What do you do with a 95-year-old man who refuses any help and lives alone?

I think you'd be less frustrated by acknowledging that trying to change him not only isn't going to be effective, UNTIL and/or UNLESS he's ready, and that forcing him into anything will only alienate him.

Remember, it's the family's opinion that AL would be better for him. It isn't what he wants, and you do have to respect that, as well as respect that it's his life, to live the way he wants to, even if it's not safe.

I'm in a similar situation, but have learned to choose my "battles" carefully, and I've given up on getting my father to go to AL. He'd be absolutely miserable and would give up and die quickly. He wants to be free, in his own home. He wants to walk down the street to visit neighbors and interact with them and their families.

He wouldn't have that option in AL. Sure, he'd be much safer, and also much more bored being around only other older people. He wouldn't be able to enjoy the children in the neighborhood, the seasonal decorations, interacting with the mail carrier.

We've discussed this and even though I still drop hints, I know that he'll stay in his own home and the only way I could get him to AL would be to override his own judgment and desires. And I won't do that.

I also won't when I get older. I'd rather die in my own home than in a starchy facility with a lot of other older and sick people. (No offense intended toward anyone whose parent is in AL; some people can enjoy it. I'm not one.)

So, ask yourself whether you want your GF to go to AL b/c it's the family's impression it would better for him, or if you think that's the best thing for him, including taking away his freedom to still live what he probably considers a good life.

If he is still competent, there isn't much you can do until a crisis hits. The next time he calls you because he fell and needs you to pick him up, you can go over or call the paramedics. Afterwards, ask him if he wants to stay at home or go to a nursing home. If his house is full of trash and rotting food, having a cleaning lady come twice a week would help. State that the paramedics might report the state of his house and his falling will put him in a home and it won't matter what he wants. To remain safely at home, he must hire a cleaning lady at least twice a week, he must have an aid or two come in three times a week to help him out.

jnana43, it will not be easy to bring into your Grandfather's home a caregiver. Some elders welcome it, others will refuse big time. The secret is to bring in someone who has a lot in common with Grandfather, that way they would have a lot to talk about.

Whatever you do, even if Grandfather finally gives in and wants a caregiver, is for you to pay for this cost. Such cost should be paid for by your Grandfather.

Many of us here had to wait until there was a serious medical issue, such as a fall that requires hospitalization. But don't be surprised if Grandfather wants to return home even against his doctor's advice. Usually it takes several serious medical issues for the light bulb moment to happen.

SO-o he doesn't want help. Try for little changes that will help but don't look like it. When someone visits, bring a dish of whatever that you made and thought he might enjoy. Something that can EASILY be reheated. Some homemade soup for example. And didn't you get confused and bought more bananas and already had some at home, could he help and take a few?
At 95 he is part of the depression era generation, waste not want not. Invite him out for a meal at a diner so he gets a nutritious meal. A saturday afternoon event, so to speak. Can someone (in small steps) eliminate dangerous spoiled food from his frig? I did this at my MILs each visit. I didn't get there often but did what I could.
My 93 year old uncle was exactly as you are describing. The nieces/nephews ultimately set up a schedule for weekly visits with some meals and groceries. It is hard to turn down some delicious food items! He too was proud but loved the goodies. Stop asking and just start doing things --- a LITTLE change at a time.

SO-o he doesn't want help. Try for little changes that will help but don't look like it. When someone visits, bring a dish of whatever that you made and thought he might enjoy. Something that can EASILY be reheated. Some homemade soup for example. And didn't you get confused and bought more bananas and already had some at home, could he help and take a few?
At 95 he is part of the depression era generation, waste not want not. Invite him out for a meal at a diner so he gets a nutritious meal. A saturday afternoon event, so to speak. Can someone (in small steps) eliminate dangerous spoiled food from his frig? I did this at my MILs each visit. I didn't get there often but did what I could.
My 93 year old uncle was exactly as you are describing. The nieces/nephews ultimately set up a schedule for weekly visits with some meals and groceries. It is hard to turn down some delicious food items! He too was proud but loved the goodies. Stop asking and just start doing things --- a LITTLE change at a time.

