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My brother lives in his own home and has a home caregiver every day for 4 hours. He has no short-term memory and tends to become very combative at times. He also does not believe he has any problems and at times sees me (his sister) as the bad guy trying to take away his freedom. After a short hospital stay, the social worker refused to release him without a home care service arrangement made. Thank you for any suggestions!

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If he has no short term memory, try telling him that you did as he asked and had a contractor come look at his roof/plumbing/electrical/etc. system. He will need to move out for a few weeks since it wont be possible for him to live there while it is repaired. Then tell him you found a long term apartment where he can stay while it is fixed.

When he asks-and he will-when he can go home, tell him that there has been a supply chain issue and it will be another week. Next week it will be something else.

Eventually he will continue to deteriorate and will think he is at home.

This sound harsh and it is but many thousands of people have been in your shoes. This is one way they deal with it.

See other responses.....you can take charge of the situation right now or wait until an "event." There is no way of predicting how severe (expensive) that event will be.
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felixmental Jul 2022
We did exactly this with my mother earlier this year. House in unliveable shape, must move somewhere, a friend has a retirement home you can stay for a while, then delay. She has now forgotten about her house, her cat, her caregivers..

We did it because we were always "one phone call away from disaster". Caregivers could get covid, cancel, house problems, she could wander off, ...
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Maryannmm: Per your profile, you state that "you are caring for David with Alzheimer's/dementia." Perhaps David would be best suited for managed care facility living in a memory care unit.
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My in-laws together went to AL, not memory care. We were told they could be maintained there unless they became wanderers. My f-in-law did NOT want to go, even tho his dementia was worse than hers. Maybe the worse dementia made him not realize his memory problems? We did choose an AL that has memory care attached so, if that day comes, it won't be the drastic change of moving to a different facility. If there is anyone from his circle of friends, organizations, church, who is in AL, take him for a visit to that facility.
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When they can no longer safely care for themselves or when their actions could put others at risk. If they can't remember to take their meds or if they are cooking and leaving burners on, it's time to move them.
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My mom was combatitive, thinking she had no problem. She felt her freedom would be taken away as well. However, it turned out good! We told her her doctor wanted her to try this memory care place to try to make her memory better. She listens to anything her primary tells her. We had her stay at our house while a few of us packed up the moving truck and moved her stuff to memory care. When my brother dropped her off she did say her life is now over. In a way, she was right, but in many ways it was better! She now had a different kind of freedom. She could be, think, and do what she wanted within the safety of careworkers who are trained in dememtia care. Now she sings all the time, cries grateful tears for MC, feels loved, has fun, is more active, and loves the food. MC was cheaper than having a 24 hour care person in her home. Most of the time she thought her house of 60 years was her childhood home from when she was 12 years old. I think the toughest part is getting them in there...what will you say, who will get things set up to move, but afterward is so assuring people are watching over them. It will 2 years this August. She still wants to go home in the evenings, but mostly quite content. I hope it works out for all of you!
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Cover999 Jul 2022
So in short she is in a way. *institutionalized*
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Did your brother see a Neurologist and get a MRI or talk with a neuropsychologist and get a formal diagnosis ? They can do cognitive testing - someone has to make a formal diagnosis. I don’t think legally a social worker can force you to have full time care . I maybe wrong but many factors are involved . The VNA can offer services . He could get a script for Physical therapy sometimes excercise grounds the person . Have you looked into Elder services or Senior care or day programs ? Go to your local Senior center and get some advice . Care.com has caregivers for hire . No one wants to be the Target 🎯 of another’s anger . Do some research on your own . Also Next Door is a website that you can find caregivers. Where I live is a website called Nesterly where you rent out a room in exchange for caregiving and errands .
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Your brother's social worker is the "bad guy." Blame everything on the social worker. A cognitively impaired person can create havoc in a nano-second--imagine having 20 hours to get into mischief! If your brother's budget allows for 24-hour in-home care, hire the caregivers now! If his budget does not allow 24-hour in-home care, move your brother to a facility ASAP.
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If there’s no short term memory, he is a danger to himself, probably others. Could easily start a fire or other issues (like if he’s in an apt, forgets and leaves the tub running to over flow etc).

You will be the bad guy. The bad guy who is doing something incredibly hard for your brothers own good. He will continue to decline. You can throw the dice and wait until his level of understanding is almost gone and hope no major disasters or accidents happen before that. No telling if that will be months, weeks or years.

Do what is best for your brother. Suck it up me be the bad guy. Or you can stand back and wait and watch what happens to him.

Unless you or your siblings can either afford to hire 24/7/365 care in his home or one of your homes.

