How do I convince my older brother to get rid of things, including his car? He has vascular dementia and when he can’t afford much anymore.

Often extreme irrational stubbornness in seniors is one of the earliest signs of dementia. Dementia comes on very gradually and then one day their family realizes that he's changed. Once this lightbulb goes off in your head it usually means he may be in the moderate state of dementia. He's stopped doing things or making good decisions because it now confuses him, he can't or that change now scares him.

Please take out your PoA paperwork and read it. What actually triggers your PoA authority? Does it say "durable"? This means there is no criteria for your authority to be in force, just the need for you to act. Often it will list an official medical diagnosis of impairment in order for you to make decisions legally on his behalf. You would therefore need to get him to his primary care doctor for this evaluation. You will need to get any diagnosis on the clinic's letterhead and with his doctor's signature and you keep this with your PoA paperwork, which you will need to have with you at every doc appointment or to manage any of his financial institutions.

You are probably close in age to your brother. The best scenario is when a PoA is a generation or two younger, is in close proximity, and is will/able/competent to carry out this ongoing responsibility.

Once your authority is active, you do not need to discuss anything in advance with him. Getting him to buy-in to your decisions will be a waste of time, just like it is right now.

You do have the option to resign the PoA and allow the county court to assign him a third party legal guardian. This may happen anyway if you age along side with him and can no longer perform your PoA duties.

As PoA you will need to manage his finances in a way that will not delay or disqualify him from any future Medicaid help, which it seems like he will definitely need.

If he isn't making basic rational decisions then either step up fully as his PoA or resign and let a legal guardian do it. But do not hover in a grey zone and do nothing because he won't like your decisions. This won't be helpful to him at all. Now you are the only one of you two who is capable of change and progress: he will just continue to decline and resist. Make a decision about yourself and act on it. That's your job right now.

FYI he does NOT seem like a candidate for an independent senior apartment unless you want to continue to orbit around him. He needs a higher level of care based upon him losing weight and muscle mass. You will need to trick him in to going to his doctor to see why this is happening. From there you can make better decisions for him, like maybe AL or a NH is a much better solution, whether he likes it or not.

It’s difficult to push change with a parent, and even harder to push change with a sibling – especially with one older than you. The only way to ‘force change’ is by stopping the propping up that gives Bro the illusion of independence. Stop running him around to doctors appointments, and certainly don’t let him move in with you.

I guess that you love your brother (it isn’t always the case!) but it might be a good idea to find ways to ‘make him fail’ without it being lethal! Remember that you are NOT responsible for another sibling adult who has no disabilities.

My dad had symptoms and signs of three different types of dementia including frontotemporal, vascular, and Alzheimer’s. He had all the issues you describe. Would not or could not drink enough water or other liquids (swallowing problems are common in dementia), would not eat anything other than small amounts of ice cream, lost huge amounts of weight, was cold all the time, developed a lot of other health problems. Ignored doctor orders and did not understand or care that he had dementia and could not drive or handle money. He refused to bathe or change his clothes and did dangerous things. It was a huge waste of time to try to get him to understand anything.

I had to work around him. Took away the car keys and the car and had him declared incompetent so that he could no longer access his accounts. No, he did not like any of it.

If your brother is anything like my dad, a senior apartment is going to be a disaster. Living alone anywhere is a disaster waiting to happen. Living with you — do NOT even consider it. I think your brother needs to be moved into a facility. As his POA, you must take charge and figure out how to get him on Medicaid.

I know how awful it is! Good luck!

There is some great advice here! If I were to answer, it would only be a repeat of what everyone else has said.

Sister E, so sorry for your situation.

Unless you saw a certified elder law attorney in brothers state, I would question him not being eligible for Medicaid.

If the reason is that his income is greater than the state cutoff, there are work arounds. Usually a trust where the excess is kept until his passing and then paid to Medicaid.

Each state Medicaid laws are different in some respects.

Medicaid doesn't normally pay for ALF/Memory Care. But there are exceptions. Waivers. It depends on your state and whether the facility has Medicaid beds available. In some states where they offer this the wait list is very long.

If he is being evicted or has no choice about the planned move you may have to go through with it but if you can find him a place where he would receive more supervision it would benefit him and you.

When a person is moved their dementia will be more evident. This because they have lost the familiarity of their current residence and the inability to learn new things. So expect him to need even more help in the new location. It will depend on how advanced his dementia is. The more advanced the more he may resist to a point. You mentioned his decline which at some point might make him easier to manage as he will be less able to push back. You, as well, are on a learning curve.
you are struggling to make HIM understand, it is perhaps more important that YOU understand his situation. .

