An aunt who never married is 86 and in declining health. How do nieces and nephews convince her that she needs more help from us?

Having a heart to heart sooner rather than later is a good idea. Do you think she would be open to granting one of you Power of Attorney? This will ensure someone can promptly take over managing her finances when she can’t. Without a POA, things get much more difficult and time consuming. She may resist for her own reasons. Take the opportunity to reintroduce the idea again whenever she voices frustration with handling it alone.

·      Recommend a willing niece/nephew to be POA who is also strong in keeping their own financial house in order.
·      Perhaps another would be interested in organizing her medical records, attending doctor appointments with her, and helping to manage her medications.  
·      Another can help her with weekly grocery shopping.
·      Another can help with errands, salon visits, etc.  
·      Most importantly, get additional help when necessary to help ward off burn out.

Sorry, I’m not sure how many there are of you or if I am even addressing your concerns. It’s admirable you are all willing to serve together. She’s a fortunate lady.
Best wishes to you all.

I totally agree with Ahmijoy's suggestions. I care for my 2 unmarried Aunts who have no children. I find that asking them "Did you know...?" questions is a way to put information in front of them in a way that isn't threatening or overwhelming. Eg.: Did you know that you can pay bills automatically from your bank account and never have to worry about missing an important payment? Or, Did you know that if you don't designate someone as a representative on a HIPAA form your doctor can't release info to your family no matter what? Etc. In my Aunts' case I was trying to get them to consider in-home help from an agency. They were resistant to the very thought. But on my own I researched top-notch places, costs, details. On next call with my Aunts I had the Did you know that in-home care...? conversation. We agreed that when they felt ready they'd let me know. Six months later they asked for me to set up the care and it was all ready to go. Also good conversation starter is "Have you thought about...?" This approach will require patience but will keep her at ease about receiving info she needs to consider.

Regarding seeing signs that paperwork is in disarray...when both my in-laws were failing at the same time and resistant to help I made the decision to look for certain critical info while they were distracted or out of the house. I took photos of it with my phone: health insurance info, Medicare card, doctor's/clinic names, prescription labels, contact info of their friends and neighbors, bills, driver's license, etc. This helped us to help them until we could get my MIL to formally sign the PoA paperwork. At first I felt guilty doing this, but when we realized what a mess everything was (far worse than we ever imagined), there really was no other choice for us. Good luck!

Your aunt may feel inundated with offers of help from all of you and chances are, she’s in denial about even needing help. It sounds like she’s been responsible for herself all her life and it’s very difficult to accept that now she’s elderly and needs help managing her life and affairs.

If someone has POA or primary POA, assign them the task of convincing Aunt that you’d like to help. Don’t be shy about mentioning that her caregiver niece would like some help. Sometimes, the one being cared for doesn’t realize that even when things are going ok, the primary caregiver can become burned out and depressed. Don’t blame the burnout on Aunt. It’s just that Niece needs a “short break”. You can use that time to get her paperwork in order,with her supervision, of course. Sometimes younger minds understand all this red tape and paperwork better than us old folks do. Be kind and respectful with her. Don’t push. She will probably come around to your way of thinking.