Dad has a tremendous amount of trouble walking and caring for himself and lives alone. Have been discussing going to personal care. Ideas?

You step away until he gets taken to the hospital.

That is the reality of trying to help a vulnerable adult who is still competent.

There's really not much you can do, but wait for the next catastrophe to happen. Then you will hopefully be able to make some decisions on his behalf. At this point, it is what it is, and if dad feels he's fine on his own, then let him be on his own. Quit enabling him by going over and cleaning, doing his laundry and getting him groceries. As long as you keep doing that for him, he will continue to believe that he's fine to live on his own.
If you stop doing those things, he will soon realize that in fact he does need more help then he first thought, and hopefully be more open to discuss his long term care. I wish you well.

If he ever goes to rehab, have him evaluated for 24/7 care. If its felt he needs 24/7 care you need to tell them you cannot care for him and sending him to his home would not be a "safe discharge". There is no one to care for him. The rehab can not discharge him unless its safe. He would be transferred to a LTC facility. Since it sounds like he has no money, he will need to apply for Medicaid and his SS will go towards his care.

You can try this at a hospital too but my RN daughter says they aren't under the same rules as Rehabs are.

As others have said, there is really nothing you can do to make this happen. But I do have a couple of suggestions. As a result of reading "Being Mortal" by Atul Gawande. I took a different approach with my father in law than I had previously done.
Instead of telling him that he should move as my MIL had significant dementia and was difficult to live with, I started asking him questions about what he envisioned for the future, how he saw the next few years etc. Turns out he understood he needed to move but he was stuck by all the stuff he had at his house. It was not that he was totally attached to it, he just could not figure out how to move and where to start. They had been in their home since 1957. He had the beginnings of vascular dementia and could not really problem solve. So maybe ask him how he sees his life going, especially if you stop coming over and enabling him. That may lead to a breakthru.
And then, on your own, start researching options for him that would be near you. His financial status is going to be important here but once you know how much he has, (or does not have), you can research options just so you are aware. If there are viable options for him other than emergency placement, you can possible show him and get him to agree. If not, you will have to wait for an emergency, and there will be one. But at least you will be prepared with some knowledge ahead of time.
Good luck; such a difficult journey.

If he is a veteran he would probably qualify for a VA pension and “Aide and Assistance”. You are the aide and/ or you can use the pension for outside aid. Your local VA office would be the place to start and get questions answered. It’s been a God-send for my dad and allows me to care for him now full time. There was paperwork at the beginning that seemed a little daunting but I got through it with no problems and now working well. God Bless you both.

Stop enabling him. He’ll see that without your help he can’t live independently. If he has trouble “getting around” it’s only a matter of time until he falls and ends up in an ER. If he has no one to help him return to his apartment/room he won’t have any choice but to go into a facility. Without your help this will all end quickly.

I disagree that you should stop enabling him. He needs help and the fact that he has lost 20 lbs means he needs MUCH more help. Hire someone to get meals for him twice daily and to watch him eat. In the meantime, start looking to move him into his new home near you. You need to be around the care homes to make sure they are caring for him. Meals on Wheels will provide food and serve as a wellness check. But honestly, he needs placement into a care home.

One thing bad about this forum is bad advice. Ignoring him is very bad advice. It could kill him.

I do not like "ignore him" advice because that much weight loss means something is drastically wrong and he really needs to be in the hospital--from there he needs to get a medical and a psychiatric evaluation, and social workers can do safer placement.

TALK TO HIM FIRST and get him to the emergency room. IF HE REFUSES, you MUST fight for him. It is time to take action and call 911.

DO NOT ASSUME IS HE IS COMPETENT.

IF that were my parent and under those conditions, I would call 911 and tell them you feel your dad is a danger to himself and has something drastically wrong.

If you feel he is a danger to himself you may want to get a psychiatric evaluation after ruling out medical reasons for the weight loss. In Florida this is known as a "Baker Act".

