Mom's mobility has been declining since September 2022. She is now at the point where she has to use a walker to maneuver around the house. The home health Physical Therapist comes once a week to do exercises with her which, even though she complains and gripes about it, she still performs the exercises. However, when the therapist leaves, she refuses to do the exercises that the therapist recommends she do twice a day. Should I force her to do them and listen to her gripe and complain? I usually remind her of them and offer my help but most of the time she will say that she is in pain from arthritis and doesn't feel like doing them today.
Best of luck with a difficult situation.
Here we go. My brother was SOOOO helped by his one month in rehab after his car accident incidentally got him a diagnosis of probable early Lewy's dementia. He got a diagnosis of probably early Lewy's dementia at that time, and his balance had been poor for some time. And after doing and practicing exercises he was so much more steady on his feet.
But would he do them when he was released.
We talked. He said that there was just so little he felt in control of after all he went through, and in the middle of selling his last home, moving to ALF, getting me POA and Trustee of Trust and management of his finances, that he just had to take control of some few things, one being when and if he exercised.
I do those same balance exercises now, and I don't do them faithfully enough nor often enough no matter I know they make a difference.
I think you may be fighting a losing battle. I wish it were not so, but often the more we advocate for something the more our loved ones move away from hearing what we say. Not good. Not right. But it IS word.
I sure wish you luck. Let us know if something works.
One lady was bedbound within a year. The other went 4 years still being able to transfer, toilet, and minimal walking but is currently a hoyer lift to a geri chair every day and it's been that way for quite a while.
Both had all the proper encouragement and resources to complete the exercises as prescribed. Neither was given any exercise that they literally couldn't do. They simply did not comply with what was prescribed and all the encouragement and explaining in the world wasn't going to change them.
If she's motivated by anything at all, you could point out that if she doesn't get stronger she'll be in a wheelchair and out of her house.
My mom wouldn't do PT, and my poor dad tried everything to motivate her. He knew that she'd have to move to a facility if she became wheelchair-bound, but there was nothing to do about it.
As it was, she ended up wheelchair bound after a fall, but only after she'd been moved into a facility for other reasons. It was too bad, because she could have probably still walked again, but her room at the facility was too far from the common area/dining room, and she just didn't have the stamina to walk that far.
People can/will do their therapy with the therapist only. The uniform, name badge or professional manner works the magic.
Don't beat yourself up.
Decide if 1 x week with the therapist is ok or not. If not & you can afford it, have a therapist assistant visit 1-2 x week for a few weeks. Many community practices where I live employ assistants for this very reason.
Or if you want to be the therapy assistant yourself, make it an appointment. Today at X o'clock I will be helping you do your exercise program, per the Physio's plan. Ramp up the motivation with bribes. Big bribes! We will do X afterwards.
Or even better, can the exercises be snuck into her daily life? Eg Walk around the house twice before sitting down to lunch. 10 foot raises before putting shoes on.
Twice a day is a lot for an unhealthy senior in pain. Once a week is not enough to keep her mobile. Anything more that once a week in better than nothing. Once a day, once every two days...may be more realistic.
Let's face it. Old age is a downhill experience and she will continue to lose mobility. That's inevitable. PTs tried to get my mother to exercise when she was progressing with vascular dementia. They thought she could. She had exercised all her life. As her daughter I knew that. She couldn't do it at that point. She would have if she could have.
It's hard to see them decline, I'm 85. It's hard to be declining.
Are you living with your mother now? Or vice versa? What happens when your FMLA time runs out?
Are you the caregiving plan for your mother, or is this temporary?
My mom did very well in PT and OT and she was in her 90’s. Mom had Parkinson’s disease. She also did rehabilitation at a skilled nursing facility. She worked incredibly hard. I was amazed at what they had her doing.
My mom used a walker too.
It does work for some people and others it doesn’t.
My mother did do some of the additional exercises that they referred to as homework. I found that she always did more with the home health staff than with me.
Is she in pain? Sometimes aqua therapy is recommended. It’s done in a pool, they work out in indoor pools and don’t experience as much discomfort in the water. Is that an option for her?
Really, IMO, the 1x a week isn't doing a thing if she is not doing her exercises daily. She wasting the PTs time. She could be seeing a patient who is willing to do the work. If Mom shows no progress, Medicare will stop paying. Plus, she probably doesn't remember them. So you have to start all over working with her.
Your family leave will be over soon. What are your plans? Mom can't live on her own and with a family and a job, you don't want to care for someone with Dementia. With my Mom, we got PT into her AL. When she went to Long-term care, shevwas given therapy there.
OT is for occupational therapy. Usually for someone who needs to relearn or a different way of doing something. With my Mom there was nothing the OT could really do. She was beyond dressing herself, bathing herself, toileting herself, cooking, cleaning ect. So he discharged her.
Started with a question on PT. From an up close view.
The big picture, the wider view.. what does this look like? Now? When the OP returns to work?
Mom needing more help than she will have??
What are you going to do with the suggestions? What is your plan?