In your situation, you have to get creative. You can choose from many of the great ideas given here so far. One idea at a time, and give your grandfather time to get used to each idea. If you can get the family to rotate on a weekly basis to bring groceries and clean a room at a time, he might accept that idea. Eventually, you may be able to get a caregiver or someone in his neighborhood or from his church to join in as a part of the rotation to get your grandfather used to someone who isn't family.
I was able to do that with my very stubborn aunts and mother. My neighbor started helping my eldest aunt on a limited basis until she needed more help and eventually passed. Then she helped a bit with my next aunt. Finally, she first helped my mother when I was out of town, and now she helps her on a weekly basis in addition to what I do. My mother was resistant at first, wanting me to do everything, but you have to be gently firm and explain that you can't do everything.
If you continue to be concerned about your grandfather's safety and health, you may have to assign someone to go to his doctor visits and/or schedule a wellness check. If someone is his POA, you may have to get him/her involved, or get one designated.
Good luck!

My husband's father, age 90, in the advanced stages of diabetes and suffering from early dementia, sounds much like your GF. Even a 10 day stay on a respirator in the Intensive Care Unit was not enough to persuade him to live in our home in a specially designed senior apartment. He wants to "live on his own terms." His own terms include: 3 hypoglycemic episodes (dangerously low blood sugar) and extreme diabetic nerve pain as he is no longer able to remember how to take his medications, a traffic ticket for speeding thru a school zone (he didn't realize he was in a school zone), backing into his garage door (he didn't realize the garage door was still closed), and driving into a ditch, damaging his car substantially, backing out of the ditch and continuing to drive to the golf course where his golfing buddy pointed out the damage to his car. It surprises our family that his insurance company continues to issue him the policy.
We live 8 hours away. My husband's sister lives 1 hour away. Our solution was that Sis would stay with Pop 3 days a week, cleaning, cooking, and tossing out all the sweets he has purchased while she was not there. He gets aggravated with her presence and often asks her to leave. We all know its because she prevents him from eating sweets. Also, my husband filled out forms at the DMV asking them to request and review health information from his doctors as to his failing eyesight, numb legs, and inability to control his blood sugar. Pop failed the eye test, but has filled an appeal. It can take as much as a year for this process.
It is unfortunate that some elders early dementia prevent their seeing the logic of a change of residence, whether it be moving in with family or assisted living, or in your case, just some additional help a few days a week.
I wish I could offer a solution. Just know that you are doing the best you can in a very difficult situation.

What you have said speaks volumes about your views and values, rather than your 95yr old grandfather. Let him live his life how he chooses - there will come a time, and I'm sure he's aware of this, when he needs to accept help, but right this minute that doesn't appear to be the case with his current lifestyle and need for independence.

"Our solution was that Sis would stay with Pop 3 days a week, cleaning, cooking, and tossing out all the sweets he has purchased while she was not there. He gets aggravated with her presence and often asks her to leave." Poor SIL. And it's still only three days a week. Can't he get himself into a crisis quite easily during the other four days of the week?

What's needed is to stop asking him to make a choice about AL - I've worked with cognitively disabled and elders 30 + years and most cannot think ahead, it's not a series of rational plans and decisions - and to me, that's the piece of "your values" that can be a lot more helpful if it's adjusted.

More immediate supports can be more attractive, and lower key, even if you want a major decision made. Visit with him, and use a caregiver agency that uses older caregivers. More familiar with the hollowness of words that come from plans on paper - that's the older generation - they want to play "Host", not care receiver.

Transition plan is what makyes the difference. Hire people on different initial basis, when their real job is to allow your father to get used to them. Like hire a caregiver, but don't make a WHOLE plan for his care - just have her start as a "cleaning lady", for an hour and the rest of the time, visit with him, have tea. Or have someone help with an outdoor job, then sit and have tea.

