How can I get my stepmother to follow doctors orders for my dad?

Gosh...such good ideas/insights. I'm absorbing it all and I'm grateful to be able to benefit from folks who have been on the front lines longer than I have. The caregiver working today is great. SM called him at 10 last night to tell him to come later in the day because she wanted to take my dad out for lunch and a movie...he offered to come at his regular time to help get my dad up/dressed and to walk with my dad while they're out and about (to ensure his safety). SM told him no. He then called to give me a heads up, since my agreement on the shift I'm paying him to work today was being amended. The compromise he made with SM was he would meet them where they're having lunch, then help my dad walk with her to the movies, wait in the lobby for them (in case my dad had to go to the bathroom during the movie), then accompany them home to finish out his shift. She wasn't happy about it but she finally agreed. She likes him and says he's terrific with my dad, so right now he has a much stronger relationship and level of trust with her than I do, unfortunately. I'll definitely arrange a "ladies date" to take her out on my next trip, if she's willing...and I'll try hard to get back on a better track with her. But right now I confess I'm on pins and needles for an update from the caregiver because this is the 1st time in a few weeks SM has been "out alone" walking with my dad. Last time was when he fell and wound up in the ER. Surrendering to the reality I don't have the power to prevent bad things from happening to them, no matter what I try to do to influence the outcome, has been my own self-imposed behavior that I've built up a lot of resistance and defensiveness around. I need to figure out a way to overcome that dysfunctional behavior on my part, because I worked myself into such a worry frenzy after talking with the caregiver last night that I couldn’t fall asleep till after 4 this morning. I'm a zombie today and I'm not doing any direct caregiving, so I don't have any reason to be sleep deprived! As the caregiver told me last night...I need to work to do a better job of keeping the faith that everything will work out. Sadly, I'm finding that to be something that's easier said, than done.

Onpoint, you're doing a good job for your folks. Don't beat yourself up about every little detail.

I'm in a similar situation with stubborn elderly parents. Dad has dementia, Mom does not officially have dementia but with all her meds and at age 85 her executive reasoning is just not good anymore. Your step mom sounds similar.

I've expressed this before on this forum but again I think it fits this discussion.

There comes a point where we have done all we can do. We have done all our elders will allow us to do. We are dealing with legal competence but a reality of bad decisions and judgement. It does me no good anymore to keep badgering my mom about her diet or using her walker. It just upsets us both and changes nothing.

No matter how much we do, make the house safe, get the meds, the right docs, stuff is still going to happen. Illness, falls etc. We can't control everything.

I'm not suggesting total surrender, but pick your battles. Eventually a crisis will force things to change. Like many caregivers, I'm in the waiting game for the issue that will force my folks to accept the help they need.

Excellent insights, CWillie. I've been guilty of that myself, so this is something I'll remember. It's hard enough for older people often to just get dressed, let alone be pushed to go someplace, especially another doctor appointment.

Thanks for sharing an observation which I'm sure could apply to a lot of us, especially me.

There's one little other thing that I think is worth mentioning: getting everyone - yourself, stepmother, Dad, any observers - to allow lots of extra time for your Dad to go more slowly, and to take frequent breaks.

I've noticed on all sorts of occasions that when an older person is struggling, the instinctive reaction is to try to get them where they're going as fast as possible so that they can sit down. It's natural, but it's the opposite of helpful, because what then happens is the person gets bustled and hurried which is the last thing they need. Pausing and letting them catch their breath or steady themselves is trying on the nerves - not to mention the patience - but it is what you need to do to support independent mobility.

Combining extra time with a sturdy, seated rollator, or a lightweight wheelchair that your SM can keep to hand or in the car, or both; that should keep your father beetling about safely for as long as possible.

Therapists and other medical professionals develop excellent insights into human behavior. If one of the aides observed fear behind your SM's behavior, I would be inclined to believe that. There might also be some protectionism in her approach, e.g., as in "I'm his wife; I know how to take care of him."

I saw this same attitude in a mentally unstable cousin who managed to push family away and isolate her mother, sometimes overmedicating her with drugs (NSAIDS) to the point that eventually surgery was necessary.

I'm not saying that the same symptoms are present in your stepmother. But there is that kind of "I know better" approach.

I think there's a variation of Munchhausen's by proxy that sometimes afflicts caregivers. Instead of making their charges ill so they can effect cures or recovery, they feel that they know more than the medical professionals and are qualified to evaluate and initiate corrective measures on their own. I know at least 2 caregivers with this approach. It's impossible to make any suggestions to them because only they know what's best for their relative.

I think your plan to involve a geriatrician is a wise one. I would at least for the time being though back off entirely on having your stepmother evaluated. If the aide is right, she's responding to her own anxieties and seeing a doctor on that level would probably only exacerbate the tension between the two of you.

She needs to find a way to address her own fears, with support but not oversight. Maybe you can take her out to dinner, bring her flowers, make her more amenable to your involvement.

And if you can persuade her that you're concerned for her health as a caregiver, and want to ensure that she's still in good health, that's a different story. But, honestly, I'd be really cautious about trying to determine any kind of dementia status because I think she'd recoil like a rattle snake and you'd be the victim if she lashes out.

I'd think very carefully about how to encourage her and turn the situation around so that she does rely on you rather than perhaps seeing your efforts as threats to her own actions.

And as to replacing the one doctor, well, there are often long waits to see another doctor, you have your own life and can't call dozens of doctors, and of course you never really know what a doctor's like until you meet him or her.

A few years ago an internist was highly recommended by a surgeon, nurse and a woman with whom I shared a hospital room. I was disappointed when I met the doctor; she wasn't at all cognizant of older people's issues other than to be sure to ask certain questions segregated by Medicare for special payment.

