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My father is currently in rehab, following a hospital stay for a MRSA infection. He does not like going to physical therapy, but he goes. The therapist reports that dad can do everything he is ask to do: walk, climb a few stairs, put on his shoes, button his shirt, etc. But, when he is in his room, he lays in bed completely helpless. He makes my mother do everything for him. Dress him, cut his food, change his Depends, everything! He will not even walk to the bathroom. He asks her to hand him a urinal, which she does, even though we have stressed to her he needs to get up and walk to the bathroom. Let me add, he was making these demands of my mother even before the hospital stay. They live at home and she tends to his every need. She is 90 years old and not in perfect health. She refuses to leave his side, even when family offers to sit with dad so she can take a shower or a nap.


He probably will be released from rehab later this week. Since he demonstrates to the therapists that is able to do things for himself, they will probably say he can go home. Going home is what mom and dad both want, but family does not think they are capable. We have looked at assisted living, but it will be a battle to get them to move.


My question is - why won’t he do the things for himself that we know he can do? We know mother will continue to wear herself out doing everything for him once they get home. No reasoning with her about it. They are not mentally incompetent, but are definitely showing cognitive decline.



Any insight is appreciated.

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Gosh, there could be a variety of reasons why this is happening:
Mom has always done these things for Dad.
He likes the company of Mom.
Mom loves to do or is used to doing these things for Dad
Hard to break a pattern.
Etc.
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Why should your dad lift a finger if your mom waits on him hand & foot? She makes him feel special & important by catering to his every need, so he's not likely going to change, especially at this stage in life.

Just let them alone. If something happens that forces one of them back into rehab, they may make a determination that they can no longer live independently. At that time, the choice will be taken away from them and they'll have to be placed in Assisted Living.

Unfortunately, so many seniors refuse to make the correct decision on their own and wait until the choice is taken away from them, then wind up complaining about it for ages. Sigh.

Best of luck!
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There comes a time in life that one dies. Old age is a terminal illness. You are very fortune your folks are with it. All it takes is one fall, for example. That's a game changer.
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I went to a presentation the other day from a memory care facility where my mother is living now. The presenter had the best line when answering a question about getting parents to move --

"We've tented a LOT of houses."

In other words, a white lie of needing to get the house tented for termites (a common issue here in California) or a "major plumbing repair" will require the parents to move out for a week or so in order to facilitate the repairs. After that time, they often feel at home in their new surroundings.

I will say that my parents really did need their house repaired and we moved them to an independent living place nearby for a couple of months. They hated it, especially my dad, who was completely capable of still living at home, but was put off by how unfriendly the other residents were. (Ironically, it's a home for retired ministers and missionaries!) They weren't moved there to get them out of their house permanently, but I was kind of hoping they'd like living where they didn't have to do absolutely everything to keep up the property themselves.