It doesn't take as long as one would think. I did that, was caregiver who sat with 96 year old, independent fellow, similar attitude. I listened to his stories and showed my delight in his resourcefulness and ability to innovate. And I left. Downplayed the whole care perspective, said, I don't know if he'll want help or not. And came back, visited, helped gently with a small task he started to do. AND I agreed with his mistrust of the healthcare system - I agree anyway, for I find their expectations are designed by researchers, so instead of working in praise of a very capable old man, they are worried about answering to their supervisors who barely know the fellow.

When the fellow began to accept that I was there as a helper to HIM, not to the goals seen by family or services - and I laughed at his wonderful jokes and stories - but also kept alert to doing small things - when it was simple - he began to rely on me. One day he found his electric garage door was open when he woke in the AM. He was paranoid about neighbor vengeance, and sure this was a prank from a particular neighbor opponent. I told him I thought that unlikely, but that I agree, it needs to be fixed right away, and I stayed late that day, standing on a ladder in his garage fiddling with the control device as he read me the codes that he had stored in his wallet for decades..... We got the door closed, and I just said, "good" - for I knew that if I had left that job undone when i left him, his paranoia would have been triggered into crisis.

He came to see me as his "right hand man", even if I was a 60 year old woman, but I had owned my own home alone, and knew the challenges of upkeep, so I helped with many tasks. After he had accepted me, my Care Manager made the arrangement more formal, and a couple of weeks later, another stable caregiver was added, and for 3 years, we lived there overnight and handled care tasks through his decline.

Many care agencies know of these issues, and plan to work with them. And sometimes that resistance has meant that a caregiver just sat outside for their shift, while the client never let them in! Trying different approaches, and writing down what worked, because SOME caregivers could persuade him, others were shut outside. I was a fill in for a woman - and sat outside, until one day as the woman refused me entry again, I said, sure, I understand, but can I use your phone to call my company? My cell is not working. Allowed her to be "host" not care recipient. Once inside, I used the phone, chatted a bit, noted her nice home and chatted some more - turns out her internet had stopped working, so I said I'd try to fix it.

By the end of that day, she had accepted me, and I cleaned the kitchen and bathroom before I left. The next time I came, she might not remember - and it's just a repetition, accept, be glad to see them, follow their lead, and gradually add a bit of help. It's all a transition process, not planned in advance on paper, without the initial period of a month or two, of trial to add bits of help.

Fact is, once a place has been gradually organized for them - the brain injury people write labels on the outside of drawers - if you remove clutter, don't throw it out, but put it in a "later consider box", and they agree, then hide it from sight so they forget about it - but keep it, in case they get worried or suspicious, so they can review it again, always going along with them to support their ways of self organizing, laugh with them at the difficulties, and help by making some small change, which you are willing to undo, if they don't like it. That approach lets them experience small changes, and get used to them, not be asked to say yes or no ahead of time.

Our primary care provider (who is also my 96 year old mother's PCP) - when I brought the issue of AL and MemoryCare to him (I am my mother's caretaker for decades now), said to me with great CLARITY: The PRIMARY motivating factor regarding elderly parents' living situation is: ..........................S-A-F-E-T-Y. Without Safety, Health and Happiness do not exist. The Discharge Planner at the Hospital (after her being admitted to lots of panic attacks) said, "She can no longer live on her own." And she meant BUSINESS. I retired, moved, and bought and lived in a condo directly next door to her for years, but her ageing challenges made that situation even impossible, so I just moved on it and moved her (age 92) to a beautiful Ind Living / Asst Living residence, decorated the place like a home, spent lots of time with her, and she was fine. Her brain forced her into MemoryCare since AL had to ask me to move her due to her need for security because she was wandering.

