Our LO lives alone/not in the same state. We need a diagnosis but won't go to a dr and gets angry when mention it Everyday is so different.

Joeyko19, you will need to provide more information in order for the forum responders to give you the best suggestions.

You start by finding out WHO is legally able to DO anything on the LO's behalf. This is the only place to start.

- does anyone have DPoA for the LO?
- does the LO have a medical diagnosis of cognitive impairment, dementia, ALZ, or memory loss by a doctor in their medical records?
- is it possible that the LO has a non-cognitive medical problem, like a UTI, thyroid issue, overmedication, etc?

If the LO has not assigned a PoA AND the LO is no longer mentally competent and cannot carry out their ADLs, then social services for their county needs to be contacted and the LO reported as a vulnerable adult. If they assess that the LO is indeed too vulnerable to be living alone, then they will move to acquire guardianship and will then move him/her to a facility where LO will be safe and get medical attention, fed and social interaction. The LO's family will have no control over medical/financial for the LO's affairs, but the family can still interact with the LO as family.

I'm so sorry for the distress in trying to help your LO from afar. I would start by contacting social services (Dept of Health and Human Services for your LO's county).

We had/have a similar situation with my in-laws. When my FIL was alive, he and my MIL were not taking good care of themselves or their home. They live in Hawaii, we live in Florida, and my BIL lives in California. I had/have begged them to come live with us for years and years - no dice. During one visit from BIL, they had become emaciated and dehydrated and he took them to see the doctor and clean up their home a bit. He got food deliveries and some housekeeping set up. I tried to reason with BIL that the folks could no longer live alone, but he prevailed. Calling APS did not get any help for them. Months later, FIL died of dehydration and starvation. Within a year of FIL's death, MIL collapsed at a store with UTI induced sepsis. I suspect state stepped in since BIL didn't notify us of her hospitalization or the "plan" for 24/7 caretakers, nobody allowed into her home except caretakers, and modifications to home to put in regular kitchen appliances (fixed some unusual decisions when they were more lucid).

I relay all this to say - if you are concerned, GO TO THEM and see for yourself! Take them to their doctor for a regular physical, but relay to the doctor your concerns. If they will not willingly allow for help, have them involuntarily admitted for psychiatric evaluation - which might find dementia, infection, blood chemistry imbalances or mental health issues that are causing their problems, Social services at a hospital can help you with placement for LO if they need to stay in their area or can help with transferring them closer to you.

If no family lives near the loved one you are forced into two different modes of action.
Are you the only family? Assuming you are you need to make a trip to where the loved one, speak with him or her. If they refuse help and are clearly incompetent, will not accept help then you already have in place a way of knowing if they are home and still standing (food delivery). You will likely have to call APS from your home and report adult at risk. Explain all you have tried (going there, attempting to reason the need for placement, etc). If you have no POA, then should the assessment be that the person is no longer safe alone EMS will be called. The Social Worker at the Hospital assessing for condition will ask if you wish to be Emergency Temporary Guardian in all likelihood, and can likely get you assigned. OR you can say that there is ZERO cooperation, you don't live there, you cannot move the person by you, nor can you move by the person, and you will have to tell them you do not want guardianship. At that point the State will become conservator and it is on them to assess assets and place the person; you will have no choice where.
It is awful when this happens, but looks like it has. If there is no other support or family I can't think of other options; I hope others have some ideas for you.

My DH's uncle lived with his seriously handicapped daughter in AZ. He was living in absolute filth, evidently, and not getting his daughter the PT she needed.

He went to check on his trailer one day--it was about 110 degrees--and with no shirt on--he fell and lay on the blistering asphalt for and hour. 3rd degree burns all over his front.

His sons (live here in Utah) FINALLY had him judged incompetent and pretty much scooped him and sister up and moved them home and put her in a group home and him in a NH. They sold his trailer for junk and all he got from it was his necessary paperwork--I guess it was totally infested with rats and mice.

They'd been trying for YEARS to move him and he wouldn't hear of it.

Sadly, it took this life altering even to make it possible for the sons to step in and care for dad and sis.

Uncle has long since passed--the burns and ensuing care took all the will to live out of him...but the kids who stepped up--they were furious with him for what he put their sister through.

Sadly, he was not deemed incompetent until this horrible incident, although APS had been called repeatedly, nothing was done. I'm sure his situation was not that unusual.

