My 90 year old parents lived in IL until 5 weeks ago when dad fell (for the 3rd time) and broke his hip. Mom has severe dementia and is in respite MC because she is an elopement risk and extremely belligerent, everything is on her time. Pins were put in Dad's hip - surgery and recovery in SN has gone well. Dad tries very hard and is very successful in therapy. However he does nothing for himself when he is back in his SN room. He continues to just eliminate in his depends and expect to be pushed to meals. He never rings the nurse to tell them he needs help to get to the bathroom or when he needs changing. He is on 2 hour routine toileting checks - at which time he'll do what they tell him to but no initiation on his part. He is scheduled to move to AL in a week. I'm told he needs to be toileting (or using depends) himself to move to AL or he'll end up in LTSN. He does not want LTSN and even keeps asking if he and mom will be living together in AL. He can't take care of himself, little alone Mom. He is scoring well on the SLUMS test so dementia is not the issue.
We are lucky they are in a continuum of care facility so they will only be 1 floor apart and will be able to see each other a lot and even occasional eat together. I have talked to Dad repeated, even cried out of frustration with him, but I can't seem to get through that he has to get back to participating in life if he wants something other than LTSN. How do I get through to him?
Sadly, I don't believe there is any way to get through to him. Discuss these issues with his medical team because they need to be fully informed before he gets to a place where he can't function well enough to be happy. AL may not be for him.
He is 90 and he is only going to get more frail. You cannot expect a man at his age and in his condition to keep up the amount of self-care he needs to qualify for assisted living. Accept that he needs LTSN and move on to helping him adjust.
My DH aunt (96 with dementia, bed bound) was aware that she had a BM but not until after it happened. As she put it, “I don’t go but it does”
Your dad has gone through a lot and no doubt he is very tired. If he was your moms primary caregiver before, he may need a minute to recover if it is even possible. Many elders who have the responsibility of caring for a spouse pass before the one with the obvious issues. Even with having help, he probably feels like he must watch over her.
I would be concerned that he needs a wheelchair and isn’t using a walker at this stage of his recovery. Have you asked his PT team about that and about ongoing therapy? I’ve had a couple of elders who have gone through broken hips and they were mobile very soon afterwards so that’s surprising to me that at 5 weeks he is considered doing well in therapy but still in a wheelchair. Perhaps he is walking in therapy, just not in his room…
Was your dads SLUMS dementia testing done AFTER the surgery or before?
Just know every major event, change of location etc can cause mental decline and confusion and progression of dementias.
Since the facility you are in has a continuum of care, whoever is telling you he won’t be accepted in ALF is telling you the policy for that facility.
I think I would look for an alternate facility just to explore options. With two, especially if private pay, you might find a willingness to work with you on having them be able to see each other on a regular basis. Facilities are not all the same. We tend to think the one we have experience with as the way they all are. Not always the case.
If you will need to be filing for Medicaid at some point then you may not have a choice but to use SN/NH as most states don’t provide Medicaid in ALF/MC. You would need to check for your state.
My DH aunt was in an ALF completely incontinent. They had no problem with it. They just charged according to services needed.
You certainly have a lot to deal with. Please know that you must pace yourself and allow their needs to guide you. You being in tears because dad is incontinent will not help either of you but I certainly do understand the difficulty of these moments. I would not pressure him. He is probably doing the best he can.
I would have his tested for a UTI just in case he has one me that has increased these dementia like symptoms.
You must take care of yourself. All three of you are depending on you. Take a moment to realize that they are in decline and it’s no longer about trying harder. More about making sure they are able to get the help they need. Big hugs to you.
My FIL's AL puts up with his incontinence, that he does take care of properly on his own, Tried toileting schedule. He refuses and sits in the same depend all day. He only changes his wet depends when he gets dressed or undressed because he struggles so much with his shoes. He refuses help getting his shoes on and off or to wear slippers . He refuses help with changing depends unless he has a bad bowel blow out from laxatives that he needs.
Good luck.
The AL I worked for did not allow residents who no longer used a toilet.
Sure, people used pull-ups and pads but they were not allowed to replace the toilet.
If a resident became incontinent and stopped using the toilet, they had to be moved out.
So my guess is it is not motivation.
It's either physical (pain. stiffness, weakness) or mental (cognitive effects/delerium post surgery). Any or all of these factors.
Thinking about you.
How is dad doing in rehab?
How are you managing?
I don't think your dad is being lazy or belligerent. I think the part of his brain that controls impulse is faltering. Also, it's very possible that your dad fears he will fall again, whether up walking around or worse, going to the bathroom during the night.
Unlessyour dad becomes confident using a walker, his mobility issues will only get worse until the wheelchair is his only option.
Are there any activities your dad enjoys that would compel him to want to get up and moving? What about a family picnic?
He can be in AL with a wheelchair and Depends. Is that not possible where you are?
im 83. My bowel has fallen on my bladder so guess which one is causing me a problem. Of course it could be a brain thing too ??? But 😾 it’s not the part id “hoped” for.
i get to the bathroom sometimes and seems it’s WHAT ! Not again !!! I havent even noticed anything.
so, your dad may forget but he may also may not realize it.
Have a meeting with him and his doctor. Both of you tell him that if he refuses to start using a toilet again he will have to be in the nursing home area of the facility he's in.
Then explain to him what the differences are between that and AL.
He will not have the freedom to come and go that people have in assisted living.
He will very likely have to share a room if he's in going to be living in LTSN.
Let him know that AL allows the hiring of a private aides that come to help and who will take him out.
Have his doctor tell him in these terms too.