What this means (to me-and I am not a lawyer) is that he needs either a care home where he has enough income to pay the monthly charge or to go into a skilled nursing facility. There are two gates to access into a SNF on Medicaid. Financial and Medical. Financially where he proves he is impoverished. Medically where he has records that show he needs the care.

The gov is trying to move towards offering more help in the home instead of a SNF but due to his dementia he will at some point need 24/7 care. If he doesn’t have family to fill in the gaps for when Medicaid workers can’t be there then it’s not a good choice for him. Just mentioning this so you are aware of the shortcomings.

Perhaps medical supervision is available at the Senior Apartment? Try to shift your attention from his poor health choices to more appropriate care. All of the things you mentioned are important but sadly he has lost the ability to grasp that. As you said, it has never been important to him.
Spend your precious energy on getting him sustainable housing and medical care and make sure that everyone you talk to understands that you are not the solution.
IN this interim stage between diagnosis and need for 24/7 care, it can seem like an impossible task. I would reach out to every resource you can now on the phone. Start with the Dept of Aging you mentioned. Some SNF have good admissions departments who can explain what will be required. Some home health companies know about the care homes because they have patients they visit in the care homes who have Medicare insurance that covers the HHC services. Some ALF are willing to give you information about their ability to take Waivers. Some elder law attorneys will give a free consultation on whether they could help brother receive services. Try to find alternatives before the move date. Wishing you luck.

"Who can help him or us see that he has to accept his new lifestyle?"

You can't convince someone with dementia that they cannot do the things they used to. They are not logical anymore. You need to follow the advice given and get him into a care home where they can deal with his failing health. You have done as much as you can alone, and it's time for professionals to be called in.

You as your brothers POA must now step up and help him as he no longer is capable of making any sound decisions as his brain is now permanently broken and will only continue to get worse.
Your brother should NOT be moved into a senior apartment as he's no longer able to live by himself despite him perhaps telling you otherwise but should instead be moving into an assisted living facility with a memory care unit attached.
If your brother in fact has vascular dementia his life expectancy is just 5 years, so he doesn't have much longer to live if he's already 2 years into this disease.
He now needs you as his POA to step up and do what's best for him to protect him and others. And most definitely DO NOT let him drive his car, but remove it from him NOW, and sell it and use that money towards his care.
If you can't handle being your brothers POA, then it's time for you to resign and allow the state to take over his care by calling APS.

Does he have a care manager or in the process of being assigned to one?

You need to understand how dementia works, that your brother is not CAPABLE of understanding the things you want him to. The car must be disabled by you so that he cannot drive it and possibly kill someone. You must take over his finances because he can no longer comprehend how to budget or pay bills, his brain is not working properly. Period. He cannot use logic or reason anymore. And he cannot live alone in senior housing either. He needs 24/7 supervision now. As his POA, it's your job to make decisions FOR him now. He will get no results from a therapist either.......nobody will be able to convince him to accept his new lifestyle, it's impossible. Your brothers needs now greatly outweigh his wants. He may want to drive but he can no longer do that. As POA, it's your job to coordinate the removal or disabling of his car. To see to it that Medicaid is applied for so he can get into a long term care facility when necessary.

Read the book The 36 Hour Day and also Understanding the Dementia Experience by Jennifer Ghent-Fuller available on Amazon. Learn all you can about the horrible disease of dementia and what lies ahead for you and for your brother.

Good luck to you.

I am sorry you are going through so much on behalf of your brother! Others on here with more experience with dementia, will have sound advice for you soon. First, what kind of “senior apartment” are you moving him into? It sounds like he may have a condition that prevents him from recognizing that he has issues like dementia. Others here will use the specific name for it—it’s a real condition! So, he may never accept his deficits and it will be up to the POA to help him be as safe as possible. In that spirit, I would make sure his living conditions and any associated help that comes with them (ALF, Memory Care, etc) are appropriate to his level. I have the same issues with my very elderly father, when it comes to hydration and eating. A proper facility can help with that. Otherwise, living far away, I’m not sure what you could do except maybe set times reminders, or call to remind. I would not recommend having him move in, even if your health improves. His situation from what I understand, will deteriorate and mean quite a lot of all-consuming care.

If he was in the military, I believe there are resources that could help in many ways.

You will receive a lot of good advice here. I wish you peace of mind, strength and courage in dealing with all this, and improved health for you and your husband!