Long distance support

Welcome. It’s my understanding that a typical DPOA is effective when it is signed. There is a specific kind of DPOA that needs to be activated (I believe it’s a spring form). I would have the nephew verify it is a spring form just to be sure. I believe his doctor would need to sign paperwork stating he is not capable of making decisions himself (it actually may need to be signed by 2 doctors). Do you think his doctor would do this. A lot of work needs to be done (especially in the beginning) to keep our loved one safe and properly cared for. It’s very easy (especially in the beginning) to fall into the trap of trying to reason with them an convenience them. We have a saying here, never try to reason with a person with dementia. Logic and reasoning just don’t work! Things need to be done without consulting him (once the DPOA is activated). Fibs can be used to ease some of his anxiety and allow things to go more smoothly 🤞. So if the property sells for less then he expects, fib and tell him you got what he was expecting. There is no harm and he is happier. Could you get the letter to activate the DPOA present it to the nephew and explain to him that he needs to make the decision and his uncle is probably not going to be happy about it (but that’s his responsibility as DPOA). As far as physically getting him to move, take him to visit his sister and maybe have lunch. During the visit have others move his bed and things into the room. After lunch, show him the room. Warn the staff he is going to be mad and I would leave as asap. My mom has been mad at me for 3 1/2 years. If I’m lucky I will just get an eye roll and an occasional huff, but some visits are worse. Medication has helped. It’s just the reality of dealing with a person with dementia.
I hope something here is helpful.

https://iona.org/therapeutic-fibs-ok/

"I'm afraid it is going to eventually come to the point when my nephews will have to enact their powers and enforce him to move into a facility. Also, I think my nephews will be hesitant to do this."

Some people select their agents but think the powers will only be needed after death. You've already seen that your brother has financial and health issues that need oversight today. Perhaps sending the 2 nephews a list of what you have noticed and that you are very worried about his condition will spur them to take action now.

You could also suggest that they consider hiring a professional case manager or fidicuary/guardian if they don't have time/interest and finances allow . If the DPOA is active and your brother's finances are at risk of being scammed - that nephew should take notice or the money may not be there for future care .

If they fail to act after seeing your list, then you could tell them it puts you in a difficult position - your brother is at risk and it is their responsibility to step up. Next step would be to consider calling Adult Protective or filing for conservatorship yourself. Your brother is fortunate to have you watching over him.

When someone with progressing Alzheimer's lives over a thousand miles away, the hardest reality to accept is that logic and reasoning simply no longer work.

The belief that his property is worth triple its value, the insistence that he is taking his medication when the bottles are full, and his refusal to consider moving are classic anosognosia—his brain has lost the ability to perceive its own deficits. To him, he is functioning normally, which is why attempts to convince him feel like an unwarranted attack on his independence.

Your nephews' hesitation to step in is also very common. Family members often hold back from activating power of attorney because they dread being seen as the 'bad guys' stripping away a loved one's autonomy. What usually breaks that paralysis is shifting the burden from family opinion to objective clinical reality. The weight loss, missed doctor appointments, and unswallowed medications are documented signs of failure to thrive.

Since one nephew is a physician with medical POA, the most practical next step is for him to coordinate directly with your brother’s primary doctor to document cognitive decline and incapacity on paper, or request a formal in-home geriatric assessment. Having a clear physician determination takes the emotional blame off the family's shoulders and gives the nephews the legal backing they need to step in on finances and orchestrate a safe transition before a catastrophic emergency makes the decision for everyone.