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My brother is 65, has been on disability for many years due to diabetes and severe depression. He lives alone in a two story home that is falling apart. You can't even see the floors in his house because of all the trash and papers he throws around. He has old food containters everywhere and the house is roach infested. We live 2 hrs away. We have arranged (twice) for him to go into a retirement home and both times he has turned it down. We have tried to get him counseling which he tried for two sessions then gave up because they would not do what he wanted. He is very selfish and manipulative. He does not go out much, stays home, watches TV, eats alot and sleeps alot. We are very concerned about him, but he refuses all of our suggestions. To talk to him, he sounds competent enough, but he is neglecting his own care. He rarely bathes and doesn't clean up after himself. His house is filthy! Is there anything we can do to get him some help or intervention? We have actually tried to clean his house and even had others come in to clean and it stays that way for a short time but because he does not clean anything, it quickly becomes a trash site again. We are at a loss as to how to help. He has gained a lot of weight and often talks about wanting to end it all. Sometimes he sounds serious, but most of the time he jokes about it. He is very difficult to be around. He has no social skills and does not do well around crowds of people.

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From what you say, your brother is in full control of his faculties. Remember, your brother has a constitutional right to live in dirt and filth and squalor if that's what he wants to do. You may not want to hear it, but them's the facts. Give your brother all the help that he will allow.

It sounds like someone needs to clean the house at least once a week or more. Keep up with the house cleaning and it may help with depression. You'd be depressed if you lived like your brother, wouldn't you? Also, if someone comes in at least once a week or more to clean, do dishes, laundry, etc. your brother will have someone in the house to interact with which could also help with depression.

You may want to hire someone to help. There are several companies that offer cleaning services such as Right at Home. They are very flexible with how much or how little you want them to do. They also have several different people available so that if your brother doesn't get along with one they can send another your brother may like better.

You should also find out what community resources are available, and see if you can't have a volunteer go talk to your brother at least once a week.

I think that if your brother allows it, simply keeping his place clean and keeping him in regular contact with people will help him a lot. Your brother sounds a lot like my father and I have done the things for my dad that I suggest you do for your brother. It's working for my dad, and my dad can be downright mean. But I currently have the right people working with my dad. By the way, I live over 1,000 miles away from my dad, so I can't visit. He is an abusive alcoholic so I can't have him live with my family, and he absolutely does not want to go to assisted living/nursing home. He's as happy as he can be right where he is.
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Hi Mdovadia,
Just wanted to add another note...perhaps something more is going on with your brother in a medical sense, especially from his diabetes, if it is not well controlled. You mentioned he is on disability due to depression and diabetes. As you know, diabetes can accelerate many diseases such as arteriosclerosis. I'm not a medical professional but it could be possible he has a touch of dementia from arteriosclerosis (or not). I don't really know but it sounds like some of what I hear from children with parents that have dementia. Also, depression can cause a pseudodementia. This is not intended to add to your grief or further burden you. With his diabetes and further weight gain it doesn't seem that your brother is on a path for a happy outcome. Are you the only family member that can provide any type of support for him? If he belongs to a church or is affiliated with any spiritual groups, that would be another source of positive support. Also, volunteers may go out to visit with him, cheer him up. Let us know how it is going. Take care.
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Hi Mdovadia,
It sounds like you are stressed out over your brother's unwillingness to participate in his own recovery and well-being. All of the suggestions above are possibilities, i.e. Social Services, Adult Protective Services, a message to his MD, or former or present counselor, and a wellness check. You can not do this alone, it is better to have a third party professional assess the situation. It is also difficult to say if his suicide threat is a real concern or is he just being
manipulative, I would err on the side of caution here by contacting the appropriate professional. If you truly believe he is incompetent, guardianship or conservatorship may be an option. I believe it requires the court to declare him incompetent, this is really a last resort and often difficult to prove. Most people choose not to change, unfortunately. Consider asking him what he wants from you. Have him meet you half way. Do not put his needs before your own or spend all of your time focused on his problems. Know what you can do or you will become sucked dry emotionally. I know, I used to be a big rescurer. Take care of you.
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Hi mdovadia, Boy do I feel for you. I had a brother that behaved much the same way. He denied any and all assistance. I finally called the police and asked them to do a "well check" on him. I felt I had no choice left. They in turn put him on a 72 hour psych eval. Unfortunately, in his case he could be very charming and was quickly released, but maybe they could get your brother some help. Good luck to you.
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It sounds as if he is open to having you clean- he just can't manage the upkeep. Calling social services is a drastic measure. There are several less intrusive options you can explore. If you can, contact his doctor and describe the situation- there maybe alternative medication and treatment options. Also, ask the doctor for a home health evaluation- they will send out and RN or social worker who will evaluate the situation, make recommendations and referrals.There are many agencies out there that can help elders with disabilities remain safely in their homes. If you can afford it, hire in a housekeeper once a month to keep things under control. Hope this helps.
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My heart goes out to you, mdovadia. It is very hard to watch a loved one do self-destructive things. Severe depression is a terrible condition and can have tragic consequences. Isolation is bad for him. Sitting around is bad for him. Overeating is bad for him. Living in clutter is bad for him.

Can you get in touch with the doctor who is treating his depression? Unless your brother has authorized it the doctor won't be able to talk to you, but he or she can receive a note from you expressing your concern and listing specific things you see.

Is there any way your brother could be persuaded to engage in any kind of physical activity? A daily walk, biking, swimming? How about bowling with him a couple times of week. Exercise is therapuetic for both depression and diabetes.

Do what you can. Don't give up. But also accept that this is your brother's life and you cannot force him to be well. Tell him that he is important to you. Tell him that you love him. Make sure he hears that you love him as he is. He doesn't have to live in a clean house, or exercise, or eat right to earn your love. What you want for him is for his happiness.

I think mariesmom's suggestion about contacting social services is a good one.

Best of luck to you on this hard but important journey.
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mdovadia - sounds a bit like my Mom was in early dementia - except she had ants and roaches and refused to let us clean anything.

If you fear he is a danger to himself, either due to his living conditions or his 'jokes' about suicide, you need to take action. Generally, people don't joke about or bring up the subject of suicide unless they have at least considered it.

So - what are your choices? Bring him home with you? Another family member? if this is something you either can not or do not want to do, then a call to your county Department of Family and Children Services may be in order. Ask for Adult Protective Services. Explain his living conditions, his talk of suicide, and your thwarted attempts to get him help. Your brother need not know you made the call. A neighbor may have done.
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