Only child living in another country. What is the best way to set up plan for in-home care?

Contact Your area office on aging in your area. I have taken my father with alzhiemers into my home in February 2020 and they have helped me so much. I am sure they will be a wealth of help!

Assisted living with a nurse that comes to set up his medications.

He might be better off with an ultralong acting insulin that nurse can give at a weekly visit.

Hire a dogwalker to come twice a day to feed and walk dogs (and check on dad). If dad seems off, he can call her pronto.

The way it’s described his needs require 24/7 oversite. Unless he has a beyond huge amount of money to pay for 24/7 caregiving team at home and dog walkers, this means he goes into a facility.

Just imagine if there was a fire or power outage. What then?

I’d try to get her to look at a tiered facility. By “tiered” I mean one that runs from IL to AL, has MC and SNF aka a NH & perhaps with 2 tiers in NH (as lots of residents need loads of help with medication management but otherwise still kinda ok on ADLs) and with some type of hospice wing. So he moves along their system as his needs increase. If he gets a “needs assessment” done that will be invaluable to determine what level he needs to enter in on. Some facilities often have an assessment team of an RN & SW that is sent out to evaluate future residents that cannot come in for in person assessment. Sometimes you can contact your local Area Council on Aging to find health professionals who do need assessments. Any facility that’s worthwhile is going to want an assessment done imho. Nothing worse than getting an elder moved into AL only to get a call 5 weeks later that elder needs to ove to a higher level of care ASAP.

On the pups, well unless he has a s-ton of $ to do private pay forever, and they are trained service pups, the dogs will themselves need a new home. This could be quite emotionally difficult. If there's anyway you or her stepsister could possibly take them, that would make all this more palatable. Even if it ends up you have to find a forever home, 3 months from now for them. It gets him & the pups over the hurdle till he’s living in a new place.

Also she should speak with an atty while she’s in the states. If she’s living abroad, she may not be able to do things as his DPOA if she’s abroad. It will be hard to verify in real time that she is who she says she is should a financial or state entity require this. At a minimum, daughter will want to have bank accounts for him and for her at a bank that is available on line the US & EU or that is a “correspondent” bank for Germany. Your ex may want to appoint his atty as a coDPOA just in case there are glitches.

IF in home is the only acceptable plan, then a care manager? I've no experience with them and I'm sure it isn't cheap, but they would coordinate everything. Certainly they can arrange aides to help him. Dogs would be a potential problem if facility is needed, although some will allow smaller pets. Feeding them isn't a big deal, but unless there's a fenced yard they can run around in and do their biz, hire a dog walker too. I wouldn't rely on any care aides to provide this kind of pet care. Good ones can even take the dogs to the vet for their appts.

Trying to coordinate all this from even a few hours away would be a logistical nightmare. From halfway around the world, yikes! See if you or your other daughter can locate some geriatric care managers in the area where he lives and get estimates from them. Quick lookup says they can charge quite a bit by the hour, but they won't be the one working full time caring for him. You'd have to inquire how many hours, on average, they spend "managing" a person's affairs. It would be their job to assess the needs, make a plan, coordinate and implement the plan and then supervise in some way to ensure there is coverage and the plan is being followed.

A lot will depend on what he can afford as well. If he's fairly well off, this shouldn't be a huge problem. If there aren't assets to cover care, then forget the care manager - neither Medicare or Medicaid covers this and in general LTC policies don't either. If he doesn't have enough assets, how will he pay for either in home care or facility care? Medicare doesn't cover this and he may not qualify for Medicaid (income over the pittance limits) or the NHs (generally Medicaid only covers NH, not AL or MC and one must need NH services.)

So, I deal with someone in Germany also. The original plan was for her to get guardianship and have her lawyer (ex-boyfriend) act as the conservator and case manager who would only send updates for major, final decisions. In my case, it did not work out but it is a possibility for her.

I honestly cannot imagine anything other than in facility care in an instance like this where no one is available as support. If there are endless amounts of resources in terms of funds then in home care is a possiblity, but with the incontinence and the severity of the illness I would say that at the least Assisted Living is needed, and perhaps memory care. You just cannot manage things from half the world away otherwise with ongoing illness, needs for transit to doctors, for appointments, medications and care. Hope you find another answer but I can't imagine you would. Best of luck and I wish you the best.

With that many issues it is unreasonable to expect his daughter to try and juggle that many flaming balls from another continent. Remember there’s a 7-hr time difference as well so even her calling here would be a challenge. He needs to be in AL or hire an agency for 7-days a week. What is the point of having others orbiting around him causing hardship just because he isn’t flexible? Stubbornness isn’t “sweet” when it’s selfish. Does he have a cognitive issue? Who is caring for the dogs? Sorry for the bluntness but there’s no point in sugar-coating this life-changing issue. Life-changing for anyone trying to care for his needs from out of the country.