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My father lives with us in a guest house. He has dementia onset, is obese and is unhealthy. He has a life long habit of sleeping in a recliner with the tv on. He has severe swelling in legs from dormancy (mobility issues).


In my care, should I be waking him prior to going to bed to get him into his bed? Or do I let him live his life?

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Recliners aren't the best place to sleep because the little position changes we all make during sleep are pretty much impossible, but since it is a life long habit I wouldn't attempt to change it now unless he's willing to comply with a simple reminder. But my alarm bells are ringing loudly by your description, caring for him in the long term is going to include incontinence, at some point soon complete immobility and possible pressure ulcers if he doesn't become more active, and his obesity will make personal care extremely difficult for you. Do you have a plan for this eventuality?
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AliceLS Aug 2022
Thank you. Yes. I can ultimately trigger at any moment (gratefully). His depression was severe prior to him living here. He is better here.

Alcoholism was dealt with while in assisted living. We took him out due to cancer when they locked down facility mar ‘’20. He was in a facility with many deaths.
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It isn't for you to advise him on the best way to manage his various conditions, but it is for his health care team. What I'd do is raise the subject of his poor sleep hygiene at the next opportunity, let him listen to the advice and discuss it, make notes of the advice given, remind him of it from time to time, and otherwise leave him in peace to choose.

As a rule of thumb: encourage and praise steps in the right direction, and say nothing about poor choices.

Is he able to manage his personal care at the moment? - i.e. washing, dressing, toileting and continence care. Skin integrity will become an issue but that's a whole 'nother kettle of fish.
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AliceLS Aug 2022
HC team backs me - he should be sleeping in his bed. I Run a daily checklist to help him with daily tasks- dressing (he needs help), brush teeth, wash etc. I provide all care and meals. Continence is ok (in depends for confidence and he likes them). Skin is becoming an issue - summer yeast rash at folds caught early and being worked with.
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Let him sleep in the recliner. Once he falls asleep turn the television off if its keeping you from going to sleep. Let him be
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Alice, your profile says “I’m tired and need support as well as validation of what I’m supposed to be doing”. You took your father out of the AL over 2 years ago. You say that his depression has improved a bit, but yours has probably got worse. Deaths in facilities are much rarer now – Delta seems to have been the worst wave – and there are better activities for him in AL. His life is not worth years of your own.

I’m sorry if this isn’t ‘validation’ for what you are doing, but it could be time to think again.
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With the health history given it may be likely that he has some congestive heart failure symptoms. With this he may get short of breath if he does try to lay flat. His response to that could be anxiety fairly quickly if he is demented and not able to express himself well. Sleeping in a recliner may be his only comfortable position.
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Let him his life with as little fussing as possible. It's not the end of the world to sleep in a recliner, and is probably good for him if his legs are elevated. Talk to Medicare about getting him some leg massagers (they go around the leg and you plug them in, they give the leg a gentle massage. They have bed mattresses that do the same thing. You may need a doctor or physical therapist to prescribe it.
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My father slept in a recliner in his later stages of life. After smoking a lifetime he had emphazima . He said it was easier to breathe
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Does he use the sleep apnea equipment? If not, he may resist the bed because he can’t breath as well as he does in the chair. If it has been awhile since he has had this checked out, it might be of benefit, There are treatments that don’t require the mask if he qualifies. Also if he worries about his inability to breath or feeling breathless, an oximeter is reassuring to some. It lets him know his oxygen and pulse at just a glance. He may not know why the chair is more comfortable to him, just that it is.
I had a bit of an issue with my DH aunt not leaving her chair. It was more wherever she was, she didn’t want to move. It was getting too hard for her to walk. I was encouraging her to walk and didn’t even consider the wheelchair as I thought she “needed” to walk.
When she went on hospice and got a hospital bed, she was much happier. She really likes the bed. I was so surprised. I really hated to take her from her bed but it was too hard to change her or bath her in a low bed or the recliner.
Have you asked if your dad would qualify for hospice? You would get more CNA help and he could get all the equipment he needs.
Also he might get up more with a lift chair. He needs to move.
To me it is not that you are wanting to run his life or prolong an unhappy life, it is more about quality of life. He may have about run this phase out and will need a different routine to preserve the integrity of his skin.
Perhaps there are massage air mattresses for recliners, I’m not sure.
Is your dad on antidepressants? if so, is he on the right dosage? We increased DH aunts dosage after her having been on it for several years and it has helped. It might be worth a trial.
As far as validation, I understand that feeling. I used the ADL list and NH ratings and reasons they received warnings, etc. I judged and checked myself to make sure my mom was getting the best care possible in line with what she wanted to do. I know that may sound like a low bar to some but when I needed to know that I was doing everything I could, it helped for me to go over all the things that might go wrong and know I was doing as well as could be done for a 97 yr old at home.

With DH aunt, I have lived in fear of bedsores. She had a month of rehab therapy earlier in the year that really helped her with transitioning. She gets up almost every day and she could not/would not do that prior to the therapy. It is hard to get hospice to provide it once they have made that transition, but if he isn’t on hospice now, ask his doctor to order home therapy to see if it will help. The therapist can also advise you to keep from hurting your back. We took aunt off hospice while she had the rehab. She is back on it in a NH now. She will be 96 in Oct.
She really likes where she is and that makes it so much easier. I do understand you wanting to keep dad with you but sometimes what we want isn’t what we can do.
You have to also validate that you are doing what is best for you.
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Decide now what "battles" you want to fight.
If he wants to sleep in a recliner and he is getting good sleep and not complaining of aches and pains that might be related to the recliner then let him be.
There are going to be other things more important that you have to put your foot down on the recliner is the least of the problems.
If the TV remote can be set with a timer so the TV goes off after a set number of hours at least the sleep will be less disturbed by light and noise. (I used to have a remote that you could set a timer for 1 to 4 hours and the TV would shut off it is one feature I miss)
If the chair is a fabric one I suggest that you get a washable, water resistant cover for it. Maybe more than 1 so when 1 is in the wash the other can be put on.
I would think getting him up walking during the day would be a goal that you want to try to achieve.

