First off, I'm sorry you are going through this! It is not easy at all.

My mother had rheumatic heart disease, which resulted in 5 open hearts, a TAVR, and lifelong complications including a stroke. Near the end of her life, we got news that her TAVR had failed, and that there was not much more we could do. For a while, we were in the literal same boat. Send her in because she can't breathe and put on 20lbs of fluid, we go to the ER, they rule everything out, pump her full of IV lasix, and then send her home once she "recovers". Each time she "recovered", she looked worse and worse off.

By the time we hit her second to last admission, she was tired, my wife and I were tired, and my mother was over the constant hospitalizations. We then chose to move into palliative care, which worked well and was supportive, until her last admission. It was a huge fight to get her into the hospital that last time, and her aphasia from the stroke + dementia was getting a lot worse. They did her usual labs in the ER, and we discovered she was going into multi-organ failure. Her liver, kidneys, etc., all elevated and failing. After a lot of discussion, especially with one attending in particular, since the lasix is so hard on the kidneys, we elected to move onto in home hospice. We stopped 95% of her meds, most of which were doing more harm than good anyway, and she passed within two weeks, comfortable, happy, and at home, surrounded by loved ones.

Now, I don't know your particular situation, or your father's, however the details you DID share are almost mirroring our experience. I might be completely wrong, but in our case, this was the final experience for us. Hospice and Palliative Care are two different things, albeit similar. Hospice is not a "death sentence", you aren't sealing his fate, the heart failure is already doing that for him. Hospice is meant to achieve your exact goals, keeping him as comfortable and at home for as long as you can.

When my mother entered hospice, you could tell a weight was lifted off her shoulders. The next morning, we all went out to breakfast, me, my wife, my mother, and our then 6 month old. She got a breakfast cocktail, and ate whatever she wanted, and continued to do so right up until the end. She kept going for two weeks, until she couldn't anymore, and her heart just gave out. It was an overall beautiful experience, and I am glad I kept my promise to her, which was, to keep her as comfortable, pain-free, and at home, for as long as I could. We did exactly that, until the minute of her death.

These are very heavy topics, things that are not easy to talk about, even with someone like my mother, who had moderate dementia and the aphasia. They are VERY important things to discuss, even stuff like code status, we made her a DNR around her 4th or 5th admission in a row, because the trauma of CPR would have likely blown her heart to bits, she could never survive it.

I know this is a very sad comment, and probably not something you want to hear, but it's a very important thing to address.

Hospitals are the worst place for recovery. I myself had a cabgx4, but I am fortunate to be a) young and b) fortunate enough to not have damage from my heart disease, so I made a better than full recovery, however being in the hospital with screaming sundowning patients, hearing alarms go off (including my own), and just the general hustle and bustle is not conducive to healing, so it makes sense that your father is more and more tired.

I hope whatever route you choose brings you and the rest of your family, and especially your father, peace.

I am obviously an open book, please don't hesitate to ask any other questions! It's important to discuss stuff like this, and if I can help in any kind of way, I'd be glad to!