He has dementia and she is barely mobile. They basically do nothing all day. He sleeps and she just watches TV. There are hygiene as well and medical care issues. I live three hours away and cannot be there for them. They have a trust set up for a nursing home, but not for assisted care.
Likely, they are afraid. Change is hard. They aren't happy, but they don't want to make changes. That's not unusual even for healthier, younger people.
If there are really serious issues, you can see if the local social service people can check on them.
Unfortunately, sometimes there's nothing that can be done until someone has a bad fall or a serious health crisis. This is hard to accept, I know. Try to find a third party person they will listen to, and let them know you will help them resettle. But don't be surprised if they still refuse. Unless they are court-determined incompetent, they have the right to decide.
Good luck with this,
Carol