Thinking about this...if your dad is eligible for Hospice they would provide a hospital bed that can be placed where the recliner is. The head can be raised and the foot of the bed adjusted so it is comfortable for him. The hospital beds that Hospice can provide have an air flow so that it will help prevent pressure sores. If he is spending a lot of time in the recliner pressure sores will be of concern.
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stillhurting Aug 2022
Thank you for this reply. NO ONE even told me about hospice. My Mom should have been told about Hospice, she was 94 and certainly eligible. No one including me was told or knew about hospice. I did not know. I sat and watched her dye in the nursing home and still no one told me about hospice. Hospice should have been available for Mom and me as I sat with her all through the day dying inappropriately at the nursing home. Its too late now, but maybe someone will see this and know about hospice. I did not know how to let someone die or what i should do or say, I did not know that hospice was available. And where was the pastor. I am really angry at my sister for not taking care of this as executor, etc. I just did not know about it. I have to live with this as you dont get an extra chance. Thanks for your input
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My dad became very stooped and his legs permanently bent from sleeping in a recliner so much. I made him get up and get in bed each night when he came to live with me. Also the obesity will become more of a problem as time goes on. If he falls you’ll be having to call paramedics to get him back up. Medicare paid for a PT and and OT to come to the house to help my dad with his mobility issues. It helped for a while but was very hard to get him to keep up with the exercises.
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As long as he's sleeping with his legs elevated, leave him alone.

My mother refused to sleep in a bed when I first moved her to a nursing home and insisted on sleeping in her big leather chair that wasn't a recliner. She, too, had CHF, and eventually her legs were literally dripping water from them because they were never elevated. The staff at the nursing home tried to get her to sleep in a bed, but she claimed to be afraid she'd fall out of bed and refused, so they gave up.

Eventually I decided to move her to memory care, and we didn't bring the chair to her new place. She happily went straight to her new bed and her edema improved markedly.
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AliceLS: This is an issue that your father's physician should be made aware of, if he or she is not already privy to and see what the physician suggests in regard to his health problems including his sleep.
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Mom lived on her own. I could tell when I visited that she left in a recliner. We had home health care, but they only came in to change the dressings on her pressure sore. She was urinating in her chair so that became an issue and when i came down to see her, water was dripping from her legs. I took her to doctor the very next morning, she was placed in e/r.. Then hospital, then nursing home until er death 3 weeks later. If I could have had the "say so" of her health matters, I would have insisted on her moving in with me as I lived 65 miles away, or had her into assisted living so that she could have had proper care and not have slept in her recliner. Personally, I think she just became easy to stay in her chair 24 hrs a day except for preparing her meals. She really should not have been allowed to be by herself.If you dont have a voice for her health, please talk to medicare or someone outside the family who WILL ensure he/she is well cared for and the right decisions are made. Ma was very a very small town and the caregals were just not very good. I WILL ALWAYS live with this regret. YOUR dad should be comfortable, period, healthy, clean and safe. If he gets any sores, or declines rapidly that is a red flag that the recliner is not best suited. I am not a nurse. SO PLEASE GET OPINIONS FROM QUALIFIED people. Call around. Dont let your siblings make the judgement call if that is the case. You will never forgive yourself down the road. I MISS MOM and wish I could have been better at helping her even if it meant being the one to rock the boat. I did not rock the boat and have to live with knowing she had sores from sitting in her recliner, wetting herself, etc. I just wish I wuld have made her come live with me and have PROPER care.
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My neighbor slept in a recliner towards the last few years of his life. He could not sleep well in a bed because he had a hard time breathing (this was before the days of CPAP machines).

I would discuss pros and cons with the doctor and possibly OT.
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I suggest seeing if a hospital bed would be more comfortable for your dad. An incline (similar to the recliner) could be maintained to assist with breathing issues, (and an incline at the knees if needed) but the bed can be lowered to a flat position to aid in getting into and out of it. It is also wide enough to aid in bathing if that ever becomes necessary.
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My moms memory care fought the battle to get my mom to go to bed.. she wouldn’t. I think because it was painful for her to get up..I became a nag trying to help her with elevating feet etc.. I wouldn’t do that again
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My mom sleeps in her recliner most of the time.., and she has a nice adjustable bed. We think it's because she has better control than in the bed (getting in and out). At times she chooses the bed for several days. When she isn't feeling as good... it's the recliner. Hers will help her stand too, so it has a remote with a cord. She's 97 with knee arthritis. It's ok... though I used to try to get her to the bed... now I leave it up to her.

Lately though she's risking a fall by the way she gets out of the chair. She doesn't always put the chair back in the upright position and basically climbs off of it. Used to happen occasionally, now at least once per day. I can't reason with her about it anymore:( I'll have to have a talk with my brother about it soon and we may have to take the chair away! It's a tricky issue with some people.
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This is how mom got a bedsore. Get him into bed with one of the special bedsore prevention mattresses for overnight.
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