Nevertheless, your dad sounds like he needs skilled nursing and your mom needs assisted living. Perhaps their house will need some "work," and you can get them in someplace where they're in the same location and he can work toward moving to assisted living with her rather than getting home again. That might be more of an incentive to get him doing for himself again, because he wouldn't qualify for assisted living in his current state. You mom will kill herself taking care of him (as my dad did with my mom), and then he'll be in a nursing home alone.
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This is a dynamic of your parents relationship. Maybe they have always been this way. It is difficult to sit there and watch this happen but this is their relationship and probably it's all they know. The best that you can do is to take your mom out for special time with together. Nails? Coffee? Events that she may enjoy to decompress.
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In the days when they were a young couple (they were young and beautiful once:) the woman doted on the man...hand foot and finger (so to speak) And it worked for them. They clearly love each other very much to this day. And Im sure they are aware they don't have much longer together here on the earth. And are afraid of losing each other.
However, its become a little unbalanced.
Although, from how you explain the situation neither complain..and both seem content with the dynamics.
Your concern for their health is understandable
I agree with other comments about home physical therapy and your Father getting the body moving.
With apathy he will die sooner than if he was mobile.
You might speak to him quietly by yourself and kindly explain that by getting the body mobile daily, it will give him more time here with your loving Mother
This is a fact. If he loves her as I think he does, once he understands the probable consequences of his laziness, he will improve himself.
They are lucky to have such a caring daughter.
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Dad is content and likes being waited on.
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I recognize this description so well. This was my dad and mom. Although your dad can do these things, he has probably deconditioned. Plus, your parents who I imagine have been married a long time are in the habit of her waiting on him. But here's the danger. My dad didn't appreciate the level of deconditioning that he underwent, so within a few days of discharge, he fell and fractured his pelvis. That fractured pelvis put him into the hospital, then rehab. After all he had been through leading up to the fractured pelvis and beyond, he admitted to feeling depressed and seemed to give up for a few weeks which led to an admission into long-term care. He almost improved enough to discharge to home, but frankly, living in facility is likely to expose you to more things and it did. A community illness nearly killed him, didn't, but resulted in dad spending his last two and half years in a nursing home. Long story short, your dad is increasing his chances of falling daily and your mom is overwhelmed. Is she afraid he will fall so prefers him to stay in bed? Your dad should get some at-home physical therapy when he discharges. That person will give him work to do and will be able to tell if he is following through or not. If you want to use my dad's cautionary tale, do so. Get "signed off" by the physical therapy staff in rehab to walk your dad. Get him moving. Help him do the assigned exercises. Also, talk to your dad's social worker to voice your concerns. It's possible that there are programs that your mom and dad can tap into to take some of the burden off your mom. Talk to you mom about why she caters to his every need. See if you can figure out through her observations what motivates her actions. Perhaps he has fallen before. Last, if he does discharge home, you can help him do the required exercises and work in everyday activities that sneak more physical activity into his day. I bought a nice portable wheelchair and took mom and dad out for brunch once a week. If I took dad to the dentist, for example, we stopped for coffee and doughnut on the way home. That meant getting in and out of the car and walking into the shop. (This was when he almost discharged home) At some point, like my dad, it may be necessary for you dad to be in LTC. If that happens, make sure your mom stays active. Keep her strength going. Take care and good luck.
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He won't do those things because your mom is a willing partner. It's not him you need to work on to change - it is her. Tell her that she is actually harming his ability to be at home. Send someone there when he is released to help give her some backbone to say no. But don't be surprised when she's alone w/him for things to return to her waiting on his every need.
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Doing things for your father probably helps your mother feel useful and needed. She needs to help as much as your father expects her to do it.
If AL placement is not likely to be tolerated, would they accept some part-time help at home?. Hired help for bigger chores might make some pressure off your mother. She could still be in charge of meal planning and personal care.
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If your dad is still mentally competent, I would tell him that 40% of caregivers die before their loved one, and your mom needs to take care of herself first so she can take care of him.  Sad as it is, I think you have to appeal to his self-interest.  

It may be that he thinks, right or wrong, that she gets joy from helping him.
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This is just what they do - you won't be able to change either of them.

Your mother feels needed and your father feels taken care of. At their age, habits are already deeply ingrained and you will not change them.

RE: the Urinal: This is actually very common for his age. My DH used one starting around age 93, after his heart valve replacement and it was preferable to me as he never used Depends until his last 3 days on earth, and he was almost 97. Until he became bedridden during the last 3 days, he still went to the bathroom to eliminate, but I had to assist him.
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Dad can obviously do things for himself, but he has had your mother doing things for him for a long time. It is the usual, a bit dysfunctional, pattern of their relationship. You will probably not be able to change this if mom does not want to change, because dad (and mom) obviously likes arrangement.

As long as they can meet all their needs and nobody is at risk, they can go home. If they need help, there are lots of options: assisted living facility, home health care aides, family and friends...
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Why? He is spoiled by your mother, she obviously thinks that he is her little 2 year old. This is a generational thing, the little woman is the servant of "Daddy", that is her role.

Nothing is going to change, your acceptance is the key. My step father does the same thing, I have learned to let it go and continue to work on me.

Good Luck!
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You said that your mom did for your dad prior to rehab, so why wouldn't it continue.If it works for them then I would let it be.I totally understand your concern for your mom's health but if the caregiver isn't complaining.Keep an eye out and be supportive.
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Mjs2699 Feb 2020
Thank you for your answer. They will be coming home tomorrow. A hospital bed will be delivered today, which she said will make it easier for her to help him stand. All we can do know is pray they do not fall.
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Your profile says they both have Dementia. As such they cannot really make informed decisions. This will get worse. Now or later the POA is going to need to take over. If the POA says "when no longer competent to make decisions", this is when you have them evaluated and a letter from the doctor saying they are no longer competent.

They always do well in therapy. Its a good way to be sent come. Like said, Mom waiting on Dad is a pattern that ur not going to break. Early stages of Dementia they lose the ability to reason. So u can't reason with them either.
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Work on your mother, first. Two points to get across to her:

1. The sky will not fall in if she doesn't monitor his every waking moment.
2. Even more important: her doing things for him DISABLES him. It is actively the WRONG thing to do for the person you want to remain healthy and functioning.
Every time she hands him that urine bottle, she is stopping his heart getting the mini workout involved in his going to the bathroom. And cutting up his food? - is her manly husband a spoiled infant at heart?

