My father is 78 and until December, lived alone in his own house. In February, 2019 he went to a rehab facility after a 2 week hospital stay. He did do rehab, but his progress peaked and Medicare stopped at the end of March. He’s remained in the rehab room as private pay ever since. (We’re trying to figure out where he’s going to live - as he cannot go back home anymore due mostly to physical limitations). Dad has been on a horrendous medical spiral for the past 9 months and it’s taken it’s toll on him not just physically but mentally as well. He has suffered anxiety, depression, delusions, and just about every coping skill I can think of. Besides that, he’s sort of eccentric and odd and always has been. Everyone at the rehab thinks he has dementia but he has not been diagnosed by a neurologist or has had a brain scan or MRI in 6 years (6 years ago he had back surgery and after falling into a depression from having to use a cane, I asked for an MRI of the brain to be sure dad didn’t have the beginning signs of dementia. At that time, the neurologist said no dementia). I am his only child and I am the POA.

Over the past 4 or 5 months, I noticed that my father says he works at the rehab (and gets paid). I believe in honesty and my father doesn’t show signs of any other delusions most of the time, so I very calmly try to explain that whatever he does is voluntary just because he’s that type of person, but he does not work there. Recently, I found a folder in my father’s room with about 8 essays inside (needing to be graded) as well as a rubric to record the grades. If you haven’t guessed, dad was a teacher in his previous career. Problem #1 - I was not consulted about using using this “being part of their world” tactic (and again.... I am trying to be honest with dad when I tell him that he doesn’t work there). Problem #2 - the “work” inside the folder are 3 year old college essays from one of the employees at the rehab. SHES AN EMPLOYEE - NOT A STUDENT! Problem #3, the entire activity is fake and a lie no matter which way I look at it. As a daughter and someone who visits dad every day, I feel so defeated because I have tried to be so up front with him about things.... if the facility would have asked me if this was ok, I would have said no. But they never asked. What gives them the right to feed into these delusions (or even encourage them) and give my dad busy work to keep him in his room and out of their hair? It’s not like he’s suffering from anxiety now..... they are just building and reinforcing a delusion. Is this something that can be reported? I'm so upset by this

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Your father's "spiral" could be from being in rehab. These are not the nicest places to be. Very lonely. Nothing around is familiar. Does this place have activities for your Dads mindset. I know Moms seemed to cater to those with Dementia. Making a card or coloring for me would be boring. Its just all so unfamiliar. You can't just get up out of ur chair and go into the kitchen to get a cup of coffee.

Why are u paying for LTC when he could be in a nice AL. Is his care more than an AL is able to handle. The cost would be less. He would have a room with a bath and kitchenette. He would be able to get out of his room and go to a common area. U are going this way but there is a waiting list?

When you are hospitalized, rehab or LTC, the doctors there are in charge of your care. I asked one doctor to call my Moms PCP concerning the handling of her care. I was told while she was in the hospital, he was incharge of her care. I think these doctors should bring a PCP into the picture since they know the patient better.

The nurses always told me when a med was introduced and why. Having an RN in the family I consulted with her. You should be getting a care meeting every 90days. Mine never gave me time for questions so I always asked the RN on duty. Like "there is a folder in Dads room with test papers in it like he is suppose to grade them?" See her reaction. If she acts surprised, explain that he was a teacher and he does get confused, but I really don't want someone playing into that confusion" If it goes the other way, same response. The main thing is, was this an order from the doctor or someone thinking they were doing a kind thing. If it was the latter, then you should have been asked. If the doctor OKd it then you need to talk to him. If he feels Dad is showing signs of Dementia, then tell him you want a Psych eval to determine that. That will put ur mind at peace and you can go from there. Because with Dementia, no matter how many times you tell them "Dad u don't work here", it won't work.

Usually Drs. associated with facilities are General Practioners. You have a right to take Dad out to see a neurologist or whatever. He is not in prison. At this point, I think thats what you need to do.

There is all kinds of things that could cause Dads confusion. Ask for labs to be done to test for UTI, low potassium, thyroid, dehydration. These all can cause depression and confusion. Good Luck. The worst part of caregiving for me was the worrying. Its like your damned if you do your damned if u don't.
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I see this a little bit differently, and in fact think it might be therapeutic for him to believe that he's still teaching.  

There's not always benefit to being completely frank with someone exhibiting signs of aging, and grading papers can not only give him something to do that harks back to better times, it can redirect and channel his brain activity.

Rehab centers do not have to consult you; it's up to you to make sure they know you want to be involved, so I don't think it's fair to be critical of them.    It's not clear to me what level of involvement you've had that didn't make you aware of these activities.   But if you haven't met with the therapists and discussed what they're doing, I don't think it's appropriate to be angry now b/c you weren't aware of their plans.  

Interacting at rehab varies by individual and family; some families just don't get involve with care plans.  Others do.    Perhaps a nice friendly chat might be better than considering taking action against them, or reporting anyone.   That won't win you any friends with the staff, and you do want to work with them for your father's benefit. 

Could you elaborate on why you feel the teacher mode is so inappropriate?
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JoAnn29 Sep 2019
She feels like they are feeding into a Dementia he hasn't been formerly diagnosed for. She wants him in the here and now.
It definitely bears discussion. But it does sound as though your dad now needs a very thorough neuro workup to try to guage where he is on the spectrum. So this would be a great time to ask to be included in care planning. The best time would have been when in rehab because now I wonder if he might not be considered rooming and paying as resident, and no care plan really involved. Do check in in the administration office and see where all that is at. Ask then if they can arrange for their doctor to order a neuro workup. Much of whether this was appropriate is dependent on his diagnosis. If Dad is suffering from dementia and this makes him happy and productive, it is a good thing. I think you really need a diagnosis now. It will help anyone dealing with him, but it will help settle in your own mind what expectations you can have of your father now.
Wishing you good luck.
So so remember the days of car accident, workup, diagnosis, rehab, where will he live; they were a nightmare for me. You have my heart.
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Maybe what they're doing falls under the theraputic lie category. With all his issues going on, maybe they think that it does not hurt anything for him to "think" he works there even if it's b.s.
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I doubt if this is part of a care plan. It maybe an employee trying to help. Giving Dad something to do and feel productive. I would talk to the DON.
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