Dad refusing to follow advice

[SassyD]

Hello,
I’ve just found this group and hoping for some advice as Dad has been in hospital for the last 5 weeks after another fall.
He’s very frail with no muscle and the doctor has confirmed he is likely to have vascular dementia as his short term memory has now gone almost completely. Ie can’t remember recital examination straight afterwards - sorry about the detail but for me this highlights the extent to which his short term memory has gone.
When he’s good he understands what he is being told and is very clear he wants to go home and to die at home
He’s capable of making good decisions in the moment but can’t remember them and has told us he is going to sleep in his room upstairs and not downstairs as he’s fed up of being told what to do.
The huge risk is that if he wakes and tries to go to the loo he either falls down an open staircase or falls over the railings along the landing. It’s a big old fashioned house with no way of reducing these risks.
How do I approach him and help him understand the risks are too great and persuade him to sleep in the living room which will be a constant reminder to him that things are not as they were and he is getting to the end of his life.
The second told him this and he understands but has always put off making decisions all his life and has a very fixed mindset.
This is a real emotional hurdle for me balancing his choices and free will with the reality of the situation where we need to keep him safe. He’s used to having his own way so can be quite unpleasant sometimes with my
Mum.

 

[canary]

Hello @SassyD and welcome to Talking Point

Unfortunately, as dementia advances the person with dementia loses understanding of their own limitations and thinks they can still do everything and they also find it increasing hard to make decisions and become very fixed in their ideas. This means that they dislike change and if you ask them to do something different the answer is almost always "no". This is fine if the question is something like "would you like to wear your new shirt", "would you like chicken for dinner" or "would you like to go for a walk", but when it is a question of safety, its a totally different matter.

You are not going to get your dad to understand, accept and remember that he has to sleep downstairs for his own safety, so you are going to have to make this decision for him. Move the bed downstairs and tell him this is what the doctor said he had to do. You can sweeten the pill a bit by telling him that its a temporary thing until he recovers, if you like - he probably wont get better, but there is no need to tell him that bit.

I know we all want to try and get our person with dementia to agree and we want to try and work things out so they can do the things they want, but, unfortunately, with dementia there comes a time when you have to stop enabling their wants and start enforcing their needs.

 

[try again]

The hospital should trigger off an independent living assessment or similar. Get adult social services involved, it's easier for him and you if any decisions or advice come from professionals.

 

[Shedrech]

hello @SassyD
a warm welcome from me too

I appreciate that you and your family want to honour your dad's choices as it's tough to begin to make decisions for him ... however although he can tell you he wants to go home, he is not grasping the repercussions of making such a decision, so it's not a good decision ... therefore it's time to organise what he needs, rather than what he wants, and use 'love lies' or 'therpeutic untruths' to allow him to accept what happens

I suggest you arrange a move into residential care, or at least an assessment placement, and tell him that doctors have prescribed this for him to recuperate and build up his strength to enable a move home, rather as the old 'cottage hospital' used to work ... then when he asks to go home from the care home, keep saying that you are checking with the doctors and they think another week will make the difference (or some other excuse) ... this way you and your mum won't take the blame and can be seen by him as on his side wanting him home but can't go against 'doctor's orders'

 

[Dunroamin]

I dont think your dad is refusing to follow advice at all.He just cannot internalise information anymore. @Shedrech 's post is both - sensible and helpful post - even if that is not what you want to hear.

 

[Bod]

hello @SassyD
a warm welcome from me too

I appreciate that you and your family want to honour your dad's choices as it's tough to begin to make decisions for him ... however although he can tell you he wants to go home, he is not grasping the repercussions of making such a decision, so it's not a good decision ... therefore it's time to organise what he needs, rather than what he wants, and use 'love lies' or 'therpeutic untruths' to allow him to accept what happens

I suggest you arrange a move into residential care, or at least an assessment placement, and tell him that doctors have prescribed this for him to recuperate and build up his strength to enable a move home, rather as the old 'cottage hospital' used to work ... then when he asks to go home from the care home, keep saying that you are checking with the doctors and they think another week will make the difference (or some other excuse) ... this way you and your mum won't take the blame and can be seen by him as on his side wanting him home but can't go against 'doctor's orders'

+1 from me.
The best advice there is at this stage.

Bod.

 

[SassyD]

hello @SassyD
a warm welcome from me too

I appreciate that you and your family want to honour your dad's choices as it's tough to begin to make decisions for him ... however although he can tell you he wants to go home, he is not grasping the repercussions of making such a decision, so it's not a good decision ... therefore it's time to organise what he needs, rather than what he wants, and use 'love lies' or 'therpeutic untruths' to allow him to accept what happens

I suggest you arrange a move into residential care, or at least an assessment placement, and tell him that doctors have prescribed this for him to recuperate and build up his strength to enable a move home, rather as the old 'cottage hospital' used to work ... then when he asks to go home from the care home, keep saying that you are checking with the doctors and they think another week will make the difference (or some other excuse) ... this way you and your mum won't take the blame and can be seen by him as on his side wanting him home but can't go against 'doctor's orders'

Thank you Shredech