How do you decide what type of care is needed and what if they refuse?

Edit: It's good that he *is* undergoing the battery of tests.

You speak to his doctor after the tests are finished and a conclusion is drawn as to the level of care that's required based on the diagnosis. You don't follow the flippant, across the board advice that's handed out here about how all elders should "deffiently benefit more and are happier staying in their own home and you shod hire caregivers." The range of dementias do not have a one size fits all answer for what's "best" nor can anyone tell YOU what constitutes the right care for your brother. If he requires 24/7 care, as most dementia patients do, the costs of in home carers is very prohibitive compared to Assisted Living.

My mother is definitely better off living in a Memory Care Assisted Living community due to the level of her needs and how much of a social creature she is. Truth is, she'd be bored stiff living with me because there's no Activity Director or chef or staff of caregivers here. #Truth

See how things play out with his tests and what his doctor has to say afterward. Be sure to let him know about the confrontational behaviors you've witnessed as well, as they will need to be addressed no matter where he winds up living.

Good luck!

People deffiently should and usually benefit more and are happier staying in their own home. You shouldn't make him give elsewhere. If he needs help, you shod hire Caregivers

Littlesistercg: Imho, it's good that he undergoing the 4 hour battery of tests to assess whether an AL is the right fit for him. Perhaps he requires a higher level of care.

If he is already having delusions and is not taking care of himself he needs more than AL You might as well look into Memory Care b/c AL is not going to be sufficient for very long. If you chose Home Help, it might have to be 24/7.

Since he is STILL having hallucinations, he might do better in an inpatient geriatric psych ward temporarily. Let a psychiatrist try to help solve the issues of his hallucinations while he is also evaluated for dementia and other needs. When he is stabilized as much as possible, social services can help you find him a residential facility that meets his needs, based on doctor recommendation.

Normally I would say opt for Memory Care rather than AL for a diagnosis of dementia but when someone is just diagnosed, high functioning and just needs reminders I would hesitate to place them in MC. Assisted Living would be an option. A Group Home might be ideal. He might also do well with cameras monitoring him for a while. But that would also depend on how close someone would be if he did need assistance.
This would be something to discuss with the doctor and get their take on the situation.
A lot may depend on the cause of the hallucinations and delusions. And is there a possibility that he could become violent?
Once diagnosed with dementia I would think the POA becomes effective although if he is high functioning I would still give him some autonomy.

Whichever professional is doing the whole 4 hours of tests will be able to collect this info & translate it into real-life skills. Eg short term memory deficits may mean being less likely to remember when medications were last taken. Deficits in reasoning may correlate to being unable to think to turn the aircon on despite a blisteringly hot day. I don't know the specifics, but the professional will. This should lead to a conversation of care level recommendations - from pop in care visits, daytime supervision to 24/7 care.

If you aren't given specific care need level information, ask for it. Don't be afraid of getting a 2nd opinion if you need or want also.

Just keep in mind who is giving the advice. An agency may know what clients need based on a medical diagnoses - or not. They may be 'not for profit' or very much FOR profit. Same with care homes.

I have experience of one (unscrupulous) agency advising & charging my relative for un-needed 24 hour care.

My mother was the same age, and had similar behaviors due to the Alzheimer’s disease. Now, she is 75. Combination of the Alzheimer’s medication like arecept, name fat, and the lowest dose risperidone made a big difference. She was very receptive to this medication.

Once diagnosed the POA should come into effect. Meaning the nephew can make the decision, in the best interest of his Uncle. If the Uncle has money he could be placed in an AL. No money on Medicaid.

It's great that nephew has DPoA. Is he local to your brother?

It's also great that he has a comprehensive exam scheduled...however getting him there may be a challenge if he resists. Best to have a "therapeutic fib" thought up in order to get him there, whatever you think would work. Plan on leaving early for that appointment just in case.

Your question is basically: Can his DPoA make him do things he doesn't want to? Well, not forcibly, and if it's in his best interest, which also includes making the caregiving efforts less taxing. This is where "therapeutic fibs" are important, because it is not immoral to tell him non-truths if it keeps him calm and gets him to his appointment, or gets him to move into AL or MC.

Sixty-two is quite young so he may have early onset ALZ. If finances are an issue his DPoA can apply for Medicaid to cover the cost of MC. Some state's Medicaid will cover some or all of AL, and some don't cover any. Any facility you consider for him should be one that accepts Medicaid recipients, as not all of them do and they don't always tell you up front.

If your brother becomes agitated, belligerent, and totally uncooperative he made need more/different meds to help with that so he can receive the care he needs. Wishing you success in helping him.

Does the POA cover both his healthcare and finances? That’s what gives you the leeway to make decisions in his best interests. Most facilities have a director who can help you find the most appropriate setting