Appropriate familial care for an 82-year old Stage IV CHF patient?
My 82-year old dad was diagnosed with CHF a week ago and given low dose lasix, which did not reduce lower limb swelling or dyspnea. Two days ago, the echo showed an EF of 15%. Cardiologist said end stage CHF. We are shocked. My Dad has no other heart involvement or other comorbidity factors (diabetes, for example), and is otherwise healthy, albeit with orthopaedic impediments due to two prior spinal surgeries. He has left leg swelling, intermittent dyspnea, is easily tired, and is not eating. He is also starting to cough, but I don't know if that's a side effect of the lisinopril or an indication that fluid is pooling in his lungs. Last week, my dad climbed stairs, made coffee, cleaned his dishes, dressed himself, and the like. Since the end-stage diagnosis two days ago, my sister and I are taking turns living there, and we now do almost everything for him. My sister-in-law, who is a wonderful nurse and has been a true Godsend during this time, suggested that we not do this as it will make his condition worse. She thinks that if he has any chance of improvement, it will be because (a) the drugs (lasix, coreg, lisinoprel) kick in and relieve the severe swelling in his legs and likely lungs; and (b) my dad remains as self sufficient as possible and learns how to accommodate for the disease. I see her reasoning and will do whatever is best for him. At the same time, I've been with him around the clock for the last two days. He dresses and shaves himself, but is unsteady and exhausted while doing so. He only eats if I finagle food into him. When I discussed this with my dad, he said that he wanted me to stay with him. I gladly will, but I don't want to hinder any potential progress. Moreover, I fear that, if left unattended, he will fall, sit around in his pjs all day, not eat, or have a MI or severe dyspnea. My brother says to leave him with his medilert necklace. I have no idea what is best for him. We don't see his doctor again until Thursday. How much or how little help do I give him? Is this a marathon or a blink of an eye? Should I go on FMLA now or wait to see if he's going to need much more acute care down the road? If my Dad only has a few days left to live, I damn sure don't want to be sitting at my desk while he's all alone in his house. Thank you, in advance, for your thoughts.
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