Its so hard, but you must think of his welfare.
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If your brother has no short-term memory as you say, then he cannot live alone anymore.
The caregiver comes for 4 hours. Who watches and supervises him the other 20 hours in a day?
He needs to have a live-in caregiver/companion or has to be placed in the appropriate care facility.
There is no question here. Your brother is not safe on his own anymore.
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Was the social worker blunt with no compassion or empathy?
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If you're wondering if it's time, then it probably is.
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My friend’s husband was capable of staying home alone, or so they thought. Then one day he decided to boil an egg and forgot about it. He was capable of boiling the egg, but not capable of remembering he started it. Also after not smoking for years, he decided to smoke. His decision, but from an addled mind. Considering he’d come close to starting a fire by leaving the stove untended, what would happen with a cigarette? He wasn’t incontinent. He could converse. But it was time for him to go to memory care. Different reasons for different people, and it’s never easy. Just don’t let him endanger himself or others by preferring to believe that it’s all going to be okay when it isn’t.
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Given what you have written, he may need skilled nursing care. He would benefit from a short stay in an inpatient psych unit to evaluate and treat his behavior problems - especially the combativeness.
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Impossible Jul 2022
It's quite possible that he has dementia or Alzheimers. My mother has dementia and no short term memory. The only times she becomes combative is when she is hospitalized. She is 93. When in a place that is not familar they get very confused and scared and that causes them to act out. It's just a result of the dementia.
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He has two basic choices, have home caregivers or move to assisted living. If he prefers staying at home, he may eventually need home caregivers 24/7. He'll also need caregivers who know how to handle people who have dementia. His options also depend on his financial situation. Are you his POA for medical and financial matters? If not, you don't have much say in the matter. He needs to get all of his paperwork in order very soon while he is capable of signing legal papers, if he hasn't done this. He'll need to set up powers of attorney for medical and financial matters, a living will with his advance medical directives, and a will if he has assets. If he has assets, he may need an attorney to do this. Good luck to you both!
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Are you POA?
Does he have 24/7 help?
Is he diagnosed as unable to function for himself now by his doctors?
I would recommend at least a try at ALF now. Some thrive with short term memory loss, though seldom with anger issues. Worth a try esp if you find a facility that has a MC he can move to if such a move is indicated.
When he is alone does he wander? Can he cook and clean safely for himself. I am assuming he lives along. Are you nearby for several time daily checks?
A lot figures in all this and you would be the best guesser at when it is right to make a move I am thinking.
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If you have a social worker who won’t release him, the social worker has done you a favor. If the social worker believes he needs 24 hour assistance, then your brother can either pay for 24 hour care or the social worker can start the process for finding him a care home.

The problem with these brain issues is that the person with the issue cannot see the problem. If they have a difficult time with trust, then it is even harder to get them to agree to do something about it. Memory Care facilities are prepared to deal with people who don’t believe they should be there or are placed there against their will.

Either way, I see a lot of mental anguish and work for you in the future. Please make sure you are healthy as you begin this journey.

Best wishes!
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Once the person has become a danger to themselves and others I’d say it’s time to be placed.

I have a friend whose elderly father burned their house to the ground ( they lived together and the dad wanted maximum independence ), the father forgot about a wood stove fire he started , and also died due to the flames and smoke inhalation. Sharing this not to be morbid, but because placing people can be REALLY hard, however, sometimes it is the least bad choice.

After weighting the options you’re doing the best you can for all concerned, but boy it often doesn’t feel like it.

Truly wishing you the best!
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for us, it was time to put mom in memory care when caring for her in her home became untenable. we, her 3 daughters, had been taking turns staying with her because she couldn't be left alone. we did that for about 6 months until she started waking us up every night, several times a night. she would sleep all day, get up around 5pm, and be wide awake until around 7am the next day. around 10pm we'd be in bed and she'd start roaming the house, trying to cook, and coming into our rooms and literally shaking us awake, always saying "oh, i just didn't know who that was." like if someone is sleeping in my house and i don't know who it is i'm not going to go shake them awake! and imagine how it feels to be shaken awake and see someone standing over your bed! but that is her demented mind. she'd do it over and over, literally 6 times a night. she'd go back to her room, come back out 5 mins later, see us lying in our bed, and come shake us awake again. all night long, and we had to work in the morning! closing or blocking the door did not help because we had to know when she was getting up so we could make sure she wasn't starting a fire in the kitchen or wandering outside. once it hit this stage we had to put her in memory care where someone is on duty all night. they now have her on a normal sleep schedule so she's not wandering at night and it's not perfect, she's not exactly happy there, but we can now get some rest and not be terrorized by her nighttime behavior.
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Cover999 Jul 2022
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Is he still in the hospital? If so, they can transport him to Memory Care.

If not, it might be time for therapeutic fibs to get him into the MC. This will take some help, arranging for his furniture to be moved, etc, before he is actually taken there.
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Yes he has been diagnosed with dementia. And yes I have POA. Thank you.
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Is your brother diagnosed with dementia?
If not, no one can force him to move anywhere.
Are you his POA if he IS diagnosed?
Clearly, whether you are POA or not you are now attempting to manage his care. This may enable him to avoid the necessity of placement.
Hope you can update us on his diagnosis, prognosis from his doctors, and your ability to act for him in any realistic and legalistic capacity. This may not be in your hands at all.
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