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My father has been assessed by the VA. They were helpful in getting a new pair of hearing aids, New Walker, etc. they also did a home assessment. We already had grab bars and ramps, so house checked out. We have had Lifeline for past three years, so even if no one is at home, if he’s ill or if he falls, he can reach someone, although typically he’s never alone for more than 1-2 hours. He’s ambulatory. He told the VA worker that we won’t bring him food. But when the VA worker queried him, it came out that meant he would often wake up and then yell for someone to bring him food. At times, that happens when we’re at church or at a grandchild’s ballgame. But often we are at home and he just can’t hear us, so he’ll yell, or call, or do a group text to get someone to walk a sandwich or bowl of cereal back to his room. If we know we’re going to be out of the house, we try to get him to eat before we leave, or will tell him we’ll bring him something after church, etc. but he often will drift off and lose track of time and think we’ve been gone longer than what it’s been.


We do try to get him out of bed for 30 minutes once a day... usually at supper. However, it’s getting harder and harder to get him to rouse. The VA worker told us to make him get up and walk around. I just don’t know how to make someone get up who just refuses to do so. It’s sad...but also embarrassing when he tells people we’re not feeding him. He will also call on our phones... even if we’re in the house... to bring him food. Even if it’s after we’ve gone to bed, or we’re in church, or if he forgets that we’ve gone out of town and one of our kids is staying at the house with him. (We don’t leave him alone except for short periods.) I know he sometimes forgets... but sometimes he doesn’t, and then it’s aggravating that he expects my husband or me to be at his beck and call. Especially after the VA worker encouraged him to be a little more self-reliant.


Sorry for venting. I know some of it is just not always realizing what time it is. And some of it is due to limited mobility. But it’s a vicious cycle of not moving, then feeling stiff. And there is also elements of depression, too. But he won’t even go out for short drives.


Thanks for letting me post.

Sorry for your difficult situation
A couple of thoughts for you.
Does your dad qualify for in home PT or OT? Sometimes our parents may listen to a stranger , better than family .
When we go out sometimes we'll leave a small snack, just in case, crackers, chips, cheese sticks, grapes. A note stating "dad we'll be back by 6 o clock, in case you're hungry before then, we left a snack and water"
Good luck.
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ruthie1460 Dec 1, 2019
All good suggestions.
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I don't know what state you're in. but if there are not restrictions on narcotics prescriptions there, there probably will be soon. The possibility of his getting Norco PRN on a repeated basis may go away. Norco/Lorcet is a heavy duty opioid combination, and he may be addicted and/or physically dependent. While you cannot ask his doctor for medical info about your (step-) father, you could share your own observations with the doctor, who might consider reducing his opiod prescription (if he is not legally forced to soon). This would need to be done very carefully, but it probably could and should be done. Your father may be using his status as a physician to push the prescriptions, so you need to push your concerns to his doctor(s)! I'm not someone who's caught up in the present over-reaction to the time when getting narcotics prescriptions was quite easy, and I'm not suggesting your father be left in pain. However, if your father is taking a lot of Norco, it's not surprising that he is spending a lot of time in bed. There may be a vicious cycle going on here, and medical intervention could be needed to change it.
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ruthie1460 Nov 10, 2019
Oh, I’m sure. His medications in this regard are another email posting all together! I’ll just say that my father has quite a stash of pain killers in anticipation of the very scenario you’re describing. The prescribing physician it’s well aware of what he was doing. And I’ll just leave it there.
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I’m sorry. You’re in a tough situation. Hugs. The more he remains sedentary, the weaker he will get. Of course, the desire to do it on his own will lessen. I bet he isn’t very strong.

Is it possible for the doctor to order occupational and physical therapy at home? They will make him move, build up his strength. Is he afraid of falling? If he doesn’t move he is losing muscle mass.
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ruthie1460 Nov 5, 2019
You are so right about the muscle mass. I don't know the regulations about in-home OT or PT. It's a great suggestion because he has lost the ability to unscrew jar lids if there is even the least bit of resistance or open packages of chips. Basic life skills are definitely being affected.
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I agree with VA---If you don't get him out of bed, he will become dependent on you and may develop bed sores...If the bed sores don't go away, then he will need surgery to remove them, that is what happened to my mother's neighbor (he's in a wheelchair most of the time). Does the VA provide Physical therapy for him? A visiting PT could help him with trying to use his walker. If he is concerned about not getting food, then maybe you want to see if he qualifies for meals on wheels. Caregivers also can receive MOW. Some MOWs will ask you to walk to the door and get your meal from the volunteer, some will not. Just ask them.

Don't worry about venting on here, it's encouraged on here. That is what this board is for. I do hope your situation gets better for you.
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ruthie1460 Nov 5, 2019
Thanks for being understanding. Yes, he qualifies for our community's meal delivery system. Actually, we live less than five blocks from our senior center (which we have tried to encourage him to attend). This center provides the meals, and it could be an option. However, to be fair to my father, if we would not be at home, he frequently does not hear a doorbell...even if he stays awake which is rare. I had thought about teaching him how to use Cargo which allows him to order from a variety of restaurants...but I don't think he would ever hear the delivery person come to the door.

