Unmotivated Patients

This week my post is also about patients who simply aren't motivated for rehab.
A pt that I'm currently seeing has had a stroke over a month ago, and is still in the acute neuro ward awaiting a rehab bed. Not to judge anyone, but given this mans social history etc etc he is just loving being in hospital at the moment. No kidding! Before his stroke, he lived quite isolated from friends and relatives in a not very nice environment, didn't go out anywhere to do anything, didn't drive, and didn't cook meals etc etc. He is now in an environment where all of his needs are taken care of, he gets meals, friends and family have come in to visit quite regularly (he can't come to physio in the afternoons due to visitors.....), and he has displayed absolutely no motivation to get out of hospital.

I can not believe the quite manipulative nature of this pt. He has managed to get himself a single room on the ward, not by being out and out rude, but by complaining he can't sleep due to the other patients in the room (who are all on sedatives of a night anyway - don't know what noise they're making?) He manages to stay in bed most of the day until we come and get him up - which the other pt's don't manage to do, he pretends to be asleep when we come in, he will claim either way if he hasn't yet had a shower he can't come to physio, and if he has had a shower in the morning he can't come because he's tired, oh and he can't come in the afternoon due to visitors coming. He also manages to sleep most of the day - or for about 3 hours during the day, then get a sedative at night as he complains he can't sleep!!!

I'm wondering.....if depsite several conversations that physio is a very important aspect of his 'stay' in hospital, and the pt's claims he is trying.....if we can really take up a valuable rehab bed with this pt? Of course I want what is best for this pt, however if he can't display motivation for rehab or any desire to get any better, where physio is only for approx. 1 hour a day, how will he go with intensive rehab?? I am wondering how we're all going to go as physios saying that a pt is not appropriate for rehab really due to psychological motivation?? Not saying that this pt is not suitable....there may be some reason he has regarding his health/home lifestyle that he doesn't want to get back to it...and it also may be a factor accounted for by the stroke, however I'm certainly not comfortable declaring this at this stage....and I'm not quite sure the physios on the ward are either.

Mads