Do I trick my dad into surgery?

Happy to hear that the doctors have figured out that this surgery is probably not the best solution and/or isn't likely to happen! Hopefully there might be some kind of topical treatment that might help in some way - slow it down or treat it a bit.

Also concur on the idea that not everyone can go the AL/MC route. Too many immediately suggest placing people without considering that many can't afford the cost (even worse are those who say NH because people have to meet certain needs to be eligible for that - needing specialized nursing care, dementia isn't enough - and it is even more expensive than AL or MC! On top of that are those who say Medicaid will pay - not always the case there either!)

Although we didn't have to go the guardian/conservator route, I do understand that management of their care takes effort and sometimes a lot of work! Our mother is in MC (thankfully she can afford it) and although I have 2 brothers, all the financials, medical care, paperwork, contact, etc, goes through me. Some months are better than others, but it is still a lot of work!

Blessings to those who have to tackle all these things AND provide the hands-on care! For many reasons (esp any physical care) I can't care for her myself, even if we could hire help, but ensuring she is safe and cared for is something I can provide.

Hoping things go well for you, as best they can given all the issues.

Have y'all ever just applied Vitamin E oil and other skin repair agents -- organically and all? There has to be a eastern (oriental) method that is less invasive. Surgery should always be the last resort. Tea tree ointment and/or tea tree oil can maybe slow the growth . Good luck, and Godspeed.

Update! The surgeon called again yesterday , after consulting with an expert and was advised to not undertake this surgery. Aside from my dad being against it--and he was clear about that-- she said it would likely disfigure him to the point of him not being able to eat, and that infection was too likely, as well as the trauma of putting him through it all.

She was very gracious in the reversal of what had been her original reaction, prognosis and plan (or lack there-of). I'm so thankful she consulted an expert. I am grateful that she and her staff and his regular MD, his caregivers and case worker, and the court investigator are all kind to him, caring and not grossed out by his hygiene issues. He does the best he can. I do the best I can.

We all need to understand that memory care facilities and assisted living are for people that have money- not very poor people. My dad will eventually be in a nursing home or mental hospital ( via Medi Cal)--but not until he is failing in other areas. There are a lot of people checking in on him. Being a conservator is not something one takes on lightly. There are a lot of hoops to jump through and checks and balances.

I thank everyone for their response and input. We're all in this together.

When the surgeons suggested the sedative to get your father to cooperate with the surgery, did they have a game plan for explaining the bandages and alteration of his face? When the physician said that he will have a hole in his face eventually, could he provide a time frame? It seems to me that there are more pressing issues to address such as his hygiene. I think he needs to be placed in a facility. A physician preferably a geriatric psychiatrist needs to be consulted to manage his behaviors with medications. I'm worried that someone may call protective services and charge you with neglect.

Do what the doctor said. He really needs to be in a nursing home. Nobody in his shape should be living alone and nobody should go 8 months without a shower. I can’t even imagine the stink or the stuff crusted on him. It doesn’t matter what he thinks at this time in his life. He isn’t in his right mind.

IMHO, he should be told about the surgery and should have it. Someone is going to have to handle his hygiene, though.

If you know he would not want the surgery, then I would not do it.

Regarding my uncle, due to his dementia I did not consent to treatment as I knew being in hospital would just cause him more stress and he could get quite belligerent at times if confused. Yes it was signing his death - but he went on another 15 months longer than the doctors predicted. For the majority of that he was happy and non stressed with pain relief and doing the things he enjoyed.

First of all-- tricking him is not being mean-- it is helping him--- he SHOULD NOT be living at home but be in an assisted living facility and he needs to be tricked to get in there as well--- so Invent a reason or two-- tell him you all are going to a big hotel and give him something to drink-- and knock him out.... then when he comes to, tell him his home burned down because he left the stove on. My father-in-law did that-- they were stupid and took out the stove--- they should have taken him out--- he died from falling a week later. STOP playing fairly--- be that POA-- or let someone else to it who is going to be more about helping him instead placating his insanity. After 2 weeks in the facility he will forget about his home and be all about making every meal on time and watching TV in his room. Do not feel guilty about being the Tough Lover. It is your job.
OH-- btw--- he will need to be in a place where they can bathe him and change the bandage on his face--- and he may have to be restrained the first few nights to keep him from scratching it.

