Reverse psychology on stubborn DM?!

[orzoisorange]

My DM is in hospital with cellulitis in her legs. They're getting better, but she is not getting up, walking around and putting weight on her feet–she was lying down pretty much 100% of the time for about three weeks there.

The physios are trying to get her moving and ready for discharge, but she is utterly stubborn about cooperating with them, to the point of complete refusal. She got from bed to chair the other day and back again –much praise and celebration all round –but now she is refusing to move, saying everyone is trying to bully and blackmail her, and that she will do her exercises at her own pace once she gets home.

Nothing can convince her that it would be better to start moving NOW, when the physios can see/help/make adjustments etc, and going on past experience, she really won't do stuff herself once she's back home –at least not enough to make a proper difference.

She is so unbelievably obstinate about only doing what SHE wants to do, precisely when SHE decides to do it, even if it's cutting off her nose to spite her face, that we are all –family and medical staff –at a loss as to how to go forward. I should mention there is a diagnosis of mild personality disorder as well, and lack of capacity at the moment, which makes things even more complicated and perhaps out of our hands.

But I was just wondering if there's ANYTHING anyone can think of that might persuade her to cooperate and get up and move. Saying she can't get home until she's shown the physios she's safe is making no difference, and just causing her to dig her heels in even more.

Grateful for any ideas! Thanks.

Maybe she doesn’t want to go home? Maybe she’s scared?
They need to look at why she’s refusing.

Is she aware she's lacking capacity? As in aware that some decisions are maybe being made for her at the moment?
IME this type of thing is sometimes down to feeling a loss of control and trying to regain some back in any way possible, which comes through as not cooperating with others even when it's in their best interests to do so and they do understand that, but are willing to take the concequences of not ifyswim.
Or is it possible she doesn't feel safe at home (if she lives alone for example and isn't confident she'll manage when she goes home) so trying to ensure she stays in hospital as long as possible?

It's a very difficult situation, because usually neither the carrot nor the stick works in these situations.

What about talking to her about some respite care in a home? She can't stay in hospital forever and if she's not safe to go home then it may be the only option anyway. How do you think she'd feel about it? It might work out that she loves it and wants to stay, or hates it and will start engaging if it means she can get back home?

Blimey, she sounds like my son who has ''demand avoidance''.

With him, I deal with his demand avoidance by faking insouciance and saying things like ''well, if you don't want to go to school the teachers will still get paid''

Pretend that you don't care. I obviously do care but with my son I"ve found that if I show that I'm not invested in to the out come, it seems to encourage him a little.

If I'm flapping and obviously invested, he seems to wither.

It's frustrating.

Does she quite like being ill, cared for, checked up on?

Perhaps you should spell it out loudly in a breezy way, ''well, the less mobile you are, the less we'll be able to meet up''

And then leave the conversation there and make your exit.

Does she thing that the family will be in her life more the greater her disability? Flip that delusion on its head.

Say things like ''well it will be more difficult to meet up if you're not mobile''.

This may sound like too much (amateur!) psychology but I think sometimes people outsource the worry.

They don't realise they're doing it and it's stupid because nobody else can show up for them/do their physio for them, but they FEEL like it's under control when somebody else is doing the worrying.

This may sound brutal but what age is she? If you said something like ''well, you're 77 now if you want to accept descent in to reduced mobility that's your choice, you're no spring chicken!'' and fake total acceptance.

Then that gives the person who has unconsciously outsourced their worry a bit of a jolt.

It's different but I said to my son, well if you want to work 18 hours a week in supervalu I'll still love you!

And he was like, hang on, what............. he upped his game a tiny bit. He's not transformed though.

I suspect what she is doing is magical thinking - it was all better when I was at home because I wasn't actually ill then so as soon as I go home everything will go back to normal.

The response of 'I was fine before I came into hospital' is incredibly common when you work in hospital, as if fit and well people just popped in for a coffee and became trapped and mysteriously bedbound. The whole bit where they actually got unwell beforehand is erased from their memories.

She is so unbelievably obstinate about only doing what SHE wants to do, precisely when SHE decides to do it, even if it's cutting off her nose to spite her face

In other words, she's desperately clinging to the few remaining shreds of her autonomy.

