What can I do if 96 yr old dad refuses substitute caregiver when his full-time person has to go out of town?

I told my father that I would give a caregiver a key and that he would have no say unless he started doing his daily teeth brushing etc. He only shaves and brushes his teeth on days that I take him out. Which is about 3 to 4 times a week. He is capable.

We went through a very similar situation with my father. The most difficult aspect we had to confront was that dad was once a vibrant, involved, active, self-sufficient, and domineering man. His illness stripped him of all of this: he retained most of his mental faculties, but his body caged and strapped him to a chair or bed. With the exception of my mother, he refused any additional care. Finally, our mother's health began to fail -- and she needed surgery with 6 month rehabilitation. As much as dad hated it, we had two of his physicians explain to him that HE needed to be hospitalized for care while Mom was also hospitalized. He was told the situation was warranted and would most likely be temporary. We placed him in a very comfortable nursing home -- and although he grumbled about it (which we knew he was doing to maintain his own pride), we think he was content with the decision. Mom got better as the months went by, but Dad continued to decline. He never came back home: the care he needed became too great for just family members to help out. He had daily visitors (family, friends)....Our family (all musicians) put on small performances for him and the residents; and we did our best to make good connections with staff members -- so Dad felt more like he was with family than hidden away in a nursing home......He passed away 2 years later - wit my mom, brother, and myself at his room......It wasn't sad: it was a life lived to its fullest and he lives on in memories and the many contributions he left behind...

Warmsaltybreeze, I believe you, and so do most of us here. We just wish we could find the magic words. For my father, threatening - no, offering - to take him out to "the back 40" to shoot him sometimes helped. Under other circumstances, nothing worked. (sigh.)

I know! You can lead a horse to water...! When anybody is in my car, though, I tell them that if they were hurt in an accident I could be in trouble with my car insurance company, not them, so sorry, they HAVE to wear the seatbelt if they want to be IN my car. Isn't it just amazing what parents at that age will do? I think they still think we are 'children' and we aren't supposed to boss them around! My husband and I don't smoke and we do not allow it in our home at all. We live in a southern, tropical state and we have a 'caged' pool area which is also covered with a roof in part. It is always nice outside and we consider it perfectly reasonable, beside the fact that it IS our house, to sit there to smoke. But my dad will go back in the part of the house where we have made a really nice 'suite' for them when they have stayed with us - and open to door to the back yard from a pool bath and think that the smoke will actually go out the door and we won't ever know he smoked back there! It just infuriates me and is really disrespectful to us when we are putting them up for a month or so at a time but there it is! STUBBORN. You are so right!

Thanks all I think I'll take your advise too, and go to the Dept of Social Services/Older Adults Counsel, and see about getting help or a social worker for my mom. Maybe somebody from outside can reason w/her, maybe even talk her into letting me hire somebody to come in to ck her meds etc.... I'm a little scaired of how her mind works now; my mom never use to lie, but she lies all the time now, to include in court. I don't want to get caught up in her saying, "She tried to OD me"...that's just how her mind works now, and I have to be one step in front of her. She's always been stern, digs in and hold her ground. Thanks again.

I would try to find a substitute from the agency or elsewhere. If the primary home health aide knows of a co worker who is very good, I would have them work together for a couple of weeks prior to the regular aide's departure.

I would try to win his confidence in the substitute aide. It is important to have a few aides who are acceptable because it is not that unusual for an aide to need time off for a variety of reasons (sickness, sick children etc). Often even live in aides have family issues which will require time off outside of a scheduled time off. Agencies are supposed to have acceptable replacements but I found that do can be a problem when push comes to shove. I had a retired LPN who would help at those periods so I could maintain my work schedule.

I found my father would become concerned when the regular aide was not available on short notice. He was more at ease when the part time aide who he knew arrived even though it wasn't as good as the regular aide who he really enjoyed. Consistent care givers are really, really, really important. The 6:15 am call from the agency saying the aide could not come, was a scary call for me as well as my elderly father.

I wish you well. I would try not to tell him he has to accept an aide who he isn't comfortable with and does have confidence in. Also since he may need a nursing home in the future, I would not threaten him with nursing home placement prior to his need for it. I know the aide coverage issue is a rough one to handle particularly if you are arranging it from a distance, but your dad will
probably come around if reassured. Having consistent home health aides and substitutes is vital to keeping the elder in his/her home.

Just do the best you can. I really know how difficult this type of problem is, having lived with it myself.

Elizabeth

I wish that kind words and logic worked...well-meaning friends and family have "coached" me in what to say to my dad but they really don't understand the depth and degree of stubbornness and denial and delusion that some of our parents live under. Rational "non-violent communication" words simply DO NOT work in some situations.

Frustrated2 -
"I remind him that he may not die but end up in a wheelchair or paralyzed and then his activities will really be cut short and he may not be able to keep his home." I used that logic on my father about seat belts in my car. I told him he could take it off only at highway speeds, but that he had to wear it around town to prevent non-fatal injuries. Stubborn old coot!

