Before anyone acts over a refusal, the legal question is simple to state and hard to answer: what does your father still decide, and who has the authority to decide the rest? Those two answers control whether a visit, a doctor appointment, a report, or a move is something you can do, something you need a signed paper for, or something you cannot do at all. Check them before you commit to a plan that depends on them.

Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.

Start with his capacity

A competent adult can refuse help, even help you think he needs. Family members do not decide that he lacks capacity, and a note from you does not change it. Capacity is judged about a specific decision, and his doctor is the person who can speak to it in a medical record. Ask the doctor directly whether there is a concern about his ability to make decisions about his care or his home, and write down the answer as the doctor gives it.

Find out which papers exist

Look for three kinds of paper: a financial power of attorney, a health care power of attorney or proxy, and any advance directive. Each reaches different things. A financial document may let someone handle bills and bank matters, while a health care document speaks to medical decisions. The names used for these papers change from state to state. Check whether the document is in effect now or only after a doctor certifies a condition, whether it was signed and witnessed the way the state requires, and what the bank or provider says it needs before it will accept it. If your father lives in Illinois while you work on the Missouri side, the document, the office, and the rules can all differ.

Know what you can do without his consent

You can talk with his doctor, ask for an appointment, and bring your concerns in writing. You can contact Adult Protective Services in the state where he lives to report a concern that an adult may be at risk of harm or neglect, and that office decides what happens next. In an emergency, call 911. A police welfare check is a request for an officer to look in on someone. None of these lets you override a competent person's no, and asking whether a step is lawful before you take it is the point of this check.

Bring these questions to an elder law attorney

Ask which document applies in his state and whether it is in effect now. Ask who decides if he refuses a move, a test, or a particular provider, and what happens when the named person and the family disagree. Ask what a court process would involve and how long it takes in your county. Ask what records you should keep as the person acting for him, and what the attorney needs from you before the first meeting. This is a checklist for that meeting, not legal advice, and the answers depend on the facts in his file.

The next move

This week, find every power of attorney and advance directive your father has signed, and put copies in one folder. Then call his doctor's office and ask whether the doctor can speak to his decision making. If the papers are missing or unclear, book a consult with an elder law attorney and use the list above to run the meeting. For local names, start with the Local Help in St. Louis page.