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I am primary caregiver for my 66 year old brother. He had an accident last May and almost died. Afterward he spent 5 weeks in the hospital, 2 months in a nursing facility, and the last 7 months in assisted living.


There were indications of mental illness prior to the accident, including that he was living in a dilapidated, filthy house, which needed extreme repairs - and was unconcerned with the situation. His kitchen and bathroom were barely functional (if that).


He has now recovered enough to adamantly (and constantly) insist on going home, but not enough to understand that that is not a good decision. In addition to the condition of his house, he now has a catheter, which is likely permanent, and I seriously doubt that he will take care of it appropriately.


I currently have power of attorney, but he is threatening to revoke that. I know he is making plans to go home, though I don’t know if he can actually pull it off. I have contacted Adult Protective Services and met with the staff and care team (who are great!), but there is no real answer to how to deal with him in this situation. What should I do if he is able to make his way home?

I think you will need to allow him to revoke the PoA and let the chips fall where they may because: even with being his PoA (and it's not active until he gets a formal medical diagnosis of incapacity) you *still* won't be able to force an resistant person to do something they are strongly fighting against.

But you will need to back completely away: no loaning money; no going over there to clean his house; no managing his catheter or health. You keep reporting him to APS until they get him a court-assigned 3rd party legal guardian.

I'm so sorry, I know he's your brother and you care deeply about him but sometimes this is the only solution and the more you insert yourself (and exhaust yourself) the longer it takes for a permanent solution to be put into place. In the end he will still most likely go down this path regardless of how much effort you put into propping him up.

May you receive clarity, wisdom and peace in your heart as you move through all of this with boundaries in place.
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LisaBaker255 Mar 13, 2025
I wish I had read before posting my question, I feel like we are in exactly the same situation….I will be following to see what you can do, God bless
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Your sad situation with your brother could be my future with my sibling with lifelong undiagnosed mental illness. He lives in an ever increasing hoard and becomes more unreasonable with each passing day. I had to learn a number of years ago to enact some firm personal boundaries to protect myself and now have a semi friendly, not close relationship with him. He’s currently threatening suicide (a near constant theme for many years) over the need for a surgery he doesn’t want to do. I’m not his POA and wouldn’t accept the role if he asked. In your shoes, I’d back off and let brother do as he wishes. Protect yourself emotionally and financially. I well know the sadness of this, unfortunately wishing it to be better doesn’t make it so. I wish you peace
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Reply to Daughterof1930
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You have made the right moves to contact APS. What DID they say. You tell us "there is no real answer how to deal with him in this situation".
Just what does that mean?
Have you asked if you can be his temporary guardian in order to keep him in care?
Are you POA or guardian at present?
Do they consider your brother competent to make his own decision?

Either YOU can make the decision legally after a diagnosis or you cannot.
Hoarding and bad housekeep won't be enough to keep him in care.

If your brother is judged competent enough to discharge himself I would withdraw from contact with him and would let his doctor and the facility and APS that you are doing so.
If you have no rights to make this decision then that is that; it's over. Put a period at the end of the sentence and let brother have emergency numbers for his problems as they arise.
Be certain that one of those number is NOT your own.
You cannot possible manage care for someone uncooperative, non-compliant and mentally ill.

I recommend you read Liz Scheier's book, a memoir called Never Simple. It is about a daughter who attempted to manage her mother's care for several decades, despite the woman's mental illness. She had the full cooperation of the auspices of the social workers of the city and state of New York, and it was all to no avail. The woman died alone and in a total mess, just as she had lived her entire life.
Not everything can be fixed.
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Nweaster Mar 13, 2025
Thank you for your response. APS had 2 suggestions: 1- pursue guardianship, either me/another family member or court appointed. However his psychiatrist says she cannot say that he is incompetent. 2- see if the city will condemn his house. I am contemplated this, just wish I had done it sooner before he became so insistent about going home. At this point it would just infuriate him, but that may just have to be.
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You have already met with adult protective services. And your brother wants to go home to live in the conditions he was comfortable with. You say he has recovered but not enough to understand that it is not a good decision. It seems he was already "making the bad decision" to live that way prior to this accident.
I would not want to live that way, but I recognize we are all different and some people are comfortable living the way your brother has.

Unless he is deemed incompetent and unable to make decisions for himself, he can decide to live any way he wants. You only have POA if he is unable to speak for himself.

What you do if he is able to make his way home? - Let him. You do not need to continue to be his caregiver. Having POA does not obligate you to be his primary caregiver.
Take care of your own life. Let him live his as he wishes. You can step in and help him and you can make decisions for his care needs when he no longer is able. You can call APS again once he is home and have them inspect and make a decision. He may be forced to leave his home. You have to decide if that is really in his best interest and what he wants.
He may die in a filthy house with an infection from an improperly maintained catheter. You know your brother. Is that how he wishes to live out the rest of his life? It seems cleanliness is not something he is concerned with.
Would he rather be in a skilled nursing facility with all his physical needs taken care of for the rest of his life? Or are you simply trying to extend his life and take charge of how he lives it - to your standards?
You can't control how anyone else lives. You can only control how you manage your life.
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Reply to CaringWifeAZ
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Isthisrealyreal Mar 17, 2025
This, he had already shown the world what he is okay with. If he can pull off going home, your POA doesn't mean anything.
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I’m so sorry for yours and your brother’s situation. I had almost the exact situation with my brother. His judgment and behavior was irrational and it reached the point where I couldn’t reason with him. I suggest that you have him evaluated by a neurologist who will do a MOCHA test to determine competency. That is the key for a guardianship in the court system. I turned guardianship over in the court to a private agency because my mental and physical health had been deteriorating from all of the stress. If you don’t take care of you, no one else will either. Don’t abandon your brother but allow his guardian to handle the stress. I hope this helps and wish you both well.
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Can you get the house cleaned up and sell it while you have POA? (I don’t know which is why I’m asking).
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MiaMoor Mar 16, 2025
Not while his psychiatrist says that she cannot state that he doesn't have competency.
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You may enlist the help of the primary care physician or whoever treated him in the hospital to declare the home environment unsafe. This will affect how he is paying for care as well. He may lose benefits if he goes home.

You may also seek help from a professional organizer or de-clutterer if he is a hoarder. They can do clean outs, and sometimes help you list for sale if proceeds are needed for care.
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Any way you can convince him that the home was condemned due to its being uninhabitable because of its deteriorating conditions? And/or that it is in the process of being torn down? Or can you in fact began to put such a process in order?
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Reply to johnawheeler
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Are you POA? If so or even if not, have him evaluated and if found he needs 24/7 care, thats your answer. He can not live alone and you not willing or can't care for him. Then the State can step in and become his guardian.

I would have his home condemed, then he has nothing to go back to.
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Has he been able to go back in his house to collect some belongs while recouping? You may be able to talk with him, telling him that there is a list of things that must be done to bring the house up to code. That per[municipal] authorities, he is not allowed to live in the house until all codes are met. If nothing else, that will buy you sometime, while allowing you to clean out the house, make necessary repairs to eventually put it on the market. While this is not an easy task, for the welfare of your brother it may be an option
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