How do you reason with a parent who will not face reality? Can you? How do you encourage someone to help herself?

I am curious as to whether her care manager at the nursing home is a nurse or a social worker. Some of what you reports sounds like 'false hope' to me.
Once bowel function is lost, it is hard to retrain the body, You mention a spinal infection and diabetes....if the nerve pathways that control defecation are damaged, she will remain incontinent. Her pain medication usually causes constipation, so she may be on stool softeners to prevent severe constipation.
Your mom's lack of distress/embarassment about the diapers seems like a tip off to her general attitude...I'll let others take care of me...they are paid to do it/my family has to take care of me.
Sometimes taking care of someone you love is ensuring they are safe and reasonably well cared for...in a SNF. You are right, it sounds like your dad is giving in to pressure to take her home. I'd have a family. meeting (dad, you, niece, etc) and be clear about the limitations of what each of you can and cannot do - and run through a few scenarios and try to kick around solutions, to see if he has that sort of planning ability.) What to do if she falls, what happens if he gets the flu and is bed bound himself for several days, his cooking skills, etc. This might reveal the need to locate additional resources such as hired caregivers to help with everything.
By the way, check with the ombudsman for the facility. (name and number should be posted in facility, so look around for it.) Often a SNF will indicate that if a patient is no longer in active rehab, that the person has to move to a different facility. They want to keep rehab patients as the rate of reimbursement is better.
The ombudsman can clarify for you if the SNF must keep her in the facility (maybe a different room) at the private pay/Medicaid rate, or if they can legitimately discharge her home even if it is an unsafe discharge.

When my mom got sepsis and had a heart attack etc. from a kidney infection she spent six weeks in hospital and then was transferred to a rehab facility. My mom had always been the sweetest, kindest, most reasonable person but when she was in the rehab place she became stubborn and uncooperative. She refused to participate in the rehab exercises. A few times I'd go to the sessions with her and even participate myself just to get her to do it. The things they did were simple like throwing a ball back and forth to each other or kicking the ball back and forth. Everyone looked shy and embarrassed but they did it. There were people there in far worse shape than my mom. One was a man who had his leg amputated but there he was getting with the program.

I think this is one of the few times in my life I remember getting mad at my mom. I tried to explain to her if she ever wanted to live on her own again she'd need to do this but she refused. They eventually released her cause they needed her bed for someone who would try and she went back home with home health care in place which she also did not cooperate with. She ended up in a nursing home. She basically just gave up I guess.

It's frustrating but when it comes right down to it a person needs to want to succeed. Sounds like your mom would rather not be independent and continue to poo into her diaper. I feel for your Dad but he shouldn't allow himself to be taken on this ride with her at the risk of his own detriment. Unfortunately love does not conquer all in some cases.

Is your mother in the SNF for rehab purposes, short term, or is she there permanently? If she's there for short term rehab, and refuses to do the physical therapy that's expected of her, then Medicare can refuse to continue paying for her b/c she will not be making the required 'progress' and she'll be released. It'll be a moot point as to whether your dad will take her home b/c he feels guilty.......there will likely be no choice in the matter!

If she's there for the long term, Dad needs to KEEP her there until & unless she makes the required progress that will enable her to come home w/o killing HIM by doing so.

Defecating into an adult brief because 'it's expected of her' is a new one I've never heard before, and a big fat excuse if ever there was one!!!! Is your mother suffering from cognitive decline in addition to her other ailments, by chance? Has she been tested with a MoCA or SLUMS exam? Also, why is she bowel incontinent? Has the doctor given you a reason for such a thing?

In any event, you can't force your mother to do her PT, nor can you force her to face reality. What you can do, however, is talk to your dad about placing her permanently into managed care if she refuses to be cooperative b/c expecting HIM to take care of THIS level of neediness is asking too much, in my opinion. If she's "72 and too old to care" which translates to eating/drinking whatever she wants & destroying her body in the process, which means DAD is paying the dues for her behavior, then he has to review his options now. Expecting him to clean up bowel incontinence and get her around when she refuses PT is a huge job for anyone! You're right; he can easily get hurt and require care HIMSELF if he's trying to lift her up b/c she won't do PT and help herself get mobile again. He needs to at least call in caregivers to help him every day and if she balks at that, she can stay in the SNF and get 24/7 assistance with her myriad needs. Just diabetes alone is enough to cause severe problems down the road, especially when it's ignored; my late sister in law had her leg amputated due to ignoring her diabetes and loving sweets MORE than she loved her life. She died at 64 from Covid, but would have passed away in short order from liver and kidney failure had Covid not taken her more mercifully without pain & suffering.

