Not great options for in home care and my father not willing to explore options.

Sounds like a big heaping spoonful of not your problem.

My experience with APS and authorities they don't do anything unless a violent crime or severe accident has occurred due to the right to rot or self neglect laws in most states, and the person has to be in the latest stage of severe dementia and deemed incompetent. Then it can take 2 years of arguing in front of judges about assets, etc. Life expectancy of stage 7 dementia approximately 1.5 years. I have witnessed falls, homeless people, squatters and hoarders, the frail, elderly, disabled who self neglect or mutually abuse the frail or elderly or blow things up; who simply say "I choose to live this way", and the authorities quickly move on to the ones with broken hips, collapsed lungs, heart attacks, strokes, assaults, severe burn injuries, etc. Squatters have rights in the area where I live and I have seen them (vulnerable adults) use those rights as power to fill 3000 square foot estates with hoarding clutter filth chaos and drugs. Unless an inheritance is involved where you will be compensated for empowering people like this with the good quality care they so richly deserve, and even then be prepared for a ton of hard work, grief, and pain as people forget love, grief, caregiving the toughest jobs out there, most people don't want to do the work, or pay for that hard work, instead complaining, whining or arguing about it. I am sorry you are going through this. I compare it to choosing to bring new life into this world. when we choose to have kids, we choose to commit to providing them with the care they need and our lives are never ours again from the love (and work and sacrifice) required to ensure their survival. The hardest thing about elderly parents is they say no to the help, or refuse to accept that anything is wrong, and the people who gave us life we now try to give them life and they fight it. So we have to decide what to do about it. Just know it is a huge responsibility like choosing to have a baby only in reverse and the person is used to it being the other way around. .I work in hospice eldercare and I have never seen these things handled perfectly. I would ask if you have anyone else, siblings, cousins, who can work as a team. Sit your Dad down and tell him you want to commit to his wishes for end of life. That you need him to define his wishes while still decisional, or does he wish to wait where he becomes so incompetent a judge will decide for him. That you are asking for this responsibility. Tell him he committed to bringing you into this world, honored your demands changing poopy diapers in the middle of the night, and takes care of you mom with dementia. I guess he must have done a decent job committing to your survival as you are a grown adult with a job, the gumption (and love) to ask their dad (and the woman that gave you life your mom) to commit to their end of life wishes, that they did there best to honor your life. That now you feel the need to ask to do that for them, even if it means he choose someone else other than you or fire you if they don't like your work, do they want the neighbors to do it, or the ones that they chose to bring into this world??. Then say bluntly I was shown what commitment and love looks like from my parents, and now I am going to do the same for you and mom. Tell him that everyone dies eventually from some type of organ failure, the heart, lungs, skin, kidneys, BRAIN, etc. That could he commit to what he wants things to look like if it is his BRAIN or heart or lungs, etc. Then ask the tough questions and listen. Don't argue, but also don't accept excuses as many people (especially men hate committing). Then keep asking for commitment. Then fill out the state forms in front of a notary through the court social workers, then file it. Think of it as the time you proposed marriage or brought a baby into this world or said I love you or found a job. Courage, conviction, commitment and contribution. Never gone wrong if acting from one of the 4 c's.

I think you are right in your thinking--absolutely right.
I think that you already mentioned all the reasons you can do nothing about this.
I think that perhaps you have to look on the "bright side of things".
Your parents are aged. One is infirm and the other not far behind. They have lived lives in which they are somewhat reclusive (not a negative judgement; I am the same).
They live alone at home.
They have had their lives.

Let me ask you, what good would it do them to live a bit more safely and a bit longer in a nursing home?
Think about that a few moments.....................................
I would comfort YOU. Would it comfort them? They are still hoping to exit their home feet first.

You have chosen to move and make a life many miles away. That's actually something I often recommend to children. What good would it do if you were next door? You could check; that would comfort you. But ultimately their care could ALSO kill you dead; we have seen that here.

To my mind, do nothing. And at 82 my thinking has changed a lot.
You will get the CALL. Be sure of it.
SOMEONE, neighbor, cops or hospital will be on the phone: I got the call from Desert Regional Hospital saying "Hi, you know we have your brother here with us". Nope. I didn't know. But I did with the call. A doc will tell you of a broken hip or a cop will tell you of a neighbor calling or APS will call saying they got a wellness check order or a coroner will call and say "we got a call and.....".
I am just saying, there will be a collapse or a broken bone or a death and you can't predict this.
What you CAN do is not much.
Arrange a call service that checks in daily. Have APS do a wellness check and assessment if you like. But if you do that, be ready with a packed suitcase.

I am so sorry. Aging in America simply does NOT have good answers.
And many will find my response negligent.
But that's my thinking, now, as an 82 year old woman thinking A LOT ABOUT THESE very issues.

Good luck. Update us on what you plan.

Thank you for your response. I'm sorry, I don't even know what APS is, can you explain?

My parents were in a similar situation a few years ago except the genders were reversed. At the time, I lived about 800 miles from them and visited 3 or so times per year. It reached a point where I asked my mom if they could move near me if I coordinated everything. She said yes. Even once they were near me, there was a lot of the same kind of issue you are wrestling with now. I offered every option I could think of or find out about. She rejected 99% of them. To be frank, I got a lot more used to the idea of “stuff happens” and 911 calls because my dad fell a lot and eventually went into home hospice (and continued falling) and she couldn’t help him up and would never help with bathing, brushing teeth, didn’t seem to notice or care when he did dangerous things like climb half naked onto ladders to the roof, wander onto neighbors property, etc. At certain points I would intervene against my mom’s wishes, but it was all really hard. (She and I both had DPOA for him.)

Would it help at all to put it on the line with your dad? Like ask him has he thought about she might wander off and get hit by a car, or fall in a ditch and no one finds her for 24 hours, or she might set the house on fire from a kitchen accident or cause a flood when he goes to the grocery store and leaves her alone? And what does he want or expect to happen if HE passes before your mom? Or if he falls and breaks his ankle or even gets the flu? Who is going to prepare meals?

My only other suggestion would be, could you set up some kind of “authority” who would be checking on them once a week or whatever and chalk it up to a requirement? Like for Medicare or home insurance purposes at their age, this is now required.

good luck and best wishes!!

don’t blame yourself or feel guilty. You didn’t cause any of it.

Be aware that in Texas the “right to rot” is a real thing. If he’s managing both their care even if imperfectly APS and the police may “do nothing” until an accident or major medical event happens. And the options for Medicaid covered in home care in remote areas of Texas are almost nonexistent. You may be stuck waiting for something to happen before you can act. Your father may have his own cognitive issues.

You seem to keep wanting your Dad to be someone he isn’t and maybe never was.

The time to call APS is now since there aren’t any options for an adult who won’t cooperate and cannot be reasoned with. For your Mom’s sake report her as a vulnerable adult to APS so she can get appropriate care and more socialization. She won’t be able to “age at home” and neither will he. That’s not an option in this situation.

I’m so sorry for this distressing situation but you won’t be able to do anything unless you’re in the same country and you are their PoA.