It feels good to pamper and be pampered, but she can do this in better ways that won't render him helpless and immobile. As for why does he let her? - ooh, lots of reasons. Because he's tired, it's easier, it's nice to be cared about and waited on, it's what they're both used to... If you want him to start *liking* being more independent, never criticise him, only ever praise and flatter good efforts and good habits that are more in keeping with an autonomous adult.

Short of breaking her leg, can you get her away on some pretext for his first few days at home? If not that, can someone go and stay in the house with them at the beginning?

We currently have a lovely client with a lovely wife, in her eighties and tiny and she has been forced to accept our service because she physically can't manage his needs. There was a farcical moment a couple of weeks ago when she tried to wrest his overnight catheter bag from me as I went to the bathroom to dispose of it. I hitched the bucket out of her way and kept going with thanks and a smile; but she has a hard time letting anyone take over what she can manage. Doing absolutely everything can be a point of pride, I think.
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Mjs2699 Feb 2020
Thank you for your answer. Family and staff at rehab have told her many times she is hindering his health by not making him get out of bed and do things for himself.

As others have suggested, there is no reasoning with either of them. Hopefully, when they get home tomorrow, she will at least be able to get a little more sleep.

Family will keep a close eye on things. We will be calling several times a day, dropping in unexpected, bringing groceries, doing laundry, etc. We can concentrate on helping her, so there is a chance she will stay healthy enough to take care of him.

Thanks again for your suggestions.
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Mjs2699, my Mom [also in her 90's] came from a social generation where the wives job was to oversee the household, take care of their husband and children.

I remember when my Dad had a heart attack, he was very weak and it was recommended he go live in Rehab until he got stronger. Well, that didn't sit well with my Mom, she insisted she could take care of Dad, that was her "job". Little did she realize she no longer had the strength to pick Dad up when he fell, which he did on a regular basis until he regained his strength. And Mom wasn't able to help Dad climb the stairs to the bedroom, so she would sleep in the livingroom on the sofa and Dad slept in his recliner.

And Mom even insisted that Dad didn't have a heart attack.... what would be the neighbors think? Say what? Apparently that generation the health of the husband was a reflection on the wife. My Dad being sick would have been a poor reflection on my Mom. Good grief.

My take on this, let Dad be home with Mom, and let her cater to him which she is doing out of love [I know, we may not see it that way]. You can't break with tradition.
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Mjs2699 Feb 2020
Yes, you are exactly right. Starting tomorrow, when they get home, this is the approach we will be taking.

Thank you you for your thoughtful response.
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I'd make sure the therapists know the truth. Also, I'd discuss it with the social worker. I'd ask them to consider if wife is an appropriate helper at home, even if he is doing better. Do they have the proper grab bars, ramps, etc. that dad might need?

I've known people who say, him going home with mom to provide care, in her condition is not a good idea and we don't support it. You might not be able to prevent it, but, I would still be clear to them and the staff at rehab. One reason is that it is a recipe for disaster. Things won't go well......and, then the adult kids will get the calls.......so, the adult kids will become the caregivers while parents live in their own home. I suppose that works for some people.

I'll add this, since you said you thought there was some cognitive decline....I know that prior to my LO having dementia, she exhibited odd behavior of not wanting to do things for herself, even though she could. Her refusal to do use toilet, bathe, change clothes, etc. were the first signs of dementia. She could talk, remember, pay bills, etc., but, it was an odd sort of apathy and lack of initiative. I wouldn't hold faith in you being able to convince a 94 year old person to do more things for themself. He's likely very tired and not motivated to do more, if he doesn't have to. I fully understand how he might feel.
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You can’t change a pattern that has been in place for probably 60+ years.
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It’s your mother that has set up the pattern here. If she’s not willing to change there’s little you can do. Your dad has a slave for a wife and it seems she likes it that way. Sadly, it may take her health failing to change their dynamic
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You are fighting an uphill battle. If Mum has met his every need for 50 or 60+ years, she is not going to stop now as she does not know any other way to behave.

It is a sad situation and you may have to wait for a major event to get them to move in to assisted living.

Do your parents have all their paperwork in order? Updated Wills, POA, Healthcare Representative etc up to date? I think you may be better to push to make sure this is all in order, that way when Mum collapses from the stress, a family member can step in.
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Mjs2699 Feb 2020
They do have a Will, POA, and health care directive, stating they do not want artificial means of life support. I am currently gathering information on all bank accounts, insurance policies, etc.

Your assessment of the situation is probably correct. Thank you for your answer.
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