My dad ideally needs PT a couple times a week and OT to optimize function. A past PT who came a few times and an OT who came for an initial eval both refuse to come back again, reportedly due to my dad saying he will be non compliant, and being argumentative about everything, and the OT said he raised his voice. The home health agency is now struggling to find another OT and PT instead. THis would be Medicare covered home health therapy.
An option mentioned is going to a PT/ OT clinical practice, but getting him there twice a week would just not be feasible and he is resistant/ refusing that option - he wants people to come in.
Any ideas on how I should handle this? Should I tell him that its because of his antagonistic behavior that people are not wanting to come? (but I dont think that will be effective with his personality plus dementia - he tends to never accept that his behavior is at fault). The other option is to tell him that PT/OT is just not possible, so he wont get any physical improvements then if he is not fully on board and cooperative?
He should be told by the administration of the Home Health Agency (not you) that his rude and uncooperative behavior is causing therapy to cease.
so you are right probably that means he is technically competent.
He has expressed himself as non compliant. IS HE? I am certain he likely is. So that this is a huge waste of funds and resources.
Deterioration is likely inevitable.
I faced this with my brother who ordinarily was so VERY cooperative with everything. He improved so much in rehab a month with exercises for balance. SO MUCH IMPROVEMENT which he actually acknowledged. But once home, and later in ALF he refused to do these simple exercises despite knowing how much they had helped him, and acknowledging that fact. He just wouldn't do it. Other than the fact that he already now suddenly had all SORTS of people at him about what he "should do", and his need as a man who liked control of his own life to have at least SOME control of SOMEthing, there wasn't much I could do to explain this refusal to do the exercises. But he was stubborn and adamant that he would "do them when he wanted" and he never did want to.
I would give up on this. YOU can't control it, either.
Part of it is that he says he is so tired all the time, and often going to the bathroom with loose stools, he doesnt feel he can keep up with all of these appointments.
I'm ok if he just skips these at this point. I just dont want to be a "Bad POA" or "POA not doing what should be done by a POA"
however, for healthcare decisionmaking, he has not officially been declared chronically incompetent as BarbBrooklyn mentions.
The DPOA pertains to financial stuff. The healthcare proxy document says that I take over in medical decision making when he is not able to , but from my understanding, ability to make own decisions can fluctuate over time I believe....
The norm is get a programe. Client does on own in their home/room.
Only those highly motivated individuals can do so.
To succeed, many may need many things. Need 1:1 staff to do it with them, staff they connect to very well, ensure pain relief is given prior, a clear reward at the end.
The stars to align just right.. not always possibe.
When he becomes wheelchair bound due to lack of physical exertion, and has no core strength left, then he'll be wheeled around like my mother was. And helped out of bed because he won't be able to do it alone.
There are consequences to all actions we take in life. Including those taken by stubborn elders. And there's certain things an MPOA cannot fix for stubborn elders, too. #Fact
This outpatient twice a week stuff is much more limited. Even if they do come, without him practicing daily the exercises, it may not accomplish anything anyway.
My Dad had a bad heart and was having problems with his legs. In home was ordered for him. The PT was a woman and came into his home with barrels blazing. "Well, Mr E we are going to do this and that" My Mom said she was overbearing. My Dad told her no d**ned woman was going to tell him what to do. The PT discharged him on the spot. Mom was called and told that Dad can't talk to the PTs that way. Mom admitted Dad is hard to deal with but in his defense, the woman was overbearing. So they sent out another PT and Dad had no problem with her.
If you are Medical POA its probably only in effect when a Dr. says Dad is incompetent to make his own informed decisions. Your part is only to make sure Dads wishes are carried out by Drs and staff. If something comes up that is not covered by the MPOA then you make the decision based on what you feel Dad would want. The MPOA does not mean you physically care for him or need to take him to appts. The MPOA just gives you the ability to talk to Drs and staff and make decisions for Dads health.
I had great luck with therapy in home for both parents and dh aunt. My mom did her exercise on her own which aunt never did but all were benefitted . . It is simply amazing how little it takes to make a difference.
Something you might consider for your dad is talk therapy. Original Medicare pays for it. You might find someone who would come to him. If dad is good with the phone he could more easily find someone who would call him. This would give him a sounding board for his complaints and might free him up to do pt or ot when he’s had a good vent or has a chance to discuss his issues with someone who seems more on his side.
I have one I talk to twice a week. We often recommend therapy for caregivers but it could also help your dad. Just a thought.
But if dad doesn’t want to do ot/pt, perhaps table it for now and offer again later.
File under 'Oh well' 😶
Sorry, I can't think of anything else. All I know is my Oh Well file is growing nicely.
Why bother with the PT if he will not cooperate? I wouldn't, it is what it is. If he doesn't want to get stronger and do what is needed that is his decision, trying to force the issue will accomplish nothing.
Hang in there, next week there will be another issue to deal with, choose your battles.
My Mom (who died 4 years ago), and was very opposite to my dad, was similar to what you describe with your Dad. She felt motivated to try, enjoyed having something to do and someone to chat with a couple times a week, did the sessions but did not really practice much on other days, but did not really make any progress, just slowly declined. Maybe the PT helped to slow down the speed of decline? Who knows, but she was happy with doing the sessions, and the PT was fine with it, so we kept going.
My dad - the opposite in most ways!