Caregiving ‘rules’ certainly do affect the way things are done especially between homecare vs institutional care.
Staff cannot compel or force Patti to do things. Patti’s participation must be based on choice.
This all seems simple except when you deal with Patti her answers can be driven as much by mental confusion as by choice. Of course, how can you really know?
In homecare a different set of rules would apply extending through “just do it!” That would never be acceptable in an institutional environment.
As a result one of the obstacles within institutional care ironically can be Patti herself.
For example, currently there is a problem with Patti’s participation in physical therapy. When the plan is discussed she wants PT and is interested. Yet later when a PT aide comes to get her, she would rather take a nap <grin>, is not interested,or would rather do something else.
Depending on which time of day, which aide, their persistence, their creativity in phrasing the question, their available time to follow up (Patti might respond differently minutes later if asked the same question) and other variables all can affect what might seem so simple from the outside.
In ‘living with MS’ and symptoms of mental confusion the traditional cause and effect way of approaching problem solving just does not work.
Sometimes I think caregiving talents were determined back in Kindergarten. You either put the round pegs in the round holes or you began a lifetime fascination with trying to fit the square pegs into the round holes.