What should we do? Need your opinion.

It’s a rough time yes! But have patience with him, whatever his journey is keep in mind that this is a mental thing. Doctors & nurses aren’t always right. Spend 2 full days with him to see how he cooperates with staff. Give him time, this is most likely a cry for help .

He pulling out of the childish stops and it's making things a mess. That's right about what the social worker said. Prayers to you.

He wants to go home and he’s showing his behind and being obnoxious so none of them will take him. If he is not competent to figure that plan, then he really is mentally unstable and you may need to take him to a psychiatrist for exam. My Mom did this when she was being evaluated at the hospital and they released her one day earlier than planned due to her wearing them out accusing them of doing things they were not doing. She ended up on the right meds because they observed her for 8 days and nights! Now, she did get to go home back then with a new bag of meds but later, when she ended up back in the hospital with worsened dementia, we had no problem getting her in a facility.

Yes, I went through this with my mom, only worse.
She was 93 and has always been strong-willed and independent. Having dementia has taken away her ability to do be self-sufficient in almost every aspect of her life and she resists it by being combative with anyone who tried to help her, including me.
During her last hospitalization I realized that she could not return to my house. After exhaustive research, I found a beautiful well-regarded memory care facility within walking distance of my home. Initially, the facility refused to accept her because of the notes in her chart. But after a few days of calmness due to medication by the hospital’s geriatric psychiatrist (and a lot of begging from me), the facility began the admissions process when I put down a large deposit. Sadly, my wonderful plans fell through when Mom refused to participate and became combative again. The facility bowed out and returned the deposit.
Like you, my family and I despaired about where Mom would go. In a turn of events that we didn’t expect, advice from A Place for Mom Representative and luck helped us find another facility. This facility didn’t have the same bells and whistles as the first one and was 30 minutes away, but the staff has worked with Mom in ways that I know the other place never would. Mom continues to have bad days, but I know that she also has had some good ones too.
The point I am making is that in looking for help, your family may need to be open to places and actions that you might not have considered at first. (For example, in addition to Assisted Living, Memory Care, and Nursing Homes, you might want to check out Group Homes. I have heard that their smaller size can provide more support for difficult elders.)
Good luck at this difficult time!

The skilled facility saw a chart full of uncooperative behaviors. Rehab works best for those that cooperate with care, not those that have to be pleaded with to try... and who abuse staff.

Consider that your dad may need a psych consult. He is acting out for a reason: fear, frustration, feeling lack of control.,. When you get the reason behind the behavior dealt with, your loved one should have more compliant behavior. Then he will be ready for rehab.

I just want to make sure that this insight from Beatty doesn't get lost in the replies:
"Guilt should never be in charge of the care plan."

I think that says it all. The mantra should be on a mug given to all caregivers when they sign the POA agreeing to take responsibility for a loved one.

My mom had to go to Senior Psychiatric twice to get her mind and behavior under control.
Your dad isn't trying to make you or anyone else unhappy. I suspect he is not able to control his behavior at this time. It doesn't matter why; it just needs to be addressed.
If he has an injury as well as behavior problems that is even more complicated.
Talk to a psychiatrist or social worker for help on how to proceed.

Do not know where you live or where your dad resided prior to hospitalization, but your two best options are 1. In-home rehab or 2. Hospice.
My 93 year old mom hated SNF and it was hard on my dad to have to go everyday. Last time she needed rehab, we denied SNF and got in home services. Mom loved the attention of the therapists and cooperated in the comfort of her familiar ALF.

If he refuses to cooperate Medicare will not pay for rehab therapy--there must be documented evidence of improvement. If he's on Medicaid, send him to a nursing home. If he's not on Medicaid get him on it and place him in a nursing home. There he can vegetate and do what he wants. But if he assaults the staff they can put him on the psych floor where he will be medicated. If he continues to assault staff, they will simply kick him out too. The only other alternative is be his full-time caregiver and take care of dead weight. Taking care of someone bedridden is not easy because you will be dealing with a lot of poop and urine...and if he can't go you have to use laxatives. Trust me if you are by yourself it's NOT easy. And if you don't keep his skin clean and protected he will get bedsores very quickly which can tunnel into deep infectious wounds. Urine is very acid and it will cause wounds if his skin is not kept clean.

What does your dad want...........
Does he want to improve his quality of life?
Does he want to go to rehab?
Can he control his anger or if not would he agree to medication that would help him with anger and anxiety?
OR
Has he given up?
Does he want to die?
If the answer to the first few questions is YES then discuss this with his doctor to begin to find medication and rehab that will accept him under those conditions.

If the answers to the last 2 questions is YES then you should support him in his decision and ask the doctor if he thinks he is eligible for Hospice and then call a few and have him evaluated.

