My father was diagnosed with moderate dementia and he has no problems with mobility yet. The doctor recommended assisted living, but he refuses to go. He doesn’t have a place to stay. He has lived with me in the past couple of months, but I can no longer help him due to my own illness. My sisters don’t want to take him in. He wants to go back home overseas to his own house and place of birth. The doctor says we should let him go and enjoy whatever life he has left. I feel horrible to let him go because he needs help, but at the same time, he refuses help here. He does take meds properly and doesn’t follow up on doctor's appointments. He does not believe he has dementia. The illness he believes he has is colitis. He is getting very up and angry at everyone. The retirement homes don’t want him either because he is disturbing the environment. What is the right thing to do!?

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I've often said (half jokingly) that when I get very old, I'll move onto a cruise ship with a suitcase full of mumuu's and nothing else, just a toothbrush & a comb. I'll live on the ship, which is cheaper than an ALF, and eat myself into oblivion every day from the buffets. When I die, they can throw me overboard which is cheaper than a funeral; it's free of charge.

If I were a doctor & recommending that to one of my patients with moderate dementia, I'd have my license taken away. And rightly so.

The 'right thing to do' is to find another doctor for your father. The one he has may be suffering from dementia HIMSELF for suggesting your father move overseas to 'enjoy whatever life he has left.' Who's going to take care of dad when he gets there? Who's going to oversee the chaos he creates while living in someone else's home & decides it's a good idea to cook at 3 am & leaves an empty pot on a red hot burner? Or decides to go for a stroll at 2 am and gets lost? Who's burden will he be in another country, and how will YOU get there to clean up the mess he makes when you're called to do so, like Geaton wisely said?

Get dad in to see a geriatric psychiatrist asap who can medicate him to where he's not 'disturbing the environment' or getting very angry at everyone. Agitation at this stage of dementia is very common; my mother benefitted greatly from a low dose (.25 mgs) of Ativan every 8 hours. Once dad is calmed down & a bit more rational, THEN you can perhaps talk to him about where he can safely live. And if worse comes to worse, he's better off living in a small apartment HERE where you can look in on him & help him if he refuses to go to Assisted Living. If he gets very sick or hurts himself, that choice will be taken away from him by the hospital & he'll be forced into AL at some point.

But sending him off to another country is absolutely NOT the right thing to do, and you know that in your heart.

Wishing you the best of luck with a difficult situation
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You have to afford an Assisted Living. Very few State Medicaid will pay for it. My State you have to pay privately for at least 2 yrs to apply for Medicaid to allow u to stay in that AL.

There is a lot to consider here. Did your Dad work long enough in this country, with a green card, to receive Medicare and Social Security. If so, then he has lived here over 5 years and is entitled to resources.

If not, then I would research what he is entitled to from his country of origin. If he has relatives there, maybe they can help setting him up for resources.

If he is in his early stage, maybe for now find him housing. If low income HUD does have apts where you pay 1/3 of your monthly income for rent. Then u apply for resources as needed.
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If you help him relocate back overseas knowing that he really can't take care of himself -- then what? Does that country have a good national system for taking in and caring for the elderly/infirmed? If not then you will have a dumpster fire on another continent. Are you willing to be involved in solving this? If not, I'd do everything to prevent him from going.

If he stays here, is he a legal citizen? If not, would he ever qualify for Medicaid? This is a critical question because in many cases the answer will be "no" -- and you need to know the answer to this asap because the answer will shape his future care plans. You can consult with a Medicaid Planner for his state.

Does he speak enough English so that if he ever went into a facility here he can communicate with staff? This can also be a challenge to immigrant parents with no or limited English.

As far as him "disturbing the environment" in the AL... is anyone his medical PoA or legal guardian? If so, this person can work with his doctor to get him on meds for anxiety.

As far as his doctor giving such an inappropriate and ill-informed opinion on what to do with your father: get a different doctor for him. I wish you much clarity, wisdom and peace in your heart as you move through making decisions.
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lealonnie1 Mar 2022
Amen sister.
Everyone is assumed to have capacity - unless proved otherwise. At present Dad can make his own legal decisions. This includes lifestyle choices, such as where to live, alone or with others in assisted living, in your town/city or his birth country.

If he had lost capacity & this was proved, whoever has been granted Guardianship, or assigned POA would be able to sign for him.

I think you are talking less about legal duty & more about ethics? *Should* you let him fly OS if your gut says he can't fend for himself?

Sometimes older folk get wild ideas & want to go home. They have thick rose tinted glasses on & what they really mean is *I want my old, younger life back*.

Sometimes the younger gen can wish to wrap in cotton wool. Placing safety above all else - but this may limit freedom of choice. Restrict quality of life.

I think a good place to start here is open the discussion with Dad of what he REALLY wants for this next phase of his life. What are HIS values? What makes a good day for him?

Maybe then he could plan out Plan A & also a backup Plan B he could live with.
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I wonder why the doc would suggest this. People with dementia cannot get on a plane to cross an ocean by themselves safely. And when they wanna go home, it isn’t just to a place but a time typically.

Now if he isnt entitled to Medicare and social security plus has this property there, plus a social safety net stronger than ours, and friends or relatives that can oversee his care needs, then maybe. But otherwise not.

The most compassionate thing, truly, is for you to get him into al that will take Medicaid when the time comes. It may mean selling a house to which he cannot realistically return to in place let alone time.
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