Options for in-home care?

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My 90 year old grandmother moved into an independent living community early last year. Over the course of the past year, her health has deteriorated somewhat; she has congestive heart failure, she wears oxygen, and she basically goes from her chair in the living room, to the bathroom, and to bed. She has a hard time getting out of the house, and she's pretty much always short of breath. The biggest challenge is, I do not live near her (I'm in CA, she's in NM - a full day of travel to get there) - I have a Nest Camera in her home (with her knowledge) to keep an eye on comings and goings and to make sure that nothing is out of the ordinary. Lately, she has slipped out of her recliner a couple of times, and I've had to have the caregiver come over and help her up. When I was with her at Christmas, she seemed slightly more confused than usual - just sort of subdued and not herself. I know this is a normal part of aging, and that she won't be around forever. I wanted to respect her desire to live independently, and she can afford to get more in home care, if needed. I worry about her, but I feel like I am doing everything that I can given the circumstances, and she does not want to move into assisted living where she would have to give up her cats. Just curious whether anyone has experience with a similar situation or any advice...

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The IL that gran is in, it is part of a tiered or a CCRC facility? Like where there’s an IL, AL & NH within the overall footprint? If so, I’d suggest you call the IL to have gran evaluated for higher level of care or AL.

I’m assuming your her mpoa & dpoa.
BUT, If not, I’d really really suggest you get back to NM and get all her legal updated to be able to show your clearly legally able to do whatever for gran BEFORE doing anything. As an aside, NM has a pretty overarching appointed by the court guardianship system if no in state nearby family or legally done in NM POA paperwork. So you need your documents in order.

My mom was in IL and one of the big criteria for her and other residents to continue to be in IL was ability to successfully participate in fire drills. Her IL was 3 story & yeah her apt was on 3rd floor. I was there for a drill and it was quite the organized chaos. If your granny is beyond her ability to understand what fire alarms mean and get herself out of her apt & over to the meet up location, she needs to be in a higher level of care ASAP. Often elderly residents as they were living at home before the move to IL, have not done a fire drill in ages. Perhaps beyond decades. My mom’s iL was strict about drills; she was good, but others weren’t and got the “need to be evaluated” letter. So pause to think if grans slipping out of recliner is just one of many other issues.
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I agree with cdnreader. It might be doable if you were close enough to pop in on her daily, but your aren't. If we cling to the familiar even when it no longer works for us simply because we are afraid to change we will often find ourselves having to make those changes anyway in a time of crisis.
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Dear Heather,

This is difficult situation. I know you are doing the best you can. I too thought I could monitor my dad remotely from work with a Nest camera, but his health really demanded more attention then I could give.

I feel for your mother's own well being I think it might be best for her to be in an assisted living or nursing home facility. Or maybe hire a full time caregiver to live with her. Having CHF is very hard to manage.
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