Elders who distort reality, for lack of a better way to describe it. Is there a helpful approach to get around some of this?

No one should be killing themselves doing his lawn. If he's as strong as he says he is, he should be able to keep it up himself. Then he can see what happens.

Other than that, there's no "getting around" this. You need to call APS or get POA.

The only way to introduce him to reality is to step back and/or call in APS to determine if he is competent to care for himself.

His lack of reality testing does not obligate you to kill yourself keeping up his charade of independence.

You do not indicate if there are any medical problems. (dementia popped into my head with the refusal to shower)
All you can do is WAIT until something happens that will require a visit to the hospital. THEN you can honestly say that he is not safe to return home unless he has help and a plan in place. the hospital will not discharge him if it is no t safe.
The other thing you and the rest of the family has to do is stop propping him up. He is able to stay at home because y'all are doing what needs to be done in order for him to remain. Why would he accept help when y'all are doing the work he would have to pay someone to do?
Why cook a meal when meals are brought to him by a family member. Or why have someone come in a cook and clean and do laundry when you are all doing that.
Is there a family member that has POA for Health? for Finances?
Stop killing yourselves. It will be difficult to do and the house and yard will look terrible. It may even take a call to APS and report him as a vulnerable senior. That might shake him to the point where he will have to accept help.
That is IF he does not have dementia. With dementia you can not reason with him and someone will have to step up and assume responsibility (if no one has POA) A Guardian will have to be appointed.

As long as you and your siblings maintain his "charade of independence" he has no reason to change and, after 5 years, it's high time you and your siblings tell him that you're no longer enabling that charade. You can't really "get around" it. Time for straight talk.

His needs are only going to increase. He needs to pay for in-home services like housekeeping, grocery shopping/meal prep, and lawn care.

There's also probably a touch of dementia in the works.

When my ALZ father kept insisting he could keep up 3 acres of land, and I kept finding the new tractor dead in the lawn.. ( and he kept calling the dealer when it was actually out of gas_) I just hired a lawn service. Mom and I told him was "free" and he went for it! Mom just gave me the money and I paid them, and they were warned in advance to play along. Would your siblings go along with this? Sounds like they might as they are killing themselves also? Meals on wheels is sort of free.. would he go along if he was told it was a free service? As to the no bathing and falling,,, I have nothing

Sandy, stop killing yourself and say "no, I'm not doing the lawn (fill in the blank for other jobs)" any longer.

Can you do that?

Sandy, you were perfectly clear. None of the replies assume that Dad is ‘acting helpless’, in other words faking. The household needs the help, and it doesn’t really matter if it’s Dad who can’t do stuff, or you, or his other kids. Please read the replies again. Realise that no-one is criticising you or Dad, and the ‘charade of independence’ is a very common issue and not a game. It just happens when the problems get masked by other people killing themselves to cover them up.

Oy vey! Men!

My dad had the same perception as yours.

I would just hire help, get a housekeeper, he pays his fair share, hire a personal chef to do prepared meals, he pays his fair share, hire a lawn service, again he pays his share. Be decidedly immobile with your resolve that you need this help, period end of discussion,. Ya know dad, not everything is about you!

My dad was less rebellious when he believed that I was the one that couldn't cope. I learned that he was going to believe whatever about his own abilities, so I quit bringing that subject up.

Maybe have a date night that you both dress up for once a week. Showers, shiny shoes (rubber soles) shave, the whole shebang.

My dad always said it was his 1st fall, every single time. I learned to keep sharp objects out of his way and how to determine if he was hurt or just shook up. Saved many ER visits.

Learning to pick our battles is a challenge and letting go even a bigger challenge but, it saved my sanity.

It sounds as if your dad is in an unsafe situation and the only reason he is still living where he is, is because the family provides the support he needs. If the family steps back and leaves dad to his own devices the truth of the situation will be uncovered. If the family decides to step back call APS (adult protective services) to check on him.

You can also leave dad where he is, continue to prop him up but the next time he falls take him to the hospital and let the Drs. know his true situation.

Does anyone have DPOA over dad. If so, that person can hire and pay from dad's money for lawn care and in-home care taking over several of the duties dad needs.

Dad can refuse to move to an appropriate facility unless he is deemed to be living in unsafe conditions - why calling APS or delivering him to ER after an accident/fall that leaves him injured.

Know that dad won't thank any of you for doing this, but what should be in the families' mind is dad's safety. Your family should meet and make plans on what is next. Look into facilities that best meet his needs and pare down the list to a couple and keep them in your back pocket when the time comes to move him.

Wish you and your entire family the best.