Wow, all great answers. My 97 yr old dad finally went into AL, and he was in perfect condition , except was starting to fall (mostly because he rushed alot) . He was only at AL 3 mos. He passed away from a fall 6 mos from moving there. I feel the move upset him so much that he got more paranoid. This paranoia caused him to rush to the bank for money and he tripped. (he had $$200 in his wallet but wanted to make sure he still had money in the bank) If i could do it over, he should have stayed at his home. You can set up a camera system to check on him,and he could wear a life alert. Both would be less expensive than moving him to AL. But make sure the life alert signals when he falls and he can't reach to press the button if he were unconscious. And he might not wear the life alert...
Be creative An example: As siblings one occupied him with an all day outing, and we had his house cleaned and one washed his clothes. We took photos to put everything back EXACTLY as he left it

I think you or another family member should just help him clean up his house and check on him every few days. Also get him some kind off call alert system or make sure he carries a cell phone with hi so he can call for help if he falls. Just do things to show him love and support. I just don't think that people should lose rights just because they age. He hasn't been in a bad wreck yet and is passing his eye exams and you say his mind is still sharp. Therefore just love him as much as you can while he is still on this earth, and support him in a non-controlling manner.

I am writing about these folks that we call the self-neglectful elders...you need to gather in all the services he uses and plan a different course of action..

Here in MN, a relative or doctor can alert the DMV about the driving issue and the DMV will require them to do a driving test, both behind-the-wheel and the written part, but only with a letter from the doctor saying it is safe for them to test him. If they don't get that letter, no test and license is revoked. Then the issue is to get the keys. My friends for whom I am their POA would not stop driving, so I called Adult Protective Services and they responded by coming to the house to do an evaluation. The husband sounded credible for the first two minutes, then began repeating himself because he can't remember what he has said. When asked how they got their groceries, he said they drove to the store. When reminded that their licenses were revoked, big surprise! "They are?!" She asked the husband what he thought they should do with their car if he couldn't drive and he said "Sell it! and get some money for it." At that point I was able to get the keys and move their car to a friend's garage to get it ready to sell. The APS lady also alerted me to how bad the wife's frontal temporal dementia was and about how much longer she would live. She was very accurate in her assessment. So, the DMV and the APS were keys to getting them to move into a memory care apartment I had found for them.
We had an interim help service coming twice a week at first to help with the wife's self cleaning neglect and chores, then for 24 hours a day when she became incontinent and started to wander out of their town home. At that point, it became clear she needed much more help and a controlled environment and the husband agreed to the move. We made their one bedroom memory care apartment look just like their town home bedroom and den with the same furniture arranged the same way, same pictures on the wall, etc, so their transition went very smoothly. I understand the pride he must feel, along with the fear of losing those abilities so he can't admit to an issue. There is a condition called ansognosia (or something like that) where it is impossible for a person to see/understand their failings, but I don't know what the answer to that is. A physician's diagnosis and recommendation would give some ammunition for getting the change to happen. Paying for AL-MC is another issue. Those places are not cheap and that must be considered as well.

Of course your concern is well founded, but so is his decision to live out the remainder of his life as he wishes. He very well may die in his home, just as he wishes, from a fall or something else. But I bet he won't regret being there when it happens. He probably knows his time is limited and doesn't want it to be any where else. As an RN, I have seen so many families agonize about this and end up placing their loved one in assisted living or a nursing home where the individual usually loses their will to live. I've sat with so many people who were resigned and bitter about their placement and talked about going home.

My own father fell and broke his hip at age 92. The hospital course got complicated by other reasons, and both nurses and social workers would come in daily and tell me that he had to go to rehab. I kept saying: "No, he'd be mad". Finally, when he was able to communicate, his MD said: "Mr X, they want to send you to rehab." Dad's immediate response was: "No, I'm going home. I'd be mad." Dad went home and died three months later from a UTI. He wanted no further treatment and refused to go back to the doctor or hospital. We placed his bed in the dinette where he could be in the center of things. Yes, we were fortunate that Mom was still alive and could shoulder the brunt of the caring, but the rest of us took turns in the evening and we had a good plan in place as a family to support Mom & Dad.

The other thing we put in place was hospice. Dad had severe lung disease from smoking and was oxygen dependent. His doctor felt that the COPD alone was sufficient to place him on hospice. He accepted this and we had a bath aid come in two times per week to give him a bed bath, plus the weekly visit from the hospice nurse. He morphine alone that hospice provides eased his breathing and made life more bearable for him.

