Our 86yr old neighbor is by himself along with a small dog. He has no wife or children. Just distant nephews in other states who do not contact him much, if at all. My wife is durable POA, medical POA and executor to his will. We have lived next to him for 30yrs and have always been there for him. He was taking care of a special needs female, as his background has been social work most of his life. This 40yr oldish girl recently left him. She charged up his Verizon bill, and other credit cards. He was upset by her departure with no warning. He was running dry with his checking account and running out of money. He gets an annuity and SS benefits.

Several months ago he came over the house to ask if we wanted to purchase his house and property. We have always spoke of it to him but told him just give us first refusal. We all consulted with an elder/real estate lawyer and he gave us the options of life estate and some other ideas. We couldn't make it work but did purchase 4 acres from him that was separately deeded. This gave him the cash he needed to pay some of his delinquent bills. Since then my wife has visited him every day. Assisting him with his bills and medical appointments.

She recently made an appointment for him at the doctor's for a glucose check. He is diabetic and we are fairly sure is glucose is never in check. At this appointment he was very defiant. He was upset and the entire clinic focused on him. I have never seen him like this. At a previous check with his PCP, (my wife accompanied) the doctor administered a cognitive test. He scored a 23/30. I am not sure of the meaning of the scale. He recommended he limit his driving. I have noticed he repeats himself all the time, and will ask why are we doing this, where are we going, etc. 5 min after I told him.

At this doctor appointment last week, the doctor notified our dept. of transportation to have him rechecked with his DL. She deemed him a driving risk. They never did check his glucose as he refused.

This dementia has seemed to accelerate since this girl left. He claims hes lonely, but does not want to move into apartments or assisted living. He would like someone to stay in his house, especially at night so its not so lonely. As I mentioned my wife goes over every night and we sometimes invite him over. His hygiene is good and he remembers tasks such as garbage, and getting mail, feeding the dog, etc. Medication is another story. He recently started Arecept.

I don't know what to do at this point. I have my own mother to care for as she is still independent but 87yrs old. His one nephew from out of state has been calling lately but I think its because he realizes his uncle may pass on shortly. I do not trust him nor does our neighbor. Hence why he made my wife POA and changed his will. Years ago our neighbor fell on the ice and spent days in the hospital and rehab. Not once did any nephew or niece drop by. Same goes for when he had cataract surgery and his pacemaker.

Sorry this is so long but what options are there? Thank you.

Many thanks to all of you who replied.
I think we are in that grey area where he is lucid enough to make most decisions for himself but at the same time forgets things that would be common to most. Even the attorney said its tough getting someone to give up there basic 'home' rights. It is usually taken away after something tragic happens.
The case worker from the clinic he had his meltdown in called yesterday and mentioned a few options but diverted to the local Area on the Aging. She said some red flags they look for are, not taking medication and wayward driving skills. We heard from that rep yesterday and will should know more by the end of today. With the fact that DOT will be contacting him to address his driving skill, sugar levels, and medication regiment, the system may take over and deem him not fit to live by himself. My wife does not, nor me feel comfortable on making him leave his home. But we don't want him to become a ward of the state either.
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Reply to kunkledude
Geaton777 Jul 24, 2019
We had to make my stepFIL a ward because he was dead broke, in debt, had Parkinsons at 6'4" tall and totally uncooperative. The hard part was trusting the guardian to be his best advocate. The state does what it can with resources spread so thin. My SFIL was put in memory care of a mediocre nursing home that I would not have chosen. But, that's what he planned for (meaning, he didn't plan so...) When you say you aren't comfortable making him leave his home, you mean you don't want to live the drama, which it most likely will be. But if that's what best for him? Otherwise you may knock on his door some day to find he died alone when he fell down the stairs because he wasn't taking his diabetes meds because he can't remember them. Not trying to freak you out, but that's the only other outcome if he doesn't go into a facility. When my inlaws were resistant to viewing care facilities, I went to them myself and took lots of photos of all the nice spaces and mostly cute nurses, the grounds, the residents doing stuff and I showed them. They were surprised at how nice it was. Going into a facility is like entering Heaven's Waiting Room. You know you're never coming out. This is a thing we each have to deal with and it is much harder for those who never gave it a realistic thought. Whatever you decide is still a help to him.
You are dear people for being there for him all these years. I agree with everything stated by earlier commenters except notifying the nephew. Why? Is there a law requiring this? I don't think so if he has no legal responsibilities for his uncle. Why ask for trouble...if he shows up and gets into his uncle's "good graces" your neighbor is then ripe for financial elder abuse, round 2. I would not contact the nephew nor feel obligated to tell him anything.

Regarding your durable PoA, I don't know the law in PA but you may not require any proof of incapacity to make decisions in his best interests, whether he is cooperative or not. If he's repeating himself that often, his short term memory is shot and you can't be certain he is even remembering to eat...that's what triggered us to transition my MIL into a care facility.

I recommend you get him into a great place now that has the spectrum of care (from AL to Hospice so that he never has to be moved out) and has Medicaid beds, because he will eventually need to go onto that, most likely. The facility can't kick him out once he goes onto Medicaid, but you need to ask first if they accept it. Some good places have waiting lists. Facility residents who go onto Medicaid get first dibs on those rooms, so he won't have to wait too long (FYI they are double rooms, not private and they get all the same care, food, attention, etc, just like my MIL does). Good luck and don't feel guilty for any reason.
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Reply to Geaton777

Accepting POA is a huge responsibility. And, when the person is difficult and rejects measures of help, it's even more work. But, if you don't think his family members are trustworthy, what are you to do? I suppose the only other option is the county. If he's incompetent and there are no viable, Guardian options, they could be appointed by the court. But, I'd consider if he is really is incompetent at this point. Would a doctor confirm this? Is 23 out of 30 on the Mini Mental Eval more than slight decline? It's a tough situation.
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Reply to Sunnygirl1

You’re both wonderful people for caring for your neighbor in such a kind way. However, time has come to explore other options. You have other obligations. He is declining and will continue to do so. You have been very generous to care for him for so long with no compensation or hope of any. It’s time for him and puppers to go to independent living. You must send his absent nephews notice though since they are his only living relatives. Then, with him, begin touring Independent living facilities.
Helpful Answer (2)
Reply to Ahmijoy
AlvaDeer Jul 23, 2019
It is sounding to me as though he will never be receptive to this, as at present he is exhibiting the signs of dementia and not even allowing his blood sugar to be checked. I so agree with you Ahmijoy, that this is now too much for them to handle. Real problem here is that they have a lot of power of attorney papers already made out. I think it is time to go to the physician and since there is apparently not to even be any driving by him, time to, as you say, call in his family. But I think it is time for the family to assume POA for health and financial also if possible as he is going to need 24/7 guardianship and I don't see neighbor being able to handle this. If he is becoming more demented he may become less cooperative. Can't imagine handling POA on this as hard enough with family.
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