You may not like taking time for the PT sessions, and you may not like the exercises, but your mother is not going to them on her own just b/c you are nagging her to do so.
Maybe twice a day is too hard for her? It's too much for me. Maybe once a day.
If PT wants her to be walking, would she like to walk in a store or the mall? Sometimes a change of scenery really helps.
You already know that most of the effort is coming from you. As long as you're willing to listen to the griping and complaining then carry on.
I've never seen someone like your mother all of a sudden become motivated to exercise on their own.
You've got to pick your battles.
At this point we are just trying to get her to stand on her feet long enough to transfer into the wheelchair so she can at least sit up part of the day, and have been able to do that. But every day it gets harder for me, alone without the physical therapist there, to get her out of bed and into the wheelchair. She just refuses to help or use her muscles in any way, and I find myself feeling angry at her "laziness." But I know what's really going on is her dementia. It's so sad to see that she's lost all desire to move, or even get out of bed.
The therapist assigned her exercises to do twice a day, but those exercises are all up to me, Mom can't remember that she even has exercises. So when I can (which isn't all that often) I try to go and take her through her exercises in her bed. It's just me lifting up her leg for her, pretty much. She won't do it at all, and it seems pointless.
It's also hard to have to keep arguing and cajoling and begging and bribing every time I want her to just help me out and stand up!
No one likes PT especially if it's painful. You have to do it though. It's especially important for seniors to exercize and walk because not doing so will rapidly result in increased weakness and loss of independence.
Then the person becomes imobile. Then they quickly graduate to an invalid who has to be washed, dressed, fed, and diapered by other people. Then it's a nursing home.
So if a senior wants to keep whatever level of independence they have, they have to work for it. Use it or lose it is what I got told in PT when I didn't want to do it.
If she really is suffering from pain it may be helpful to giver her a pain reliever of some sort then wait half an hour and see if she is up to doing a few exercises. Follow up the exercises with something she really enjoys doing with you--playing cards or watching something on TV.
You might see if setting up a bird feeder outside a window she would need to walk to might give her something interesting to watch. (Bear in mind, though, that it will take you some time and money to maintain the bird feeder.) My husband and I started this kind of easy bird watching in our early retirement and have maintained it for more than 15 years, now. It has brought us much more joy than either of us expected. DH was against it at first, but now he is the chief caretaker of the feeders. We both make frequent trips to the feeder windows to see what is going on. There may be other attractions outside the windows to get her moving also, depending on where you live.
Ultimately, you need to decide whether it is more important to you to have friendly relations with your mother or keep trying to nag her into doing something that she just is not going to do. I would vote for a cheerful relationship and putting up with the walker if nothing can get her motivated to move more.
Nobody could encourage her to do anything to stay mobile. I'm not even talking mildly flexible, I'm talking just being able to walk partially upright!
This is a common problem. On the last day of the last PT she recieved, I walked the PT out to his car. Asked him if she would be able to conitnue to improve and remain able to walk upright and pehaps ditch the walker one day. He looked at me and said "She will never do a single exercise again in her life. Those exercise bands will rot away in the sun. Don't expect anything, she won't even maintain the level she's at now."
Wow.
Truer words were never spoken. She went downhil, mobility wise, slowly and surely.
He said this was the 'norm' and the patients who did well were far more motivated. Said that actually very few were on board with rehabbing.
Really sad. By the time she passed, she was bent into a tigh C- curve and couldn't lift her head to see anything about about the 4'8" mark.
A cautionary tale, for sure.
Exercise is not something most of us enjoy doing. I have found that my Mom will only do some of the exercises. Others she wont even try. However, she needs to do the exercises to get the muscles to memorize the action. So I do 3 things: 1, I notice which ones she will/can do and which ones she cannot. Those that she doesn't want to do, I ask the PT guy for alternatives. 2. I do the exercises with her and give her my undivided attention while she is exercising. 3. I improvise.
For instance, I put the exercises into longer series. For instance, to do the sit to stand, she goes from one chair to another on opposite sides of the room, sitting in the chair on each end of the room. To make her lift her leg, I use a stepper board (her walker wheels fit around it) to make her legs lift her body up and down towards the middle of the walk on opposite sides of the room. When she could, instead of the "march", we used to try to get her to touch her knee to the bottom of the table. Her granddaughter used to hold her hand up and make her knee touch her hand. For agility and flexibility, we bought a small plastic ball (about 5 inches in diameter), then we take turns, with both of us sitting down, passing the ball back and forth (and I move my hands to give or receive the ball in different places, forcing the stretch and making her bend down, up and side to side).
One of the PTs suggested to me to make my Mom walk on top of folded towels to trigger her brain to automatically keep her balanced as she walks or stands.
...and yes, listen to her gripe and complain, however, make sure she is griping and complaining while she is exercising....no griping and complaining before or after. My Mom gets my undivided attention when she is exercising. She's figured that out.
However, I'd address the pain first. After that, she probably will be more willing to do the exercises. That day that we got her pain under control was a huge step is getting her more mobile and stronger.
Good luck!
Great post!