My father had a very small skin cancer removed many years ago by his nose. In his late 80s, we asked about a small spot on his temple and were referred to a dermatologist, who found 4 spots to remove in her office. Then a year later, a couple more. After that healed, they told us they didn't get it all and he needed a Mohrs (deeper surgery) for the area beside his nose, which had been removed years ago. He was tired of having his face cut in the more superficial removals; the healing process was slow and he kept picking the bandages off his face, etc. Got blood all over his sheets. I asked how important it was to get this Mohrs surgery asap. They told me at his age/dementia, we could wait a year. We chose to wait. A year later, he went in for it - knowing why he was there but still surprised at the pain. I was present in the room for it and a little horrified at how much they took off. Not even to the extent of what you describe for your father. I was amazed at the traffic in the waiting room as people filed in/out to have pieces of their face removed and I decided it must be lucrative.

When I took him in for cataract surgery - also in his 80s and with moderate dementia - the doctor and I went over and over the process ahead of time and I managed the drops since Dad couldn't. The doctor talked to him just before surgery and still, after the procedure, he was surprised by it all, thinking he was just getting his eyes examined.

Darlin. I, too, am my dad's conservator. The courts take the conservatorship very serious. You may want to consider moving your dad to a home or getting him closer to you. Drs can give rx to calm a person down. When my dad went through a combative stage with me, I had to crush pills & put them in his sandwich. If you are eating with him, just don't mix up the sandwiches. LOL.

Drs found basel cancer cells on my dad's back. I knew he would not allow anyone to hurt him. Surgery was discussed, but, biospy first. I warned the dr before she attempted to numb the area for the biospy. He threw her across the room. All the medical personnel left the room. The doctor, then, came back with a cream that could be used. It's Imiquimod usp, 5%. It comes in small packets that are applied every weekday morning, no weekends. The cream worked by taking off layers of skin without pain. It has been used several times now.

Basal Cell is typically slow growing and *generally* doesn't metastisize, but there are rare exceptions. As noted, your concern is not only how to get him to the surgery, but post-op care. Our mother, during early signs of dementia, had a spot on the edge of her lip. When pointed out, she dismissed it as a scab, hasn't been there long, etc. The only thing I would do is try to encourage seeing her dermo (she was religious about going and getting dad to go previously!) Nope, it's nothing. Even when another area on the side of her nose appeared. During one of her Mac Degen checks/treatments, THAT doctor told her she should have it looked at - then she went. Sure, don't listen to us!! By that time, the one on the nose required a little skin graft. For the most part her after-care went 'okay.' She needed prompting once in a while, but was still living alone with no care givers (we did try then at some point and within a short time she refused to let them in!)

Years later, after moving her to MC, another spot appeared on her cheek. The dermo doc suggested Mohs, which was how it was treated before, but when they said I couldn't be in the room with them, to ensure she was co-operative, they went with a "punch" biopsy instead. We did have to do it a second time, when the test results showed cells on the edge, but it was done in his office both times with just a local anesthetic. After care was handled by staff at the MC facility, but it was minimal. So far I have not seen any recurrence (2 years now?)

At her age, with dementia, I would not put her through the Mohs and told the doc that. I did want to try to nip it in the bud, so to speak, to at least delay any additional growth because of where it was on the upper cheek, about where her glasses would hit.

In your dad's case, getting him there, getting it done and treating it afterwards will be a monumental challenge. It does sound like he is on the cusp of getting facility care. You haven't indicated how long he has had dementia, what type it is or what stage he might be in. If he only has a few years left, I would focus on getting him into a facility and perhaps having at least one bath! Also, provided this is run of the mill (if there is such a thing!) dementia, not something like Lewy Body, would it be possible to get some anti-anxiety meds into him, even if the care-givers have to put it into his food? When mom had a UTI, we had to use this as she developed some serious sun-downing. Generally she is calm, fairly quiet, reads her paper, magazines, sales flyers, etc. With the UTI - off the rails! She only got the minimal dose (he might need a bit more), which was just enough to take the edge off. She was not doped up and it doesn't take time to build up in order to work. You should see results the first/every time, fairly quickly. This would be just to tone him down a bit, and perhaps make him a little more compliant with simple issues like a bath.

