How am I going to manage?

Sorry about your mom. I think your first step with your dad is to find out his finances, POA, and Will. Can he afford home care and to pay someone to take him to dialysis, because you can't do that? In fact you can't do a lot of what he needs now and will need in the near future. Figure out what you can actually do for him without costing yourself too much stress. It seems from what you say he will have to go to a facility. Could his doctors tell him that?

Your first responsibility is to your husband and to your children. Just like with your children, you must establish healthy boundaries with your dad. Like toddlers, old people do not get to throw temper tantrums and be generally uncooperative.

In my opinion, it's a bad idea to take on the responsibility for caring for any adult without having the authority to do so i.e. durable power of attorney both medical and financial. You will only be chasing your own tail and your father will drive you crazy with his refusals. Your father also needs to have a living will stating what he wants done and what he does not want done in the event he becomes unable to make his own decisions.

You can help your father manage his life. That starts with a conversation with your husband about what you are willing to do and what you are not willing to do for your father. After you and your husband have written down what you can and cannot do to help your dad, call your out-of-state sibling and tell them to have the same conversation with their family regarding your dad.

Ask your sibling to think about whether or not he or she is willing to serve as POA or backup POA. Recognize that POA, especially financial, is a lot of work.

My FIL currently is refusing to downsize to a smaller apartment at his independent living. It has caused much strife in my marriage because my husband is POA and has not yet forced the issue even though my FIL's money will now only last half as long as it would have had he downsized after MIL died. FIL will run out of money in less than four years and sooner if his caregiving needs increase, which of course they will because Murphy's law states that whatever can go wrong will go wrong. And Medicaid is not going to pay for independent living. Because of this, my FIL has become the number one bone of contention in my marriage. Do not land yourself in this situation with your own dad.

My feeling is that he will figure this out on his own. My step father has been on dialysis for 6 years, first in home, which he couldn't manage, now 3 times a week at a center. It does take a toll, he sleeps a lot, step father finally realized that he needed to be somewhere else, he and his wife are now in AL.

My suggestion is to be patient, play the waiting game, don't panic, do your research regarding AL home's, be prepared. Also make sure all the legal documents are in place, Durable POA, Will and so on. Also try and get a handle on his financial situation.

Your dad needs assistance but you'll be turning yourself into a pretzel trying to care for him because he's refused options such as an assisted living facility and/or moving out of his house.

He has to participate in his own care even if that means making choices he doesn't like. I understand his not wanting to move or move into an assisted living facility but since he's the one who needs help he can't expect to kick back in his castle and wait for help to come to him while you're needing to turn your life upside down to care for him.

Try social services. Your dad's doctor's office can refer you. It's a neutral third party that perhaps can help.