Your suggestion about the visiting PT is great, and we need to investigate that for sure. It helps a lot to have outside people encourage him...especially since he is actually my step-father and, at times, will play his bio-daughter against me...even though his bio-daughter lives seven hours away and does none of the caregiving. But can you imagine how mortified I felt when he told her 1) that we had taken his car from him (He had a stroke and was told to stop driving.) and 2) we weren't feeding him. Sigh. Having unbiased outside professionals coming into the house is a great suggestion for all of us.
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My MIL became more and more sedentary in her home. After we realized she had short-term memory issues and wasn't remembering to eat, she went into a facility. She would not get out of bed, even though she could and there was nothing medically preventing her. This went on for the 2 years she was there. Then, we moved her to another facility where I think the scenario that Countrymouse described took place (about being absorbed into the facility's routine). They actually were able to get her up and out and on field trips, to the dining room...we were shocked! However, not sure if you will be able to make this happen if your dad has cognitive issues (and it will just get worse). When trying to encourage MIL to get out of bed at the NH she would say, "I was just up!" She sincerely thought she had been up that day. Good luck!
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ruthie1460 Nov 5, 2019
Thanks. It's hard to gauge his cognitive ability. He was a physician. Oddly enough, major medical events tend to bring out the best of his cognitive ability. I don't know if all that medical information is just hard-wired into that long-term memory or what. I do know that my MIL who is at the end of stage 2 Alzheimer's has a lot more short-term loss on a more consistent basis than my father...if that makes sense. I honestly think he often over-medicates himself...so thanks a lot to the doctor who prescribed the Lorcet AND Norco PRN. However, I think the suggestions of others who have mentioned having an in-house PT and/or OT could clarify. And it would also give some structure to days. Thanks for the reply.
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If possible, I agree with getting him up and trying to keep him active. The less he does, the less he will be able to do. It's a vicious cycle.

How about telling him that he will be having meals with the family in the kitchen from now on? So, breakfast time, someone tells him it's time to eat and if he needs assistance, get him up and going and eating at the table with the other people in the house. Same for lunch and dinner and maybe snacks or whatever.

Do you have any in house assistance? If so, this would be great for them to do.

This could also cut down on his hounding you for food all hours of the day and night, etc.
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ruthie1460 Nov 5, 2019
No, we have no in-house assitance other than our housekeeper who comes once a week. But she's just a regular housekeeper, not a home-health worker. We have three adults in the house (me, my husband, and our older daughter who is in her 30s), so we have just made do. I wasn't really thinking out-of-the box about in-house PT and OT which would be great for a number of reasons...if only to give us a little perspective. It's hard to gauge decline or what is reasonable to expect. This would certainly solve a LOT of issues. Thanks!
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Did the VA worker align the assessment with your father's medical history?

I can tell you what we'd do at work, where our aim is to encourage self-reliance and confidence in people so that they can manage for themselves. We would encourage your father to get out of bed, and if he chose not to we would leave him to it. If it went on for long, his eating would become the first priority and so he would be brought food; but not without prompting him to go to the kitchen to get it, or at least to the table to be served it.

I can tell you what they'd do if your father were in residential care: they would absorb him into the facility's routine, and without actual "force" being applied he would find it very difficult to resist being got up, helped to dress, and helped to walk or be wheeled to the facility's dining room and lounge(s) - all on their timetable.

But you are not running a nursing home, and neither are you prepared to walk away and let your father shout himself hoarse, and that makes your task especially tricky. What is the typical daily household routine?

The other thing that troubles me, I don't know if you've already looked into it, is that your father's heart disease and stroke history make vascular dementia a strong suspect behind some of his ways - especially the losing track of time, the belief that you're starving him (my mother once said mournfully "are we having supper today?" literally as I was clearing the dining table after her three-course dinner), the loss of initiative and motivation, and the loss of social skills such as not being rude and demanding.

Before you make any radical changes, then: has his mental state been assessed by an older age psychiatrist, neurologist, or any other specialist in dementia?
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ruthie1460 Nov 4, 2019
You've given great anwers...and thanks for acknowledging that keeping my father in the house in not the same as being in a nursing home. Sometimes I do feel that I am running a private one. LOL.

Yes, my father has been assessed by a neurologist...the neurological hospitalist, the neurological PA, and then his regular neurologist. The only limitation they put on my father was his right to drive. I see cognitive decline, but my father was a practicing physician, so oddly enough, any medical event or visit seems to bring out the best in him.

Because he insists on managing his own medications (and his bloodwork indicates he is taking his medications as prescribed), I sometimes think that on those days that he is really hard to rouse, he has doubled down on a painkiller that is prescribed by his neurologist PRN. This breeds another vicious cycle of sleep, confusion, constipation...and I'll just leave it there, because it kind of gets messy during those times.

We have suggested putting him on the waiting list for the Veteran's Home in our area as I think he would become more engaged...but because he is still ambulatory and there has been no mention from the cardiologist, neurologist, or primary care physician of a need for a nursing home (or even in-home care), things just putter along.
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