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.
If it is something you can and want to do with her would that help?
Going for a walk either outside or through a store.
YOU can not motivate anyone to do anything that they do not want to do. (if that were the case no one would be over weight or lacking exercises themselves)
Do what you can
What she choses to do is on her.
When it is more difficult for her to get around and she has to stay home rather than go out then she might be motivated if it is not to late.
If there are places she wants to go but can't due to mobility problems you could remind her of that it might motivate her but probably won't
Play kid games with her in the sense that for instance putting your feet in her feet together as you’re sitting down and pedal a bike together. That way you’re helping her do her exercises.
try using Voltaren to ease arthritic pain or the offbrand. You can find them in the OTC pharmacy and check with her doctor first. I’m not advertising either it just work for someone I know. Good luck.
I've observed any movement is better than none, For her, there are bigger battles to be fought.
I found this link helpful, good luck!
https://www.helpguide.org/articles/healthy-living/chair-exercises-and-limited-mobility-fitness.htm
The thing about knees, as explained to me about arthritis, when you don't move that joint (or others) through out the day, it's similar to having glue on your joint and the next time you bend it, you are breaking the glue loose. Offer Tylenol (acetaminophen) in the AM and PM to help with some of the pain and tell her while sitting, just lift your legs up and down from the floor to keep the joint bending throughout the day. A water bottle lifted up and down from the elbow joint keeps that one moving.
Let her know that it's her decision on how her life plays out, but you'd prefer for it to be with her being able to get around as long as she can. Then stop the conversation and let her think about it.
You might want to buy a tens unit - Walmart or drug stores carry them. Adjustable electrical pulses seem to ease the pain. Ask dr for lidocaine patches - you wear them 12 hrs and off for 12 hrs. These helped my parent a lot. Also, before exercising there is a cream at drug stores called arnica that helps as well as a spray called Biofreeze - check the can - you want the one with 10% menthol. Some have much less.
If she watches a lot of TV, tell her she can be reminded if she does a little something each time a commercial comes on.
Another way to get it done, don't tell dr she refuses to do them, but do ask him if she could get it twice a week for legs (Phys therapy) and when that is no longer approved by Medicare to order OT (occupational therapy/upper body) in order to keep some kind of exercises going longer. Some drs try to order them both at same time, but then the approval gets used up at the same time. Leaves you with nothing for a couple of months until dr can start it again. If you can't get more days via Medicare/home health, then (if financially able), hire someone to come 1 or 2 other days per week and work with her doing same exercises that your PT person does with her. You may be able to call a college where they train phys therapists and ask if they have a student who needs the work credits. Mom doesn't have to know this person and the home health person don't come from the same place, Just tell her dr concerned that she is about the same and he thought more in home work with her would help...he wasn't sure she was doing enough on her own when PT folks weren't there. Yes, a little white lie, but for your sanity and keeping her moving it's worth it.
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!
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.
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.
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.
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!
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.
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 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.
What are you going to do with the suggestions? What is your plan?
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??
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?
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?
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.
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.
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.