My father is 92, very frail, and declining rapidly. He is bed-bound about half the time, and in a wheelchair the rest. He cannot stand at all and has to be transferred each time. He has bowel and incontinence problems and we are worried about bedsores. His PCP has made it clear he should be on hospice and have a DNR. My father does not have dementia, yet doesn’t understand things well. He does not accept his own mortality and refuses to sign a DNR, which is a horrible choice given his condition. His PCP won’t refer him to hospice without a DNR. He is in assisted living. They are helpful, but they can only do so much with his care. We really need hospice advice and direction on so many issues. My POA is only valid when my father cannot make decisions for himself. How can I get him appropriate care when he refuses a DNR? I am very frustrated and having to make decisions I am not qualified to make.
He has the right to fight to his very last breath no matter how hopeless it may be.
But, I would talk to him about his fears and if possible understand his views of end of life.
https://theconversation.com/do-you-want-to-be-resuscitated-this-is-what-you-should-think-about-before-deciding-105506#:~:text=CPR%20involves%20repeated%20chest%20compressions,in%20turn%20to%20restore%20life.
I am surprised that the AL has not asked you to send him to LTC since they are limited in the care they can give.
If he passes, then I suggest you buy the book Proof of Heaven by Dr Eben Alexander, a neurosurgeon who had a near death experience. Afterward, his fear of death was gone completely and his entire life was changed. If you can find a way to help your dad alleviate his fear of death a bit, then he won't want to extend his misery on earth any longer than necessary. Read the book together and it may be just the ticket.
Best of luck.
Do know that Hospice is much changed over the marvelous mission it was when it first began here in the USA having come over from across the pond in Europe. It has now come into the Military Industrial Complex for profit realm, and is quite limited. You basically have an aid for bath three times a week, a nurse once a week and the ability to contact a social worker. I currently have a friend dying at home on hospice. Her Social Worker doesn't know as much as her friends about how to access needed things. Medicare pays huge amounts to hospice agencies, and it is kind of a shame to see, for this old, retired RN. Hospice used to be such a godsend. While it's the best we have, it isn't what it was, and you honestly may not be missing a whole lot without it.
I am so sorry you are going through this and I surely do wish you and your Dad the best. Don't press Dad to sign a DNR. Let him talk and allow him to make his own decision.
Call the Hospice of your choice, interview a few if you wish.
They will determine if dad is eligible for Hospice services. They will contact his doctors.
I'm surprised the AL didn't have him fill out a DNR or a POLST form upon moving in. Both nursing homes my mother lived in required them just to be accepted as a resident.
Maybe check with the AL to see if there was a POLST filled out. The hospice folks might accept a copy if he does.
We have had a big push for people to complete what are called ReSpect forms here in the UK. These forms include DNR instructions and the like, usually setting out the person's health care priorities - quality of life versus sheer survival, for ward-based care but not ITU, declines transfer to hospital, that sort of thing - and they are of great value to families, paramedics, anyone who has to make a decision on another person's behalf in an emergency. But on a handful of occasions clients have told me they're not happy with what's been written and asked what they can do about it. They can rip it up, is the answer, to which I add a strong recommendation that they make another one that they are happy (happier, anyway) with.
So: challenge this stipulation on the PCP's part. Ethically, it sucks.