Mom and Dad's house was terribly cluttered and not very clean from never throwing anything away.  We didn't worry too much about that because what could we do anyway?  It was comfortable to them and they wanted it that way.  We cooked them meals and took them over, and checked the refrigerator and tried to discretely throw out spoiled food.  I cleaned the bathroom.  Other than that, we let it be.

Driver's license issues: this is not only about your grandfather's safety, but those he may affect (even fatally) if he's in an accident. Contact his doctor and ask the doctor to tell him he needs to give up his driving. This way it's not you or the family "telling him what to do" but the doctor. You can then tell him he has to listen to the doctor, and it's easier to take away the keys. This happened with my father, and it was a very difficult situation because it was about my dad's pride and they way his generation thought.

MOVING: the family may think he will do better in assisted living, but he does not. Take it from his perspective--my philosophy is that it's about their quality of life, not necessarily their quantity or complete safety. Having said that, safety IS important, but do you want your grandfather to be completely safe but unhappy or even miserable? I believe it's very different from our perspective and theirs. At 97, a move will be very emotionally difficult and upsetting. I suggest doing what you can to keep your grandfather fed by bringing meals/snacks in, getting someone to do shopping for him, and get along the best you can in the current situation. Regardless of how you proceed, it will not be easy, but it will only be for a time. Of course, there may be a time when you have no choice but to transition to institutional care, and don't beat yourself up for that. Be strong, and good luck! You're a good, conscientious grandchild.

Because your grandfather has not asked for help, you cannot force help upon him. When people outright ask for help or quietly depend upon others for assistance, that's when caregivers can shape the help given or influence the person to choose assisted living.

A nice gesture may be *asking* your grandfather if you can give him the gift of a weekly housekeeper. Keep the conversation light and, if he declines, ask again next month.

Im going to be the devil's advocate here
Why should the POA be commenced, it sounds like he has his marbles and physical health
Why is he sucking on the oxygen, what do his levels fall to? that alone is a reason NOT to be allowed one's drivers lic.
What would your attitude and approach be to him if he was 75 !!!
HOw dirty were his clothes when going to town. Heck as 15 yr old Id race in in my dirty farm clothes and gumboots cos I was in a hurry, and 55yrs later still do it.
BUT if more than grubby, and with say some incontinence. THEN he needs guidance/assistance.
IF you feel the house is a mess and needs cleaning what about suggesting a once only clear out. either the family do a four hour wonder extreme clean up. Telling him you are all coming to do something for him to get ready for winter, and for him to sit in the middle of the room and bark orders.
Dont write him off, unless he really does need to be. There isnt much left at 95 so a bit of dignity, and his memories are all he has.

