Critically ill parent

[HeadAboveWater]

Hi, Out of the FOG community. I was active here for a number of years. Your support helped me to find peace, learn about boundaries, and get myself to a better place. Though I have been quiet and not participating in discussions here recently, I often refer others to your resources, and I remain forever thankful for your help.

I'd like to once again seek the input of forum users, as I am in a bit of a family crisis at the moment. My husband's elderly father is critically ill, on a ventilator, and in intensive care with both viral and bacterial respiratory infections. We will find out this week whether he can reasonably be expected to recover and, should he recover, what supportive care he will need for the rest of his life.

In the last couple of days my husband and I have confirmed our suspicions that my in-laws were not good planners. My father in-law has no living will, advance directive, or medical power of attorney in place.(There are also a number of home maintenance matters and financial issues that we are learning about that have not been dealt with in a timely or pro-active manner.) Accordingly, my PD mother in-law, who is presently physically healthy, is the primary decision maker regarding medical, legal, and financial plans. As far as she knows, my FiL has not written anything down about his end-of-life wishes.

The trouble is that my MiL is helpless right now. This could be a manifestation of PD, it could be anxiety, it could be extreme inattentiveness, it could be age-related cognitive decline. It's also possible that she never had strong intellectual abilities to begin with. There's no way to know, and I am not sure that knowing the cause would be helpful. When I say that she is helpless, I mean that she has stated that she has no idea how to refill the bird feeder or to change a light bulb. She does not know how to navigate the hospital campus or what to do with checks made out in her husband's name. So far, she has not been able to understand basic medical terminology, like blood oxygen level/pulse oximetry, despite how often such things have been in the news during the ongoing Covid pandemic. Despite this helplessness, my MiL insists on serving as the primary point of contact with the medical team. However, I am now doubting her overall capacity for making any significant decision.

For the next couple of days, my FiL's condition will be touch-and-go. It is possible that very hard decisions, like what to do in the event of cardiac arrest or whether to withdraw life supporting measures, are upcoming. My greatest concern is that my FiL will be unlikely to recover, but that he will receive heroic interventions that will amount to medical torture before an inevitable death. I do not trust my MiL to make timely decisions that are in his best interest.

I know this is a fairly specific situation, but I imagine that some of you have been-there-done-that with older relatives who are unable to make medical decisions on their own behalf. Has anyone had any success in getting a PD decision maker to step aside and delegate to others? Are hospital social workers of any help? Are there strategies that might motivate someone to understand that she is not in a good place to make big decisions? It's probably a reach, but before I let go and just hope for the best, I wanted to see if you all had any wisdom to share.

I *do* understand that this is a problem of my FiL's making. He did not deal with pre-existing health conditions, and he did not do any end-of-life planning. He knows my MiL better than any of the rest of us, and he left her with the power to make decisions that affect him. Denial and inaction are tough things.

[Blueberry Pancakes]

Oh, I am so sorry to hear of your FIL's illness. These are some of the most challenging times.
 
I have sort of been there, and no, I was not able to get the person who had a PD and was also POA to delegate. It actually became a power struggle, and the wellbeing of the parent was off the radar.
   
Yes, the social worker did help. Your idea there is a good one. I actually spoke to the "case manager". Based on the day and time, that role rotated to other individuals, so I found I was repeatedly introducing myself and repeating the situation. How they specifically helped was I expressed my concerns and if I felt they understood my rationale, I asked if they could approach certain topics and direct the conversation a certain way to the one who held POA. I made some headway with that.   
 
It seemed to me that the hospital staff all assumed POA was the spouse regardless of age. I was surprised that nobody ever asked to see the paperwork, and they all just acted upon being informed of who was the decision maker. It was a bit chaotic, and protocols were not enforced. Of all the official paperwork my parents had completed, it barely even made a difference.
 
Aside from POA, there is the HIPPA form. If your name or your husband's is on that, I believe it should allow the medical staff to directly discuss details of your FIL's treatment plan, test results, and prognosis with you. You will not need to depend on others to obtain that insight. With accurate details, you may be in a good position to help guide dialog to the most productive course. If you live close and know when the doctor is doing rounds, etc., you could make sure you are physically in the room and are present during the real-time decision making. You could also put in a message to ask the doctor to call you and speak directly that way. Sometimes however, I never got any call at all. It helped to be more in their space.         
                     
Others will certainly chime in with other helpful insights. I will be hoping you get all that you need to attain the clarity and insight that will lead you all to the best outcomes.   
     

[Poison Ivy]

Is your father-in-law conscious and is able to communicate in any way? If he is and if he can communicate, the health-care providers should be asking him what his preferences are. "Mr. X, if you have a heart attack, do you want to be resuscitated? Nod once for yes, twice for no." If he isn't conscious or can't communicate, I recommend that you do what Blueberry Pancakes suggested. In my (limited) experience, health-care providers will give information to and accept guidance from any family members who are present, interested, and able to communicate about care decisions.

[HeadAboveWater]

Unfortunately, he is not presently conscious, as he is sedated and on a ventilator.

We did learn that upon hospital admission, he expressed a desire to be resuscitated, should he experience cardiac arrest. That is very, very helpful to know.