My husband is in a SNF for subacute care. The hospital sent him to gain some of his strength back so he can go home. He's refusing PT. Any advice?

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The problem is he has told PT and OT that he does not need it because he is going to die. He looks better and his brain function has come back to a point. The NH has called me and told me that if he does not help with PT they are going to stop it totally. My husband wants to come home but I have told him he has to work to gain back his strength or he will not come home. How do I make him realize he needs the PT and eventually we all die at some point.

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For the NH to keep you informed of your husband's progress is fine.

For the NH, the PT and OT to make you feel responsible for your husband's co-operation is not fine. Naturally, you will support and encourage him as much as you can: you love him, and you want him to recover as well as possible. But when it comes down to the hows and whats to do; well, those are part of the various professionals' remits. Therapists are trained to motivate and assist their patients.

So you'll do what you can, of course; but "making" your husband do anything is more up to them than to you. Don't assume more responsibility than you reasonably can.
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I would assume Medicare is involved. If a person refuses therapy 3x Medicare will require them to discharge the patient. We were told this when my MIL kept refusing. Rehab cannot make a resident do therapy.
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I agree with Countrymouse. Even though he is your husband, you are not his psychiatrist. You cannot possibly get into his head and find out why he has givien up. When my husband was in rehab last year, he worked as hard as he could while the therapists were with him. Once they left, he’d demand to be put back in bed. I’d go to some of his therapy sessions. I’d encourage him, but I wouldn’t interfere. He was kept as long as his insurances would pay, and then sent home with 2 months of PT and OT and Home Health. When that stopped, that was it. He is now bedridden. I care for him as best I can. I have (albeit reluctantly) accepted that we will never be like the Senior Couples in the Consumer Cellular ads. It wasn’t easy but this is the way it has to be.
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Ahmijoy, one more thing. You did not mention what his health issue is or how healthy you are. If he is refusing PT, I might suggest that you go with him on his scheduled time and ask the staff if they can help and assess if you have the strength to take care of him at home with wheelchair transfers, toileting and getting him into a car. You can see firsthand if you can accomplish this. If hospice is not in the future then I suggest while he is in rehab that you start looking at nursing homes. Learn about the financial consequences after the 21 days or so of continuing rehab for 100 days and beyond. The next costs are around 150/day or equivelent of assisted living (5 to 8K) and then nursing home will be about 8K /month. Home health care at 24 hours are about 18 to 20K /month based on other posters on this particular issue. You will need to think about these before he gets home.
Do sit down with him and have a frank discussion about his death wish. It may include some tears.
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My dad had a very serious difficult surgery and a string of complications after that. After 6 months of effort and struggle, he landed in the hospital with a broken pelvis. He admitted to me that he was depressed. Well, anyone else probably would have broken down 3 months earlier! He moved to rehab where he did not engage in rehab....not a surprise. Although frustrating, his was a very human response. My response to this was to find out what ways to motivate him using the rehab's resources. Was it technically my responsibility? No. But I hoped that if the tables were turned, someone I love would try something. The facility said he could "tap into" their restorative activities. There was a "Fit For Your Life" class that met 3 times a week. He didn't want to go....so I offered to go with him. Turns out he loved it and so did I. It was quite a learning experience for both of us. There were residents of all types of ability and impairment, the expectation being do the best one could. It reminded of my days as a teacher.....jokesters in the back of the room, hard workers in the front and one even fast asleep. Once I went with him for 2 or 3 times, he gladly went on his own. It worked. I believe one reason it did was because he was not comprised memory wise. I don't know if one has memory impairment, that the positive feedback of the class would motivate 2 days later. I guess my advice is put your head together with your loved one and the professionals and see what you can try. See if you can take the drudgery out of it. Visiting a loved one is okay, but buy a set of dominoes and play. It encourages them to sit up, use fine motor skills, their brain, and reach to pick up or place pieces, for example. They won't even know they are "working!"
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My 97 year old aunt went into rehab and refused everything including her meds. She told me that she wanted to die. She had newly diagnosed heart failure and was facing repeated lung taps for effusion. Before this illness she expressed to me, while still active, that she thought she would not make another year. I asked for a hospice evaluation for the pros to first assess her for depression as she did not have memory issues or delerium. She was granted her wish and I prepared for 24 hour help in her home. She passed within 3 days. It was hard and easy for me to help her leave this life. She did it on her terms.   I only ask if he does not gain strength, what will happen to him? Keep him in a nursing home or face long term care at home with no walking , bathing, toileting, etc.? What are the expectations vs reality. Yet he is trying to tell it like it is.
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What is the actual diagnosis and other health concerns?
If he is normally healthy, active no dementia and no reason that he can not participate in his therapy this could be a sign of depression and he should be evaluated for that.
If he has other health problems and is not a candidate for Hospice is there a way he can continue rehab at home? Most of the in home PT can be just as effective as in patient rehab.
If he has other health concerns and has been diagnosed with a "life limiting" disease then this could very well be his wishes that he does not want to go on. Have him evaluated for Hospice and go from there.

Now if he is anything like my Husband was if you explain to him that if he does not participate in rehab then Medicare will no continue to pay for extended care and he will be stuck with the bills. The thought that something would cost more to to my Husband was usually enough to get him to do what I needed him to do. (this was early on before his dementia diagnosis)
As he progressed though in the later stages there is no way he would have been able to participate, it was hard enough in the middle stages to get him to cooperate with the therapists after he broke his hip.
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This happened to my sister-in-law, who also refused to participate in PT. We were fortunate that she had her niece at her home who was willing to become her caregiver at home. I think you already have the answer. No PT, no coming back home. It will be his decision. And I wouldn't elaborate when he says he wants to come home. Tell it like it is.
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Occupational therapy. Showering, dressing, etc.. Activities of Daily Living. ADL's
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They are the medical professionals and not you. As such, he should not return home. It's not uncommon for elders to become bull-headed. He is not God. No one, thankfully, knows their end of days on HIS earth.
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