True no one can be made to accept someone from the Hospital and you will have to start from scratch. The Hospital will help because they want and need the bed Available.

I didn't go through a last minute facility rejection, but my father had an aggressive personality which vascular dementia made much worse. I was very up front with the MC I wanted Dad to enter about his behaviors and my hopes he would do better in facility care because Dad was usually nicer to the home health care workers than family care givers and I hoped he would be taking his medications better in MC. We agreed to an extra attendant for at least the first week of Dad's stay and maybe longer depending on how well he adjusted. It worked out.

Maybe the "surprise" factor was a big driver in the rehab's last minute rejection. If the facility's DON had already agreed to a program for handling your father, the chart entries might not have had as much weight.

About a year ago my mother fell and her senior facility called 911 to have her taken to the hospital to be checked out. She has severe dementia and cannot express herself in words. She didn't understand why she was in the hospital and why they were "bothering" her all of the time, she'd pull out the oxygen tubes, she bit the nurses when they did something she didn't like. At that point I realized she just wanted to be left alone. After she went back to her senior facility I consulted with her doctor and we changed her care to hospice-type care where they would just do things to make her comfortable, and changed her medical directives to "no hospitalization". I know you are going through a difficult time, but try to understand your father's wishes. This is also not easy for him.

Maybe talk to his doctor to see if there's any medication that would make him calmer.

PS you are not alone!

If it helps... Your story is so similar to a workmate. That man self-discharged last time from the rehab to home - only to fall within 12 hrs & start the cycle again. Currently recovering from broken hip, refusing to do the rehab & causing trouble. But family have wised up now. Refusing his wish for rehab-in-home & ensured a slow stream longer rehab was the path.

Sounds like your Dad just doesn't wants to be where he is & his behaviour is showing it!

Agree with NYDaughterinlaw, stop confronting him & start working behind the scenes. Oh yes - I had to learn this!

You can avocate for his care without taking on the responsibility for his behaviour. Find out the options, link in the professional services he needs (inc that Geri psyche).

Guilt should never be in charge of the care plan.

You're understandably exhausted. You and your siblings need some respite from your father. Stop going to the hospital. Stop confronting him because it's not getting you the results you want. Rather, help him by working behind the scenes with the case manager on getting him a geriatric psych consult.

Talk to your siblings. What are you all willing and not willing to do? Openly and honestly discuss his living situation post skilled nursing facility if he gets accepted into one. Come to agreement about what's best for him and then stick to the plan.

Do not let yourselves be guilted into caring for your father in his home or in your own homes. Caregiving must work for everyone involved or it does not work.

If you go ahead and get the assessment by the geriatric psychiatrist, THOSE NOTES will be entered into his chart, making him more reasonable for acceptance in a center that has a vacancy.

Since you know his character traits are unappealing to many, you will be helping him and those of you who are responsible for his care by addressing his “stuff” head on. He obviously WILL NOT CHANGE because you and your siblings are “angry and hurt”, so doing something different may help.

The bottom line is HELPING HIM into a place that will be safe and willing to take him on. He NEEDS BEHAVIOR MODIFICATION and medication would appear to be the best place to start.

Ask the social worker to recommend someone if a Google search doesn’t give you what you need by way of resources.

GOOD LUCK!!

We did go through this. Care facilities are not interested in troublesome patients. There are so many people vying for the beds- they prefer to take the easy ones.

In our case a geriatric psychiatrist was consulted and medications were prescribed to help the issue which was dementia related. Barb's advice may be hard for you to follow, but it is good advice.

Best of luck! You can't help people who don't want help.

I agree with Barb. If he has always been difficult why do you keep expecting him to be somehow different now? Definitely do not take him into your home. Do get him a full neuro/psych/cognitive work-up so you know for sure if he is in control of his behaviors or not. If he is in control, let him know that since your efforts to help him are being undermined that you'd be willing to give up control and have the county take guardianship of him . His continued stupid behavior may make them decide to put him in MC and he won't have any choice. Roll him through the MC area of his rehab and see what he thinks. But don't make a threat you aren't willing and able to carry out. And do not take him into your home. I wish you success in helping him in a productive and healthy way!

If your father has always been difficult and he sees no reason to change HIS behavior, you need to change yours.

"Sorry dad, your uncooperative attitude is bolloxing up our attempts to get you the care you need. I'm going to be stepping away and letting the chips fall where they may. I hope the hospital can find you a place."

And mean it.

I don't recall your other posts. Have you been attempting to care for him at home?

I would not care for someone who didn't show some modicum of gratitude.

Get a geriatric psych consult so that you and staff can get a better handle on what your father needs.

Has your father always had a difficult personality?