My dad is living independently with my brother’s & my help (finances /groceries /cleaning etc). He has PSW’s coming 4 x a day for a total of 1.5hrs...he allows them to change his bed, give med’s, and serve him some food. But won’t accept hygiene help saying he can do on own - but it’s often too much for him to do it.
It has gotten to to point lately that he cannot get up without extreme difficulty or needs help - his foot, hip & back is always hurting hurting. He is almost 89 yrs old. He won’t get therapy, go to doctors/hospital to get it checked out. Prior hospital stays resulted in getting temporary physical therapy at home; and lower spine arthritis, and numbness below the knees.
His ability to live on his own is running short on time in my opinion. He is stubborn, and difficult to reason with; and lacks insight (dementia symptom).
I thought about other family members to talk to him...but thinking a professional may have better experience in these matters.
The thing to point out to him is that if he wants to continue to live alone at home, he needs to manage his own care by commissioning the right services. Whereas if he wants to be wheeled into a nursing home, willy-nilly, and have no choice about which one even, he is going the right way about it. If you find yourself getting frustrated, drop the subject: you call it lacking insight, but he probably calls it "I don't want to know."
It sounds very much as though he is afraid that admitting to problems will get him "taken away." The opposite is true.
It's also possible that there is some physical or medical problem which embarrasses him - could be pressure sore, foot issues, anything under his clothing. That's another question best posed to him by professionals, not you.
He is very dependent, just living in his own home. Why would he want to change, everything is being done for him, and it does not sound like it is costing him financially?
Does he have his paperwork in order? POAs, Will etc? If you are concerned that he may be slipping into dementia, this needs to be attended to pronto.
Are you and your brother keeping good records of his financial transactions? If at some point in the future you may need assistance, this is very important.
Now how to get him into care? First you and your brother need to withdraw the help you are providing. Sorry Dad I am too busy to do your shopping. I cannot afford to pay for your house cleaning, you will have to pay now. Make it less comfortable for him to stay at home.
Hygiene, is there a community bathing facility you can use? I live in a small town and one of the IL facilities allows none residents to book the bathing facilities. There is a free, but all the equipment to safely bathe a senior is there.
Barring that, perhaps your brother can help Dad out. There are a great many posts here with tips on how to make bathing more accessible and comfortable for seniors. For some it is a fear of falling, for others modesty, others being cold and still more simply being physically incapable.
Is dad on any prescription medication? I know you say he does not like to go to the doctor, but if he is on an Rx that has been renewed over and over for a long time, perhaps you can have the doctor call him in for a check up and to review his RX.
Prior to the appointment tell the doctor your are worried about cognitive decline.
Good Luck.