getting back to you. I was unable to do so sooner.