Has anyone made the steps needed to move someone to assisted living in another state from where they live?

My sister is eight (8) years younger than me and in very poor health. She is now mostly unable to walk, falls, has COPD, diabetes, depressed, overweight..etc.
My niece is special needs (high functioning) in her 30's & they live together in the house that we grew up in. She does most of the caregiving (when she will). They fight all the time. I am 1,600 miles from them & unable to visit very often. I do call her 2x day. She qualified for 5 hours of caregiving per week due to her low SSI. I know she needs to have more care and have her considering a move to assisted living. That would mean that my niece would go to a group home that she is used to going to when her mom is in the hospital. That will reduce my sister's income. She only has SSI for my niece & herself. I have made some steps to get her the assistance she needs to be at home but it's not really good enough. She is lonely and so depressed that I know a move needs to take place. The paramedics come to pick her up off the floor so often when she falls that I suspect that it's possible that social services will require her to move soon.
The only time she goes out is to one of her doctor visits.
Assisted Living says they won't take her unless she is on Medicare/Medicaid & she is not 65 yet. Not sure what I need to do next besides what I am doing, which is just not resulting in any happy days for her.