Your dad is suffering from one of the most destructive diseases known to man. It is called pride.
My mom suffers from it as well.
When something needs to be done I just do it.
I would talk with his doctor and ask the doctor to inform him if he does not straighten up he is going into a seniors home. Worked for me.

In August you wrote this: " It has been 3+ years as a full time caregiver while also working (remotely) full time, with little to no help. Lots of helping with Dr. appointments, finances, mail, meal prep etc. for several years before that. I'm in a very dark place. I've tried many times in many ways to get help. My aging parent refuses to allow outside help and my siblings also refuse."

Yet in the latest post you write that " Insists he doesn't need outdoor/lawn help even though his kids have been killing themselves keeping up with it for 5+ years."

So I'm confused. Are your siblings helping with outdoor/lawn help or not? Regardless, you are the live-in caregiver (slave), so you do the most.

If you in a "very dark place," then you need help. NOW. Are you willing to take the necessary steps to get yourself out of that very dark place? Are you ready to move out on your own and separate yourself from your father? Why do your siblings refuse outside help? How many siblings are there?

The "helpful approach" you are trying to get from this group may be more than you expect...but it is what you NEED.

Sometimes we tend to down play or minimize what is going on with our Loved Ones; particularly parents because they were the persons who cared for, raised and taught us. There is a beginning problem with Dad. It will get worse. Make sure you have POAs and his financial items items in order. You may not want to react harshly now to Dad’s problem, but soon or later there will be an event that will cause you to make some difficult decisions. It would be helpful if you could talk to an empathetic Social Worker now, maybe Dad’s doctor/hospital can refer you to one.

Sandy, In reading your reply to Grandma1954, I believe the answers given to you still stand. I would add that counseling may help you weave your way through emotions of guilt. That you live in the same house does not change the fact that your dad needs help.

Geriatric psychologist will document his delusions about how he’s actually doing.
My diagnosed narcissist mother, on oxygen in a wheelchair, told everyone she gardens, and a bunch of other malarkey. She’s never had a garden in her entire existence.
Once she needed (2) aides and her long term care wouldn’t pay for (2), she unwillingly went into a very nice assisted living.
She hated my guts but her attorney and the probate judge, sided with me on the decision.
Her lawyer made her sign a letter saying she would stop fighting it.
Call SS and ask for a welfare check, since your circumstances are different.
You aren’t alone with this madness.
Save yourself at this point.

Admitting to needing help probably seems like admitting a whole lot of other things, especially the tough ones. Same issue with mother. I just hired people to show up and do the things that needed to be done. Didn't do a lot of explaining or trying to make her see the value or admit she needed the help. Just did it. Seems to be working so far. You need to get people who have some experience doing elder care. It's an art! Best of luck.

It might be better to say something like
"I know you can do this, but I'd like to help with...." for tasks,
"I know you can bathe yourself, but it has been a hot day, or worked a lot, or... so let's get another bath/shower now."
"I know that you're spry for your age, but let's get that checked out just in case."

Most of this is probably pride. We want to preserve his dignity and independence as much as possible. However, if he feels he is doing "us" a favor it may seem less like weakness or disability on his part.

Another problem could be that he just doesn't see that he has any problems. He truly doesn't think that any of the things you mentioned are real. It might be helpful to have him evaluated by his doctor or get a referral to a neurologist for a thorough evaluation and treatment of cognitive issues.

Please view the following link below. Teepa Snow (I feel) offers the best insight into understanding the changes which occur with AD--and how to deal with them. I wish I could post this link on EVERY concern posted on this site.
https://youtu.be/mkRvK26bkTQ
K. Allen
REMEMBERING WHAT I FORGOT

OK so I see you live with Dad, so in his house then? What if you were to hire someone to do the lawn and cook meals and do household chores say 3x a week? You can tell him you can’t keep up and need the help, leave his needs out of it, might he come around and decide to kick in? Would he be concerned about the expense and give you the opening to suggest that if he were to say he needed the help it might get covered by Medicare and convince him to go through the evaluation process for that? Kind of a back door avenue for getting both of you help and perhaps ending up with ADL help for him, showers 2x a week and trained eyes on his physical needs.

When it comes to falls and the unwillingness to be examined, this might be tricker and absolutely depends on your father and timing but might the approach of saying the thing that would prove to you he can still make those judgments would be the willingness to get checked out. It doesn’t cost anything and it may prevent bigger issues later on why wouldn’t any rational, responsible person take care of themselves? Does he have a Primary Care doctor he sees and trusts? That might be the route to take instead, you know him best. Pride or fear, to some degree your approach depends on the main driver for his resistance. The other thing to consider is his hearing, if he is that hard if hearing he probably resists medical intervention in new surroundings with people he doesn’t know. My mom is very hard of hearing and has aphasia, she simply can’t follow or trust that she is hearing practitioners and going for tests she isn’t used too…well she misses the reassurance and explanation of what to do…so either my brother or I go to every appointment with her and into testing rooms unless she expresses that she is comfortable enough without us in there and basically interpret. When she doesn’t catch something she turns to us, we make it clear to anyone walking in the room that she is hard of hearing speak loudly, slowly and directly to her. This also gives us the ability to bring up things she may not like in your case “Dad has had several falls in the last few months, nothing major yet but I’m concerned about that”.