I have a very in charge dad who is 83 and although he hasn't reached the same age with the same concerns as your dad, I can imagine what he will be like when he gets to that point. I think the words I might use with my dad (I live in a different place as well) might be something like "You know, dad, I really try to make sure you are comfortable and can be independent in your life. I love you too. Remember when the roles were reversed and you knew I wasn't able to make every decision or do everything on my own? Remember how you would have worried about me (if I didn't call and came home late, or if I was out riding in a car with friends, etc)? Well, it's the same now for me. It isn't about wanting to boss you around. It is about my own peace of mind as well as your safety and being able to continue being at home. I know how much you would hate it if you couldn't stay in your home anymore and you and I both know you need some help now. So put yourself in my place, dad. I would never forgive myself if anything happened to you. Let's work this out together".
There sort of is an implied threat that if he doesn't be sensible he may find himself in a position to not be able to stay at home. He may not like it, but it is for his own good. I believe you can respect his wishes and still gently put your foot down. Best of luck! My struggle is trying to convince my own father that he - after two back fusion surgeries, two knee replacements and a couple of surgeries due to complications from the other surgeries (!) - can't climb up on his roof and clean out his gutters. I think he thinks well, if I die doing what I want to do, then so be it. I remind him that he may not die but end up in a wheelchair or paralyzed and then his activities will really be cut short and he may not be able to keep his home. My mother is still alive but all she does is screech at him and that makes him more determined to get out of the house and work in his very large yard! In the end though, who knows? One of his doctors told him "well, I can fix your knee but I can't transplant common sense". In the end they are adults and they will unfortunately have to live with their consequences. Didn't they one day teach us the same thing?

I really can't take any more abuse from My 93-Year-Old Mother. If she does like the service, too bad. If I threatened when she repeatedly tells me that she wants to come home, even though she is in danger of falling even more. I may just leave her own condo and move out. I have family from out-of-state who will help me to relocate if the situation does not improve soon!!

PatatHome01

I would say that you cannot reason with someone who is unreasonable.... Please tell him these are the choices a substitute caregiver, or the nursing home. Medicare will pay for 2 weeks of respite in the nursing home... I say give him those choices and NO other. Do not let him manipulate you it is not fair. I have a very manipulative Mother, and I resent it when she tries to manipulate me... My Father passed away almost 3 yrs ago and I know it is hard for her. I am very kind(really) to her and I would do anything for her but sometimes she whines like a little kid. My sons(who are all grown up) always ask if I whine, would you care for some cheese Mom to go with that whine... keep you sense of humor... take care

If your caregiver comes from a company, call their supervisor and explain the situation. They may be able to give you more advice about it, or they may actually have a social worker there that could go out and speak with him about it, and explain the options to him.

You could also explain it as (if he is on medicare or priv. insurance) "Dad, I know you don't really want a different person here, but your insurance / medicare says that you MUST have someone come visit on these days, or they may stop paying for the caregiver to come out at all." A bit underhanded, but it's worked well for me with my mother. =)

Another option would be to actually speak with his regular caregiver, and explain the situation (she probably already knows) and ask her if she can have the substitute come out WITH her a couple of days, to get to know him and so he can see that she's harmless. It might be that he is scared she will be 'different' from his regular one, and not know the routine or how he likes things done. If his reg. caregiver can bring her with, it's let her show them how he likes things done, and give THEM a chance to get used to HIM as well!

I hope this helps!

Neighbors can only do so much, and many don't want to be "decision-makers". They don't want the potential liability.

I've hit "the wall" recently where I had to "take over" or be "taken down" with caregiver burnout. I told the "stubborn, domineering, difficult step-parent" that I needed to step in as the decision-maker to protect this person. Before I've been asking them to still make all the decisions for their well-being. It isn't working. Surprisingly, the time was right and the person said "ok". We are working toward downsizing a large house, fixing it up to sell, and then they move on to an independent living situation that offers "continuous care" - - which means as physical or mental needs shift (in their 90s now), that more services are provided. Look for a facility that is NICE, and takes a percentage of income vs. buy in - unless you are well financed. I was in shock what assisted living or retirement communities want to charge elderly or their family members. (Try like $135,000 - $150,000 to "buy in" then another $2000-$2700/ month on top of that!)

Finally found a nice place with a waiting list what wants 30% of income and includes everything. A wait list we can deal with -- - if needs increase before the name comes to the top, this person knows his only option is "the bone yard" as he calls "assisted living places". He described the ones where he went and looked - "wheelchairs lined up and parked and people waiting to die."

Get a Social Worker, contact "Council on Aging" (nationwide), VA Services (if your person is a Vet), and even turn to local churches for help.

Above all - - if he does go into care - watch out for clauses that obligate the family to pay the bill. That "clause" is buried sometimes 18 pages in to like a 25 page contract. Don't get stuck signing a contract without a lawyer looking it over and explaining it to you. They will sure try to make you sign and not take a copy with you.

Don't buckle! Get legal counsel. Know your rights and protect his.
You need an elder care lawyer.

Those admitting contracts - they don't protect residents' interests - they protect the companies that own the facilities.

Good luck!

I agree with Chicago. I have both Mom and Dad. Mom is totally wheel chair bound. Dad is not able to take care of himself and certainly can not care for her. They are both very strong mentally and manage their own affairs. They live in the house with us. When Dad won't cooperate with the aide situation I just let him do whatever. I hate to do that to Mom as she is the one who suffers the most from lack of care. They have been together for 70 years so I just have to let them be and let what happens happen. I actually have been known to throw a little guilt at them. "if you won't accept caregivers or go to respite then I will have to skip my vacation, or quit work, or whatever fits the situation" This usually works. Dad could care less as he is very self-centered but Mom can't stand the idea that my life is suffering because of her. So, I do my best to give her good care and when I can't be there I do my best to see that Dad makes arrangements. That is all I can do and the rest is up to the angels, as Grandpa used to say.

We had to do exactly what you describe - and leave Mother to her own devices. No one was there full time, but a bath lady came in and saw the situation and called an ambulance. Mother is very forceful, domineering, etc. My sister and I finally had to accept that the pieces were going to fall where they may. Her lack of planning, cannot always be an emergency for the rest of us, who by the way are 60-75 YO ourselves.

If you have tried "Dad I want you to allow another caretaker in, so you can stay at home. If not you need to go to respite care at the nursing home," I don't know what else you can say.

Is there a neighbor or a friend that can check in on him?