THINK SAFETY FIRST.

next time he goes into the hospital talk to the social worker. Tell them that he can not be discharged to his home as there is no one to help him and it would not be safe.
Do not pick him up and take him home. Tell them when they call to arrange discharge that you are unavailable to care for him. Possibly a bit of time in Rehab might help him strength wise.
The "of sound mind" just means that he has not "officially" been diagnosed with any cognitive problems. If you discuss it with the doctor they might do some testing and see if there is a diagnosis that would allow him to get the help he needs.
Before you go down that road though it might be wise to talk to an Elder Care Attorney and begin the process of getting POA in order. You do not want him diagnosed with any type of cognitive problems then try to get POA, they will not do that you would then have to go the Guardian route.
Unfortunately it often takes a catastrophic event to get wheels in motion.
Is there a possibility of Assisted Living for him? He would have his room, laundry would be more convenient for him and meals would be provided and easier to get or he could make his own in his kitchenette.

If your dad is already living in a boarding house, perhaps you might be able to get him into a family-style group home where there are a small number of residents, live-in staff, personal care assistance, meals prepared, etc. He might prefer this over a larger more "institutional" setting. You don't mention your dad's finances, and these kinds of places are not cheap but are less than large assisted living places or nursing homes. I don't know whether they would be covered by Medicaid in most states, but might be worth looking into.

EVERYONE “REFUSES”.

He has indicated BY HIS CONDUCT that he is vulnerable to serious threat.

Get back to your Office of the Aging and ask if they offer an in home screening OR can refer you to a PROFESSIONAL who will do one. Tell Dad that you want to be sure he has what he needs to be safe, and that ALL of the people over 65 have to have one.

I have always been able to have cognitively questionable elderly Loved Ones assessed, in home OR in the office of their personal physicians. You also need to have AT LEAST a rudimentary screening of what his cognitive ability IS.

If he DOES have an ongoing relationship with a doctor, send a note marked CONFIDENTIAL, PLEASE DON’T DISCUSS WITH PATIENT” indicating a few of his threatening behaviors and your concerns.

Other agencies have no idea any more than you do, but YOU, as someone who KNOWS him, have the absolute right to know what you are dealing with.
If there’s a POA in place, check the language in it.

This is a VERY TOUGH SITUATION for those who are trying to care the vulnerable. One way or another, you WILL get through this, and so will be. Hopefully it will proceed somewhat smoothly.

First thing if he's lost 20 lbs in one month is a big concern and he should be checked out by his Dr,, blood and urine to make sure his weight loss isn't due to something worse than just not eating much.

He may be waiting to see if you'll offer to let him live with you.

You can't blame him for not wanting to go live at a Senior place,
they are understaffed and not a fun place to live, as you loose all your rights and are told what to do and when to do it.

He wojld be happier staying where he is if he doesn't have family he could move in with.

While he's staying where he is, You could install a camera in his room that he can be watched 24 7 by your cell or computer, in case he falls, ect in side his room.

He could also wear a fall necklace in case he falls outside going to the kitchen or bathroom.

He should have a small refrigerator and a microwave in his room.

He needs plenty of easy stuff to eat in his room.

You can basically cook and warm up anything in a microwave.

They have easy microwaveable meals for breakfast, lunch or Dinner.

He should have easy snacks to eat like Breakfast Bars, Cheese Crackers, Peanut Butter Crackers, Nuts, Bananas, Apple Sauce, Yogurt, Breakfast Drinks like Ensure. Easy Soups to heat up that you don't have to mix with water, Juice, Milk.

You may try to get him on Meals on Wheels and have a meal delivered to him once a day.

Prayers

Please take him to a doctor for evaluation. He must have his physical health, his mental health, and thought processes (dementia). Please let the doctor know about what you are doing to meet your dad's needs and his difficulties. A journal would be best to document your trips to see dad. Most likely, the doctor will deem your father as mentally - and most likely physically - unable to meet his own needs. At that point, an authority can step in to take over his care.

As for who will make decisions for your dad, you and he have some discussions to have. If he would rather you be that person, please get to a lawyer to draw up legal documents, power or attorney for medical and power of attorney for financial. If you rather that another person do this, the courts can appoint a legal guardian who will do this.

