Fil wish to die at home/ not wanting treatment

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Fil is very elderly with a failing heart and has outlived expected timescales that was given over a year ago at last hospital admission. Has had a great year with no hospital admissions or seeing the gp. Has finally excepted a zimmer frame so isn't falling over all the time and ending up in hospital.

He has expressed the wish not to be treated with antibiotics/anything other than pain medication to keep him comfortable. He also adamant that he doesn't go back to hospital ever again.

What do I need to do to get his wishes in place so that it's official. I dread having to fight the paramedics to allow his wishes to be followed.

Has he made a living Will? Though I don’t know if these carry any weight with medics.

An advanced health directive is needed. They are accepted by all health professionals.

While he has capacity he can simply refuse treatment and refuse to be taken to hospital.

He can also give you and your DH lasting power of attorney for health and welfare which will help you speak with medics on his behalf. It’s easy enough to do yourselves on the govt. website without needing a solicitor.

Doesn’t he need to state/ complete a DNR?

You can ask your GP to arrange for a DNR to be put on file.

Can you ask his GP about a Respect form? My Dad filled one in with his palliative care nurse when he was diagnosed with cancer, and it was to ensure that Dad didn't receive CPR, or antibiotics - just that he would be kept comfortable and pain free. He had a copy at home in case paramedics were needed and one in his care plan etc.
https://www.resus.org.uk/respect/respect-patients-and-carers

who is calling the medics?

I've had so many family members wish to die at home. It's never happened at the end though, always need hospital for their pain etc

thank you for all your help

@Shoppingfiend i worry that I'll have to call the medics to get him pain medicine and/or I'll be in trouble if I don't call until he dies especially as he hasn't seen a doctor in a year. Plus he has carers in 3 times a day so they could call them in.

@IrresponsiblyCertainAboutSexualDimorphism yes but often before he hasn't been really with it when he has gone down hill before. Usually because he has an infection, each time he has had an extensive (traumatic) hospital stay but recovered. His health is declining and he'd rather not get treated next time because he doesn't want to decline to the point that he doesn't have any quality of life.

id also rather have his wishes clearly set out so when the time comes there isn't any guilt on his children part that they should of pushed to treat him.

Yes his GP needs to arrange a RESPECT form or whatever advanced planning document they use in your area. However, it needs to be very specific. I go to a lot of patients where the form states 'no hospital unless necessary' which is useless. It would need to say something like 'no hospital admission under any circumstances including suspected infections/sepsis, stroke, heart attack, chest pain. No artificial feeding in the event of not eating/drinking. No non-invasive ventilation.' Generally the only exception is obvious fracture ie, clearly broken leg, not just a swollen hand etc....

Agree it's worth discussing his wishes, and getting a RESPECT form done, whilst he clearly has capacity.

What @AnotherVice said. And rest assured ambulance crews are very accustomed to people who have made a well informed decision to stay at home, and will support that wherever they can. Good paperwork makes a massive amount of difference in an emergency. An advance decision is good backup but less familiar to everyone concerned.

But be aware - death plans are like birth plans; when it’s actually happening people’s needs might change in unexpected ways. Everyone wants a gentle, pain-free death; it might be that the only way to achieve this is in a hospital or a hospice.

Also, people aren’t just OK one day and then die the next. There tends to be a gathering/worsening of problems and a series of events that won’t kill him and where some treatment may alleviate the worst of the symptoms.

He needs to speak to his gp and get a DNR in place to keep at home..if he falls or anything they will help him up and anything else then leave him I was told a few months ago when my mum was dying.

It would also be good to see the doctor regularly because when he has a timeframe of less than 6 months to live they can get him on hospice at home. The hospice nurse was invaluable for us as she was able to tell us what pain meds needed increased/decreased and would call the gp/district nurses to get it done. She also told us when it was time to go on a syringe driver to control pain and other symptoms that my mum had.

Compassion in Dying has a lot of information about Living Wills, and what to do if they aren't being followed.

Worth looking at the website.

Have you thought what you would do if he needed nursing or care beyond the current carer visits? Thinking about the type of care he would need if he felt ill, has a fall, get taken to hospital sceanario.

Adding into other comments, my Dad was very keen to stay at home but once his liver started failing (cancer) it was almost impossible to keep his medication needs managed. The district nursing team was a joke, and the practice nurses unreliable in terms of timings.

He ended up in a hospice for a month where they tried valiantly to try and manage his pain; then a nursing home for the last few weeks.

A good death can be hard to manage at home. I'd want to keep him open-minded about where he can be kept most comfortable, whatever he's facing at whatever point.

Definitely talk to him about a living will : https://compassionindying.org.uk/how-we-can-help/living-will-advance-decision/

A DNR won’t cover e.g. antibiotics, IV fluids, etc.

A health and welfare P,of A stating that he wants no life-saving or life-prolonging treatment, should do it. There is space on the form for your particular wishes.