74 year old brother, living alone in large home, diagnosed about 4 years ago. Completely unable to understand why he needs help. No family members nearby. We got his car away after he crashed it. We have part time caregivers 3x week to drive him to store, bank etc. We call them his drivers, not caregivers ,so he will accept them. Hygiene questionable, memory of past events mixed up, inability to understand worrisome behaviors. Family would like to increase inhome care, eventually full time if necessary. Assisted living out of the question (he would never understand or accept). Very challenging situation!! Any ideas appreciated.
Yes this is challenging and yet very common. He can't live alone anymore and has no insight as to why. He can't have this explained to him and reason won't work. It is not safe for him to live there anymore and you will have to report him. Keep reporting him until the authorities do something.
He may need to have a dire medical emergency that requires an inpatient stay of 3 days for anything to be done about his living and ADL situation. You then tell the discharge nurse and Social worker that he is an unsafe discharge and detail all deficienties he has. If your brother can not or will not accept help with at home caregiving then he will be placed if medically necessary in a long term care facility. And if this is the route it looks like it is heading you and other friends and family have to say they can not provide care to him. And they will ask. You and others have to stick to your guns and not be willing participants in caregiving.
Good luck.
Well, he can't. He has dementia, and they get that way. What's needed is that you and his family get over thinking that he NEEDS to understand and accept. As long as you think that, you'll be banging your heads against the wall and chastising yourselves for not getting the point across. Which is silly because getting him to think your way isn't possible AT ALL.
Moving forward, POA or guardian makes the decisions without ever thinking about his understanding and accepting again. It's not as harsh as it seems. Brother will soon no longer remember where he was, what he did, who you are, or what you did. Find him a good facility where he isn't lonely and has a well-trained team to care for him. This takes the burden off of all of you, and once he's there, the situation becomes much less challenging for you.
Sometimes when we hit a wall, we have to change our perception of it. Then we climb over it or go around it, which didn't seem possible before.
If no one is the PoA for your brother, then you have no legal ability to help him, anyway. You will exhaust yourselves orbiting around an uncooperative person. I understand this is probably not the answer you wish to receive, but on this forum was are family members of LOs with dementia ourselves and can only in good conscience give you suggestions that are actual sustainable solutions that won't burn ou you or your other well-meaning family. It doesn't matter any more what your brother will or will not "accept" -- it only matters that he is protected against his own demented choices.
May you receive clarity and wisdom, and peace in your heart as you work through helping him.
(For older adults living alone with memory or judgment changes)
Purpose: This checklist helps families recognize when safety, judgment, or self-care concerns indicate the need for increased in-home support—regardless of the person’s awareness or acceptance.
SAFETY (Immediate Action Needed if ANY are present)
☐ Falls or near-falls
☐ Leaving stove/appliances on or burning food
☐ Unsafe use of heaters, tools, or ladders
☐ Wandering, getting lost, or confusion about location/time
☐ Opening door to strangers or scams
☐ Medication errors (missed, doubled, confused)
☐ Nighttime confusion or unsafe behaviors
COGNITION & JUDGMENT
☐ Does not recognize need for help (lack of insight)
☐ Confuses past and present events
☐ Poor decision-making (money, purchases, plans)
☐ Difficulty following multi-step tasks
☐ Paranoia or suspicion toward helpers
☐ Confident but inaccurate stories (confabulation)
☐ Increased irritability or agitation
SELF-CARE & HEALTH
☐ Declining hygiene (bathing, grooming, toileting)
☐ Wearing same clothes repeatedly
☐ Poor nutrition or weight loss
☐ Unsafe food storage or empty fridge
☐ Missed medical appointments
☐ Forgetting or refusing medical care
HOME & DAILY FUNCTION
☐ Clutter, trash buildup, or spoiled food
☐ Unopened mail or unpaid bills
☐ Broken items not repaired
☐ Poor temperature regulation (too hot/cold)
☐ Household tasks no longer completed safely
TRANSPORTATION & MOBILITY
☐ Driving incidents or unsafe driving history
☐ Attempts to drive despite restrictions
☐ Unsafe walking outdoors
☐ Resistance to rides except from “trusted” individuals
EMOTIONAL & SOCIAL
☐ Social withdrawal or isolation
☐ Increased anxiety, fear, or anger
☐ Depression or apathy
☐ Distress when alone
☐ Repetitive calls or fixation on worries
PATTERN ALERT (Most Important)
☐ Issues are happening more often
☐ Recovery from issues is slower or incomplete
☐ Person cannot recognize problems or risks
When this pattern is present, waiting increases danger.
GUIDANCE
• One red flag may signal concern
• Multiple red flags across categories indicate need for increased care
• Lack of understanding does not mean lack of need
• Safety and dignity take priority over agreement
Next Steps Discussed:
☐ Increase days/hours of in-home support
☐ Daily supervision
☐ Full-time in-home care planning
☐ Medical / legal consultation
☐ Family care meeting scheduled
You don’t mention what kind of dementia your brother has, if he is on any meds, how his bills are being paid, if he eats normal food, how he deals with dishes and trash, whether he has assigned DPOA, health care proxy, etc, whether he leaves the tap running, the burners on, the door wide open in all weathers, etc.
I urge you and all family to understand that your brother WILL get worse, no matter what. That “worse” will take more active forms or more passive forms or a combination of the two. Both are bad! You can find many specifics by reading other posts on this forum.
Best wishes, I am glad you know that he needs help
Maybe you could have him assessed by a geriatric social worker or just ask his doctor. Would the family abide by their advice?
Call them housecleaners if you have to.
Then, you get legal authorization to do what he needs.
If you cannot get MD authorization and he doesn't provide or agree, then there is little you can do (from what I know).
You could contact Adult Protective Services and see what they say.
I suggest you STOP placating the care you provide by changing words like drivers from caregivers. Giving in to his belief systems - in any way - is giving him power that he shouldn't have.
It may need to get worse before it will get better, which he may or may not understand.
I do not know that anosognosia is although it sounds like he is either stubborn (scared, fearing losing control of his life) and/or having cognitive issues / decline wherein he cannot make decisions in his best interest.
The family could hire an ind medical social worker and see if he'll work with a professional. Often a person will listen to a professional and not their own family.
You need to know your limits and w/o legal authority to make decisions on his behalf, there is little you can do (from what I know).
Gena / Touch Matters in Marin, CA
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