Your father is likely the one who needs to have a Come to Jesus meeting with mom. I hope he can get through to her, otherwise, he has some serious decisions to make moving forward with regard to her care options. Sometimes, in situations like this, it can be too little too late when a person ignores their health for so long. Sad, I know.

Wishing you the best of luck with all that's going on.

Hmm. The situation right now- is this sort of it?

* Mom needs a gigantic amount of care.
* Mom feels Dad can do it all.
* But that is not reasonable in your's & many others' view.

Mom won't or can't see reason. (Maybe stubbornness, denial, lack of insight (anosognosia) maybe a mixture of all of these things).

You cannot reason with unreasonable people - this is what I have learnt (the hard way..)

But you can work with Dad. How is HIS reason? How is his insight to what he can realistically do? How 'tough love' can he be?

Or will he bring her home to *make her happy*? Despite knowing he can't actually make her happy? Despite this potentially endangering his own health?

If Dad CAN reason, use that.
Ask what HE wants to do. Help him get a care plan ready: either a huge team of home aides or arrange for Mom to move into a permanent care facility. Oh & make clear you will NOT be the care plan (unless you are actually planning to be 🙄).

I would try to kindly suggest counselling to give extra support for your Dad. May help give him some more tools. Through a church or faith (if he has one) his Doctor or Elder community services.

Many elderly lack insight. They want what they want with no regard for others. Save your father! And keep her where she is safe. As a retired 27 yr clinical staff member I have seen residents adjust to nursing home life after a tough start. Have Dad visit routinely. Family involvement always helps. Where I worked staff would engage residents in activities and most adjust well. It takes some time. Good luck!

You've got a hard situation. With some people their stubbornness graduates to being unreasonable. Your mother will not see reason and doesn't want to do any of the work it will take to get stronger and be able to go home.
Deal with your father not her. Tell him everything they've said about mother refusing to do her PT to get stronger. And the part about the diapers too. He has to be convinced to stay strong and do what's best for her.
What's best for her is to not let her come home until she's steadier walking and out of diapers. If he lets her come home, she will totally give up on PT and will completely neglect her other conditions and become an invalid because she will be home and it won't be something to strive for anymore. Don't let her come home.

Seeing your father lose hope? - what are his hopes?

You may not be able to do much with your mother, but you can certainly work with him. She comes home when she is fit enough and not before. Make sure he has the same hymn sheet as you and the therapists.

I am friends with a health care worker who is caring for an elderly woman who reminds me of your mother. This woman has multiple health problems and is too weak to walk but insists that she will walk--even though she declines to do her exercises. She gets abusive with her caretakers and screams at them if they try to make her do her exercises. Your mother is not screaming. She's just refusing to accept reality and waiting for reality to adjust to her point of view. I'm an elderly (79 yr) lady myself who needs to exercise. But I have chronic fatigue syndrome and my legs hurt and they are so heavy and I am so tired. But I do want to improve. So I DO exercise--but cut back the number of repetitions. Most prescriptions say 10 repetitions 3 sets. I do only 3 repetitions. I live on the 3rd floor of an apartment building. So I won't use the elevator. My advice is "every little bit helps." Can she walk? Does she realize that she will get worse if she doesn't use her body? Don't say this as a threat. See if she has any desire to improve. Is she waiting for a pill? Say, while you are waiting, pill might not work if you get too weak, so, yes, legs are 1000 lb. They will get lighter if you can move them a little. That's what happens with weight lifters. They can lift more weight as they exercise. Tough situation. I'm struggling with myself. I also don't exercise when I'm really tired. Try showing sympathy, telling her how much you want her to improve, etc. So sorry for both you and your mother.

Sumosuzie: Your father must not give in to her pleading to go home as she is in the SNF for a reason. Many individuals are caring for her there as opposed to the potential (if mom wins) ONE individual at home. Age 72 is "not too old to care." The individual authoring this is 75 years of age.

You cannot persuade your mother to help herself; she has to want to do it. "Too old to care" is an attitude, not an age. Many of us are well over 72 and do not share that attitude.
If returning home depended on meeting specific therapy and control goals, she might comply far enough to be allowed to go home, but it sounds like she would quickly revert to being dependent on your father. Her continuing care would soon be too much for his own health and well-being. It is selfish of her to expect to be waited on instead of taking at least some responsibility for herself.