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What would the consequences be for reducing my father's care to part time opposed to 24/7?

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Koleen, I've been through this a number of times. My father absolutely will not leave his house, regardless of how many doctors tell him to. Their "orders" aren't mandatory; they're making what they in their own opinions think are the best recommendations. My father doesn't have any legal obligation that I know of to accept their orders.

What I've said when some of them really irritate me is ask them if they plan for pay for AL because we can't. That stops them right there; I think most of them don't understand the potential assistance of Medicaid, and I don't plan to enlighten them.

They could file a complaint with APS, but that doesn't mean that APS will necessarily initiate proceedings to take control of your father's life.

It sounds to me that your father is pretty health and doesn't need AL, but probably could get by (as you suggest) with a few hours of help.

Private duty help typically has a minimum of 3 - 4 hours per visit. If you decide to consider this, be prepared to do a lot of leg work. This is a private pay, unregulated environment, and vulnerable to exploitation.

Sometimes I think doctors don't have enough experience to really make a good evaluation of what a patient needs, especially in terms of home vs. institutional care.
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Due to a chemical imbalance (potassium and ammonia) my father was unstable, hallucinating and combative. He was taken to ER. They did get him balanced out and said he wasn’t able to go home without 24/7 care. He is home and doing well. He does has dementia.  He gets up, showers every morning, makes all of his own meals. I would love for someone to come a few hours a day - I don’t think he would mind that either but I don’t feel he needs constant supervision. Nor does he. What are the consequences for going against doctors recommendation?
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The doctor ordered the same for my LO. She wasn't too happy, because the only way she could do it was entering into AL, but, we finally convinced her to go, at least for a little while to get her health back. The doctor was clear that she was NOT going to let it go. So, if my LO had stayed steadfast and refused, I know the doctor was going to contact Adult Protective Services, since it was not safe for her to live alone. So, she was either getting the help willingly or it would be taken out of her and her family's hands.

So, I think it depends on the facts and just how dire the situation is.  If the judgment of the senior is so poor that their health, welfare and safety is seriously compromised, they may lack the proper judgment to follow doctor's orders.  
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My MIL's physician also ordered 24 hour care. It may have been a little aggressive on his part, but I certainly wanted at least 12 hours of care a day. She too wouldn't have any part of it. It took 6 months before I could finally get someone in 4 hours a day, twice a week. We've upped it to 8 hours a day, 3 days a week but she refuses anyone other than this one particular caregiver, and she's fired or told me to fire the others I've hired.

She's a fall risk, at a minimum. I'd like more help than she'll accept. The only thing she'd accept is me moving in with her. I have a job, a spouse and animals, live across the country, and flying in one week a month is already more than I can handle at times. Unfortunately, if she falls or has a massive bleed-out (she's also on hospice for a GI bleed), if it doesn't happen when I'm there or the caregiver is there, there will be consequences for both of us.

Others may have risks of falls, malnutrition, health and safety (I'm thinking fire due to leaving a stove on, etc.). In my case, her refusal to have more help is causing me more stress and it has side effects on me.

What are your father's health concerns? Maybe with a little more information, we could suggest other potential consequences that may help you in your decision-making process. Or not. But each individual likely has their own set of risks and negative outcomes.

Best wishes.
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Koleen, my Mom's doctor had also ordered 24/7 care and she didn't want any part of it. We tried for 3 days having 3 shifts of caregivers help out but Mom became user unfriendly, and would snip at my Dad over this subject.

What would be the consequences? It depends on what are your Dad's medical issue. I didn't see anything mentioned in your profile, so you will need to provide that information to help us give you the right answer.

For my Mom, her major health issue was falling. Sure enough a few days later she had a very serious fall, 911 was called, eventually Mom left the hospital to go to rehab, and she spent her last couple of months living in long-term-care unable to do anything for herself. If only she wasn't so stubborn and had accepted the 24 hour professional help.... [sigh]. That was her consequence.
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