If he's 95, lives alone and still does everything on his own, good for him! I don't know how common this is, but good for him! He should be congratulated and supported, not someone trying to come in and force their way in to take over. As long as the bills are still being paid, he can still drive and take care of himself and all the bills, more power to him! At very least we're not hearing about a situation where someone is taking advantage of him like what happens to so many other seniors. He probably knows a whole lot more than you realize and he's probably very aware of what's going on out in the world and is doing his best to take care of himself to prevent this from happening to him, good for him at least someone's getting the message to protect yourself especially as you age. My bio dad developed Alzheimer's and a vulture took advantage of him but if only I would've known he was alive I probably could've had a father daughter relationship with him and taught him how to protect himself. Sadly though I didn't know my dad was even still alive nor did I know what was going on until after his death when it was discovered. As long as your grandpa isn't being financially duped and as long as he's still sharp, there's not going to be a whole lot you can do because he's an adult and you can't force him to do anything. Age doesn't mean you're unable or incapable, it's what happens to you that determines whether or not you're able or capable. I do strongly agree that if he needs help with at least his laundry or even bathing, he must still be the one to reach out for help or he's going to start becoming extremely combative and I don't blame him, I'm also one of those combative types of people and others know not to mess with me. Good for him, that stubbornness and combativeness is exactly what's going to keep people from taking advantage of him especially if he's old and lives alone but still managing his own affairs. I think God gave some of us he knew who'd be alone most of the time a certain level of ability to protect ourselves because he equipped each and every one of us in unique ways that would surprise most people. Take me for example, I was born with the fighter gene, probably what's responsible for why I survived childhood abuse. That same fighter gene is also responsible for helping to keep me safe since I'm alone pretty much most of the time. Cross or provoke me and you'll be sorry you ever did and I think your grandpa is probably equipped very similarly and it takes one to no one because I am one! It takes a stubborn combative person to understand another one just like you, and I happened to be one of those types of people just like he is in the manner of when I say no, no is no and no don't mean yes and no shirt doesn't mean keep at it until I give in because I will only become combative at some point or another and I clearly understand your grandpa. No is no and that's that, leave him alone! If you don't, I would strongly encourage him to get a restraining order against anyone bothering him because then it becomes harassment if he must become combative. Hopefully he's protecting his money by keeping everything in the bank because I think he knows more than you think about how elders are defrauded and taken advantage of. If you don't know enough to take no for an answer then you don't need to be around him and again, I clearly understand him because personality wise I'm a whole lot like him and I wouldn't be a bit surprised if we happen to be mostly alike in so many ways of how we think. I don't blame him for protecting himself and hopefully he's learned by now how to do online banking and how to set up bill pay on his end and how to use a debit card and avoid carrying cash. These days and age it's very smart to already know the digital banking skills by time something happens and you actually need to have that set up, that's when it's going to most common handy and especially more so when you're old and most need it. In fact, I'm seriously considering going into the field of stopping fraud for a living since I already know some strategies on how to prevent anyone from taking advantage of me because I can share my story with others and help them untangle messes they themselves may find themselves in. Right now I do it voluntarily but I think I could do this for a living and help by doing something in my corner of the world to help people protect themselves as they age especially with their money and finances. Good for your grandpa that he is still alive at 95 because so many people die so much sooner. Instead of trying to force your will on him, be thankful he lived this long and is still living on his own and paying the bills, and especially transporting himself. Celebrate all of this instead of trying to force your will on him. He already said no, now drop it! What you need to go do is support his efforts to help himself stay free and out of the grips of others. Celebrate this instead of trying to take over, he'll thank you later and you'll be glad you backed off

There are three things that stand out to me in your post, jnan43.
1. His car has many signs of accidents. Red flag that things aren't going so well in the car. I'd have to explore that, check on accidents. Most cities have collision reports on line, so you can see what's happened. If there are none......you know that he's hitting things and just leaving. Not good either. I'd have to explore this, because it's the safety of others, him being stubborn doesn't get a pass on that.

2. Multiple falls in a short time. This can indicate strokes and/or poor balance. Poor balance can be an indication of more serious problems. Stokes can lead to cognitive problems. Has anyone actually observed him in the home, doing all the things that he says he does? I'd confirm that it's true.

3. Multiple calls to 911. I'd check to see how many and what for. People who are in distress may call 911 a lot for all kinds of reasons. It could indicate that he does need assistance, no matter what he may say otherwise.

If it turns out that he's still competent, then, I'd step aside, as it's his decision as to how he lives, even if we think it could be better, but, I would pursue that driving issue pronto.

I'm more worried about his driving more than anything else. I say, let him live in squalor, let him die with a smile on his face ' "I DID IT MY WAY". If he doesn't have dementia, let him do whatever, go in and pick up the pieces now and then. He's 95. But take away the car, take away the car keys. Take him somewhere, and have somebody move the car to a hidden place - OMG, your car has been stolen! - too bad, Dad!
.

If you believe he is a danger as a driver, report him to his local DMV, and they will call him in for a driving test. If he fails, take away his keys, and he will have to move. Don't let him kill somebody with his car.

I think it's wonderful that he is so independent, we should all hope to be so at his age. Not everyone needs to be in an Assisted Living environment. They are not always ideal, and many times lead to an early death. I would celebrate him, enjoy him and follow his lifestyle......He is very old. When death comes, he will have died from old age, and nothing else.

