Where do I begin finding an assisted living facility for an aunt and uncle refusing help?

Dear herchr,

Very good of you to look out for your aunt and uncle. I know its hard to manage from the other coast. I hope you are able too convince them to move closer to you. It sounds like you are on the right track talking with the social worker.

herchr, I'd ask the social worker in cases like this, what happens if there are no relatives able or willing to step in? What will the state do?

Then you think about how much difference you will be able to make in their lives, compared to what will happen to them if you don't. That may help you decide how much involvement you are willing to invest.

Are you existing Trustee now or Successor Trustee on the death of either? Read the Trust terms very carefully to see if you have any authority now - you might possibly be able to act under it if you do have any existing authority. That might save the cost of a guardianship hearing.

Are there any alternate or successor proxies under the powers of attorney?

Yes, my mind is spinning and I am coming up with a skeleton of a plan. I will fly down this week to try and get both of them to a doctor for an assessment. I plan to meet with the social worker while there and tour some facilities. My plan is to try to convince them to go into a 30 respite care facility so that it buys us some time. If long term care in a facility is required they will need to move to California so that I can properly care for them. Of course, I realize that requires their cooperation and may not work but I know my limitations as I have a full time career and family that come first. I will do my best to be there for them and make the best decisions for them. I love them and I want the best but will not sacrifice my immediately family. I am listed as trustee of their estate but they are listed as each other's power of attorney. I don't think they thought that they both would become incapacitated at the same time. Who would? The social worker has documented self neglect and refusal of assistance. The police have document memory issues and dementia. If I cannot get them to cooperate than I believe the social worker will request a guardianship hearing.

All very good and insightful answers. I'll focus on just one area, that of determination what's required and the level of involvement from afar.

I'm assuming that there are no children or other relatives who can handle the task living closer to your aunt and uncle?

I also assume that you haven't spoken directly to anyone from APS or the police. It probably will be difficult for you to get information from them specifically on your relatives, as APS I believe needs to be guided by HIPAA provisions.

So contact APS, specifically the social worker (I assume he/she's with APS), and as part of the introduction explain your relationship and your potential (at this point) involvement. Ask what the SW would recommend, in a similar situation. That takes the privacy issue off the table.

Ask what level of facility the SW thinks is appropriate (I agree that AL might not be adequate for their needs) and recommended. It might be that a memory care facility with wander management protocols might be more appropriate. Since there are memory and possibly dementia issues, ask what "typical" progressions these conditions might take. I.e., even if AL were appropriate now, memory care might be on the horizon.

This will also help you determine how much you can or want to be involved, from a distance.

After you have an assessment from the on-site pros, address the issue of your authority to become involved and make decisions. This is a critical step because if no powers of attorney are in place, and you do want to participate at an involved level, you may have to consider guardianship.

You'll need to know the status of these legal issues before you can consider making any kind of arrangements for placement. It might be, though, that since APS has jurisdiction, they take the necessary legal steps to arrange placement, but you can do the "leg work" in locating facilities so that your relatives aren't placed in the first facility that's available.

Once you know the level of need, you can start researching facilities, call and create a short list of ones you might want to visit, as I do agree that you'll need to make your own onsite assessment and decisions. Keep APS apprised so they don't take action in the meantime and counter or duplicate your efforts.

There's a little publication, "Alternatives for Seniors", which you could probably obtain for your aunt and uncle's area by either contacting directly (https://www.alternativesforseniors.com/) or asking for one to be sent by the local Area Agency on Aging in their area.

Create a checklist of issues to address, then start cold calling. Don't be surprised if they're all the best thing since sliced bread. At this stage you'll get a lot of marketing spiels. That's what I found in literally all but one private duty company I called.

Just to lend a bit of hilarity to a challenging and stressful process, I've been contacting private duty companies for in-home help. Most are pretty much the same, but one was owned by a guy with limited professional experience. When I asked how many people he had on staff, or whether they were independent contractors, he said that he has "12 girls available." He repeated that "I have 12 girls available" so much in our short conversation that I was tempted to ask him if he was providing private duty or some other type of less service which has nothing whatsoever to do with caring. (Visions of houses of ill repute and a more contemporary provocatively and scantily clad women with i-Phones to arrange connections and hook-ups entered my mind). And I want women or men, NOT boys or girls.

I haven't checked out this level of facility but someone else may know if Medicare reviews and ranks them....I'm just not sure about any governmental review board of these kinds of private facilities.

Contact the local AAA and perhaps the Alzheimer's Assn. I've gotten good response from the latter - recommended lists of home health care, private duty and palliative care companies e-mailed in less than 1/2 hour. They may have lists of AL or memory care facilities as well. I would start with the facilities on both lists.

This will be frustrating. After a few calls, the pitches all sound alike! So take breaks often to keep your thoughts straight (I'm speaking from experience).

