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My mother-in-law cannot physically care for him as he is in denial and is refusing help. He is also somewhat depressed and making passive statements about dying, has a poor memory, and poor ADLs. where do we start to get help when he does not want it?

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I would categorize them in terms of priority. These are some suggestions, not in priority order though, but just what I think might help.

1. Fall risk: ask one of his doctors for a script for PT either at home or at a PT facility. Add grab bars at strategic places along the walls where he doesn't have anything else to hold onto or sit on if he loses his balance. Add them especially in the bathroom and shower area, as well as by doors, indoors and out.

2. Call local hospitals or ask his pulmonary doctor if he/she is aware of any pulmonary therapy programs. They're paid for by Medicare, there's no limit on participation as there is with PT paid for by Medicare.

3. If he doesn't yet have an incentive spirometer, ask his pulmonary doctor if one would help. It's easy to use and could strengthen his lung functions.

4. If you don't have portable oxygen canisters or a portable oxygen concentrator, ask his pulmonary doctor to script for either. That will allow him to get out of the house, which can be very depressing for someone confined to it.

Plan excursions with him, perhaps once a week, whether it's to go to a senior center, library, restaurant...someplace that will be cheerful and elevate his mood.

Free concerts at libraries or churches are especially nice; music in and of itself is therapeutic.

5. Ask one of his doctors about cessation of driving; the doctor might write a letter to the motor vehicle department ask them to set him up for a test drive. It's better to let a state agency do the apparent initiation work so you or the family aren't blamed for being a party to removal of his driving privileges.

6. As to memory, perhaps list all the things he tends to forget, find ways you can help take over the memory part....i.e., if he doesn't remember to pay bills, check his bills monthly and quarterly, set up a chart as to approximate date received as well as date due, then help him go through his mail and separate the bills for payment. Calendar them as well and remind him, gently, if you have to.

I think I'd start with out of the house activities that elevate one's mood - socialization and music. If he feels a little bit better, it might make the other activities he needs to do (such as PT) a little bit easier to take.

Sometimes I think as people age they just become overwhelmed with everything that's happening to them....loss of balance, other medical issues, fatigue, inability to concentrate or do what they've done for years, and it just becomes crippling because it's hard for someone to find a path out of the maelstrom. Think of yourself as being the guide, holding the lantern and helping him find his way .... and it will be difficult, so be prepared for that.

But good luck1
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