I am 98 live alone Facebook active, use a cane no wheel chair, socially ACCEPTED AFTER I SHAVE, a Board member of a Symphony, Chairman of another Board, even travel overseas alone. Do not punish the old man till he evidences lack of cognizance and is incompetent. Keep him happy in his old age. Measure the patient do not accept that every old person needs a nursing home.

Ask first -- "safe" from what and in whose eyes? My mother suffered through a move forced by a granddaughter and died 6 months later. The granddaughter took away her "living" - the quality of life. I doubt few who had not experienced it would (or could) think about the lack of freedom and independence, the two qualities most important to EVERY human being, both of which are either removed or severely restrained in AL or a nursing home.

Can you find a retired, dependable man still active that can spend time with grandpa, swapping tall tales and puttering around the house, incidentally getting some cleaning and maintenance done? And driving for him? That might be the way to introduce a caretaker--as a driver or repair person that gets to be a friend. Obviously you would need references on the person, and family members be underfoot whenever they can.
I have a 91-yr old friend who is still in her home doing well, with a live-in retired widowed sister-in-law; a part-time cleaning person; and neighbors that keep an eye on them. One thing that has really made the whole thing possible is a middle-aged man, the son of a deceased friend, who is not able to hold a job but is capable of driving, some maintenance, and general assistance. He lives in a motor home that is parked at my friends' house most of the time but he takes it out occasionally for a day or two of camping out. The sister-in-law helps with the bills and sees to the helper's paperwork and medical care. The result is three people who are coping well with taking care of each other, none of whom could realistically live alone.

Sounds so much like my father! Anyone that meets him tells me "how well your father is doing!", or, "he doesn't look like he's 96!", etc...and yet a few years ago I noticed him repeating questions, forgetting recent conversations, and wearing the same dirty clothes day after day.
My husband and I were wondering if he was safe to continue driving? We followed him one day and witnessed him making a right hand turn on a "no turn when red" red light; saw him weave in and out of traffic without using turn signals. Our daughter gave me the wake-up call I needed: "Mom? What if he causes an accident where a little family in a minivan is seriously hurt???" Am ashamed to admit that I hadn't thought of that, as I was only thinking about my father's safety.
So, I called his doctor and asked if he could assess his cognitive capacity at his next appointment. The doctor gave him a mini-mental-status-evaluation. After the appointment he called me to tell me that my father had FAILED it. He then told me that he would need to report this change in his medical chart to he Department of Transportation. Physicians are liable for any driving accident that may occur if they have not reported a change to his medical status and it is determined that the change had been documented prior to the accident.
The DOA then recalled his license, pending a doctor's confirmation of an improvement to his medical status.
My father was referred to an occupational therapist specializing in driver rehabilitation. She gave him the full mental status evaluation. He failed it. She then told him that she could not approve a reinstatement of his driver's license.
In your grandfather's case, with family not living nearby, a similar scenario would put him in a position to HAVE A NEED. He would now need a driver. Hopefully this would be the beginning of introducing a caregiver into his life.

Have you ever been forced to leave a home you love and move to a place you hate? If you have, think about your grandfather's quality of life. What would he do? How would he fill his time? My husband is in the beginning stages of Alzheimer's. A friend who has moved to assisted living told me we should move there so he can adjust now. He would be so unhappy, he would have nothing to do. It might be ok for her and her husband whose hobby is golfing, but my husband who still does yard work, works on his building projects, and cooks would be adrift with nothing to live for. You might try some of the wonderful suggestions here so he can stay in his own home. Please don't think just of his safety, think about his quality of life.

I have a similar situation with my brother. He cant walk or use his left arm. Plus he is an alcoholic. He would purposely get himself kicked out of AL and NH and has. Smoking. So, my attitude is...if he goes into AL or NH, he may live longer, but what kind of life would he have. If he lives at home, he may die sooner, but would have lived his life his way. As far as driving, next time he has to get a license, call the DMV beforehand and insist they give him a driving test on the roads. They may deny him, and that may save his and other lives if he has an accident. Best wishes.