I would also have a frank discussion with these doctors. They clearly do not understand the whole dementia process. Gung-ho surgery away! Sure, dope someone up to come in, do the deed and then release him to himself, non-compliant? I would also be concerned about the fact that this has been 'excised' twice before - same place and same doctors? Why has it come back? Did they not do the job properly? None of mom's has reappeared.

I would also inquire about any alternative, less invasive treatments. I did find an NCBI review of the various treatments that are offered. Some have side effects, some have not been studied extensively enough to say how well the treatment works, but they have shown good results in many cases. If there is something they could offer that wouldn't require a lot of effort on his part/help from others, perhaps it could be considered (or seek second opinion.)

Focus on keeping him safe (and clean) first! We have to choose our battles!

Are you an only Child? I would request FML leave if needed as it appears you investigate the quality of home care. If your father is resistant to his caregivers in the home it may be better to have him in an assistant living facility. the first thing I would do is make sure he gets proper hygiene then take him to the doctor and find someone to help support both you and your parent. God bless.

Don’t do it. You have done all you can do.

Based upon your description, that 'sedative' would have to be a horse tranquilizer: )
By and large, I try to respect my dad's wishes unless they could harm someone else (like when we made him stop driving). He's also has mid-stage dementia and hasn't done even basic hygiene in years.
If you haven't already, press the doctor for an alternative (topical chemo, etc) that may keep the cancer from growing as aggressively.
Doctors can be incredibly obtuse about issues that the families of the demented elderly face. S/he clearly doesn't understand the degree to which your dad is resistant. Is there another doctor who could give a second opinion or at least be more realistic about options?

His neurologist can prescribe Seroquel which will calm him down. Skin cancer probably needs Mohs surgery & can be done as out patient in dr office. Good luck & hugs 🤗

Darlin: I can't imagine what you're going through. I am so sorry for what your father's going through. You've been getting a lot of wonderful advice so I won't repeat it. Here's a perspective I came up with that has helped me almost instantly know the right answer to an ethical, moral, or emotional question:

A month from now, a year from now, five years, ten years, what action could you regret?

My questions that needed answering using this technique are WAY more simple than one you're facing, but looking at this dilemma from this perspective may help you figure out what's right for your dad, and you.

As a first step, I would consider going to the doctor who diagnosed your father's dementia, and ask that doctor if your father still has the capacity to make medical decisions (and it doesn't sound like he does). Better yet, that doctor should state it in a letter so you can wave it in front of any of his doctors from now on. (I'm also thinking about end-of-life decisions here, like 'do-not-resucitate' orders, or treatment that could keep him alive, but leave him minimally functional, in which case a doctor's letter would be very helpful.)

If he no longer has the capacity to make medical decisions, then you can override her father's refusal to have the surgery, although getting his cooperation would still be preferable.

By the way, my mother is also very stubborn & very paranoid. The only time she agrees to bathe is if she's going to see a doctor, and she hasn't brushed her teeth in ages (even before going to the dentist). Even though more socialization would probably benefit her, I can't imagine most people would want to be near her because of her poor hygiene.

Maybe consider hiring an elder law attorney, who can give you advice on what you as your dad's conservator can legally do to to him in the name of "intervention" versus what you are willing to do to him. How far are you willing to go as his conservator? Have you considered getting him a long term care bed in a psychiatric hospital so that his mental illness and dementia will be treated for the rest of his life?

The trouble with letting nature takes its course (which would normally be my default position too) is that in this case nature plans to gnaw the man's face off, potentially, before it gets round to killing him.

I really would plot the "what happens if we do do this?" versus "what happens if we don't do this?" charts in as much detail as possible before deciding. Make the surgeon sit down and concentrate on the questions.

Another baffling question, if you are his conservator why is his hygiene and basic care not being addressed? How is he living alone with mental illness? I agree the skin cancer seems like down on the list of things that have to be addressed. I’m actually surprised APS hasn’t intervened.