Work your way in while building his trust (don’t throw him under the bus unless you really need to and then do it side hand if possible” lighten everything by finding the humor in everything to break the ice, it makes the moment less threatening to him and the way you react can really affect the way he reacts. Good luck

If he's in his tight mind, there is nothing you can do about it.
You could get him to buy frozen Microwaveable Healthy meals and other food that is easy to fix and easy to eat like yogurt, apple sauce, Instant oatmeal, breakfast bars, ect.

Hire a Caregiver or Maid to come once a week.

Put a handle to help him from falling in the Shower.

PUT a shower seat in the shower.

He coukd be doing bed baths or just washing up with a face cloth.

As far as yard work goes just let him know the kids don't want to do it any more and hire a weekly or by weekly service and tell him to pay for it and if he can't afford it his kids can go in together and pay for the yard work.

Very simple - sounds like he is very controlling and stubborn and has dementia. Unless you want to put up with this behavior forever, fine - keep allowing it to happen. If he does not wise up, place him where he can be watched. If that is not an option, think of it that he is making his own bed, his own choice, now let him lie in the bed he made and with the results which are sure to hit home soon. He is on his own - nothing you can do so don't feel guilty.

My daughter just came right out and said to me. "Mom, you are in denial. You walk too slow". So, I have a wheelchair when we fly. Hard on the ego but she is right. We just went through SEATAC last week, ten years ago, I walked the length of the airport with luggage with no problem. Last week, I couldn't have done it with out sitting down. It made me sad.

Think about it - he doesn't need outdoor help....it magically gets done by others and looks nice! It bothers you that he doesn't bathe - not bothering him. He hasn't fixed meals in 2 years, but he hasn't died from not eating. Again, the food shows up.

Who is doing all the work for him for his daily needs: food, probably house cleaning (if he isn't bathing or cooking, he isn't cleaning either), laundry? Does he call when he falls or do you just see bruises. Or is he calling a neighbor. If calling others, you can tell him that the children are going to get in trouble for leaving dad in an unsafe situation, alone.

Get a large calendar and mark down every fall. Ask him when was the last time he fixed his own meal - what was it? Someone is probably doing laundry, so ask him why there are no towels to wash if he bathes every other day. Mark known baths on the calendar. Start small - we can get you a bath chair so you don't slip down. We can get a lady to come in and pick up/do laundry twice a week - you might even tell him she is a friend of yours who is looking for work.

If you are too available, he's never going to see a need for help because he already has all the help he needs.

Sandy5691: Imho, pride is a hard pill to swallow for an elder.

Take a vacation - leave him to it for a couple of weeks with one of you phoning each day to "check up on him" and then all sit down in two weeks time and see how he has managed. If you leave microwaveable meals he can make himself food easily, and the lawn will survive not being cut for a couple of weeks. Perhaps if he had an emergency call pendant/wrist button he could manage -not to the standards you think he needs but in a way he feels happy.

If you're hoping to find a way to make him wake up and say out loud that he cannot manage and he does need help, forget it. Even if you do all back away for an agreed period of time, your father will achieve new heights of creativity when he gives reasons why the lawn has become a jungle, his fridge is alive with interesting moulds, his clothes look as if he's been sitting next to a messy toddler at dinner and he has eaten nothing but uncooked ramen noodles and whatever else comes to hand.
Assuming you are (very sensibly) no longer prepared to kill yourselves to keep up pretences, what are the options?

First off, stop coming around cutting his grass. The city will most likely send a notice or charge him a fee for cutting.
Second you probably should contact APS as well as his family doctor.
As long as he has family, friends doing everything, the chances of getting is not going to happen. Independence is one thing the elderly seem to need as once that is gone, they feel their life is over. Kind of like when your car keys were taken away for your Friday night outing when you were a teen.
I know as I age I see things that I can no longer do and become scared of how I will cope with when I need significantly more help.
It comes down to a delicate balance of providing help and hiring help to maintain our own mental and physical health.
Does anyone have a POA on your dad?
Would he be able to afford someone else to cut the grass?
Can he write check or does someone else have the ability to do it for him?
Best wishes.
It is very hard to accept you need help, and even more so when you are older.