She ignored 1 critical issue (anaphylaxis) and pooh poohed another (anemia). Obviously I never went back; the first visit was a waste of time.

it really is hard to find good doctors.

Thanks SO much for these responses. SM was at the dr's visit--didn't push back at all with the dr, who was quite firm in saying my dad was lucky to only have to get stitches from a badly split lip, and that he hadn't split his head open. SM really liked this doctor, who my dad has seen for a long time, but now says she wants me to find another doctor to replace him. I also discovered at the appointment that this dr had pleaded with my SM in other appointments I couldn't attend for her to get in-home aides. I pray I can nudge SM off of wanting to replace this dr., who's extremely well respected and has provided excellent care for my dad. However, I also found a geriatric specialist to help me coordinate my dad's care, and his practice has a social worker on staff. They've also tried to get SM to accept in-home care over the last 8 months my dad has been a patient there. Since SM isn't upset with them right now, I'll definitely schedule an appointment ASAP with that dr for a "fall" assessment and to request another round of in-home PT sessions for my dad. Love the idea about getting the PT professional to show SM how to handle walking with him. And it's very insightful to be asked whether SM may have dementia. I've been noticing some disturbing patterns, but when I tried to talk with her about it, she got angry and said it was just caregiver stress. A year ago, that made a lot more sense to me, which is one of the primary reasons I'd been trying to get her to accept in-home suppory. It also took me a few months to get the two of them to agree to get my dad into a neurologist to get tested though, so I figured resistance was just something I'd have to work through/accept with them. My dad was diagnosed as being in early dementia 14 months ago, but he's detriorated VERY rapidly since then. There have been a few times during that time period my breath was taken away in the physical change I saw in between my visits. He seems to have a good appetite and he's also drinking nutritional supplements. I talk to them 6, if not 7 days a week, sometimes multiple times a day. Increasingly, I brace myself every time I see their phone # pop up on my cell phone, fearing I'll hear that he's wandered again, or fallen, or worse. I've been diagmosed with an ulcer in the past few months. And I know all this is far harder on my SM than it is on me. My husband thinks I'm "enabling" both of them by not being more forceful and that I should file for guardianship, but I don't want to overeach. I already offered to serve as SM's POA/health care proxy for her, and for she and I to legally serve as co-guardians for my dad to protect both of their best interests should something happen to either one of them, but she said no. My dad fell a few days after that conversation, and now that I've been increasingly frustrated and upset with her refusal to use the wheelchair for my dad, I fear I've compromised an already challenging situation. They're both good but very strong-willed people who have lived an exciting and independent life with each other for over 30 years. And everything is changing for them in a short period of time. Good news is that they both seem "better" since the aides have been on the job. SM is still clearly functional around the apartment and she's physically quite healthy. But as one of the aides said she felt compelled to tell me this week, "what sounds like resistance when she talks to you is really fear--for your dad, and for herself about how much she seems to lose things in the apartment, and for all the changes she feels are being forced on her." SM never had children, and her remaining family members close to her age live far away, with or near their own adult children and grandchildren. I'm an only child, and I need to be the person on point for her and my dad. But I don't know how in the world I'd persuade her to be evaluated. That may be a harder outcome to achieve than getting her to use the wheelchair for my dad. -:( All of your advice is deeply appreciated though--you 've given me great ideas and lots of food for thought.

I agree with letting a therapist take the lead in pointing out the correct method. Older people often listen to them before taking the advice of a family member, even if it's the same advicde.

I would brief the therapists privately (that's what I've done several times) and ask them to tactfully demonstrate the proper techniques, every time they come, if necessary. They can also ask your stepmother to perform the moves, etc. just to "ensure that they've communicated adequately the steps she needs to take."

You might also ask them privately to document if they see stepmom isn't cooperating. They might already do that w/o prompting.

Both great answers above, but I want to add...does SM have dementia or some cognitive decline? I'd bet that she does. She's not seeing apparently, that your dad needs to use the wheelchair sometimes ( on outings, long distances, etc) and a rollator in the house, to keep him strong. Getting a good PT evaluation is key here. Schedule it soon. And i would start doing research on facilities.

I hugely sympathise. Once the PTs had shown me how to support my mother safely (safely for both us), I used to get fit to be tied when people grabbed at her upper arm and hauled her along. Well, I say people. Actually it was one person and I had other issues with her besides...

I digress. What I would heartily recommend is that you book a training session for your stepmother with a physical therapist specialising in elder care, so that the PT can demonstrate techniques and your stepmother can practice under expert supervision. I would also recommend that you look online at the vast range of walking frames and rollators available, and see if you can't see one that might be suitable for your father - indoors, outdoors or both. The thing is, your stepmother is absolutely right in that you don't give up on mobility without a fight - so she does have your Dad's best interests at heart, as you recognise.

But I also sympathise with that permanent sick, heart-in-the-mouth feeling you must have, fearing a serious fall. Hugs to you, hope you find a happy solution.

Was your SM in the session where the doctor explained this? Might it help to schedule another session for the two of them with the doctor? You could write to the doctor ahead of time and explain that SM is having a hard time understanding the wheelchair use.

My husband fell and fell and fell again when he developed dementia. He faithfully used a walker, but it did not prevent falls. His doctor suggested a wheelchair. She advised us to make sure he still did some walking so he wouldn't lose the strength to do transfers.

He loved the wheelchair! Suddenly he could scoot himself around the house (using his feet) without fear of falling. It made a huge difference in his outlook. It was one of the best things that happened in the first year of his dementia.

I think both your Dad and Stepmom may wish they'd done this sooner, once they accept it. I hope you can help facilitate that.

Please let us know how this works out.