Wheelchairgate and “can’t” vs. “won’t”

Wheelchairgate and “can’t” vs. “won’t” April 8, 2019

So here’s the latest in the “Jane the Actuary has aging parents” saga:  wheelchairgate.

Dad, as it happens, now has a physical therapist coming in to the apartment.  It’s not entirely clear how long this lasts before they say, “he’s not going to improve,” but so far the therapist has also switched him to a different walker (the old one was a medical-type walker that was jury-rigged to have 4 wheels rather than 2 wheels and two tennis balls) because she said the original one wasn’t safe, and the rollator-walker is too risky because he seems to be unable to learn to put on the brakes to use it safely.  She also arranged a transport-type wheelchair rather than an aide borrowing a wheelchair to take him to his memory-care sessions — and Mom had a fit.

A transport wheelchair, you see, is designed solely for being pushed.  Looking online, I saw explanations that a transport wheelchair is intended exactly for people who are able to walk, but tire easily.  It’s easier to take along somewhere and use it, say, if you’re out and about and covering greater distances than someone can walk — so, the circumstances in which we had in the past borrowed a wheelchair from the Senior Center Lending Closet when my parents had come to visit so that we could go places together, even if just a walk at the nature center.

But Mom objected — at first, we thought, because it appeared to signal, to her, a lesser degree of competence.  “He won’t be able to wheel himself with it!” she objected, even though it appeared to be patently unrealistic to expect that he would do so with a standard wheelchair anyway.  At any rate, in all the times that we’d gotten a (standard) wheelchair for him so he didn’t have to walk longer distances, I could not picture an instance in which he’d used the wheels to move about, even for a short distance.  Besides, I had a conversation with the therapist who said that with a  standard wheelchair you had to remember to set the brakes and she didn’t think he’d be able to do that.  Still, I thought with a follow-up call of “if you get a transport wheelchair, [my sister who lives nearby] can put it in her trunk when she takes Dad somewhere,” she’d be persuaded.

Except that in that follow-up call she voiced her real objection:  “if Dad has a transport wheelchair, I’d have to push him.  And I’m not going to do that!”   She acknowledged that for the short distances she walked with Dad, through the walkways to the community restaurant, he uses his walker, and there’s no plan for him to cease doing so, and that the only plan for the wheelchair is for it to be used when someone on staff escorts him somewhere — to the memory-care mornings, or an appointment, or whatever.  (If Dad eventually becomes unable to walk at all, or only very short distances, I imagine the type of wheelchair would be revisited entirely.)  But she couldn’t get past that.

Does she think that this is all bait-and-switch, that if she accepts a transport wheelchair into her apartment, that the staff will say, “why don’t you bring Chuck to his memory-care-group time today?”  I don’t think anyone there imagines that she has a level of physical ability that would enable her to do so.  Or does she not even have enough of an ability to reason soundly to think that, vs. an ill-defined “they’re going to make me push him”?

It’s tremendously challenging to watch this play out and try to navigate that line between being unwilling and being incompetent to do something she ought to do.  Over and over again — she is not physically incapable of doing X, Y or Z, but she is either incapable of recognizing that it needs to be done, or perpetually intends to do it “later” due to impaired executive function, or is unwilling to do so.   (The doctor suggested she might have had a stroke that wasn’t noticeable at the time, and, yup, these are some of the symptoms of vascular dementia, where memory loss isn’t as significant as with Alzheimer’s.)  So we’re trying to figure out how to “program her” into a routine from a distance.

So it’s not easy.  How do you work around the deficits of a person who appears willful and stubborn and uncooperative, and maybe just truly is so, but more likely only appears so because that’s how her deficits manifest themselves, because as far as she presents herself, and most likely as far as she is even aware, she is fully capable of everything that needs to be done, but just hasn’t gotten around to it?  And how do you navigate your way through, “well, she was never particularly organized and on-top-of-things in the first place; it’s just worse now”?   Where is the line between “mom won’t do X” and “mom can’t do X”?

So for the time being my sister will take one more crack at persuading her to accept the transport wheelchair, and if not, the therapist will get a standard wheelchair for Dad, figuring now it not (yet) the time for this particular battle to escalate.

So how was your weekend?


Image:  https://www.maxpixel.net/Disabled-Wheelchair-Vehicle-Disabled-Vehicle-798420.  Yes, this isn’t a transport wheelchair after all.  But it’s public domain.

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