Your LO may need more care now and in the future. These kinds of delusions are common as dementia progresses. Dementia can get worse, and you have to prepare for it. Is it possible to have full-time aides coming on shifts, or consider assisted living? If you have many "strangers" coming in, be sure to have all financial statements and information sent to the person who has power of attorney for financial affairs, and lock up the valuables. Be sure the paperwork is in order so that you or someone else can take over, if things get worse: POA for medical and financial matters, living will so that you know the medical directives, will if there are assets, banks and financial institutions often have their own POAs, social security and medicare should have someone on file as someone who can speak on your LO's behalf. You may need an attorney to help with these items.

It’s clear they need some attention and care. Someone needs to visit
and take control . Take LO doctor/
neurologist... and set them up so they’re safe.
you need to be more proactive

Hopefully you have POAs in place already, to assist with managing finances and assisting with medical care. Understand that these DO NOT allow for major decisions, like moving someone to MC, forcing them to accept in-home care-givers, etc. They are merely legal documents that facilitate managing some issues a person can no longer manage, such as finances, being included in medical care or making some medical decisions.

If there are no POAs, you may have to seek guardianship (even with POAs this might be required. our mother refused to consider moving anywhere and the EC atty told me we couldn't force her and suggested guardianship. I don't think she was far enough down the dementia path to qualify, but the bigger issue was the place chosen for her would NOT accept a committal. In the end, we had to use a plausible fib to facilitate the move. Staff told me "just get her here, we'll take care of the rest", which they did, awesomely!)

Since the LO won't go to a doc, or discuss the issues, can you or other family member(s) go stay with the LO for a while? This would help to observe and document behavior and unsafe conditions. Once someone else is there, I would suggest contacting either the doctor or a care-giver agency and request an in-home assessment. The LO may or may not cooperate. I had already realized mom was in early dementia, so proceeded to hire aides, just 1hr/day to check on her and ensure she took her BP meds, and get her used to having them there. They sent a nurse for assessment first, who gave mom a better "test" than the ones used in a PCP office. She confirmed what I knew and gave recommendations, such as using a timed/locked dispenser for the meds. Mom would often miss the alarms (visual and audio) or just not take them, so the aides could point it out (they can't dispense.) This didn't work out, as less than 2 months later she refused to let them in. Plan B was MC, as it was NOT safe for her to remain in her own place and we couldn't provide the care needed.

The test was done in mom's kitchen, at the table. It was less "threatening" than going to the doc office. Two of us were there as well. No way to know if your LO would be as willing to do this with family present, but it's worth a try.

If possible while there, install some cameras (hopefully there is WiFi) to observe, if the LO can't be moved. There are SO many dangers involved with dementia. The lies, accusations and hallucinations are bad enough, but when living alone, you have no way to know if they are eating and drinking properly, are exhibiting any unsafe behaviors, whether they might wander off, etc.

Worst case, get APS to come while someone else is there. YOU could allow them entry (even if LO is refusing.) In order to get guardianship (and get LO to safety while that is pending), it would be best to have it documented. I'm sure most APS can "detect" dementia and/or unsafe behavior/conditions. They can't always do anything, but having their input could help with guardianship.

If no family wants to be guardian, then the state would have to step in. Do understand that while being a guardian is a lot of work, it does NOT require YOU to provide a safe place or the care for the person. You just become the manager for theirs "affairs." Also, if the state takes on the role, no one has say where she would live, what medical care she gets and all income/assets would be taken over/managed by the state.

Imho, even though you have "it set up with food coming daily and same person ... visits each day," perhaps you would want to get a well being check (yes, I know all is not well) done by the LO's Council on Aging. Something must be amended. Prayers sent.

Just a random thought: I am reminded of the visit we made to the neurologist who is a prince of a guy. We got mom there under the pretense of it was a visit for dad...and we got through the preliminaries well enough. Ultimately the MD met with all 3 of us and just so easy going, warm and friendly that no one especially mom realized he was doing an exam of sorts and gathering info. Along with some paper questionnaires we were given to fill out related to behavior and symptoms he was able to reach his conclusions. Just wondering if in your case someone might be in town willing to make a home visit

Situations like this are heartbreaking and make me sick. Perhaps you could go and visit for a few days and then take someone with you and take the patient out for lunch but in fact go to a doctor - partial physical restraints ("so you won't fall") approach. I hate dementia and what it does and could not stand it for even a day. I would have to do something. Sounds to me like this person must be placed. Document everything and if there is some ploy to get them into a hospital setting, just maybe they would be admitted and then sent to a facility. I don't know the answers but you have to do something. In the worst case scenario - accept your hands are tied - there is not much you can do. But if they make their bed, they lie in it with the ending whatever comes along as a result of their behavior. Never feel guilt over that - it is their fault.