Parents - 91 and 81 w/debilitating rheum arth - are hiding physical shortcomings. Find out only when situations become desperate. Advice?

Have you made sure that her “stubbornness” isn’t being amplified by loss of executive functioning and or cognitive decline?

Sometimes when we’ve lived with idiosyncratic parental behavior as long as we’ve lived it’s hard to identify the point at which they’ve lost the ability to self modulate when they actually NEED TO.

When you consider that as part of current functioning, it’s time for someone (hopefully POAs in place) to stop “suggesting” and start the process for determining if “stubborn” is becoming “unable”.

Then it’s on to the next task- how and when and where to take over what’s becoming unsafe or dangerous.

If you start seeking out a geriatric specialist in the field of psychological/psychiatric assessment, you’ll have a sense of direction when you decide you need the help making those decisions.

I agree, not much you can do. Maybe talk to the Visiting nurse and ask that she talk to them. Maybe she can get APS or Office of Aging in to evaluate the situation and talk to them. There may come a time when he cannot care for her anymore. May tell her this day maybe coming and the more she does for herself now, the better.

Stubbornness, laziness, etc. are symptoms of dementia. Does she have a medical diagnosis of cognitive or memory impairment? If so does anyone have PoA for either of your parents? If so, this person needs to step in to make decisions in their best interests, even if they don't want it.

If neither of them have a diagnosis or cognitive test result in their medical records, and no one has PoA for them, then you will need to work with social services to get them on their radar as vulnerable adults. When (not if) one of them goes to the hospital or ER for any reason, you must work with the social worker on staff to make them understand they cannot be discharged back to their home, that it would be an "unsafe discharge". The hospital will apply a lot of pressure for someone to come get them and take charge but this must not happen or you'll be back to square one with them. You dad must not go get her and he must not call anyone else to go get her. A hospitalization may be the best opportunity to intervene and get her where she needs to be: in a care facility where she will get full-time help. Then you can work to help your dad, as they probably both need to be in AL or MC, unless a PoA is willing to manage a lot of in-home caregiving and they have the funds to pay for it.

Are they both of sound mind? If so, they’re free to make decisions, even bad ones. The dynamic between them has been in place a very long time and isn’t likely to change. At least until an event happens that forces change, and sadly, it will.