I would call hospice. If your dad does not want the surgery, and you as his conservator want to respect his wishes, see if he qualifies. They will make him comfortable regardless of his condition.
This is a tough situation. Sorry you are going through it,

Gosh, it seems that he really needs that surgery. It should be taken care of and hopefully for the last time. It seems to be coming back to cause problems. I wouldn't want to let anyone live with that and in the long run will cause even more problems for him it sounds like. I hope that between you and his caregivers and doctors, you can come up with a plan. Prayers for strength in dealing with this for you.

I understand your desire to get this "fixed" for your dad. Consider what the aftercare of his surgery will look like:
hating the pain and not taking pain meds?
fighting the staff to change his dressings?
trying to remove sutures or staples himself before wound is ready?
doctor or nurse having to do house call since he won't go to appointment?
possibility of eroding your dad's trust in you?
If you have a good plan in place to address these issues, go for it.

If you can't fathom how to manage the care after surgery, it might be time to admit that the time is coming near to "not do" anything except comfort measures. He might need a feeding tube inserted into his abdomen to get full nutrition if the cancer erodes a hole in his cheek. He is probably not comfortable with the cancer now and might be ok taking pain meds if explained these will help him to be more comfortable. There are skin patches that could be placed on his back - where he could not reach. He may allow massage - and somebody could also clean him at the same time. If this is more acceptable to you, talk with doctor about hospice services.

Your father's lack of hygiene and lack of co-operation sound like he needs more intervention than he is willing to accept. Does being his conservator give you legal power to force intervention for health and safety? Your father's general situation sounds more urgent than his basal cell cancer. The basal is slow growing but given that it is on a path to cause more difficult health and hygiene problems, it needs to be dealt with. It doesn't seem right to just let him wallow in filth and confusion no matter how much he protests any interference.

Darlin, I’m late seeing your question but will relate our experience with this. My dad doesn’t have dementia as yet, but does have a dermatologist and his referring surgeon pal. I’d love my dad to break up with both. My dad has has surgeries twice in his old age for skin cancers. They were both much as you describe, but one was further along and required a skin graft to repair. Both turned into long, painful, and frustrating recoveries for my dad. He simply doesn’t heal quickly or well like he did as a young man. He comes out battered and bruised, weakened and tired. For us as a family, we found it cruel. And yes, the docs paint the dire picture of all the bad that can happen with not doing surgery, but when we actually researched it, we found these cancers grow so slowly our dad will die of something else far sooner than this, he most likely wouldn’t even get to the further effects like the hole you describe. The docs don’t see the recovery part, it’s not their problem. Now that it’s finally behind us, twice, even our dad agrees that it was a mistake, and that was with a dad who thinks clearly and has god hygiene. I can’t imagine the recovery with your dad’s situation. Blessings to you in this as you make this decision, often there aren’t any right answers just the best we can do

This is complicated. You have to balance the possibility that the cancer could get worse and cause real difficulties with eating with his dislike of surgery. Is he in pain and could the pain get worse? For this one, treatment just to stop the progression of the disease may be warranted. He'd have to be anesthetized. That being said, if he hates doctors and surgery and is not in pain, perhaps it is kinder just to let him be. My mother with dementia also doesn't like to be in the hospital (she was biting the nurses), so we put her on hospice-type care where we just make her comfortable and she doesn't go to most of her doctor appointments any more, just the one that is in her assisted living facility. She has "no hospital" medical directives. She seems much happier this way.

I don't see any answers here that really address it properly. You are in charge of doing what is best for your father, exactly like the role a parent has for their child. Now when a child isn't doing what is in their best interest you have to make a decision to force them to do it. Similarly, your dad wants to live. Now ignoring cancer is incompatabile with that goal. So the fact that he isn't in a right state of mind and is scared of pain doesn't matter in the bigger context of doing what he needs. So listen to the doctor and trick him.

If you are this Conservator, You have Dead On Rights Here, dear. Enfdangering the Welfare of an Elderly person is against the Law, And e'en if Dad don't Care because he is not Glued on Tight, You have no Fight. Get all you can to Intervene and Get him to even a Place where he is 24 Seven Care.

You cannot legally trick or fool someone into surgery. Ask for an ethics committee conference.