Yeah, brutal is the only thing that works & then not always. I have a mother who won't do the exercises & is currently immobile, but in denial.

You can lay out the options but you can't make her do any of them.

@QueenDanu

This may sound like too much (amateur!) psychology but I think sometimes people outsource the worry.

They don't realise they're doing it and it's stupid because nobody else can show up for them/do their physio for them, but they FEEL like it's under control when somebody else is doing the worrying.

This may sound brutal but what age is she? If you said something like ''well, you're 77 now if you want to accept descent in to reduced mobility that's your choice, you're no spring chicken!'' and fake total acceptance.

Then that gives the person who has unconsciously outsourced their worry a bit of a jolt.

It's different but I said to my son, well if you want to work 18 hours a week in supervalu I'll still love you!

And he was like, hang on, what............. he upped his game a tiny bit. He's not transformed though.

Ta for that, you may have helped me with what my DM is doing. 😊

THANKS for all the replies; I really appreciate them.

To answer a few questions: she is desperate to get home, she absolutely hates being in hospital –the lack of privacy, toilets full of other people's germs, as she would say, "bad" nurses manhandling her and making her do things she doesn't want to etc...

@QueenDanu thanks for those –no, she really doesn't like being ill and having random people in and out of her room all the time. She is fiercely private and antisocial and just wants to be left alone. She thinks everything will be roses as soon as she gets home and shuts the door on the world (there will of course be carers coming in regularly when she gets home this time, though, so she won't be alone). Before this hospitalisation she hadn't left her house at all in about 18 months.

She's 75 btw.

@Maverickess thanks. I don't think she's aware about the capacity thing, no, and would just deny it, I think. I'm afraid she would just hate a care home, too. She's completely convinced that all will be perfectly fine if people would just let her home.

@Pemmican she absolutely is, I agree. She just doesn't seem to be able to make the connection between playing by the rules in the short term and doing what people are asking of her, to improve things long term ie get to go home. The autonomy thing really is the number one most important thing to her, and I feel as though she'll never compromise.

I suppose I'll just have to try and put it to her that she only needs to "compromise her principles" temporarily –make the effort to show the physios she can get up and walk –to achieve what she wants. But I'm pretty sure she'll insist she will only do things "at her own pace" and not to the schedule of anyone else. It's so difficult!

@orzoisorange is the capacity issue temporary ie does she have delirium, or does she have a diagnosis or dementia/ cognitive impairment?
Did she have carers before or will that be new and if so how is she about that new development?

@jiggeryjaggerywoo it's temporary –has just been diagnosed since she's been in hospital this time, it comes and goes but is pretty subtle and hard to diagnose (as she's highly articulate and good at coming across as totally reasonable in her views, when she's really not). She has been sectioned in the past.

She had carers briefly last year after another stay in hospital, but they basically got their marching orders and withdrew their service after just a few weeks as she wasn't taking them up on any of their help. So I'm sure she won't receive them very willingly again this time –she sees them as intruders.

I think I'm just going to say to her when I go in next that the medical staff have a duty of care, and whether she thinks that any patient should just be able to refuse help and say "I'll get better at home, by myself", and the staff should just accept that? She is worse physically this time than any time she's been in hospital before, and I worry it's just going to be a revolving door and she'll be back in in no time. (She was in for the same reason back in February, though only for 9 or 10 days that time.)

Can you try bribery of some kind? Rewards usually work better than punishments and threats.

What does she really like? Favourite chocolates that you will bring a few of in when the physio says she's cooperated?

Well it would work with me!

@Mosaic123 it would work with me too! 😆But not my mum, unfortunately –she would immediately clock what we were trying to do and dig her heels in even more against it. It really does feel like she's reverting to childhood a bit, in her determination not to do things just because other people want her to do them.

I'm going to have to try and impress on her that in the weeks until she's allowed home, she'll only get worse/weaker if she carries on refusing to move. She unfortunately has always had this notion in her head that to recover and get better from anything, you have to sit completely still and do absolutely nothing at all, until you feel like it. It's really damaging and has brought her to the state she's currently in, though she would refuse to see this connection.