Which is the best care for an als patient; home care or a nursing home. brian seems to be doing fine with home care but his brother who is the legal guardian thinks a nursing home is safer?

You question lacks detail. In some instances home based care can be preferred, when the specialized equipment and staffing is available to tend to the ever increasing needs of an ALS patient. If not, the 24/7 staffing and equipment in a residential facility may be better suited for the care. Home care is difficult in a patient that is on Bipap/CPAP almost continuously/tube fed/in diapers/etc.

ALS is a dreadful disease, but generally, if there is minimal breathing and swallowing dysfunction, much can be handled within home setting. As the disorder progresses, bulbar involvement is a compelling reason to go to a chronic care facility.

It is a question of decision making capacity of the patient. If he has DMC and he wants to stay home knowing the limits of care at home, his legal guardian as a surrogate decision maker should make the decision as patient would make. For some people quality of life is more important than mere quantity of life. Hope it helps . If. court has declared him incapacitated, legal guardian will make it.