The Banjoman is currently in hospital “recovering” from the operation to pin the break in his femur after he fell in his room in the Care Home a fortnight ago. As expected, his physical and mental abilities have deteriorated, to such an extent that he struggles with eating and drinking, needing assistance with both, which he persistently resists. Because he is consuming so little the staff have tried to fix him up with a cannula for a saline drip but he continually pulls it out. They want to do blood tests but cannot get near him because he fights them off quite violently. He also objects to any personal and medical care. Visitors have managed to feed him a few times with ice cream & jelly or some soft foods and he has accepted some form of liquid food syringed into his mouth by a nurse (possibly because he had visitors and decided not to make a fuss in front of them?) but most of the time he just wants to be left alone. His cognition is such that the physiotherapist has not been able to get him out of bed because, as the nurse told me, “He cannot engage with them”. I know that he cannot understand the simplest of instructions so I think he is going to be bed ridden for the rest of his life. His speech is indistinct, before hospitalisation he was perfectly understandable though not always talking sense. I have told the ward that an Advance Directive is in their possession and personally I am beginning to feel that if he is refusing sustenance most of the time, and there is very little chance of him improving, that maybe they should be taking the AD into consideration because the only thing happening is that his life is being extended while he is suffering mentally and physically for no good reason and, I believe, against his wishes. Has anybody else dealt with this situation please? I think the problem is how the medical staff interpret the conditions of the AD, especially if he accepts some food from visiting family but fights off medical staff. I should say that I have LPA for H & W (his original choice) along with family members who I insisted should be on there for just this type of situation as I felt they should be the ones to decide ( and I wouldn’t get a load of come back if they didn’t agree with me).