I wish you the best, as well as a successful "investigation" and as peaceful a journey with your aunt and uncle as might be possible under the circumstances.

Long-distance caregiver here, too.

Like WindyRidge, how much are you willing to take on? Are there other family members? Are you close with your aunt and uncle, to the point that you are already their POA and can make decisions? If not, do they have capacity/competency to give your or another family member POA and begin to intervene? Are you or another family member willing to become their guardian and conservator if they are not able to execute POAs?

Long-distance caregiving can be done, but I sure don't want to overloading you with ideas without knowing if this is even something you are going to take on, or if you are in a position to intervene.

I've been doing this long-distance caregiving bit for almost two years. I fly from Ohio to California each month. I get a bit more accomplished or set up on each visit. I won't lie, this is difficult and stressful, but at this point, I've managed to get her POAs taken care of, met with her estate planning attorney so that she knew what was gonig on and assure my MIL that what's hers is safe, I've managed her health appointments and finances, changed the trustee to her son, moved her into an independent living, sold her home and moved the assets to her trust for management, helped her with the transition to hospice earlier this year, (for a health condition that will likely kill her before the Alzheimer's does), was told she definitely had Alzheimer's Disease and had to give that news to her, arrange for groceries and services, take her car away, manage her Uber rides, and on the last trip, hired a companion/caregiver a few days a week (all she'll allow right now), and got her LTC claim approved (although we are in an appeal as to covered services). And honestly, monthly visits are hard and she always wants me out there, and I can't be there 24/7 - yet she refuses to move out here where her son and I could visit each day.

It can be done, but it's hard. What are you up for? What are you able to give? Is there any other help/family available? Are you in a position to even make decisions for them?

Right now, I'll bet your head is just spinning. Mine still is at times, and I've been doing it for a while. But please come back and let us know what you are facing - I hope our stories can help.

Best wishes and best of luck.

The above is good, detailed advice. But the first question is do you really want to take this on? It could  possibly be the most frustrating and difficult thing you've ever done.

If you do decide to help, you can do a lot from afar but you'll have to get an eyeball on things at some point and make the trip.

You can also help these folks but not assume full responsibilty.  It sounds like the local authorites have stepped in and these folks will get dealt with in some fashion.

I'm a long distance caregive for my folks. They aren't this bad yet but they're getting there, refusing all help etc. I make the trip regularly and do all they'll let me do. They love it when I wait on them hand and foot but won't even let me sign them up,for meals on wheels. No one is ever going in that house.

I've resigned myself to the reality that I can only do so much. I may have to call APS to intervene in the future.

Best of luck to you.

If your aunt was found wandering she might need a higher level of care than an assisted living facility. I'm assuming you're in touch with APS. What are they recommending?

Get some recommendations on facilities from APS then you will probably have to go to your aunt and uncle and see for yourself what's going on. They don't sound as if they're in a position to tell you accurately and truthfully what they need from long distance. While you're there, with your APS recommendations in hand, visit some facilities. If your aunt needs a nursing home will your uncle go with her or will he be able to be placed in an assisted living facility? Will he want to be separated from her? The legwork for this can be done from your home via internet. Look at local nursing homes. Compare prices. Take virtual tours. When you get to town have a look at 2 or 3 that you saw online or that were recommended to you.

Another main priority is to figure out their finances. Can they afford to live in facilities? Who has POA? Do your aunt and uncle have children and if so, where are they? It may be too late to get POA over your aunt as she doesn't sound lucid but you may be able to get it over your uncle. If they can't handle their own finances someone will have to be POA. This can be a family member or a lawyer you hire to help with this situation.

Everything that has to be done can't all be done in one trip. If your aunt and uncle can afford it, hire a lawyer in their city to begin looking after their interests. You'll need an elder care attorney.

Don't spend any of your own money outside of traveling to and from your aunt and uncle and your own expenses while you're there. If they can afford it hire home healthcare aides if you think they need supervision once you're gone. This is a temporary situation until you can figure out what kind of long term care they're going to need. And you may discover that home healthcare is appropriate for the time being. Again, do some research on agencies in their area. Have some aides come out for short shifts to see if it could work. Be there to meet the aides. I guess my point is that someone has to be there to facilitate home healthcare and to meet the aides. You can't go by what your aunt and uncle say. If they're left alone they might just not let the aide in the house.

I'm really sorry this all fell into your lap. I know it's overwhelming. Keep in touch with the social worker and let him/her know what actions you're taking. Social workers have so much information and so many contacts it will help you if you keep the social worker in the loop.

Eventually your aunt and uncle's house will have to be dealt with. If one or both of them go into a skilled nursing facility you may have to look into Medicaid on their behalf in order for them to afford a nursing home. But these things aren't your immediate priorities.