Not sure where your Dad is located but you can check with the Office on Aging or perhaps search and see if you have a geriatric advisory council in your state; if Dad is will to consider moving, they may be able to recommend some other type of living arrangement other than the larger (and more expensive) assisted living, long term care facilities that he dislikes. In NJ we have Adult Family Care homes which allows those who are no longer able to live alone the opportunity to move in and share the home of a caretaker who is capable of providing needed assistance and supervision. AFC provides a home-like environment where participation in the family and community are encouraged. These homes are supervised by a "sponsor agency", which has been licensed by the NJ Department of Health. The individual has the right to participate in the planning of their treatment, access shared areas of the house such as the kitchen and living room, and to make choices with respect to services and life-styles. We also have boarding homes under different level classifications. Class C boarding homes provide rooms, baths, linens and meals. Rooms and baths may be either private or shared. In addition, Class C homes provide 24‑hour supervision and personal and financial services, including monitoring of self‑administered medications. I'm sure most states have the equivalent living options although ferreting them out is always a difficult process.

Dad may be at the point that he requires more assistance than these type of 'non-medical' situations can provide but you won't know that until you can convince him to get a full physical including a neurological assessment. See if anyone has his DPOA and medical proxy. Someone.... you or a highly trusted friend really should get these documents as soon a possible. Dad may know that he is slipping. Trust me ...... that knowledge is unbelievably frightening so one tries to deny it at all costs..... including your own safety.

He may have made friends in the area and may not wish to leave them even to move closer to you so the best thing to do is ask him how he sees his life and what does he want in a non threatening way. You might have to have several rounds of this because his first shot could be totally unrealistic but keep going. When either of you starts to get frustrated, take a break and breathe.
Good Luck and keep us updated.

As easy as it is to say 'just grab him and haul him to the ER for an evaluation'...it usually just does not work.

If he can pass the dementia 'test'..they will do nothing for him. Maybe run a few bags of saline to hydrate him and send him home.

The weight loss is concerning--and you don't know why this happened. Likely he's just old and tired and doesn't want the hassle of preparing his own meals. My FIL did that. Ate next to nothing and drank coffee all day.

I'm afraid that all you can do is wait for the 'fall' that is almost bound to happen. I hope you have POA, or someone who cares for him does.

I can't blame him for refusing to go into a facility - who in their right mind would welcome that? They would be insane. I say first of all, consult an eldercare attorney for obtaining all legal documents required by law to have you as the person in charge. Second of all, I would consult a good medical doctor for possible medical solutions and appropriate options. Third, I would sit him down and "lay down the law" - age, safety, the works and your boundaries and effects on you. Get him to think the best option is to be somewhere safe with care. You might also contact Adult Protective Services, different than the office on aging. You must take definite steps - I think he has dementia and won't face facts.

Get a small microwave & dorm fridge for his meals that he can keep in his room. This way he does not have to go outside in all weather for his meals. Pick up some of the Tuna cracker packs or lunchables, Boost or Ensure. Can you hire someone to bring a meal in daily. Maybe someone in the boarding home would be willing to fix an extra dinner daily for dad for a small fee. Check into meal on wheels. If he is active in a church, maybe members would be willing to take on one meal every week or every other week.

The laundry will probably still fall on you weekly.

How much of a difference would there be between a boarding house or a retirement center with some type of supervision of his well-being? Unless cost is the problem, there are places he can have a lot of privacy and do as he pleases, but won't have to worry about his laundry or cooking or shopping for food (and neither will you). Maybe I am being silly in approaching him with it in that manner, but maybe worth a try. He might even enjoy having the company of others, if he so chooses and lessen the need for your visits for social reasons.

The county he lives in should be taking charge. Please call his counties human services department. You can also contact the state he lives in (dept of human services) and file a complaint based on self neglect. They will have a nurse come out and inspect.

Imho, quite a few elders, barring on some (who may verbalize 'I require assistance') hold firm with their incorrect thought process that they do not need help, when it may not be the case at all. However, if your father goes to the ER, how is he returning home and why? - answer: an emergency room is just that - to treat what is deemed a medical emergency. Of course the emergency room physician knows not of his living requirements (and need for assistance).

If you have Meals on Wheels in your area they will deliver a hot meat to him once a day everyday. This would cut down on his danger of falling. An alert button would be helpful too.