Needs Assessment - Personal care (bathing, dressing): Partly met. She manages dressing but you describe her avoiding the shower since the fall. That is a common and telling signal — people stop bathing when they are afraid of the bathroom, not when they stop caring about hygiene. This is addressable with equipment before it is addressable with staffing. - Medication management: Partly met. Six medications with a pill organizer she fills herself is workable while cognition is intact, but there is no backstop if she misses a day. - Meals: Unmet. Eating cereal for dinner most nights is the specific detail that matters most here, because poor nutrition accelerates frailty and it is the cheapest problem on this list to solve. - Transportation: Unmet since she stopped driving at night. Daytime errands are handled; medical appointments and evening social events are not. - Household upkeep: Partly met. She keeps the inside tidy; the yard and heavier cleaning have lapsed. - Finances: Handled, and worth protecting. She pays her own bills accurately, which is meaningful information about her cognition. - Social contact: Unmet and probably underweighted in your thinking. Since she stopped driving at night, her church group and her Thursday card game both dropped off. Isolation in an 82-year-old is a health variable, not a quality-of-life extra. Not mentioned, worth confirming: whether she has had a formal fall risk assessment, whether her vision has been checked recently (night driving avoidance is often a vision change rather than a confidence change), and whether anyone holds a health care proxy or power of attorney. Care Options and Realistic Costs - In-home aide, 12-16 hours a week: roughly $1,400-2,200 a month at typical private-pay rates of $28-38 an hour. This covers bathing assistance, meal prep, light housekeeping, and transport, and is the option that best matches the needs above. - Meal delivery, either a senior program or a commercial service: $150-400 a month, and it solves the highest-impact problem immediately. - Adult day program, two days a week: $600-1,200 a month. Addresses the isolation directly and gives structure, but only if she would find it appealing rather than infantilizing — that is a real question, not a formality. - Assisted living: $4,500-7,000 a month in most markets. Not indicated here. Her cognition is intact, her finances are managed, and she is not a candidate for a move on these facts. - Costs vary widely by region and these are general figures. Get three local quotes; agency rates in the same city commonly differ by $8-10 an hour. Budget: your $2,500 a month covers the in-home aide plus meal delivery with room to spare, which is a genuinely comfortable position. No gap to flag. Recommended Starting Plan 1. Bathroom safety equipment first, this month: grab bars installed into studs, a shower chair, and a handheld showerhead — roughly $200-400 including installation. This addresses the actual reason she has stopped showering and it is the highest-value spend on this entire list. 2. Meal delivery starting immediately. Solve the cereal-for-dinner problem before anything else, because it is fixable this week. 3. In-home aide, 12 hours a week to start: two 4-hour weekday visits for bathing assistance, meal prep, and housekeeping, plus one 4-hour block for errands and appointments. Starting smaller than you think you need is deliberate — it lets her build a relationship with one consistent aide rather than experiencing a takeover. 4. Transportation for evening activities, so the card game and church group resume. This may be a rideshare arrangement, a volunteer driver program through her church, or aide hours moved to evenings. Family Division of Labor - You, 20 minutes away: you are the logistics lead by geography. Hiring and managing the aide, medical appointments, and being the emergency contact. - Your sister, 3 hours away, visits monthly: she takes the things distance does not obstruct — insurance paperwork, prescription refills by mail order, bill review, and researching the day program options. Her monthly visits should be scheduled as your relief weekend, not as social visits layered on top of your ongoing load. - Your brother, out of state, limited availability: rather than nothing, give him one bounded, recurring thing — a standing phone call every Sunday and ownership of the annual insurance re-enrollment. Vague availability produces no help; a specific small assignment usually does. - The honest note: even with this split, you will carry roughly 70% of this. That is normal for the geographically closest child, and it is also the single most reliable predictor of both burnout and long-term resentment between siblings. Name it explicitly at the family conversation, in numbers rather than feelings, and revisit it every few months. If your sister's monthly visits lapse, the plan quietly becomes entirely yours. Safety: Urgent vs. Ongoing - Address now: the bathroom. She has already fallen once, and the bathroom is where falls most often become fractures. A second fall is the event most likely to end her independent living, and it is partly preventable with $300 of equipment. - Address now: get her vision checked. If the night driving stopped because of a vision change, that has implications well beyond driving. - Ongoing, not urgent: the yard, the day program question, the longer-term conversation about whether this house works in five years. What Depends on Her Agreement All of it. She is cognitively intact and manages her own finances, which means every part of this plan is a proposal to her, not a decision about her. If she declines the aide, you do not have a fallback that overrides her — you have a slower conversation. Start with the equipment and the meals, which most people accept readily because they are objects rather than people in the house, and let the aide follow once the first two have visibly made her life easier. Talking Points - Lead with what she has said she wants: staying in her home. Frame every item as serving that goal, because it genuinely does. - On the bathroom: "I want to get grab bars in so the shower stops being something you have to think about." Equipment first, staffing later. - On the aide: offer a trial with an end date. "Would you try someone for a month, and if you hate it we stop?" A bounded trial is much easier to accept than a permanent arrangement. - On meals: "I'd rather not worry about whether you're eating. Can we try a delivery service for a few weeks?" - Avoid opening with the fall, with worry, or with what "we've decided." Those framings reliably produce resistance in someone whose competence is intact and who correctly perceives the conversation as being about losing ground. Where You Need a Professional - Her physician: the fall, the night vision change, and a medication review of all six prescriptions for interactions and fall risk. Several common medication classes increase fall risk substantially, and a review can be the cheapest safety intervention available. - An elder law attorney: if there is no durable power of attorney and no health care proxy, get them done now, while her capacity is unambiguous. This is far easier and cheaper today than it will be after any cognitive change, and it is the single most common thing families regret not doing earlier. - Your local Area Agency on Aging: free or low-cost in-person needs assessment, plus information on subsidized transportation and meal programs you may qualify for regardless of budget. This is a planning framework, not medical, legal, or financial advice, and no plan written at a distance substitutes for someone assessing her in person.